After the US Supreme Court's hugely controversial ruling in Burwell v. Hobby Lobby on Monday, 90 percent of American corporations will no longer be required to pay for insurance that covers contraception (though many likely will choose to anyway). American women who suddenly won't have insurance-subsidized contraception won't be alone globally — as this map shows, the world is pretty divided on whether governments should pay for birth control.
Using data from Harvard University's Center for Population and Development Studies, Slate put together a map of where almost every country in the world stood on public provision of oral contraceptives. They divided the world into three categories: "the pill is free" (blue), "partial subsidy" (purple), and "no subsidy" (orange). Here's how the globe looks, adjusted for today's ruling:
One thing that's interesting here is the total lack of consistency. North America is the only continent where the pill is free or subsidized everywhere. In Western Europe, most countries offer a full or partial subsidy for the pill, but Spain and Ireland - two countries with strong Catholic roots - offer none. Neither does much of former-Soviet Eastern Europe. In the Middle East, maybe unsurprisingly, Saudi Arabia does not offer subsidies for the pill - but Iran makes it free. Norway doesn't subsidize the pill, but Sweden does. This suggests there's no clear consensus, regionally, about the state's proper role in providing birth control.
Inside countries, there are some interesting patterns. J.M. Ian Salas, an economist at the Harvard center Slate's data came from, wrote up the results of several recent papers on birth control subsidies around the world. Here's what he found:
- Despite a financial crisis and a sharp increase in contraceptive prices between 1998 and 2008, Indonesian birth control use rates remained stable. The government-run National Family Planning Institute, set up in 1968, distributes contraceptives and provides family-planning counseling.
- Comparative studies of six African countries found that the abortion rate increased when access to contraceptives, provided by non-governmental organizations, decreased in the countries that most depended on NGOs to subsidize contraception.
- Poor Filipino women were significantly more likely to have an unplanned birth after even a temporary disruption in free access to contraceptives.
Taken together, Salas concluded that "countries with strong family planning programs may be able to withstand unexpected decreases in public funding, and that high contraceptive use could be sustained after a critical point has already been reached." That said, "the availability of subsidized contraceptives is still a huge factor in allowing women from disadvantaged backgrounds to manage their fertility."
What does that mean for the US after the Hobby Lobby ruling? It's hard to say for sure, but the international evidence certainly suggest that America's poorest women will be the most-affected by the court ruling. Poverty clearly makes affording contraceptives harder, and even a temporary disruption to a woman's access can lead to an unplanned pregnancy.