At Issue: U.S. Health Care
Nancy Brajtbord, RN, (L) administers a shot of gardasil, a Human Papillomavirus vaccine, to a 14-year old patient (who does not wish to be named) in Dallas, Texas. REUTERS

The Institute of Medicine, or IOM, has recommended that the federal government consider having free birth control as part of its preventive services supporting women's health.

The report, released Tuesday, titled Clinical Preventive Services for Women: Closing the Gaps, recommends the full range of Food and Drug Administration-approved contraceptive meth­ods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.

Having the full range of these services provided to women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth out­comes, according to the authors of the report.

The Patient Protection and Affordable Care Act, or ACA, also known as the U.S. Health Care Reform Act, passed in 2010, placed a great deal of emphasis on preventive services in order to move away from reacting to a health problem and towards promoting better health attitudes.

Women stand to benefit from this shift given their longer life expectancies, reproductive and gender-specific conditions, and historically greater burden of chronic disease and disability, the authors wrote in a report briefing.

Should the U.S. Department of Health and Human Services accept the recommendations from IOM, it could result in some economic benefits for women, especially those from low-income households. This is because the ACA removes cost-sharing requirements for specified preventive services. This will in turn remove the out-of-pocket costs that often put screenings, counseling and procedures supporting health out of reach for moderate- and lower-income women, according to the report.

Last year, the HHS tasked the IOM to review what preventive services are important to women's health and wellbeing. HHS also asked that IOM recommend which of those services should be considered when developing comprehensive guidelines.

The HHS hasn't indicated as yet whether it will accept the recommendations and are expected to decide soon.

In the meantime, Health Secretary Kathleen Sebelius told CNN that the report is being closely reviewed. Sebelius also said that the department's recommendations of what additional preventive services for women at no cost will be released soon.

The Centers for Disease Control and Prevention stated that back in 2001 that about half of the pregnancies in the U.S. were unintended. Such pregnancies are associated with an increased risk of morbidity. Also women with an unintended pregnancy may delay prenatal care, which can affect the infant's health, according to the CDC.

With the availability of free birth control, more women will be able to better space out the time between births.

Millions of women, especially young women, struggle every day to afford prescription birth control, said Cecile Richards, president of Planned Parenthood Federation of America. Today's recommendation brings us a step closer to ensuring that all newly insured women under the health care reform law will have access to prescription birth control without out-of-pocket expenses. This would be a tremendous stride forward for women's health in this country.

Co-pays for birth control pills can range between $15 and $50 per month, and other methods, such as IUDs, can cost several hundred dollars, even with health insurance, according to Planned Parenthood.

Other recommendations from the IOM include:

  • Screening for gestational dia­betes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes;
  • The addition of high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results. Screening should begin at 30 years of age and should occur no more frequently than every three years;
  • Annual counseling on sexually transmitted infections for all sexually active women;
  • Counseling and screening for HIV infection on an annual basis for sexually active women;
  • Comprehensive lactation sup­port and counseling and costs of renting breastfeeding equipment. A trained provider should provide counsel­ing services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the com­mittee recognizes that interpretation of this varies);
  • Screening and counseling for interpersonal and domestic violence. Screening and counseling involve elicitation of information from wom­en and adolescents about current and past violence and abuse in a culturally sensitive and supportive man­ner to address current health concerns about safety and other current or future health problems;
  • At least one well-woman pre­ventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care. The committee also recognizes that several visits may be needed to obtain all necessary recommended preventive services, de­pending on a woman's health status, health needs, and other risk factors.