Does the U.S. Care about Women? That Depends on Where They Live

The Department of Health determines that contraception is not preventive care for women in the US, but USAID continues to expand access to contraception in the developing world? Talk about a split personality!
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Is the U.S. government schizophrenic when it comes to women's health? The latest evidence that indicates that might be the case is the Department of Health and Human Services (HHS) determination that contraception is not preventive care for women and will not be covered without co-pays in the new insurance plans. Meanwhile, the U.S. Agency for International Development (USAID) continues its 40-year investment in expanding access to contraception in the developing world.

According to HHS, the issue needs "further study." Perhaps USAID is withholding the findings from the dozens of studies -- paid for with millions of U.S. tax dollars -- that have already proven that birth control is an important element of preventive health care for women. Or maybe contraception is only for poor women in poor countries; American women should just pony up the money, or take their chances and risk an unwanted pregnancy and/or sexually transmitted disease.

HHS's decision has not gone unnoticed: last week 60 groups from around the country sent a letter urging HHS to fall into line with existing federal policy and widespread scientific consensus.

The facts are unequivocal on the issue of contraception. Indeed, a recent publication funded by USAID called Family Planning Save Lives makes the point rather well:

Considered a "best buy" among health investments, family planning is one of the most cost-effective, high-yield interventions that exists today. Countries that invest in family planning can reap immediate health benefits, investment savings in the health and education sectors, and social and environmental benefits that extend well beyond a single generation.

The authors point out that their message about family planning is the same in this 4th edition as it was in the edition first published in 1986.

The most obvious benefit of contraception is the prevention of unintended pregnancies -- women who are able to space their births are likely to have healthier pregnancies and healthier children. But, citing Guttmacher research, the above publication states the numerous other health benefits including:

  • Averting maternal deaths and disabilities
  • Reducing the number of abortions
  • Reducing infertility
  • Preventing high-risk pregnancies - among adolescents, women who have had many births or births spaced too closely together, women with HIV/AIDS and other health conditions

Using contraception to space births results in:

  • Lower rates of newborn, infant, and child mortality
  • More time to breastfeed, improving infant health
  • More time for women to recover physically and nutritionally between births

And let's not forget disease prevention. Condom use is the only current method of HIV prevention that we currently have. Not only will using condoms protect couples, it will also reduce mother-to-child transmission of HIV and the number of AIDS orphans. Condoms also prevent syphilis, gonorrhea, and herpes, among other sexually transmitted infections. Research in the Lancet reminds us that syphilis infection in a pregnant woman can lead to stillbirth, congenital syphilis in the child, and death.

These diseases, all of which are preventable, have wide impact on individuals and populations as a whole which is why we have public health entities like the Centers for Disease Control worrying about them .

None of this touches on the social benefits -- women who can control their fertility can complete their education and hold jobs, ensuring a better financial position for their families. In fact, using birth control is such a basic decision for women of reproductive age in this country that we hardly think of it: according to the Guttmacher Institute, among fertile, sexually active women who do not want to become pregnant, 89 percent are practicing contraception. I'm sure it will be news to these women that HHS does not agree with their view that they are preventing pregnancy and disease by using contraceptives.

This is all old news that HHS seems to have missed, and they are also unaware that our government has long been the largest supporter of contraceptive use around the world. Indeed, hundreds of millions of taxpayer dollars have been spent on this very idea. For our own government to now order a study and a review of the evidence to prove that contraception is a preventive measure for American women seems like a colossal waste of time and dollars.

As is so often the case with reproductive health issues, I suspect that this ruling has nothing to do with science and evidence and everything to do with HHS caving to pressure from the US Conference of Catholic Bishops who, according to Sharon Lerner of Slate, sent a letter to HHS urging them to make this decision about contraception permanent. Which brings me back to my original question: Do women in the United States have the right to health care based on the evidence put forth by the USAID? Or based on theology which appears to be the HHS view? Talk about a split personality.

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