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Copyright 2000 The Washington Post  
The Washington Post

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August 5, 2000, Saturday, Final Edition


LENGTH: 636 words

HEADLINE: Birth Control: Basic Health Care For Women


In "Why Cover Contraceptives?" [op-ed, Aug. 2], Lila Arzua says that covering contraceptives would decrease health care choice for women because it would impose insurance premium costs on women who don't choose to use contraceptives. I thought the whole point of insurance was to spread costs over a large group.

I don't have diabetes, but my premiums go to pay for insulin for diabetics. I am male, but my premiums pay for pregnancy care. If Arzua is right, then I should expect a refund for all these things. But if I did, I would have no right to expect others to bear the cost of my medical care. What's fair is fair.

--David DiSabatino

Lila Arzua says that the cost of covering the full range of FDA-approved prescription contraceptives would be an "additional" $ 21.40 per employee per year. What she doesn't say is that typically the employee would pay at least 20 percent of the cost and that the full amount would only apply to companies that now offer no contraceptive coverage.

In fact, many companies already provide full coverage and would see no additional costs, and many more provide coverage of at least some methods. Moreover, even the total amount would increase annual employer insurance costs by only six-tenths of one percent.

Beyond cost, Arzua alleges that contraceptives are basically ineffective anyway, since about half of American women who have an unintended pregnancy each year say that they had been using a contraceptive during the month they became pregnant. But she misses the point. While it is true that about half of unintended pregnancies occur to the 39 million women using contraceptives, the other half occur to the only 3 million women-at-risk who are not.

Undeniably, contraceptives "work." The most widely used contraceptive methods reduce a woman's risk of pregnancy by more than 90 percent.

--Cory L. Richards

The writer is vice president

for public policy at

the Alan Guttmacher Institute.

Lila Arzua places contraceptives in the same category as contact lenses or cosmetic acne treatment. Yet more health risks are associated with pregnancy than Arzua acknowledges. And I seriously doubt there's a way or a desire to screen for all pregnancy-related risk in order for sterilization to "plausibly be considered medically necessary."

Furthermore, some birth control pills have been shown to have therapeutic value beyond their ability to prevent unintended pregnancies--such as in treating endometriosis, acne and excessive menstrual cramping.

Would it be reasonable for a health plan to approve birth control pills but mandate that they be "covered" only where birth control is not used to control birth?

--Arlette Collier

Lila Arzua argues that covering contraceptives in health plans would be prohibitively expensive. On the contrary, improved access to and use of contraception would save insurers and society money by preventing unintended pregnancies.

Insurers generally pay the medical costs of unintended pregnancy, including ectopic pregnancy ($ 4,994), induced abortion ($ 416), spontaneous abortion ($ 1,038) and term pregnancy ($ 8,619). In fact, a study of claims under the Utah Public Employees Health Plans suggests that coverage of contraceptives appears to increase their use and decrease health care costs because of adverse pregnancy outcomes.

As the American College of Obstetricians and Gynecologists stated, "[t]o ignore the health benefits of contraception is to say that the alternative of 12 to 15 pregnancies during a woman's lifetime is medically acceptable."

Contraceptives are not a matter of mere convenience, as Arzua implies. They are basic health care for women.

--Kate Michelman

The writer is president

of the National Abortion

and Reproductive Rights

Action League.



LOAD-DATE: August 05, 2000

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