Birth control: science’s most important achievement
Effective birth control is, arguably, the most important human invention since language. Also the most important contribution of science to human welfare ever.
Discuss. But you’re going to have to work hard to convince me otherwise. For a few of the reasons why contraception matters so much (to men as well as to women and children), consult economist Sonia Orrefice’s recent post at The Conversation.
How to get free birth control
The government has just cracked down on insurance companies that haven’t been providing free birth control products as required by the Affordable Care Act (aka ACA–yes, the much-hated Obamacare.) The rules also apply way beyond Obamacare policies to other medical insurance policies, such as many offered by employers.
The US Department of Health and Human Services says insurance companies must offer women at least one of each of the 18 types of contraceptive options approved by the Food and Drug Administration. This includes not just the pill and intrauterine devices (IUDs) but also emergency (after-sex) contraception, sterilization, the patch, injectables, and other methods.
The right-wing Washington Times presents this news as just one more example of Obama’s imperial overreach (“HHS rewrites Obamacare rules: Orders free birth control for all”.) But of course free birth control (not to mention other no-copay women’s services) were always part of the ACA. The new regulations are simply very explicit about precisely what must be covered. The reason for such specificity is that a number of insurance companies have been weaseling out of that commitment.
The new regulations apply only to birth control methods for women. Male sterilization and condoms are FDA-approved but are not on Jost’s list. If dependent children are covered on a woman’s policy, the free contraceptive services are available to them, too. The government’s detailed–very detailed–FAQ list is here.
The new regs don’t necessarily mean that women will be able to get a specific contraceptive free. As Phil Galewitz explains at Shots, “the plans may still charge fees to encourage individuals to use a particular brand or generic. For example, a generic form might be free, while a brand-name version of the drug can include cost-sharing, HHS said.” Also, the regulation doesn’t go into effect until the new plan year, which in most cases means not until next January.
However, a workaround from the government FAQs: “If an item or service is not covered but is determined medically necessary by the woman’s attending provider, there must be an easily accessible process for the woman to get that item or service.”
God is in the details. And you can be sure that religious opponents of birth control will be looking for Him there.
The most effective birth control method is an IUD
They work really well, but intrauterine devices (IUDs) are not all that popular. Sarah Kliff’s Vox IUD FAQ notes that some of that foot-dragging is probably due to hangover bad press from the Dalkon Shield, an early ’70s IUD that injured hundreds of thousands of women and killed some of them.
Today’s IUDs are quite safe and keep sperm away from eggs far more reliably than anything else except sterilization, which is permanent. Although fewer than 10% of US women use IUDs, 40% of gynecologists do. Which tells you something.
The IUD’s great virtue is that it prevents pregnancy invisibly and automagically, but for only as long as the user wants it to prevent pregnancy. No daily pill, no weekly patch, no ducking into the bathroom to grease up and insert a diaphragm when opportunity knocks unexpectedly. With an IUD, get it and forget it. And when you’re ready to get pregnant, take it out.
See Kliff’s post for the few cons. All the approved birth control methods (and their risks) are compared and contrasted in the FDA chart here.
Although the IUD is cheaper than, say, the pill in the long run, a big barrier to IUD use has been the upfront cost. For one thing, inserting an IUD requires training, skill, and professional credentials.
At Salon, Valerie Tarico describes how her daughters paid $1200 each for hormonal IUDs, the reasons why this method has been so costly, and plans for making a new IUD, the Liletta, available more cheaply to low-income women. Find more details on the Liletta from Martha Kempner at RH Reality Check. The FDA approved it in March.
IUD adoption is growing, along with use of the other long-acting reversible contraceptive, the birth control implant, according to Madeleine Schwartz at Fivethirtyeight. Making them available free through the ACA is going to increase their popularity. Especially as word gets out about the statistics on effectiveness Schwartz quotes: “The IUD has a failure rate of less than 1 percent and is considered to be 45 times more effective than the pill and 90 times more effective than male condoms based on typical use.”
Andrea Grimes is a Texas writer who recently reported at RH Reality Check on a wine-and-cheese gathering she threw for a few friends. It was not just a social occasion. The women were there to learn the World Health Organization’s protocols for safe self-induced abortion with the drug misoprostol.
It was something of a brave move. In Texas, Grimes explains, assisting someone to obtain an illegal abortion is a felony (although, she says, “the law prevents pregnant people themselves from being prosecuted for attempting to induce an abortion on their own.”)
So Grimes proceeds carefully. “I let people know that the WHO information exists and that it is a medically sound, evidence-based protocol. I am always careful not to advise people directly to use miso; I don’t want to break the law, and neither do others who share the WHO protocols.”
Misoprostol is the second half of the conventional drug-based procedure known as medically induced abortion, commonly used for early abortion. Medication abortion is a standard medical procedure. It is not at all the same thing as emergency contraception, like Plan B, which is used to prevent fertilization shortly after unprotected sex.
The first half of conventional medically induced abortion employs mifepristone, RU-486, which is taken at a clinic or doctor’s office. Misoprostol is taken later, usually at home. Find a friendly description of standard medically induced abortion, including potential risks and side effects, at the Our Bodies, Ourselves site. Or see the more straight description at WebMD.
But as the latest edition (2012) of WHO’s “Safe Abortion” explains, the two-pill process is only one approach to abortion. The second pill, misoprostol, can induce abortion by itself. (See, for example, the Executive Summary, p. 4. The “Safe Abortion” PDF can be had free directly from WHO here, and also for free from the US National Library of Medicine here.)
Misoprostol is widely available because it has other medical uses. Some have nothing to do with reproduction–for example, preventing ulcers in people taking NSAIDS. It’s used in veterinary medicine too. In the US, misoprostol requires a prescription. But it is available over the counter in many other countries.
Women on Waves cites studies showing that misoprostol-only abortions are successful 90% of the time and work best and most safely before 12 weeks of pregnancy. The site also has photos of what misoprostol tablets look like in several parts of the world.
There’s also news about the 2-drug form of medically supervised abortion. A study published in April in the journal Contraception described new evidence-based protocols, conducted over 5 years with 13,000 women at Los Angeles-area Planned Parenthood clinics. The researchers found that the protocols were more than 95 percent effective up to 63 days of pregnancy, according to Emily Crockett at RH RealityCheck.
The 63-day limit matters because the FDA has approved the two-drug medical abortion regimen only up to 49 days of pregnancy. The new protocols also used lower drug doses. At Medscape, doc Peter Kovacs found this pretty convincing, concluding “Several studies suggest that new protocols could be developed to extend the availability of medical termination services beyond 49 days’ gestation.”