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Why Birth Control Coverage is Fundamental – A Response to the Arguments

March 3, 2012

black and white photo of a birth control pack

Photo by Stacy Lynn Baum and used under a CC BY-NC-ND 2.0 licence.

While debate has been raging about women’s access to birth control and employers’ coverage of contraception, I’ve mostly been unable to write about it. Strange, I know. But every time I heard some ridiculous thing out of woman-hating Rick Santorum or Rush Limbaugh, I was really just too full of sputtering rage to coherently post. After several quick arguments with other folks online, though, below are responses to some common arguments I’ve heard. For more in-depth discussion, I highly recommend any recent clips from The Rachel Maddow Show, where it has been very well handled.

But you can live without birth control.
There are many items of covered medical care people can “survive” without having – orthopedic surgeries for painful injuries or disabilities, vasectomies, prenatal care. People can “survive” without many types of preventive medicine (including birth control) and even cancer treatment – for a while. What is appropriate for insurers to cover has never been based on “what you can’t live without,” and it’s a pretty poor standard to have.

Women who don’t want to get pregnant should just not have sex.
This is extremely hostile to women, and to the male partners of heterosexually-partnered women. It assumes that the sole purpose of sex is procreation, any time is the right time for a child, and as many children as possible are welcome. There may be some religious sects who technically support this belief, but we know that even among Catholic women, rates of birth control use are very high. For most people, it’s unreasonable to suggest that they never have sex if they’re not willing to be pregnant all the time or at any time. This perspective also puts women in the constant, stereotypical position of being the ones to fend off sexual advances, rather than supporting the idea that a man and a woman can be equal partners who both desire sex and make responsible choices about preventing unintended consequences. It denies women the agency of having their own desire, and puts them squarely in “aspirin between the knees” territory. Let’s be clear. Humans have sex, women can seek and enjoy sex, and women have purposes other than making babies.

Women who don’t want to get pregnant could just have a hysterectomy – those are probably covered.
Hysterectomies of course are not an equivalent to contraception, as they permanently prevent pregnancy, rather than allowing a woman to best time pregnancy to her own economic and health situation. It also ignores the non-contraceptive medical uses of birth control drugs, as well as historical inequities that inform which women get to choose hysterectomy and which women have had hysterectomy forced upon them.

Pregnancy is not a disease. So it’s not medical care to prevent it.
No, pregnancy itself is not “a disease” – neither is birth. But pregnancy can and does injure and even kill women. Pregnant women can require frequent medical care, and may encounter any number of complications over the course of pregnancy, from morning sickness so severe it requires hospitalization to eclampsia. So while pregnancy itself is not a “disease,” it is a medically vulnerable state for women that can necessitate frequent medical attention and can indeed result in disease and death.

Churches shouldn’t have to cover birth control.
Churches were not going to have to cover birth control. Period. Religiously affiliated institutions like Catholic churches and hospitals were going to have to cover it, but were given a generous out in which employees would be covered but the employers would not have to be the ones providing that coverage. These are institutions which in many states are already required to provide birth control coverage, and many individual institutions across the country do so in the absence of any requirement. Why? Because these employers need to attract talent, and they can’t or won’t get that talent purely from the pool of professionals who adhere to their own institutional religious affiliations (and even most Catholic women in the U.S. use birth control anyway). Catholic hospitals for example may hire doctors and nurses from any or no faith, because they need qualified people to provide the services that make them money and keep the doors open. They also recognize that providing employees with easy, cheap access to contraception is much cheaper than paying to cover pregnancies and a lifetime of medical coverage for numerous children and their mothers.

No employer should have to provide coverage for things they’re morally opposed to.
I have the slightest bit of sympathy for this perspective, but suspect it’s an extremely slippery slope. With absolutely no requirements for coverage, employers could stop covering lots of different things for economic reasons and claim moral objections. Employees would also be at the mercy of mergers and acquisitions. Imagine finding your company bought by another that would no longer cover blood transfusions, health care for LGBT individuals, any care related to any outcome of premarital sex, psychiatric drugs, or other common therapies. Of course, if employers started gutting already reduced service/higher cost insurance coverage based on their “moral objections,” we might actually start to see more widespread public support for movement away from employer-based coverage to a federal/universal model, so just chew on that. 😉

