IUDs and Obamacare

One of the good things about Obamacare is that many women will now get contraception covered under their insurance plans. This is really important since the most reliable and properly used birth control method is the IUD, as the pill has a relatively high failure rate (boldface mine):

We’ve learned that some kinds of contraception are more prone to human error than others. But have we taken the lesson to heart? Half of the 3 million annual unintended pregnancies at any age in the United States occur among people using birth control. The pill is the most popular method, used by more than half of all women trying to avoid pregnancy. People believe it is highly reliable because it is over 99 percent effective when “used correctly” in supervised drug trials.

And therein lies the catch. In the real world, only 40 percent of adults and 25 percent of teens actually remember to take the pill every day, which makes the real-world risk of pregnancy much higher than expected.

Earlier this year, Washington University researchers led by Jeff Peipert reported in the New England Journal of Medicine that 5 percent of women in a study who were on the pill got pregnant within a year. Among those under 21 years of age, almost twice as many did. Take a moment to reflect on that. Imagine you are a concerned parent who accepts that your high school senior has sex. You take her to the doctor and she starts taking the pill. The data show that this is much better than just telling her to use a condom during intercourse. However, before graduation, 1 in 10 such girls will be headed for the delivery room or abortion clinic. That is a breathtaking failure rate.

If that same woman is active from 18-21, she has about a 1 in 3 chance of becoming pregnant. The IUD is much more effective and is ‘easier to use’–once inserted, there’s not much else to do. Unfortunately, there’s an ‘entry fee’ problem (boldface mine):

Before the health care law, if I wanted to get an IUD, I would have had to pay about $1,200 upfront for the device and the insertion. I’ve been through pretty much every other type of contraception out there, and they just weren’t working for a variety of reasons—some I am allergic to, some made me a crazy lady, and others came with a steep monthly price. Then there was the fact that I am just not very good at taking a pill every day at the same time, which is crucial if your birth control is going to actually control birth. And I’m not the only American woman who sucks at taking birth control.

Enter the IUD. Like many women, it was the right choice for me. But although it’s cheaper in the long term because it’s good for up to five years, I didn’t really have $1,200 laying around to cover it upfront. This is true for a lot of women, according to Dr. Nancy Stanwood, an obstetrician/gynecologist with the Yale School of Medicine and a board member of Physicians for Reproductive Choice and Health. “I have seen so many women want to choose a method of contraception but have it out of reach financially,” Stanwood says. “Instead of women looking at their medical needs and the needs of their family, they had to instead look in their pocketbook.”

Obama/Romneycare isn’t that good–if Massachusetts is any guide, it has major affordability and cost-control problems. We could have and should have done much better. We should be knocking down walls, not tunneling under them. But it does make a difference in many people’s lives. And as part of my effort to reach out to the asshole community, women are people too.

An aside: By now, it should be well established that the anti-safe and legal abortion professional activists are against contraception too. Don’t waste your time with the “you can decrease abortion by providing better contraception” argument (even though it’s right). They don’t care.

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