The report won praise from the American Congress of Obstetricians and Gynecologists. “I'm delighted with the terrific work the IOM committee did,” said Dr. James N. Martin Jr., ACOG president and director of the division of maternal-fetal medicine and obstetric services at Winfred L. Wiser Hospital for Women and Infants in Jackson, Miss.
ACOG has pushed for better coverage of preventive services, including many on the IOM's list, for many years, Dr. Martin said in an interview. “The recommendation for coverage of the annual well-woman visit is going to go very nicely with the other things suggested, especially the recommendation for [copayment-free] contraception,” he said.
Dr. Martin noted that the recommendation for copayment-free contraception should help to reduce the number of unplanned pregnancies in the United States, especially for low- and middle-income women who may have had trouble affording birth control.
“It's amazing to me that a country as advanced as we are is as casual as we are about contraception.”
He also called out the IOM recommendations for better breastfeeding support along with coverage of gestational diabetes and domestic violence screening, saying they will help improve overall women's health.
“All of these are good recommendations,” Dr. Martin said. “I couldn't be happier with this report.
The recommendations also were hailed by Planned Parenthood on its website, which said the recommendations could remove barriers which keep many women from using birth control consistently.
However, Cardinal Daniel DiNardo of Galveston-Houston, Tex., chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, said in a statement that “Pregnancy is not a disease, and fertility is not a pathological condition to be suppressed by any means technically possible.”
Cardinal DiNardo urged HHS to block the recommendations on contraception, as did the conservative group Family Research Council, which focused specifically on the recommendations for coverage of emergency contraceptives in the statement on its website.
Dr. Rosenstock noted that many health care plans currently provide coverage for these services and added that “This is just a recommendation for first-dollar coverage.”
The Affordable Care Act of 2010 requires health plans to provide first-dollar coverage for the preventive services listed in HHS' comprehensive list of preventive services beginning in 2014.
These include the services with Grade A and B recommendations made by the U.S. Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.
However, HHS officials, concerned that some preventive services key to women's health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women.
At the request of HHS officials, an IOM committee made up of women's health experts identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.
The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.
The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group's charge also required members to consider only services provided in clinical settings, even though “preventive services can be effective when provided in settings outside the physician's office,” she said.
The report backed up each of the committee's recommendations with the science behind it. For example, it noted that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women's preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.
To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urged HHS to consider adding the full range of Food and Drug Administration– approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This included emergency contraceptives such as levonorgestrel.
Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report went further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.
Mary Ellen Schneider, New York Bureau, contributed to this story.