Do you know your birth control options? Contraception is currently a hot topic in our political and social media world. With the election of President-elect Donald Trump, the threat of an appeal to Obamacare immediately brings focus whether access to contraception will remain. Would access to contraception be a target of the appeal or would it be inadvertently taken away in the aftermath of a repeal of Obamacare as a whole? There are many unanswered questions and this uncertainty is driving this heated discussion across the country. We as Obstetrician Gynecologists support access to contraception for any person who desires this measure in their life. Access should be open to all persons regardless of health insurance status. You may be thinking, “Why would anyone want to argue about birth control? If someone wants to avoid pregnancy, it is their own prerogative, right?” Well, since the late 1800s, birth control and politics have had nothing less than an inflammatory relationship. No matter your stance or political or religious beliefs, be informed and be a part of the conversation.
Obamacare has opened the door to well woman’s visits and access, to what I call a buffet of contraceptive options. Under the Affordable Care Act, a physical exam and birth control consultation is considered a preventative service. It is therefore offered without having to pay a copay for these services. Mind you, there are grandfathered, religious and short-term health insurance plans that are exempt and result in out of pocket costs. For the majority, it is estimated that Obamacare has afforded women nearly 50% savings in their birth control expense and has been said to equate to 1.4 billion dollars. There are officially as follows:
• Sterilization surgery
• Surgical sterilization implant
• Implantable rod
• Copper intrauterine device
• IUDs with progestin (a hormone)
• Oral contraceptives (the pill), with estrogen and progestin
• Oral contraceptives with only progestin
• Oral contraceptives, known as extended or continuous use that delay menstruation
• The patch
• Vaginal contraceptive ring
• Cervical cap
• Female condom
• Emergency contraception (Plan B/morning after pill)
• Emergency contraception (a different oral medication named Ella)
Thanks to Obamacare, we now have a buffet of options to discuss with women and have been able to take cost concerns off the table. When exploring a Patient’s contraceptive needs, I advise them that choice depends on personality and lifestyle. I often say, “You may find that you try one, but you may try them all until you decide which option works best for you.”
With Obamacare, the category of “implantable” birth control has lifted barriers to this more effective option. The intrauterine device and implantable rod placed in the arm are known as LARCs – long-acting reversible contraception. They are proven to be 99% effective in preventing pregnancy. Compare this to pills and condoms which prevent pregnancy only 92% of the time. The use of LARC has increased from 2.4% to 11.6% of all women using contraception from 2002 to most recent studies as of 2013. Once placed, the rod and IUD can provide effective birth control for 3-5 years depending on the device chosen. The cost of the device is well over $1000 and with Obamacare is now completely free. If and when it is time to remove the device, it may be replaced with a new one or removed at any time to become pregnant right away. Why wouldn’t every woman choose such a reliable and modern device? It is a “set it and forget it,” until one is ready to pursue a pregnancy. Prior to Obamacare, cost was a major barrier, but now it is lack of awareness and a historical bias that has hindered the rise in women choosing a LARC. The implantable devices of decades past resulted in serious side effects and consequences and were removed from the market. The LARC devices we have at present have proven safety but the reputation of devices past have left distaste among older generations who may be influencing the present.
With the current political climate and uncertainty of contraceptive coverage, however calls to question what happens if contraceptive coverage is eliminated or the cost increases? Social media has seen thousands discussing this topic. Some are asking, “Should I hurry and obtain a LARC to have long term contraception before Obamacare is repealed? But if I do, what happens when I want or need it taken out? What would be the cost to me?” We cannot answer many questions as it stands now, but in my present knowledge, I counsel Patients that a LARC is a great choice per its effectiveness to prevent pregnancy and from a cost perspective long term if even Obamacare was lost. The removal of a LARC device without insurance coverage averages around $300. If you keep the device in place for more than one year, it averages to equal the cost of birth control pills that one would have paid for that year. If you keep the LARC in place even longer, then costs are clearly in favor of choosing a LARC at this time.
When it comes to contraception, I counsel Patients on a daily basis that no choice is a wrong choice. It is what is best for you, your situation and fertility plans. With Obamacare, there is a buffet of contraceptive options, however if access if called into question over the coming years, it may be wise to consider your long-term goals and options. When choosing a LARC, it is ideal if there are no immediate plans for fertility. No matter your current life stage, stay tuned and be informed to support all women. We pray the landscape of the future maintains contraceptive access for all.