Across the country and the globe, some women are fortunate enough to take personal control over their health, economic opportunities, and lives. They are granted an unprecedented freedom with the help of various contraceptive. However, it is only the fortunate that control their fate for various state and federal laws within the United States make this freedom all the more onerous to attain. To understand how we came to these restrictions it is first necessary to explore the purpose of the medicine and then the history of restrictions and allowances in the United States. Finally, alternative methods of access as seen in in certain states will illuminate potential future policy aspirations.
Uses and Affects
All women have personal reasons to take birth control, in any of the many forms available. One such reason is preventing unwanted pregnancy. Of sexually active women of a reproductive age (15-44) in the United States, roughly 70% are at risk of an unwanted pregnancy. Within this group 68% of women who use contraceptives only account for 5% of unwanted pregnancies. The combination of risk and preventability profess the incredible need for accessible birth control. Statistics show the demand; in 1960 the pill became available and within five years 6.5 million American women used it. Today, 80% of sexually experienced women have used the pill. Also, alternative methods are increasing in popularity including sterilization, hormonal methods, IUDs and male condoms.
While many women choose to take birth control to avoid becoming pregnant, there are multiple uses for the drug. An estimated 72% of women take oral contraceptives for non-contraceptive reasons alone, or for non-contraceptive reasons in tandem with contraception reasons. The pill has the ability to reduce cramps, menstrual pain, regulation, and acne treatments. It also has farther reaching effects like controlling endometriosis and polycystic ovary syndrome. Endometriosis is a condition affecting millions of American women that causes such severe pain as to drastically affect women’s ability to go about their daily lives. Polycystic ovary syndrome, on the other hand, can increase the risk of endometrial cancer and death if not properly regulated. This condition affect one in ten women and hormonal birth control is the most common treatment. In addition to health concerns, birth control has the ability to affect many aspects of a women’s lives.
Birth control and reproductive control are essential to women’s legal and economic status. Indeed during her Senate confirmation hearing, Ruth Bader Ginsburg famously said:
“The decision whether or not to bear a child is central to a woman's life, to her well-being and dignity. It is a decision she must make for herself. When Government controls that decision for her, she is being treated as less than a fully adult human responsible for her own choices.”
Restricting women’s access to birth control methods is discrimination on the basis of sex. Sex discrimination is treating someone unfavorably because of their sex; it is cited both in terms of sexual harassment and economic opportunities. To understand access to birth control as a discriminatory issue it is essential to recognize the legal and economic repercussions. First, in regards to legality, women are only treated as independent persons under the law when they have the freedom to choose. Restricting women from this right is paramount to treating then as a lesser person under the law, unable or unqualified to make decisions for themselves. Second, birth control access is essential for protecting women’s economic opportunities. When women are able to regulate pregnancy on their own terms, the results are swift and definite. Birth control advances women’s economic status and educational opportunities. In the job market, young women have previously been relegated to low level jobs and deprived of promotions because companies assumed that they would leave within a few years to start families. Birth control has helped cull this trend and has allowed women the freedoms to choose when and if to start families. Indeed, more women are choosing to put off having children, many in favor of their job opportunities; today, a third of wage gains to women are a result of birth control access. Additionally, women’s educational opportunities are affected. Birth control is the most influential factor in women choosing to stay in college and is a large component of many women’s choice to attend in the first place: even with a bachelor’s degree, an estimated 30% increase of women in skilled jobs (medicine, law, dentistry) can be attributed to birth control access. The effects don’t merely stop with opportunities; oral contraceptives are associated with lessened risk of ovarian and endometrial cancers. However, it is important to mention that there are potential costs to taking oral contraceptives as well; namely, the associated increased risks in cervical (5% increased risk) and breast cancer (7% increased risks). Yet, both risks decline or disappear when use of oral contraceptives end. Considering the evident benefits both to women and the economy it is important to investigate the political history of birth control to understand today’s regulations.
History
The history of birth control is riddled with inaccuracies. Since the beginning of humankind people have avoided unwanted pregnancy. However, many historic methods were very unsafe, if effective. In more modern times researchers have focused on safe and effective methods to prevent unwanted pregnancies. In the early 19th century many methods of birth control were available and easily accessible including condoms, diaphragms and douches. However, the American Medical Association began attacking these options in the 1850s. Anthony Comstock, in particular, crusaded against contraceptives and orchestrated the 1873 ban on sending contraceptives or distributing information through the mail. It was not until the 20th century that birth control increased in popularity, largely in part to the efforts of Margaret Sanger. She is attributed with coining the term “birth control” and started the American Birth Control League, later known as Planned Parenthood Federation of America. Sanger also lobbied biologist Gregory Pincus to develop a birth control pill. Pincus partnered with physician John Rock, a catholic doctor who educated people on sex and treated and tested infertility. Rock’s research on infertility paved the way for birth control pills that were later approved by the FDA in 1957. Regardless of the serious side effects of the first available version of the pill, by 1965 6.5 million American women were taking the pill. Only five years later, President Nixon signed Title X into law providing federal funding for family planning services. Other methods of birth control began taking off following this funding, most notably the IUD.
