Is Birth Control Preventive Medicine?

Almost no-one will argue that effective preventive medicine is the future.  Preventing a disease is almost always less expensive than treating that disease after a diagnosis. 

Less clear is the answer to the question, "What is a disease?"

Seems simple, right?  Well, maybe not...

Webster's Dictionary defines the word disease like this - a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

With that in mind, let's move to this question, "Is pregnancy a disease?"

Oh...  A little harder...  Objectively, pregnancy is manifested by distinguished signs and symptoms.  Yes, occasionally a man can get himself in some social trouble mistaking some extra pounds for a motherly glow...  But, for the most part, it's pretty clear when a woman is expecting - at least after she crosses the 6 month mark or so.

I think the more important point on the definition of a disease is "impairs normal functioning."  This is likely even more contentious.  Are there things that a person of the female perspective can't (or shouldn't) do while pregnant?  Should a woman be considered "impaired" while pregnant.  Now, my wife was certainly a little less emotionally "stable" while pregnant (and right after birth...) but I wouldn't agree that she was "impaired."  About the only "normal" thing impaired during pregnancy might be menstruation.

So, according to my incredibly skilled analysis above, preventing pregnancy could not be claimed to be preventive medicine, as I don't believe we can classify pregnancy as a disease.  A physical (and maybe mental) condition, yes. But, not a disease.

But, pregnancy IS expensive.  Now, if you're willing to boil water, clench your teeth on a stick, and do it the old fashioned way, maybe not.  But, to do it according to current American standards, it is. 

So, the point of this post...  Should pregnancy prevention be considered preventive medicine? A panel will begin meeting in November to decide that, among other questions.  If birth control is found to be preventive medicine, it could come to pass that insurance companies will be required to provide birth control to women at no cost.

Dr. David Grimes, an obstetrician-gynecologist who teaches medicine at the University of North Carolina makes this argument:

"There is clear and incontrovertible evidence that family planning saves lives and improves health. Contraception rivals immunization in dollars saved for every dollar invested. Spacing out children allows for optimal pregnancies and optimal child rearing. Contraception is a prototype of preventive medicine."

To me, from a cost perspective, this argument is pretty sound.  Save lives.  Optimal pregnancies.  Good return on investment.  Sounds good.

Others are not so convinced, and it is rooted in the disapproval of birth control in general.

"We don't consider it to be health care, but a lifestyle choice," says John Haas, president of the National Catholic Bioethics Center. "We think there are other ways to avoid having children than by ingesting chemicals paid for by health insurance."  Not a surprising stance from the Catholic church. 

Objectively, and if you ignore the argument about the morality of birth control, preventing unplanned or unwanted pregnancy could be a good thing financially for both the health care system and individuals who are impacted by lifelong costs (that they may have otherwise not incurred).  About the only group negatively impacted could be hospitals.  If estimations that about half of all pregnancies are unplanned, and we assume that half of those (25% of all pregnancies) would be delayed and the other half would have been prevented all together, then revenue for hospitals could be reduced and postponed if birth control was utilized at near-universal levels.

So, there are really unarguable financial benefits to universal availability of birth control (especially those that are more effective, like implants and intrauterine devices) and so the support for coverage really comes down to your position regarding the morality of birth control.

My crystal ball tells me we'll see universally covered (at little to no patient cost) birth control.