TIME Sex/Relationships

Doctors Advise IUD Use as Best Birth Control Method for Teenagers

A copper IUD
A copper IUD B. Boissonnet—BSIP/Corbis

A boost for a little-used but widely effective method of contraception

A leading medical group on Monday recommended implantable rods and intrauterine devices (IUDs) as the best form of birth control for teenage girls other than abstinence.

The new guidance from the American Academy of Pediatrics (AAP), published Monday in the group’s Pediatrics journal, touts birth control methods not commonly used in the U.S. despite widespread agreement about their effectiveness. The AAP says pediatricians, who teens consider “a highly trusted source of sexual health information,” should recommend, in decreasing order of effectiveness, progestin implants, IUDs, injectable contraception, and oral contraception for use among adolescents.

(MORE: The best form of birth control is the one nobody is using)

The doctors call oral contraceptives the least effective options for teens because many fail to use them properly and consistently. About 18% of women experience an unintended pregnancy when using male condoms, compared to 0.8% who experience unintended pregnancy while utilizing a Copper T IUD. Though IUDs are expensive at the outset, the AAP says the long-term cost is less than the cost of over-the-counter oral contraceptives.

TIME faith

Missouri Lawmaker Sues for Control of Daughters’ Sexuality

Birth Control Pill
BSIP—UIG/Getty Images

Adult women should be allowed to make their own reproductive choices

PatheosLogo_Blue

 

This article originally appeared on Patheos.

Did you see this one coming? (From MSNBC)

One Missouri lawmaker has taken the fight against birth control coverage to a new and very personal place: His own daughters, two of whom are adults.

State Rep. Paul Joseph Wieland and his wife Teresa are suing the Obama administration over its minimum coverage requirements for health plans under the Affordable Care Act, which includes contraception. They say the government is forcing them to violate their religious beliefs because they have three daughters, ages 13, 18 and 19, who are on their parents’ plan and might get birth control at no additional cost.

Wieland’s lawyer makes this comparison:

[Attorney Timothy] Belz also said that making birth control more accessible under health plans was “as though the federal government had passed an edict that said that parents must provide a stocked unlocked liquor cabinet in their house whenever they’re away for their minor and adult daughters to use, and Mormons came in and objected to that. It is exactly the same situation.”

Except that that’s not how insurance works. No one is requiring Wieland to hand his daughters birth control, or to keep a stock of birth control on the kitchen table for easy access. What the law says is simply this: health insurance companies must cover birth control with no deductible or copay. That’s it. Yes, Wieland has his daughters’ on his health insurance plan. His wife is on it too, so she, too, has access to birth control as well. It’s about ensuring that insurance companies cover women’s healthcare, period.

Look, health insurance companies cover blood transfusions. I suspect they’re required to by law, too. Could a Jehovah’s Witness parent object, because his adult son might get a blood transfusion should he ever be in need of one? Applying Wieland’s logic leads to a mess. I mean by his logic, parents should be able to pick and choose through their children’s health insurance and pick and choose which things their children can have covered, provided they can make a religious justification and completely irregardless of their adult children’s religious beliefs.

Now of course, the fact that Wieland’s daughters can get birth control on their parents’ plan doesn’t mean they have to get birth control. And if they share their parents beliefs on the subject, they won’t. But Wieland is concerned that they might not share his beliefs.

One of the judges pointed out that parents might have more control over their kids than employers, and that parents could just say to their kids, “We expect you do abide by our religious tenets.” Belz replied, “Well, we all have high hopes for our kids, that is true. We all expect and want them to obey us, they don’t always …”

These girls are 18 and 19. They’re not children, they’re adults.

There are two ways to look at this. We could say that Wieland is trying to prevent his adult daughters from having access to affordable birth control, and we would be correct. But Wieland’s legal claim is slightly different. Wieland says that paying for his daughters birth control would violate his religious beliefs. In other words, he says this is about his beliefs and his conscience, not about whether or not his daughters are using birth control. But again, this isn’t how insurance works. It wasn’t in the Hobby Lobby case, and it isn’t here. Unfortunately, Hobby Lobby won its case, suggesting that the Supreme Court thinks this is the way insurance works.

Now, Wieland could simply drop his daughters from his plan, and maybe we should be grateful for them that he’s not going that route. Wieland is arguing that his religion requires him to provide birth control for his daughters. The problem is that he’s using this argument to prove that the law requiring birth control coverage violates his religious beliefs.

