I am a physician. I went to medical school to help women become mothers and help parents form families. Now, the women I serve are uninsured and underinsured urban women who struggle with domestic violence, drug addiction, rape and assault, and chronic pain. These women sacrifice daily for their families to try to stay alive, and many live in desperate situations. Pregnancy is an especially vulnerable time for women with respect to both financial stability and personal safety, and this vulnerability is exacerbated by the conditions in which many of my patients live.
On Oct. 6, President Trump rolled back the Contraceptive Coverage Mandate. This provision of the Affordable Care Act guaranteed no-copay coverage of contraception for all private plans, with limited exceptions. Trump’s reversal goes well beyond the “accommodation” that came out of the Hobby Lobby Supreme Court trial, which enabled women to maintain coverage if their employer declined to cover it for religious reasons. Instead, it allows any employer with a religious or moral objection to deny coverage of this essential women’s health service.
More than 62 million women are currently eligible for this coverage. Even though attorneys general from two states have already announced their intent to bring suit against the change, the new regulations went into effect immediately. The change will impact countless women and families, inserting their employer in their most personal health care decisions. It could also have catastrophic ramifications for some of my patients.
Contraception was put on the chopping block because of perceived religious oppression. As an OB/GYN—specifically one who treats chronic pain and complex gynecologic conditions—let me clarify a few things about hormonal contraception.
Contraception is a vital part of women’s health care and does much more than “just” prevent pregnancy. Women use hormonal contraception medication to treat pelvic pain, ovarian cysts, abnormal and irregular bleeding, painful periods, acne, endometriosis, and many other diseases. None of these conditions or treatments afflicting women should offend religious morality, and yet women are now facing incredible obstacles to obtain basic health care.
But it is also completely appropriate for women to need contraception “just to prevent pregnancy.” Sexual health and libido are part of being a normal human, so we should treat medicine aimed at mitigating the consequences of these normal behaviors no differently than another other medication. As a woman, wife, and mother myself, I needed birth control to space my children out and complete medical school and residency training. Contraception has helped my friends and relatives (and countless other people) be present for and involved with their children, plan their families, optimize their finances, and be the best parents they can be.
Studies are crystal clear about the benefits of access to no-copay contraception. For every $1 spent on contraception, $7 are saved. Since the ACA guarantee of contraception, women have saved $1.4 billion on out-of-pocket costs—in 2013 alone. Unintended pregnancies, teen pregnancies, and abortion rates have significantly dropped due to federally funded contraception services. It is estimated that without this coverage, the unplanned pregnancy rate would have been 68 percent higher in 2014. Large studies out of Washington University in St. Louis show that when the cost barrier is removed, women will choose the most effective, longest-acting methods, which results in a decrease in unplanned pregnancies. The data bear out that the solution to reducing abortions and teen pregnancies in this country is to give women access to effective contraception. We also know that contraception allows women to take better care of themselves and their families, support themselves financially, and finish their education. In other words, allowing women to care for their own reproductive needs helps everyone in society.
But for the current administration, this seems to be just the start. It’s also endorsing anti-abortion language in its multi-year health care plans.
We know that data are not what moves people to make decisions or form opinions. So instead of more data, please hear my impassioned plea: Congress must pass legislation ensuring that contraceptive coverage is a guaranteed part of health care reform. The well-being of every man, woman, and child, in every stage of life, is threatened when we take away the health and happiness of women.
