Contraceptives and Government: PCPs, Add Your Voice

Robert W. Morrow, MD


March 21, 2012

This feature requires the newest version of Flash. You can download it here.

Hi. This is Dr. Bob Morrow from the Medscape "Transparent Practice" blog. I am a family physician in the Bronx, New York.

Today I wanted to talk a bit about some of the noise we have been hearing about contraception and family planning. There -- that made some of the phones light up. Maybe we will also touch on abortion. Ah, now all the phones are lit.

The issue I want to raise and hear your comments on is where doctors should be -- particularly primary care doctors -- when it comes to this national debate about the role of the government in contraception. This is a debate many of us thought was settled by the Supreme Court in the 1960s, and of course the folks at the Institute of Medicine issued a report that made it stunningly clear that investments in contraception improved the health of women dramatically, improved the economy, and in general improved the status of women by enabling all sorts of control over their life trajectories.

This does not seem to be the current view of many in our political parties who feel that, to some degree, contraception is a primal sin. So, where do we fit in with this? In general, I believe that most of us in primary care skirt the issue of religion with our patients. But I need to hear from you [about your position]. I know what my position is, because in my community, well over 98% of women have used some form of contraception in their lives, even women who have same-sex partners.

Why would one use contraception? Of course, [contraception is used] for many, many medical conditions [in addition to birth control]; polycystic ovaries is one, and painful menses -- you know the list. So why would we remove this from insurance? Why should an employer say, "I morally oppose the use of contraception, therefore my insurance will not cover it," when some birth control pills are quite high in cost, around $90 a month? Intrauterine devices can cost around $600 or $700, maybe more. Long-acting reversible contraception [may cost several hundred dollars]. Thus, it does become important.

Let me pose this funny concept to you: Suppose the owner of the company that is buying the insurance had strong moral objections to immunizations and said that the company would no longer pay for them. You would perhaps object to that when the patient came to your office. The concept that financial support [for healthcare] is valuable to health and to the economy is clear. Should we and our physician organizations take a clear stand? I have not heard from our organizations in a loud voice that these moves are generally retrogressive and misogynistic and should be loudly objected to. I would like to hear what you think about this.

As long as we are going to make this a little controversial, the question of pregnancy termination also comes up. Should women have the right to decide [to terminate a pregnancy], for whatever reason, regardless of the circumstances of the pregnancy, whether it was intended or unintended? In the United States, 50% or more of pregnancies are unintended, [ironically] because of the difficulty of getting contraception. Where do we stand [on this issue]? How many of you remember [when abortion was not legal]? How many of you are old like me and remember being in the emergency room and seeing women come in after illegal abortions? We very much know that wherever abortion is not legal, it is nonetheless performed frequently, illegally, with fairly dire consequences, particularly for poor women.

Is this something that we in the medical world should take a stand on from the position of health, and is it something our professional societies should be more aggressive about? I welcome your comments.

Thanks for listening. This is Bob Morrow from the "Transparent Practice" medical blog.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.