A report released this week says free and accessible birth control is an essential part of a full range of preventive health services that should be offered to all women as part of the Patient Protection and Affordable Care Act (ACA).

The highly anticipated report from the Institute of Medicine (IOM) recommends that eight preventive health services for women be added to the list of services that health plans will cover at no cost to patients under the ACA. The ACA requires plans to cover the services listed in the U.S. Department of Health and Human Services' (HHS) comprehensive list of preventive services. At the agency's request, an IOM committee identified critical gaps in preventive services for women as well as measures that will further ensure women's health and well-being.

To reduce the rate of unintended pregnancies, the report urges that HHS consider adding the full range of FDA-approved contraceptive methods as well as patient education and counseling for all women with reproductive capacity.  Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy.  Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.  

The full list of services the IOM recommends adding:

• screening for gestational diabetes
• human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
• counseling on sexually transmitted infections
• counseling and screening for HIV
• contraceptive methods and counseling to prevent unintended pregnancies
• lactation counseling and equipment to promote breast-feeding
• screening and counseling to detect and prevent interpersonal and domestic violence
• yearly well-woman preventive care visits to obtain recommended preventive services

Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support that includes coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding. 

HHS should consider screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes.  The United States has the highest rates of gestational diabetes in the world; it complicates as many as 10 percent of U.S. pregnancies each year.  Women with gestational diabetes face a 7.5-fold increased risk for the development of Type 2 diabetes after delivery and are more likely to have infants that require delivery by cesarean section and have health problems after birth.

HHS's guidelines on preventive health services for women will need to be updated routinely in light of new science.  As part of this process, HHS should establish a commission to recommend which services health plans should cover, the report says.  The commission should be separate from the groups that assess evidence of health services' effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.

The report addresses concerns that the current guidelines on preventive services contain gaps when it comes to women's needs.  Women suffer disproportionate rates of chronic disease and disability from some conditions.  Because they need to use more preventive care than men on average due to reproductive and gender-specific conditions, they face higher out-of-pocket costs, the report notes.

It's unclear whether HHS will implement the report's recommendations. That decision could come as early as next month.

"We are reviewing the report closely and will release the Department's recommendations of what additional preventive services for women should be covered without cost sharing very soon," said HHS Secretary Kathleen Sebelius. 

For more information, visit http://iom.edu.

Do you feel strongly about encouraging HHS to include contraceptives as a preventive service without out-of-pocket costs including co-pays?    For many years, the National Women's Law Center has been working to get contraception covered in all health insurance plans and they currently have an online petition you can sign  asking Health and Human Services Secretary Kathleen Sebelius to accept these medically-based recommendations and to support no-cost contraception.       

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