Does Obamacare Mean The End Of The Pill?

Now that more effective (but expensive) contraception options are covered by insurance, will women switch to IUDs?

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Before August 2012, long-term birth control options like an IUD or contraception implant could cost hundreds of dollars. But since the Affordable Care Act began mandating that contraception be completely covered by insurers, women can now get these options for no cost at all. Will Obamacare make IUDs — the most effective form of birth control but also the most expensive upfront — the go-to choice of contraception for women across America?

A study released this week in Obstretrics and Gynecology looked at the overall effects on pregnancy and abortion when contraception is offered at no cost. They found many positive results — primarily that pregnancy and abortion rates dropped dramatically. But another point stood out: when cost wasn’t an issue, the great majority of women chose an IUD or implant. Implants are placed under the skin, while IUDs are inserted into the vagina. Although less than 7% of women across the country use IUDs or implants as their primary form of birth control, over 75% of women in the study chose one of those two options.

“When we removed the cost, education and access barrier, most women chose an IUD or implant,” explained Dr. Gina Secura, the study’s Project Director.

The 9,256 teen and adult women in the study, most of whom were recruited through two abortion centers in St. Louis, were educated about the various birth control options in order of proven effectiveness: IUDs, implants, Depo Provera, the pill, the patch, the ring, and then condoms. Costs were not mentioned. The women were free to choose any option as long as it was different from whatever they were currently using.

An IUD.

According to Secura, high prices and a lack of knowledge among patients mean that many doctors and clinics don’t often prescribe IUDs and implants right now. Old ideas about these methods being unsuitable for young people also prevail, even though the FDA recommends them for all ages. An IUD in the 1980s caused infections and infertility in some women, and though the options available today are entirely safe, myths prevail.

“Not many providers are offering these methods,” Secura added. “People don’t think they are an appropriate method for teens or women who haven’t had kids.” She believes that with Obamacare and its coverage of these options, they’ll become immensely more popular.

But Robert Trussell, a Princeton professor who has studied contraception extensively and was familiar with the study says we shouldn’t expect three-quarters of American women to switch over to IUDs and implants right away.

“There is little doubt in my mind that use of these options will increase when women have no deductible or copay. I don’t think we will see those levels in the study though,” he said. The study’s researchers, he explained, were very positive on IUDs and implants, which most doctors are less likely to be.

Doctors, Trussell feels, will need to embrace the methods before they take off exponentially. “The Affordable Care Act won’t change the behavior of doctors. That’s not going to automatically change,” he said. “You need more positive attitudes on the part of physicians and people trained to insert IUDs and implants.”

Secura, meanwhile, believes women will begin changing the attitudes of health care providers. “My hope is that there will be a huge demand and providers will stock them on their shelves,” she said.