Debunking the hysteria over birth control

When the Institute of Medicine's independent panel of health experts recommended last week that insurers offer preventive services to women without co-payments, the reaction was swift. Despite IOM's reliance on medical science, its recommendation on contraception, in particular, was greeted with howls of disapproval.

Some of the right-wing's ravings have been positively unhinged. Jeffrey Kuhner of the Washington Times wrote that contraception "violates the natural moral order" and that the recommendation on birth control is a step toward "forging a pagan society based on consequence-free sex." Fox host Bill O'Reilly claimed the recommendation would be ineffective because "many women who get pregnant are blasted out of their minds when they have sex and [are] not going to use birth control anyway." Fox's Greg Gutfield, bizarrely, argued that eliminating copays would help so many low-income women that it must bepart of a plot to "eradicate the poor."

To listen to the hysteria, you would think that coverage for birth control is divisive. It's not. Most plans already cover it, and a majority of states - 28, to be precise - require it be covered by insurance. Virtually all women - 99% - have used birth control, and religious adherents, even Catholics and Evangelicals, use birth control at the same rate as the general population. (Ninety-eight percent of sexually active Catholic women have used birth control; the rate is even higher among Evangelicals.) In addition, government insurance plans currently cover contraception, albeit with copays.

This near-universal acceptance of contraception is remarkable. In this age of red and blue states, we may not agree on politics, or even basic scientific truths: half of Americans don't believe in evolution, and one in three Americans believes in ghosts. Yet Americans are united in their acceptance of birth control, making it as mainstream as anything could be.

At the same time, access to affordable contraception is lacking. The U.S. leads the developed world in unintended pregnancies--a shocking half of all American pregnancies are unplanned. Unintended pregnancy can harm women's health, and closely spaced pregnancies are associated with low birth weight and prematurity. Cost, sadly, has been the major factor preventing the more widespread use of birth control, particularly in an economic downturn. Moreover, the high cost of long-acting contraceptive options like IUDs places them out of reach for millions, leading to contraceptive failure when antibiotics or mere forgetfulness renders birth control pills less effective. The IOM's recommendation to eliminate copays for the "full range" of approved contraceptives was grounded in two facts: contraception is non-controversial and has been used by virtually every American woman; and women lack access to affordable contraception.

Yet this common-sense, evidence-based approach is under attack. Not only by the hyperbolic antics of television's talking heads, but also the misleading statements of the U.S. Conference of Catholic Bishops. Its public statements repeatedly and deliberately conflate contraception with abortion, which is beyond the scope of IOM's recommendations.

The all-male minority and avowed celibate Bishops want a heckler's veto over the entire American healthcare system, including preventive services for women. Sister Mary Ann Walsh, a spokeswoman, has argued for an exception to allow religious insurers to operate under a different, special set of rules. Never mind that Catholics need and use birth control just like everyone else, and that a special rule for some insurers would deny coverage to many non-believers who happen to work for religiously-affiliated hospitals or schools.

When considering religious prohibitions that she does not share, Walsh gets the distinction and shouldtktk between what an individual chooses to use under a plan and forcing everyone to forgo it. In the Washington Post's On Faith blog, she notes that "[b]lood transfusions are not verboten to me, but I respect Jehovah's Witnesses' right to refuse them." The obvious rejoinder, then, is that for the rest of us, "contraceptives are not verboten to us, but we respect Catholics' right to refuse them." Religious adherents who object to a particular medical service are under no obligation to use it. Jehovah's Witnesses are not compelled to get blood transfusions, and Catholics are not compelled to use contraceptives.

Respect for other's choices isn't what Walsh and the Bishops want. Instead, they seek a rule that would allow any insurer allied with a set of religious beliefs to deny coverage to everyone they insure. Under this dubious logic, the government couldn't mandate coverage for any medical service that anyone had a religious objection to, allowing religious dogma to trump sound public health policy.

The purpose of healthcare reform is to make needed medical care practically available and uniform for a much larger group of people, thereby improving health and diminishing costs. (The IOM focused on health, but noted cost savings would be $19 billion). The IOM's recommendations are a critical step to improve the health of millions. Birth control should finally take its rightful place as an essential medical service. It is medically sound, cost effective, and uncontroversial. Any set of special rules that would reduce access for some would merely diminish the quality of care for everyone.

