Earlier this week, the Food and Drug Administration took an important step for millions of women by moving emergency contraception out from behind the pharmacy counter and making it available to people ages 15 and older with valid identification.
As a doctor, I know that this is good news and a great first step. Emergency contraception is a safe and effective form of birth control that can prevent pregnancy if taken within five days of unprotected sex. By reducing barriers, this announcement will help more women prevent unintended pregnancy.
At the same time, the Obama administration said this week that it is appealing last month’s federal ruling that would have eliminated the age restriction completely. Citing scientific research and evidence, the judge removed the age and point of sale restrictions that made it harder for all women to access emergency contraception. That ruling should stand.
Unprotected sex sometimes happens – a condom breaks or non-consensual sex occurs. When it does, all women, regardless of their age, need access to emergency contraception quickly and confidentially.
Remember, emergency contraception prevents pregnancy. The sooner it is taken, the more effective it is (but if you are already pregnant, it won’t work). That’s why removing unnecessary barriers that delay access can help a woman prevent an unintended pregnancy.
The research shows that emergency contraception is safe for women of all ages, including young people. Research also indicates that teens understand how to use emergency contraception and understand it is not intended for ongoing, regular use. It doesn’t increase risky behavior either.
A recent study published in the medical journal Pediatrics found that sexual activity is exceedingly rare among the youngest adolescents. However, when sex does occur among teens under 14, it is often non-consensual and contraceptives are not used.
So despite some of the myths out there, emergency contraception is a safe, effective way to prevent pregnancy for all women, regardless of age (though, as someone who talks to parents everyday about health care, I also know it’s crucial that parents have conversations with their children about these issues).
The good news is that this week’s decision makes it a whole lot easier for women to get access to emergency contraception. More should be done to remove all barriers and unnecessary hurdles. While the teen birth rates have declined significantly in the last two decades, they are still high, including in states that lack access to medical providers and preventive health care.
That’s why, as a doctor, I know it makes good scientific and medical sense to expand access to emergency contraception to all women.
By: Deborah Nucatola, MD, Senior Director of Medical Services for Planned Parenthood Federation of America, Debate Club, U. S. News and World Report, May 3, 2013
America’s Big Religious War ended on Friday. Or at least it ought to.
A little more than a year ago, the Obama administration set off a bitter and unnecessary clash with the Roman Catholic Church over rules mandating broad contraception coverage under the Affordable Care Act. The Department of Health and Human Services’ announcement of new regulations is a clear statement that President Obama never wanted this fight.
The decision, the administration’s second attempt at compromise, ought to be taken by the nation’s Catholic bishops as the victory it is. Many of the country’s most prominent prelates are inclined to do just that — even if the most conservative bishops seem to want to keep the battle raging.
But more importantly, the final HHS rules are the product of a genuine and heartfelt struggle over the meaning of religious liberty in a pluralistic society. The contraception dispute was difficult because legitimate claims and interests were in conflict.
The vast majority of Americans believe that health insurance should cover contraception. At the same time, the Catholic Church has a theological objection to contraception, even if most Catholics (including regular churchgoers) disagree with its position. The church insisted that its vast array of charitable, educational and medical institutions should be exempt from the contraception requirement.
The church made a mistake in arguing its case on the grounds of “religious liberty.” By inflating their legitimate desire for accommodation into a liberty claim, the bishops implied that the freedom not to pay for birth control rose to the same level as, say, the freedom to worship or to preach the faith. This led to wild rhetorical excesses, including a comparison of Obama to Hitler and Stalin by one bishop and an analogy between the president’s approach and the Soviet constitution by another.
But the church had good reason to object to the narrowness of the original HHS definition of what constituted a religious organization entitled to exemptions from the contraception requirement. If an organization did not have “the inculcation of religious values” as its purpose and did not employ or serve primarily those who shared the faith, it got no exclusion at all.
The problem is that the vast charitable work done by religious organizations to help millions, regardless of their faith, is manifestly inspired by religion. The church could not abide the implicit reduction of its role merely to private expressions of faith. Don’t most Americans devoutly wish that religious people will be moved by their beliefs to works of charity and justice?
The HHS rules announced Friday scrapped this troubling definition in favor of long-established language in the Internal Revenue Code. In an interview, HHS Secretary Kathleen Sebelius showed a becoming humility, and it would be nice if this rubbed off on her critics. However defensible the original rules might have been, she said, “they really caused more anxiety and conflict than was appropriate.”
“What we’ve learned,” she said, “is that there are issues to balance in this area. There were issues of religious freedom on two sides of the ledger” — the freedom of the religious institutions and the freedom of their employees who might not share their objections to contraception.
This is where the other accommodation kicked in: Many Catholic institutions self-insure. While the administration rightly wants broad contraception coverage to include hospital workers, teachers and others at religious institutions, it also seeks to keep religious organizations from having “to contract, arrange, pay or refer” for coverage “to which they object on religious grounds.”
