Universal access to contraception could be a life saver

Last week a Lancet study estimated that providing contraception to women in developing countries could reduce maternal deaths by nearly a third. Following this, the Bill and Melinda Gates Foundation pledged $560 million to provide family planning services to millions of women from the poorest countries.

This is exciting from a global perspective, but we must not lose sight of just how critical contraception is to the health and well-being of women and families right here in the US, including the women of Nevada, where I am an ob-gyn.

In 1999 the CDC declared family planning one of the 10 greatest public health achievements of the twentieth century. It said, "Smaller families and longer birth intervals have contributed to the better health of infants, children, and women, and have improved the social and economic role of women."

Yet, the US has the highest rate of unintended pregnancies in the developed world. About half of all pregnancies - 3 million - each year are unintended and about half of these end in abortion. We also have the unfortunate distinction of having the highest teen pregnancy rate among comparable countries. Approximately 82 percent of all teen pregnancies are unintended.

Adolescents have higher rates of preterm birth, low birth weight infants, and infant deaths. Teen mothers are more likely to drop out of high school, remain single, live in poverty, and rely on public assistance. Their children are more likely to have behavioral problems, rely heavily on public health care, drop out of high school, and become teen parents themselves. The cycle keeps repeating with these negative societal costs and an $11 billion annual cost to US taxpayers.

An estimated 10 percent of infant deaths could be prevented if all pregnancies were planned. Women who have unintended pregnancies are more likely to delay prenatal care and to expose their fetuses to poor nutrition and harmful substances. This puts their babies at a much greater risk for negative birth outcomes. Not only does contraception improve newborn health, using it to space births improves maternal health and lowers the risk of low birth weight and preterm birth.

Contraception is literally lifesaving for women with serious medical conditions. A woman's ability to control her fertility is critical if she has heart disease, cancer, or diabetes. For these women, an unplanned pregnancy can worsen their health and, for some, could be fatal. Contraception allows these women to prevent pregnancy altogether, or to postpone a pregnancy until such time as their health improves.

Our nation took a giant step forward when the US Congress guaranteed that women would receive full coverage for all FDA-approved contraceptives without co-pays or deductibles in most employer-sponsored health insurance plans. A recent survey by Hart Research Associates shows that the American public clearly supports this decision: Nearly 3 out of 4 voters agree that we should do everything we can to make sure people have affordable access to birth control. While this is enormous progress, we can do more to improve access to contraception.

We must provide women universal access to contraception to bring down the number of unplanned pregnancies and reduce their cost to society. Price alone is a major barrier to women's access to some of the most effective, longest-acting contraceptives. The Affordable Care Act's contraceptive mandate will help address this problem.

Other obstacles, too, must be corrected. The FDA should eliminate the age restriction on over-the-counter access to emergency contraception, as in most other countries. Given our high rate of unintended teen pregnancies, removing the age restriction is critical to help prevent unintended pregnancies and subsequent abortions. All hospitals need to provide EC to every woman who seeks care as a result of sexual assault.

Some women are denied contraceptives even when they have insurance. Medicaid, which covers 42 percent of all US births, places unreasonable limitations on women enrolled in the program who want postpartum sterilizations, limitations not faced by women with private health insurance. Half of women who are denied sterilization will be pregnant again within a year. Federal requirements need to be changed so that Medicaid-insured women have the same options for control over her fertility as every other woman.

Contraception is a basic and essential element of women's preventive health care and a basic public health necessity. Family planning is about freedom-the freedom to decide when and if to have children. Every woman should have this freedom through access to the same core set of essential health benefits, including contraception, regardless of what state she lives in, her income, or her employer's beliefs.

Carson City physician James T. Breeden, M.D., is president of the American Congress of Obstetricians and Gynecologists.