Obama's Birth-Control Rule Will Help Prevent Accidental Pregnancies

In the United States, nearly 50 percent of pregnancies are unintended. A new health care rule which
stirred controversy due to its implications for church-affiliated organizations' coverage of contraception
has the potential to significantly reduce accidental pregnancies by increasing access to birth control,
according to public health experts.
And the accommodation made by President Barack Obama on Friday (Feb. 10) making insurers rather
than the church-affiliated organizations responsible for contraceptive benefits won't change this, they
say.
"It will have a huge effect," said Diana Greene Foster of the Bixby Center for Global Reproductive Health
at the University of California, San Francisco. "It is not the entire solution, but it is such an obvious first
step."
The cost
Reducing unintended pregnancies is a well-established public health goal. They are associated with a
variety of health issues for both mother and child from maternal depression to birth defects. There are also
economic consequences, particularly for teen mothers who are less likely to graduate from high school,
according to the U.S. Department of Health and Human Services.
By fully covering the spectrum of contraceptives and eliminating copayments, the rule would give women
the option of picking the method of birth control best suited for them, regardless of cost, according to
Adam Sonfield, a senior public policy associate at the Guttmacher Institute.
The most effective forms of contraception are long-acting, like intrauterine devices and implants that are
put under the skin. Both can last for years, eliminating the possibility that a woman will miss a dose or
use the inconsistently, according to Sonfield.
"They are extremely effective in the long run, but in the short run, they often have high upfront costs,"
Sonfield said. "Rates of unintended pregnancies are many times higher among poor women, [so] this has
the potential to really help with that."
The rule originates with the health care overhaul, which Obama signed into law in 2010, and it packages
contraception along with other preventive care. It exempts churches and houses of worship from offering
insurance that covers contraception. Earlier this year, Obama rejected an exemption to this coverage for
organizations with religious affiliations, such as, a Catholic hospital or school. This sparked accusations
that the rule violated religious liberty by forcing institutions to buy something they opposed. (The
Catholic Church considers deliberate contraception a sin.) [8 Ways Religion Impacts Your Life]
The math
Nowadays, most American families want two children. This means the average women will spend five
years pregnant, recovering from pregnancy or trying to become pregnant and three decades trying to
avoid becoming pregnant, according to the Guttmacher Institute. (This assumes she is sexually active
throughout.)
"People are going to have sex," said Carol Hogue, a professor of epidemiology and the Terry Professor of
Maternal and Child Health at Emory University. "When contraception is easily available, free or

inexpensive, and it is widely known how to get it and how to use it,abortion rates plummet, because the
only way couples control their fertility effectively without abortions is through contraception."
A program in California demonstrates the potential benefit of increasing access to contraception,
according to Foster, who is a demographer in UCSF's department of obstetrics, gynecology &
reproductive services. In 2007, contraceptives offered by the state's Family PACT program averted an
estimated 286,700 unintended pregnancies which would have included 122,000 abortions, according to
data she provided.
In addition to reducing abortions and teen pregnancies, and providing other health services like screenings
for cancer and sexual-transmitted diseases, the state's program has proven quite cost effective, according
to Philip Darney, director of the Bixby Center at UCSF.
According to the Bixby Center's cost benefit analysis of the program for 2007, each averted pregnancy
saved the public sector about $14,111 in costs for both the woman and the child, from conception to age
5.
Why it happens
According to the Guttmacher Institute, just over half (52 percent) ofunintended pregnancies result from
couples not using contraception, while 43 percent result form incorrect or inconsistent use, and the
remaining 5 percent result from failure of the method.
The National Survey on Family Growth offers a different take. Between 2006 and 2008, women who had
experienced unintended pregnancies said they had not used birth control for the following reasons: (The
842 women who responded could select more than one reason.)

14 percent did not expect to have sex

44 percent did not think they could get pregnant

16 percent were worried about the side-effects of birth control

17 percent had a male partner who objected

23 percent didn't mind if they became pregnant

As the sizable percentage of women who say they were neutral to the prospect of getting pregnant
demonstrates, there's nuance hiding within the term "unintended pregnancy."
Researchers typically divide them into two catagories: mistimed pregnancies, typically meaning they
happen too soon, before a woman is ready, and unwanted, meaning the woman has no desire to have a
child.
"The definitions seems simple and straightforward, but in reality, they are complex," said Roger Rochat, a
professor in the Rollins School of Public Health at Emory University. For instance, a teenager may say
she never wants to become pregnant, but over time, she may change her mind, he said.