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

The ability to avoid conception is just part of what’s at stake; 1.5 million American women rely on birth control pills solely for other medical purposes.

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

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.

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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.