On Friday, the Trump administration issued new rules that allow a wide range of employers and insurers to be exempt from the Affordable Care Act's provision that grants women contraceptives without additional payments. The move may appeal to social conservatives who object to contraception, but is it a good idea from a medical perspective?
Birth control pills, shots and other devices — especially the still-ubiquitous little pink or blue pills — are about much more than preventing pregnancy. Many women suffer from major hormonal fluctuations in their monthly cycle. This can lead to irregular periods, menstrual pain, depression and acne flare-ups. It is also a risk factor for serious conditions such as endometriosis, in which the tissue that lines the uterus may grow into the fallopian tubes or ovaries, and polycystic ovary syndrome PCOS, in which a woman's eggs may not develop or be released as they should be.
While hormone treatment with birth control pills isn't a cure for any of these conditions, it can manage hormone levels so that they are less-serious issues. In the case of endometriosis, it can keep the abnormal tissue growth from expanding and in PCOS, a combination hormonal contraceptive — with estrogen and progestin — helps prevent a complication that involves the build up of the uterine lining.
This is one reason the original authors of the Affordable Care Act considered contraception a basic part of women’s health care, which is a basic part of medical care, which the law guarantees. In fact, the Guttmacher Institute's Rachel K. Jones estimates that more than half, or 58 percent, of women who use oral contraceptive pills use them “at least in part for purposes other than pregnancy prevention” — including menstrual pain, acne and endometriosis. About 14 percent of women — or about 1.5 million in 2011 when Jones's report was published — use oral contraceptive pills only for noncontraceptive purposes.
She also found that many women who have never had sex also take the pill. While they only make up a small proportion of the total number of oral-contraceptive users in the United States, they number an estimated 762,000. Nearly all of them report using the pill for reasons other than birth control.