As physicians focused on reproductive health, we hear every day from women whose health and well-being are affected by their inability to afford basic preventive care such as birth control, breast and cervical cancer screenings, and basic checkups. That's why today's historic decision by the Supreme Court to uphold the Affordable Care Act (ACA) is a victory for millions of people across the country and one of the greatest advances in women's health that we've seen in a generation. Among many other benefits, nearly 13 million women of reproductive age will be newly eligible for insurance coverage under the ACA. Under the law's women's preventive health services provision, women will also have guaranteed access to ob/gyn providers without referrals and, starting this August, their birth control will be covered without co-pays.
Today's decision will provide women with peace of mind and crucial health care that until today has been elusive for too many. One such woman is Yvette, a Brookings, SD, resident who has polycystic ovarian syndrome. She struggles with weight gain and borderline diabetes, which are likely related to her condition. Diabetes is a serious, sometime fatal condition for pregnant women and their babies, so delaying pregnancy until she is healthier is a critical health goal for Yvette. In addition, use of a hormonal birth control method can also help prevent many of the complications of polycystic ovarian syndrome, such as endometrial cancer.
For Yvette and millions of other women, effective birth control is not a convenience; it is a critical health need. In fact, birth control has had such a dramatic impact on women and families in this country that the Centers for Disease Control and Prevention named it one of the top 10 public health achievements of the past century. There's plenty of proof to support that assertion. In the 47 years since the U.S. Supreme Court issued another landmark decision in the case of Griswold v. Connecticut -- which recognized the use of contraception as a constitutionally protected right and expanded women's access to birth control -- we have seen a dramatic improvement in maternal and infant health. In 1965 (the year of the court's ruling), 32 women died for every 100,000 live births in this country. Today, the rate is less than half that. Infant mortality has made an even more significant decline, falling by 74 percent as more children are born to parents who plan and space their pregnancies by at least 18 months. Bottom line: better access to birth control has given women like Yvette the means to reduce the likelihood that they and their newborns will experience poor health outcomes related to mistimed or never- intended pregnancies.
The falling U.S. teen birthrate -- which hit a record low in 2010 (the most recent year reported by the CDC) -- is almost exclusively the result of better use of birth control by teens. Reducing the teen birthrate is a critical public health goal in part because infants born to teens are more likely to have low birth weight, suffer from childhood health problems, and be hospitalized than those born to older mothers.
Still, too many women and sexually active teens in this country aren't able to realize the health benefits facilitated by nearly five decades of legalized access to contraception simply because they struggle to pay for it. Today's Supreme Court decision will remove cost as a barrier to birth control, and that's a significant gain since decades of public health data shows that childbirth- related deaths are higher among women who have greater problems accessing birth control. These preventable deaths begin with the fact that unintended pregnancy rates for poor, low- income, young, and minority women are higher than for non-Hispanic white women, in large part because women in the former groups have greater difficulty accessing birth control. Those women are the very ones who experience higher maternal and infant mortality rates.
As doctors, it is heartbreaking for us to talk with women who want to take the steps necessary to prevent unintended pregnancy, but for whom a birth control prescription is nothing more than a piece of paper because they don't have the up to $600 to pay out-of-pocket every year for contraception. In fact, a third of women voters have struggled at some point to afford their prescription birth control methods, causing them to use it inconsistently, according to a 2010 Planned Parenthood poll. The numbers are even more dramatic among young black women and Latinas, with 54 percent and 57 percent respectively saying they sometimes have not been able to pay for their birth control.
For us, the Supreme Court's decision to uphold the ACA means women will no longer have to decide between paying rent and getting the care they need. It provides the opportunity to change the health care dynamic in this country and improve outcomes for millions of women and their families.
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