Trump Officials Dispute Birth Control Benefits to Justify Rules

(Bloomberg) -- When the Trump administration elected to stop requiring many employers to offer birth-control coverage in their health plans, it devoted nine of its new rule's 163 pages to questioning the links between contraception and preventing unplanned pregnancies.

In the rule released Friday, officials attacked a 2011 report that recommended mandatory birth-control coverage to help women avoid unintended pregnancies. That report, requested by the Department of Health and Human Services, was done by the National Academies of Sciences, Engineering and Medicine -- then the Institute of Medicine -- an expert group that serves as the nation's scientific adviser.

“The rates of, and reasons for, unintended pregnancy are notoriously difficult to measure,” according to the Trump administration's interim final rule. “In particular, association and causality can be hard to disentangle.”

Multiple studies have found that access or use of contraception reduced unintended pregnancies. 

Claims in the report that link increased contraceptive use by unmarried women and teens to decreases in unintended pregnancies “rely on association rather than causation,” according to the rule. The rule references another study that found increased access to contraception decreased teen pregnancies short-term but led to an increase in the long run.

“We know that safe contraception -- and contraception is incredibly safe -- leads to a reduction in pregnancies,” said Michele Bratcher Goodwin, director of the Center for Biotechnology and Global Health Policy at the University of California, Irvine, School of Law. “This has been data that we've had for decades.”

Riskier Behavior

The rules were released as part of a broader package of protections for religious freedom that the administration announced Friday.

The government also said imposing a coverage mandate could “affect risky sexual behavior in a negative way” though it didn't point to any particular studies to support its point. A 2014 study by the Washington University School of Medicine in St. Louis found providing no-cost contraception did not lead to riskier sexual behavior.

The rule asserts that positive health effects associated with birth control “might also be partially offset by an association with negative health effects.” The rule connects the claim of negative health effects to a call by the National Institutes of Health in 2013 for the development of new contraceptives that stated current options can have “many undesirable side effects.” 

The rule also describes an Agency for Healthcare Research and Quality review that found oral contraceptives increased users' risk of breast cancer and vascular events, making the drugs' use in preventing ovarian cancer uncertain.

Federal officials used all of these assertions to determine the government “need not take a position on these empirical questions.”

“Our review is sufficient to lead us to conclude that significantly more uncertainty and ambiguity exists in the record than the Departments previously acknowledged.”

To contact the reporter on this story: Anna Edney in Washington at aedney@bloomberg.net.

To contact the editors responsible for this story: Drew Armstrong at darmstrong17@bloomberg.net, Timothy Annett