Women's health deserves respect

Two months after Viagra hit the market in 1998, men could count on more than one half of insurance plans to reimburse them for the radical new treatment. Yet women, who have the potential to get pregnant for over 30 years of their lives -- and who without contraception would be expected to have between 12 and 15 pregnancies over a lifetime -- cannot expect insurance coverage for any sort of contraception in 37 states, Pennsylvania and New Jersey included. While no insurance company or employer may restrict Viagra access, eight of the 13 states requiring full contraceptive coverage for women permit an employer or insurance company to prohibit contraceptive coverage based on the organization's religious views, according to Planned Parenthood. Such byzantine rulemaking would change, however, if the Equity in Prescription Insurance and Contraceptive Coverage Act becomes a national law. EPICC would require coverage of such reversible contraception as birth control pills, IUDs, diaphragms, Norplant implants and Depo Provera injections. Yet the bill never got out of committee in the last congressional session. The delay is costly. The National Commission to Prevent Infant Mortality calculated that in 1989, 4,000 lives -- 10 percent of all infant deaths -- could have been saved had the pregnancies been planned. Not only is maternal and infant mortality increased by unintended pregnancy -- contributing significantly to the stubborn U.S. lag behind other Western nations in those indicators -- but many women with certain disorders must be careful to avoid unintended pregnancy. Women are at increased risk of death from such diseases as lupus, high blood pressure, asthma, HIV, sickle-cell anemia and diabetes while pregnant. Contraceptive coverage is vital compared to mere quality-of-life prescriptions like Viagra. Estimates of the cost of contraceptive coverage are minimal -- as little as $1.43 per employee each month according to the Alan Guttmacher Institute. Contraception costs will continue to decline as more generics become available. Indulgence of religious minorities makes less sense when contraception coverage can yield a meaningful reduction in infant mortality and low infant birth weight, a complication with proven long-term irreversible effects on public health. Unintended pregnancies result in 1.4 million abortions per year. Yet to suggest that insurance plans cover contraception to reduce abortion is a heresy as deep to some as proposing that the earth rotates around the sun. (For Galileo's perspicacity, the Catholic Church excommunicated him). Not only must we pay the social costs, but soon we will pay the legal ones. Businesses must pay for costly litigation of a state-by-state remedy as EPICC luffs. Recently, a class-action lawsuit brought under the Pregnancy Discrimination Act seeks damages, monetary relief, back pay, attorney fees and costs from an employer whose insurance plan failed to cover contraception. Specifically, the suit claims sex discrimination. Plaintiff Jennifer Erickson alleges that prescription contraception "is basic medical care for women who have the potential to become pregnant but who wish to control that potential by reversible means," according to her complaint, filed in September. Erickson, a pharmacist, claims that "the failure to provide coverage for prescription contraception treats medication needed for a pregnancy-related condition less favorably than medication needed for other medical conditions." The coming wave of litigation could be a good deal bigger than phen-fen. If EPICC fails to pass this legislative session, who is to say how high the costs of litigating each class action claim one by one will ultimately tally? Restricting contraception is a terrible way to promote sexual morality. Perhaps we do not need to insist that the sun revolve around the earth. Perhaps it is an indulgence we can no longer afford.

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