Oregon is about to become the first state in the nation to try and reduce unwanted pregnancies by encouraging the use of the most effective contraceptives.
On a recent rainy Friday afternoon, 25-year-old Amanda Jenkins was at Oregon Health & Science University to see her doctor, Maureen Baldwin.
“So you’ve been on birth control I think in the past, right?” asked Dr. Baldwin.
“Yeah,” said Jenkins. “I’ve been on the pill for like five years now and I think it’s just something that’s getting a little old. I want to switch to something that’s a little more effective.”
Such medical conversations are not unusual. But what is unusual is that the state now wants to measure them.
The plan, said Helen Bellanca, chair of the Association of Reproductive Health Professionals, is to encourage doctors to ask female patients whether they want to get pregnant. If a woman does want to get pregnant, then there’s no need to talk about contraception. But if she doesn’t, the doctor will then ask what form of contraception she’s using — and whether she’d like to use something more reliable.
“So the metric is effective contraceptive use among women at risk of unintended pregnancy,” Bellanca said.
Ballenca explained that the state will count methods like IUDs, the pill and Depo shots for the metric, but not unreliable methods like withdrawal and condoms, “And that ‘s important,” said Ballanca, “because a huge number of women that are at risk of unintended pregnancy are using ineffective methods, primarily condoms.”
She said the hope is that steering women toward more effective contraception methods, will reduce unintended pregnancies.
“The majority of unintended pregnancies are not happy surprises,” said Ballanca, “they can derail women’s education plans, they can derail employment or job opportunities.”
Also, the unintended baby that’s not born, will save the health system a lot of money.
That’s why the state wants to make sure that at least 50 percent of women who don’t want to become pregnant are using effective methods.
The trouble is, the only practical way to document what contraceptive method women are using is through claims data — that is by counting the claims that patients make on their health insurance.
But there are gaps in claims data. For example, a woman who had a hysterectomy five years ago is not going to show up.
“We cannot measure through billing claims whether a woman desires to become pregnant or not and that’s why we have a benchmark that’s much lower than 100 percent,” said Lori Coyner with the Oregon Health Authority.
The coordinated care organizations that run Oregon’s version of Medicaid are currently providing about 35-40 percent of those women with more reliable contraception.
Cheryl Green is making a film about disability rights. She’s in favor of the new metric, but says she’s also concerned some doctors have a bias against certain people reproducing, like the disabled or poor.
“I can imagine that some providers will skirt over the ‘Do you want to have kids?’ question too quickly,” said Green. “I can see some doctors skipping it.”
Helen Bellanca says the state is aware of this kind of bias and there’s no intent to stop disabled women or women on Medicaid from reproducing: “When it comes to contraception we have to be particularly sensitive because we have a pretty awful history in this country of doing that,” she said.
Twenty-five-year-old Amanda Jenkins is not on Medicaid. She was the woman visiting her doctor at OHSU, and she decided to give up the pill. She lay back on a table and allowed Doctor Baldwin to inject a contraceptive implant into her upper arm. Jenkins is in favor of the new metric, because she said, being asked about contraception helps her stay in control.
“I think it’s good,” she said. “I mean for me, I really want to be on top of it you know because right now I have other health problems. I’m really not in a place in my life where I’m wanting a child.”
The new metric is scheduled to roll out in January.