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Employer-Based Birth Control Coverage Is Smart and Right

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BIRTH CONTROL PILL
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"No American woman should be denied access to family planning assistance because of her economic condition."




-President Richard Nixon, who in 1970 signed into law Title X, a federal grant program to provide family planning for low-income women

For once, I agree with the former Republican president. Unlike what we hear these days from a handful of Republican politicians, so do a majority of Americans. Contraception, which since 1970 has improved in variety, quality and availability, is becoming the great equalizer between women and men. This is particularly true now that the Affordable Care Act requires employer-based health insurance plans to cover contraception without co-pays or deductibles.

Unfortunately, not all businesses and non-profits are happy about this. Several have filed suit, saying that by supporting coverage of contraception, they are violating their religious beliefs. Their objections will soon be taken up by the Supreme Court. Interestingly, this year is the 50th anniversary of the signing of the Civil Rights Act, which outlawed discrimination on the basis of sex as well as other categories and paved the way for women to secure good jobs, in part because they could plan their pregnancies.

Prior to the passage of the Affordable Care Act in 2010, 26 states already had adopted the contraception requirement. In doing so, they were in step with most Americans. Consider a couple of findings from one national survey:

  • 70% of adults (including 86% of Democrats and 67% of Republicans) believe that health insurance companies should be required to cover the full costs of birth control without co-pay, just as they do for other preventative services.
  • An even greater proportion of adults -- 81% (including 91% of Democrats and 66% of Republicans) think the government should continue to help women acquire birth control, including the most effective methods, if they can't afford it.

(The survey was commissioned two years ago by The National Campaign to Prevent Teen and Unplanned Pregnancy, a non-profit, non-partisan, research-based organization.)

Birth control not only helps women space their babies; it also protects their health. As health writer-editor Susan Perry noted in a column, pregnancy and childbirth pose significant health risks for women. This is particularly true for women who can't afford or don't receive good health care. Each year, 52,000 women in the United States experience severe pregnancy-related medical complications, including cardiac arrest, kidney failure, aneurysms and respiratory distress. About 650 of those women die. "Giving birth is more dangerous for American women than for women living in 49 other countries," says Perry. Birth control is also sometimes prescribed for medical conditions other than pregnancy, she notes.

Rank-and-file Republican supporters of birth control have been largely silent of late. Perhaps this is not surprising given the noisy opposition of certain party leaders, including GOP presidential hopeful Mike Huckabee (who, as governor of Arkansas, signed into law a policy requiring insurance coverage of contraception). More than 20 heads of businesses and at least a dozen non-profit leaders have been equally loud, saying that insurance coverage of contraception violates their religious beliefs and therefore they should not have to provide it. According to Kristi Williams, a sociology professor at Ohio State University, there are currently 80 court challenges related to this provision of the Affordable Care Act.

In the years following World War II, jobs expanded in number and the need for women to remain in the home declined. The birth control pill, which went on the market in 1961, made it easier for women to acquire and hold jobs. After the Civil Rights Act became law, jobs available to women began expanding in number. In 1978, the Civil Rights Act was amended to require employers to include pregnancy and childbirth in sick leave and health benefits. This boost helped women return to work after they had a baby.

"Contraception was a vital part of women being able to take advantage of the Civil Rights Act," says Stephanie Coontz, author of A Strange Stirring: The Feminine Mystique and American Women at the Dawn of the 1960s. "Job expansion gave women the motivation to work," says Coontz, "the Civil Rights Act gave them the legal right to work, and the birth control pill as well as other methods of contraception gave them the social and personal freedom to work and not be driven by their biology."

It's also interesting to note that in 1964, three years after the pill went on sale, former Republican presidents Harry Truman and Dwight Eisenhower served as honorary co-chairs of Planned Parenthood, which assists women in obtaining contraception.

Including birth control in employee benefit packages makes all kind of sense, and solid research results are beginning to show that. For example, a study of private businesses by Mercer Human Resource Consulting and Marsh Inc. found that the cost of offering family planning coverage to employees accounts for less than one percent of total employee coverage costs. These costs are easily offset by savings to the employer due to averted unplanned births.

Another example comes from Colleen McNicholas, assistant professor of obstetrics and gynecology at Washington University School of Medicine. She and several colleagues conducted a study of more than 9,000 women in St. Louis, where the university is located.

"Women overwhelmingly chose the most effective methods," she wrote in a letter last month to The New York Times, "including IUDs which normally cost hundreds of dollars. The unintended pregnancy rate, and also the abortion rate, plunged dramatically."

Why doesn't the last part of that last sentence alone not convince at least some of the naysayers?

The critics are, thankfully, a comparatively small group. The demand now by women and health professionals for new, more reliable means of birth control is growing, and this has encouraged scientists to develop better methods. Remarkably, especially to those of us who put up with contraception that could be messy and unreliable, a woman of child-bearing age can now choose the type of contraception that is right for her from 11 highly effective, low-maintenance methods, a few of which are 99 percent effective.

Safe, reliable contraception allows a woman to go to college, train for and take a job, have a baby when she is ready and return to work. What American women don't receive -- that women in other industrialized countries do -- is subsidized, job-protected leave if they have a baby. If they can't afford reliable birth control that works for them, many of them will give birth, which forces them to quit their jobs or cut back on work. This creates a lifetime earnings penalty, says Joan Williams, a law professor at the University of California-Hastings. Motherhood, according to Williams, is a major reason why women at every educational level earn less than men with the same credentials.

Fortunately, as contraception improves in reliability and an increased proportion of women use it, the pay gap between women and men is narrowing. Consider these figures from a report for the Council on Contemporary Families, a non-profit, non-partisan organization of social scientists and practitioners. In 1963, seven years before Title X was enacted, full-time working women earned only 59 cents for every dollar men earned. Today, they make 84 percent of men's hourly wages. Those between the ages of 25 and 34 make 93 percent. Nearly 40 percent of working wives now outearn their husbands and 23 women are CEOs of Fortune 500 companies. In 1964, no Fortune 500 company had a female CEO.

"Providing contraception without cost barriers allows women real choices -- choices they can't make now," says Washington University's McNicholas. "These decisions should remain among a woman, her family and her doctor."

It's hard to understand why officeholders in both political parties, especially pro-life, pro-family officeholders, don't agree. Most Americans certainly do: 73 percent say that policymakers who oppose abortion should be strong supporters of birth control.