Birth control has become contentious during America’s 2012 electoral season. But what kind of issue is it? Much of the current tug of war centers on the free preventive health services guaranteed by Obama’s Affordable Care Act. The Department of Health and Human Services ruled that birth control and other contraceptive services are part of preventive care and thus must be covered by insurance plans without co-pays. (Houses of worship are exempted from the requirement, and a later adjustment excuses religiously affiliated institutions from paying for contraception coverage, which all employees will get directly from the insurance provider). Despite such accommodations, Republicans have responded to pressures from conservatives who oppose contraception as well as abortion. Waving the flag of “religious liberty,” virtually all Republicans support a huge legislative loophole, the Blunt Amendment, which would allow any employer to invoke a right of “conscience” to refuse to insure contraceptive services for employees. Democrats decry this as part of an ongoing GOP “war” against women’s health care.
To shift public attention, presumptive GOP presidential nominee Mitt Romney played the economy card. Women aren’t all that interested in birth control, he declared. His wife Ann tells him that “the economy” is what women “really care about.” But treating contraception and the economy as separate issues is highly misleading. Access to birth control makes it possible for many women to earn the wages and salaries essential to the economic wellbeing of U.S. families.
Birth Control and Women’s Economic Prospects
In its 1965 Griswold decision, the United States Supreme Court legalized birth control, and since then its use has become an accepted part of American culture. By now, fully 98% of U.S. women tell survey researchers that they have ever used contraception for pregnancy prevention. We should not be surprised, because the development of modern birth control technologies has been closely linked to women’s economic advancement.
In their classic study, “The Power of the Pill,” Harvard economists Claudia Goldin and Lawrence Katz demonstrated that the diffusion of oral contraception among young college-educated women around 1970 was a significant factor in increasing U.S. women’s participation in professions to which they had previously enjoyed little access. Another more recent study from the National Bureau of Economic Research shows that women’s use of oral contraception has substantially contributed to the narrowing of the wage gap between men and women. This matters, because 59% of U.S. women over the age of 16 are working for wages or looking for such work. Women now comprise nearly half of the total U.S. labor force. Their earnings sustain not only themselves but millions of children in single-parent families. Analysts predict that women are on track to become sole or primary breadwinners for a majority of American families.
Not Always Affordable
Contraception use may be widespread and essential, but it is not readily affordable for all women. According to the Guttmacher Institute (the leading private research organization that tracks reproductive health), some 36 million women were in need of contraceptive care in 2008; that is, they were women of reproductive age trying to avoid pregnancy. The Institute estimates that close to half of these women (17.4 million) needed publicly funded services. But public funds were available for only nine million of them. Since 2008, the U.S. economy has plunged into recession and recovered only slowly, putting a tight economic squeeze on millions more women. In the medical community, reports abound about women who cannot consistently use prescribed contraceptive methods because they cannot afford to pay for them. Indeed, a Guttmacher Institute study of low and middle income women shows that 30% of them had put off a visit to a health care provider for birth control in order to save money.
Public debates often ignore the fact that the most effective birth control methods are also the most expensive. The Affordable Care Act will make a big difference here by stipulating coverage with no co-payment for contraceptive methods certified by the FDA as safe and effective.
- Leaving aside sterilization, the most effective birth control methods are daily use of oral contraception and the insertion of intra-uterine devices (IUDs, which are now far safer than the earliest models of the 1970s). The failure rate of the pill as a birth control method is 5%, and the failure rate of the most effective IUD is between 1 and 2%. In contrast, male condoms fail to prevent pregnancy 17% of the time.
- But pills and the IUD are also quite costly. Without subsidies, a woman must pay around $700 for a year’s supply of pills, a substantial cost for anyone making a low or modest income. The cost of an IUD, including insertion, averages about $1000 and can be considerably more. For a woman of means an IUD is not such a bad deal, because the device lasts up to ten years. But lower-income women have difficulty paying the initial fee.
A High Stakes Issue
After the 1960s, most Republicans as well as Democrats found common ground in support for contraceptive use and funding, even as groups took opposite sides in fiery abortion battles over “women’s right to choose” versus “the right to life.” In recent years, however, the abortion conflict has escalated to include contraception, because some on the religious right see certain birth control methods themselves as a form of abortion, and others resent the broader economic access to contraception promised by federal health-care programs. Suddenly, an issue that seemed off the radar is caught up in the ongoing political wars pitting conservative Republicans against Democrats and Independents. This unfortunate development certainly jeopardizes the health of American women. But the battle also has high economic stakes for most American women and their families. Citizens who care about “the economy” can hardly afford to ignore women’s need for access to affordable and safe birth control services. The technologies are there and the vast majority of Americans support their use. But full access depends on making birth control affordable for all women – just like any other essential preventive health care service.
With updated facts, this brief draws upon Carole Joffe, Dispatches from the Abortion Wars (Beacon Press, 2010).