Before the Affordable Care Act, better known as Obamacare, was passed, I remember so many times when our insured, employed private patients could not afford effective birth control. There was a good clinic at our hospital that took Medicaid and had a sliding payment scale for the uninsured. In Pennsylvania, Medicaid did provide some coverage for contraception though many women, especially during their college years, relied upon Planned Parenthood.
Many of our patients of reproductive age had insurance through their employers, who chose not to cover contraception or maternity care. Birth control pills -- even generics -- cost up to $30 a month, or $360 a year, too expensive for many.
Even more costly are the newer safe intrauterine devices now $850, plus the office fee for insertion, or contraceptive implants. These long-acting reversible contraceptive methods are very safe and effective, and now recommended by the American Congress of Obstetrics and Gynecology as the most reliable form of contraception. Back in those pre-ACA days (and until a recent policy change by the Pennsylvania Medicaid program), we couldn't give new mothers long-acting contraception until 6 weeks after birth. That was just long enough for many to get pregnant again, despite their wish to delay another birth.
In addition to my regular job, I also volunteered at a free clinic in Bucks County, caring for patients who had no insurance. In my private practice, I could give samples from a pharmaceutical company to women who couldn't pay for the pill. But I wasn't allowed to do that because the clinic, although not affiliated with a religious organization, was run by a nun who refused to let us stock contraception, even for treating painful, heavy menstrual cycles. All I could do was tell women to go to Planned Parenthood to get the pill.
A few of these young women relied on condoms, got pregnant and then had abortions, an unfortunate and undesirable consequence of not being able to pay for reliable contraception.
Since passage of the ACA, I've seen two big changes in my practice: More women have come in for routine exams and contraception, both of which are covered under ACA plans with no out-of-pocket cost to the patient. College students and young professionals who once had no coverage now can stay on their parents' insurance until age 26 if needed. And all plans now cover pregnancy and delivery. This makes both humane and economic sense.
Prevention of undesired pregnancy also lowers the incidence of abortion, which is not covered by Medicaid and by many private insurance plans. We cannot return to the days when women who couldn't afford reliable contraception and got pregnant then tried to abort themselves (yes, I'm talking about wire hangers) or went to an illegal abortionist.
Some of us remember the pre-Roe v. Wade days when hospital beds in wards known as "septic tanks" held women who hemorrhaged, had serious infections, became sterile, or even died.
The best answer is affordable, effective, available contraception for any woman who chooses to prevent pregnancy. Hopefully, this will remain the case, and abortion will continue to decline, needed only for rare cases when the "morning-after pill" is not given in time, when the mother's life is in danger, or when the fetus has a condition incompatible with life.
I have seen the latter two reasons several times, and in each case, the "choice" was very painful -- imagine having to consider what will happen to your other children if you die. As physicians, we must act in the best interest of our patients. This is our moral obligation and a deeply private matter between patient and physician that must not be subjected to the loss of high-quality, affordable health care.
Sherry L. Blumenthal MD, MSEd, FACOG, is a recently retired OB/GYN who was in private practice in Womencare OB/GYN, an all-women practice in Abington and Willow Grove, and was on the medical staff of Abington Memorial Hospital, now Jefferson-Abington.