SAHM Statement Regarding Contraceptive Access Policies

Access to affordable, confidential contraceptive services is critical to promoting health and avoiding unintended pregnancies among adolescents and young adults.  Over the past several months, the Trump Administration and House of Representatives have taken a number of actions that would limit access to these essential services including passage of the American Health Care Act (AHCA), expansion of conscientious objections to contraceptive coverage for employers, and the elimination of funding for the United Nations Population Fund (UNFPA). Also concerning are the Senate’s just released “Better Care Reconciliation Act” and recent reports that the Administration is considering further executive actions which would curtail mandatory coverage of all FDA-approved contraceptives as currently guaranteed by the Patient Protection and Affordable Care Act (ACA). As a multidisciplinary, international organization focused on promoting the health of adolescents and young adults across the globe, the Society for Adolescent Health and Medicine (SAHM) strongly opposes policies that limit access to contraception.

The U.S. has the highest teen pregnancy rate in the developed world; policies that limit access to contraception are harmful to America’s youth.

Despite historic declines, the U.S. still has the highest rate of teen pregnancy in the developed world. Teen pregnancy in the U.S. is associated with significant public costs of over $9 billion per year and teen parents and their children have poor medical, social, and financial outcomes. Additionally, nearly 50% of all pregnancies among U.S. women are unplanned with rates higher among historically disadvantaged, poor, and rural communities.  Research confirms that improved use of contraception is the largest factor contributing to historic declines in the rate of teen pregnancy that have been observed over the past 10 years. Consequently, unhindered access to contraceptive services for adolescents is recommended by prominent professional organizations including the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the World Health Organization (WHO). Likewise, SAHM opposes policy changes proposed by the Administration and Congress that threaten to derail effective and evidence based efforts to reduce teen pregnancy. 

Tens of millions of American youth are covered as dependents on private health plans and could lose access to contraception if health plans are allowed to opt out of the contraceptive coverage mandate.  

The Departments of the Treasury, Labor, and Health and Human Services recently created a draft document proposing to curtail the contraceptive coverage mandate issued through the ACA. The proposal asserts that an exemption to the contraceptive mandate should extend to all health plans that object to contraceptive coverage on religious grounds or based on “moral convictions”.  In contrast to the rationale laid out by the Administration, SAHM is concerned that adolescents and young adults at highest risk of unplanned pregnancy would be disproportionately affected by this policy change. Over 55% of the U.S. population was covered by a private insurance plan in 2015, including 46 million children and 21 million young adults age 19-25 covered as dependents. Though adolescents and young adults may not be the primary holders of employer-based health plans, they will certainly be affected as dependents on such plans. Furthermore, it is well documented that cost is a major barrier to contraceptive use among adolescents, especially the high upfront costs associated with the most effective contraceptive methods such as implants and IUDs. The ACA contraceptive coverage mandate effectively reduced cost as a barrier to contraceptive access.  Curtailing this provision would be particularly harmful to adolescents and young adults. Consequently SAHM stands in opposition to further exemptions to the contraceptive coverage mandate.

The American Health Care Act and Better Care Reconciliation Act cut funding to programs that provide contraceptive services to youth who rely on publicly funded safety net programs.

Access to contraceptive care for adolescents and young adults is also threatened by the cuts to the Medicaid program, elimination of the Medicaid expansion, and prohibition of payments to Planned Parenthood that would result from implementation of the health care proposals passed by the House and introduced in the Senate.  Medicaid provides comprehensive health insurance coverage for over 30 million children, including adolescents through age 18.  Older adolescents and young adults ages 19-26 experienced the largest increase in insurance coverage following the Affordable Care Act and Medicaid expansion and are particularly threatened by policy changes to these programs. SAHM urges the U.S. Senate to reject the Better Care Reconciliation Act and maintain the essential health benefits and access to insurance coverage currently provided by the Medicaid program and the ACA, including the Medicaid expansion.

Cuts to U.S. funding of international family planning programs will result in more unplanned pregnancies and induced abortions around the globe. 

Finally, U.S. Policy has significant implications for provision of essential reproductive health care around the world.  Data from the Guttmacher Institute indicate that funds initially appropriated by the U.S. for international family planning aid in fiscal year 2017 would result in receipt of contraceptive services and supplies by 26 million women and couples; prevention of 8 million unintended pregnancies, including 3 million unplanned births; aversion of 3.3 million induced abortions (the majority of which are provided in unsafe conditions); and prevention of 15,000 maternal deaths.  SAHM opposes the elimination of funding to the UNFPA, one important recipient of U.S. international family planning aid, which will result in adverse reproductive outcomes among women in countries around the world.

SAHM members working with young people in the United States and internationally know first-hand the beneficial impacts of policies that guarantee confidential and affordable access to contraceptives.  We are committed to continuing our work to improve the health of adolescents and young adults and to oppose policy changes that will restrict their ability to access essential contraceptive services.


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