Earlier this month, the Trump administration made good on a campaign promise to rollback the Affordable Care Act’s mandate on birth control coverage. Employers can now cite “moral objections” (in addition to religious ones) to leave contraception out of insurance plans offered to employees. But while the pushback to the administration’s decision has been swift and significant, there’s one argument surfacing around protecting birth control coverage that’s problematic. It’s this: oral contraceptives should be covered because they’re not just for preventing pregnancy. And while it’s true that the pill is useful for alleviating a number of reproductive conditions, it’s also irrelevant. Birth control should be covered, even “just” to prevent birth. Women shouldn’t need to validate their reasons for taking birth control to anyone but their medical providers.
Obviously, women (and gender non-conforming people who need birth control) can and do have any number of medical reasons for choosing birth control. Speaking to Elle magazine in the wake of the Supreme Court Hobby Lobby decision, New York OB-GYN Dr. Eileen Krim said that “birth control pills are not named correctly as they do so much more than prevent pregnancy.” She went on to explain that the benefits of oral contraception went far beyond the ability to prevent unwanted pregnancy, including protecting against ovarian cysts, preventing certain forms of cancer, treating endometriosis, and balancing polycystic ovarian syndrome and other hormone deficiencies.
In fact, according to the Guttmacher Institute, out of the 9.7 million women in the U.S. who use oral contraception, at least 14 percent — or roughly 1.5 million — take the pill for reasons other than avoiding a pregnancy.
To be clear, the Trump administration’s decision to cut birth control coverage hurts every woman or anyone who uses the pill, no matter the reasons they have for taking it. By allowing employers to cite moral objections — no matter how subjective or capricious their reasoning — the federal government has given companies the right to impose their thinking on their female employees’ personal choices. But fighting that decision shouldn’t involve imposing greater scrutiny on women’s reasons for wanting the pill.
Focusing on the noncontraceptive uses of the pill sends a message that the rights of women who want the pill to avoid pregnancy are somehow less worthy of protection. It’s essentially reviving the old judgments against women who have sex for pleasure. Somehow, more than 50 years after the pill was first introduced, we’re still punishing women for taking control of their sex lives and their own reproduction — which is a medical decision.
And that old battle around the validity of women’s choices and the agency we have over our sex lives couldn’t have resurfaced at a worse time.
During his presidential campaign, Donald Trump made ending the Obama-era workaround that allowed women to access birth control coverage even if their employers refused to offer it a signature message to conservative supporters. As if to ensure the resulting plan would meet those ideals, he crafted the plan with input from members of his team long associated with attacks against contraception as a concept and advocating against it as a legal right, according to the New York Times.
So, it’s no surprise that on Oct. 6, when the new guidance on contraception went into effect, as many as 18 attorneys general came forward in opposition to Trump’s birth control rule. And the attorneys general for Massachusetts, California, Pennsylvania, and Washington state filed federal lawsuits challenging the administration’s decision.
The National Women’s Law Center estimates that the Trump rule could affect as many as 55 million women who depend on contraception without co-pay under the ACA mandate. That alone makes this a battle worth having. But no one should be arguing that some coverage for oral contraceptives is more essential than others because it’s used for medical conditions that have nothing to do with intercourse or preventing pregnancy.
That shouldn’t matter. Pregnancy is a medical condition the person who can become pregnant should have control over — just like someone with endometriosis should be able to control their health to the best of their abilities. And offering up explanations for why a woman might want a birth control — other than, “Because I want it. Gimme.” — is a setup for prioritizing some patients and their needs over others. In the fight to protect agency over a woman’s reproductive choices, no argument could be less helpful.
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