St. Louis study explores benefits of providing free contraceptives as preventive care

Friday, March 9, 2012 | 10:44 a.m. CST

WASHINGTON — What does birth control really cost anyway?

It varies dramatically, from $9 a month for generic pills to $90 a month for some of the newest brands — plus a doctor's visit for the prescription.

Want a more goof-proof option? The most reliable contraceptives, so-called long-acting types like intrauterine devices or implants, can cost $600 to nearly $1,000 upfront to be inserted by a doctor.

That's if you don't have insurance that covers at least some of the tab, though many women do. And if those prices are too much, crowded public clinics offer free or reduced-price options. But it might take a while to get an appointment.

Questions about cost and access to birth control have been swirling for weeks now, intensifying after a Georgetown University law school student testified before congressional Democrats in support of a new federal policy to pay for contraception that she said can add up to $1,000 a year, not covered by the Jesuit college's health plan. Talk show host Rush Limbaugh's verbal assault on her comments became the latest skirmish in the birth control wars.

Soon, the new policy will make contraceptives available free of charge as preventive care — just like mammograms — for women with most employer-provided health insurance. Churches are exempt. But for other religious-affiliated organizations, such as colleges or hospitals, their insurance companies would have to pay for the coverage, something that has triggered bitter political debate.

A major study of nearly 10,000 women that's under way in St. Louis provides a tantalizing clue about what might happen when that policy takes effect.

Consider: Nearly half of the nation's 6 million-plus pregnancies each year are unintended. Rates of unplanned pregnancies are far higher among low-income women than their wealthier counterparts. Among the reasons is that condoms can fail. So can birth control pills if the woman forgets to take them every day or can't afford a refill.

Only about 5 percent of U.S. women use the most effective contraceptives — IUDs or a matchstick-sized implant named Implanon. Once inserted, they prevent pregnancy for three, five or 10 years. But Jeffrey Peipert, who works in the gynecology department of Washington University in St. Louis' School of Medicine said many women turn them down because of a higher upfront cost that insurance hasn't always covered, even though years of pills eventually cost as much.

"How can we cover Viagra and not IUDs?" wondered Peipert, who is leading the new study.

Called the Contraceptive CHOICE Project, the study is providing those options and a range of others for free. Participants can also choose from birth control pills, a monthly patch, a monthly vaginal ring and a once-every-three-months shot. They're told the pros and cons of each but that the long-lasting options have a lower failure rate.

About 75 percent of women in the study are choosing the IUD or the implant, Peipert says. After the first year of the ongoing study, more than 80 percent of the women who chose the long-acting contraceptives are sticking with them compared to about half the pill users, he said.

According to the Guttmacher Institute, the average woman who has two children will spend three decades trying to avoid an unintended pregnancy. The Institute of Medicine said that's one reason women tend to incur higher out-of-pocket costs for preventive care than men.

Yes, there already are some options for more affordable contraception, such as public clinics or Planned Parenthood.

About 55 percent of local health departments offer some family planning services, according to the National Association of County & City Health Officials. Many of those receive federal Title X funding, which means they can offer contraception on a sliding fee scale. The poorest women might get it free, while others pay full price or somewhere in between.

There are cheaper generic pills. Peipert said there's little difference between them and pricey new brand-name versions like Yaz.

But some women go through a number of brands before finding one that doesn't cause uncomfortable side effects, said Sarah Brown of the National Campaign to Prevent Teen and Unplanned Pregnancy. Her organization operates a website that details options along with the price range.

"Not every woman can use generic pills, by any means," Brown says. "Do we say to people, 'Just go get generic cardiac medicines. Hope that works out for you?'"

Peipert noted that contraception is cheaper than what insurers or taxpayer-funded Medicaid pay for prenatal care and delivery. He said economic studies have found that every $1 spent on family planning can save nearly $4 in expenditures on unintended pregnancy.

Do women ask about the price?

"Oh, my gosh, absolutely," said obstetrician-gynecologist Monica Dragoman of New York's Montefiore Medical Center.

