Birth Control Uncoverage

One doodle that can be undid, homeskillet

by by Katie Okamoto

From teenage whoopsidaisies to one night stands gone unglamorously wrong, unintended pregnancies were big in the world of movies this year. But they have also been big in the real world, as prices for contraceptives became dramatically higher for college students and low-income women.

Try as legislators might to assert themselves as women's advocates, they have a tendency to overlook practical, often complex factors that affect a woman's emotional and physical health as well as her sexual activity. Now add the stigma associated with birth control: a crutch for frivolous women intent on leading a capricious sex life. This sort of judgment is ignorant of the importance of birth control in preventing unintended pregnancies and abortions. It is also a total dismissal of the social and economic benefits that family planning provides to the nation's communities.
An example of this dissociation of women's issues--especially poor women's issues--is obvious in the recent price hike for hormonal contraceptives in low-income health clinics and university health centers across the nation. After passing the Deficit Reduction Act of 2005, which went into effect last year, Congress may not have foreseen the staggering effects it would have on low-income women's access to birth control. Although these effects are said to have been unintentional, Congress's oversight proves that it rarely does its homework on the potential consequences of its actions. Now it must do its make-up work.

No money, mo' problems
Women who rely on low-income and university providers have reported that monthly costs for oral contraception have risen by factors of two to four, according to the Associated Press. Prices for other forms of birth control, like NuvaRing, have increased by up to 900 percent at some clinics.

Before last year, pharmaceutical companies would sell drugs at discounts to a wide range of health care providers, colleges and low-income clinics among them. Drug manufacturers paid rebates to states for prescription drugs covered by Medicaid, the main federal health insurance program for low-income Americans. Since 1990, discounted contraceptives sold to university health centers and clinics were exempt from rebate calculations in an effort to encourage the discounts. This exemption didn't cost taxpayers a cent.

Things changed last January. When the Deficit Reduction Act of 2005 went into effect, it brought an end to the exemptions for discounted contraception sold to university and safety net clinics. The intention was to end drug company fraud in rebate evasion. To fix the problem, legislators created a list of health providers whose business would excuse drug companies from paying the state. In an act of negligence, university centers and low-income health clinics did not make the list.

Rx-y business
With no more incentive for drug companies to provide discounts to college health centers, monthly prices for oral contraceptives are doubling, tripling, quadrupling. These changes translate to a rise in several hundred dollars per year at some schools, affecting the annual budgets of students at universities ranging from Indiana University, Texas A&M and Tufts to Duke and Brown University.

In The New York Times' November coverage of the price increases, Monica Davey noted that some people "wondered why college students, many of whom manage to afford daily doses of coffee from Starbucks and downloads from iTunes, should have been given such discounted birth control to begin with, and why drug companies should be granted such a captive audience."

This simplistic and ignorant judgment overlooks the extent to which the discounts have helped lower-income students, for whom the choice is seldom Starbucks or the pill--it's books or the pill. Of course, it would be naïve to ignore how companies profit from the business of young women when they sell birth control at lowered prices. For many students, it is their first time using hormonal forms of birth control, and it is in the manufacturers' interests to hook loyal customers. This motive, however, does not detract from the increased access to birth control that benefits students, whether they choose to use hormonal methods or not.

Many women who do not attend universities are also feeling the effects of the high price of birth control. These are women who can afford neither Starbucks nor iTunes and rely on low-income health clinics for their reproductive care. These important safety net clinics fill prescriptions for an estimated 500,000 women.

Some 400 community health centers nationwide used by low-income women have reported steep price increases in hormonal forms of birth control, and one quarter of Planned Parenthood clinics are ineligible for the price discounts. The price increases come at an especially difficult time for the nation's expanding number of poor and uninsured.

Health centers can no longer afford to offer the range of hormonal contraceptives that were previously available to students and low-income women. Non-oral methods like the patch and NuvaRing will no longer be carried by many university health centers. Some clinics, like the center at Bowdoin College, have stopped stocking prescription contraceptives altogether.

While the extent of damage inflicted by raised prices is still unclear, some college clinics have reported drops in contraceptive sales. The American College Health Association reported that fewer students are filling prescriptions at university health clinics, and an apparently corresponding number are asking for emergency contraception and pregnancy tests. This should be alarming not only to anyone concerned with women's health, but also to those intent on reducing the number of national abortions. It would be a no-brainer for both social conservatives and liberals to unite over the pill.

An ounce of prevention
For a woman, the option to plan if and when she wants children must be a fundamental right. It also has larger societal feedbacks. Reputable studies have shown that preventing medical mishaps--which usually end up burdening both the system and the patient--is cost-effective and beneficial to the larger social and economic structure.

The average cost for a one-year supply of birth control pills is $350, while the average cost for one pregnancy is $10,000, according to a 2004 study on contraceptive coverage in employer insurance plans. Yet more than one in four women across racial and ethnic backgrounds have reported difficulty obtaining, refilling or renewing prescriptions for hormonal contraceptives, even before the increase in price.

Almost 39 percent of American undergraduate women--three million students--use oral contraceptives, according to the American College Health Association. Young college-age women (18- and 19-year-olds) have a birthrate three times higher than high school-age women (15- to 17-year-olds), a fact that strengthens the argument that university health centers need discounts to help women prevent unwanted pregnancy and abortion.

To many people, oral contraceptives may seem like a luxury that can be cut from the monthly budget when it comes time to make ends meet. But for women who remain sexually active and do not want or cannot afford a child, hormonal birth control provides security against unwanted pregnancy that other forms of birth control cannot. Since convenience, simplicity and cost are key factors in determining whether or not a woman uses contraception, unaffordable prescriptions will only guarantee a greater number of unwanted pregnancies.

The US government has spent $1 billion on abstinence education programs, with no real benefit. In fact, the national teen birthrate just rose for the first time in 14 years, according to the Centers for Disease Control and Prevention. The federal solution to the rising price of hormonal contraceptives on college campuses and for low-income women is simple, time-tested and free to taxpayers. There is every reason to restore the incentive for contraceptive discounts.

Pick up the slack
Late in 2007, lawmakers pushed for a correction of the new Medicaid law in a bill known as the Prevention Through Affordable Access Act. Among them were Representative Joseph Crowley (D-NY), Senator Claire McCaskill (D-MO) and Senator Barack Obama (D-IL). Despite bipartisan support and a quarter of senators and representatives signing on as cosponsors, the bill (H.R. 4054/S. 2347) remains floundering in the congressional sea.

Citizens of all sexes and budgets must demand that H.R. 4054/S. 2347 gain the momentum it needs. The majority of Americans are on board: 76 percent of all voters and 79 percent of voters who are conflicted about abortion support access to contraception as a way to prevent unintended pregnancies.

It is important to remember that the bill does not require pharmaceutical companies to again offer low prices to target providers. Lawmakers, candidates and voters must acknowledge the larger problems of nationwide medical expenses, access to health care and coverage the and concerns of American women and their personal security. Addressing these problems will significantly lower the strain on low-income women who are burdened with high birth control costs. Both leading Democratic presidential candidates have proposed plans for health coverage for all Americans, and these plans should come under scrutiny considering what hangs in the balance.

American women deserve options, regardless of their financial and academic situations. And for the near future, it is time to forge a health care for all. Nobody should have to rely on the whims of drug companies to plan for her chosen lifestyle.

KATIE OKAMATO B'09 does not advocate Woody Allen contraception.