It has become nearly perennial that a bill is introduced in the Nebraska Legislature to expand Medicaid eligibility for free contraception. This year is no exception as LB 77, introduced by Sen. Jeremy Nordquist, would expand income eligibility for Medicaid funded contraception to 185 percent of the federal poverty income guidelines.
The main argument for such a measure boils down to this: the more people who use contraception, the fewer unintended pregnancies there will be and, therefore, the fewer abortions there will be. And, if the recipients of free contraception are people receiving public assistance, the state will ultimately save money because the cost of providing free contraception will be more than offset by what the state saves in not having to pay for pregnancy and child-related expenses.
Although this argument may have some intuitive appeal, there is little or no meaningful data to support it. No one has demonstrated any causal link between either greater access to contraception and fewer unintended pregnancies and abortions, nor between greater usage of contraception and fewer unintended pregnancies.
It is simply assumed that what may work on an individual level will work on a societal level; but data and experience contradict this assumption. On a national level, unintended pregnancies have risen along with increased access to contraceptives through various public programs.
According to some family planning researchers, increased access to contraceptives may actually drive unintended pregnancy and abortion up, not down. Non-marital pregnancies, for example, increase in the long term when access to contraception increases, which studies suggest is due to “risk compensation” – the belief that one is insured against the risk of pregnancy. Encouraging this false sense of security may end up achieving the opposite of what this bill intends.
This result is born out in numerous studies, conducted by family planning proponents, demonstrating that greater access to contraception does not reduce unintended pregnancies and abortions. For example:
James Trussell who originated the claim that easier access to emergency contraception could “result in a greater than 50% reduction in abortion rates” has conceded that 23 published studies from 10 countries disprove his claim. According to every one of the 23 studies, published between 1998 and 2006, easier access to EC fails to achieve any statistically significant reduction in rates of unintended pregnancy and abortion.
The cost-savings argument simply assumes that if Nebraska expands government funding for contraception more women in the target population will use contraception and, as a result, fewer pregnancies will occur providing savings to our state by reducing prenatal, delivery and postnatal costs that would otherwise be paid for by Medicaid.
This argument is undermined by the primary study used to make the cost-savings claim. The 2004 study examined six states that had implemented a Medicaid expansion of contraceptive coverage. The study claims that all six states experienced a net cost savings by reducing the number of pregnancies and births that would result without this expansion of contraception.
However, the study reveals that not every state that was examined experienced an increase in family planning use and only two of the six states “appeared” to experience a reduction in unintended pregnancies. How can the study credibly claim that all six states saved money by averting births due to better access to contraception when not every state experienced an increased use of contraception and four of the six states did not experience a decline in unintended pregnancies? This strains credibility.
It is encouraging to know that some women are beginning to challenge the general assumption that women’s health and equality are advanced by greater access to contraception and abortion. A group called “Women Speak for Themselves” formed in response to the phony “war on women” narrative created by those trying to exploit women to advance an ideological agenda. I encourage you to check them out at www.womenspeakforthemselves.com.