The Wielands have argued in their brief that providing health coverage to their daughters – which, thanks to the same Affordable Care Act, they can do until their children turn 26 – is also part of their religious beliefs. “The Plaintiffs cannot terminate their daughters’ health insurance coverage without violating their religious duty to provide for the health and well being of their children,” they wrote in one brief.

I think it’s awesome that Wieland believes he should continue to pay for his daughters’ health and well being through providing them with birth control. It would be even more awesome if that belief extended to all of women’s health care. The problem is Wieland’s view of birth control. You would think that a parent in his shoes might want his daughters to abstain from premarital sex, but also want them to have access to birth control should they decide to have sex anyway (after all, a parent cannot prevent an adult daughter from having sex). But no.

Christians who oppose sex before marriage tend to feel that access to birth control increases the likelihood that young people will have sex. This is probably not all that true for young people who are already taught that sex before marriage is sinful. After all, if you belief something is sinful and may send you to hell, whether or not you are protected against STDs or pregnancy is the less important worry. Christians who oppose sex before marriage also tend to believe that having unprotected sex is less sinful than having protected sex. This is because using birth control shows that the sex is premeditated. You can see this last point illustrated in this short video clip:

Wieland is Catholic, which adds another dimension. The Catholic Church teaches that birth control is unacceptable for even married couples. Families may use natural family planning to space their children out—provided they go about it with the right attitude of openness to children—but that’s it. So for Wieland, this isn’t just about his adult daughters having premarital sex, it’s about them using birth control at all. Of course, they’ll have to leave their father’s insurance when they marry, so Wieland won’t have any say regarding their use of birth control in marriage.

I have no idea what Wieland’s daughters think of all of this. They may be completely involved and invested, as I would have been at their age. I would have seen it as a way to fight back against the big bad government in favor of our religious beliefs. But at 21 I would have seen it differently. At 21 I would have felt used, and I would have wanted out. Frankly, I probably would have gotten off my parents’ plan entirely and found a way to make a go of it on my own, were I in their shoes. After all, that’s what I did when it came to paying for college. I didn’t want anything else they could use to control me and my choices.

When it comes down to it, Wieland wants the right to use his daughters’ insurance coverage to control their sexuality. He wants to have a say over whether the insurance he obtains for his family gives his adult daughters’ access to birth control. In a world where patriarchy reigns supreme, this request would be reasonable. But we don’t live in that world. We live in a world where adult women are allowed to make their own reproductive choices (or at least, that is the world we should live in).

Libby Anne was raised in an evangelical family, was homeschooled and was taught that a woman’s place is in the home. She became a non-believer after college and now writes on purity culture, Christian right politics, and the importance of feminism.

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TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME 2014 Election

Republicans Can’t Stop Talking About Over-the-Counter Birth Control

Thom Tillis
Republican senatorial candidate Thom Tillis speaks during a live televised debate at UNC-TV studios in Research Triangle Park, N.C., Monday, April 28, 2014. AP

Republicans may have found an answer to the Democratic “War on Women” battle cry in the most unexpected place: The women’s health section of your local pharmacy.

GOP candidates across the country are calling for birth control pills to be available over-the-counter without a prescription, elevating a once obscure conservative proposal to reduce women’s dependence on health insurance programs. Four GOP Senate candidates have advocated for over-the-counter birth control, Colorado’s Cory Gardner, Thom Tillis in North Carolina, Ed Gillespie in Virginia, and Mike McFadden in Minnesota. “I actually agree with the American Medical Association that we should make contraception more widely available. I think over-the-counter oral contraception should be available without prescription,” Tillis said last week in his first debate against Sen. Kay Hagan.

Liberal groups, not wanting the GOP storyline to take hold, have come back swinging, accusing Republicans of engaging in a deception to fool women. On Monday, Democratic groups in Colorado launched a five-figure television ad campaign to push back on Gardner’s embrace in a television ad last week of the policy proposal, arguing that the plan could raise out-of-pocket costs for women, since insurers who now provide no-cost contraception tend not to cover over-the-counter medication.

The controversy has put Democratic candidates in the odd position of seemingly opposing a policy proposal that voters are inclined to believe they support: the availability of birth control without a doctor’s prescription. From Colorado to North Carolina, Democrats have rejected the proposal as a distraction, contending that it amounts to a clever way of undermining the new benefits provided under Obamacare.

