Millions of women may soon gain free access to a broad menu of birth control methods, thanks to a recommendation issued Tuesday by health experts advising the government.
An Institute of Medicine panel recommended that the government require health insurance companies to cover birth control for women as a preventive service, without copayments. Contraception - along with such care as diabetes tests during pregnancy and screening for the virus that causes cervical cancer - was one of eight recommended preventive services for women.
The law already requires most health plans to provide standard preventive care for people of both sexes at no additional charge to patients, but the women's health recommendations were considered so sensitive that the nonpartisan institute was asked to examine the issue and report back. The IOM advises the government on complex issues related to medical science and health care policy.
A half century after the introduction of the birth control pill, the IOM recommendations may help to usher in another revolution. Medical experts say easier access could start a shift to more reliable forms of long-acting birth control, such as implants or IUDs, which are gaining acceptance in other economically developed countries.
First, expect a fight over social mores. Catholic bishops and some other religious and social conservatives say pregnancy is a healthy condition and the government should not require insurance coverage of drugs and other methods that prevent it.
However, short of repealing provisions of the health care law, it's unclear what opponents can do to block the recommendations. The final decision, by Health and Human Services Secretary Kathleen Sebelius, is expected to be issued quickly.
Birth control use is virtually universal in the United States, according to government statistics. Generic versions of the pill are available for as little as $9 a month at big drug store chains.
Yet about half of all pregnancies are unplanned. Many occur among women using some form of contraception, and forgetting to use it is a major reason. Experts say a shift to longer acting forms of birth control would help.
Birth control is about more than sheer prevention of pregnancy - it can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birthweight, even autism.
Other preventive services recommended by the IOM panel include: HIV screening; support for breast- feeding mothers, including the cost of renting pumps; counseling about sexually transmitted infections; screening for domestic violence and at least one "well-woman" preventive care visit annually.