THE NEW BIRTH CONTROL DANGER
THE NEW BIRTH CONTROL DANGER
CRAZY AS IT SOUNDS,
THE
FIGHT TO LIMIT— OR EVEN BAN—
B I RTH CONTROL
i s a k e y i ss u e i n t h e u p coming pre s i d e n t i a l e l e c t i o n .
A N D S T R I P P I N G WO M E N O
F T H E I R
R E P R O D U C T I V E
FREEDOMS
would
j e o p a rd i ze not only
their financial future
BUT ALSO
T H E I R HEALTH .
READ ON TO
LEARN HOW YOUR CHOICES ARE
ENDANGERED
AND
WHAT YOU NEED TO DO TO KEEP
THEM FROM
BECOMING EXTINCT.
Maybe it’s daily pills or monthly shots or some other
form of pregnancy prevention. Maybe you already have all the kids you want, or
you’re waiting until you’re ready to have a baby, or you’ve decided you’ll
never be ready. And perhaps your contraceptive of choice also eases a medical problem—whether
it’s painful endometriosis or scary ovarian cysts or disabling
pelvic cramps—or helps stave off a new one, such as ovarian
or uterine cancer.
When it comes to controlling your reproductive health
and destiny, birth control has
always been there for you and always will be, right?
In a word, no. Because today, there’s a national
discourse raging around access to birth control—40 years after the Supreme
Court legalized contraception for all women, irrespective
of marital status, and five decades after the birthcontrol pill’s introduction.
And while fringy far-right extremists have always
blasted away at contraceptive use, they have now infiltrated the mainstream—in
the form of Tea Party Republicans and GOP presidential candidates. “It is
shocking to see the vehemence of the attacks on contraception
that we are facing these days,” says Marcia Greenberger, copresident of the National Women’s Law Center.
All of this has left young women around the country
fretting about what a conservative-crafted future would mean for them. Take
Chris Mascaro, a 29-year-old graphic designer in Rockford, Michigan, who earns
$35,000 a year working for an employer who doesn’t offer
health coverage. Rent, student loans, groceries…they
gobble up her paycheck, leaving
nothing—certainly not the more than $150 she would
need to pay a private ob-gyn for a Depo-Provera shot, which she has used in the
past not only to help her put off having kids until she can afford them but
also to treat her debilitating and painful endometriosis. Thankfully, she had
access to a Planned Parenthood clinic, where she paid $59 to cover this
basic health need. But she worries, constantly, that women’s health programs will lose their funding and shut down.
Her fear is well founded. Some of the recent attacks launched by staunch conservatives are chillingly retro and misogynistic: Rick Santorum’s financial backer pining for the days when a woman stuck an aspirin between her knees to avoid pregnancy; a GOP legislator in New Hampshire, Lynne Blankenbeker, proposing that married—married!—couples could practice abstinence unless they want to conceive; a panel of all-male House Republican legislators and religious leaders debating contraceptive coverage at a House Committee meeting; conservative the radio the host a Rush the Limbaugh going on a three-day on-air tirade against law student Sandra Fluke, calling her a slut and a prostitute for speaking up in favor of birth-control coverage. And, particularly scary for Chris, Republican presidential candidate Mitt Romney
pledging to defund Planned Parenthood if elected.
Also out of luck if Romney wins: the one in five women
in the U.S. who have received basic health care and disease screenings at one
of Planned Parenthood’s more than 800 clinics.
Fanning
the FLAMES
The attacks grew fiercer immediately after President Obama announced last year that all FDA-approved contraceptives would be a required benefit of employersponsored health insurance, with no copay, as part of the Affordable Care Act. That was the recommendation of a panel of women’s-health experts at the nonpartisan Institute of Medicine (IOM), which
determined, after a year of analyzing the
data, that family planning should be considered
preventive medicine.
“There is extraordinary evidence, a wealth
of scientific literature, that shows that family planning works,” says Linda
Rosenstock, M.D., the dean of UCLA’s Fielding School of Public Health and the
chair of the IOM panel.
“Contraception helps women avoid
unintended pregnancy— which accounts for nearly half
of all pregnancies in this country—and
improve birth spacing, with substantial positive consequences for infants,
women, families, and society. It was an easy pick for us as a committee of
experts.”
