Debate on free birth control looms

Senator Barbara Mikulski of Maryland, a Democrat and author of the women’s health amendment, said the clear intent was to include family planning.

But is birth control preventive medicine? Conflicting answers frame what could be the next clash over moral values and a health law that passed after a difficult compromise restricting use of public money for abortions.

For many medical and public health experts, there’s no debate.

“There is clear and incontrovertible evidence that family planning saves lives and improves health,’’ said obstetrician-gynecologist David Grimes, an international family-planning expert who teaches medicine at the University of North Carolina. “Contraception rivals immunization in dollars saved for every dollar invested. Spacing out children allows for optimal pregnancies and optimal child rearing. Contraception is a prototype of preventive medicine.’’

But US Catholic bishops say pregnancy is a healthy condition, not an illness. In comments filed with the Department of Health and Human Services, the bishops said they oppose any requirement to cover contraceptives or sterilization as preventive care.

“We don’t consider it to be health care, but a lifestyle choice,’’ said John Haas, president of the National Catholic Bioethics Center, a Philadelphia think tank whose work reflects church teachings.

So far, most other religious conservatives have stayed out of the debate, though that could change. Some said they are concerned about any requirement that might include the morning-after pill. The Food and Drug Administration classifies it as birth control; some religious conservatives see it as an abortion drug.

Jeanne Monahan, a health-policy analyst at the conservative Family Research Council, said her group would oppose any mandate that lacks a conscience exemption for moral and religious reasons.

As recently as the 1990s, many health insurance plans didn’t cover birth control. Protests, court cases, and new state laws led to dramatic changes. Today, almost all plans now cover prescription contraceptives. So does Medicaid, the health care program for low-income people. Generic birth control is available at Walmart stores for $9 a month.

The use of birth control is “virtually universal’’ in the United States, according to a government report from the National Center for Health Statistics.

Still, about half of all pregnancies are unplanned, and many occur among women using some form of contraception. The government says the problem is rarely the birth control method, but “inconsistent or incorrect use,’’ such as forgetting to take a pill.

Advocates say free birth control would begin to address the problem. It would remove a cost barrier that may keep women away from more-reliable long-acting birth control, and also aids those who don’t do well on inexpensive generics.