In the heated debate over to what extent religiously affiliated employers should be required to provide free contraception for workers, no one has talked much about what methods are available to women who want to prevent pregnancy and how their choices might change if cost were removed from the equation. But its an important subject.
With methods ranging in price from about $1 for a partners condom to more than $800 for an intrauterine device, some women might switch if they could afford to.
Thats exactly what many womens health advocates hope. Long-acting methods such as the IUD and the hormonal implant are nearly 100 percent effective, require no effort after insertion and protect against pregnancy for up to 10 years. (In contrast, birth control pills are about 92 percent effective.)
Some women worry that having a device inserted in the uterus or under the skin is riskier than methods such as a pill, a patch or a vaginal ring that they can discontinue at will.
But experts such as Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a non-profit research center on reproductive policy, point out that IUDs and implants eliminate the possibility of inconsistent use.
Theyre also among the most cost-effective methods available in the United States, according to research by James Trussell, a professor of economics and public affairs at Princeton University.
These longer-acting methods, however, carry a hefty upfront price tag of between $500 and $1,000 for the device itself and its insertion. Meanwhile, insurance coverage is uncertain.
Under the new health-care law, starting in August, new employer health plans or those that change their benefits substantially will be required to cover all FDA-approved contraception methods and related counseling without co-pays.
Catholic bishops and others have objected to imposing this requirement on employers who oppose contraception on religious grounds. The Obama administration offered a compromise that would allow women who work for religious organizations to obtain contraception directly from an insurer, still without co-pays. But the debate continues.
Although eliminating cost concerns might help encourage the use of longer-acting methods, thats only half the battle. Educating women and providers is also critical, say experts.
Only 5.5 percent of women practicing birth control used an IUD in 2006 through 2008. An even smaller percentage used hormonal implants. In contrast, 28 percent of women used birth control pills.
The Contraceptive Choice Project is testing the idea that by educating women about longer-acting methods and removing cost barriers, more will decide to use them and fewer will become accidentally pregnant.
In 2007, researchers at Washington University in St. Louis began to enroll 10,000 women, offering them free contraceptives of any type for three years and focusing on education.
Seventy-five percent chose IUDs or implants. After a year, 86 percent of those using IUDs or implants decided to continue with the longer-acting method; only 55 percent who were taking birth control pills continued with that method, according to preliminary figures.