Women who want to use birth control are just wanting to be irresponsible.
In a country in which half of all pregnancies are unintended, the active choice to prevent pregnancy until it is medically and financially viable is an extremely responsible choice. It actually represents a woman assessing her current situation and thinking explicitly about whether it is appropriate for her to be pregnant and potentially become a parent at this time. Unintended pregnancies also are associated with worse outcomes such as from delays in accessing prenatal care, quitting smoking, or resolving other health issues, the possibility of upsetting women’s ability to earn an income to support their existing families, and other economic, health, and social adverse effects. Many women have health conditions which make it very important to prevent or time pregnancy, and access to birth control makes it possible for them to be the most responsible for their own bodies and the bodies of potential offspring.

Also, the tip off that what we’re really talking about is controlling women’s abilities to make their own choices and to have sex without pregnancy, it’s extremely rare to hear an argument that grocery and drug stores should stop selling condoms, or that men should not have such easy access to condoms, because it just enables them to be irresponsible. Rush Limbaugh is not going to come out saying that men just want easy access to condoms because they’re sluts, I guarantee it – because he and his ilk don’t think *men* should just not have sex if they don’t want to get someone pregnant.

Nobody has a right to birth control.
Well, sure, if you don’t think healthcare is a human necessity and right (a point on which I disagree). What we’ve really been arguing about over the last few weeks, though, is not so much about whether healthcare is a fundamental right, or whether all the specific pieces of usually un/covered healthcare is a right, but about birth control specifically. The politicians and pundits have not been arguing over healthcare as a right generally, but specifically about women’s ability to time and prevent pregnancies, and their ability to have sex without high risk of having a pregnancy *just because some groups of men think women should not be able to have sex without risking pregnancy.* Note that we have not been arguing over whether gestational diabetes screening, HIV testing, domestic violence screening, or lactation support are “rights” – and these are all other services the Institute of Medicine said should be covered as preventive care for women under healthcare reform. Why’s that? Because this debate was never about what care people have a “right” to – it was always about who gets to have a say over women’s control over their own bodies and reproduction.

8 Comments leave one →
  1. March 3, 2012 1:26 pm

    Well said and well written. Thanks!

  2. Pat permalink
    March 5, 2012 8:55 am

    This is a nice defense of the legalization of birth control (which is not even an issue); but it’s totally ineffective as an argument for why health insurance providers should be mandated by law to ONLY offer insurance plans that cover BC, even if their clients want a plan that does not.

    • March 5, 2012 9:38 am

      Pat, I think you’ll find from reading above that the premise of the post was not “why health insurance providers should be mandated by law to ONLY offer insurance plans that cover BC, even if their clients want a plan that does not.” It was intended, as stated, to address some of the specific anti-contraception arguments I’ve heard recently about why women don’t “need” contraceptive coverage, and to express why contraceptive coverage is important to women. If you’d like to read an argument only specifically addressing your one point of interest, I’d direct you to online discussion that occurred when any of many states enacted such requirements.

  3. Diana H. permalink
    March 15, 2012 7:40 pm

    I’m still trying to find someone to explain why contraception coverage should be paid for by everyone. Nobody I know is objecting to a woman’s right to have contraception! But if our tax dollars should pay for that, why stop there? It is scientifically irrefutable that diet and exercise significantly reduce many, many health risks. Why not include coverage for the purchase of brown rice and fresh vegetables (healthy eating tends to be much more costly than fast food junk)? Why not include the cost of health club membership and personal training? At what point do WE, the PEOPLE, take a little bit of responsibility for the CHOICES we make to live our lives without expecting someone else to fund those choices??

    • March 25, 2012 6:31 pm

      Diana I like the way you have argued out your point by stating a simple progression of what should be logical. Birth control however necessary, should be an individual choice. If the government is willing to use tax payer dollars to finance this then it is only logical that they finance other healthy options and activities such as gym membership. This in mind, a median solution would be to subsidize birth control and make it available to all those who need it.

  4. Gked permalink
    March 18, 2012 10:37 am

    Rachel, thanks for another fabulous post. Very thoughtful and well-written.

  5. September 25, 2012 12:23 pm

    …what about condoms? And natural family planning through paying attention to menstrual cycles?

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