Washington's Old Boy's club still has its knickers in a wad over the deficit "compromise," but women across the country can breathe a slight sight of relief this week. The White House just issued health reform guidelines that will mandate insurance plans to provide birth control to women at no extra cost. The measure is long overdue, part of an array of preventive services recommended by the Institute of Medicine for improving women's health. But the promise of broader contraceptive access coincides fittingly with the debate over the nation's budget woes, because birth control is an economic issue.
Consider how essential birth control is for working women. When women can control whether and how many children they bear, they can delay pregnancy until they feel they're ready, and in the meantime focus on career goals, finishing school, paying off that mortgage or signing divorce papers. The “choice” in reproductive choice refers not only to her ovaries—despite the right-wing scaremongering about unfettered female sexuality—it's about every choice in life affected by pregnancy and sex.
At the height of the economic crisis, the costs of family planning grew more severe, as did the consequences of having to forgo it. According to a 2009 study by the Guttmacher Institute:
Overall, 29% of surveyed women agree with the statement, “With the economy the way it is, I am more careful than I used to be about using contraception every time I have sex.” Those who are financially worse off are more likely than others to agree with this statement (39% vs. 19%).
The same economic dilemma ironically creates barriers to contraceptive care. Eight percent reported sometimes skipping birth control “in order to save money,” and this was “more common among those who are financially worse off.”
While access to birth control helps poor women weather hardship (and being poor conversely limits reproductive freedom), it's also historically aided the long-term advancement of women in the workforce. A retrospective look at the impact of the pill shows a parallel with women's social and economic rise since the 1960s.
A recent study by Martha J. Bailey in the Quarterly Journal of Economics mapped out women's workforce participation since the widespread introduction of the pill and concluded that
Legal access to the pill before age 21 significantly reduced the likelihood of a first birth before age 22, increased the number of women in the paid labor force, and raised the number of annual hours worked.
Certainly, changing social norms with respect to marriage, fertility and women's rights were also major factors in boosting women's economic power, but Bailey concludes, “within the social, legal, and economic context of the 1960s and 1970s that the pill provided a powerful tool for women wishing to capitalize on the emerging labor market opportunities.” If the pill wasn't exactly an economic cure-all, it helped countless women pursue opportunities that were previously out of reach.
Eventually birth control became a legal touchstone in the struggle for gender equality, according to the National Women's Law Center. The Equal Employment Opportunity Commission finally ruled in 2000 that “an employer’s failure to provide insurance coverage for prescription contraceptives, when it covers other prescription drugs, devices, and preventive care, constitutes unlawful sex discrimination” under the Civil Rights act.
The healthcare system had some catching up to do, too: Years before the EEOC ruling, insurance companies started widely covering Viagra (hardly preventive care for men unless you count preventing embarrassment). But by 2002, insurance coverage of a broad range of contraceptives had more than tripled since 1994, thanks in part to state regulations on contraceptive access.
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But today, with the economy still slumped and poor women still priced out of quality health coverage, birth control access remains entwined with economic destiny.
But today, with the economy still slumped and poor women still priced out of quality health coverage, birth control access remains entwined with economic destiny. Not that you'd hear much about this from GOP deficit hawks who rail against wasteful spending but ignore the value of comprehensive reproductive healthcare. The culture wars mask the fiscal and social burden of contraceptive inequity—either in potential costly abortions or the even costlier consequences of carrying an unwanted pregnancy to term.
Laura Hessberg of the National Partnership for Women and Families testified last November at an Institute of Medicine meeting:
A child who is born as a result of an unintended pregnancy is at greater risk for having a low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development.
Coupled with the other measures recommended by the IOM, such as counseling on domestic violence, programs to promote breastfeeding, and screening for sexually transmitted diseases and diabetes, contraception is just a common sense way to keep women healthy. Limited access to contraception not only contributes to soaring healthcare costs but ensures that the poorest, most vulnerable women will bear the brunt of the burden.
Amanda Marcotte lamented the right's testosterone blinders:
Conservative opposition to this new regulation may have been predictable—right-wing media outlets rarely miss a chance to rail about the evils of women having sexual intercourse too early—but it still makes no sense.
Republican-driven political discourse of late has been about nothing but the importance of cutting spending and saving money, and so the GOP should be delighted with this simple and clear-cut promise of long-term savings by making contraception free.
Actually, birth control wouldn't be totally free under the new guidelines, but rather, paid for through overall insurance costs (not co-pays). We're still stuck with the inherent inequities in the private insurance system (plus there's that icky religious exemption for anti-birth-control institutions). But widely available birth control does save money through improved health outcomes for women and by extension children and families. Everyone benefits when mom can go to work in the morning and pay for daycare, and can afford to send junior to basketball camp and the dentist.
That little pill isn't just a money saver for an individual household or mom's insurance company; it's an investment in women's potential as workers, and in the next generation of economic citizens. Every healthy decision made on their behalf is priceless.