at last — we can all stop playing pregnancy roulette

So according to feminist org Ultraviolet, as of today, all kinds of groovy stuff related to women’s health is covered by insurance — including birth control:

Birth control covered by insurance probably doesn’t seem like a big deal. But it has the potential to be a game-changer for this country’s reproductive politics.

One in three women in America has struggled to afford birth control. According to this nifty birth control cost calculator, a 25-year-old woman who uses the Pill will spend a truly astounding $46,649 without insurance, or $8,289 with insurance, to keep herself covered for the rest of her fertile life. This alone would be reason enough to want to ensure that everyone had insurance that covered birth control.

But here’s the dirty little secret: the Pill is a terrible deal. It’s not just expensive — it’s also just not that effective when used by real people who sometimes forget to take a dose or two. Darshak Sanghavi has the story:

Half of the 3 million annual unintended pregnancies at any age in the United States occur among people using birth control. The pill is the most popular method, used by more than half of all women trying to avoid pregnancy. People believe it is highly reliable because it is over 99 percent effective when “used correctly” in supervised drug trials.

And therein lies the catch. In the real world, only 40 percent of adults and 25 percent of teens actually remember to take the pill every day, which makes the real-world risk of pregnancy much higher than expected.

Earlier this year, Washington University researchers led by Jeff Peipert reported in the New England Journal of Medicine that 5 percent of women in a study who were on the pill got pregnant within a year. Among those under 21 years of age, almost twice as many did.

Condoms are worse, of course — again, because people are human — and withdrawal, which a surprising number of people are using (because it’s free), is less effective still. (Though, please note, gentlemen — still vastly more effective than not withdrawing. Do the right thing.)

Here’s Sanghavi on what does work:

[T]he risk of contraceptive failure was 22 times higher with the pill than with IUDs in adult women, and double that for teens. Just imagine, Peipert recently told me, if a miracle drug suddenly slashed cancer deaths or heart attacks by 95 percent. Every patient would demand it and no one would want the older therapies.

Ah, the humble IUD. Heard of it? Yes. Using it? Probably not. According to Sanghavi,

[W]hen contraception was free [paid for by the study], almost three-quarters of teens and adult women chose intrauterine devices like Mirena or ParaGard, which last five to 10 years, over alternatives like the pill, contraceptive patch, cervical ring, or Depo-Provera. (Modern IUDs can be implanted easily in young teens and do not carry additional risks of pelvic infection.) Similarly, IUD adoption doubled in California when the devices were made free….

However, only 2 percent of teens and 4 percent of American women now get IUDs. More couples than that rely on withdrawal, which has an estimated 25 percent risk of failure, as their preferred contraceptive method.

And now the bombshell:

Peipert makes another persuasive argument. Though this aspect of his research is still in peer review and awaiting publication, he suspects that the abortion rate can drop by half when women are given free access to IUDs.

Yes. Imagine a world in which most young women get IUD’s in their teens, and the specter of unwanted pregnancy simply vanishes. Just think about that.

The IUD is a big expense upfront — hundreds of dollars — which is why women often don’t get one. But it’s far cheaper over a woman’s lifetime than the Pill (which doesn’t work as well), comparable in price to an abortion, and obviously it’s vastly less expensive, in every way, than raising an unwanted child. From a social good standpoint, giving women access to this technology is a win from every conceivable side — financial, humane, and moral.

And God bless Melinda Gates, who’s crusading to get women better access to birth control worldwide:

Visiting vaccine programs in sub-Saharan Africa, Gates would often ask women at remote clinics what else they needed. Very often, she says, they would speak urgently about birth control. “Women sitting on a bench, 20 of them, immediately they’ll start speaking out and saying, ‘I wish I had that injection I used to get,’” says Gates. “‘I came to this clinic three months ago, and I got my injection. I came last week, and I couldn’t get it, and I’m here again.’”

They were talking about Depo-Provera, which is popular in many poor countries because women need to take it only four times a year, and because they can hide it, if necessary, from unsupportive husbands. As Gates discovered, injectable contraceptives, like many other forms of birth control, are frequently out of stock in clinics in the developing world, a result of both funding shortages and supply-chain problems.

Women would tell her that they’d left their farms and walked for hours, sometimes with children in tow, often without the knowledge of their husbands, in their fruitless search for the shot. “I was just stunned by how vociferous women were about what they wanted,” she says.

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