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The Answer Blog

Birth Control

No Co-Pays for Women’s Health Care: Better But Not Perfect

August 9, 2011

Birth controlIn a groundbreaking move, the U.S. Department of Health and Human Services announced last week that, as part of the Affordable Care Act, it would for the first time ever require new health insurance plans to include coverage for the costs of a wide range of preventive health services for women without co-pays. At Answer, we were particularly delighted to see sexually transmitted disease (STD) counseling, HIV counseling and testing, and FDA-approved contraceptive methods included on the list of preventive services. Finally, an administration that has elevated the health needs of women and their families to where it needs to be!

I truly do believe this decision is unprecedented. At the same time, however, having worked in the nonprofit sector for nearly 25 years, my social justice autopilot is permanently set on “who’s missing?” So when I read the announcement, the first question that came to my mind was, “What about all the people who do not have health insurance?”

In 2010, 39 percent of people ages 64 and younger had no health insurance, according to the Centers for Disease Control and Prevention (CDC). This is the highest rate since 1997. That translates to roughly 48 million people. Hispanic and African-American individuals were, as always, disproportionately represented among those who did not have insurance. And when the CDC says “uninsured,” that means no private health insurance, Medicare, Medicaid, Children’s Health Insurance Program, state-sponsored or other government-sponsored health plan or military plan. Unfortunately, none of these people would benefit from the Affordable Care Act’s provision.

Historically, uninsured individuals could go to their local family planning organization for their health care needs, but not any more. Not when more and more state governments continue to irresponsibly eviscerate the funding budgets for those organizations, many of which are the only places women and men go to for their health needs. This remains one of the biggest oversights and tragedies of the conservative agenda to eliminate family planning services. In doing so, they are often eliminating the only health care some people will ever have access to or receive. And the fewer preventive services that are available, the higher the cost down the line for treatment and care for the illnesses that can result—for women AND men. See, according to the HHS announcement, “Women are more likely to need preventive health care services.” But according to the CDC, boys and men are more likely than girls and women to be uninsured. This issue affects everyone, regardless of gender or age.

So as we celebrate this bold move—and truly, we must—we cannot rest on our laurels for very long. We must remember that well-woman visits are invaluable for early detection, diagnosis and treatment of illnesses for which the uninsured remain disproportionately at risk simply because they do not have access to these services. We must remember that at the same time that well-woman visits are imperative, so too are preventive and well-care services for boys and men. And in the same breath with which we celebrate victories like this, we need to remember those who are habitually forgotten and neglected, and whose lives can be made or broken based on politics and reckless cuts to invaluable programs and services.

The Pill that Changed the World Turns 50

June 9, 2010
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If some imaginative person had made a birthday cake for it, she—it would have had to be a she—might have put 100 million candles on it. For that represents the number of women around the world who start each day by swallowing it.

No, it is not a vitamin pill. It is a birth control pill—known generically as the Pill—and many celebrated its 50th birthday on May 9th with justifiable gratitude and fanfare.

May 9, 1960, is one of those days that will shine bright in American history: it is the day that the U.S. Food and Drug Administration (FDA) approved the sale of the tiny pill that gave women control over their fertility. The FDA’s “blessing” attested to the safety of hormonal contraception, or “birth control,” in the words of Margaret Sanger. The Pill changed the world.

When it was approved, 500,000 women in the U.S. were already taking it, according to the recent Time cover story. This number would continue to swell rapidly, leading The Economist magazine at the end of 1999 to predict the far-reaching and wide-ranging impact that the scientific discovery had on women’s—and men’s —lives. In her book When Everything Changed: The Amazing Journey of American Women From 1960 to the Present, author Gail Collins called the Pill “the one invention that historians a thousand years in the future will look back on and say, ‘That defined the twentieth century.’”

A recently released National Survey of Family Growth study found that the Pill is “the most popular method [of contraception] in the United States, used by 10.7 million women between the ages of 15 and 44. The Economist’s crystal ball seems to be working well. The early years in the life of the Pill were relatively easy ones. Millions of women “embraced” it, whatever the public arguments were for or against its use. It was an effective and convenient way to avoid pregnancy.

