Many privately insured women in Washington State do not receive key reproductive and sexual health care benefits-including gynecologic, sterilization, pregnancy termination and infertility services-because these are not part of standard health insurance offerings, according to a new study. While nearly all plans surveyed for the analysis offered HIV, sexually transmitted disease and reproductive cancer screening services, and most covered gynecologic and maternity services, there were widespread restrictions on or outright exclusions of many types of specific contraceptive services, infertility treatment and counseling related to reproductive and sexual health concerns.

The study, "Reproductive and Sexual Health Benefits in Private Health Insurance Plans in Washington State," by Ann Kurth of the University of Washington et al., appears in the July/August 2001 issue of The Alan Guttmacher Institute's bimonthly, peer-reviewed journal, Family Planning Perspectives. The study is based on a survey administered to a market-representative sample of 12 health insurance carriers with a total of 91 insurance plans in Washington State to assess benefit coverage for reproductive and sexual health services.

While single-state data are not nationally representative, Washington State is a good case study for examining current levels of reproductive and sexual health insurance benefits. It closely mirrors the country as a whole with regard to private insurance coverage. Nearly three-fourths (72%), of Washington State residents rely on private health insurance, compared with 70% of U.S. citizens. The two populations have similar demographic characteristics, and Washington State has been a bellwether in terms of health policy.

The most striking finding of the study was the degree to which coverage for contraceptive methods, including those offering STD prevention, lags behind that for other health services. For example, half of private insurance plans surveyed cover no reversible contraceptive methods, 75% of female enrollees lack core coverage for reversible contraceptive services, 53% have no coverage for induced abortion and 98% lack coverage for infertility treatment. The analysis also found that pregnancy termination is covered by plans at a higher rate than pregnancy prevention methods, and HIV and AIDS treatment services are the only category covered by 100% of all types of plans.

"Half of the unintended pregnancies in the United States are among women who are using contraception, but not always consistently or with maximum effectiveness," says AGI President Sara Seims. "Cost concerns affect the contraceptive choices women make, and even a brief gap in coverage can have a major impact. Most important, in the absence of insurance coverage, some women may forgo contraceptive use entirely, and a sexually active woman who is not using contraception is many times more likely to become pregnant unintentionally than a woman who is."