Contraception, sterilization not preventive health services, panel told

WASHINGTON – Contraception and sterilization should not be included among mandated “preventive services” for women under the new health reform law, a spokeswoman for the U.S. bishops told an Institute of Medicine committee Nov. 16.

“As you study the vital question of preventive services for women under the Patient Protection and Affordable Care Act, I urge you to focus on services that will offer authentic care and save lives,” said Deirdre McQuade, assistant director for policy and communications at the bishops’ Secretariat of Pro-Life Activities.

The Institute of Medicine’s Committee on Preventive Services for Women is charged with recommending to the Department of Health and Human Services a list of preventive services for women that will be mandated for all health plans under the new health reform law. HHS is to announce that list next August.

Addressing the committee at its first meeting, McQuade echoed a letter sent by the Office of the General Counsel of the U.S. Conference of Catholic Bishops to HHS Sept. 17.

“The conference has a particular concern that contraceptives and sterilization not be mandated as ‘preventive’ services,” she said. “To prevent pregnancy is not to prevent a disease – indeed, contraception and sterilization pose their own unique and serious health risks to women and adolescents.

“In addition, contraceptives and sterilization are morally problematic for many stakeholders, including religiously affiliated health care providers and insurers,” McQuade said.

HHS’ interim final rules for women’s preventive services include such medical services as blood pressure and cholesterol screening; diabetes screening for hypertensive patients; various cancer and sexually transmitted disease screenings; routine immunizations; and counseling related to aspirin use, tobacco cessation and obesity.

Those services “pose little or no medical risk themselves, and they help prevent or ameliorate identifiable conditions that would pose known risks to life and health in the future,” McQuade said.

But the use of prescription contraceptives “actually increases a woman’s risk of developing some of the very conditions that the ‘preventive services’ listed in the interim final rules are designed to prevent, such as stroke, heart attacks and blood clots …, so a policy mandating contraceptive services as ‘preventive services’ would be in contradiction with itself,” she added.

McQuade also said the mandated inclusion of contraception and sterilization would violate the freedom of conscience of those employers and insurers who object to them and of the insured who prefer that their policies not include them.

“Thus the administration’s promise that Americans who like their current coverage will be able to keep it under health care reform would become a hollow pledge,” she said.

The Institute of Medicine is “an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision-makers and the public,” according to its website. It is an arm of the National Academy of Sciences.

In their September letter to HHS, Anthony R. Picarello Jr., USCCB general counsel, and Michael F. Moses, associate general counsel, raised several other arguments against the inclusion of contraception or sterilization as mandated health services.

“Some may claim that contraception and sterilization are ‘preventive services’ in the sense that they ‘prevent’ abortion,” they said. “But this is implausible for several reasons. … Studies have shown that the percentage of unintended pregnancies that are ended by abortion are higher if the pregnancy occurred during use of a contraceptive. Finally, numerous studies have shown that contraceptive programs do not reliably or consistently reduce abortion rates.”

Picarello and Moses also said the drug ulipristal, an “emergency contraceptive” marketed as ella, is specifically targeted to women who might already have conceived and is administered up to five days after unprotected sex.

“The policy advanced by Planned Parenthood – mandating coverage for ‘all forms of FDA-approved prescription contraception’ as a preventive service – would therefore be in direct tension with the statutory prohibition on mandating any abortion service, as at least one of the drugs covered by that policy is an abortifacient drug,” they said.

Catholic Review

The Catholic Review is the official publication of the Archdiocese of Baltimore.