After the Trump administration’s rollback of the controversial and heavily litigated contraceptive mandate from the Affordable Care Act, everyone from Cecile Richards to Nancy Pelosi to Hollywood stars are crying foul.
When the mandate was put into effect in 2010, it was touted as “necessary” for women’s health and access to contraception. We have now had seven years to see whether the Mandate is actually “necessary” for women to access contraceptives. Short answer: it’s not. Research from the reproductive rights think tank, Guttmacher Institute, found that since the Affordable Care Act and the Mandate began, there has been no change in sexually active women’s use of contraception.
This is not surprising. Before the mandate began, a Centers for Disease Control (CDC) study found that among the 11 percent of women who do not use contraception, cost was not even a “frequently cited reason” for not using birth control (2). Guttmacher found that only 3.7 percent of women obtaining an abortion cited cost as a barrier to using contraception.
The 11 percent of women who do not use contraception have good reason to avoid it. It has been shown that some of the “birth control access” that we have pushed is correlated with an increase in casual sex, and in some cases, STD rates. Birth control has other serious health consequences for many women that are often not adequately communicated to them — nor the alternatives for spacing births or treating hormonal conditions. Saying birth control is essential healthcare for women can do them a disservice.
Birth control and skyrocketing STD rates
Many advocates of the HHS mandate support it because it ensures that all women will have free provision of long acting reversible contraceptives (LARCs). LARCs, which include intra-uterine devices, implants or hormonal injections, help keep women effectively sterile. LARCs are associated with increased rates of casual sex among teen girls, likely in part because they foster the illusion that sex can be “consequence free”. LARC users are more than twice as likely to have two or more sexual partners in the previous three months, and twice as likely to have four or more lifetime partners, than those who did not use LARCs”. An especially popular LARC, Depo Provera, is also associated with an increased rate of HIV transmission.
The defense of the contraceptive mandate comes at the same time that the CDC released its annual report on the status of Sexually Transmitted Diseases in the United States in 2016. The figures are staggering. The United States has reached record high rates of gonorrhea, syphilis and Chlamydia, with over 2 million new diagnoses. Especially heartbreaking is the CDC’s assertion that over half of 20 million new diagnoses of all STD’s occur in individuals aged 15-24. Interestingly, LARCs are currently being pushed to this exact population.
Birth control can harm women’s health
In addition to STD rates, contraceptives have other risks that have been largely ignored in this push for free birth control access because “women’s health” supposedly depends upon it. Hormonal contraceptives have been designated as a “known carcinogen” by the World Health Organization, and also carry an increased risk of blood clots which can result in heart attacks, pulmonary emboli or strokes. For example, Merck, the maker of the IUD, NuvaRing, paid out $100 million to settle 3,800 lawsuits related to blood clots. Bayer paid out almost $1.6 billion to settle suits related to Yaz and Yazmin birth control pill complications, which had led to heart attacks and strokes.
If our goal is really to support women’s essential health needs, then we need to start with a basic tenet of solid medical practice-informed consent, specifically in this case, actually informing women of the risks of these medications and devices. As a nurse, I have given presentations to college-aged women about contraceptives. The majority of these educated young women have little to no knowledge about these risks, or even about how contraceptives function in their bodies. I’ve heard these young women exclaim, “Why aren’t we told about this?”
It is disingenuous and simplistic to pretend that women as a group “need” hormonal birth control for their health, and that there are no alternatives for avoiding or achieving pregnancy, or treating hormonal conditions. Many hormonal conditions can be more effectively treated with targeted hormone therapies, rather than a daily contraceptive pill which only masks the underlying disease rather than actually treating it. I personally struggled with pelvic pain and irregular menstrual cycles and many physicians recommended the birth control pill; advice I didn’t take, due to both medical and moral concerns. Instead, I have found reproductive health through progesterone treatment during a limited, specific part of my cycle.
Further, women looking to space pregnancies have alternatives to birth control that are side-effect free and cost-free in the long run. Fertility awareness based methods empower women with knowledge about their cycles that they can use for a lifetime to avoid or achieve pregnancy, no hormonal manipulation necessary.
As a healthcare provider, I am ashamed that we have reached the point that we make women, both young and not-so-young, feel as if they “need” contraceptives to be healthy, or to succeed in life, and that we must force anyone and everyone to pay for it. Consequently, in that quest for access to free birth control, in the effort to paint BC as necessary for women’s health, we have failed to educate women about risks and alternatives.
Janet Garcia writes from Minnesota. She is a wife, mother and registered nurse. Janet is a member of Women Speak For Themselves.