Debunking “FloozyCare”

Image: Tanya Little (Flickr / Creative Commons)

As the implementation of the Affordable Care Act continues, controversy remains around requiring contraception coverage as part of minimum preventive benefits. This study examined whether providing free reversible contraception was associated with a change in sexual behavior.

Using data from the Contraceptive CHOICE Project, researchers performed a secondary analysis. The CHOICE Project is a prospective cohort study that followed 9,256 women, ages 14-45 years old for 2-3 years. CHOICE freely provided all methods of reversible contraception to reduce unintended pregnancy.

Secura and colleagues evaluated whether providing women with contraception at no cost was positively associated with known risk factors for pregnancy and transmission of sexually transmitted infections (STIs): number of male sexual partners and frequency of intercourse. Researchers compared data during the previous 30 days at baseline to data at 6- and 12-months. Out of the entire group, 85% or 7,751 participants completed 6- and 12-month telephone surveys.

Researchers found that the median number of sexual partners was unchanged from baseline to 6 and 12 months. About 71% had the same number of sexual partners at 6 and 12 months, while 13% reported a decrease and 16% reported an increase (P <0.01). Out of the 16% who reported an increase in number of sexual partners, more than 80% had an increase from zero to one partner.

Regarding frequency of intercourse, about 50% of respondents reported an increase while the other 50% reported no change or a decrease. Increased frequency of intercourse did not result in increased incidence of gonorrhea or chlamydia at 12 months (P <0.16). Overall, little evidence suggests that improved access to contraception is associated with increased sexual risk-taking behavior.

Commentary

It is hard to forget the image of five men testifying at a U.S. House of Representatives committee hearing concerning the impact of the contraceptive mandate on religious freedoms. Some media pundits have smeared a woman who was denied the ability to testify before the panel, calling her a “slut” and “prostitute” while calling the contraceptive mandate “FloozyCare”. These ugly campaigns focusing on promiscuity influenced the researchers to look whether data supported such claims.

Secura and colleagues have found statistically significant evidence supporting improved contraceptive access as a tool in reducing unplanned pregnancies without increasing promiscuity. Including contraception as part of essential benefits for health insurance allows women access to various options to find the best method for themselves so they can plan when to have a child.

A Centers for Disease Control and Prevention (CDC) report from February 2013 found that 99% of women of reproductive age who have had sexual intercourse have used birth control at least once. Women are using contraception already.

Let’s make it easier for women to reduce unplanned pregnancies.

Secura, GM et. al. Obstetrics & Gynecology. 2014; 123 (4): 771-776.

by

Bich-May Nguyen, MD, MPH