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Why Do 24 States In The U.S. Refuse To Cover The Most Effective Form Of Birth Control?

IUDs are more popular than ever ... but in half the country, they come with a hefty price tag.

For many women, choosing the right form of birth control is a game of hormonal roulette. A pill that works great for your friend gives you terrible mood swings, and the one that made you lose weight causes your friend to gain it.

The Pill remains the most common method of birth control: 26% of all contraceptive users are on it, but 30% of them will discontinue use because they are unhappy with its effects.

Cultural shifts away from use of the Pill have researchers at the Kinsey Institute wondering if we should be called "The Pullout Generation."

While a growing number of young people prefer the withdrawal method, research continues to indicate that it's far from the safest option.

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With perfect use over the course of a year, condoms are 98% effective at preventing pregnancy, whereas withdrawal is 96% effective, according to Planned Parenthood. With imperfect use over the course of a year, the effectiveness goes down to 82% and 73% respectively.

What, then, is a woman who needs more effective protection -- and who has had bad luck with the Pill -- to do?

For many, the answer lies in IUDs, which belong to a category of birth control referred to as LARC (Long-Acting Reversible Contraception).

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These are implanted devices that come in both hormonal and non-hormonal versions, which are currently soaring in popularity. From 2011-2013, Planned Parenthood centers nationwide saw a 91% increase in the use of IUDs and implants. In other words, IUDs are having their Taylor Swift moment.

“There is more marketing and information about the IUD nowadays in the U.S. than there ever has been," says Dr. Vanessa Cullins, Planned Parenthood’s Vice President of External Medical Affairs.

She explains that Washington University's Contraceptive CHOICE study from 2012 found "that when women were given the choice of all the various kinds of contraceptive options -- and when they didn’t have to put forth money that they didn’t have -- they choose the more effective birth control method, which is really the IUD as opposed to the Pill.”

In other words, when money is not an issue, most women chose IUDs as their preferred method of birth control ... except that money is an issue.

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With IUDs, margin of error is essentially no longer an issue -- there is no pill you must remember to take daily, and no condom to properly put on.

In theory, the Affordable Care Act (commonly known as "Obamacare"), which expands coverage of basic preventative care, says explicitly that IUDs should be covered at no cost to the patient. Why, then, are there still millions of women who lack access to no-cost birth control, as well as a full range of options for a birth control method that doesn’t backfire on them?

Because 24 states won't take federal money intended for low-income patients.

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Medicaid is a government health care program, created in 1965, that helps cover bills for Americans with limited resources. But nearly half of U.S. states opted out of the ACA's expanded Medicaid funding.

“The IUD should be a more popular form of contraception --- however, it’s extremely expensive," says Cullins. "Under the ACA, the IUD should be accessible ... without any type of copay or any type of extra payment." Which isn't the case in states "that have refused Medicaid expansion."

She explains that, because of this, "5 to 6 million women [can't] choose an IUD without having to pay money out of pocket.”

You can check to see if your state has expanded Medicaid here:

As these states restrict access to IUDs, they are likely increasing the odds of unplanned pregnancies. The American Pediatric Association recently recommended IUDs as the first method of contraception that should be offered to teens seeking birth control. The CHOICE study found that "providing no-cost [and] highly effective contraceptive methods can significantly reduce unintended pregnancy.”

Additionally, the U.S. Supreme Court ruled that many employers don't have to pay for IUDs.

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It's one of the forms of birth control that, SCOTUS decided last year, certain businesses can abstain from covering. For example, the craft store Hobby Lobby, which claimed that birth control violated the company's religious beliefs.

Critics of this decision included Justice Ruth Bader Ginsburg, who, in her dissent, pointed to what she saw as the classism inherent in the decision: “It bears note in this regard that the cost of an IUD is nearly equivalent to a month's full-time pay for workers earning the minimum wage.”

And this all gets at another issue: Why would insurance only cover sexual health if reproduction is involved?

“Recreational sex among married and non-married women should be acceptable in this country by now," says Cullins. "The issue that we have in this country, the conservatism that we have in this country, is around sex only being procreational -- and I’m going to tell you that’s just wrong and dumb.”

As with many kinds of birth control, IUDs may have possible side effects.

They can be painful for some women, although this can usually be avoided if inserted by a doctor who has plenty of experience. "There is the issue of awareness, knowledge, and skill, in terms of [providers inserting IUDs in] teens and older women who have not had kids yet," Cullens said. "It takes quite a bit of confidence to ask a provider how much experience they have."

While conversations with a physician are confidential, young people using their parents’ health insurance should be aware that the explanation of benefits may tip parents off to what happened during the visit, Cullins says. She adds that at facilities like Planned Parenthood, young people can receive services without utilizing their parents' insurance.

To choose the right kind of birth control, a woman needs a doctor whom she can trust ... and access to the widest possible variety of methods.

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There are a number of factors for women to consider -- their reactions to various methods, age, the type of relationship they're in (this tool may help you decide) -- but many medical professionals and legal experts believe cost and availability should not be among those factors.

"What should be required in terms of money is nothing," Cullins says. "If you don’t have insurance, it is very, very expensive. ... People need to be aware of this, and, actually, should be protesting."