Some of the media coverage of Tuesday’s arguments before the Supreme Courton the contraception mandate tended to pit women’s rights activists against social conservatives, making contraception seem like a lifestyle choice that only benefits some women — you know, the ones who have sex.
What often gets lost in the debate is why contraception is considered a preventive health issue — and why treating it as such is beneficial for everyone.
During the healthcare debate, the Department of Health and Human Services charged the Institute of Medicine (IOM) with reviewing preventive services that are important to public health and well-being, and recommending which ones should be considered in the development of comprehensive guidelines.
IOM came up with this evidence-based list of preventive services for adults and children, all of which are now covered by insurers with no required co-payment. Take a look at the IOM report, which explains the selection process.
For women, this includes annual well-woman visits, testing for STIs and HIV, support for breastfeeding, and screening and counseling for domestic violence.
It also includes FDA-approved contraception methods, as well as patient education and counseling on contraception. What makes contraception a health issue? Well, with all due respect to Mike Huckabee, it’s not about women’s libidos.
Here’s the deal: When women use contraception, they can avoid unwanted pregnancies and space planned pregnancies to promote optimal birth outcomes.
When a pregnancy is planned, women can start prenatal care, including increasing their intake of folic acid; work with their healthcare providers to address relevant medical conditions, as well as substance abuse; and take other steps that lead to healthier outcomes for both the mother and the infant.
Pregnancies that are unplanned are more likely to be affected by delayed prenatal care, maternal depression, low birth weight, poorer childhood physical and mental health, and other complications. Breastfeeding rates are also lower after unintended pregnancies.
Social conservatives should also take note that 40 percent of unintended pregnancies end in abortion. And there is an economic cost: Two-thirds of unintended pregnancies are paid for by publicly funded insurance programs, usually Medicaid. For more information, Guttmacher Institute has a terrific fact sheet on unintended pregnancies that explains the incidence rate, demographics, outcomes and costs.
When you look at the facts, contraception is smart public health policy.
Of course, for some women, birth control is essential for other health reasons, including acne, fibroids, endometriosis and to reduce problems associated with irregular or very heavy periods.
Despite the proven health benefits — and the benefits to society as a whole — Hobby Lobby and Conestoga Wood claim that the requirement to provide health insurance that includes no-cost contraception violates their religious freedom.
Not surprisingly, the Court’s three female justices were most skeptical of their position. As Jeffrey Toobin writes in The New Yorker:
After Paul Clement, the lawyer for Hobby Lobby, began his argument, twenty-eight of the first thirty-two questions to him came from Ruth Bader Ginsburg (four questions), Sonia Sotomayor (eleven), and Elena Kagan (thirteen). The queries varied, of course, but they were all variations on a theme. The trio saw the case from the perspective of the women employees. They regarded the employer as the party in the case with the money and the power. Sotomayor asked, “Is your claim limited to sensitive materials like contraceptives, or does it include items like blood transfusion, vaccines? For some religions, products made of pork? Is any claim under your theory that has a religious basis, could an employer preclude the use of those items as well?” Clement hedged in response. When Clement asserted that Hobby Lobby’s owners, because of their Christian values, did care about making sure that their employees had health insurance, Kagan shot back:
“I’m sure they want to be good employers. But again, that’s a different thing than saying that their religious beliefs mandate them to provide health insurance, because here Congress has said that the health insurance that they’re providing is not adequate, it’s not the full package.”
At Talking Points Memo, Sahil Kapur wrote:
The most forceful was Justice Elena Kagan, who repeatedly asked aggressive questions throughout the 90-minute argument about the legal dangers of exempting certain entities from laws on the basis of religion.
“There are quite a number of medical treatments that religious groups object to,” she said, positing that a ruling against the Obama administration could empower business owners to seek exemptions from laws about sex discrimination, family leave and the minimum wage. “You’d see religious objectors come out of the woodwork,” Kagan warned, arguing that it’s problematic for judges to test the centrality of a belief to a religion or the sincerity of beliefs that are invoked in court.
Much of the argument also centers around whether companies really have religious freedom, or if that really only applies to people — whether corporations count as “people” has been a major issue before the Court in the recent past. In “The Hobby Lobby Case Represents The Worst Kind Of Anti-Choice Arrogance,” Sarah Erdreich writes:
But even if the owners do have a religious commitment, Hobby Lobby is not pretending that it is a religion. It is a business. That any business should have power over what can literally be the life-and-death health decisions of its employees, well, that’s another issue for another day. But as long as Hobby Lobby sells its supplies to saints and sinners alike, it has no business questioning what its employees do when they go to see the doctor.
Access to birth control is important for everyone — for preventing pregnancies, and to allow women and families to best time and plan healthy pregnancies. Hopefully the male members of the Supreme Court will see it that way, too.
To catch up on the issue, check out this coverage:
- Argument recap: One hearing, two dramas
- Birth control, business, and religious beliefs: In Plain English
- Supreme Court Appears Divided in Contraceptive Coverage Cases
- Obama Administration’s Weak Defense May Prove To Be Birth Control Benefit’s Achilles Heel
- Justices Divide By Gender In Hobby Lobby Contraception Case