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The evidence is clear: Eliminating ACA’s contraceptive mandate would harm women’s health

REUTERS/Canice Leung
A protester displaying a knitted replica of the female reproductive system at the Women's March in Washington, D.C., on Saturday.

It appears as if the Affordable Care Act’s contraceptive mandate, which requires health insurers or employers that provide health insurance to cover women’s contraceptive costs, is in the Trump Administration’s crosshairs. It’s likely to be one of the first aspects of the law to be overturned.

If that happens — if American women do not retain free and full access to birth control — many women’s health would be harmed. For, as I’ve explained here before, women do not need free access to birth control because they’re unable “to control their libido” (as Mike Huckabee, a former governor of Arkansas and a 2016 Republican presidential candidate, implied a few years ago). They need it to control — and protect — their health.

Let me explain why: 

  • Pregnancy and childbirth, even in seemingly healthy women, poses serious health risks — a factor too often overlooked when politicians talk about birth control.  This is no small matter. Each year, more than 50,000 women in the United States experience severe pregnancy-related medical complications, including cardiac arrest, kidney failure, aneurysms and respiratory distress, and, tragically, more than 600 of them die, according to the U.S. Centers for Disease Control and Prevention (CDC). 
  • For women with certain existing health problems, getting pregnant can be life threatening. This includes women with heart malformations, clotting or bleeding disorders and chronic medical conditions, such as multiple sclerosis.
  • Some types of birth control are used to treat specific reproductive-system-related medical conditions, including fibroids and endometriosis, which can cause significant pain, and heavy menstrual bleeding (menorrhagia), which can lead to anemia.
  • Birth control is also sometimes used to lower the risk of uterine and ovarian cancers in women who are at high risk of developing those diseases. There’s also some evidence that it may help lower the risk of colorectal cancer.
  • The Food and Drug Administration (FDA) has approved certain birth control pills for the treatment of acne. Some are also used to treat hirsutism, a condition in which women develop male-pattern hair growth on their face and body.

Not just for contraception

As I’ve also reported here before, a 2011 survey from the Guttmacher Institute found that 1.5 million American women rely on birth control pills solely for noncontraceptive purposes. And 58 percent of the women surveyed said they used the pills at least in part for reasons other than preventing pregnancy.

Here’s another statistic that emerged from that survey: About 800,000 women in the United States who take oral contraceptives have never had sex. They’re using the pill mostly to treat acne or to control their menstrual periods and pain associated with those periods.

Finally, better access to birth control appears to be the primary factor behind falling rates of abortion in the U.S. in recent years.

You’d think the abortion evidence alone would persuade the Trump administration as well as politicians, pundits and others on the political right to retain the ACA’s mandate regarding women’s free and full access to birth control. But then, it’s not clear that evidence — facts — holds much weight with them.

Indeed, on Monday, President Trump issued an executive order that reinstates a policy from the Ronald Reagan and George W. Bush administrations prohibiting U.S. funds being sent to international health organizations that counsel women about abortion as a family-planning option, even if that counseling is done without U.S. money.

That ruling also ignores the evidence. A study that looked at the policy’s effect on 20 sub-Saharan African countries during the 1980s, when Reagan was president, found that it was associated with a significant increase in abortion rates, largely because women also loss access to contraception and family planning services.

FMI: You’ll find more information about contraception use in the United States at the Guttmacher Institute’s website.

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Comments (6)

  1. Submitted by Connie Sullivan on 01/24/2017 - 10:03 am.

    This is a good reminder of how ignorance continues to propel much of the so-called “pro-life” opposition to funding anything that helps women with their reproductive health.

    Opposition to birth control methods by “pro-life” people reveals that they are not “pro-life”; they are anti-women and want desperately to control women’s sexuality.

  2. Submitted by Ray Schoch on 01/24/2017 - 10:16 am.

    The photo

    …I saw online yesterday showed Trump signing a reinstatement of the “global gag order,” which prohibits U.S. funding of NGOs the provide family planning and contraception to women around the world, even if abortion is not among the services that U.S. dollars pay for. The caption was something like “Donald Trump, surrounded by white males, reinstates anti-abortion gag order.” The caption failed to mention, I think, that most of those males qualify as “elderly,” including Mr. Trump. That kind of hostility to women makes me embarrassed to be an elderly white male myself.

    The numbers cited in Susan’s column are themselves evidence that great harm can – and will – be done to women around the world as a result. More and more I’ve come to believe the cliché that, if men got pregnant, attitudes toward a host of sexual and/or reproductive-related policies would change overnight. And, of course, we’re only a few days into an administration that has already glaringly demonstrated that it has no interest at all in evidence or facts.

  3. Submitted by joe smith on 01/24/2017 - 12:24 pm.

    Thank goodness we are no longer going to

    pay for other peoples contraception … I don’t understand how it became “your human right” to have me pay for your birth control. Of the many disagreeable aspects of Obamacare this may have been the worse. Vitamins are good for you, do expect me to pay for that also? Where will this “you owe me” mentality stop?

    • Submitted by Matt Haas on 01/24/2017 - 12:50 pm.

      When you stop complaining

      About having to pay for the resultant humans produced as a result of the lack of contraception coverage. Unless you’ve come up with a solution to unplanned pregnancy that has evaded us for, oh say, 25000 years, give or take a few millennia. Btw telling people not to have sex isn’t a solution, who knows maybe you’d like to criminalize and institutionalize them again, that went well.

    • Submitted by Tim Smith on 01/24/2017 - 01:22 pm.


      how about 100% coverage for insuline and pumps for diabetic children? you know, those who really deserve the coverage…

    • Submitted by Jon Kingstad on 01/24/2017 - 09:26 pm.

      Health care is a human right

      It’s not a matter of anyone “paying” for anyone else’s anything. Decent health care is a human right. Birth control or abortions are no different than colonoscopies for humans prone to colon cancer or cancer treatment for this who get it.

      For now, Congress is going back to its “get sick and die” policy for people who have pre-existing conditions, work for employers who will not provide benefits or simply cannoot afford to buy their own insurance plan. But I’m sure that women who can afford good plans will still be able to afford plans that cover birth control or abortions. Does that mean those who are opposed to insurance covering abortion or birth control will be paying for those who do? Or will they simply boycott insurers who offer those plans to women?

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