Abstract
The paper discusses the issues of contraception under the Affordable Care Act. The notion of contraception is tightly connected with this reform. It is the main subject of heated debates, which were conducted in the U.S. government lately. According to the new provision, starting from August 2012, women will receive eight health care benefits free of charge. Those benefits include contraception and contraceptive counseling, HIV counseling, sexually transmitted disease counseling and others. Due to this reform, approximately 47 million women will receive free contraception coverage. One should take into account that before the adoption of Affordable Care Act nearly half of the American women between ages of 19-64 years avoided visits to the doctors, as they could not afford them.
Keywords: contraception, family planning, Affordable Care Act
Family Planning: Contraception under the Affordable Care Act
Introduction
Family planning is a relevant issue that is essentially important for all the women around the world. Every woman dreams about successful life with happy family, breathtaking career, loving husband and entertaining leisure. In order to achieve all these benefits a woman should be able to manage her time in a right way. Contraception is a useful tool in family planning. It gives women an opportunity to plan pregnancy, which is one of the most vital things in human life.
With the birth of the child, life not only acquires specific meaning, but also presupposes the change of the lifestyle and every day habits. Unfortunately, sometimes these changes turn out to be not so positive, as it seems at the first sight. The unexpected pregnancy affects the career, relationship with husband, and even the state of soul. The experience has shown that conscious approach to family planning is extremely important. It helps a woman to live and freely pursue her goals, to embody her creative and professional potential, and to devote herself to motherhood. Such rational approach to family planning is typical for women in the U.S. and modern contraception methods are vitally important for it.
Definition
While discussing the notion of family planning and contraception, one should take into account that contraception entails the use of drugs, chemicals, devices, surgery or behavior that control fertility amongst sexually active heterosexual people (Russell, Sobo & Thomson, 2000, p. 5). Contraceptive methods are the determining factors of sexual relations between the partners. The primary objective of modern society is the preservation of reproductive health and safe motherhood. According to the research conducted by Adam Thomas (2012) most of the unplanned pregnancies in the U.S. occur due to lack of motivation, which is necessary to avoid becoming pregnant, lack of information about contraceptives, and lack of access to contraceptives.
Every day, the problem of unplanned pregnancies is increasing in the U.S. This has been attributed to the little knowledge about contraceptives which are directly proportional. Cost issues also have been pointed out to bar women from getting the best contraceptives for their specific cases. Several researches have indicated that there are more unintended pregnancies among the teens, the poor and the unmarried. Women are at a potent age; they have low income that is below poverty level and have no health insurance that increases their chances of getting unwanted pregnancies.
There are a number of methods that might be useful to avoid pregnancy. These are: surgical, physiological, hormonal, and barrier methods. The issue of contraception is related to family planning clinics and is important for both nursing and healthcare consumer.
A nurse has an obligation to improve the overall health status of a society through preventing the risks, and advocacies that are geared towards increasing the knowledge of the people about their health. According to statistics, unwanted pregnancies have always been a threat to the health and even life of the mother and the new-born. The pregnant mother could seek for prenatal care at later stages of the pregnancy, increasing the risk of death for the infant and the mother. Teenagers are even worse placed because they are more exposed to miscarriages, maternal illnesses, neo-natal death, and even still births. This is as a result of the not yet mature anatomy that could lead to maternal complications as well as delivery of underweight infant, which is below 2.5kg. Such problems are experienced when people lack education thus knowledge on the best ways to maintain the infant and the overall pregnancy. Since it was unwanted in the first place, some pregnant mothers are not even keen to take care of their unborn infant. They lack knowledge and education on how to maintain their pregnancies. They also lack information on the risks involved if they did not take good care of their pregnancy. In such cases, the mother could have ignored the available sources of information leading to the lack of sufficient information, thus poor health development in a given society.
The role of nurses in this whole issue is to delve into the problem and come up with workable measures to reduce deaths at birth, either for the mother, infant or both. Unwanted pregnancies lead to adverse behavior of substance abuse which further endangers the infant and the mother. The mother who uses substances with teratogen is risking the health of the infant or adverse conditions that would lead to placement of the infant in NICU (Neonatal intensive care unit). This increases the cost of keeping the infant by far, a challenge felt by the government and the taxpayer, leading to a financially poor society. These pregnancies are experienced by poor women who would not afford the care, hence all the burden is shouldered by the government. It is therefore important for the nurses to create awareness and provided education to the vulnerable women about contraception, which would reduce the cost and psychological imbalances. The nurses would then teach the women on sex education to reduce chances of maternal deaths due to unwanted pregnancies. Nursing is therefore the most direct field to this menace of unwanted pregnancies, hence are the best to use to popularize contraceptives.
The use of contraceptives is also beneficial to the health care consumer, in this case the women. They are allowed to determine the time when they want to get children and control the number of children they can get hence their family sizes. They also reduce their expenses in pre natal and post natal care thus improving their overall livelihood.
