In their latest assault on an increasingly hollow Affordable Care Act, the U.S. Supreme Court ruled, on 30 June 2014, that “family-owned” or “closely-held” companies could exclude contraception from workers’ health plans by invoking “religious objections”. The 5-4 decision was unsurprisingly split along the justices’ conservative-liberal divide, the dissenting liberals lead by none other than the famous women’s rights advocate, Justice Ruth Bader Ginsburg.
Aside from further undermining Obama-care, whose provision on the matter of contraceptives had already exempted churches and religious-run entities, the ruling sparked a number of furious debates online. Newspapers, blogs, Facebook feeds, Twitter accounts… everyone seems to have an opinion on the Hobby Lobby ruling and its expected impact on American families.
Sitting on the sidelines of this digital yelling match, what one progressively notices is not the contrast in conclusions reached by opposing parties, but the contrast in premises used as starting points. Let us temporarily set aside the otherwise very deserving debate on the validity, transparency and flawed nature of the American justice system. Instead, this article will focus on those presumptions which reveal a worryingly outdated view of contraception, its affordability and its importance to societies both in the US and abroad.
1) “Contraception is a want, not a need.”
“People don’t need contraception; it’s not like they’ll die without it”: over and over again, this same argument is stated by politicians and civilians alike. Weighed against the subsidy of lifesaving operations such as heart or brain surgery, the free provision of brightly packaged, mass-produced “johnnies” does seem somewhat trivial. That, however, is the strategic art of clever comparison.
There are a lot of things provided for by Western healthcare systems that individuals wouldn’t “die without”: arthritis medication, cures for certain types of STDs, cholesterol medication, anti-depressants … These items are provided for because modern, advanced healthcare wishes to go beyond saving lives — it wants to save livelihoods as well, preventing individuals from living with conditions which, although non-lethal, restrict their freedom or happiness.
A child should never be considered a burden; their conception should never be referred to as an “accident” or a “stroke of bad luck”. On the contrary, conception is the miraculous, against-all-odds completion of our most complex biological obstacle course. It is also the start of a lifelong commitment, requiring endless amounts of attention, effort, time … and money. No, there is no sugar-coating it: children cost a lot. Food, clothing, healthcare, college all add to up to a rather hefty amount. Should a family’s already decreasing household income prove unable to foot the bigger bill, both the state’s public funds and the child’s life will suffer.
2) “Contraception isn’t a key aspect of healthcare.”
Withholding contraception, even in a developed country like the U.S, does endanger both lives and livelihoods. In what might be a shocking revelation to a seemingly very mislead public opinion, a woman giving birth in America is more likely to die than a woman giving birth in China. Maternal deaths in the US are at their highest rate in a quarter century, claiming 800 lives in 2013 (twice the rate of neighbouring Canada and thrice that of the United Kingdom). Responsible for this spike is first and foremost a significant increase in the number of higher risk pregnancies; a trend that only reflects the growing number of US women with hypertension or diabetes.
A consistent use of contraception would lead to an estimated 95% decrease in the number of “accidental” pregnancies. For many, it would also allow a break in an otherwise looming cycle of intergenerational poverty.
Of course, not every individual seeking contraception does so out of a radical fear of maternal death. Most of them simply do not want to have a child. About 51% of pregnancies in the US are unintended; in other words, an estimated 3.4 million children are born to parents who had considered themselves neither emotionally nor financially capable of raising a child. These unintended pregnancy rates are “highest among poor and low-income women, women aged 18-24, cohabiting women and minority women”. Thanks to the limited trickle down effect of gender equality, women in these categories are often “de facto” assigned the traditional parenting role, forced to leave their jobs and place their careers on a likely permanent hold in order to stay at home — that is, if they are not raising the child alone and forced to juggle both.
A consistent use of contraception would lead to an estimated 95% decrease in the number of “accidental” pregnancies. For many, it would also allow a break in an otherwise looming cycle of intergenerational poverty. Of the children born of unintended pregnancies, 65% will depend on public insurance programs. Studies have also found these children to be at a greater risk of experiencing physical and mental health problems, more likely to drop out of school, and more likely to engage in delinquent behaviour.
Beyond preventing unintended births likely followed up by difficult lives, contraceptives also have other, often forgotten medical uses. A Harvard study found that a consistent use of oral contraceptives could cut women’s risk of ovarian cancer by half. Contraceptives such as the birth control pill can be used to treat endometriosis, dysmenorrhea, menorrhagia, metrorrhagia, acne, and can reduce risks of anaemia and uterine cancer.
3) “People can afford contraception themselves.”
As some members of the Supreme Court brilliantly argued, cheap condoms are, in fact, quite cheap. They are also only 82% effective — and that’s assuming they were a reliable brand with an accurate expiry date. Meanwhile, the most efficient methods of contraception come at a much higher price. Without insurance, the cheapest options available to a US resident are contraceptive injections ($590 per year), the pill ($1210/year) and the birth control patch ($1200/year). Implants cost $1100 every 3 years, and intrauterine devices require $1000 every 5 to 10 years. Surgical sterilisation is $6000 — and all of the above is in a country that spends 16% of its GDP on healthcare, making it the biggest spender worldwide.
In the end, what is most frightening is the underestimation, even in a country as developed as the U.S, of just how much contraception matters. Access to birth control was recently declared a universal human right by the United Nations. Studies around the world have time and time again linked women’s exercise of their reproductive rights to poverty reduction, health improvement, gender equality promotion, school attendance and labour force participation. These added benefits, along with the reduction in public spending on unintended pregnancies, would make the provision of free contraception one of the most cost-effective policies to date (using the US as an example, every dollar spent on contraception saves an estimated $3.00 in pregnancy related healthcare). All we needed was for one of the world’s most influential countries to take the lead — instead, the US turned a blind eye to its most vulnerable populations and, as stated by Justice Ginsburg in her scathing dissent, “ventured into a minefield”.