A spokesperson for Democrat Kay Hagan of North Carolina did not respond to a request to clarify whether she would support the over-the-counter proposal, while a spokesman for Mark Udall of Colorado and official with Planned Parenthood Action Fund said they would only consider the issue as long as it is coupled with maintaining insurance mandate. In Colorado, MoveOn and NARAL Pro-Choice America released a five-figure television buy against Gardner on the issue Monday.

Democrats and Republicans trace the political origins of the proposal, which has been pushed by doctors since at least 2012, to Louisiana Gov. Bobby Jindal. In a December 2012 Wall Street Journal op-ed, the 2016 presidential hopeful and former Assistant Secretary of Health and Human Services argued that contraceptives should be made available over the counter to increase access and bring down costs. “As an unapologetic pro-life Republican, I also believe that every adult (18 years old and over) who wants contraception should be able to purchase it,” Jindal wrote, calling for “the end of birth-control politics.”

Because it would be sold over the counter, Jindal argued that prices would be lower because of additional competition, while removing a doctor from the equation would make it easier for women to access it.

It was a shrewd policy proposal designed to provide Republican candidates a safety zone on the thorny subject of contraception. Most Republican candidates have objected to the contraception mandate in the Affordable Care Act which requires most employers’ health insurance to cover birth control despite their religious beliefs. Republicans generally celebrated the Supreme Court ruling in June in the Hobby Lobby case that closely-held companies with religious objects could abstain from covering contraceptives.

Jindal’s political aides, and many GOP operatives, believe birth control is a gateway issue for women voters. While the politics of abortion have remained consistently split, Republicans fear being cast as anti-birth control could cost them a generation of women voters. “It’s often an immediate shutdown,” said one Jindal aide.

But the simple proposal is hardly comprehensive, and is a long way from going into effect anyway. No birth control manufacturer has applied for an over-the-counter designation from the Food and Drug Administration, and only the contraceptive pill would be covered. If private plans didn’t cover other forms of birth control, like IUDs, patients who use them would be forced to spend more out of pocket.

“If Cory Gardner and others were serious about expanding access to birth control, they wouldn’t be trying to repeal the no-copay birth control benefit, reduce Title X funding for birth control, or cut women off from Planned Parenthood’s preventive health services,” said Dawn Laguens the executive vice president of Planned Parenthood Action Fund in a statement. “This is simply a cynical political attempt to whitewash his terrible record and agenda for women’s health. The reality is that Cory Gardner’s proposal would actually cost women more by forcing them to pay out of pocket for the birth control that they are getting now at no cost thanks to the ACA.”

But other Democrats see the GOP strategy as playing right into their hand, with Republicans implicitly acknowledging that women have reason to be skeptical of their agenda. As another Democratic operative put it, “The more time that we spend talking about birth control, we’re winning.”

TIME Innovation

Five Best Ideas of the Day: August 27

1. A reimagined NATO – with rapid response capability – could balance the Putin doctrine.

By David Francis in Foreign Policy

2. Hold the bucket: Focusing on a single disease isn’t a good use of philanthropy dollars.

By Felix Salmon in Slate

3. The Navy’s audacious plan for a new warfighting vessel was too good to be true. The result is a ship that meets none of our needs well. Cancel the Littoral Combat Ship.

By William D. Hartung and Jacob Marx at the Center for International Policy

4. The conventional wisdom is that social media stimulates debate, but self-censorship online actually leads to a ‘spiral of silence.’

By Keith Hampton, Lee Rainie, Weixu Lu, Maria Dwyer, Inyoung Shin and Kristen Purcell at the Pew Research Internet Project

5. Better living through design: Injectable, long-acting birth control will revolutionize family planning in the developing world.

By Heather Hansman in Pacific Standard

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

MONEY Health Care

How Some Insurers Still Avoid Covering Contraception

Locked up birth control pills
Nicholas Eveleigh—Getty Images

Under health reform, your birth control should be fully paid for by insurance. But even before the Supreme Court gave more employers an out, some insurers have been pushing back.

How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn’t stopped some from trying.

Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re entitled to.

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.

Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.

In addition, the federal government has given plans some flexibility by allowing them to use “reasonable medical management techniques” to keep their costs under control. So if there is both a generic and a brand-name version of a birth-control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the federal Department of Health and Human Services said in an email, “The pill, the ring and the patch are different types of hormonal methods … It is not permissible to cover only the pill, but not the ring or the patch.”

