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How Free Birth Control Changed America

Before a 2012 contraceptive mandate, 30 to 44 percent of women's medical spending used to go toward birth control. After the mandate, those numbers fell to 13 to 22 percent.

The Trump administration is considering allowing any company and university to refuse to cover birth control in its health-insurance plans, according to a leaked document obtained by Vox. Under current rules, health insurance must offer at least one Food and Drug Administration-approved contraceptive at no cost to enrollees. Religiously affiliated non-profits and small for-profit companies can apply for an accommodation that exempts their plans from the rule, but in that event, a third party will cover birth control, so employees can still get it for free. The leaked draft regulation would allow any company to not cover birth control because of moral objections. It also doesn't require insurers to pick up the slack, Vox reports.

It's not clear whether the final rule—pending approval from the Office of Management and Budget—will look like the draft Vox obtained. In the meantime, the figures below show the effects that fully covered contraception have had on American women since the birth-control mandate was implemented by the Obama administration in 2012.

The Mandate Cut How Much of Women's Medical Costs Went to Birth Control

  • For the average woman on birth-control pills, 44 percent of her yearly out-of-pocket medical spending used to go to the pills, according to a recent study of people covered by a private insurance company. Immediately after contraceptive coverage went into effect, that number fell to 22 percent. The median was 0 percent.
  • An intrauterine device would take up 30 percent of the average woman's medical spending before the coverage rule went into effect. After, it took up an average of 13 percent of women's health-care spending—and 0 percent, at median.

It Encouraged More Effective Birth Control

  • After the birth-control mandate went into effect, women whose employer-provided health insurance fully covered birth control were slightly more likely to get any prescription contraceptive. They were also more likely to choose more expensive, long-acting methods, such as implants, intrauterine devices, and sterilization. One study has found people using such methods are 20 times less likely to have an unwanted pregnancy compared to people on birth-control pills, patches, and vaginal rings.
  • The contraceptive mandate also helped women take birth-control pills more regularly. (When taken perfectly, pills are more than 99 percent effective.) One study of insurance claims found that co-pays as low as $6 increased the likelihood that women would stop filling their generic pill prescriptions.

It Might Have Prevented Abortions

  • There's evidence that free birth control prevents pregnancies, births, and abortions among teenagers. Before the passage of the contraceptive mandate, scientists ran a study offering zero-cost contraceptives to more than 9,000 girls and women, ages 14 to 45, in the St. Louis area. Thirty-four out of every 1,000 teens who participated in the study became pregnant, and 10 out of every 1,000 had an abortion. The national teen pregnancy rate at that time was 159 per 1,000. The teen abortion rate was 42 per 1,000.

Among all of the Obama administration's health policies, the birth-control mandate had among the more widespread effects. Should it be rolled back, it'll represent a turnaround once again for women and families across the United States.