In August of this year, the Department of Health and Human Services announced that, as part of its preventive health initiative under the Patient Protection and Affordable Care Act, insurance companies would be required to provide birth control with no co-pay beginning in August of next year. This decision empowers women to have more control over their reproduction and should (hopefully) decrease the percentage of unintended pregnancies, which currently stands at a shockingly high 50 percent. Evidence shows that the medicalization of contraception—that is, positioning physicians as gatekeepers to contraception—increases cost and decreases access. In evaluating what contributes to unplanned pregnancy, 54 percent of women stated cost as an obstacle to contraception use and 66 percent claimed that an inability to obtain contraception played a role.

Today there are eleven contraceptive options for women: female condom, tubal ligation, cervical cap, diaphragm, implant, injectable, IUD, patch, pill, ring, and sponge. On the whole, female methods tend to be more expensive than male methods because most require at least one physician visit and some involve a renewable prescription. Only two of the eleven female-only contraceptives—the sponge and the female condom—do not require seeing a physician. This means that 82 percent of female methods require at least one physician visit in order to acquire the contraceptive. Moreover, 36 percent of female methods require a prescription (injectable, patch, pill, and ring), which means women must continually renew their contraceptive by going to the pharmacy or doctor. Most doctors will not continue renewing prescriptions without seeing their patients yearly, so the initial visit when the doctor prescribes the contraceptive is not enough to ensure continued access to the contraceptive.   

Due to the expense of initiating and maintaining contraception, women spend 68% more out of pocket toward their reproductive health care than men of the same age. Currently 28 states mandate insurance companies to cover contraception to the same extent as they do for other prescription medications. However, 20 of these states have provisions in place for providers, plans, or employers to deny contraceptive coverage for religious or moral reasons.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

Last week, Health and Human Services Secretary Kathleen Sebelius overruled the decision of Food and Drug Commissioner Margaret A. Hamburg to allow the wider availability of Plan B One-Step® (levonorgestrel, Teva Women’s Health, Inc.) without a prescription to all women of child-bearing age, more specifically to adolescent girls under age 17. This was the first time that a health secretary has ever publically exercised statutory authority to reverse an FDA commissioner. Moreover, Secretary Sebelius was fully supported by President Obama in this action.

However, today’s headline – “Sebelius: Decision to keep Plan B age restrictions not political” – is difficult to believe. Particularly, when Plan B decisions have almost always been political. See here and here.

It’s difficult when a career politician dismisses the professional advice of experts and claims that the decision did not involve political considerations. But what gives credence to the Secretary’s stand is: (1) her pro-choice positions as governor of Kansas, (2) the fact that she’s facing considerable opposition from well-known Democratic leaders around the country, and (3) her willingness to reconsider the issue if the manufacturers of Plan B reapply with additional data about the “significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age.”

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

We humans might not be able to regrow a leg, as can a cockroach or salamander, or regenerate a missing half, like a flatworm, but our organs can replenish themselves – thanks to stem cells. Two new reports about opposite ends of the respiratory system may pave the way for replacement breathing parts.

A 36-year-old grad student from Eritrea was facing certain death from a golf-ball-sized tumor obstructing his trachea and sending tentacles towards his bronchi, the paired tubes that lead into the lungs. He was saved with a “tailored bioartificial nanocomposite” replacement trachea seeded with his own bone marrow stem cells, reported in The Lancet.

Cancer of the trachea is often inoperable and rapidly fatal because even a ventilator can’t push air into the lungs. But the combination of a glass-like tube standing in for the natural cartilage plus the patient’s own stem cells lets biology take over. Extracellular matrix spread over the tube, new capillaries sprouted, and a coat of epithelium knitted itself. The man is now well and lived to see the birth of his child, thanks to the tissue engineers at the Karolinska Institute and the University of Iceland.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.