Are contraceptives really cost-effective?

The May 5, 2011 issue of the New England Journal of Medicine ran an article titled “Family Planning as a Cost-Saving Preventive Health Service.” It was authored by pro-contraceptive scientists and Planned Parenthood employees.  Written no doubt in response to Congress’s recent discussions to consider withholding federal funding for Planned Parenthood, the article attempts to make the case that widespread use of contraceptives is cost effective.  The primary argument is that a Medicaid-covered birth costs $12,613 (2008 dollars) while the annual per person cost of contraceptives was $257.  The claim is made that for every $1.00 dollar spent on contraception tax payers would save $3.74.

After I was able to get past just how inhumane this pro-contraceptive mentality has become (treating newly conceived lives made in the image and likeness of God as nothing more than $12,000 unit costs), I began to think about what’s missing from their economic argument.  The authors have ignored a few important and completely predictable costs if every fertile woman was using contraception.

First and foremost, several studies where increased access to contraceptives has been examined for its impact on unintended pregnancy and abortion have concluded that increased access has no impact on reducing abortions or unintended pregnancies. For example, James Trussell, one of the authors of this editorial, wrote a review on emergency contraception (EC) where he cited four independent studies that each concluded wider access to ECs did nothing to reduce unintended pregnancy or abortions. A recent study in Spain found that over a 10-year period ending in 2007, while access to contraceptives increased 60%, elective abortions doubled! This would suggest wider contraceptive access in the U.S. will create increased costs rather than save precious health care dollars.

Next, the authors ignore the predictable increase in serious medical side effects from so many more women using hormonal contraceptives. Increased health care costs for more blood clots, more breast cancer, more heart attacks, and cardiac deaths among smokers using hormonal contraceptives are all widely predictable. The latest survey of contraceptive use in the U.S. showed over 80% who stopped using hormonal contraceptives did so for either a side effect or a fear of a side effect. How can a health cost analysis just ignore this cold hard reality?

Beyond this, what about the costs of increased rates of sexually transmitted disease that will result? I can also envision the skyrocketing costs to vaccinate every female child against HPV (after all, the proponents will scream,  if we have the technology we must vaccinate everyone whether they want it or not; doing so will save on health care costs!). As abortions no doubt increase we will also carry the increased costs of millions more women living with post-abortion trauma.

You can see how quickly the $3.74 “saved” evaporates in added costs of treating the consequences of contraception. Of course the learned experts from Planned Parenthood seem to be able to simply ignore these inconvenient truths.

Finally, the irony in the need for this study cannot be missed. After all, the current debate over government funding of Planned Parenthood is driven by our country’s inability to pay for the growing number of senior citizens with the declining number of working persons paying taxes. If we had simply kept having babies who grow up to be working adults, the issue just wouldn’t have come up.