Most women who walk into a doctor’s office plan to pick up a magazine while they wait. Dr. Donald Cannon, who works at OG/BYN Care of Southern New Jersey, says his office in Camden County is no different: it’s busy most days. But a new birth control bill just might have them waiting less often. Signed by Governor Chris Christie, the law requires insurers to pay for six-month supplies of birth control.
“This will be a great benefit to our patients,” Dr. Cannon said. “They won’t have to make a trip to the pharmacy every month. If you’re a very busy person, you could delay getting your contraception, which could lead to unintended pregnancies.”
The bill’s sponsors argued that the new regulations will impact public health and improve the lives of women in New Jersey. They reasoned that having a half-year’s worth of birth control on hand isn’t just about convenience: it’s about staying consistent.
“The core issue with this bill is that for birth control to be the most effective, consistency is critical,” said Casey Olesko, the communications director at Planned Parenthood Action Fund of New Jersey. “For women who work full time, or work long hours, or have multiple jobs, it might be hard to get out to the pharmacy. Women might have childcare that they have to balance … or they have to make sure they have reliable transportation.”
The law will go into effect in March, which means most women will have to wait until next year to use this benefit, when they buy a 2019 health insurance plan. And not all plans are eligible: the law affects state-regulated plans, but not “self-insured” plans, which are regulated by the federal government.
Dr. Cannon says that his patients run out of birth control for a variety of reasons. Many women only notice that they’re out when they’re traveling, whether it’s for work, the holidays, or even an emergency trip. Many offices aren’t open over the weekend, he explained, and many on-call services don’t process prescription refill requests.
“They can go several days without it. And it’s not as effective if you don’t take it every day, at the exact same time every day,” Dr. Cannon said. He added that patients who try to catch up on missed pills by doubling their dose should keep this in mind.
“Patients will say, ‘I was taking the pill, but it didn’t work.’ Or, ‘I got pregnant on the pill.’ Usually, we understand that to mean that they probably weren’t taking it consistently,” he said. “Any discrepancy in how you take it, or if you’re not on schedule, can lead to an unintended pregnancy. And we see that all the time,” he said.
“People may have decided that they’ve ended their childbearing, and all of a sudden, they have another pregnancy that they’re dealing with,” Elizabeth Nash, Senior State Issues Manager at Guttmacher said. “You’re then, of course, thinking about different options: whether or not to carry to term, or adoption.”
“We do know that almost half of all unintended pregnancies end in abortion,” she added. A 2017 fact sheet from the Guttmacher Institute cites data published in the New England Journal of Medicine, which found the percentage of unintended pregnancies that resulted in abortion remained stable over a three-year period, between 40 percent to 42 percent, though the overall rate of unintended pregnancy fell by 18 percent.
“Unintended pregnancy has a whole host of outcomes, from issues with birth spacing to delayed access to pre-natal care, because someone wasn’t expecting to be pregnant at that point in time,” Nash said.
The CDC and the U.S. Office of Population Affairs recommend that doctors should “provide or prescribe multiple cycles (ideally a full year’s supply) of oral contraceptive pills, the patch, or the ring to minimize the number of times a client has to return to the service site.”
The original version of the New Jersey bill, which was vetoed by Governor Christie, would have required insurers to pay for a year’s supply at a time.
Only two states — New Jersey and Maryland — have passed legislation that requires insurers to cover birth control for six months at a time. The rest of the states that have passed legislation on this, have passed twelve-month bills. For this reason, Nash sees New Jersey’s law as a compromise.
“In his veto message, Gov. Christie was touting his track record on women’s health issues which — uh — it took me a back a little bit,” she said. “Because this is the same governor who eliminated $7.5 million for publicly-funded family planning services.”
The family planning services line item was removed from the state budget in 2010, shortly after Gov. Christie began his first term. The funding was provisioned to cover preventative reproductive health care services, from breast and cervical cancer screenings to birth control.
Nash added that Christie also withdrew the state’s application for the Medicaid family planning expansion, which would have allowed low-income residents who don’t qualify for Medicaid to access family planning services under the Medicaid program.
“He has spent the last eight years — his whole administration — restricting access to reproductive health care in New Jersey. So maybe Governor Christie is trying to remake his image, and appear more concerned about women’s health, despite years of evidence to the contrary,” Olesko said. “Nonetheless, we’re glad that he’s showing compassion towards New Jersey’s women,” she said. She added that Planned Parenthood Action Fund of New Jersey will continue to advocate for a twelve-month birth control bill.
“We’re really excited for Governor-elect Phil Murphy to restore that funding for family planning services,” she said.