The foundation of a family's future: Affordable maternity care and birth control

Affordable maternity care and birth control benefits not only women, but also families and our entire community. Considering these services essential to our families and community turns the conversation from, "Why should I pay for that?" to "Supporting the women in our community is a win for all."

Affordable birth control is vital. It is the most effective way to decrease unintended pregnancies, improve maternal health and decrease maternal deaths. Contraception comes in many forms, but the most effective form for women interested in preserving fertility is a long-acting, reversible contraceptive (LARC).

Colorado has an ongoing, successful program, the Colorado Family Planning Initiative, to combat unintended pregnancies using LARC. Since implementation of this program and the Affordable Care Act's mandate for contraceptive coverage, the data from the Colorado Department of Public Health and Environment spanning 2009-2016 shows a drop in:

unintended pregnancies by 40 percent;abortion across all age groups by 42 percent;the teen birth rate by 48 percent, and a drop in the teen abortion rate of 48 percent (the teen birth rate declined more than any other state); andteens with repeat births of 57 percent.For every $1 invested in the LARC program, an average of $5.85 in birth-related expenses was avoided within a three-year period by Medicaid. On the national level, a 2014 study found a savings of just over $7 per each dollar spent on family planning services.

The drop in birth rate for Medicaid-eligible women in Colorado ages 15 to 24 saved $69.5 million in entitlement program costs from 2010 to 2014, and there was a 25 percent reduction in WIC program infant enrollments.

According to Dr. Haywood Brown, the president of the American Congress of Obstetricians and Gynecologists, in June, "for the first time in history, more than 62 million women have affordable access to all forms of birth control with no cost-sharing ... During this time, the United States achieved a 30-year low in the unintended pregnancy rate, including among teens. We must not turn back the clock on women's health after such tremendous gains and, the fact is, cost is a significant barrier."

Access to a medical provider before, during, and after pregnancy is crucial to healthy outcomes for moms and babies. Addressing women's safety, Brown wrote that decreased access to contraception with pending insurance changes will be particularly prevalent in underserved rural communities. In addition to the social and economic benefits of planned pregnancy, he argued that "the ability to avoid pregnancy amounts to more than just dollars and cents. It can be lifesaving for women who already face serious medical conditions ..."

And yes, women die during pregnancy and childbirth. The U.S. has one of the highest maternal mortality rates in the developed world. Reducing contraceptive and maternity coverage for women is likely to make the problem worse. Access to medical care before and during pregnancy saves lives and improves health for women and children. It's the foundation of a family's future.

Family planning and affordable contraception makes sense financially and socially. Unintended pregnancy is defined as a pregnancy sooner than desired or entirely undesired. In 2006, 64 percent of unintended births were publicly funded and cost Colorado Medicaid more than $160 million.

Women under the age of 20 are an especially vulnerable population, with three out of four pregnancies unintended. Children born as a result of unintended pregnancy are more likely to experience child abuse and poor mental and physical health, and do not do as well in school.

The cycle of poverty is perpetuated by limiting access to family planning services. Women with unintended pregnancies are more likely to have low paying work, poor educational attainment, higher risk of illness and diminished opportunities before they become pregnant. The same is true after an unintended delivery.

For a mother to work, she needs affordable child care, reliable transportation and time off when her baby is not in day care. This can be challenging in the best of circumstances, but in an at-risk population it can be insurmountable.

When I moved to Durango in 2003, the small practice I joined did not offer health insurance to its 10 employees and instead gave a $200 monthly stipend to use as the employee chose.

There were only two companies writing individual medical policies for our community, and neither of them offered maternity coverage. I had a job, husband and child care, so I was able to return to work after the delivery of our son and pay off the over $10,000 bill. But after delivery, I again encountered an out-of-pocket expense: birth control.

Why worry about access to contraception and maternity coverage now? Because my past experience may again be your family's reality.

If maternity care is not a covered insurance benefit, we will return to out-of-pocket payment for pregnancy and childbirth in addition to the premiums, deductibles, co-pays and co-insurance already paid. If contraceptive coverage is lost or contraception is excessively expensive, the social, economic and medical implications are staggering.

Affordable maternity and contraception coverage benefits every one of us, in many ways, and Coloradans should demand it continue.

Kim Priebe, MD, has been practicing OB/GYN in Durango for 14 years. Reach her at drkimpriebe@gmail.com.