Just last week, she saw a woman whose heart condition could make another pregnancy life-threatening but who couldn't afford the IUD that Dragoman wanted to prescribe, and chose a cheaper option.

If a family's already struggling financially, "sometimes contraception is one of the first things to fall off," Dragoman says.

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Ellis Smith March 9, 2012 | 3:10 p.m.

"If a family's already struggling financially, 'Sometimes contraception is one of the first things to fall off,' Dragoman says."

Could be, but allowing it to "fall off" could lead to an even greater financial strain on the family.

[There's an interesting joke about the name of a new 100% effective contraceptive especially for males. Perhaps you've heard it. I can't reproduce the name here because it would lead to deletion of this post.]

(Report Comment)
Jonathan Hopfenblatt March 9, 2012 | 5:02 p.m.

Yeah, strange that contraception would fall off, considering that the cost of not using it will be insanely higher than even the most expensive, top-notch contraceptives out there.

I may be a liberal scumbag to you all, but I'm also big on personal responsibility and making smart choices. If contraception is too expensive for you and yet you own an iPhone 4S with unlimited data, texting, etc., you need to re-evaluate your priorities big time.

(Report Comment)
Jimmy Bearfield March 9, 2012 | 6:30 p.m.

Today's print edition (but not the online version) of the Tribune has a Mona Charen column listing all of the ways that birth control is already free for Medicaid recipients, deeply subsidized for many other low-income people and easily accessible to virtually everyone. She didn't mention that Medicaid recipients also can get sterilized for free.

Of course, none of this is free if you're among the 51% who pay federal income taxes, but that's another topic.

(Report Comment)
Ellis Smith March 10, 2012 | 3:12 a.m.

To Jonathan:

One of my favorite sayings is W. C. Fields' perversion of an old nostrum involving horses:

"You can lead a horse to drink but you cannot make it water."

In the present case, you can make contraceptives available (see Bearfield's post) at no charge but some people will still "screw up."

However, bad as that may be I find it preferable to having a government with the power to TELL us what to do, and back it up with force of law. Freedom and responsibility are inseparable. Part of our present problems is that we've stopped teaching that in homes and schools.

(Report Comment)
Jimmy Bearfield March 11, 2012 | 5:03 p.m.

"However, bad as that may be I find it preferable to having a government with the power to TELL us what to do, and back it up with force of law."

We have that situation today. If you object to being forced to pay for other people's irresponsibility, the government takes your money anyway and gives it to those people. If you object too much, such as by refusing to pay taxes, the government will put you in jail, and the irresponsible will still get your money.

The only viable alternative is to work as little as possible because if you don't make it, the government can't take it.

(Report Comment)
Ellis Smith March 12, 2012 | 6:40 a.m.

"The only viable alternative is to work as little as possible because if you don't make it, the government can't take it."

If that's meant as either humor or sarcasm - or both - I'll definitely buy it.

Frank Christian (from one of his posts) probably thinks I'M a pessimist, but I can't hold a candle to that gloom and doom.

The situation calls to mind the parable of the ants and the grasshopper. The ants may have gotten a raw deal, but I'd rather be an ant than a grasshopper (assuming those are the only two choices).

But us "one percenters" are a different breed of cats. :)

(Report Comment)
frank christian March 12, 2012 | 8:18 a.m.

Ellis - As is often the case,am having trouble deciphering a message from the master. In my opinion one must accept "if you don't make it, the government can't take it.", not as a pessimist but as the truth "of the matter". It is what happened during J.E. Carter's "stagflation". I haven't produced the numerical formulas that some do, but can relate conversation with a prominent Columbia business man who told in late '70s, that his business earned him $10,000 (a princely sum then) the previous year. He had thought of expanding and figured he could increase earnings to $15,000, but after noting his increased taxation, he had decided expansion would not be worth the effort. Multiply this instance by the millions of people in business whom were doing the same thing then and it should be easy to understand why today we are said to have trillions of investment funds being held "on the sidelines" until our government, whose expected duty has always been to provide favorable basis and atmosphere for All legal business in our country, can be returned to those willing to do this, rather than the "pick and choose" failures of the Democrats controlling us now.

