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A new Committee Opinion published by the American College of Obstetricians and Gynecologists (ACOG) in Obstetrics & Gynecology outlines the current barriers women face when attempting to obtain contraception and provides strategies to overcome these barriers.
Unintended pregnancy and abortion rates are higher in the United States than in most other developed countries, says ACOG; the most recent data report that 49% of US pregnancies are unintended.1
The cost of unintended pregnancy
The human cost of unintended pregnancy is high, says ACOG, because women must choose to carry the pregnancy to term and keep the baby, decide for adoption, or undergo abortion. Women and their families struggle with this challenge for medical, ethical, social, legal, and financial reasons. US births from unintended pregnancies resulted in approximately $12.5 billion in government expenditures in 2008. Affordable access to contraceptives would not only improve health but also reduce costs, as each dollar spent on publicly funded contraceptive services saves the US health-care system nearly $6.1
“The most effective way to reduce abortion rates is to prevent unintended pregnancy by improving access to consistent, effective, and affordable contraception,” states the Committee Opinion.1
What are barriers to use?
Major barriers to contraceptive use include lack of knowledge, misperceptions, and exaggerated concerns about safety among patients and health-care professionals, says the Committee.
Patients are concerned that oral contraceptives are linked to major health problems, that intrauterine devices (IUDs) carry a high risk of infection, and that certain contraceptives are abortifacients (although no FDA-approved contraceptive is an abortifacient).
Health-care professionals also may have knowledge deficits: some are uncertain about the risks and benefits of IUDs and lack knowledge about correct patient selection and contraindications.1
What strategies does ACOG support?
One in four American women who obtain contraceptive services seek them at publicly funded family planning clinics, cites ACOG.1 The Affordable Care Act (ACA) provides that all FDA-approved contraceptive methods, sterilization procedures, and patient contraceptive education and counseling are covered for women without cost sharing for all new and revised health plans and Medicaid. However, many employers are now exempt. Women covered by exempted employers and those who remain uninsured will not benefit from ACA coverage. For these women, cost barriers persist and the most effective methods (IUDs, contraceptive implant) likely will be unattainable, says ACOG.1
Insurance companies, clinic systems, or pharmacy and therapeutics committees create additional barriers, including the number of products dispensed at one time. Insurance plans prevent 73% of women from receiving more than a 1 month supply of contraception at a time, yet most women are unable to obtain refills on a timely basis. Some systems require that women “fail” certain contraceptive methods before a more expensive method (IUD, implant) will be covered. ACOG states: “All FDA-approved contraceptive methods should be available to all insured women without cost sharing and without the need to ‘fail’ certain methods first. In the absence of contraindications, patient choice and efficacy should be the principal factors in choosing one method of contraception over another.”1
Additional strategies ACOG supports and recommends to ensure affordable and accessible contraception include:
- Full implementation of the ACA requirement that new and revised private health insurance plans cover all FDA-approved contraceptives without cost sharing, including nonequivalent options from within one method category (levonorgestrel as well as copper IUDs)
- Easily accessible alternative contraceptive coverage for women who receive health insurance through employers and plans exempted from the contraceptive coverage requirement
- Medicaid expansion in all states, an action critical to the ability of low-income women to obtain improved access to contraceptives
- Adequate funding for the federal Title X family planning program and Medicaid family planning services to ensure contraceptive availability for low-income women, including the use of public funds for contraceptive provision at the time of abortion
- Sufficient compensation for contraceptive services by public and private payers to ensure access, including appropriate payment for clinician services and acquisition-cost reimbursement for supplies
- Age-appropriate, medically accurate, comprehensive sexuality education that includes information on abstinence as well as the full range of FDA-approved contraceptives
- Confidential, comprehensive contraceptive care and access to contraceptive methods for adolescents without mandated parental notification or consent, including confidentiality in billing and insurance claims processing procedures
To see all of ACOG’s recommendations, access the full report.
