Everything I know about contraception I learned from being a mother.
OK, that's an exaggeration, but as the Supreme Court considers the arguments made in the Hobby Lobby and Conestoga Wood cases this week, I would like to offer some maternal insights for the Justices.
Let's start with a dose of reality. Pregnancy may or may not be a blessed event, but it is a serious medical condition that puts a significant strain on your body. For women living with medical ailments such as a chronic heart condition or lupus, an ill-timed or poorly managed pregnancy can cause permanent damage or worse.
These conditions occur with greater frequency in certain low-income and minority communities, and the risks of pregnancy are disparately felt by women in these groups. This may be one of the reasons that a recent study in New York City reported a maternal mortality rate of 79 deaths for every 100,000 live births among African American women, compared to 10 deaths per 100,000 live births among white mothers, or why the U.S. ranks below much of the industrialized world in maternal mortality.
In addition, a badly timed pregnancy can have a catastrophic impact on the fetus. For example, more than 11 million prescriptions for drugs that have been shown to cause severe fetal harm are filled every year by women of child bearing age. Pregnancies occurring in short succession pose a greater risk of low birth rate and neonatal death.
These are just a few reasons that every single major medical association and the Centers for Disease Control and Prevention recommend contraception as a "standard of care" for women. This term of art refers to the culmination of years of research and clinical data that indicate what a reasonable and prudent medical professional should do in a given situation -- ordering additional tests, prescribing (or not prescribing) antibiotics, asking certain follow up questions -- and offering birth control.
Because the benefits of contraception far outweigh its costs, both fiscally and physically, the Affordable Care Act required all insurance plans to include contraception as a covered "preventive service," meaning women no longer need to pay an additional deductible or co-pay to access it.
To be clear: no doctor is required to prescribe contraceptives, and no woman is required to take them (though studies show that 99 percent of all sexually active women have done so), but if a woman and her doctor agree that it is the healthy thing to do, money will no longer stand in her way.
Enter Hobby Lobby. Ranked 135 in Forbes' list of largest private companies with 597 stores across 40 states and employing roughly 23,000 people, the company is seeking an exception to the ACA's requirement because it conflicts with its owners' religious beliefs.
Let's put aside the fact that the company had previously offered health insurance plans that included contraception (oops) and operated in several of the 28 states that had required, as a matter of state law, contraception coverage before the ACA. Let's also put aside that the very purpose of corporations is to create an entity separate from their owners (hence limited liability), and that not a single Fortune 500 company -- nor, indeed, the U.S. Chamber of Commerce -- filed a brief in Hobby Lobby's defense. (Full disclosure: NHeLP filed an amicus brief in support of the government.)
Instead let's think about the potential impact of a Supreme Court decision finding that a secular, for-profit company does not have to follow a federal law of general application on the grounds of religious freedom.
Of course, you could think about it as a business -- what an innovative way to disrupt the market among your competitors! But I am writing today as a mother, and thinking of my own daughters as they enter the work force.
If the Supreme Court finds for Hobby Lobby, where would it -- where could it -- draw the line? Could a private company forbid female employees from taking contraception at all because doing so conflicts with its owners' religious beliefs? Could it refuse to cover blood transfusions? Could it legally discriminate against gays and lesbians, even if state and federal law forbids such discrimination?
These hypotheticals may be just that. We are unlikely to know the Supreme Court's decision for another few months.
But I am a mother, and so I worry.