An ounce of prevention

America is supposed to be among the most developed countries in the world. But in the last 20 years, maternal mortality rates in America have doubled. Maternal mortality is the death of a woman who is expecting a child, due to complications of her pregnancy or her delivery. A majority of these women are living under the poverty line and did not intend to become pregnant. Affordable obstetric care is out of the question for most of them.

But preventive care might be available for them soon—free of charge, as it should be.

Preventive care, like it sounds, is any care or medical treatment given to prevent disease or injury rather than treating the symptoms later. In September of this year, all insurance companies were required to start paying for preventive care without charging so much as a co-pay. Immunizations, blood pressure screenings and other such preventive treatments are now free to anyone with insurance. And, depending on the outcome of a meeting between public health experts and the government later this month, birth control—not just the pill, but injections, IUDs and other, more effective methods—very well could fall under the heading of preventive medicine too.

The benefits of labeling birth control as preventive medicine are enormous. Studies show that increased availability of affordable birth control drastically reduces abortion rates. This also means a reduction in unsafe abortion practices—self-administered and unlicensed abortions in particular. In addition to reducing abortion rates, making birth control free would also cut down on complications due to the pregnancies themselves by making family planning easier.

The risks of pregnancy complications increase among those with low or limited income; these people are also the most likely to have an unplanned pregnancy due to lack of affordable birth control. These complications can include loss of calcium to bones and teeth, resulting in osteoporosis, injuries to the spine and back, gestational diabetes, pre-eclampsia, broken bones (pelvis and ribs in particular), acidosis and torn abdominal muscles. Infants born with poor or no prenatal care also tend to be underweight and have a higher chance of complications in delivery.

Proper family planning puts women at a lower risk for many of these complications. Complications increase with consecutive pregnancies (pregnancies in rapid succession), so appropriate spacing between children is important. It also makes sense economically. People can wait until the right time to start or to continue a family. And according to a study by the Princeton University Office of Population Research, “[the] direct medical costs of unintended pregnancies were $5 billion in 2002. Direct medical cost savings due to contraceptive use were $19 billion.” On small and large scales, the economics are sound.

Opponents of free birth control under the label of preventive medicine point out that the contraceptives wouldn’t be free; they would be paid for by taxes. Part of this is true, but the combined costs of unwanted pregnancies also paid for by taxes—welfare and government assistance, foster care, etc., far outweigh the potential costs of offering free birth control.

Another argument against this change is the definition of “disease or injury.” The United States Conference of Catholic Bishops says that fertility is not a disease, and as such, treatments to avoid the natural consequence of fertility are not preventive. The Catholic Church even suggests that availability of birth control has caused the rise in unintended pregnancies in the recent era. It is not surprising that they do not support this change. However, evidence in support of the church’s claim is scarce; an overwhelming majority of studies have found the opposite. In regards to fertility not being a disease—it isn’t. But the complications of a pregnancy for a woman who is not prepared can be devastating physically and emotionally.

While other developed nations are seeing a decline in their rates of maternal deaths, the United States is seeing a definite upward trend. And that doesn’t include the numbers of women who survive and are left injured and sick, sometimes with lifelong health problems. It doesn’t include the women who couldn’t carry their child to term or gave birth to a child they couldn’t care for. For all these women and their families, free birth control could be the answer to their prayers. ?