Contraception is hardly a new or radical feminist notion. Throughout the ages, women have sought to control how and when or whether they became pregnant. In 3000 BC, for example, it was reported that condoms made from goat bladders and other animal intestines were used. We’ve come a long way, but the recent move by the Trump Administration to restrict access to contraception promises to turn back the clock.
Restricting women’s ability to control how and when they become pregnant is also not new. It was the 1873 Comstock Act that first banned advertisements, information, and the distribution of birth control in the United States. In 1914, Margaret Sanger was jailed for distributing birth control and reproductive health information from the nation’s first, albeit secret, birth control clinic, in Brooklyn.
It took until 1972 before the right to birth control was legalized for all citizens in the Supreme Court case “Baird v. Eisenstadt.” Another milestone moment came in 2010 with the passage of the Affordable Care Act, which provided coverage for contraception without co-pays, a provision the Trump Administration now seeks to undo.
In the last decade, the U.S. has seen a steep reduction in unintended pregnancy and elective abortion. In fact, in just three years, between 2008 and 2011, the rate of unintended pregnancy fell by 18 percent. Despite these gains, however, 45 percent of the estimated six million pregnancies in the U.S. each year are unintended, with significant health, social, and economic costs. The unintended pregnancy rate in this country remains high compared to other high-income nations.
The decision by the Departments of Health and Human Services, Labor and Treasury to allow religious or moral objections to covering contraception under the preventive services requirement of the Affordable Care Act threatens to undo recent gains and stymie further progress.
Affordability is a big deal. The cost of contraception is a barrier for many women, and the methods most effective at preventing unintended pregnancy are also the most expensive. Before the ACA, IUDs (which are 99 to 99.8 percent effective at preventing pregnancy) cost nearly $1000 for insertion and follow-up visits. Following the ACA, women’s out-of-pocket spending on birth control dropped considerably.
Even before the ACA expansion, numerous studies showed that when cost barriers are addressed, the use of the most effective contraceptive methods increases, and the rate of unplanned pregnancies decreases – a fact that the Administration is disputing as rationale for allowing a roll-back of women’s access to contraception. When Colorado made long-acting reversible contraception available without cost, the unintended pregnancy rate among women age 20-24 dropped by 20 percent and the abortion rate by 18 percent.
Recognizing the powerful benefits of affordable contraception, a majority of Americans support access to birth control, as shown in study after study. A national survey released in 2014 found that 71 percent of all voters, including men and women, said prescription birth control should be included as preventive health care services, covered without any out-of-pocket costs.
Nevertheless, the current administration has sought not only to reinstate restrictive laws of the past, but to expand the restrictions. Following several cases in 2014, including Burwell v. Hobby Lobby Stores, religious organizations and some private employers were allowed to deny women birth control. The new rules, comments to which will be accepted until December 5, broaden the exemption to employers with religious or undefined moral objections.
It is clear that the Trump Administration is not concerned with the public health implications of enacting these rules, as the interim final rules document specifically states that doing so “will result in some persons covered in plans of newly exempt entities not receiving coverage or payments for contraceptive services.” It continues: “The Departments do not have sufficient data to determine the actual effect of these rules on plan participants and beneficiaries, including for costs they may incur for contraceptive coverage, nor of unintended pregnancies that may occur.”
Restricting women’s access to affordable contraception is only part of a broader attack on programs that seek to improve the reproductive health of women and girls, and specifically the most vulnerable among us. This summer, the Administration cut funding to all 81 teen pregnancy prevention programs. Earlier, Trump signed into law H.J. Res.43, which rolled back a key rule that prohibited states from blocking some family planning providers (including Planned Parenthood) from participating in Title X, a program that provides more than 4 million Americans with reproductive health care. Simultaneously, the Administration has worked to restrict access to abortion, most notably through the Pain-capable Unborn Child Protection Act, leaving women with unintended pregnancies with few options.
This attack on women’s access to contraception is also part of a move to attack women’s access to health care in general. From 2010 to 2015, about 5 million women of childbearing age got health care coverage through the ACA, but this year the budget to advertise open enrollment for ACA health plans was slashed by 90 percent, and the open enrollment period was cut nearly in half. Ongoing efforts to repeal the ACA propose severe cuts to Medicaid. And these attacks are not limited to the U.S. The expansion of the Global Gag Rule affects $8.8 billion in foreign aid, and threatens women’s health in more than 60 countries in the developing world.
As public health practitioners we ask, why is this administration intent upon denying American women services to which they are legally entitled? Why is this Administration intent upon destroying decades of public health progress?