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Contraceptive Equity

Health insurance and managed care organizations deny contraceptive coverage to millions of women.
Although contraceptive coverage has increased significantly in the past few years, more than ten percent of health plans do not cover oral contraceptives.1 This absence of insurance coverage for contraception causes economic harm to women. In addition, women without coverage may choose cheaper, less effective methods of contraception that lead to unintended pregnancies.
The denial of contraceptive coverage constitutes sex discrimination.
More than 99 percent of health insurance plans provide coverage for prescription drugs.2 Both the Equal Employment Opportunity Commission and a federal court have ruled that an employer who fails to cover prescription contraceptives but covers other preventive medicines and devices commits sex discrimination in violation of federal law.
The same health plans that refuse payment for contraception routinely cover Viagra.
This insurance company practice that favors men and discriminates against women has been called “redlining in the bedroom.”
Increased access to contraception decreases the need for abortions.
Each year, there are more than three million unintended pregnancies in the United States, approximately half of which end in abortion.3
Increased access to contraception improves women’s and children’s health.
Women who become pregnant unintentionally are less likely to obtain timely, adequate prenatal care, which increases the likelihood of low birth-weight and infant mortality. Effective family planning could reduce the incidence of low birth-weight by 12 percent and infant mortality by ten percent.4
Americans support equitable coverage for contraception.
A nationwide poll sponsored by the NARAL Foundation found that 77 percent of Americans support legislation that requires health insurance companies to cover the cost of contraception. A 1998 survey by the Kaiser Family Foundation found that 73 percent of Americans support insurance coverage of contraception even if it increases premium costs by one to five dollars per month.5
Twenty-three states have enacted contraceptive equity.
Since 1998, 23 states have enacted comprehensive laws or regulations to address imbalances in private insurance coverage for contraception (AZ, AR, CA, CT, DE, GA, HI, IL, IA, ME, MD, MA, MO, NV, NH, NM, NY, NC, RI, VT, WA, WI, WV).
Insurance industry claims that equitable coverage for contraception will drive up the cost of health care are false.
The added cost for employers to provide coverage for the full range of reversible contraceptives is approximately $1.43 per employee per month, according to a comprehensive analysis. The cost is significantly lower for health plans that currently cover some form of contraception.6 Insurers generally pay the medical costs of unintended pregnancy, including ectopic pregnancy (average cost $4,994), spontaneous abortion ($1,038), and term pregnancy ($8,619). Therefore, contraceptive coverage could save insurers a considerable sum.
Denial clauses hinder contraceptive equity.
Opponents of contraceptive equity sometimes propose denial clauses—also called “conscience” clauses—which permit employers and insurers who object to contraception to refuse to provide for its coverage. These refusals leave patients unable to obtain necessary care.

This policy brief relies in large part on information from NARAL Pro-Choice America.

Endnotes
  1. Henry J. Kaiser Family Foundation, “Employer Health Benefits 2004 Annual Survey,” September 2004.
  2. Ibid.
  3. Henry J. Kaiser Family Foundation, “Women’s Access to Care: A State-Level Analysis of Key Health Policies,” Spring 2003.
  4. Rachel Benson Gold, “The Need for Mandating Private Insurance Coverage of Contraception,” Alan Guttmacher Report on Public Policy, 1998.
  5. Henry J. Kaiser Family Foundation, “Kaiser Family Foundation National Survey on Insurance Coverage of Contraceptives,” 1998.
  6. Jacqueline Darroch, “Cost to Employer Health Plans of Covering Contraceptives: Summary, Methodology and Background,” Alan Guttmacher Institute, 1998.
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