(Report Comment)
Michael Williams March 12, 2012 | 8:55 a.m.

Ellis: I don't think it was humor or sarcasm. I think it was just a statement of fact that's easily implemented.

I've been in that place before. In 1997-98, I had the opportunity to double the size of my business. Once I added up all the taxes and realized my tax bracket would go up and I would be in the 50% tax bracket, I decided against it. I wasn't going to double/triple my work for only 50 cents on the dollar.

As a consequence, 12 new people were not hired, no new building was built, those 12 people (hired outside of Columbia) did not buy homes, refrigerators, shoes, cars, pay taxes, or contribute to this community in any way.

I think Jimmy was referring to a similar thing.

And, in case there are those who do not believe the arithmetic of the 50%, consider: Federal tax, 39.5% at that time; Missouri, 6%, all other city/county/business/users/sales taxes, ca. 4.2%.....the sum rounds to 50%.

There was no good reason to do it. I already had a satisfactory income and really enjoyed my work; I weighed "50 cents on the dollar" versus longer hours and said to hell with it. Speaking only for myself, taxes did indeed destroy my "desire".

Yes, I'm aware of studies that show the opposite or at least "no effect". Not for me, tho.

Government can make me work, but it cannot make me work efficiently and it cannot get my ideas or change my desire.

(Report Comment)
Ellis Smith March 12, 2012 | 11:24 a.m.

Jimmy, Frank and Michael:

Changing the subject slightly - BUT NOT MUCH - here are quotes from an op ed piece in this morning's WSJ by Allysia Finley (assistant editor of Opinion;

Dear President Obama,

Can you believe the nerve of employers? Many of the seem to think that they should be allowed to determine the benefits they offer. I guess they haven't read your 2,000-page health law...

That's a good thing, too. Employers for too long have been able to restrict our access to essential health services like contraception by making us pay some part of the bill. Really, it's amazing that we aren't all dead...

[The piece goes on for several hundred more words, but in the same manner.]

As for my previous post, bear in mind that grasshoppers don't appear to interact much socially, as do ants, and in fact don't seem to get together "socially" except to have sex [how was it for you?], and endlessly eat without doing anything required to produce what they eat. Sound familiar?

(Report Comment)
Jimmy Bearfield March 12, 2012 | 11:32 a.m.

"I think Jimmy was referring to a similar thing."

Right, but I would include all of the things that I can do for myself now that I'm working less. For example, instead of hiring someone to mow or fertilize my lawn, I can do that myself, so that's less business for those companies. I have plenty of time to clean my house and vehicles, so that's less business for maid services and car washes. The list goes on and on.

Also, when less I pay in taxes, that shortfall has to be covered by big-government advocates -- or at least those who aren't part of the ~48% who owe no federal income taxes.

Finally, Ellis, you need to understand the law of diminishing returns: Why put in the extra effort when doing so moves me up a tax bracket, where I take home less? It's like working for an hourly wage, and when you get to 40 hours, instead of making time and a half or double time, you get paid at 80% of your wage.

(Report Comment)
Ellis Smith March 12, 2012 | 11:54 a.m.

As a career engineer I think I have some understanding of "diminishing returns," a subject that covers far more than government and taxes. When one attempts to improve a process, he/she often encounters the law of diminishing returns: further improvements just aren't worth the cost of making them.

"Utopianists," which doesn't include Bearfield, Williams, Christian or Smith, would have us spend no limit of capital to gain at best marginal improvement.

(Report Comment)
Michael Williams March 12, 2012 | 1:19 p.m.

Re: Diminishing returns:

Such as the 80:20 or 95:5 rules when applied to decision-making:

Spending 80% or 95% of your time trying to find the last 20% or 5% of the information...trying to guarantee a correct decision.

Unfortunately, the information curve is asymptotic to 100% and never quite gets there.

In my experience, I have found use, or misuse, of this rule is the dividing line between entrepreneurs and those who work for others. It's the difference between the risk-averse and the risk-assessors/takers.

