Birth Control is Healthcare, and Healthcare is a Human Right

By Caroline Orr

The Trump administration on Friday released new regulations allowing any employer to deny birth control coverage for moral or religious reasons, a move that effectively wipes out the Affordable Care Act’s contraceptive mandate and imperils birth control coverage for countless women. The decision is just the latest in a series of efforts by the Trump administration to expand “religious freedom” at the expense of women’s health and rights.

The new regulations, which go into effect immediately, will let any employer or insurer—with or without a religious affiliation—stop offering health insurance that covers birth control if they claim a religious or moral objection to it. According to officials at the Department of Health and Human Services, employers won’t even have to file anything with the government if they want to stop offering birth control coverage. All they have to do is notify their employees that they will no longer be providing it.

Under the Affordable Care Act, insurance companies were mandated to cover all FDA-approved birth control and most employers were required to provide health insurance that includes birth control coverage at no additional out-of-pocket cost to women. The contraceptive mandate was one of eight women’s health benefits designated by the Institute of Medicine as an essential preventive service. Other required benefits include mammograms, HPV testing, breastfeeding supplies and domestic violence screenings and counseling.

The ACA exempted houses of worship and religiously affiliated hospitals and universities from having to comply with the mandate. In 2014, the Supreme Court ruled in Hobby Lobby v. Burwell that “closely held” private businesses (with no religious affiliation) could also exclude birth control from their insurance plans based on religious beliefs.

The new rules vastly expand the pool of those exempted from the mandate to include non-profit organizations, for-profit companies and other non-government employers. They also allow schools and universities to deny birth control coverage to students. On top of that, the Trump administration created a new “moral exemption” to allow employers more latitude to deny contraception coverage.

While it’s unclear exactly how many women will be affected by the new regulations, the broad language opens the door for almost any company to stop providing birth control coverage for any reason. This essentially tells companies that it’s okay to discriminate against women in the name of religion or vague moral convictions.

So what does that mean in practical terms?

Thanks to the ACA’s contraceptive mandate, more than 55 million women in the United States have birth control coverage with zero out-of-pocket costs, according to the National Women’s Law Center. The mandate saved women an estimated $1.4 billion on birth control pills alone in 2013. Under the new regulations, women whose employers decide to deny coverage could still access birth control, but they would have to pay for it out of pocket—and for many women, that’s not an option. Prescription birth control methods can cost upward of $1,000 a year, a price that is prohibitively expensive for millions. Studies show that women who struggle to pay for birth control are more likely to use it inconsistently, incorrectly or not at all. Furthermore, intrauterine devices, which are the most effective type of birth control, are also one of the most expensive types. This means that some women may stop using birth control altogether, while others will be forced to use less effective methods of birth control simply because they can’t afford anything else.

In 2014, the U.S. abortion rate reached its lowest recorded level. Improved contraception use, not abortion restrictions, account for most of the drop.

Besides preventing unintended pregnancies, women use birth control for a host of health conditions, like endometriosis, menstrual disorders and acne. About 14 percent of women who take birth control pills (more than 1.5 million women) rely on them exclusively for non-contraceptive medical purposes, and 58 percent of women on the pill use it for a combination of contraceptive and non-contraceptive purposes. Among teenagers who use birth control pills, one-third use them solely for non-contraceptive purposes. This is why it’s so important for women to have access to the full range of contraceptive services, including birth control pills, IUDs and implants. But under the new regulations instituted by the Trump administration, some women will no longer be able to afford the birth control method that’s best for them.

Access to affordable contraception plays a vital role in preventing unintended pregnancies as well as helping women plan and space wanted pregnancies. By reducing unintended pregnancies, contraceptive use reduces maternal mortality and pregnancy-related illness and injury. Women whose pregnancies are planned are more likely to initiate prenatal care at an early stage and attend more prenatal care visits, which contributes to healthier pregnancies. Appropriate spacing of pregnancies is also associated with improved infant outcomes, including reductions in premature births and low birth-weight babies.

By reducing unintended pregnancies, increased access to affordable contraception has also reduced the abortion rate. In 2014, the U.S. abortion rate reached its lowest recorded level and researchers say improved contraception use, not abortion restrictions, account for most of the drop. Some of this can be attributed directly to the ACA’s contraceptive mandate, which increased the use of highly effective contraceptive methods. (And despite what the Trump administration claims today, research shows that expanding access to contraception and other reproductive healthcare services doesn’t encourage risky sexual behavior). Studies estimate that expanding the birth control mandate could prevent up to 70 percent of abortions annually. This means, of course, that reversing the mandate will result in fewer women using the most effective methods of contraception, resulting in more unintended pregnancies—and ultimately, more abortions.

The ability to decide whether and when to have children has empowered women and played a major role in the advancement of women in society, enabling them to complete their education, plan their families, and work outside the home. In a 2011 survey of more than 2,000 women seeking contraceptive services, 63 percent said access to birth control allowed them to take better care of themselves or their families, 56 percent said it helped them support themselves financially, 51 percent said it helped them complete their education and 50 percent said it helped them get or keep a job. Research shows that access to contraception is responsible for a third of women’s wage gains since the 1960s—and the benefits even extend to the next generation. Children born to mothers who used contraception to plan their pregnancy have 20 to 30 percent higher lifetime earnings, as well as increased college completion rates.

Access to affordable contraceptive services is essential to the financial security of women.

That’s why ensuring that women have access to affordable contraceptive services is essential to the financial security of women and their families, as well as to the economy at large. Doing the opposite not only threatens the physical health of women, but their economic wellbeing too. The Supreme Court even acknowledged this in their 1992 ruling in Planned Parenthood of Southeastern Pennsylvania v. Casey, which stated, “The ability of women to participate equally in the economic and social life of the nation has been facilitated by their ability to control their reproductive lives.”

Ultimately, that’s what this all comes down to: control of women’s bodies and lives. By enacting these new regulations, the Trump administration has declared that employers can wield claims of religious liberty and moral conviction to evade federal law and trample on the rights of others—and that the federal government will have their back when they do it.