Starting today, all new private health plans will have to provide certain preventive services for women without a co-pay or deductible. These Department of Health and Human Services rules include annual physicals, testing for HIV and other STDs, domestic violence counseling, and birth control. Much of the debate over the new requirements has focused on religious employers' objection to the birth control provision. For now, though, women (and their children) who get private insurance will be covered, and that could have a big impact on their lives. Some experts are hopeful it could drive down teen pregnancy rates — which, as of 2006, stood [PDF] at 71.5 pregnancies per 1,000 teens, or about 7%.
Dr. Yolanda Evans, who specializes in adolescent medicine, says that as the requirement goes into effect (which will take some time as it applies only to new plans, meaning some women will have to wait until the beginning of their next plan year for benefits), "there's definitely a strong potential for teen pregnancy rates, which are really high in the U.S., to drop." That's because teenagers whose parents have private insurance will be able to afford not just any contraception, but "the kind of contraception that might be the best and most effective for them."
For some teens, that means IUDs. New research shows they're one of the most effective methods for teens, who may struggle to use condoms and birth control pills consistently and correctly — among teens, the pill has a failure rate over 40 times that of the IUD. The devices are also extremely popular with doctors themselves — a recent poll found female ob-gyns are three times more likely to use them than the general public. But the IUD can have a high upfront cost — Evans says the device and the procedure to implant it can cost up to $1000, which can leave girls and their parents with a big bill even if insurance pays a portion. Under the new rules, insurance companies will have to cover the full cost.
IUDs are still more commonly prescribed for adults than for teens, and doctors once thought they were only a good option for women who had already had children. But clinicians now say they can be a good contraceptive for teens too. Dr. Tara Kumaraswami, an ob-gyn, says that "IUDs are safe and effective for teens as well as adults," and that they can be especially good for teens because they don't require users to remember something every day. She adds that her practice counsels all patients on STD awareness as part of the birth control decision process.
Conservative groups have opposed the birth control coverage rule, arguing that it infringes on religious freedom. Family Research Council spokesperson Jeanne Monahan says, "We think that the landscape of separation of church and state really changes tomorrow" with the start of the new requirements. She said the FRC was "profoundly disappointed" with the new rules, and cited two religious universities that had chosen to stop offering health insurance to students rather than comply. However, she declined to comment on whether the changes would reduce teen pregnancy.
Monahan says the FRC hopes the birth control coverage rule will be overturned in the courts. For the time being, though, it may give some teenagers options they didn't have before.