Easy, given that the average woman who
wants two children spends three decades trying to avoid pregnancy and
only five years pregnant, postpartum, or trying to conceive. That’s 30 years in
which, unless she wants to pop kids out Duggar-style, a woman (and don’t forget
about her man!) needs access to birth
control. Without it, her very future—whether she wants to have children or not;
whether she’s able to build her pregnancies on the shifting sands of work,
finances, and relationships—will be like playing a game of Russian roulette…for
three decades.
“Controlling our reproductive destinies is
a pretty fundamental part of who we are as women,” says Susan
Cohen, the director of government affairs at the Guttmacher Institute,
the nation’s premier reproductive-health research
group. “It’s a prerequisite to being able to have control over our own lives,
our autonomy.”
Indeed, numerous research papers have linked the introduction of the birthcontrol pill with positive social and economic gains for women—from completing higher education to marrying later to narrowing the pay gap. The most recent, out of the National Bureau of Economic Research this year, found that earlier access to the Pill was linked to higher hourly
wages later in life—no trifling fact in a sagging
economy that’s buttressed by roughly 40 percent of working wives outearning
their husbands.
And yet here we are, in the throes of a jihad against birth control. “I was surprised by the extent of the firestorm,” says Rosenstock. “The degre to which that whole discussion
has gotten politicized is not just disappointing but remarkable,
as it threatens to swamp years of settled policy and settled science.”
Unprecedented is the word Cohen slaps on the inflammatory and
regressive political attacks of late.
“It does not make any sense to me that certain
organizations are trying to limit family planning, because most of the country
feels positive about contraception, regardless of religion,” says Mark
Hathaway, M.D., M.P.H., codirector of Family Planning Fellowship for Women’s
and Infants’ Services at MedStar Washington Hospital Center.
“Every day I see a patient who is pregnant and didn’t
want to be pregnant, or wasn’t ready
to be pregnant, or didn’t plan her pregnancy. It’s so
sad to me.”
Yet if the conservative ranks in today’s Republican
party have their way, it could get a
whole lot worse. And the reproductive
rights women have worked so hard to win could be lost.
THE BIGEST BATT LES
Today’s war against birth control is being
waged on three main fronts. What you need to know:
{Battle #1}
Conscience Clauses In an attempt to appease those
who couched their criticism of the birth-control mandate by
claiming it infringed upon their “religious liberty,” President
Obama announced in February an expanded accommodation: While
churches had always been
exempt from offering birth control to
their employees, now religiously affiliated institutions—such as hospitals,
charities, and colleges, which employ workers of all faiths—could have the
required benefit for its employees paid by insurers instead of by the
institution.
It was a brilliant win-win, said many on
both sides of the divide: Women could have their IUDs, but religious
institutions wouldn’t have to pay for them.
And yet, just weeks after Obama announced
the compromise, Senator Roy Blunt (R-Mo.) proposed legislation that would allow
any employer or insurance company to decline to cover
any medical care for any moral or religious
reason. Under the law, your boss would have free
rein to pick and choose your medical care
as he or she saw fit—so if the boss believed
that birth control were an affront to God
and nature, well, too bad for you; you’d have to
shell out the full monthly cost for your
pill pack. The Blunt endorsed)was
blocked in the
Senate with an extremely narrow margin—51 to 48—with Maine’s
Olympia Snowe (who
announced around the same time that she would not be seeking
reelection) the only Republican voting against it.
But that didn’t stop various states from attempting
their own end runs from the flank. Though the Blunt Amendment was defeated by
the Senate, the Republican House in Arizona passed a
similar—though more extreme—measure: It gives any
employer the power to request that women being prescribed birth control provide
proof that they’re using it for nonsexual reasons. In other words, a woman would
have to get a permission slip from her doctor—verifying she was using
contraception solely to treat a medical issue, such as ovarian cysts, painful
periods, or acne—and then share her private medical condition with her boss.
(And if she just wanted to avoid getting knocked up, she’d
be out of luck.) Soon after that, the Republican-controlled House in New Hampshire
passed a bill that gave employers the right to opt out of covering
contraception in health insurance if they had a religious objection.
These conscience clauses leave the IOM’s Rosenstock
disconcerted. “If every employer could decide what services they thought their
employees should get, if we all of a sudden opened up
our health-care system like that, we’d wreak havoc,” she says. “What if an employer didn’t like vaccinations?
Some of them don’t. We can’t have employers dictating health
care for individuals.”
And it’s not only employers who could deny you your
birth control.