Guidance from the federal government clearly states that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.

But despite federal guidance, “we’ve seen this happen, plenty,” says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. “Clearly insurance companies think things are ambiguous enough that they can get away with it.”

If you are denied coverage, your defense is to appeal the decision, and get your state insurance department involved.

“The state has the right and responsibility to enforce this law,” says Sonfield.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

More on the Affordable Care Act and contraception coverage:

 

 

 

 

 

TIME Cancer

Recent Birth-Control-Pill Use Linked With Breast-Cancer Risk

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Birth control pills Raymond Forbes—Getty Images/age fotostock RM

But only pills containing high-dose estrogen

Oral contraceptives and an increased risk for breast cancer have been linked in the past, but now researchers have made the link again, showing women who recently used birth control pills with high-dose estrogen have an increased risk for breast cancer compared to women using other versions.

The researchers looked at pharmaceutical oral contraceptive records and prescriptions of 1,102 women diagnosed with breast cancer and and 21,952 controls. Compared to women who formerly used birth control pills or never used them, the risk for breast cancer was increased by about 50% for women who did. The researchers note that the highest risk was for high estrogen—and there was no risk found for low-dose pills. The study is published in the journal Cancer Research, under the American Association for Cancer Research.

The researchers stress that caution is needed when interpreting their findings. “Given that these results have not yet been confirmed, and the importance of assessing the many established benefits of oral contraceptives as well as the risks, we are not able to give any clinical recommendations based on this study,” says study author Elisabeth F. Beaber, a staff scientist in the Public Health Services Division of Fred Hutchinson Cancer Research Center. “It’s an intriguing finding, but there really do need be larger studies with larger sample sizes in different populations to really confirm if these results hold up.”

The formulations of oral contraceptives have changed over the years, and in fact, Beaber says that in general that there are few high dose estrogens formulations on the market. In their study, among the controls, less than 1% filled a prescription for a high-estrogen pills.

For now, the study is a call for further research. With prior evidence, the National Cancer Institute says that evidence shows their might be an increased risk for breast cancer, especially younger women, but that their risk returns to normal after 10 years of discontinued use. Women using oral contraceptives are shown to have a lower risk of ovarian and endometrial cancer. You can learn more about the link between oral contraceptives and cancer.

TIME Religion

Pro-Life Nurse Sues Family Planning Clinic for Hiring Discrimination

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Birth control pills Raymond Forbes—age fotostock RM/Getty Images

She said she would not prescribe birth control

PatheosLogo_Blue

This article originally appeared on Patheos.

We have a new frontrunner in the race for dumbest Christian Right lawsuit.

Sara Hellwege, a pro-life nurse, applied for a job at Tampa Family Health Centers (in Florida) this past April. TFHC is a Title X clinic, meaning they’re all about things like family planning, contraception, and birth control.

So when Hellwege mentioned her affiliation with the “American Association of Pro-Life Obstetricians and Gynecologists” in her resume, the interviewer (Chad Lindsey) asked her if that would be a problem since, you know, conservative Christians + birth control = crazytown.

Hellwege said she couldn’t prescribe birth control since, in her unscientific mind, it caused abortions. Lindsey, knowing that all of the job openings involved prescribing birth control, told her there were no other positions available and that there was no reason to proceed with the interview process.

So she’s suing him.

I repeat: She’s suing him because he’s not hiring her for a job she refuses to do.

It makes as much sense as a vegetarian suing Taco Bell for not hiring him even though he told the manager he couldn’t be near meat.

The misnamed Alliance Defending Freedom reiterated the whole misunderstanding about how birth control works while completely ignoring the job description:

Willingness to commit an abortion cannot be a litmus test for employment,” added ADF Senior Counsel Steven H. Aden. “All we are asking is for the health center to obey the law and not make a nurse’s employment contingent upon giving up her respect for life.”

I know we’re talking about birth control, and most forms of birth control are not abortifacients, but let’s roll with it for a second. If the job involves helping women obtain abortions, and you don’t want to help women obtain abortions for whatever reason, go find another job. Hellwege can’t do the very thing they need her to do.

No one owes her a job when she refuses to do it.

Maybe I should apply for an attorney position at ADF. My own sincere beliefs prevent me from defending Christians who have martyr complexes, but screw it. ADF owes me a paycheck.

