Our women, at home and abroad: family planning in 2017
by Vaidehi Nafade
Amidst the usual political suspects (taxes, scandalous Congressmen, guns, healthcare), one topic has recently featured prominently in American newspapers: birth control. It is somewhat baffling that Americans are arguing about this in 2017, but the battle for contraception has been a long one. That makes this debate particularly troubling: recent events seem like backwards progress.
Progress was Griswold vs. Connecticut, the 1965 Supreme Court ruling that married women had the right to take birth control. Progress was the Obama-era mandate, part of the oft-maligned Affordable Care Act, that required most employers to provide birth control without co-payments (there was an exception for religious organisations). Since its introduction, that mandate is estimated to have saved American women over $1 billion per year in out-of-pocket expenses [1]. And yet, that has now been rolled back; under new rules announced last week by the Departments of Health and Human Services, Treasury and Labour, employers can deny this coverage to their employees on the basis of a ‘moral objection’, a phrase that is purposely vague [2].
The pill, a form of oral contraception. Source: The University of California Irvine.
Also in October, the U.S. House of Representatives passed a bill banning late-term abortions [3], a bill that has been proposed and struck down many times before. Really, neither this nor the birth control rule should be surprising, considering that Mr. Trump began his presidency by reinstating the infamous Mexico City Policy (not-so-affectionately nicknamed the ‘global gag rule’). It seems that this administration’s only interest in foreign aid and women’s health (and perhaps human health in its entirety) is figuring out how to scale back.
These legislative actions claim to protect a variety of people and interests: hard-working American employers, American financial interests, religious and family values, and, of course, the unborn. Ultimately, though, all they do is systematically disempower women. It’s predictable that most legislators in the U.S. are male; only 19.6% of the members of Congress are women [4].
The unfortunate truth is that we don’t have to look very far to see just how important family planning is for women and the societies they live in. The Bill & Melinda Gates Foundation estimates that in developing countries, there are more than 220 million women who want but lack access to contraception and family planning services. The consequences? Unintended pregnancies, and women being forced to resort to unsafe abortions [5]. In fact, a new study published in Lancet suggests that of all abortions performed worldwide between 2010 and 2014, 45% were most likely unsafe [6]. That is twenty million women facing a perfectly avoidable health risk.
In developing countries, accessible contraception is more than just a way to avoid the consequences of unintended pregnancy. In the Gates Foundation 2017 annual letter, Melinda Gates wrote, “Contraceptives are one of the greatest antipoverty innovations in history” [7]. As she rightly goes on to say, every now-developed country has profited from contraception use. (As a side note, Ms. Gates is putting her money where her mouth is; the Gates Foundation is a key partner in Family Planning 2020, which aims to provide contraception to 120 million women by 2020 [8]). Controlled trials providing family planning services have shown that this not only reduces fertility, but improves outcomes – education, health, and wealth – for women and children alike, while also enhancing economic growth [9].
The U.S. is, in some ways, a birth control success story. Planned Parenthood estimates that one-third of wage gains by women since the 1960s have been due to oral contraceptives, and college enrollment has historically been higher among women with access to the pill [10]. Women account for 50% of the population, after all. Where women have the freedom to make their own choices and pursue their own success, everyone in the community benefits.
The global scope of the problem makes the story of the U.S. even more disheartening. Here is a country with a long history of contraception use and the infrastructure to provide every woman with family planning services. Yet the idea that accessible birth control is a necessity (really, a human right [11]) is apparently and inexplicably contentious. If the U.S. government should be passing any new law about birth control, it should be a plan to ensure affordable access for every American woman. And it should be a commitment to the provision of family planning services in developing countries that are still waiting to reap the developmental and economic benefits of contraception.
Still the debate continues. It’s almost as if some would still have an American woman live yoked to her uterus, her body subject to the whims of legislators. Perhaps this is a cruel reminder for women to never take anything for granted; now and as always, we must fight for every inch of progress.
Vaidehi is a first-year MSc. student in epidemiology at McGill University. Her research interests are in infectious disease and antimicrobial resistance, but she is also passionate about social justice and the intersection of human rights and health, particularly immigrant health and women’s health.
References
1. Becker NV, Polsky D. Women Saw Large Decrease In Out-of-Pocket Spending For Contraceptives After ACA Mandate Removed Cost Sharing. Health Affairs. 2015;34(17):1204-12011. http://content.healthaffairs.org/content/34/7/1204.abstract
2. Pear R, Ruiz RR, Goodstein L. Trump Administration Rolls Back Birth Control Mandate. The New York Times. 2017 6 Oct. Available from: https://www.nytimes.com/2017/10/06/us/politics/trump-contraception-birth-control.html
3. Associated Press. House Passes Late-Term Abortion Ban Pushed by GOP. NBC News. 2017 3 Oct. Available from: https://www.nbcnews.com/politics/congress/house-passes-late-term-abortion-ban-pushed-gop-n807286
4. The Bill & Melinda Gates Foundation. What we do: Family Planning. Available from: https://www.gatesfoundation.org/What-We-Do/Global-Development/Family-Planning
5. Center for American Women and Politics, Eagleton Institute of Politics, Rutgers University. Available from: http://www.cawp.rutgers.edu/women-us-congress-2017
6. Ganatra B, Gerdts C, Rossier C et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31794-4/fulltext
7. Gates B, Gates M. Dear Warren: Our 2017 Annual Letter. Gates Notes. 2017. Available from: https://www.gatesnotes.com/2017-Annual-Letter
8. Family Planning 2020. http://www.familyplanning2020.org/entities/206
9. Canning D, Schultz TP. The economic consequences of reproductive health and family planning. The Lancet. 2012;380:165-171. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60827-7/fulltext
10. Planned Parenthood. Birth Control Factsheet. Available from: https://www.plannedparenthood.org/files/1614/3275/8659/BC_factsheet_may2015_updated_1.pdf
11. United Nations Population Fund. State of World Population 2012. Available from: http://www.unfpa.org/sites/default/files/resource-pdf/EN-SWOP2012-Summary.pdf