Already 12 states have conscience clauses on the books
that allow some health-care providers—such as pharmacists—to refuse services
related to contraception. In February, a
Washington State federal judge, an
appointee of George W. Bush, ruled that the state could not force pharmacies or
pharmacists to dispense Plan B or other emergency contraception if they had a
religious objection to it. While you might think, Big whoop—a woman could
just cruise down to a more liberal
pharmacy to have her prescription filled (that is, if
she doesn’t live in a rural one-pharmacy
county), the psychological impact is harder to overcome. “Shame is powerful,”
says 26-year-old Rhiannon Andreini, a case manager in Seattle who also works as
a waitress to cover her graduate-school costs. “I felt this paralysis.”
Rhiannon was visiting her parents’ new
home in Edmonds, Washington, during Thanksgiving break a few years ago when she
had unprotected sex. Angry with herself—“I should have
known better,” she says—she drove to the
local Albertsons to get Plan B. The older man
at the pharmacy counter told her,
disdainfully, that they didn’t have that there.
Feeling “judged and small and red-faced,”
she cut short her vacation with her parents
and fled, crying, an hour and a half back
to her college town, where she knew she could
get emergency contraception without an
extra dose of shame. “I’m a politically charged, educated adult of means,” she
says. “I think about what that refusal would mean to my clients— dispossessed
students at an alternative high school without much, if any, material means or
psychological fortitude to overcome the humiliation.” Precisely the women who need
timely, judgment-free access to emergency contraception.
{Battle #2}
Personhood Amendments
Even if folks have long debated when life
begins, it’s been well established when pregnancy
begins. Until now. There’s a burgeoning national movement underfoot, called Personhood USA, that seeks to upend the definition of pregnancy as beginning with the implantation of a fertilized egg in the uterus. The Personhood movement not only proposes to redefine pregnancy as occurring at the moment of fertilization (even though up to half of fertilized eggs don’t result in a sustainable pregnancy) but also wants that sperm-hittingegg mash-up—still weeks away from a potential pink plus sign on a stick—to be recognized as a complete
human being. With legal rights.
If zygotes were people too, Personhood laws would, of
course, criminalize all abortion. But—and here’s the rub—they would also probably
outlaw some forms of birth control (not to mention IVF treatments and stem-cell
research), as well as complicate the legality of medical interventions in the
event of a life-threatening ectopic pregnancy or a pregnant woman’s cancer
diagnosis.
Here’s the slippery slope: “The main target of
Personhood is emergency contraception,” says Cohen, with Personhood proponents claiming
that emergency
In the
Hospital, Out of
Luck
In November 2009, a pregnant 27-year-old woman was brought
to the hospital—St. Joseph’s Hospital and Medical Center in Phoenix—with pulmonary
hypertension. Doctors there determined that if they did not terminate her
11-week pregnancy immediately, her risk for death was nearly 100 percent. They
decided to save the young woman’s life.
Why is this completely legal—and logical—case even notable?
Because it occurred at a hospital affiliated with the Catholic Church, a hospital
that was obligated to follow the church’s religious directives—which prohibit
abortions under any and all circumstances—instead of following the standard of
medical care. The hospital was stripped of its church affiliation, and the nun
who was involved in the decision was excommunicated.
The Catholic hospital system operates 15 percent of
the nation’s hospital beds. In 2010, approximately one-sixth of all hospital
patients were admitted to a Catholic institution.
As these hospitals merge with and take over
cash-strapped secular ones, “the restrictions they impose on health care are so
severe that in some quite dire circumstances, the actual life of the woman is
at stake,” says Marcia Greenberger of the National Women’s Law Center.
Although these institutions have voluntarily chosen to
serve the general public—with a mission that is not primarily religious—the
medical care is determined more by religious
doctrine than by medical need. And this affects access
to birth control: It means no emergency contraception, even after being raped;
no tubal ligation, even if that means having to undergo a subsequent surgery at
another hospital following a cesarean section; and no contraception, even if
you’re one of the 98 percent of sexually experienced Catholic women who have used
it. Says Susan Cohen of the Guttmacher Institute: “Often, a Catholic hospital
is the only
one a woman has access to.”
contraception is an abortifacient since,
they say, it could theoretically prevent an already fertilized egg from
implanting. (Medical experts, however, vehemently disagree, stating that
emergency contraception actually works before pregnancy begins, with no effect
on a fertilized egg once it implants.) “And since emergency contraception is
only a higher dose of the birth-control pill, then they’re effectively going
after the Pill as well. So that’s their goal.”
In other words, that little pill could, in
the world of Personhood, be deemed a lethal weapon, an instrument of homicide.
