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It is 2020. The American Health Care Act has become law, and the Department of Health and Human Services (HHS) has eliminated contraception from its list of essential preventative services that must be covered by insurance without cost sharing.
Let’s imagine a woman named Margaret. She is 25 years old and has Type 1 diabetes requiring insulin. She has high-deductible health insurance through her job with a construction company. For the past 2 years, high out-of-pocket medical and prescription costs have led Margaret to avoid doctor’s visits, and her sugar levels are too high.
Margaret and her husband want to delay having children for a few years until they become more financially stable. Additionally, Margaret’s doctor recommended that she delay pregnancy until her sugar levels are better controlled, to improve outcomes for both Margaret and a baby.
Thankfully, since Margaret is well aware of her body and her family planning choices, she’s already using the Sympto-Thermal Method (STM), a form of natural family planning (NFP). It’s all-organic, non-hormonal, and totally within her control. The start-up costs were very low: just enough to cover a one-time class, a basal thermometer, and an inexpensive chart booklet. After that, there are virtually no continuing expenses. Margaret and her husband chart together — she shares her fertility symptoms with her husband, and he records them in the booklet — allowing the responsibility of family planning to fall evenly between them. Margaret feels empowered knowing how her body works and — since women’s fertility is strongly linked to overall health — her recorded symptoms can even hint at other issues such as thyroid problems which tend to be comorbid with diabetes.
Margaret discovered that most forms of contraception — some rather expensive now that AHCA has been implemented — carry significant risks and many of them delay pregnancy by shutting down women’s healthy reproductive systems, rather than working with her body. Furthermore, even when contraception is prescribed to help women with pre-existing health issues, it usually masks the symptoms rather than targeting the cause. STM, on the other hand, allows Margaret to understand and cooperate with her reproductive system for everything from planning children to managing her periods to identifying other health issues.
Luckily, none of costs associated with contraception have any bearing on her ability to avoid pregnancy. After all, STM has no copay at all and comes with many other benefits to both her health and the health of her marriage. Besides benefiting from deep knowledge of her body and an increased ability to spot reproductive problems early on, Margaret and her husband have found that their communication has also improved. They regularly communicate about her charts, fertility, and readiness for a baby, so other difficult topics have become easier to approach as well. Their marriage isn’t always perfect, but they’ve developed many of the skills they need to honor their wedding vows and build a strong relationship.
Whether or not the ACA’s no-cost coverage of contraception is repealed will have no effect at all on stories like Margaret’s. Margaret wasn’t satisfied with the claim that her healthy reproductive system needed to be shut down for the sake of her overall health, so she searched until she found an alternative that respected her fertility as much as the rest of her body. She, like many other women with chronic illness — even reproductive illness like endometriosis or Polycystic Ovarian Syndrome (PCOS) — knows that NFP works with all sorts of conditions without ever pitting one part of her health against another. She’s empowered by understanding her fertility as beautiful and taking her overall health into her own womanly and very capable hands.
Studies show that when used to avoid pregnancy, STM’s effectiveness is equal to or better than most forms of contraception, including the Pill. Even allowing for human error and using the least flattering statistics, STM is still 98.2 percent effective, whereas the Pill has a typical effectiveness of 91 percent, relying on the most optimistic reports. Why should Margaret worry about contraception and copays when she can just as easily focus her energy on using and sharing a healthier, safer, greener, more reliable alternative?
As employees at a non-profit NFP education center, we see cases like Margaret’s every day. The research, doctors, and families who helped to develop modern NFP understood that knowledge of a woman’s body empowers her to know herself and be actively involved in her own health, providing long-term benefits to women and their families. However, amid political and medical ignorance over the reality and effectiveness of NFP, lawmakers, doctors, and contraception activists often overlook the fact that natural methods of family planning not only save lives, but increase female health in the meantime.
As Congress considers the repeal of the ACA, patients and doctors must take a good hard look at the realities of contraception — on bodies, marriages, mental illness and overall mental health — and compare them to the healthier but less lucrative reality of NFP. No-cost (or extremely low cost) NFP works, and should be a component of any nation’s — and particularly any doctor’s — commitment to its citizen’s health.
— Forest Hempen
Marketing and Communications Associate
(Special thanks to: Beth Turner)