Jimmy is right; there's more time for doing things yourself instead of paying someone to do it for you. Folks think wealthier people store money in mattresses and/or safety deposit boxes. They can't comprehend the opposite...which is the behavior in play. For example, I own a farm. I do the work myself. I do not hire it done.

How does that behavior on my part help the velocity of money and tax accumulation?

I've been thinking about making a canoe from scratch.

(Report Comment)
Jonathan Hopfenblatt March 13, 2012 | 5:38 p.m.

frank said: "I haven't produced the numerical formulas that some do, but can relate conversation with a prominent Columbia business man who told in late '70s, that his business earned him $10,000 (a princely sum then) the previous year. He had thought of expanding and figured he could increase earnings to $15,000, but after noting his increased taxation, he had decided expansion would not be worth the effort."

I would argue that the problem is not high taxes, period, so much as our tax code's inability to recognize that some people make A LOT more money than others even at the upper end. From a population standpoint, the highest marginal tax rate in the US affects only ~1% of the population IIRC, but this doesn't change the fact that 35% of $372,951 is a pretty sizable chunk of change compared to 35% of, say, $30M. The percentages are the same, but the guy who makes $30M can still live a life of luxury after 35% of that is taken away. Whereas, taking 35% from your comparatively meager $373K could very well kill your dreams of expanding your company.

A lot of people find themselves in the latter situation, and I wouldn't be opposed to lowering tax rates on small-business owners if it would encourage them to invest and grow their business. But, there are also a few people out there in the former situation, and I wouldn't mind at all raising their taxes. Let's remember that the $30M in my example is still is chump change compared to the kinds of money these guys handle.

(Report Comment)
Michael Williams March 13, 2012 | 6:39 p.m.

Jon, if I'm reading you correctly, you're saying that salary should (eventually) not be proportional to productivity (wish I could graph in this place). That is, as the productivity for which a person is responsible goes up, his/her salary may initially be proportional to the increased productivity, but at some unknown and undefined point enough-salary-is-enough and the proportionality decays. Hence, a person responsible for...say...doubling the profitability of a company from 500 million to 1 billion should not see a proportional increase in salary because he/she "can still live a life of luxury" at the lower salary level.

So, where's the motivation for enhancing productivity? Why do it?

Also, no one will state when enough-is-enough, although you did set personal limits between $373K and $30M, which is the best start we've ever had in this place.

(Report Comment)
Jonathan Hopfenblatt March 13, 2012 | 8:16 p.m.


That's pretty vague terminology you're using there, "productivity for which a person is responsible," nevermind the perennial correlation vs. causation problem.

"Hence, a person responsible for...say...doubling the profitability of a company from 500 million to 1 billion should not see a proportional increase in salary because he/she "can still live a life of luxury" at the lower salary level."

1. If the increase WERE proportional that would be a huge improvement already.
2. Whether the person should or shouldn't get said increase doesn't really matter. What matters is that the person doesn't need it, whereas there are a bunch of people out there who do. Here's a recent study (based on poll data) suggesting that a person's overall level of happiness is unaffected by wealth past ~$75,000.

"Also, no one will state when enough-is-enough, although you did set personal limits between $373K and $30M, which is the best start we've ever had in this place."

The last time we had this discussion I also asked some questions of my own that no one bothered answering: Would you see no problem if there was a single trillionaire in the US and 40$ of the population lived below the poverty line? Is there nothing wrong with that picture?

(Report Comment)
frank christian March 13, 2012 | 8:59 p.m.

Micheal - You said "Jon, if I'm reading you correctly..." I had thought that by now you would have understood that to read this guy "correctly" is an impossibility, unless you answer his concocted queries in the affirmative. Otherwise he will change essence of the question and wait for another reply.

I believe that only one willing to spend another sleepless night, would hang on until able to read Jonathan "correctly".

I may have found an answer in my above. Tho it may be a journalistic injury to an honest poster, "answer his concocted queries in the affirmative"! This may possibly allow him to relax and thus sleep. Only 'til morning of course, when he will begin to bugg us again.

