There are 62 million women of childbearing age in the United States, 43 million of whom are "at risk" for unintended pregnancy. This costs us a minimum of $12 billion dollars a year, and that doesn't include long-term costs. "At risk" implies an uncontrollable danger. An unavoidable event that happens to a person by accident or as the result of poor decisions. This situation is neither. We persistently withhold valuable information and technologies regarding fertility and its management. Usually, individuals and societies try to reduce risks, especially those that are recognizable and preventable. But, not us. Not this one. We'd still rather tiresomely entertain Scarlet Letter sanctimony and give mainstream voice to ill-informed, nostalgic conservative malaise than enable teenage girls and adult women to manage their own reproduction. ANYTHING but that. Actually, I take that back. The only other thing we are possibly equally loathe to do is invest seriously in developing long-acting forms of male hormonal contraception, opting instead to continue relying on the updated version of 12,000 year old sheepskin. Deliberately fettering sperm for more than 30 seconds? Can't be done. This from a country that put human beings on the moon and can fit the entire contents of the LIbrary of Congress on a nanochip. Male hegemony is nothing if not selectively innovative.
Women manage their fertility for an average of 30 years. Despite the fact that we just had a national referendum on this issue, we seem willing to forget that even talking about birth control in the ways that we did this year was surreal.
Preventable, unplanned, very often unwanted and unmanageable pregnancies pervasively affect us all. The consequences are personal, societal, economic and fiscal. And I'm not only thinking about the "motherhood penalty," direct medical costs or calculable expenses related to having children. There are clear linkages to increases in other social ills: like crime, lower education levels, higher incidences of domestic abuse, increased pressure on the welfare system and more. Children who result from unplanned pregnancies are far likelier to experience developmental problems, poorer physical and mental health, to struggle in school. These steep costs exponentially exceed the cost of society's providing easy, affordable access to birth control.
Here are 50 facts detailing those costs in case you are interested. I've been, for some unexplicable reason, on a 50 facts binge. If you think unplanned pregnancies are unrelated to issues like rape and domestic violence (the other 50 facts), I beg to differ. They are often interrelated and co-incidental, which only more dramatically highlights this fact: Failing to educate and make safe medical technologies available to our population when we need and want them is the effective gender-biased control of fertility. If it doesn't strike you as ridiculous that any boy or man (none of whom can actually get pregnant) can regulate his fertility with no interference by buying a $1.34 condom and girls and women must continue to deal with overt societal regulation, including but not limited to the unnecessary intervention of doctors, nurses and pharmacists, in order to do the same commensurate with their biological needs, then I don't know what would.
The most obvious and urgent issue is the fact that emergency contraception, Plan B, is not available without a prescription to girls under the age of 17 (and even then they are being misinformed by many pharmacists.) The longer term issue is why American women are not using long-acting forms of reversible contraception.
It's been almost exactly a year since, in an unprecedented move, Health and Human Services (HHS) Secretary Kathleen Sebelius, in an act of what some called scientifically unethical "national malpractice," overruled a Food and Drug Administration recommendation and restricted access to emergency contraception long known to be safe and effective for all females of childbearing age. This was roundly condemned by reproductive health care advocates as a political act, contrary to good public policy, sound scientific reasoning and bad for women and their health.
"Emergency contraception needs to be on the pharmacy shelf between condoms and pregnancy test kits, available to women and couples without delay or hassle," explains Kirsten Moore president and CEO of Reproductive Health Technologies Project, which has led a coalition advocating for this very action for more than 10 years. "Doctors are leading the way saying that all contraception should move over the counter and be available to women of all ages. Politicians need to follow doctors' lead and get the politics out of women's health care once and for all."
Many people still do not understand how Plan B works. Plan B is safer than Tylenol, as easy to use and understand, and is not an "abortion pill." The irony is not lost. Using birth control is pretty much the only known, predictable, reliable method of safely reducing abortions. When it's free, it reduces the incidence of abortion by more than half.
But, beyond Plan B. Last week the American College of Obstetricians and Gynecologists (ACOG) endorsed over-the-counter birth control pills (OTC).
Allow yourselves to dream for a minute, ladies: Imagine not having to pay, with your money or time, for doctors visits to get prescriptions. Waiting for or dealing with a pharmacist, who may or may not have religious or other objections to your private decisions. Imagine being able to walk into a store and buy months worth of your contraception of choice by picking it up on a shelf and taking it to the cash register where some nice person smiles, takes your money, gives you change and puts your cute (or garish) little box in a bag before you leave.
