Although health care reform through the Affordable Care Act has not been perfect, it did bring about many beneficial changes for women's health. One was the contraceptive coverage mandate, requiring that health insurers and employers providing employee health insurance cover costs for birth control as they would other preventive health medications. This has afforded tremendous gains for women in their intimate personal relationships, family lives and careers.
As an OB-GYN, I have seen the positive effects of the contraceptive mandate for patients. I know many women whose lives would be dramatically and negatively altered without it. Unfortunately, the Trump administration wants to effectively strip this away by allowing any insurance provider or employer to apply for exemption from this mandate for any moral objection.
Contraception should not be a controversial issue subject to the whims of "moral objection." It is a key component of women's health care. Not only can it allow women to plan if and when they will have children, which is important for healthy pregnancies, but various forms of birth control have additional positive medical effects. While condoms are readily available and should certainly be used for prevention of sexually transmitted infections, they are one of the least effective methods of pregnancy prevention and do not carry these life-changing benefits.
Increasing obstacles for women in accessing the range of contraceptive methods available increases the unintended pregnancy rate. Unintended pregnancies cost the government billions of dollars annually and place women and their babies at increased risk of adverse outcomes. Higher rates of unintended pregnancy also correlate with higher rates of abortion, a medical decision this administration has made clear it adamantly opposes.
According to the Guttmacher Institute, the unintended pregnancy rate in the U.S. is at a 30-year low, and the abortion rate is the lowest it has been since the decision in Roe vs. Wade. These positive findings are likely related to increased access to contraceptives as a result of the ACA, particularly the most efficacious methods that are otherwise not easily accessible due to high upfront costs.
While sometimes ideal and magical, pregnancy also places women at risks of significant complications within nearly every body system. It can result in death, and the U.S. is the only developed nation with a rising rate of maternal mortality. These risks are particularly high for women who have health problems that are not adequately controlled at the onset of pregnancy. The ability to time pregnancy is crucial for these and all women.
Difficulty obtaining contraception also increases risks to women using these medications for purposes other than birth control. Women may lose quality of life as well as work production due to inability to control pain associated with conditions such as endometriosis and fibroids. Heavy bleeding can lead to life-threatening anemia if not suppressed. Ovarian cysts may not only cause pain, but sometimes require surgery and even removal of the ovaries. This involves the inherent risks of surgery as well as reduced fertility. If both ovaries ultimately require removal before the natural age of menopause, we see an increased risk of cardiac events, bone fractures and death by any cause.
Oral contraceptive pills have been shown to greatly reduce the risk of ovarian cancer and are particularly beneficial for women with a family history of breast and ovarian cancer conditions. Progesterone-only methods can protect against development of endometrial cancer (cancer of the lining of the uterus), and progesterone IUDs can even treat early stages of this disease. Oral contraceptive pills have been shown to reduce the risk of colon cancer, especially with recent use.
It is time to call on our local leaders to ensure that Minnesota law protects against the potential harms of interference by politicians, religious figures and employers in personal health care decisions.
Our women and their families deserve our support.
Erin Stevens is an OB-GYN physician at Clinic Sofia with offices in Edina and Maple Grove.
