At work with the CDC

Healthy pregnancies start with planning

By Lisa M. Koonin, MN, MPH, Lynne S. Wilcox, MD, MPH, Lori deRavello, MPH, and Julianna S. Gonen, PhD

Each year in the United States, 6 million women become pregnant and 4 million babies are born. Only about half of those pregnancies are intended. Nearly half of American women aged 15 to 44 years have had at least one unintended pregnancy. This is often seen as an adolescent problem, but between a third and a half of adult women's pregnancies are unintended as well.

Unplanned pregnancies represent missed opportunities to provide information and care that could mean healthier mothers, babies and children.

Women need preconception counseling on topics like avoiding smoking, alcohol, illicit drugs and certain medications and taking folic acid supplements because serious problems can develop—or be avoided—before a woman even knows she is pregnant. CDC studies have shown, for instance, that taking B vitamin folic acid daily before conception and during early pregnancy can reduce the occurrence of spina bifida and other nervous system birth defects by at least 50 percent.

CDC researchers have also found that women with unintended pregnancies often delay seeking prenatal care. Early and regular prenatal care and monitoring chronic conditions such as diabetes and epilepsy reduces complications for both mother and child. The connection between complications and unplanned pregnancy is strong enough for the federal government to have set a Healthy People 2010 goal to increase the proportion of pregnancies that are intended to 70 percent.

For a woman, the personal, social and economic costs of an unintended pregnancy are high. For a business, the financial consequences can be significant. Pregnancy care is among the top health care cost drivers for employers, and just one premature baby can cost a self-insured company $250,000. High-risk pregnancies, according to a 1999 study, cause the largest number of total days lost in productivity among all health conditions, including depression, heart disease, cancer and diabetes.

Although most women in the United States bear at least one child in their lifetime, they spend the majority of their reproductive years trying to avoid pregnancy. No contraceptive method is completely effective, but most unintended pregnancies result from either lack of use or ineffective use of contraceptives. Access, availability and cost determine what methods women choose. In turn, the choice and use of a contraceptive method directly affects whether a women will have an unintended pregnancy.

Contraceptives are available over-the-counter, but the more effective methods are available only by prescription and are often the most costly. Furthermore, information on correct and consistent use of the method is a key factor for proper use. Therefore, in addition to providing preconception services to women who are planning a pregnancy, corporate health plans also need to provide contraceptive services, supplies and counseling to women who are trying to avoid pregnancy.

Direct health plan costs for coverage of the full range of reversible contraceptive methods is estimated at $21 per year per employee. Based on standard cost sharing between employees and employers and averaged over the entire workforce, this cost would be approximately $17 per employee per year. However, when indirect savings are taken into account, researchers have found that it's 14 to 17 percent more expensive for employers not to provide any contraceptive benefit.

Promoting healthy pregnancies makes sense, and many employers and health plans are addressing this challenge. An annual survey by the Pharmacy Benefit Management Institute found that the percentage of employers not covering oral contraceptives dropped 9 points to 36 percent between 1998 and 1999. Only last month, the Equal Employment Opportunity Commission ruled that employers can't discriminate against women by paying for preventive drugs for conditions like high blood pressure while not paying for prescription contraceptives.

Laying the groundwork for healthy pregnancies—and ultimately the healthiest possible mothers and babies—includes covering the full range of contraceptive methods and encouraging pregnancy planning and optimal timing.

Lisa Koonin, Lynne Wilcox and Lori deRavello are with the Centers for Disease Control and Prevention. Julianna Gonen is with the Washington Business Group on Health.

To learn more, visit CDC's Division of Reproductive Health web site, www.cdc.gov/nccdphp/drh. For a bibliography and employer's action plan, e-mail LMK1@CDC.GOV.

Lisa Koonin. Healthy pregnancies start with planning.

Business and Health

2001;1:55.