Who is Representing the Uninsured in the Contraception Debate?

Yesterday’s House oversight committee hearing on contraception was far from productive. This is hardly unexpected; the committee is comprised mostly of men making decisions on women’s health, and the witnesses called were more of the same. To add insult to injury, Chairman Darrell Issa refused to allow law student Sandra Fluke to testify, citing her youth and inexperience. Fluke’s testimony was largely based on the personal contraceptive experiences of a friend. Issa’s refusal of the testimony sent a dual message: young women are not welcome, nor are their personal stories – a pretty strange message to send in a hearing purporting to be about contraception.

This disconnect between the committee’s demographics and the objective of the hearing became so great that Delegate Eleanor Holmes Norton walked out in protest of the dearth of women. Norton is right to be outraged; the homogeneity of gender representation at the hearing spoke far louder than any discussion held. Yet Norton has another reason to protest this hearing, for the disconnect in representation is not just gender-based. The committee and witnesses were not only a group of men, but they were also overwhelmingly white and middle-aged or older –- precisely the population least likely to have worries about either contraception or insurance coverage, as the charts below show.

This homogeneity in race and age adds another layer to the contraception debate -- the need for all Americans to have health insurance and have access to contraception through that insurance. Today, nearly half of all pregnancies every year are underintended -- over three million pregnancies a year. About forty percent of these abortions end in abortion. Moreover, according to the Guttmacher Institute: "Unintended pregnancy rates are substantially higher among poor and low-income women, minority women, women aged 18–24, cohabiting women and women with exactly one child than among other groups."

Unintended pregnancies leading to births or abortions can not only be profoundly difficult and disruptive for women, but cost all of us money. A study last year by the Brookings Institution found:

We find that taxpayers spend about $12 billion annually on publicly financed medical care for women who experience unintended pregnancies and on infants who were conceived unintentionally. After accounting for the fact that some of these pregnancies are merely mistimed while others are altogether unwanted, we also estimate that taxpayers would save about half of this amount if all unintended pregnancies could be prevented.

Yes, employers should provide free contraception coverage to all their employees, but what about those who don't have insurance at all, particularly the young and the poor who can least afford to a misstep in life? This is an issue that urgently needs to be discussed -- but the make-up of yesterday's hearing ensured that such a discussion would never occur.

Comments

[Physician of Many Uninsured]

I totally agree the uninsured are not well represented in all aspects of medical care. For nearly 25 years, I have provided care to medically indigent patients (40% of my practice). We provide contraceptive services to many young females through Title XX Family Planning through the state of PA. Our Oral Contraception options have gone from over 10 choices to 3 and sometimes 1, depending on contracted supplies! I hope these "free to patient" supplies never dry up, but with a more fiscally conservative government now at our state level, this is a grave concern of mine! These women need a female VOICE!!