(Report Comment)
frank christian March 13, 2012 | 9:01 p.m.

Michael - I can spell your name. noticed the typo too late. Sorry.

(Report Comment)
Michael Williams March 13, 2012 | 10:14 p.m.

Jon: I guess I wasn't reading you correctly.

All I really needed to know from your response was the "doesn't need it" part. The rest was filler.

(Report Comment)
Jonathan Hopfenblatt March 14, 2012 | 2:08 a.m.

Do you disagree?

(Report Comment)
Ellis Smith March 14, 2012 | 6:37 a.m.


Are you going to make a concrete canoe? Teams of engineering(and other) students make concrete canoes for paddling competition. I don't know whether MU students do that or not; however, I do know they participate in Formula SAE race car competition (as do our students, who also build "Baja" cars - off-road vehicles).

There are something like 20 of these competitions (some of open to students from any country); MS&T students participate in most of them. Teams depend mostly on donated materials and "dialing for dollars," to obtain funds from alumni and friends.

Possibly the most esoteric competition internationally is "mucking." (One must type that word CAREFULLY!) It is for mining students only, and consists of drills of various mining procedures as well and disaster drills (securing and transporting injured miners). The prize usually goes to MS&T or a university in Australia. There are male and female teams. Yes, there are now women studying Mining Engineering.

(Report Comment)
Michael Williams March 14, 2012 | 8:12 a.m.

Ellis: My comment on the canoe was a tongue-in-cheek example to show I didn't *have* to pay someone else to build it and, hence, there would be no contribution to money velocity or collection of taxes...since I have too much time on my hands. I slowed down and then quit when I was 52.

When I was a boy, (a looooong time ago), a guy in my hometown started building a sailboat out of concrete. It was huge. It must of taken him 10 years, off and on, to build it. Then, one day, it was gone. I heard later he and his wife had transported it to the Gulf and retired. Hope he knew what he was doing and paid close attention to Archimedes.

Another word to "watch out for" when typing.....public.

Don't leave out the "L", otherwise "public office" takes on a whole new meaning.

(PS; I sure would hate to transport a concrete canoe on the top of my auto.)

(Report Comment)
Jonathan Hopfenblatt March 14, 2012 | 8:50 a.m.

To my knowledge, Mizzou does have a concrete canoe team, or at least it did the years I was there. Apparently we tend to get 3rd place a lot in the regional competitions.

(Report Comment)
Mark Foecking March 14, 2012 | 9:51 a.m.

USF had a concrete canoe team (and likely still does) when I was an undergrad there, and one day their entry was in the hall of the building basement on a stand (where their workshop was). I was curious and tried to pick one end up. While I couldn't have gotten it on to a car roof by myself, I was surprised that the whole thing didn't weigh more than maybe 120-150 lb. They're not necessary heavy (for what they are).


(Report Comment)
Ellis Smith March 14, 2012 | 6:14 p.m.

@ Mark Foecking:

That's the heart of the canoe competition, lightweight structural concrete. Some of the teams' efforts have been known to fail while paddling. Paddlers should know how to swim.

@ Jonathan:

There are several teams at MU. At MS&T the solar car, guided aircraft, and steel bridge teams have done well; I've previously mentioned solar home competition.

MS&T has an entire building devoted to teams, an off-campus converted bread bakery. It's a good thing too. What else is there for students in Rolla, Missouri to do nights and weekends - things that aren't illegal, immoral or could land you in the student health center or regional hospital? :)

(Report Comment)
frank christian March 14, 2012 | 8:18 p.m.

I believe most of today's floating boat docks are installed with walkways of concrete, Usually 2 ft. squares seemingly of less weight than the steel frames underneath them. The encapsulated styrofoam underneath it all seems to have an easy time of floating this as well as the crap most boaters drag on to them.

However,the 3" of freezing rain and 14"of wet snow in that 24 hour period in Dec 2006 on the steel roofs covering most docks at Lake of Ozarks were too much and many docks along with the boats moored there sank, or received much damage from collapse of the roofs.

(Report Comment)

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