Sixty years after ‘The Pill,’ the war on contraception continues

by Dr. Erin Saleeby, OB-GYN

The Pill was controversial when it was approved 60 years ago and remains so today as Congress aims to roll back affordable access to contraception.

Sixty years ago, the FDA approved a medication called Enovid for treating menstrual problems and infertility. Three years later, this combination of the synthetic hormones norethynodrel and mestranol, was approved as a contraceptive. The medication, which came to be called “The Pill,” was controversial then and remains controversial today, largely because of shenanigans in the health care bills aimed at replacing the Affordable Care Act.

The pill was revolutionary. It allowed women to take charge of their sexual and reproductive health and, in turn, plan their families and their futures and define their own lives. Contraception opened doors for me and millions of other women, creating a pathway for our full participation in society and in the workforce, while also contributing to better outcomes in maternal and child health.

As an OB-GYN, I have seen firsthand the benefits of access to affordable contraception for women of all ages, races, and socioeconomic status.

From healthier pregnancies and birth spacing to economic and educational attainment, we have much to celebrate. Women’s participation in the workforce grew from 40 percent in 1950 to nearly 60 percent in 2015, improving living standards along the way. More women have been attending college since the 1970s, and last year women accounted for 57 percent of the undergraduate student body. Some of these gains can be attributed to women being in charge of their reproductive health.

Today, most women can choose the contraceptive that works best for them without facing financial barriers. The ACA requires coverage for contraception without copays in most insurance plans. Whether that method is the pill, which has been the choice for 2 out of 3 women at some point in their lives, or the newer and more effective long-acting and reversible contraceptive devices, such as IUDs and implants, women can make their own decisions about their reproductive health based on the medical evidence and their own preferences.

Within just three years of the ACA’s no cost-sharing policy for contraception taking effect, insurance claims for IUDs increased from 36.6 percent in 2010 to 87.6 percent in 2013. This shows that when there is no financial barrier and women are free to choose, utilization of contraception increases.

Expanding access to contraception and making it affordable also improves women’s health. For the first time in decades, the unplanned pregnancy rate is declining and the abortion rate is the lowest since Roe v. Wade.

Despite this clear evidence for the benefits of contraception, the fight for universal access to affordable contraception wages on. Instead of celebrating the progress we have made over the past six decades, we are fighting off policy threats that could harm women’s health. The Senate is currently debating a health care bill that would not only devastate Medicaid and the public health care delivery system that pays for nearly half of all births in the country, it would also defund Planned Parenthood and allow states to let private insurance plans deny women preventive services and maternity coverage.

Such ill-advised policy proposals would jeopardize access to affordable contraception for many of my patients in California and millions of women across the nation. The potential repeal of the ACA, plus threats to undermine the Title X federal family planning program, could roll back contraceptive coverage and endanger access to essential sexual and reproductive health care for more than 20 million women in need of publicly supported contraception.

This isn’t bad just for women’s health. It is also fiscally irresponsible. The return on investment for contraception — every dollar invested in family planning saves $7 — should be compelling to all taxpayers.

It is unconscionable for our representatives in Congress, most of them men, to play politics with access to contraception. In this time of uncertainty in health care, let’s call on our lawmakers, from both sides of the aisle, to show they are invested in the health of women from all walks of life who depend on the security of safe, effective, and accessible contraception to realize their myriad critical roles in our society. Our representatives should start by preserving access to the full range of FDA-approved contraceptive methods without cost sharing, fully funding the Title X program for 2018, and not discriminating against women’s health providers who play vital roles in the health care safety net.

We cannot afford to turn back the clock on access to contraception and threaten the progress we have made in women’s health. §

Erin Saleeby, M.D., is the medical director of Essential Access Health, the administrator of California’s Title X federal family planning program. This article is displayed with permission from STAT.

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