By overlooking methods used by men, women’s birth control choices limited

While the contraceptive coverage provisions of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) have taken the spotlight, a report by the Guttmacher Institute notes that contraceptive methods used by men, such as vasectomies and condoms, were left out of the ACA’s guarantee of contraceptive coverage without cost-sharing. These methods of contraception also provide health benefits for women by preventing unplanned pregnancies and helping to space planned ones, according to the report.

Exclusion under ACA

Section 1001 of the ACA, which added Section 2713 of the Public Health Services Act, requires that women’s preventive care include “the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity,” but does not list specific methods. The Health Resources and Services Administration (HRSA) within HHS determined that because the law specifies “with respect to women,” methods used by men, such as vasectomies and male condoms, could not be included. Thus, “[n]otably missing from the preventive services provision is anything to meet the needs of adult men, beyond the limited recommendations of the [U.S. Preventive Services Task Force (USPSTF)] and the immunizations committee,” states the report.

The exclusion of contraceptive methods used by men was rooted in the focus of lawmakers and advocates on the historical neglect of women’s health issues, as services needed primarily or exclusively by women, such as maternity care and contraception, were excluded or unfavorably covered by health plans. Because there are comparatively few health care services exclusively or primarily utilized by men, there are similarly few high-profile gaps in the coverage of those services.

Importance of methods used by men

Not only do methods of contraception vary in their effectiveness, but they are often chosen based on concerns of side effects and drug interactions, the expected frequency of sex, the perceived risk of STIs, worries about confidentiality and control, and other factors. Because women’s comfort level and satisfaction with their contraceptive method of choice can have an effect on the consistency of usage, the effectiveness of the methods can be compromised. Thus, “people need unfettered access to not just any method of contraception, but to the one most suitable for their individual needs and circumstances at any given time in their reproductive lives,” according to the report, including those primarily used by men.

Potential solutions

The report suggests that Congress enact legislation explicitly including the full range of contraceptive methods under the contraceptive coverage provision of the ACA. However, it notes that attempts to undermine the provision are more likely than attempts to bolster it. Just as unlikely is the option of the Obama Administration adopting a different interpretation of the provision to define methods used by men as preventive care for women. Health plans could also be part of the solution, the report suggests, by covering vasectomies as well as female sterilization, as it is less invasive and less costly.

State action to encourage coverage of contraceptive methods used by men may be more plausible, but an obscure provision of the ACA requires states to cover the costs of new mandates for plans subject to the essential health benefits standards in the small group and individual markets. Thus, states may be hesitant to create new mandates in including such contraceptive methods.

Finally, the report states that the most promising approach would be for the USPSTF to incorporate a recommendation to cover contraceptive methods used by men, as the ACA states that any positive recommendation from the USPSTF is automatically incorporated into the preventive services requirement following a one-year grace period.