IOM Report: Birth Control Should Be Free

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Pills, IUDs and patches without the co-pay? A new report says free and accessible birth control is an essential part of a full range of preventive health services that should be offered to all American women as part of the Patient Protection and Affordable Care Act (ACA) of 2010.

With the ACA came a new emphasis on preventive care as a cost-saving and effective way to pre-empt illnesses and cut medical costs. As Kate Pickert reported over on TIME’s Swampland:

This guideline, though non-binding, is expected to heavily influence the Department of Health and Human Services as it further refines which services will count as “preventive medicine” under the Affordable Care Act.

Since Sept. 23, 2010, all new plans have been required to cover preventive services with no out-of-pocket costs for consumers.

The law’s very existence has been politically controversial, but the new report from the Institute of Medicine (IOM) — which deals exclusively with women’s health and reproductive issues — may be especially so. It was commissioned by the Department of Health and Human Services as part of an effort to determine what should fall under the preventive rubric, and while opponents might see a political agenda at work, the Institute insists that its nonbinding recommendation is based on straight-up clinical data.

“The committee defined preventive health services as measures — including medications, procedures, devices, tests, education and counseling — shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition,” wrote the report’s authors.

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Still, for people involved in women’s health advocacy, the news felt like a political victory. “As someone who has worked on women’s rights for nearly 30 years, I can say that today’s news marks one of the biggest advances for women’s health in a generation,” said Nancy Keenan, president of NARAL Pro-Choice America in a statement. “Currently, nearly one in three women finds it difficult to pay for birth control, and that’s why the United States has a far higher unintended-pregnancy rate than other industrialized countries. Making family-planning services available at no cost will help millions of women prevent unintended pregnancy and thereby reduce the need for abortion.”

The need for such a reformulated policy, Keenan and others say, is very real. Planned Parenthood Federation of America reports that half of all pregnancies in the United States are unintended, at great expense to tax payers (to say nothing of the financial and psychological burden on the new mothers). And with co-pays that can reach $25 or even $50 a month for oral contraceptives, even insured women can find the monthly cost untenable, especially in a poor economic climate.

All the same, opponents of the recommendation believe that it may create a dilemma for some consumers. “Say for example that I had a problem with [contraceptive services]; I would be paying into a plan that would be covering them,” Jeanne Monahan, director of the Center for Human Dignity at the conservative Family Research Council told NPR. “So in a way I would be forced to pay for it myself.”

MORE: Are Doctors’ Exams a Barrier to Birth Control?

The specifics of the plan are not likely to make folks like Monahan any happier. (Read a full summary here.) Among the benefits:

Free birth control: The recommendation calls for providing “the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity.” The inclusion of an education clause is especially noteworthy since for many people, it’s not the lack of contraceptive devices that’s a problem, but the lack of knowledge about the proper way to use them.

HIV testing: Currently, HIV/AIDS is the third leading cause of death among African-American women, ages 25-44 and the majority of those infections occur through heterosexual intercourse, according to an analysis by the Henry J. Kaiser Family Foundation. While rates of HIV infection are lower — and more likely to be caused by intravenous drug use — in other ethnic groups, HIV and AIDS is a reality for all sexually-active women in the U.S. The IOM report advocates  providing “counseling and screening for human immunodeficiency virus infection on an annual basis for sexually active women.”

HPV genetic testing: “The addition of high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results. Screening should begin at 30 years of age and should occur no more frequently than every 3 years.”

In English: while Pap smears test for irregular cells on the cervix — a potential sign of HPV infection, cervical cancer or pre-cancer — that may not be sufficient to prevent the 4,000 deaths and 12,000 diagnoses of cervical cancer each year. Instead, the report recommends using an increasingly popular genetic test that detects the strain of HPV, especially high-risk subtypes that are more likely to turn into cancer, such as HPV-16 and HPV-18.

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The committee additionally offered recommendations to improve care for pregnant women, including more universal gestational diabetes testing and lactation support for women who chose to breastfeed. Domestic violence and abuse was another area of focus for the committee members, who recommended that all women and teenage girls receive information and culturally-sensitive counseling about what constitutes abuse. Given a recent estimate that 5 million women and girls are physically, sexually or emotionally abused by their partners in the U.S. each year, the counseling may reach an important population that’s more prevalent than visible.

“The inclusion of evidence-based screenings, counseling and procedures that address women’s greater need for services over the course of a lifetime may have a profound impact for individuals and the nation as a whole,” concluded the committee.

Meredith Melnick is a reporter at TIME. Find her on Twitter at @MeredithCM. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

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