Other notable victories for birth control include the 2000 Equal Employment Opportunity Commission (EEOC) decision on contraceptives. The EEOC ruled that employers must cover contraceptives costs if their health insurance plans also pay for a number of other products that enhance well-being. Various legislations of this nature were already in effect in 28 states by the mid-1990s. The right to contraceptives through health plans were solidified at a federal level in 2010 when President Obama signed the Patient Protection and Affordable Care Act (ACA). The ACA added contraceptives to the list of preventative services covered without patient co-payments. Ultimately, protections of this manner have been lessened by President Trump. Religious and moral opt-outs by companies are now affecting thousands of women’s access to birth control. The religious exemptions have a basis in Burwell v. Hobby Lobby in 2014. The case allowed Hobby Lobby to opt out of providing contraception under the Religious Freedoms Act. Justice Ginsburg wrote the dissenting opinion, stating that “the exemption sought by Hobby Lobby and Conestoga would…deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage.” A similar case has recently come under scrutiny with the nomination of Judge Brett Kavanaugh to the Supreme Court by Trump. During the senate confirmation hearing Judge Kavanaugh was asked about his decision in Priests for Life v. the U.S. Department of Human and Health Services. Judge Kavanaugh sided with the religious organization that argued against health plans covering birth control because IUDs and emergency contraception are “abortion inducing drugs.” This term, used by Judge Kavanaugh is alarming to those who use and promote access to birth control. This turn of events and increasing restrictions for birth control are making access increasingly difficult, especially considering the price of attaining birth control.
Policies
Birth control varies in cost by type of contraceptive. The average cost of the pill is anywhere in between $0-$50 before insurance that covers birth control. To be able to get the pill, many states require a yearly doctor visit costing from $0-$350, again dependent on insurance. Many have rallied against the provision of having a doctor’s visit, especially considering that many women who take the pill have done so for years, and that women have been proven to be just as accurate at self-screening as a doctor. Additionally, there is a shortage of OB/GYNs in the United states, making it difficult for women to get a prescription in the first place. Indeed, many parts of the world have easier access to oral contraception than America.
Photo from: http://ocsotc.org/world-map/
In response, seven states have made it possible to get the pill without a prescription. California, Oregon, Colorado, New Mexico, Hawaii, Maryland and Colorado all allow pharmacists to sell birth control over the counter. States considering legislation of this manner include Illinois, Minnesota, Missouri, and New Hampshire. The District of Columbia and Utah also recently authorized similar legislation, although they have yet to implement it. This ease of access will not only lower the cost of entry, but this free-market solution also has the potential to drive down costs. Also, birth control via mail is more readily accessible. Companies like Nurx let women get a prescription and order birth control online. The prescription part of the service is mere health questionnaire that is later reviewed and submitted to a partner pharmacy. Nurx offers over 40 types of contraception and emergency contraception. This service is already available in 18 states and is particularly popular in “contraception deserts” where women lack access to health services. Other services offer different types of birth control and have their own methods of prescribing.
Apps are also going up in popularity. There are both apps for ordering birth control via mail or to a pharmacy, and apps that provide birth control advice. Natural Cycles is an app based on the temperature method. The temperature method is the tracking of a woman’s temperature to estimate her fertility on any given day. Natural Cycles tracks the temperature and alerts women to days when pregnancy is likely or unlikely to occur after unprotected sex. The method, if used properly, is 91% effective— the same as the pill. In August of 2018 the app was approved by the FDA.
Policy Recommendations
Birth control is a necessary medicine to the equal opportunity of women under the law and in regard to economic and educational opportunities. Birth control also provides women with needed protections from various ailments and conditions. Given the obvious need for access as seen in statistics mentioned earlier as well as contraception deserts and economic restrictions to obtaining birth control, as well as religious infringes, the United States needs to pass comprehensive legislation protecting and expanding women’s access to birth control. The approval by the FDA of Natural Cycles is an excellent start that will affect many women, yet women who chose other methods or need other methods to curtail personal conditions are not protected. Federal legislation should be pursued to include the following:
Allow pharmacies to write prescriptions
Allowing pharmacies to write birth control prescriptions ensures that women have an ease of access to vital medicine while still receiving a consultation. If a woman has any questions on birth control types or situations, she has a trained professional to ask who won’t cost her. This method is also necessary for contraception deserts where alternative medical professionals are not available.
Allow prescriptions to be sent via mail
Contraception deserts tend to be in rural areas, away from many medical professionals and urban areas. Women in these areas must be allotted the same rights to birth control as women elsewhere, and thus should be able to revenue medication through the mail. Mail prescriptions have already been proven to be highly affected in these areas, and the opportunity should be afforded to all American women.
Restore protections to birth control under all health care plans irrespective of the provider
Companies that refuse to provide their employees with access to birth control are not only overstepping their bounds as a capitalist business but are also imposing their beliefs on their employees. All Americans are free to pursue their own belief system and to not be coerced into a certain religion. The federal government should protect this right by imposing a level rule over health care: companies should not be able to opt out and disproportionately affect their employees. Furthermore, this precedent opens door to refusing such services as antidepressants and anesthesia, to name two medications opposed by various religions.
Conclusion
Birth control is a divisive topic in America, yet it helps both individual women and the enhancement of the American society and economy. Certain companies and states are making headway via online access with enormous success, and should be considered an ideal for the future, yet the government needs to act to apply these benefits across all 50 states. To best serve American citizens and to yield the highest possible results for the country, birth control should be made more accessible through health care protection and ease of access.