My patient Michelle, age 25 and newly married, has a severe congenital heart disease. Pregnancy would be life-threatening; Michelle has a 50% chance of dying if she carries a baby to term. She isn’t willing to take that risk.
Condoms are effective only 85% of the time, and the pill isn’t safe with her heart condition. Together we agreed that the IUD would be best, an extremely safe and effective method that costs $800. Michelle was able to afford it only because her job’s insurance paid for it in full.
If she worked for one of the institutions now in court over contraception coverage, Michelle would be suffering financially or gambling with her life—all in the name of someone else’s religious freedom.—Sara Pentlicky, MD, Philadelphia
Raquel, age 23 and mother to a seven-year-old son, had never been able to afford long-acting, effective contraception. In her subsequent unintended pregnancy, she was hospitalized with pulmonary hypertension, or high blood pressure in the lungs, a life-threatening condition in pregnancy. After four months in the hospital, Raquel gave birth to a girl. Twenty-four hours later, she died, her son crying by her side. She left behind two kids and a compelling message about the need for contraceptive coverage. Lack of coverage can have tragic consequences. I will never forget Raquel and her family. —Jennifer Kerns, MD, San Francisco
As an obstetrician/gynecologist, I have many patients like Jennifer, a 22-year-old Catholic mother of one. She has decided to postpone expanding her family while she works and finishes school. For birth control, she selected an IUD, a long-acting, extremely effective method. Her job’s insurance took care of the cost.
But if Jennifer worked for an institution that refused to cover contraception, she might not be able to afford the device or strain her family finances to afford it. Or she would be forced to set aside the IUD she knows would be best for her and use cheaper, less effective birth control, increasing her risk of an unintended pregnancy. With health reform’s contraceptive coverage, more women will finally have access to affordable contraception.—Kathleen Morrell, MD, Brooklyn
My patient Cathy, now in her 30s, was a teen mother. Recently she brought her two daughters, both in their teens, to see me for contraception. The young women each received an IUD, a highly effective contraceptive that the family wouldn’t have been able to afford out of pocket. Cathy offered her daughters an opportunity she didn’t have: a chance to finish school and decide when and if to become parents. She gave them the gift of self-determination.
As we celebrate such signs of progress, we must remember that many women still lack access to affordable birth control options—for themselves and their daughters. All women should be able to count on their health insurance for this basic need, no matter who employs them.—Lori Gawron, MD, MPH, Chicago
In these hard economic times, I have patients who must choose between contraceptives and household bills, settling for cheaper, less effective forms of birth control. Consider Michelle, 22, whose migraines would get worse with the estrogen in most birth control pills. She and I decided on an intrauterine device, with its extremely low failure rate compared to the pill and most other contraceptives. But Michelle’s insurance doesn’t cover the IUD, and she couldn’t afford its $750 cost. I prescribed progestin-only birth control pills, both of us knowing her insurance had put her at greater risk of unintended pregnancy.
This is shameful. Birth control is a fundamental part of women’s health. Every employer, regardless of religion, should provide an insurance plan that meets this need.—Zowie Barnes, MD, Baltimore
Maria is 15 years old. I met her after she had her first menstrual period. She bled so heavily that she had to be admitted to the hospital and receive a blood transfusion. The best treatment for Maria’s condition (menorrhagia) is birth control pills. They regulate the menstrual cycle and prevent dangerous bleeding for patients like Maria. In fact, one-third of U.S. teens use contraception for reasons other than avoiding pregnancy. Maria and her family are practicing Catholics. I discussed birth control pills with her parents. If she did not start the medication, every time she had her period she would be at risk of bleeding so much she would need another transfusion—possibly every month. After carefully weighing the decision, her parents decided that birth control pills would be the best way to keep Maria healthy and out of the hospital.
Birth control pills are not just for contraception—they help manage conditions like Maria’s as well as lower the risk for certain cancers. All families need affordable access to medications that safeguard their health, including birth control.—Yolanda Evans, MD, MPH, Seattle
When I was in residency in Pennsylvania, I took care of Rita, a young Catholic mother of five. Rita was suffering from a serious heart defect. She was six weeks pregnant and had a defective cardiac valve that had to be replaced with a synthetic one. Pregnancy put her at high risk for blood clots forming on the new valve and travelling to her brain, where it could kill her.
Rita had not been using contraception because she had no insurance to make it affordable—not because she didn’t want to use it. While in the hospital, despite taking blood thinners to treat her clots, Rita had a stroke. The woman I had spent hours with talking about caring for her five living children, her marriage, how to handle her unplanned pregnancy—that woman could now no longer speak or walk. When I think of birth control access, I think of Rita and her family.—Jennefer Russo, MD, Orange, CA
Two years ago, my colleagues and I treated Beth, a 40-year-old with complications from catastrophic blood loss during her period. We couldn’t save her. The right contraception could have prevented her death.