And, men, daydream for them. There are some serious upsides that accrue for guys who are, as Sarah Silverman says, bro-choice. Not to mention just basic fairness. Unlike for your girlfriends, wives, sisters, mothers and female friends, most people, doctors and those with regulatory and medical authority over these decisions, understand through experience how your John Thomas' work and all that that implies in reproduction. After all, almost 75 percent of doctors and more than 80 percent of legislators have them. Some make no bones, no pun intended, about lacking empathy with women's reproductive needs. Reverse those numbers and imagine what its like. And, really, your boxes are so easy to get and even have the advantage of being thematically organized for maximal pleasure. Heck, you can even customize them.
USA Today ran pro-OTC and anti-OTC pieces. I found it super interesting that the pro-OTC piece was written by, well, an actual doctor, Dr. James T. Breeden, who happens to not only be an OBG, but the president of ACOG. The anti-OTC was written by the editorial board of the paper, otherwise known as AGCU (Amateur Gynecological Club of USAToday). Among their objections they listed "medical risks. The AGOG has weighed those and come down firmly on their being minimal and far exceeded by the benefits of deregulating the pill. In addition, there was the concern that women will forgo going to the doctor if they don't need to get birth control pills. I have no idea why this is relevant. Women aren't children who need ovary-based prompts to care for themselves. Lots of men need to get to the doctor as well and no one is withholding contraception involving their bodies. On the contrary. Just type "Free Viagra" into your browser. Then try "free birth control."
Personally, given the fact that for the first time ever we have a health care law that requires FDA-approved contraceptives to be available without copays for women, I am deeply cynical about the timing of the announcement. I mean, here we are making birth control pills "free" for women for the very first time and all of a sudden we're talking about moving them OTC where women will have to pay for them again? And where there is the risk, due to costs, that they will use them even less?
Birth control is even more reliable and effective if it is available at no cost. A landmark study released in October, involving more than 9,000 women, revealed the totally unsurprising effects of providing free birth control: far fewer unwanted pregnancies and "dramatic reductions" in abortions. This study's findings are echoed in the terrific fact that our teen pregnancy and abortion rates, while still ridiculously high, have been going down. You would think that these findings would make even the hoariest God-fearing patriarchs giddy. But, GFPs actually believe researchers, like voting machines, are colluding with sex-crazed, irresponsible, lying harlots in order to dupe good Christian men and take away their magical powers. This is happening not because girls are opting to wait to have sex in exchange for the traditional "protections" of marriage, because they are using both hormonal and other forms of long-acting birth control more effectively. Fully 46 percent of teenagers are having sex. Scary numbers of them using no birth control, including condoms. During the heyday of federal spending on abstinence-only "sex ed" during which we committed up to $170 million a year (ironically, federal spending under a Republican administration), the unwanted birth rate for girls and women 15-24 doubled. Providing a range of birth control options isn't going to help if if people don't know how to use them properly. Although all states are involved in providing sex ed to kids, only 18 require that information be medically accurate. Our teenagers need respect and honesty and have a right to factual information about their health and access to ways to manage it.
The last part of reducing unplanned pregnancies is promoting the use of Long Acting Reversible Contraception (LARC), which is far more successful than the most commonly used form -- birth control pills. Studies consistently show that the rate of failure of LARC methods is much lower. "The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception." Consider this Contraceptive Choice Project video:
Aside from those who use deliberate breeding a as a weapon or those who chose feel it is their God-given place to protect women from themselves through legislation, most people understand why family planning and birth control are critically important parts of modern life and successful modern economies. Conservative legislators, chose to ignore that American innovation, creativity and dynamism might include women, their bodies and their full participation in the economy. They continue to pursue a systematic, state-by-state focus on reducing women's reproductive health options and high on their list is removing family planning options. (Michigan is currently in a race to the Dark Ages with Mississippi.) This while simultaneously arguing that our declining birth rates are unpatriotic and hurting our economy. To quote Katha Politt, "Oh, honestly. What nonsense." Birth rates in industrialized nations decline not because women are using birth control in bubble-headed, traitorous fashion, but because birth rates decline when women and families cannot find economic and workplace support for their lives, lives which include children. Consider the difference between France, Sweden and Italy.
We saw this past year exactly how fractious the debate over birth control in this country still is. A lot of conservative language focused on slutty entitlement. We really need to redefine the word "entitlement" for policy purposes. You know what the entitlement is: being a white Christian man with power, not in possession of a human uterus, historically blithely unconcerned with "women's issues," like babies, who benefits from laws that immortalize those those three facts. That is the entitlement. Not equitable and appropriate access to birth control for women as part of their non-penis-possessing health care. That pillow on my desk is wearing thin.
At the moment, however, the Reproductive Health Technologies Project has started a petition to urge Health and Human Services Secretary Kathleen Sebelius to get us on the right track today and put women's interests back into the women's health equation. It seems to be a good way to let her know how you feel about this issue. Otherwise, you might want to add these cycle beads to your wish list for the holidays.