This post will not offer a position on personal matters of conscience or belief.  Despite politicization of the issue, contraception will remain an integral health coverage mandated coverage under Health Care Reform that the health insurers must be prepared to address.

The purpose of this article is to clarify the medical role of contraception, beginning with a primer on the birth control pill.

What the Pill Is and How It Works

The birth control pill contains the hormones estrogen and progesterone. It is taken daily to prevent pregnancy. Most birth control pills are “combination pills” containing a combination of the hormones estrogen and progesterone to prevent ovulation (the release of an egg during the monthly cycle). A female cannot get pregnant if she doesn’t ovulate because there is no egg to be fertilized. The Pill also thickens the mucus around the cervix, making it difficult for sperm to enter the uterus and reach any eggs that may have been released. Finally, the hormones in the Pill can sometimes also affect the lining of the uterus, making it difficult for an egg to attach to the wall of the uterus.

Combination Pills: Most combination pills come in either a 21-day pack or a 28-day pack. One hormone pill is taken each day at about the same time for 21 days. Depending on the pack, the birth control pills are either stopped for 7 days or a pill that contains no hormones is taken for 7 days. During the week that the female is taking no pills or pills that don’t contain hormones, she has her period. Some women prefer the schedule in which pills are taken every day of the month because it helps keep them in the habit of taking a pill every day. Also available is a combination pill that reduces the frequency of a woman’s period by supplying a hormone pill for 12 weeks and then inactive pills for 7 days. This reduces the number of periods to one every 3 months instead of one every month.

Low-dose progesterone pill: Another kind of pill that may change the number of monthly periods is the low-dose progesterone pill, sometimes called the minipill. This differs from other birth control pills in that it only contains one type of hormone — progesterone — rather than a combination of estrogen and progesterone. It works by changing the cervical mucus and the lining of the uterus, and sometimes by affecting ovulation as well. It may be slightly less effective than the combination pills at preventing pregnancy. The minipill is taken every day without a break. A woman may have no period at all or may have irregular periods. In order for the minipill to work, it must be taken at the same time every day, without missing any doses.

Every type of birth control pill works best when it is taken every single day at the same time of day, regardless of whether a female is going to have sex. This is especially important with progesterone-only pills. It’s very important not to take anyone else’s pills. If pills are skipped or forgotten, she is not protected against pregnancy and she will need a backup form of birth control, such as condoms, or she will need to stop having sex for a while. For the first 7 days of taking the Pill, one should use an additional form of contraception, such as condoms, to prevent pregnancy. After 7 days, the Pill should work alone to prevent pregnancy.

How well does it work? Over the course of a year, about 8 out of 100 typical couples who rely on the Pill to prevent pregnancy will have an accidental pregnancy. The Pill is an effective form of birth control, but even missing 1 day increases the chance of pregnancy.  In general, how well each type of birth control method works depends on many things. These include whether a woman has any health conditions or is taking any medications or herbal supplements that might interfere with its use. For example, antibiotics or an herb like St. John’s wort can interfere with the effectiveness of the Pill.  It does not provide protection against STDs.

How much do they cost? The Pill usually costs between $15-$50 a month, depending on the type. Many health and family planning clinics (such as Planned Parenthood) sell birth control pills for less. In addition, birth control pills and doctor visits are covered by many health insurance plans.

Why It Will Be Provided As A Core Medical Benefit?

It’s a prescription medication that must be carefully regulated: Because of the possible effects of the Pill, it must be prescribed by a doctor or a nurse practitioner who will ask about a woman’s health and family medical history, and do a complete physical exam, which may include a pelvic exam. The medical professional should thoroughly explain when to begin taking it and what to do if pills are missed.  A woman should return to the doctor in a few months to have her blood pressure checked and asked about any problems. After that, sexually active women should get routine exams every 6 months to a year, or as recommended by a doctor. While this is a prescription medication, one exception is the emergency birth control pill, Plan B One-Step, which is sold over the counter to women 17 and older.

