July 22, 2011

Last week, in my work as a doctor of adolescent medicine, I had to tell three 19-year-old patients that they are pregnant. Their circumstances varied, but for all of them, pregnancy was unexpected, unplanned and unwanted. Two of the young women are already caring for very young children; the other is a college student planning a demanding career. All of them have been pregnant before.

I take my job as a physician seriously and feel strongly that it is my ethical duty to inform my patients about all of their options to prevent or manage an unplanned pregnancy. I work hard to support the decisions they make and to ensure that they have access to whatever medical services they need, even if I cannot provide them myself. As a mother, I am also deeply saddened by how often I see teens and young women who are faced with decisions about unplanned pregnancies that they cannot handle and that I know we could have easily prevented though the use of effective contraception.

That is why I was very pleased to read in the July 19 Post that the Institute of Medicine has declared that contraception is an important preventive health service and should be covered fully by health plans under the Affordable Care Act.

The United States leads the developed world in teen pregnancy — nearly 800,000 per year, according to the Guttmacher Institute. More than 80 percent of these pregnancies are unplanned, and nearly a third end in abortion. The District’s teen pregnancy rate is more than double the national average. These are not statistics to be proud of. They are particularly disheartening in light of the fact that methods of contraception are available that are nearly 100 percent effective.

Healthy People 2020, the outline of our nation’s public health priorities by the Department of Health and Human Services, includes goals to reduce the rate of teen pregnancies by 10 percent and increase the percentage of planned pregnancies overall by the same amount over the next decade. If we are to achieve these important objectives, we must increase the use of effective contraceptive methods. The Institute of Medicine has taken an important step in support of this goal.

While news stories have characterized as controversial the institute’s support of health-care coverage for the full range of contraceptives approved by the Food and Drug Administration, I beg to differ. The real controversy here is the number of unplanned pregnancies occurring daily in our city and our country. I urge Health and Human Services Secretary Kathleen Sebelius to follow the evidence, rise above the controversy and ensure that contraception is covered as an essential preventive health service for all women in the United States.

The writer, a physician and researcher
in adolescent medicine, lives and works in the District.