The U.S. Supreme Court ruled Wednesday that employers could deny people contraception coverage because of religious or moral objections, upholding the Trump’s administration gutting of the Affordable Care Act’s birth control mandate. It’s a devastating and despicable decision (especially when you consider the 7-2 ruling—Breyer? Kagan? What’s up with you two?) that critically jeopardizes access to contraception for people around the country.
Those of us in the reproductive rights community have been bracing for this decision, hoping it would go the way of June Medical Services v. Russo, this term’s surprise abortion rights win. But instead, the Roberts Court decided to prioritize religious and “moral” objections over the health and well-being of people who can become pregnant and who need reproductive health care.
Whenever the conversation turns to birth control accessibility some will always argue that the restriction of birth control is especially harmful because people use it to treat medical conditions. It’s an angle offered by (well-meaning) advocates, and it took me all of four minutes scrolling Twitter on Wednesday morning to see a tweet on my timeline invoking it. It’s used as a defense of birth control—a way to say, “Hey, this isn’t just about sex, it’s about people’s health too!”
But embedded in this rhetoric is an insidious kind of shaming and stigma—an implication that birth control is only justifiable because people need it for things other than having sex and preventing pregnancy. When we use this argument as a shield for birth control coverage, what we’re actually saying—just under the surface—is that using birth control for pregnancy prevention and sex is not as valid or as necessary.
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Before we get any further, let me make something clear: I have endometriosis, and doctors have prescribed practically every form of birth control in the book (even though birth control doesn’t actually treat the disease, and does little to mitigate my symptoms).
I currently have an intrauterine device (IUD) to manage suspected adenomyosis—in which endometrial tissue spreads in the wall of the uterus—and to stave off a hysterectomy, which is the only complete cure for adenomyosis. I also use birth control because, when we’re not in the middle of a global pandemic, I have sex. I have sex casually, and I have it in relationships; I have it on first dates, and I have it with both people I know well and people I’ve just met. I like sex—it feels good, and, as someone with a chronic illness, it allows me to connect with my body in a way that feels pleasureful and empowering. I also want a family one day, and birth control allows me to have as much sex as I want now while ensuring that, when the time comes for me to try to get pregnant, I can do so on my own terms.
Frankly, that should be enough to warrant access to birth control.
Having consensual and pleasurable sex is a good thing, and when we cloak our arguments for birth control in justifications about the benefits it provides other than pregnancy prevention, we concede that there is something salacious or controversial about just plain old having sex—about wanting to come home from a long day, or wake up in the morning, or spend your WFH lunch break getting off with another person. (Of course, sex does not have to mean penetration, and reducing it to that definition also feeds into a stigmatizing and shameful narrative about pleasure and intimacy—but I digress.)
Birth control is not a perfect solution: Anyone who’s been prescribed it knows navigating the side effects and finding the right one for you can seem like a never-ending game of hormonal Russian roulette. And the racist origins of obstetrics and gynecology persist in much of the way birth control—specifically long-acting reversible contraceptions (LARCs)—is prescribed by doctors. But we can’t fight for better birth control if we whittle down access to serve only a privileged few.
None of this is to say that the other medical benefits of birth control aren’t a crucial reason to ensure coverage; so many people, myself included, rely on birth control to maintain our quality of life, and that cannot be erased from our conversations either. And preventing and planning pregnancy is itself a health issue; pregnancy comes with its own set of risks and health implications, and being able to control when and if it happens is inextricably tied to health.
The problem arises when we act like we need to foreground the argument that birth control should be accessible because it has nonpregnancy-related health benefits—like we need to use it to convince people that birth control is necessary and important. When we do that, we relegate the use of birth control for safe sex to a position of degradation—we are saying that consensual sex is not a valid priority.
Even if all birth control did was prevent pregnancy, that would be enough. Birth control is health care: not only or primarily because some use it to manage health conditions, but because sexual health and retaining autonomy when it comes to making decisions about sex is a valid and important part of our lives.