Birth control may soon become much more affordable if federal regulators decide to include it on the list of preventive health services that insurance plans will be required to provide under health reform beginning on September 23. This may not come a moment too soon, given that an increasing number of teenage girls say they rely solely on the rhythm method—abstaining from sex on days when they're likely to be fertile—to avoid getting pregnant; about 17 percent of teen girls with some sexual experience reported in a new government survey that they use this method, up from 11 percent of teens who responded to a similar survey in 2002.
The majority of employer-based health insurance plans already provide some contraceptive coverage, but reproductive rights groups like Planned Parenthood would like to see every plan offering comprehensive coverage for all forms of contraception, from birth control pills to surgical sterilization to intrauterine devices. The group recently launched this website to get women to share how the pill has transformed their lives. On the opposing side, the American Life League and other anti-abortion organizations are planning a "Protest the Pill Day" this Saturday to call attention to what they call the pill's "potential for fatal effects on pre-born children."
While this political football gets thrown back and forth, the Centers for Disease Control and Prevention last week issued some new safety advice on the use of hormonal contraception for women with specific health conditions, ranging from heart problems to fibroids to rheumatoid arthritis. "These recommendations will let a woman know whether or not a particular method is safe for her—though not which method is more effective or in line with her personal preferences," says CDC health scientist Kathryn Curtis who helped write the guidelines. For instance, oral contraceptives have a failure rate of just 0.3 percent when used perfectly by taking the pill at the same time every day. But because most women occasionally skip a pill or fudge the timing, these methods have a "typical use" failure rate of about 8 percent. Ditto for the contraceptive patch and vaginal ring, which need to be replaced monthly. Implantable methods, like intrauterine devices (with a failure rate of up to 0.8 percent) don't have the same variation between typical and perfect use, since they require no user effort once they're inserted. The rhythm method increasingly favored by teens has a 25 percent failure rate. "Safety is just one small piece of the puzzle," says Curtis. But it's a crucial consideration for women with the following conditions:
• Lactating. During the first month of breast-feeding, women should avoid using any hormonal contraceptive containing estrogen (the pill, patch, or ring) because the hormone could reduce milk supply. Progesterone-only contraceptives and barrier contraceptives, like condoms, are fine to use, says Curtis. Most women, however, find that they don't need to use contraception for the first six months of nursing if they're not supplementing with formula or solid food and haven't resumed menstruation, since breast-feeding suppresses ovulation. It's still a good idea to check with your doctor to be sure.
• Blood clots. A diagnosis of deep vein thrombosis means you should abstain from any hormonal products with estrogen, since this hormone can increase the risk of clots. Progesterone-only contraceptives, like the Depo-Provera shot or the progesterone-releasing Mirena IUD, are safe to use.
• Breast cancer. None of the hormonal methods are safe for breast cancer patients, says Curtis, but it's fine to use the ParaGard IUD (which doesn't release progesterone) or a barrier method, like condoms or a diaphragm; some women may also opt for sterilization.