The recommendations are based on a review of existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. The committee identified diseases and conditions that are more common or more serious in women than in men or for which women experience different outcomes or benefit from different interventions. The report suggests the following additional services:
· screening for gestational diabetes
· human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
· counseling on sexually transmitted infections
· counseling and screening for HIV
· contraceptive methods and counseling to prevent unintended pregnancies
· lactation counseling and equipment to promote breast-feeding
· screening and counseling to detect and prevent interpersonal and domestic violence
· yearly well-woman preventive care visits to obtain recommended preventive services
"This report provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, dean, School of Public Health, University of California, Los Angeles. "The eight services we identified are necessary to support women's optimal health and well-being. Each recommendation stands on a foundation of evidence supporting its effectiveness."
Deaths from cervical cancer could be reduced by adding DNA testing for HPV, the virus that can cause this form of cancer, to the Pap smears that are part of the current guidelines for women's preventive services, the report concludes. Cervical cancer can be prevented through vaccination, screening, and treatment of precancerous lesions and HPV testing increases the chances of identifying women at risk.
Although lactation counseling is already part of the HHS guidelines, the report recommends comprehensive support that includes coverage of breast pump rental fees as well as counseling by trained providers to help women initiate and continue breast-feeding. Evidence links breast-feeding to lower risk for breast and ovarian cancers; it also reduces children's risk for sudden infant death syndrome, asthma, gastrointestinal infections, respiratory diseases, leukemia, ear infections, obesity, and Type 2 diabetes.
HHS should consider screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. The United States has the highest rates of gestational diabetes in the world; it complicates as many as 10 percent of U.S. pregnancies each year. Women with gestational diabetes face a 7.5-fold increased risk for the development of Type 2 diabetes after delivery and are more likely to have infants that require delivery by cesarean section and have health problems after birth.
To reduce the rate of unintended pregnancies, which accounted for almost half of pregnancies in the U.S. in 2001, the report urges that HHS consider adding the full range of Food and Drug Administration-approved contraceptive methods as well as patient education and counseling for all women with reproductive capacity. Women with unintended pregnancies are more likely to receive delayed or no prenatal care and to smoke, consume alcohol, be depressed, and experience domestic violence during pregnancy. Unintended pregnancy also increases the risk of babies being born preterm or at a low birth weight, both of which raise their chances of health and developmental problems.
HHS's guidelines on preventive health services for women will need to be updated routinely in light of new science. As part of this process, HHS should establish a commission to recommend which services health plans should cover, the report says. The commission should be separate from the groups that assess evidence of health services' effectiveness, and it should consider cost-effectiveness analyses, evidence reviews, and other information to make coverage recommendations.
The report addresses concerns that the current guidelines on preventive services contain gaps when it comes to women's needs. Women suffer disproportionate rates of chronic disease and disability from some conditions. Because they need to use more preventive care than men on average due to reproductive and gender-specific conditions, they face higher out-of-pocket costs, the report notes.
Statement from Susan F. Wood, PhD
Associate Professor of Health Policy
Director, Jacob Institute of Women’s Health
The George Washington University School of Public Health and Health Services
Former Assistant Commissioner for Women’s Health, FDA
Women know that preventive services for women includes family planning. Today the IOM confirmed that contraception is prevention and is part of the prevention package that should be covered by all health care plans. By reducing co-pays and deductibles for women getting contraception, this will help women and couples plan their families, space their children, reduce unintended pregnancies, and promote better health for women and children. Preventing unintended pregnancies is the best way to prevent abortion.
Women spend decades of their lives trying to prevent pregnancy, and only a few years actually trying to get pregnant and having children. Making contraception affordable by eliminating co-pays and deductibles is common sense for millions of women and couples across the country – and a real benefit that women will see immediately in their pocketbooks. This coverage of contraception will truly help “Close the Gaps” for women.
Contraception is not controversial – except sometimes for politicians. But this should not be political; coverage of contraception should be based on the evidence as outlined by IOM, which shows that contraception for women is indeed safe and effective prevention. Along with well-woman visits and critical screening for gestational diabetes, STDs, domestic violence, and other important women’s health preventive services, the IOM report “Closing the Gaps” has helped ensure that women’s health counts when we talk about prevention. Women should not be blocked from these critical preventive services due to cost or political debate.