History
The history of male and female contraception goes back to antiquity. The rudiments of modern methods of pregnancy prevention and pregnancy termination occurred centuries ago. Even in the ancient times people understood that unplanned pregnancy just disappoints future parents, and for that reason they tried to avoid it. The journey to legalize the use of contraceptives has been long and challenging. In the past, men dominated the policy making processes and their word was taken very seriously. Women were only to remain subjects to whatever men decided about them. Men rejected the issue of contraceptive use but some women started to fight against the decision. Among the well known women was Margaret Sanger who fought for women liberation and founded American Birth Control League and Plan parenthood. This organization was remembered under her leadership due to the revolutionary move the development of the contraceptive pills. She also lobbied for women to be allowed to access health institutions in order to determine their HIV status, STDS, and birth control education and tests. They were also able to receive advice on the best preventive measures to all these cases.
Some of those who were opposed to the use of contraceptives were the churches which held the value that contraception was equivalent to abortion. This was a very poor way to approach the issue because most contraceptives reduce the chances of conception, thus abortion ruled out in case there is no conception.
American President Barack Obama suggested creation of health care reform. When he became the President of the United States, he made health care reform one of the key issues on agenda. This reform was the subject of heated debates, which were conducted in the government.
There was a great conflict between the Catholic Church and American President. The matter is that according to the health care reform, the Catholic schools and hospitals had to pay for the birth control measures. Forty three Catholic Institutes have sued the Obama administration. Catholic bishops called Affordable Care Act the unprecedented attack on religious liberty.
Besides, such politicians as Joe Manchin, Mitt Romney, John Boehner, and others supported the Catholic Church. Joe Manchin stated that this decision was the direct affront to religious freedom. John Boehner accused Obama administration of violating the First Amendment to the U.S. Constitution, which guarantees freedom of religion. Mitt Romney pointed out that Obama has declared war against religion. As a result of all these accusations and lawsuits, Barack Obama stated that president’s administration will not demand the coverage for contraception from religious institutions. Under the new amendment to the reform, women will receive free contraceptives from an insurance company in case of employer’s denial because of his/her religious beliefs. On June 28, 2012 the reform was affirmed by the U.S. Supreme Court (Sonfield, 2012).
People Interested in Affordable Care Act
Everyone in the United States is affected by the Affordable Care Act (ACA). The women are the beneficiaries in that there are in most cases the ones who will access theses services that will help them reduce the cases of unwanted pregnancies. Men are integral parts of the society and they are among those who help in paying the burdens of birth of infants that are unplanned for. In family situations, they support the family when the wife is undergoing the birth process.
Tax payers are also affected by ACA in that the whole issue is funded by money obtained from taxes. When the costs increase, the tax obligation of the taxpayer increases as well, thus hurting their income. The contrary is the same and when the amount of burden reduces, taxpayers are better off. The Federal government is also affected because it contributes all the funds, as well as planning and implementation of the Act. The church also feels that there are plans to ruin the family life. The church stands for the use of natural family planning methods but unfortunately they are not working. This leads to the feeling that the role of creation and Godly reproductive ways are being undermined. Plan Parenthood is impacted because it is concerned with all births and ensure that the young ones get the best prenatal and post natal care.
Policy
Policy makers have always looked for the best way to cure the problem that is slowly becoming serious. They have always looked for the best ways to reduce unwanted pregnancies, abortion, and increase of people who seek for subsidized public services. Among the most prided solutions that they have is the ACA which offer free contraceptives in government hospitals thus reducing the funds needed in the health sector.
As more people visit health centers for prenatal and post natal care for free, they put more pressure on the economy. It is therefore more advisable for the people to go for contraception which will save a lot of money from the government treasury.
According to the ACA, every woman will receive eight health care benefits free of charge starting from August 2012. Those benefits include contraception and contraceptive counseling, HIV counseling, sexually transmitted disease counseling and others. Due to this reform, approximately 47 million women will receive free contraception coverage. One should take into account that, before the adoption of Affordable Care Act, nearly half of the American women between the ages of 19-64 years avoided visits to the doctors, as they could not afford it. This health care reform will change the situation.
The reform is extremely important for families living beyond the poverty line, young women, and teenagers, who cannot afford private insurances. According to the World Health Organization, approximately 16 million girls of teen age give birth to children each year. In most cases, pregnancy is unplanned, and it is associated with health risks. Minors should have “easy and confidential” access to contraceptive services (Weiss, 2012, p.4). When parental consent is required, the teen is threatened and avoids contraception. Due to this factor, the risk of unplanned pregnancies increases. It should be stated, that 80% of teen pregnancies in the USA are unplanned, and usage of contraception reduces the risk of becoming pregnant.
Impacted Parties
Insurance Companies
While discussing the ACA, one should take into account the viewpoint of insurance companies towards this reform. A number of people consider that this law is cost effective for the insurers. However, it is not so. After a detailed investigation of insurance companies’ profits, it becomes understandable that they gain money not from private insurances, but from the federal programs Medicare and Medicaid. The Affordable Care Act presupposes insuring a large number of people, who live beyond poverty line, free of charge. It means that all the expenses will be covered by the government. As a result of this reform, insurers will definitely flourish. A writer Wendell Potter discussed this topic in his article “Why Insurers Want ObamaCare’s Medicaid Business” states that people should not listen to what information was coming from Washington (Potter, 2012). He said that the reform in health care could be a very profitable venture by giant benefactors of GOP. These benefactors are the insurance companies. Insurance companies will benefit from the ACA, as it is more profitable to provide people with contraceptives, than pay thousands of dollars for abortions prenatal care.
