WASHINGTON, D.C. -- The debate over President Barack Obama's new contraception-coverage rule has been largely been considered through the frame of religious liberties, federal authorities and electoral consequences.
For Kimberly Dudley, however, there is a significant, often delicate, medical component being lost in the discussion.
Dudley is one of approximately five million women who suffer from Polycystic Ovary Syndrome or PCOS, a complex disorder that is a major cause of female subfertility. The condition affected her mother and her six aunts, all of whom were forced to have hysterectomies before the age of 35.
Dudley, now 35 herself, is threatened with a similar outcome. A hormonal imbalance makes it difficult if not impossible for her body to have normal menstrual cycles. Periods can last weeks if not months. Her most recent one started on October 3, 2011. It ended three weeks ago.
"It almost killed me," she said, "the doctors couldn't stop the bleeding." They tried a number of medications before finding one that worked: a double-dosage of Aygestin, a drug that can be classified as a birth control.
"Had the last one not worked I would have likely had a hysterectomy," she said.
The Obama administration's rule change would force hospitals and schools owned and run by the Catholic Church and other religious organizations to offer health care plans to their employees that cover drugs like Aygestin. There is a year grace period before it becomes law and reports early Friday morning suggest that the administration will alter the language to allow religious groups more leeway in (and distance from) providing such coverage. Even when the new rule takes effect, Dudley won't be directly affected. A self-employed real estate broker, she pays $55 every month for her medication. Her insurance company covers the rest.
But that doesn't mean she doesn't have a deeply personal stake in the game. Her husband is a dean at a local North Carolina college. Were he to get a job offer at a Catholic university in one of the states that don't require those institutions to cover the co-pays of their employee's contraception, with her then being dependent on his plan, they'd be unlikely to move. "It would be sad he would have to make job choices based on something like this," she said.
Dudley brings to the debate a perspective that has been largely absent from public view. When the White House initially weighed the merits of changing federal policy on contraceptives, a cadre of largely female advisers invested in expanding health care coverage for women were pitted against mainly male aides, including several prominent Catholics, who warned that it would cause a political firestorm. Since the former won out, the president has come under intense pressure to reverse course.
Members of the Catholic Church, reportedly prepping for months for the battle, have been vocal with their concerns that the rule forces them to violate tenets of faith. Republicans and even some Democrats have warned that the policy represents a dangerous overreach by the federal government. It has been less common to hear from those whose lives (and not just their sex lives) are directly affected by current law.
"I'm a married woman," Dudley said. "I am a Christian. I don't believe in abortion. But this has nothing to do with any of that. This is a health issue for me and for millions of women."
The Guttmacher Institute estimates that roughly 14 percent of birth control prescriptions are written for non-contraceptive purposes, helping some 1.5 million women with issues like ovarian cancer, ovarian cysts, endometriosis, and endometrial cancer. Their stories, filled with difficult details of medical trauma and personal sacrifice, aren't usually the fodder for piqued political conversation, at least not until this week.
Dudley, for her part, kept the details of her condition secret from all but close friends and family. She only came forward on Thursday morning, when she sent an email to a wider group after finally hitting a boiling point with news coverage of the controversy. She forwarded that email to The Huffington Post shortly after.
Her first inclination that something might be wrong came when she was 18 years old. She went to the campus nurse at the University of North Carolina at Greensboro, who recommended that she see an off-campus doctor. An ultrasound was conducted confirming PCOS. Her life since has been filled with efforts to manage the consequences. She shyly changes topic when people ask why she doesn't have more children (she and her husband have a nine year old.) She misses big events and birthday parties, including her best friend's 40th.
"When you are bleeding that high a volume there are times where you have to wear adult diapers," she says, by way of explaining why she's occasionally housebound.
Even more serious has been the medical complications. One recent large loss of blood resulted in severe iron deficiency and anemia. Things stabilized eventually. But Dudley said her doctor later told her that the doctor had thought she was going to die.
Finding the right medication has changed her life, she says. And she counts herself among the fortunate for having the resources to cover the costs. But she also recognizes how close she comes to being among the cast of the less lucky.
The Church may be sincere in arguing that Obama's new rule violates their consciousness. Lawmakers may be earnest in expressing concerns about the reach of government into world of contraception policy. But that doesn't change the fact that many women suffering from Dudley's condition, as she notes, "do not have access to health insurance coverage to pay for this medication simply because they work at places owned or run by the Catholic Church."