The new federal regulation on birth control coverage will go a long way to help women stay healthy and safe. I hope someday it will apply to everyone, no exceptions.—Claire Bolander, MD, Baltimore
Yesterday I took care of Adrienne, a 36-year-old mother of three who wanted to use an intrauterine device (IUD). However, she doesn’t have medical insurance, or the approximately $800 it would cost her to pay for an IUD. While it’s true that some contraceptives are relatively cheap (a condom costs approximately $1), they are also less effective. The one year failure rate for a condom is 15%, compared to less than 1% with an IUD.
Covering all contraception for all women will expand access to long-acting, highly effective birth control methods and will allow women to make decisions that are right for them.—Aileen Gariepy, MD, New Haven
I am an obstetrician/gynecologist, and every day I see patients who rely on their insurance to pay for contraception. There’s Alice, who wouldn’t be able to afford the $1,000 out-of-pocket cost of an intrauterine device (IUD) on her grad student salary—thanks to her insurance coverage, she has an IUD so she can wait to start a family until she finishes her degree. I think of Tanesha, whose debilitating migraines every month often forced her to miss work. The only treatment that reduced her pain? The birth control pill, covered in full by her insurance.
And then there’s Amber, who suffered from severe heart disease during her last pregnancy. An unplanned pregnancy could kill her, leaving her three kids without a mom. Thankfully, her insurance plan covered her contraceptive implant, giving Amber three years of highly effective contraception.
All of my patients and the millions of women across the country deserve access to these safe, reliable, and vital drugs and devices, regardless of where they work. Any decision about whether to use birth control and which method must be left to the woman and her health care provider—not the organization she works for.—Jennifer Robinson, MD, MPH, Baltimore
Just last week, I saw Leslie, who is in her 30s. Leslie has a malignant tumor in her breast, and it is the type that feeds on hormones. If Leslie were to become pregnant, the resulting upsurge in hormones would make her tumor grow faster, rapidly increasing the likelihood that her cancer would spread and kill her.
Leslie can’t use less expensive forms of birth control, like the pill, because they contain hormones. For her, a copper IUD is the only option, but it costs at least $800, way beyond her budget. What employer would be so cruel as to deny Leslie this vital health care at a price she can afford?—Anne Davis, MD, MPH, New York, Consulting Medical Director, Physicians for Reproductive Health
Some women I treat use contraception because they have medical conditions that could kill them if they became pregnant. I think of Denise, who suffered from cardiomyopathy (a potentially lethal heart disease) during pregnancy. If she were to get pregnant again, she would have a significant risk of heart failure. Denise deserves insurance that covers contraception and her other basic health needs, wherever she works.—Andrea Angelucci, DO, Los Angeles
My patient Rebecca was recently married and wanted to start a family. However, she has a genetic condition that weakens her blood vessels and caused a stroke when she was young. Multiple doctors counseled her that a pregnancy could further damage her blood vessels and kill her. Rebecca and I decided on an intrauterine device (IUD) as a long-lasting, highly effective contraceptive that would protect her against the life-threatening risks of pregnancy.
Because Rebecca’s insurance plan included birth control, most of the $913 IUD device and insertion fee was covered. But I have other patients whose health is at risk because their employers refused contraception coverage. These women can’t afford such high upfront costs out of pocket. I look forward to the day when every employer understands that women need a full range of preventive health services, including birth control, to have healthy and productive lives.—Jennifer Tang, MD, Chapel Hill, NC
I recently saw Tammy, a married mother of two who has a congenital heart disease. For her pregnancy is life-threatening, and estrogen-containing birth control methods, such as pills and the patch, are will make her condition worse. Fortunately, Tammy had insurance coverage through her employer for her copper IUD (a highly effective and very safe intrauterine device). It cost $1,000. Without insurance coverage for contraceptives, Tammy would have been unable to afford this life-saving device.—Sara Pentlicky, MD, Philadelphia
I recently cared for a 24-year-old woman named Somsri. She had come to see me about contraception. Somsri has a genetic blood disorder that caused a dangerous blood clot in her leg. To manage this condition, she needs to be on an anticoagulant cocktail for the rest of her life. Somsri also should not get pregnant because it would be very dangerous for her.
An IUD would be the best form of contraception for Somsri. Unfortunately, her health insurance did not cover the IUD’s cost, and she did not have $1,000 to pay for it out-of-pocket. Somsri left without an IUD. Her only affordable option was condoms, which have a significant failure rate.
Six months later Somsri was pregnant. Because of her condition, her pregnancy was very complicated and she nearly died, ultimately needing a hysterectomy to stop her bleeding.
All women deserve accessible and affordable contraceptive services, no matter where she works or how much money she makes.—Orawee Chinthakanan, MD, Atlanta
Christine came to see me for an IUD. She is 40 and had been pregnant recently. She and her husband have two children, and they wanted to have another baby.
But Christine’s insurance doesn’t pay for labor and delivery. Her doctor estimated that even an uncomplicated birth would cost thousands more than she and her husband could afford. And their income was too high for Medicaid.
So instead of having the third child she and her husband wanted, Christine had an abortion, for which she paid in full because her insurance didn’t cover that, either. The final insult? Christine wanted to make sure she wouldn’t become pregnant but her insurance wouldn’t cover her IUD.—Anne Davis, MD, MPH, New York, Consulting Medical Director, Physicians for Reproductive Health