Most saw its promise in offering a different life beyond child rearing. More women were able to imagine a life that included both children and job. The results soon became plain: more companies, no longer afraid that women would leave as soon as they conceived a baby, eagerly opened their doors. Congress passed Title IX in 1972, ending not only discrimination in college athletics for female undergraduates, but also throwing open the doors of law, medical, and business schools to women.

But in the 1990s, the recent cover story in Time reported, when the Pill was about 20 years old, a backlash developed. The impetus for the counter-revolution started, or was ramped up, by organized religions and conservative political advocacy groups. The Catholic hierarchy consistently opposed the Pill from its inception, even though in 1970, “two-thirds of Catholic women were using birth control and more than a quarter were on the Pill.” Many Evangelical Christian denominations followed suit, framing their disapproval in the context of what “God intends in marriage.” Church leaders proclaimed that “using contraception can weaken the marital bond by separating sex from procreation.”

These pronouncements—and funded public policies like abstinence-only-until-marriage education school programs, which denigrate the use of contraception—may have had a serious effect on the Pill’s current use. A National Campaign to Prevent Teen and Unplanned Pregnancy study recently found that 86 percent of young men and 88 percent of young women “say it is important to avoid pregnancy in their lives right now.” But the same study showed that “63 percent of this group says they know little or nothing about birth control pills, and much of what they think they know is wrong.”

On the eve of its 50th birthday, Katherine Spillar, Ms. magazine’s executive editor, summed up the precarious situation in which the Pill currently finds itself: “We’re still fighting those battles in Congress [like allowing hospital workers and pharmacists who have moral qualms about contraception to refuse to fill prescriptions]. To think that in 2010, 50 years after the birth control Pill, we still have to fight for access and effective family planning—it’s painful.”

If women gaining access to the Pill is painful in the U.S., it is infinitely more painful for women in the developing world. Investigative journalist Michelle Goldberg writes of this dilemma in her book, The Means of Reproduction: Sex, Power, and the Future of the World. In her concluding chapter, “Sex and Chaos,” she paints a frightening picture of what will happen if we do not provide women in the developing world with the family-planning help many so desperately desire.

She reports that 6.7 billion people share this planet and its dwindling resources of food, water, and energy. She writes of an increasing number of food riots, because of hunger and continued lack of clean water. “Despite falling fertility rates in many parts of the world, global population is still increasing by 78 million people a year,” and it will add a number close to this one through 2020 if no interventions are planned. In 2050, adding only two children to every family, the population will reach 9.2 billion. If fertility remains half a child higher, there will be 10.8 billion people vying for the fundamental resources of life.

In developing countries overall, 15 percent of married women, and “seven percent of unmarried women have … an unmet need for contraception,” Goldberg writes. “This means they are sexually active, do not want to become pregnant, and yet are not using birth control.” In sub-Saharan Africa, the number of unmarried women with an unmet need for contraception is 24 percent and in many Latin American countries, “more than 40 percent of births were unwanted.”

The director of the population program at the William and Flora Hewlett Foundation tells Goldberg that “in some ways, contraceptive access is worse now [particularly in urban areas of Africa] than it was in 1979.” Goldberg concludes by saying nothing less than “a massive investment in women’s education, birth control access, and income generation would lessen the danger that the world’s population would outstrip the planet’s resources.”

To honor its first 50 years of existence and plan for its future, perhaps we need to consider mounting a second revolution for the Pill: a revolution of access. First, we must get the message out in the U.S.— especially in school programs and health clinics in poor urban and rural areas—that the Pill is effective, safe, and does not cause cancer, strokes, or blood clots, as many of its opponents claim.

Then we need to stand shoulder to shoulder with our sisters around the world in their quest to gain access to the Pill. Perhaps our goal should be that in another 50 years, when the Pill marks its 100th birthday, every woman on the planet who wants it should be able to start her day by swallowing the tiny tablet.

Indeed to reach this goal would be historic, and a success that The Economist in 2099 might say “defined the twenty-first century.”