Dear Chairwoman Castro and Members of the Commission:

On behalf of the American College of Obstetricians and Gynecologists, an organization representing 40,00 physicians dedicated to womenís health care, I urge the EEOC to issue a policy guidance prohibiting the exclusion of contraception from prescription drug coverage. It places an unfair burden on women for an employer covered by Title VII to exclude insurance coverage under its employeesí health plan of prescription contraceptive drugs and devices while covering other prescription drugs and devices. This practice is sex discrimination in violation of Title VII of the Civil Rights Act of 1964.

Two-thirds of US women of childbearing age rely on private, employer-related plans for their health coverage. While 90% of these plans cover prescription drugs and devices, many exclude at least some prescription contraceptives from coverage. For example, nearly half of traditional indemnity plans do not cover any of the five most commonly prescribed reversible methods of contraception. Clearly such disparity in coverage of drugs used solely by women is nothing short of gender discrimination.

ACOG believes contraception is medically necessary to providing quality health care to women. A woman needs contraception to protect both her health and quality of life. Contraceptives afford a woman the opportunity to choose the number as well as the timing of her pregnancies. Most women can become pregnant from the time they are teenagers until they are in their late forties -- meaning a woman can become pregnant for thirty or more years. A woman cannot opt out of the need to control her fertility during the three decades prior to menopause without risking multiple pregnancies. For some women with serious medical conditions, controlling their fertility is a matter of life or death. In addition, appropriate timing between pregnancies and limitations on family size, as a result of the use of contraceptives, are closely related to improved infant and maternal health. According to an article in the New England Journal of Medicine, "infants conceived 18 to 23 months after a previous live birth had the lowest risks of adverse perinatal outcomes." For all of these reasons, access to contraceptives is critical in achieving healthy families, both in medical and economic terms.

The cost to employers and employees of providing contraceptive coverage is minimal. A June 1998 Alan Guttmacher Institute report, "Cost to Employer Health Plans of Covering Contraceptives," estimates that the average total cost of adding coverage for the full range of reversible contraceptives to health plans that do not currently cover them will increase total health coverage costs for employers by $21.40 per employee per year -- $17.12 of employersí costs and $4.28 of employeesí costs. The added cost for employers of providing this coverage corresponds to $1.43 per month, which represents an increase of less than 1% in employersí cost of providing employees with medical coverage. A 1996 estimate provided by the Health Insurance Association of America placed the cost of adding oral contraceptive coverage to a drug plan at $16.20 per employee per year, or $1.35 per month per employee.

Contraceptive coverage would eliminate a major obstacle ob-gyns encounter in providing quality health care to our patients. We urge the EEOC to clarify that an employer offering insurance coverage for prescription drugs and devices but excluding coverage for prescription contraceptives violates Title VII.

Sincerely,

Ralph W. Hale, MD