When I heard that President Obama was starting to move on his comprehensive reform bill, my thoughts turned immediately to sexual and reproductive health services (SRHS). As a sexologist whose post-doctorate specialized in this area, I hope to see radical improvements to our SRHS - ones that could ultimately save us billions of dollars in the coming years.
With maintaining one's sexual health a fundamental human right, every American is entitled to world class health care that holistically prevents and treats sexual concerns, problems, and disorders. Quality accessible and affordable services will pay off, helping us to...
1. Reduce unplanned pregnancies and related costs. Sexually active individuals need more easily attainable contraceptives, including emergency contraceptives. According to the Guttmacher Institute, nearly 50% of pregnancies amongst American females are unintended, with 4:10 of these aborted. Increasing contraceptive services and supplies to more women would help to reduce the emotional and financial costs of such situations. Case in point: in looking to expand Medicare coverage, 2006 Clinton-Reid legislation hoped to help 500,000 women to avoid unintended pregnancy, and thus prevent almost 200,000 abortions. Such efforts were also predicted to save Medicaid $1.5 billion in three years' time.
2. Help to control the spread and costs of HIV. According to the Centers for Disease Control, the HIV prevalence estimate was 1,106,400 in the U.S. at the end of 2006 (which is the latest data we have). An estimated 21% of those individuals are undiagnosed. According to a CBS News report, the U.S. tripled its spending on HIV-related care between 1996 and 2006. With the lifetime cost of having HIV $618,900, there's a lot of money to be saved in helping to stop transmission. This starts with diagnosis and evidence-based education.
3. Make people more sexually informed and infection-free. As stated on the American Social Health Association website, more than 50% of all people will have a sexually transmitted infection (STI) at some point in their life. An estimated 65 million people in the U.S. are living with a viral STI - meaning there are 65 million individuals who have this infection for life and who can potentially transmit herpes, HPV, whatever.... to their lover(s). There are at least 19 million new STI cases yearly, some of which are curable.
As a sex educator, I know that, beyond issues of people using prophylactics incorrectly and inconsistently, sexual ignorance spawns many STI cases. In coming from school systems that have been largely preaching abstinence-only for the last couple of decades, many people are uninformed or ill-informed in how to protect themselves from STIs. Many don't know the differences between viral and bacterial STIs, what symptoms to look out for (or that they can be asymptomatic), and how STIs are spread.
Hence, approximately $8 billion is spent every year on diagnosing and treating STIs (not including HIV). This is good in that at least some people are attending to their sexual health (though less than half of 18-44-year-olds have ever been tested for STIs other than HIV). This tab could, however, be reduced via patient education on topics like how to protect each other by practicing safer sex and when it may be necessary to seek testing services.
4. Decrease the number of broken homes. Happy lovers make for happy families, yet sexual fusion is often lacking in the moralizing family values discourse. Sex is one of the top reasons people get divorced. Yet there is little support for Americans in need of sex and relationship rescue - many cannot afford the typical $150 per session. (Compare that to the $600/hr fee for a family law attorney during divorce proceedings and it's a steal.)
Thus, in helping half of all marriages avoid the $5,000 - $15,000 it can cost to get divorced (not to mention the ultimate bill often footed by society), more coverage and offerings need to be provided in terms of sex therapy and counseling. In cases where one or both lovers are serving in the military, sex therapy/counseling should be free. Repeated and long deployments, amongst a host of other difficulties, have this population's divorce rate higher than the norm.
While all of this may make for a tall order, let's not forget that "yes we can" applies to realizing a sexually healthy tomorrow. This starts, however, in the need to protect and support the existing health care centers and community-based providers. In many cases, these clinics are the only source of health care an individual has to rely upon. From there, given the already at-the-seams demand, we need to make more SRHS available - services that address the barriers that impact use, e.g., inconvenient hours of operation and confidentiality concerns.
We also need to stress prevention-first. As stated by the World Health Organization, "Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity." The money required for realizing maximum well-being via prevention efforts is an investment, funding that will ultimately drive down the cost of overall SRHS expenditures.
Providing everyone with the information, skills, and health services needed to make healthy sexual and reproductive choices throughout the life cycle is a moral obligation and social responsibility. We cannot afford the risk of SRHS getting lost in healthcare reform efforts, as they so often do.
SRHS coverage shouldn't be a luxury; it's a necessity. It's 'time to deliver' on SRHS.