Under the new rules, employees who want it will be able to get stand-alone coverage from a third party. Some of the costs will be covered by small offsets in the fees insurers will have to pay to participate in the new exchanges where their policies will be on sale. It’s an elegant fix.
There are two reasons for hope here, particularly for Catholic progressives. First, the administration recognized the problem it had created and resolved it. Vice President Biden played a key role here, keeping lines of communication with the church open.
Second, many bishops have come to realize that the appearance of a state of war with Obama not only troubled many of the faithful — Obama, after all, narrowly carried the Catholic vote — but also threatened to cast a church with strong commitments to immigrants, social justice and nonviolence as a partisan, even right-wing organization.
This war has been bad for everyone involved. Obama has moved to end it. Here’s a prayer that the bishops will also be instruments of peace.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, February 3, 2013
The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment.
But the issue hasn’t gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case.
With that in mind, let’s talk about a conservative argument that isn’t simply about religion or the morality of birth control. It’s the suggestion that birth control coverage simply doesn’t belong in health insurance, because it’s not an expense that all of us should be subsidizing.
Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs “less than the cost of a weekly trip to Starbucks” and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs:
Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense.
Actually, it makes economic, social and moral sense.
Let’s put aside the question of whether contraception coverage should be “free,” because that’s not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses.
And, one more time, let’s dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They’re not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization.
How many women fall into those categories? It’s a minority of the population, to be sure. But that’s always the story with health care and health insurance. At any one time, most people don’t require expensive medical care. Only a small number of people do. It’s precisely for the sake of that group – the ones who face high expenses, and could face financial or medical turmoil without assistance – that insurance exists.
Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you’re not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn’t insurance be there to take care of a woman who needs more expensive forms of contraception?
No, birth control isn’t treatment for an acute condition. It’s routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year’s supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs – because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run.
The very same things are true of birth control. Pregnancy is a wonderful thing, but it’s also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians – or ask a woman who has been pregnant.) Don’t forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren’t really related to avoiding pregnancy.
Some critics insist there’s a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. “No one is touching your birth control, ladies,” conservative writer Amanda Carpenter tweeted on Friday. “We just don’t want to be forced to pay for it.” But, according to statistics from the Guttmacher Institute, 99 percent of women use birth control at times during their reproductive years. Based on that, I think it’s safe to assume that non-procreative sex is an activity in which virtually everybody engages, at some point or another, and for which a large majority will need birth control.
And so we’re back to the question that’s always been at the very heart of our health insurance debate: Do we think responsibility for medical expenses should lie primarily with individuals, even if that means some won’t be able to afford it? Or is it a burden we wish to spread more broadly, across society, so that everybody can get the care they need, at a price they can afford?
You know where I stand on that question.
P.S. When the administration announced its options for accommodating religious institutions on Friday, it also released a rule about health plans for college students – and, in so doing, revealed that, for legal reasons, it does not have the authority to regulate all the plans. Sarah Kliff has the story. It doesn’t sound like a huge deal, but, as she notes, it’s yet another reminder of how complex insurance regulation is in the U.S.
By: Jonathan Cohn, The New Republic, March 16, 2012
First, a bill that gives immunity to doctors who lie to couples about the results of their prenatal tests in order to prevent them from getting an abortion. Now, a bill that would give your boss the green light to fire you for using birth control. You think I am kidding? I wish. For a decade now, Arizona insurance companies have been required to provide coverage for contraception just like other prescriptions. But, because they saw an opening to score some political points, some politicians there are suddenly moving to take that coverage away from women and their families.
And we aren’t talking here just about exemptions for religiously affiliated employers like Catholic hospitals and universities. We are talking about authorizing secular, for-profit employers to deny a woman coverage for birth control if the employer doesn’t believe that she and her partner should be allowed to have sex without getting pregnant. Yup, that’s right. If the owner of the Taco Bell where you work opposes birth control, Arizona legislators want to give him a legal right to deny you insurance coverage for your pills.
Sadly, that isn’t even the half of it. You may want to sit down for this one. Arizona legislators know that whether or not her insurance covers it, a woman may get the prescription she needs to prevent an unintended pregnancy. They want to give her boss the right to control that too. The bill they are pushing would not only allow employers to take the insurance coverage away, but it would also make it easier for an employer who finds out that his employee uses birth control to fire her. You heard me right . . . to fire her. And I thought Rush Limbaugh’s comments were as low as you could go on this one.
The Arizona bill has, incredibly, already passed one house, but we can still stop it. We’ve seen what can happen if we make our voices heard. So, if you’ve had enough; if you think the decision about whether to have a child is one for you and your partner, not your boss and your senator, I urge you to speak up now. Tell the legislators in Arizona to stop playing politics with women’s health and put personal and private decisions back in the hands of a woman and her family.
By: Jennifer Dalven, Reproductive Freedom Project, ACLU Blog, March 12, 2012