A cost-effective approach to women's health

Social conservatives have recently gone into fits over a report released last week recommending that insurance coverage include free access to birth control as preventive care for women under President Barack Obama's health care overhaul. That insuring preventive care whenever possible — and thus saving far greater sums associated with unwanted pregnancy — might be construed as a bad thing defies reason, of course, but it's par for the ever-shallow national health care debate.

It's no surprise that certain religious groups are upset because they perceive contraception as sinful. That is their right (although it's clear not all members of the Catholic faith, to name one high-profile opponent of birth control, support this controversial view). But the business of deciding whether women in the U.S. might have better access to contraception should not be about religious beliefs or even social mores but about maximizing the health care dollar.

Indeed, somewhat lost in the breathless cable TV commentary is the context of the report from the Institute of Medicine. A non-partisan panel of health experts was given the task of recommending to the U.S. Department of Health and Human Services a list of preventive health services that ought to be covered at no cost to patients.

Counseling and contraception to prevent unintended pregnancies was one of eight services recommended. The others caused barely a ripple on the public airwaves and included screening for gestational diabetes, testing for human papillomavirus, lactation counseling, counseling on sexually transmitted infections and counseling and screening forHIV.

Why should any of these be available without co-pay? Because, as the panel reported, not only would these services greatly contribute to the health and well-being of women but because not providing them is so outrageously expensive to society and the health care system.

In other words, for the lack of a $5 co-pay, a teenage patient might not bring home the contraceptive that might have protected her from getting pregnant. Women with unintended pregnancies (which account for almost half of U.S. pregnancies) are less likely to seek prenatal care and to smoke, drink alcohol, and deliver a baby preterm or at low birth weight, which raises the risk of serious health and developmental problems.

Someone with strong religious convictions regarding family planning continues to have the absolute right to decline a contraceptive. And while it's possible women who could easily afford a co-pay or even to pay out of pocket for birth control would benefit, too, one can only say, so what? The insured would still pay for all these services through premiums — just not on a piecemeal basis.

Granted, even some health experts will concede that the exact financial return on any of these preventive services is not clear. For every dollar invested in contraceptives, how many dollars does society save in other services not rendered? That's simply not known in absolute terms.

But that doesn't mean there's a shortage of information about the effects of unwanted pregnancy on individuals and communities. One need look no further than study after study by the World Health Organization, the Guttmacher Institute and others that found countless lives saved and economic circumstances improved when family planning services are provided in countries around the globe.

It's up to HHS to decide what health plans should cover and to gauge cost-effectiveness of services. But it's hard to see how providing contraception to patients cost-free could be anything short of efficient and economical.

Those who oppose abortion ought to be the first to approve of this strategy. With fewer unwanted pregnancies, the desire to terminate them will be diminished. This approach to preventive medicine can also reduce the number of low birth-weight babies and lower infant mortality, something with which Baltimore has significant experience.

Ignoring those very tangible benefits would allow the religious beliefs of some Americans to trump the best interests of individual women and of the community at large, which inevitably has to bear the burden, financial and otherwise, of unwanted pregnancy. If the country is truly serious about reducing health care costs, including those imposed on taxpayers, the choice is abundantly clear.

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