Regulations released by the Trump administration on Friday could jeopardize access to a medication that millions of Americans take every day and that saves countless lives every year.
This may not be how many Americans think about birth control, especially in a time when legislators around the country are cutting funding to clinics that provide it. But it’s true: By allowing any employer to request a religious or moral exemption to the birth control coverage mandate established under President Barack Obama, the Trump administration is limiting access to one of the most common forms of life-saving medication available today.
In the United States, four out of five women who have had sex have used birth control pills at some point in their lives, according to the Centers for Disease Control. In 2012, 9.7 million women used the pill, making it the most common form of contraception. Another 3.9 million women used an IUD, and 1.7 million used an injectable method.
These are just a few of the ways such medical treatments help Americans lead healthy lives
Birth control allows people to plan their pregnancies, resulting in better health for both mother and child. Worldwide, the ability to plan pregnancy is associated with lower infant and maternal mortality, lower mother-to-child transmission of HIV, and fewer abortions, especially unsafe abortions.
Like many necessary medical treatments, birth control helps women work, learn, and lead fulfilling and productive lives. In one survey of patients at family planning clinics, 64 percent said birth control helped them extend their education, 71 percent said it helped them support themselves financially, and 77 percent said it helped them take care of themselves or their families.
Many women have health conditions that make pregnancy dangerous, or take medications that are dangerous to a developing fetus. Birth control allows them to prevent pregnancy or plan it carefully in concert with their doctors.
Beyond preventing pregnancy, however, many of the millions of Americans with endometriosis use oral contraception to control their symptoms. Without it, many would experience severe pain, and some would be unable to work or care for their families.
One in 10 women of childbearing age has polycystic ovary syndrome, which can cause irregular periods, acne, and facial hair growth and can increase the risk of endometrial cancer. Hormonal birth control, one of the most common treatments for PCOS, helps regulate periods and lowers patients’ cancer risk.
Birth control is a treatment for a variety of other health conditions, including menstrual migraines and premenstrual dysphoric disorder. Overall, 58 percent of people who take oral contraceptives do so at least in part for reasons beyond contraception, and 14 percent take them for noncontraceptive reasons alone, according to a 2011 study by Rachel K. Jones of the Guttmacher Institute.
As debates over contraceptive access have raged in recent years, many women have told stories of how birth control helped them. “As an older mom who chose to wait and raise three kids after years of travel, study and professional growth — I can't imagine an equally fulfilling life for myself, any other way,” one American woman told the Gates Foundation. “‘Choosing’ requires access to effective contraception. There is no other way.”
How did we get here?
How did an incredibly common, life-saving medication become a political lightning rod? To answer that, it helps to look back at the earliest campaigns against contraception and abortion in the United States. In the early 19th century, no laws in the United States prohibited either, and both were becoming increasingly common, as the legal scholar Geoffrey R. Stone writes in Sex and the Constitution. (Methods of contraception at the time included condoms, diaphragms, douches, and withdrawal.) But starting in the 1850s, a number of groups, including the American Medical Association and the anti-obscenity crusader Anthony Comstock, began campaigning to restrict women’s right to decide when they got pregnant and whether they stayed that way.
Horatio Storer, a gynecologist and the chair of the AMA’s Committee on Criminal Abortion, wrote in an 1865 essay that women’s purpose was to have children: Motherhood was “the end for which they are physiologically constituted and for which they are destined by nature.” Therefore, he argued, contraception (“otherwise than by total abstinence from coition”) and abortion “are alike disastrous to a woman’s mental, moral, and physical well-being.” Storer also said that women couldn’t be trusted to decide whether to continue or end their pregnancies, because their decisions would be “warped by personal considerations.” (Also, they were prone to “derangement, under the stimulus of uterine excitement,”)
Comstock, meanwhile, was the architect of an 1873 federal ban on sending contraceptive devices or even information about contraception through the mail. He argued, according to Stone, that contraceptives were immoral because they reduced “the risk that individuals who engage in premarital sex, extramarital sex, or prostitution will suffer the consequences of venereal disease or unwanted pregnancy.”
Those fighting abortion and contraception had a variety of motivations. Comstock was a true believer, who blamed the death of one of his friends (possibly of a sexually transmitted infection) on pornography. By arguing that abortion should be illegal unless a doctor decided it was necessary to save the mother’s life, the AMA was able to take control of the procedure away from midwives, who, as Stone notes, had previously performed most obstetrical and gynecological care. Whatever the motivation, though, the argument was essentially the same: The state had an interest in maintaining control of pregnancy.
That argument, with some permutations, crops up now in every debate over women’s sexual and reproductive health. Today, for instance, opponents of the birth control mandate are asking the state to give some measure of control over employees’ reproductive lives to employers.
This particular debate started in 2012, when the Obama administration released a rule requiring that employer-based insurance plans cover birth control with no copayment. The administration added some exceptions for religious employers, but some employers found them insufficient. The owners of Hobby Lobby, for instance, wanted an exemption from the mandate even though their company is a for-profit corporation, not a religious hospital or university. They won their Supreme Court case in 2014, meaning that “closely held” corporations (which includes about 90 percent of companies) could request exemptions from the mandate on religious grounds.
The new regulations from the Trump administration will let any employer request an exemption for moral or religious reasons, weakening the mandate and giving companies greater influence over the reproductive health care their employees receive.
One thing is just as true now as it was in the 19th century: You can have state (or corporate) control over pregnancy, or you can have a healthy, productive, and free female citizenry. But you can’t have both.