Gregory M. Lipper of Americans United for Separation of Church and State put it simply: “Even after Hobby Lobby, this lawsuit retires the trophy for chutzpah.”

Hemant Mehta is the chair of Foundation Beyond Belief and a high school math teacher in the suburbs of Chicago. His latest book is called The Young Atheist’s Survival Guide.

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TIME Birth Control

The Future of Birth Control: Remote Control Fertility

Birth Control Choices
Birth Control Choices Jenny Swanson—Getty Images

This startup hopes to give women ultimate control over their contraceptive device

We may be just years away from the longest-lasting and most hassle-free contraceptive ever invented.

The Bill and Melinda Gates Foundation has announced that it is backing a Massachusetts biotech company that is developing an implantable contraceptive that can be activated and deactivated by the user, the MIT Technology Review reports.

Current contraceptive implants—inserted into a woman’s upper arm where they release the hormone progestin—last about three years and are the size of a matchstick. MicroCHIPS Inc. is building a wireless device that is only 20 millimeters long and that would last 16 years. The chip, which would lie under the skin in the buttocks, upper arm or abdomen, slowly releases levonorgestrel, a hormone used in some types of the Pill, in some types of hormonal IUDs and in Plan B.

If the chip works as intended, women could “deactivate” their birth control without a trip to the doctor, which can be a major barrier for women who don’t have easy access to health care, such as in the developing world. The chip’s long lifespan would also minimize doctor’s visits: Currently no type of hormonal birth control lasts longer than five years. The non-hormonal copper IUD lasts 12. (Read more about IUDs here.)

The device is currently being tested for safety, efficacy and security. MicroCHIPS hopes to introduce the product, which would need FDA approval to be used in the United States, in 2018.

[MIT Technology Review]

TIME politics

The Only Controversy About Birth Control Is That We’re Still Fighting for It

Supreme Court Issues Rulings, Including Hobby Lobby ACA Contraception Mandate Case
Supportes of employer-paid birth control rally in front of the Supreme Court before the decision in Burwell v. Hobby Lobby Stores was announced June 30, 2014 in Washington, DC. Chip Somodevilla—Getty Images

Decisions about women’s health are being made, yet again, by judges and politicians who will never need to use birth control.

On Monday, the Supreme Court ruled that it’s better to be a corporation than a woman in America. In a devastating ruling, the Court gave CEOs of some closely held profit-making corporations the right to deny their employees coverage for birth control because of the CEO’s personal objections – even if those objections are not supported by science or medicine.

The Court’s ruling has unleashed an outcry from people across the country who are incredulous that decisions about women’s health are being made – yet again – by judges and politicians who will never need to use birth control. This decision — by five male Justices — opens the door for corporations to interfere in the private health decisions of their employees, who happen to be women. Both the Hobby Lobby ruling and the recent decision striking down protections for women entering healthcare centers that provide abortion reflect a staggering lack of awareness of what women have to go through to get health care. It’s no coincidence that all three women on the Court signed the dissent, which spoke to the realities of women’s lives and sounded an alarm. As Ruth Bader Ginsburg wrote, the Court “has entered a minefield.”

The decision in favor of Hobby Lobby and Conestoga Wood Specialties sets a dangerous new legal precedent treating some, perhaps all, for-profit corporations as if they were people, fully capable of expressing deeply held religious beliefs. The result? Some corporate owners have been given a free pass from following the law if they claim that doing so violates their religious beliefs – allowing them to enjoy both the legal protections of being a corporation and the privileges of being a person.

It’s unbelievable that in 2014, we’re still fighting for access to birth control – but we are. Ninety-nine percent of women in this country have used birth control at some point in their lives, including 98% of Catholic women. For millions of women in this country, the only thing controversial about birth control is the fact that we’re still fighting to have this basic health care covered by insurance – especially given the overwhelming evidence that birth control, when used correctly, has a host of health and medical benefits. It can help relieve painful menstrual cramps, avert infertility by addressing the symptoms of endometriosis, and – shockingly – prevent unintended pregnancy.

Birth control is only a social issue if you’ve never had to pay for it. Many women pay an average of $600 a year — and sometimes much more — for contraceptives. A 2010 survey found that more than one-third of women voters have struggled to afford prescription birth control at some point in their lives – but when they have access to it, they can support themselves financially, complete their education, and plan their families and have children when they are ready. It’s good for women, it’s good for families, and it’s good for this country.