 Other Medical Benefits: The Pill also has some medical benefits effects other than preventing pregnancy. It usually makes periods lighter, reduces cramps, and is often prescribed for women who have menstrual problems. The Pill may be taken to regulate irregular menstrual cycles and to help in the transitional period prior to menopause. A variety of menstrual disorders that the Pill is prescribed for include amenorrhea (absence of menstruation), dysmenorrhea (abnormally painful menstruation) and hypermenorrhea (heavy menstrual bleeding).

Taking the Pill can improve acne, and some doctors prescribe it for this purpose. The Pill may be prescribed to treat a number of other conditions, including polycystic ovarian syndrome (PCOS), hirsutism (abnormal hair growth) and endometriosis.  Birth control pills have also been found to protect against some forms of breast disease, anemia, ovarian cysts, and ovarian and endometrial cancers.

 Possible Side Effects:  The Pill needs to be monitored by a health care professional. For individuals with some health histories, the  health care professional may advise against oral contraceptives. Smoking cigarettes and using the Pill can increase the risk of certain side effects, so health professionals advise girls who use the Pill not to smoke. Side effects that some women have while on the Pill include:

  • irregular menstrual bleeding
  • nausea, headaches, dizziness, and breast tenderness
  • mood changes
  • blood clots (rare in women under 35 who do not smoke)

Some of these side effects improve over the first 3 months on the Pill. When there are side effects, a doctor will sometimes prescribe a different brand of the Pill.

Guarding against complications of pregnacy: The Pill can protect against numerous consequences and complications that women may face in pregnancy. Many common conditions  can complicate a pregnancy, including heart disease, high blood pressure, kidney problems, autoimmune disorders, sexually transmitted diseases, diabetes, cancer,infections. Some conditions can make pregnancy extremely risky, like gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them.

Guarding against teenage pregnancy: There is an even greater need to protect young people who tend to be more careless than adults.  Teenage pregnancy is not only a medical but a social problem. One of the advantages of the pill is that it provides protection 24/7.

Teen pregnancy is one of the most critical issues facing America today. The explosion of out-of-wedlock teen births is so critical that each year, one million American teenagers become pregnant and the United States now has the highest teen pregnancy rate in the Western World.

Startling statistics about teen pregnancy

  • 560,000 teenage girls give birth each year. Almost one-sixth of all U.S. births are to teenage women.
  • Babies born to young teen mothers have a higher risk of serious health problems.
  • Physical and mental birth defects affect many babies born to very young women. The high rate of teenagers having babies is a national health and social problem that demands attention.

Health Risks to the Teenage Mother – The teenage mother has special problems, physically and emotionally, including:

  • The death rate from pregnancy complications is much higher among girls who give birth under age 15 than among older mothers.
  • The teenage mother is more likely to be undernourished and suffer premature or prolonged labor.
  • During the first three months of pregnancy; seven out of ten pregnant teenagers do not see a doctor or go to a clinic.
  • Poor eating habits, smoking, alcohol and drugs increase the risk of having a baby with health problems.

Health Risks to the Baby:  Low birth weight is the most immediate health problem. Babies born to teenagers often are born too small, too soon. Low birth weight babies may have:

  •  immature organ systems (brain, lungs, heart).
  • Difficulty controlling body temperature and blood sugar levels.
  • Mental retardation.
  • A risk of dying in early infancy that is much higher than among normal weight babies (5 1/2 pounds or more).

Consequences of Teenage Pregnancy: The future does not often hold great promise for a teenage mother and her child:

  • Two out of three pregnant teenagers drop out of school.
  • With her education cut short, the teenage mother may lack job skills. The income of teen mothers is half that of those who first gave birth in their 20s. The teenage mother may become financially dependent on her family or on welfare.
  • Teenage marriages have a much greater chance of ending in divorce.

Snap principle of Health Care Reform:

The insurance industry will need to clearly address even contentious healthcare issues.