Medicaid
The Affordable Care Act will have a significant impact on the governmental health care program Medicaid. Starting from the 2012, it will definitely change the structure of Medicaid by making health care services, including family planning services, available to all layers of the population, regardless of their family status and income. It will provide insurance to all people, living below 138% of the federal poverty level. The family planning services are intended to reduce the number of abortions and unplanned pregnancies. One should take into account that approximately 5% of all pregnancies in the country are unplanned, and every child birth costs approximately $9,000. The program Medicaid funds nearly one third of all pregnancies, thus it is not difficult to calculate that it will reduce its expenses by providing contraception counseling and making contraceptives free. The national researches have shown that every dollar spent in Medicaid on family-planning saves approximately three dollars of the program’s expenses on prenatal care and abortions.
Resources
It was already mentioned that Affordable Care Act is a costly reform. According to a research conducted by the George Mason University, in the period from 2012 to 2022, the U.S. federal expenditures on the mentioned above reform will be approximately 1.15 trillion dollars. In March, the Office of Congressional Budget has published its own estimates concerning the cost of Affordable Care Act. According to the official data, this reform will cost 1.76 trillion dollars. It becomes understandable that this Act involves comparative increase in health care costs in the next 10 years. However, the share of additional costs is less than 0.5% of GDP (potter, 2012). That is why it might be supposed that this reform will not have a significant effect on the U.S. economy. People are better off because of this reform, because they will not pay extra costs for the contraception and some medical services.
Solution
More funds to intensify sex education should be availed. Under sex education, young girls should be introduced to the different contraceptive methods. Safe sex practices should also be included to the people who are sexually active. At the same time, the education should include the dangers and risks of having unsafe sex. Since they are poor and would rather not attend to then in case they are paying.
One of the possible solutions to the above mentioned problems is governmental insurance, which helps American citizens to cover almost all preventive-health costs. Even when a person buys contraceptives, those costs will be less than prenatal care costs. In 2003, about 1 million ladies received contraceptives through the Family PACT. Of these, 217000 were aged between 13 and 19 years while about 783000 were aged between 20 and 44 years. Oral contraceptives were preferred by about 449000 ladies, injectables attracted 162000 while long term contraceptive methods were administered to 22000 (cledad, 2011). About 37000 ladies received emergency contraceptives.
However, it is worth mentioning that religious employers object to paying the insurance that covers the preventive healthcare services. For that reason, “alternative ways to fulfill the contraceptive services” (ACA’s Contraceptive Services Coverage Mandate: Regulatory and Judicial Update, 2012, p. 2) are considered, and some optimal ways to satisfy the requirements of both sides. Unfortunately, as a result of those objections, ordinary workers suffer; a lot of them cannot afford qualified preventive health care without insurance that is covered by the employer.
Proposal
The best proposal in this situation is proceeding with adoption of this reform. It would be wise to make healthcare services free to all people. Of course, at first sight this idea seems naïve but a closer look it would show a contradictory idea. The matter is that when a low-income family or teenagers give birth to a child, the government spends more funds on it than it could have spent on the birth control measures. Free contraceptives help to improve the health of the population. One should take into account that unwanted pregnancies impose burdens on women and their families.
According to this act, nearly all people have the access to health care. This reform helps to stop a number of sexually transmitted diseases, as it makes medical counseling free of charge. It presupposes family promotion seminars. The matter is that teenagers are not children; they should be aware of all methods of birth control, and understand that a child should be born in a family. The educators from Planned Parenthood Association in Utah state that: “the more a teen knows the better decisions they will be able to make” (CPSUC, 2012). , and it is true.
Implementation of the Solution
In order to proceed with ACA adoption, people should vote for President Barack Obama, who suggested it. One should not listen to the opponents, as human health is the most important thing. It is understandable that this reform presupposes a slight GDP increase; however, one should think about its aim. It was implemented to provide the insurance to thousands of American residents, who live below the poverty line. This one of the first steps, made to reduce the number of unplanned pregnancies, constant abortions, and sexually transmitted diseases.
Conclusion
In conclusion, it should be stated that contraception, as well as other health planning services, is a vital issue for a woman. American President Barack Obama understood it well. Most people in the U.S. cannot afford proper medical care, which they need. Affordable Care Act makes medical services to be available to all the layers of population. One should take into account that before adoption of this reform, the U.S. did not have free medicine. Medical services were paid by the insurance companies. Obama’s initiative was designed to reduce the cost of insurances, and to make medical care AFFORDABLE.
Contraception available to all American people is one of the wisest things in this act. The opponents state that free usage of contraception violates the freedom of religion; however, high cost of contraceptives seems to be the violation of the right to choose. When a person cannot afford a thing, he/she does not think about it at all.
Finally, it should be mentioned that this reform is important because it will save thousands of human lives.