The Birth Control Benefit Fight Is for the Fundamental Right of Agency Over Our Bodies
This piece was published by Rewire on January 28, 2019.
OiYan Poon, a former professor at Loyola University Chicago, distinctly remembers the shock and fear she felt when Loyola informed her in 2014 that it would no longer provide birth control coverage as part of its health-care plan, which covered hundreds of individuals across the campus.
While the Affordable Care Act (ACA) required employers to provide contraceptive coverage without a co-pay, religious nonprofits could opt out of the requirement on the basis of their religious objections. Loyola, a Catholic and Jesuit university, had decided to opt out. Loyola employees were informed that they could receive birth control coverage directly from the insurance company that provided Loyola’s health insurance, but the types of birth control that were fully covered were much more limited. Poon’s medication was not on the list of ones that were covered. This left her torn: Should she stay on the university’s health-care plan and either change her birth control method or pay out of pocket for the one she was using, or transition to her spouse’s plan?
Poon decided to stay on the university’s plan, as she and her partner chose to start a family around that time—but she continued to feel the effects of Loyola’s policies, which were influenced by its religious views. While trying to get pregnant, Poon miscarried during the first trimester and needed to have a procedure done to remove the tissue. During this emotional time, she was forced to endure repeated intrusive questions from an insurance company representative who insisted on verifying the purpose of the procedure to make sure it aligned with the employer’s coverage.
Poon’s story illustrates the harm that many women will likely experience if the Trump administration’s new birth control coverage rules are permitted to take effect. Thanks to federal judges, the rules have been temporarily blocked, but that doesn’t mean our worries are over. The administration appears more than willing to continue trying to take away our birth control access until it succeeds.
While the Supreme Court’s decision in Burwell v. Hobby Lobby allowed privately-held companies with religious objections to refuse to cover birth control for their employees, the Trump administration’s new rules would vastly expand the number of employers that can do so. As a result, the rules threaten access to birth control for many of the 62 million people who now have birth control coverage without out-of-pocket costs because of the ACA birth control benefit. If the rules are allowed to go into effect, it will mean even less access to affordable birth control and increased health risks for women. And for women of color, LGBTQ people, young women, and immigrant women who already face health disparities and numerous barriers to accessing birth control, the risk of harm is even greater.
This is why we at the National Asian Pacific American Women’s Forum are fighting these rules. With other reproductive justice and rights organizations, we have filed amicus briefs in cases challenging these rules to inform courts of the serious harm that these rules could cause people facing multiple and intersecting oppressions. It is vital for courts to understand that the harm will be compounded by inequalities and disparities shaped by historical and ongoing oppression and discrimination against women of color and other groups.
Contraception is a vital component of preventive health care: It not only combats unintended pregnancy and resulting health consequences, it also helps people avoid exacerbating medical conditions related to or resulting from pregnancy. Different forms of contraception offer a variety of health benefits, which include menstrual cycle regulation and reduced premenstrual syndrome symptoms. In fact, 13 percent of women between the ages of 18 and 44 use birth control solely to manage a medical condition.
Unfortunately, the Trump administration seeks to chip away at access to this crucial health care. The administration’s rules would allow virtually any employer or university with religious or moral objections to refuse to comply with the ACA’s requirement that all employers provide insurance coverage for birth control without additional cost. With no requirement that employers certify or otherwise establish or explain their objections, these rules would provide a sweeping exemption to the ACA contraceptive coverage requirement. In pushing for these rules, this administration is essentially sanctioning health-care discrimination against those who have the ability to get pregnant—and condemning them to face an ever-growing list of disparities in health care.
Race, financial ability, immigration status, language competency, and other factors play a significant role in determining who can have access to birth control, what type, and when. That is why health insurance coverage of birth control through employers and universities is so important: It allows broader access for many who already face barriers in obtaining contraceptives. By taking away access to affordable and effective birth control, the administration’s new rules will not only increase the rate of unintended pregnancies for women of color and young people, including LGBTQ youth, who are already at higher risk, it will also harm the mental and physical health of individuals and families, particularly those already suffering negative health outcomes for which access to contraception is critical, because it takes away their agency to decide what happens to their bodies.
Further, these rules will only serve to exacerbate wage disparities between men and women, particularly those for women of color who face the highest wage gaps. Contraception has played a critical role in advancing gender equality by reducing the wage gap between many workers. When women are able to access and use contraception, they have more control over if, when, and how they want to parent—most importantly, it allows them to space their births apart and be more prepared for each child.
This is particularly important for women in low-wage jobs, who are disproportionately women of color. Women in the low-wage workforce are less likely to have parental leave or predictable or flexible work schedules and are among the most affected by pregnancy discrimination.
The rules would hit especially hard in the Asian American and Pacific Islander (AAPI) community. Of the over 50 percent of AAPI women who are of reproductive age, data show that we are using less effective, cheaper contraceptive methods at much higher rates compared to women of other races and ethnicities.
Young AAPI women who have not received fact-based sex education will be especially affected.
What’s worse, many AAPI women who lose their health-care coverage will have to pay out of pocket for family planning services and will be forced, due to cost constraints, to switch away from providers that they trust and that are familiar with their medical histories and can make accurate assessments of their health. Interrupting continuity of care poses particular challenges for people of color, people with limited English proficiency, and LGBTQ people, who already face multiple difficulties in obtaining adequate reproductive health services—including language barriers, a lack of culturally competent care from providers, providers’ limited geographic availability, and implicit bias and discrimination.
For now, district courts in California and Pennsylvania have barred the Trump administration’s rules from going into effect. But the Trump administration has made clear that it is set on limiting access to birth control. In fact, it has issued these rules twice; when courts barred its initial rules from going into effect, the Trump administration issued “revised” rules that were essentially the same in substance. So we will continue to fight these rules.
If this administration cares about the well-being of women, girls, and all individuals who can become pregnant, it needs to focus on making sure more of us have access to affordable health care that ensures that we have agency over our bodies, our families, and our lives. And it must start by removing barriers to health-care access instead of fighting to take away crucial reproductive health care.