Here’s the good news: Despite the Supreme Court, the birth control benefit of the Affordable Care Act remains in place. More than 30 million women already have access to this benefit, and in its first full year, women saved an incredible $483 million more on birth control prescriptions than they did the year before. This is the biggest step forward for women in a generation.

The real consequence of this ruling is that it invites “closely held corporations” to pick and choose what methods of birth control are covered by insurance. Far from a narrow ruling, the Court’s decision affects enormous for-profit companies employing thousands of women and more than half of the workforce in this country. This is unacceptable, and we have heard from members of Congress, the White House, and numerous medical groups including the American College of Obstetricians and Gynecologists, the American Medical Association, the American College of Physicians, the American Academy of Pediatrics, and the American Nurses Association—all of whom are fighting alongside Planned Parenthood to make sure that women have access to affordable birth control. We’re working with women’s health champions in Congress to ensure they protect and expand women’s access to no-copay birth control, and we encourage companies to do the right thing and provide women full birth control coverage. And we’ll take this fight to the ballot box in November, showing women across the country where candidates in their state stand on their access to birth control.

Meanwhile, our #JointheDissent campaign lit up the social media landscape, with nearly 6 million people seeing and sharing our campaign information with their friends on Facebook in the first day alone. Even if the Supreme Court doesn’t understand what’s at stake for women, Americans around the country do.

The bottom line: Our health care decisions are not our bosses’ business – and neither is our use of birth control, for any reason. That we even need to argue this point is incredible – but politicians, corporations and the Court need to hear from women.

Cecile Richards is the president of Planned Parenthood Action Fund.

TIME politics

5 Things Women Need to Know About the Hobby Lobby Ruling

Obamacare Contraceptive Rule To Be Decided On By Supreme Court
Activists who support the Affordable Care Act's employer contraceptive mandate demonstrate outside of the U.S. Supreme Court in Washington, D.C., U.S., on Monday, June 30, 2014. Bloomberg—Bloomberg via Getty Images

What the Supreme Court's ruling on contraception means for women

On Monday, the Supreme Court ruled in a 5-4 decision that the government cannot require certain employers to provide insurance coverage for birth control if they conflict with the employer’s religious beliefs. The ruling on Burwell v. Hobby Lobby Stores, Inc. is not only a blow to the Affordable Care Act but also, critics argue, to women’s rights.

Here’s what women need to know:

1. If you work at certain types of for-profit companies, they no longer have to cover the cost of any contraception that they say violates their religious beliefs

The Affordable Care Act (a.k.a. Obamacare) requires most health insurance plans to cover birth control without cost-sharing. Without healthcare coverage, the pill can cost about $25 a month and an IUD (intrauterine device) can cost up to $900 (though it’s inserted once and lasts up to 12 years).

Before the ruling, houses of worship were already exempt from the birth control insurance mandate. Non-profit organizations with religious affiliations, like Catholic colleges and hospitals, have to inform the insurer if they object to contraceptives, and the insurer is then responsible for figuring out a way to guarantee contraceptive coverage for the workers without the company using its premiums to pay for it.

The privately-owned corporation Hobby Lobby, an Oklahoma-based craft store with self-described Christian values, argued that they too should not have to cover certain emergency contraception because of their religious beliefs. The company objected to paying for emergency contraception including Plan B, Ella—both commonly known as the morning after pill—plus two types of IUDs. Hobby Lobby said they believe these types of birth control amount to abortion. The company did not object to covering other types of contraception, including birth control pills.

The Supreme Court ruled in favor of Hobby Lobby, but the ruling applies only to companies considered “closely held.” According to the IRS, a company is “closely held” if five or fewer people own more than half the corporation. Closely held firms make up over 90% of all American businesses, and about 52% of the American workforce works for a closely held corporation, according to studies from Columbia University and New York University. The Affordable Care Act, however, only requires employers with 50 or more employees to provide health insurance to workers, so many “closely held” firms are already exempt.

Justice Samuel Alito suggested in his ruling that the Health and Human Services (HHS) department could extend the accommodations that they have in place for religious non-profits to these for-profit companies so the insurer would provide birth control without charging the company. However, both religious groups and women’s rights groups think this would be insufficient. Some religious non-profits have alleged that these accommodations still infringe on their religious beliefs and are suing the federal government. And advocates at the Women’s National Law Center have said companies should be required to provide contraception as a basic healthcare need. The Obama administration may need to come up with a an alternative way to provide coverage, but it’s unclear what those options would be or how difficult they would be for consumers to access.

