Don’t Gut the Affordable Care Act If You Want Fewer Unintended Pregnancies and Abortions

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Commentary Abortion

Don’t Gut the Affordable Care Act If You Want Fewer Unintended Pregnancies and Abortions

Dr. Ilana Addis & Dr. Lisa Soltani

As women's health-care providers, we've seen contraception benefit our patients. The ability to choose if and when to become a parent gives women the power to control their future, be more economically successful through improved educational opportunities and wages, and raise healthy families.

The United States’ abortion rate has reached its lowest point since Roe v. Wade legalized abortion in 1973. But far too many U.S. women still get pregnant without advance planning. The statistic is startling: Almost half (45 percent) of all pregnancies are unintended.

Congress is back in session, with Republican leaders demonstrating that eliminating the Affordable Care Act (ACA) is their first order of business. This policy is incredibly shortsighted and at odds with many of our conservative legislators’ stated interest in reducing abortion. Endangering access to contraception would not decrease the abortion rate. In fact, the exact opposite would occur.

Now President-elect Donald Trump announced U.S. Rep. Tom Price (a former orthopedic surgeon) as his choice as Health and Human Services secretary. It is not a secret that Rep. Price (R-GA) is no friend of the ACA and the law’s requirement to offer contraception at no additional cost. In addition to Price’s baffling claim that there is not a single example of a U.S. woman who has not been able to afford effective contraception, he has somehow interpreted the ACA’s birth control mandate as an affront to religious liberty.

These kinds of statements show an alarming lack of understanding about the economic hardships many Americans face and also undermine the most effective method for reducing abortions.

Roe is gone. The chaos is just beginning.

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As women’s health physicians, we have seen that increased access to contraception benefits our patients in numerous ways. The ability to choose if and when to become a parent gives women the power to control their future, access improved educational opportunities and higher wages, and raise healthy families.

The best way to prevent unwanted pregnancy is through access to proven contraceptive methods. Methods like the intrauterine device (IUD) or implants that deliver hormones (Nexplanon), for example, have now been shown to be as effective as permanent surgical sterilization at a fraction of the cost and effort through a simple office-based procedure.

Evidence shows that these long-acting reversible contraceptives (LARCs) can be used safely in the entire continuum of child-bearing years, from adolescence to post-pregnancy, and in a much broader range of women than previously thought. In fact, for most people, there are now very few health reasons not to use these very safe and effective methods that are relatively inexpensive over the long term.

What remains is to continue to encourage awareness of these methods through more public education; more training of primary care providers; and retaining the improved coverage, without out-of-pocket costs to women, that exists under the ACA. Without the ACA, contraceptives—LARCs in particular—will be increasingly out of financial reach for many women.

Data from two states illustrate the powerful relationship between removing barriers to contraception and plummeting abortion rates.

Since 2008, before the ACA, Colorado has successfully increased access to family planning services throughout the state. The Colorado Family Planning Initiative has increased health-care provider training and reduced costs, enabling more than 30,000 women in the state to choose LARCs. When contraception, particularly long-acting methods, became more readily available in Colorado between 2009 and 2014, the abortion rate fell 48 percent among women ages 15-to-19 and 18 percent among women ages 20-to-24. 

In St. Louis, Missouri, the Contraceptive Choice Project began enrollment in 2007. In four years, almost 10,000 women were enrolled and counseled on their contraceptive options. Seventy-five percent chose a LARC method such as IUD or implantable hormone rod. During all three years of follow-up, researchers found that women using LARCs had a lower unintended pregnancy rate than women using the pill, patch, or ring.

Recent decreases in abortion can’t be entirely attributed to the ACA’s contraceptive mandate or other programs that make access easier. But we can’t downplay that the ACA is a significant factor: Under it, the uninsured rate for women has dropped by more than a third overall and by almost half among women in states that adopted Medicaid expansion. Both Medicaid and the ACA currently cover contraceptive services with no co-pay or cost-sharing.

If our lawmakers really want to reduce abortion, they must understand the best way to do so is to avoid unwanted pregnancies in the first place. It is our responsibility, as a society, to ensure greater access to reliable contraception. Don’t let this benefit be another to get lost in partisan politics. Our nation’s families should not suffer.