On Tuesday, the Supreme Court hears Sebelius v. Hobby Lobby Stores, which argues that the birth control benefit in the Affordable Care Act (ACA) is a direct attack on religious freedom of for-profit companies.
As an OB-GYN and a patient advocate, I want to move the discussion out of the courts for a moment and into my clinic, to focus on the lives of women and their families. I feel an immense sense of responsibility to the women I care for, and part of that responsibility includes advocating for insurance coverage
of birth control.
Here are my top five reasons for why contraceptive coverage is essential and needs to be protected.
Sex. Abortion. Parenthood. Power.
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1. Contraception saves lives. I realized this the moment I placed my patient Rosa’s intrauterine device (IUD) while she was in the ICU for a condition called peripartum cardiomyopathy, a cause of heart failure during pregnancy. Rosa (not her real name) was transferred to our hospital in florid heart failure and suffered a stillbirth at eight months of pregnancy. While I was counseling Rosa on her contraceptive options, she told me that she had wanted an IUD after her first pregnancy, when she faced similar complications. However, she was unable to get an IUD then because of restrictions on contraception at the religiously affiliated institution where she received medical care at the time. Fortunately, I saw her at a facility where she could utilize her insurance and get the care she needed. Rosa’s story is similar to that of many women for whom pregnancy can be life-threatening. Ensuring access to the full spectrum of contraception is a vital part of comprehensive women’s health care.
2. Contraception helps build healthy families and healthy communities. Half of all pregnancies in the United States are unintended. Women with unplanned pregnancies are at greater risk for preterm birth, low birth weight, and delayed prenatal care, whereas planned pregnancies have better birth outcomes. Numerous studies have shown that increased access to contraception leads to a reduction in unintended pregnancy and birth rates, leading to healthier outcomes for mothers, babies, and families.
3. Contraception is one of public health’s top ten greatest achievements. It’s right up there with vaccines and water sanitation. According to the Centers for Disease Control and Prevention, access to contraception has improved birth spacing and has led to smaller families, which in turn “have contributed to the better health of infants, children, and women, and have improved the social and economic role of women.” The young women I see in my clinic are from all walks of life but many will be the first in their families
to graduate high school and attend college without having their dreams interrupted by an unintended pregnancy. Contraception is as valuable as any other preventive public health measure that has made a positive impact on our society and thus, like clean water, should be accessible to all.
4. Contraceptive coverage would allow a woman to choose the method that is right for her, not just the one that fits her budget. From 2007 to 2011, the Contraceptive CHOICE Project conducted a large prospective cohort study of almost 10,000 women in the St. Louis area to determine what would happen if cost was not a factor for women seeking birth control. The study found that when financial barriers were removed, 75 percent of the study’s participants chose a long-acting, highly effective method (an IUD or contraceptive implant), which typically has a high up-front cost of hundreds of dollars. In today’s economy, when families are struggling to pay for basic needs, the cost of contraception can be overwhelming. Cost should not be a limiting factor to the provision of quality preventive care. Not every woman can use a generic pill or other lower cost birth control methods. It is critical that women have coverage for the full range of Food and Drug Administration-approved contraceptive methods so health-care providers can work with each patient to determine what works best for them.
5. Contraception has many health benefits. In addition to preventing pregnancy, some contraceptive methods can also decrease the risk of pelvic inflammatory disease and ovarian and uterine cancers, and treat other gynecologic conditions such as endometriosis and heavy bleeding. As a resident, I cared for Patty (not her real name), who was diabetic, struggling with infertility, and who also had irregular bleeding because of a condition called endometrial hyperplasia, which carries a risk of uterine cancer. After she and I came to the decision of optimizing her overall health and treating her condition before she would resume trying to become pregnant, I was able to place her hormonal IUD, which resolved her hyperplasia as her overall health improved. She and her husband now have a beautiful daughter, and Patty continues to use an IUD.
Affordable family planning services are essential to building healthy families and communities. I hope that when the Supreme Court justices consider the Sebelius v. Hobby Lobby Stores case, they recognize the value of contraceptive coverage to all Americans.