Yesterday’s determination by Kathleen Sebelius’s Department of Health and Human Services that all FDA-approved contraceptive drugs and devices, as well as sterilization, are preventative care and should therefore be covered without co-payment or deductible by all insurance plans follows on the heels of the Institute of Medicine’s recommendation to that effect two weeks ago. It is a decision that vastly expands the federal government’s commitment to promoting the avoidance of pregnancy as a public-policy priority. The government makes this move in the teeth of a mountain of evidence suggesting that its efforts in this regard have been thoroughly counterproductive over the course of the last 30 years.
President Johnson’s fruitless War on Poverty kicked off the nation’s misguided birth-control crusade with grants for “family planning” in 1965. The effort was redoubled in 1970 when, thanks to the efforts of John D. Rockefeller III and George H. W. Bush, Title X of the Public Health Service Act was signed into law by Richard Nixon the day after Christmas. Since 1970, the out-of-wedlock birthrate has tripled to 41 percent. With the help of the Supreme Court with its 1973 Roe v. Wade decision, we have also seen the number of abortions spike through the 1980s and reach an equilibrium today at between 1.2 and 1.3 million annually. Both results are at least unexpected from the perspective of a public policy based on the premise that access to contraception will decrease the rate of unintended pregnancies.
But perhaps such an outcome should not be surprising. Several economic studies, notably one by Berkeley economists Akerlof, Yellen, and Katz, indicate that access to contraception and abortion alters the sex and mating markets and, through risk compensation, actually increase the number of unintended pregnancies. Just as anti-lock brakes lead drivers to drive faster, follow closer, and brake later, the already nearly universal access to contraception seems to increase the number of sexual encounters, thereby increasing the number of contraceptive failures. We know risk compensation is at work with bicycle helmets, seatbelts, ski helmets, and skydiving gear. To deny its obvious role in the sex and mating markets is to let ideology triumph over reason and science.
While it is true that HHS’s determination is somewhat symbolic since many states already mandate contraceptive coverage and many insurance companies already cover contraceptive devices, it is nevertheless a troubling symbol for several reasons. It reveals a blind commitment to longstanding public policy which has been proven severely counterproductive over the course of four decades. It implies that pregnancy and childbirth are conditions to be prevented as though they are diseases and unsafe for women, the latter of which is only true absent basic medical care, except in rare cases. It perpetuates the notion that population growth is a hindrance to development, which is only true in the absence of economic opportunity. It blurs the line between contraception and abortion by including drugs like ella, which can act, in some cases, like RU-486, as an abortifacient. And it implies that the conscience objections of religious individuals are illegitimate. This last is most disturbing.
While the HHS regulations allows exemptions for institutions whose primary objective is the propagation of religious faith and which are not-for-profit corporations, there are no exceptions made for religious providers of health care or social services, or for individuals of religious faith or philosophical conviction who, as business owners, wish not to provide coverage for contraceptive drugs and devices to their employees, or who, as individuals, purchase insurance independently, and do not wish to contribute to the provision of contraceptives to others. Are the concerns of these individuals of no consequence? Are they to be compelled to act against their conscience? Will not this be yet another incentive for some small businesses to cease offering health insurance to their employees?
An editorial by a doctor in the employ of Planned Parenthood published in the New York Times on the morning of the release of the IOM report contains a classic example of the fake sob stories often used by those who promote government sponsored contraception. The author laments that her daughter can’t afford an IUD, and is left to make do instead with a contraceptive injection. “Health insurers continue to charge fees that make it difficult, sometimes impossible, for women to prevent unintended pregnancy.” One could quibble that there is one obvious alternative for the author’s daughter, an employed, divorced mother of three — one generally not subject to any fees.
“Today’s system of co-payments and deductibles for birth control,” the author concludes, “sends a terrible message to women like my daughter: when it comes to planning your family, you’re on your own.” Alas, it is no longer so. It is no longer enough for women to be free to make decisions about their own sexual behavior. Now we all must shoulder the economic responsibility for those decisions.
— Greg Pfundstein is executive director of the Chiaroscuro Foundation.