So far, Personhood legislation has been
defeated in Colorado (twice) and Mississippi, but bills
or initiatives are being considered in at
least 17 other states, including Florida, Alabama, Montana, Ohio, and Wisconsin.
The House in Virginia passed a Personhood
bill earlier this year, but the Senate
decided to defer voting on it until 2013.
{Battle #3}
Family-Planning Services
Given the astonishing fact that the United
States has a higher rate of unintended pregnancy
than most other industrialized countries—again,
that would be nearly half of all pregnancies in this country— one would think
that ensuring access to affordable birth control would be a
humongous national priority (especially for those who are against abortion and single parenthood). That, however, is not the case: Instead, federally funded familyplanning
services are under siege like never
before.
Title X, the only federal grant program
devoted solely to family planning and related preventive health services,
offers its services (including birth control) to more than
36 million
approximate number of sexually active women in the U.S. who don’t want to get
Pregnant 5 million low-income people. Planned
Parenthood, the leading provider of reproductive-health services
in the country, provides
contraception to 2.2 million
patients every year, as well as
screenings and other basic
health care for women of all
socioeconomic backgrounds.
According to the Guttmacher Institute, publicly funded
family-planning services help women avoid 1.94 million unintended pregnancies
each year, which would result in 860,000 unintended births and 810,000
abortions.
Without those services? The number of abortions would be
two-thirds higher than it is today. Quite simply, family planning works.
And yet, when Tea Party Republicans in the House were
seated in 2011, they worked overtime trying to eradicate the very programs that
reduce abortion and single parenthood. Democrats managed to squash the
relentless and sustained blitzkrieg on family planning—including the Pence
Amendment, which would have eliminated all funding for Planned
Parenthood, and the budget bill, which would have eliminated all funding to
Title X. Regardless, Mitt Romney has promised
to “get rid of” Planned Parenthood if he is elected.
In the meantime, the battle rages on at
the local level: At least five states—including
Arizona, North Carolina, and Kansas—have
attempted to either limit or deny funding to
Planned Parenthood. Most notably, in
March, Texas governor Rick Perry supported legislation that excluded Planned
Parenthood from participating in the state’s Medicaid program— essentially
shuttering the entire enterprise.
Planned Parenthood estimates that about
160,000 women per year in Texas will have to do
without birth control and other health
services—a devastating blow, as Texas has the highest rate of uninsured women
in the country.
And the effects are already playing out:
Planned Parenthood was forced to close four of its eight clinics (and may have
to close another two or three) in two desperately poor counties
near the Mexican border; it closed another
in Odessa, Texas, in March, forcing women in need of birth control and other
services to travel 20 miles to an overburdened affiliate (a
Particular hardship for those without
cars). Worried yet?
THE
PERFECT POLITICAL STORM
While it seems ludicrous that we, as a
country, are even having this conversation in 2012, it may well be that now is
actually the ideal cultural moment for sexual fundamentalists to
strive for something as unfathomable as
outlawing— or extremely limiting access to—contraception. “When you merge
Republican leaders’ opposition to birth control in general with the vehement
partisan opposition to the Affordable Care Act, it’s just a combustible mix
that trivializes women’s reproductive health,” says Cohen.
Throw religion into the tinder and it only
fuels today’s firestorm.
But, reproductive-health experts say,
women do not have to huddle back and wait to get burned; our votes can extinguish
this whole mess.
“During the midterm elections, a lot of the
candidates let voters believe that the economy
was going to be their number one priority.
But right after they were elected, it became
clear that they didn’t have any ideas
about how to fix the economy, but they had a lot
of ideas about how to fix women,” says
Dawn Laguens, executive vice president for public policy, advocacy, and
communications at Planned Parenthood Federation of America, citing the record
number of reproductive-rights provisions—1,100 in all— proposed in 2011. “A
government that would limit your access to
the health care you need and the tools to make healthy decisions for you and
your family says something about what they think of you as a citizen.”
Conscience clauses, Personhood amendments, defunding family-planning services—these are not mere talking points for those seeking to score votes from a conservative base, and this is not just political shadowboxing. It’s actual legislation. “Limiting access to contraception would be devastating,” says Greenberger. Adds Laguens, “There are so many worstcase scenarios” that it is hard to envision the fallout.
The repercussions—for women, for families,
for society—are very real.
All Fitness ___ THE NEW BIRTH CONTROL DANGER
by GRETCHEN VOSS
photographs by CHRISTOPHER GRIFFITH
photographs by CHRISTOPHER GRIFFITH
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