2. All three female Justices dissented, arguing that this ruling limits women’s rights

Justice Ruth Bader Ginsburg wrote the dissenting opinion and was joined by Justice Sonia Sotomayor, Justice Elena Kagan and Justice Stephen Breyer (the only male justice who dissented). “The exemption sought by Hobby Lobby and Conestoga would…deny legions of women who do not hold their employers’ beliefs access to contraceptive coverage,” Ginsburg wrote. “Religious organizations exist to foster the interests of persons subscribing to the same religious faith. Not so of for-profit corporations. Workers who sustain the operations of those corporations commonly are not drawn from one religious community,” she continued.

Ginsburg notes that an IUD without coverage costs a month’s pay for minimum-wage workers. And critics of the ruling say that because a federal work around hasn’t been developed yet, many of the women who currently work for places like Hobby Lobby have lost easy access to key family planning options and the most most effective type of birth control. Even after the gap is filled, it still may be cumbersome to acquire birth control. While some women are able to choose their place of employment taking health care into consideration, because of geography and economic restrictions, that’s not possible for all women.

(Read the entire opinion and dissent here.)

3. The ruling may depress use of IUDs at some privately held corporations that deem it a form of emergency contraception

Health groups have begun to lobby for an increased use of IUDs. The IUD has a failure rate of less than one pregnancy per 100 women in a year, better than both the pill (9 pregnancies per 100 women per year) and condoms (18 pregnancies per 100 women per year), according to the CDC. Despite all these benefits, just 9% of women in America use it—the lowest of any developed country. (By comparison, 23% of women in France and 41% of women in China use IUDs.) It’s just starting to gain traction in America: Planned Parenthood reports a 75% increase in use since 2008.

Today’s decision, which gives certain companies the option of not covering the IUD among other types of contraception, arguably undermines gains made in IUD usage. The IUD can also be used as emergency contraception if it is inserted five days after intercourse, hence the Hobby Lobby’s objection to it and not birth control pills.

This isn’t the way most women use the IUD: many gynecologists will only schedule an appointment for IUD insertion until after a woman gets her period that month so as to ensure she’s not pregnant. Some will even perform an ultrasound. There are no statistics on how many women use the IUD as an emergency contraceptive method instead of alternate methods like the “morning after” pills, but James Trussell—a Princeton Professor who has done extensive research on the topic—told TIME’s Sarah Begley, “I would say that the number [of women] who get IUDs as emergency contraception is miniscule.”

The fallout from today’s ruling could be that some women who work companies that refuse to cover the IUD may be discouraged from using this effective birth control method by additional costs they may incur or the complications of finding supplemental insurance.

4. Women’s rights groups are angry because they see the ruling as a loss of autonomy for women

Some women’s rights advocates have taken the argument even further than Ginsburg did. Up until this point the Religious Freedom Restoration Act (RFRA) has been interpreted as a protection for individuals’ religious practices—not those of corporations. The Supreme Court just said that these protections also extend to for-profit companies, but didn’t protect a woman’s right to choose her method of birth control. Thus, many critics argue, the Supreme Court decided that corporations are people, but women are not. Women’s rights groups say restricting insurance coverage for some types of contraception, or making coverage more difficult to obtain, undermines access to birth control in general and point to studies that have shown that offering greater access to contraception—rather than restricting it—leads to fewer unintended pregnancies and thus reduces the number of abortions by 75 percent annually.

5. Under the ruling, some corporations could attempt to refuse coverage for other, non-contraceptive medications and procedures citing their religious beliefs

As Ginsburg writes in her dissent, “Would the exemption…extend to employers with religiously grounded objections to blood transfusions (Jehovah’s Witnesses); antidepressants (Scientologists); medications derived from pigs, including anesthesia, intravenous fluids, and pills coated with gelatin (certain Muslims, Jews, and Hindus); and vaccinations?”

In the majority opinion written by Justice Alito, he specifies that the ruling applies only to the contraceptive mandate, and states that it should not be understood to include to other insurance mandates, like those for blood transfusions or vaccinations. But Ginsburg notes that even if the Alito exclusion holds, there are other issues: “Approving some religious claims while deeming others unworthy of accommodation could be ‘perceived as favoring one religion over another,’ the very risk the [Constitution's] Establishment Clause was designed to preclude,” said Ginsburg.

 

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