Facts about Contraceptive Coverage
The National Partnership for Women & Families strongly supports EPICC, the Equity in
Prescription Insurance and Contraceptive Coverage Act.
Contraception is a critical component of basic health care for women. Contraception
allows women to safely plan their pregnancies, which research has proven is critical to
ensuring healthy outcomes for both mother and child. Unplanned pregnancies are more
likely to result in negative health outcomes that generate increased medical costs.
The out-of-pocket cost of contraception is, however, a serious barrier for many women.
Despite its cost-effectiveness and importance to women’s health, many health plans do
not provide coverage of all Food and Drug Administration-approved methods.
Without insurance coverage, women are often forced to choose a contraceptive method
based on cost rather than effectiveness or medical indications – thereby increasing the
risks of unintended pregnancy and other negative health consequences.
What is the Need?
• Only 39 percent of Health Maintenance Organizations (HMOs) cover all methods,
and 7 percent cover no prescription contraceptives at all.1
• Half of fee-for-service plans don’t cover any reversible contraception, and only 15
percent cover five prescription methods – oral contraceptives, IUD, diaphragm,
implants, and injectables. While 97 percent cover prescription drugs, only 33 percent
cover oral contraceptives.2
• 63 million women in the United States are in the childbearing years of 13-44; 18
million (29 percent) are ages 20-29, while 32 million (51 percent) are ages 30-44.3
• A woman who wants only two children will need to practice contraception for at least
20 years of her life.4 A woman who engaged in regular sexual activity during this
period of her life and used no contraception could expect to experience 12-15
pregnancies.5
Why Is Contraception So Important?
• Up to 49 percent of all pregnancies are unintended – more than 3 million every year
in the United States – and 76 percent occur to adult women over the age of 20.6
Unplanned pregnancies happen to women of all ages, backgrounds, education,
income levels, and in every workforce.
• Approximately 25 percent of pregnant women receive little or no prenatal care.
Studies indicate that women who accessed family planning services in the two years
prior to conception were more likely to receive early and adequate prenatal care.7
• Unintended pregnancy makes timely prenatal care unlikely– which can adversely
affect both the woman’s health and the birth outcome. Women who had unintended
•
pregnancies are 1.3 times as likely to have a negative outcome than women whose
pregnancies were planned.8
Increased access to family planning could potentially reduce the number of low birth
weight babies by 12 percent and the infant mortality rate by 10 percent.9
What Will It Cost?
• Contraceptive coverage is likely to save, rather than cost money, by reducing the
costs of unintended pregnancy such as pregnancy complications, abortion, childbirth
and other costs.
• According to the Washington Business Group on Health, which represents large
employers and works with its members to improve quality health care, employers
consistently report childbirth-related costs as among the highest cost drivers of their
health care expenditures, accounting for anywhere from 10-49 percent. Costs can
range from $5,000 for a healthy term pregnancy, to closer to $500,000 for
complicated and premature births, to as high as $1 million for newborn requiring
extensive neonatal intensive care.10
• In contrast, estimates show that providing contraceptive coverage would cost
employers just $1.43 per month per employee, which represents an increase of just
0.6 percent in employers’ costs of providing employees with medical coverage.11
Does Contraceptive Coverage Make A Difference?
• Contraceptives can be prohibitively expensive for some women. Costs for supplies
alone can run approximately $360 per year for oral contraceptives, $180 per year for
the injectable, $450 for the implant and $240 for an IUD. In addition, the bulk of the
cost for some of the most effective methods must be paid up front. Many women
delay in filling a prescription due to these up-front costs.12
• In the absence of comprehensive coverage, three-fourths of women say cost is a
factor in what method they choose.13 Not every method is right for every woman,
and contraceptive coverage will allow all women to choose the safest and most
effective method for them.
1
“U.S. Policy Can Reduce Costs Barriers to Contraception,” The Alan Guttmacher Institute, Issues in Brief
1999 Series, No. 2, p. 2.
2
“U.S. Policy Can Reduce Costs Barriers to Contraception,” The Alan Guttmacher Institute, Issues in Brief
1999 Series, No. 2, p. 2.
3
“Contraceptive Services,” The Alan Guttmacher Institute, Facts in Brief.
4
“Contraceptive Use,” The Alan Guttmacher Institute, Facts in Brief.
5
“Promoting Healthy Pregnancies: Counseling and Contraception as the First Step,” Washington Business
Group on Health, Family Health in Brief, Issue No. 3, August 2000.
6
“Contraceptive Use,” The Alan Guttmacher Institute, Facts in Brief.
7
“Women’s Health Care Issues: Contraception as a Covered Benefit,” William M. Mercer, p. 2.
8
Kost, K., Landry, D., Darroch, J., “The Effects of Pregnancy Planning Status on Birth Outcomes and
Infant Care,” Family Planning Perspectives Vol. 30, No. 5, September/October 1998.
9
“Women’s Health Care Issues: Contraception as a Covered Benefit,” William M. Mercer, p. 2.
10
Gonen, J., Bonoan, R., “Promoting Healthy Pregnancies: Counseling and Contraception as the First
Step,” Washington Business Group on Health, Family Health In Brief, Issue No. 3, August 2000.
11
Darroch, Jacqueline E., “Cost to Employer Health Plans of Covering Contraceptives,” The Alan
Guttmacher Institute, July 1998.
12
“U.S. Policy Can Reduce Costs Barriers to Contraception,” The Alan Guttmacher Institute, Issues in
Brief 1999 Series, No. 2, p. 2.
13
Kaiser Family Foundation National Survey on Insurance Coverage of Contraception, conducted May 2226, 1998.