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Women Should Get Free Birth Control, HHS-Backed Group Urges

Birth-control pills are among the contraceptives that could be offered at no cost to Americans; Creative Commons photo by flickr.com/nateone

All U.S. women should have access to free birth control as part of the 2010 health care reform law, the Institute of Medicine recommended Tuesday, along with eight other suggestions for preventive health services.

Commissioned by the Department of Health and Human Services to identify “critical gaps” in the agency’s list of preventive services, the highly influential IOM report recommends that all U.S.-approved birth control methods be covered by insurers. That includes the controversial “morning-after” or “Plan B” pill that is considered by some to be a form of abortion because the woman takes it in the hours after sexual intercourse. The reform law requires insurance plans to cover services on the HHS list, meaning the adoption of the recommendation would make the pill co-pay free for “all women of reproductive capacity.”

Planned Parenthood immediately applauded the report. In a statement, Cecile Richards, president of Planned Parenthood Federation of America, said the announcement will make life easier for “millions of women, especially young women, struggle every day to afford prescription birth control.”

“Today’s recommendation brings us a step closer to ensuring that all newly insured women under the health care reform law will have access to prescription birth control without out-of-pocket expenses. This would be a tremendous stride forward for women’s health in this country.”

Conservative groups cried foul, noting that the government will foot the bill for a large portion of the health care reform law and adoption of the IOM recommendation to cover the “morning-after pill” would “essentially would mandate coverage for abortion.”

Jeanne Monahan, the director of the council’s Center for Human Dignity, said in a statement that:

“[I]f HHS includes these mandates, the conscience rights of millions of Americans will be violated. HHS should focus on items and services that prevent actual diseases, and not include controversial services just to placate the abortion industry.”

The IOM committee identified diseases and conditions that are more common or more serious in women than in men — or those that might require specific interventions for women. Women received special attention in the report because they require more preventive services than men and therefore pay more in out-of-pocket costs that should be covered under the reform law, the authors say.

“The eight services we identified are necessary to support women’s optimal health and well-being Each recommendation stands on a foundation of evidence supporting its effectiveness,” said Linda Rosenstock, the study’s committee chair and dean of the University of California Los Angeles’ School of Public Health. “If these are thought to be warranted (by HHS), we believe there should be a decrease in the barriers to what are proven to be evidence-based, effective procedures.”

Here in detail are the eight IOM recommendations, with additional thoughts directly from the group for several of the more complex suggestions:

  • Contraceptive methods and counseling to prevent unintended pregnancies: “To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the U.S. in 2001, the report urges that HHS 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 capacity. Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born pre-term or at a low birth weight, both of which raise their chances of health and developmental problems.”

  • Counseling on sexually transmitted infections

  • Counseling and screening for HIV

  • Human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30: “Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women’s preventive services. Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions and HPV testing increases the chances of identifying women at risk.”

  • Yearly well-woman preventive care visits to obtain recommended services

  • Screening for gestational diabetes: “The United States has the highest rates of gestational diabetes in the world; it complicates as many as 10 percent of U.S. pregnancies each year. HHS should consider screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. Women with gestational diabetes face a 7.5-fold increased risk for the development of Type 2 diabetes after delivery and are more likely to have infants that require delivery by cesarean section and have health problems after birth.”

  • Screening and counseling to detect and prevent interpersonal and domestic violence

  • Lactation counseling and equipment to promote breast-feeding: “Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support that includes coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding. Evidence links breast-feeding to lower risk for breast and ovarian cancers; it also reduces children’s risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and Type 2 diabetes.”

HHS Secretary Kathleen Sebelius will make the final call on whether to adopt the recommendations – possibly as early as Aug. 1. Immediately after its release, Sebelius called the report “historic” and “based on science and existing literature.” She said that “before today, guidelines regarding women’s health and preventive care did not exist.”

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