Fifty years after the pill, another birth control revolution may be on the horizon: free contraception for women in the U.S., thanks to the new health care law.
That could start a shift toward more reliable — and expensive — forms of birth control that are gaining acceptance in other developed countries.
But first, look for a fight over social mores.
A panel of experts advising the government meets in November to begin considering what kind of preventive care for women should be covered at no cost to the patient, as required under President Barack Obama's overhaul.
Sen. Barbara Mikulski, D-Md., author of the women's health amendment, says the clear intent was to include family planning.
But is birth control preventive medicine?
Conflicting answers frame what could be the next clash over moral values and a health law that passed only after a difficult compromise restricting the use of public money for abortions.
For many medical and public health experts, there's no debate.
A major research study now taking place in St. Louis provides a glimpse of how things might change.
The Contraceptive CHOICE Project is providing free birth control to as many as 10,000 women, tracking their decisions and the results. About 70 percent have chosen long-acting contraceptives such as IUDs (intrauterine devices) or implants, which are reversible and have a much lower failure rate than pills or condoms. The proportion of U.S. women using such methods remains low; part of the reason seems to be higher upfront cost.
"The shift we need to see in the United States is a shift away from methods like the pill and condoms to the most effective methods, like implants and IUDs," said Dr. Jeffrey Peipert, a principal investigator on the study. "And we'll only see that shift if somebody is willing to pay for it."
How the Obama administration will apply the law remains to be seen. It could allow insurance plans wide discretion on meeting the coverage requirement. A panel convened by the Institute of Medicine will hold its first meeting Nov. 16 to begin work on recommendations to HHS. The department has until next August to make its decision.