Politics and the Pill
The debate over contraceptive coverage heats up


Eighty-five years after Margaret Sanger opened America's first birth control clinic and 40 years after the development of "the Pill," the full range of prescription contraceptives is still not covered by most health insurance plans. In a country in which half of all pregnancies are unintended, this is disgraceful. By this standard we are no better off than many third world nations.

How did this happen, and what is the remedy?

This is not the result of any great conspiracy among pharmaceutical companies, insurance companies, employers and the government. Rather, it is more due to the historical ignorance and discomfort of American men regarding women, sex and reproduction, and the historically low status of women in the workplace.

As long as men have regarded birth control as the sole responsibility of women, they have not known enough about it to understand its significance to the overall health of women, children and families. And since men haven't had to pay for it, we really haven't known how expensive it can be. We've been lazy, stupid and cheap, but we came by it honestly.

For their part, women have not traditionally had enough security or status in the workplace to insist that contraception be covered as an employee health benefit. Nor has it been socially acceptable to acknowledge women's sexuality, other than pregnancy, in the workplace. To request insurance coverage for contraceptives would be to advertise that a woman- especially a single woman-might have sex for non-procreative purposes; to demand an expansion of employee benefits would risk termination.

Thankfully, men are getting smarter and women more powerful. Smart enough and powerful enough that together we can make contraceptive coverage a reality for every insured woman in South Carolina.

How can we make this happen? Gov. Jim Hodges has taken a brave political step in recommending that the state health plan extend coverage to include oral contraceptives. It is brave because the state budget, suffering from decades of mismanagement and political manipulation, is finally imploding, making the expansion of insurance benefits an easy target for opponents to snipe at.

It is brave because the record of our state on issues affecting women is barbaric, and his proposal bucks this history. And it is brave because Gov. Hodges knows that he alone cannot make it happen. Whether or not it is politically pragmatic, politically popular or politically possible, it is the right thing to do.

The governor's plan is an excellent place to start, but it does not go far enough. Contraceptive coverage should apply to all FDA-approved methods of birth control, not just pills.

Currently there are only four other methods available: injections, implants, intra-uterine devices and diaphragms/cervical caps. While the selection is slim, each method has distinctive characteristics that may make it more medically appropriate, or otherwise more effective as a contraceptive depending on the individual user. Technologically, we are beyond 1916 when any kind of car was available as long as it was a black Model T Ford and any kind of contraceptive was available, as long as it was an illegally smuggled diaphragm.

Contraceptive coverage should be an element of all health insurance plans in the state, not just the plan for state employees. Currently the only programs mandated to include contraceptive coverage are Medicaid and Title X, the nation's family planning program for lower-income and under-insured women. It would be ironic if the only women in South Carolina lacking contraceptive coverage were those with private employer-paid insurance, which is presumed to be superior to government plans.

Employers and insurance companies who traditionally reject "mandated" coverage will be wise to embrace contraceptive coverage, whether voluntarily or otherwise. Industry studies clearly show the overall cost savings of contraception. Compared to the costs of unintended pregnancy, including obstetric or abortion care, contraception is a genuine bargain.

Contraceptive coverage must also include emergency contraception, also known as the "morning after pill." (For more information on this, go to www.plannedparenthood.org.) Don't confuse this pill with mifepristone, also known as RU-486 or "the French abortion pill." Emergency contraception is just that, and cannot cause an abortion even if you want it to. What it can do is provide an 80 percent chance of not getting pregnant if taken within 72 hours of a contraceptive failure, such as a broken condom. Unless it becomes available over-the-counter as the AMA has recommended, insurance coverage is the best way to make it more widely available.

For contraceptive coverage to become a reality, all we have to do is write four letters each: one to the governor to thank him for making this a public policy issue, one each to our state representatives and senators asking them to make it law, and one to the local newspaper to keep it in the public eye.

A lot more will have to be done to achieve adequate health coverage for the uninsured, the unemployed, and children of South Carolina, and that will be a much greater challenge. In the meantime, let's get this one while we can.

Chris Jueschke is CEO of Planned Parenthood of South Carolina.

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