A new report for the US government recommends that women receive free prescription birth control as part of services that new health plans will cover at no cost to patients under the Affordable Care Act. The Institute of Medicine (IOM) report released on Tuesday, recommends the US Department of Health and Human Services’ (HHS) include eight additional services as necessary to support women’s optimal health and well-being. The most contentious of these appears to be the free contraception service.

The report confirms that because of gaps in the current guidelines, womens needs for preventive services are not being met and this results in them suffering a disproportionate rate of chronic disease and disability. And, because they need more preventive care than men, due to “reproductive and gender-specific conditions”, they end up paying more out of their own pockets.

The report recommends that health plans should cover all the contraceptive methods approved by the US Food and Drug Administration (FDA), as well as sterilization and counseling to prevent unintended pregnancies. It says women also need counseling to help them space their pregnancies, and become more aware that conceiving within 18 months of a previous pregnancy increases the risk of adverse outcomes.

The IOM report says unintended pregnancies accounted for nearly half of all pregnancies in the US in 2001. Women who find themselves with an unplanned pregnancy are less likely to receive timely antenatal care, they are more likely to smoke, drink alcohol, be depressed and experience domestic violence while they are pregnant. Babies born as a result of unintended pregnancies are also more likely to be born preterm or be of low birthweight: both factors that increase the risk of developmental and health problems later in life.

The IOM also recommends that health plans cover screening for gestational diabetes, testing for HPV as part of cervical cancer screening for women over 30, counseling on STDs, counseling and screening for HIV, counseling on lactation, equipment to promote breastfeeding, annual well-woman care visits to help them access recommended services, and screening and counseling to identify and prevent domestic and interpersonal violence.

The US has the highest rate of gestational diabetes in the world, a condition that not only increases birth complications but also raises a woman’s risk of having type 2 diabetes after she has given birth by 7.5 times says the IOM report. The report recommends that the HHS consider health plans offer free screening for gestational diabetes in women whose pregnancies lie between the 24th and 28th week of gestation.

Fewer women would die from cervical cancer, if when they went for their Pap smear test, they were also to receive DNA testing for HPV, the Human Papilloma Virus, which can cause cervical cancer, says the report. Also, HPV testing, vaccination, screening and treatment of precancerous lesions increases the chance of identifying women at risk.

Counseling on lactation and the pros and cons of breastfeeding is already included in the current HHS guidelines, but the report says this should be extended to include more comprehensive support such as paying for renting breast pumps, as well as paying for trained professionals to help women start and continue breastfeeding. There is evidence that breastfeeding lessens a woman’s risk of developing breast and ovarian cancer, and children’s risk for a range of diseases.

The report says the HHS should establish an ongoing committee to review the guidelines in the light of new science, and recommend changes accordingly. Such a commission should be separate from panels that assess the evidence of which services are effective and which are not, it urges.

The report has been well received by the Planned Parenthood Federation of America, a large nationwide pro-choice group and healthcare provider. In a press statement released on Tuesday, their president, Cecile Richards, described the IOM recommendation on free prescription birth control as “a tremendous stride forward for women’s health in this country”. She said:

“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,” she added.

The report has not been well-received by pro-life groups and US Catholic bishops.

In a statement published by pro-life news channel Lifenews.com, Jeanne Monahan, Director of the Family Research Council’s (FRC’s) Center for Human Dignity said the FRC wished to express “strong opposition to the Institute of Medicine’s recommendation to the Department of Health and Human Services that health care plans be mandated to cover no cost-sharing contraceptives, including those that can destroy human embryos such as Plan B and Ella.”

The FRC particularly objects to the fact offering drugs such as Ella “essentially would mandate coverage for abortion”, and that it was not right to give free contraception because this means people who are against it are subsidising those who are not. There are “no conscience protections for health care plans that object to such coverage, or for health care providers in insurance plan networks who object to prescribing such drugs,” said Monahan.

Meanwhile Catholic leaders in the US are also expressing strong opposition the IOM recommendation.

Chairman of the Committee on Pro-Life Activities of the United States Conference of Catholic Bishops, Cardinal Daniel DiNardo of Galveston-Houston, said he was strongly against the IOM recommendation that the HHS “mandate coverage of three particular practices in almost all private health plans: surgical sterilization; all FDA-approved birth control (including the IUD, ‘morning-after’ pills, and the abortion-inducing drug Ella); and ‘education and counseling’ promoting these among all ‘women of reproductive capacity’ “.

He said the IOM decision was in effect a “mandate coverage of surgical sterilization and all FDA-approved birth control in private health insurance plans nationwide”.

Linda Rosenstock, dean, School of Public Health, University of California, Los Angeles, chaired the IOM committee that wrote the report. She said in a statement that:

“This report provides a road map for improving the health and well-being of women.”

“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,” she added.

Sources: IOM; Planned Parenthood; Lifenews.com; US Conference of Catholic Bishops, Secretariat for Pro-Life Activities (via PR Newswire).

Written by: Catharine Paddock, PhD