Bio: Nancy Northup is President and CEO, Center for Reproductive Rights. The opinions expressed in this commentary are solely those of the author.

[anne623]

More important - the new regulation also cover well woman exams, STD, HPV, AIDS testing and gestational diabetes testing. The birth control is only one part of the recommendation. To everyone who doesn't want their tax dollars to pay for this - my tax dollars go to lots of things I think are immoral (like two wars), agricultural subsidies to factory farmers. I don't get to opt out and neither do you. Overall, a good bill.

[byrdh5n1]

A few notes:
* "Consequence-free sex?" - Sounds like this guy thinks pregnancy is a punishment. Me too.... but for very different reasons. Sex is not a sin that should be punished.
* "...not use contraception anyway?" - Then the inclusion of free contraceptive in the Affordable Health Care Act doesn't really matter to ya, now does it.... Shut up unless you have something valid to add...
* "Eradicate the poor?" - DUH! Fewer children, less burden, more chance of earning out of poverty. Yep, let us certainly eradicate the poor....
* ">98% of Evangelicals use contraception." - GOOD!

[Mather2]

You have got to love the the party which is against ensuring affordable access to contraceptives for women is also against paying for any welfare programs that may support unintended pregnancies that are carried to turn. I may just be confused, but are the Republicans really advocating for an abstinence only adulthood?

[memestryker]

Thank you for a reasoned article, Nancy. There is so much extremist spin on things today that it's difficult to ferret out the facts. All these people complaining about cost to we the people forget that pregnancy that comes to term is exponentially more expensive for we the people, especially if the pregnancy involves complications and/or the baby has special needs, sometimes even requiring life-long care. Most people use contraception at some point in their lives. I'd like to see sterilization for both men and women offered at no charge, so when their procreation is complete, they can avoid future unwanted pregnancies and save we the people a LOT of money in the process.

[dancingmoon]

The cost of the insurance program that covers federal employees and their dependents is paid partially by the feds (that's us folks cause that is where the feds get the money) and partially by the insured. There are about 4 million federal employees covered and with their dependents there are about 8 million covered. The feds pay up to 75% of the premiums.

The average monthly premium for 2011 family plans is $1,100 or about $13,000 annually. Even if some of the 4 million federal employees covered are under the single plan and not the family plan, the feds (we the people) are picking up billions of dollars of insurance premium costs annually.

The insurance companies that serve federal employees are required to cover birth control.

Additionally, while the insurance companies don't cover elective abortion, they do cover abortions to save the life of the mother or in cases of incest or rape.

Why should we the people have to pay for better insurance coverage for federal employees than we are allowed to have?

[imnho]

I fail to see whats wrong with conquence free sex. I also think that there is nothing wrong with two adults finding recreation and individual gratification by having sex. Eliminating individual gratifacation from good sex is basically impossible. That is the very nature of sex.It sounds like this wingnut thinks that non-procreative sex should be punished and that married couples should refrain unless they are trying t have a baby. This smacks of a person who serious unresovled control issuses. Trying to make married couples refrain from having recreational sex is absurd and impossible to implement. I wonder if Jeffrey Kuhner ever consider the fact that one of the reasons to get married is to have recreational non-procreative sex?

[yeeoflittlefaith]

Here is the equation. No contraception, no need for abortion. Right? Why aren't Roman Catholic Bishops and bible thumpers handing out condoms in the street? So simple.

[RCC_Soldaten]

Pick up a book on the Catholic position on birth control. Read it. Then you won't be so ignorant.

[Void-Master]

Jeffrey Kuhner of the Washington Times wrote that contraception "violates the natural moral order" and that the recommendation on birth control is a step toward "forging a pagan society based on consequence-free sex."

***

Only Pagans are allowed to have consequence-free sex? Really?

[imnho]

Trying to make adults practice abstinence is a hopeless endvor. It will never have a signifcant impact. Its more logical to make birth control avaiable to as many people as possible.

This would not be a perfect solution, but it would minimize the rate of STD's,unwanted pregnancies and dysfuntional familes.

For a lot of the far religious right its all about control and not about the best interests of society. People should have a say in how many babies they bring into the world. The push to get rid of birth control is all about punishing people for having sex

[darwufche]

Great article, Nancy. Thoughtful, rational, and correct. Thanks.