On January 20th, Secretary of Health and Human Services Kathleen Sebelius issued a final rule requiring that all women have access to free preventative care services including contraceptives. Since then, I haven’t been able to read through the news without seeing mention of the subsequent controversy. Catholic leaders are upset there’s no exemption for religious hospitals, universities. Obama announced a compromise. The Catholic leaders and GOP said the rule still violated religious freedom. The House called an all male panel to testify. Furious reaction burst up regarding the all male panel. Sandra Fluke testified before Congress. Rush Limbaugh called Sandra Fluke a “slut.” Republican presidential candidates commented awkwardly on the situation. And so it continues to this day.
Despite the verbosity that exists on this topic, it seems no one has been able to step back and clarify the issues at stake. At the heart of it all, what are we really debating?
There are two separate issues central to the current controversy surrounding contraception. Though related, they are fundamentally different issues and their confusion is dangerous to women, to the right of privacy and to the right of families to decide their own trajectory. One issue is who should pay for preventative care services like contraception. The other is the acceptability of using contraception as a preventative care treatment.
The debate over who should pay for insurance, medical benefits and preventative care is not new. Contraception is just one subcategory of prevention. Across political lines, people agree that our medical system is broken and reform is needed. The coverage of preventative care such as contraception is and should be part of the broader debate over health care and coverage.
A fundamental problem of this debate is when the issue of who should pay for contraception becomes confused with the acceptability of using contraception as a medical, preventative care treatment. Then it becomes a jumping off point to attack the use of contraception and those who use it.
Most recently, we had Rush Limbaugh attacking Sandra Fluke personally because she testified on the issue of who should cover contraceptives. Instead of arguing against Fluke’s reasoning as to why her school should cover it, Limbaugh launched into trying to shame Fluke by calling her a “slut” and a “prostitute”. Limbaugh completely falsified Fluke’s testimony saying, “she’s having so much sex” she needs birth control pills. This clearly comes from a position where contraception is unacceptable even as a medical treatment and those who advocate for it deserve the label of promiscuity, and little to do with the coverage of contraception.
Santorum is a perfect example of the use of harmful anti-contraception rhetoric that illustrates an unwillingness to see contraception as a medical preventative care treatment. Santorum stated about contraception, “I don’t think it works, I think it’s harmful to women, I think it’s harmful to our society to have a society that says that sex outside of marriage is something that should be…tolerated.”
Here’s the problem: contraception is a medically established preventative care treatment. The Institute of Medicine among other medical organizations has published scientific reports to that effect. Let legislative matters be left to politicians and medical matters be left to medical professionals.
Additionally, the legal acceptability of contraception was decided long ago. Perhaps it’s been so long that we no longer remember. In 1965, the Supreme Court in Griswold v. Connecticut established that a state’s ban on the use of contraceptives violated the right to marital privacy. It wasn’t even a controversial decision with a 7-2 vote. In 1972, the Supreme Court extended the same protection to unmarried individuals in Eisenstadt v. Baird with another uncontroversial 6-1 vote.
For these reasons, the current debate about contraception coverage should focus on one issue only: where the responsibility lies on monetary coverage of contraception. The medical community established contraception as preventative care and, as such, it falls under the category of general preventative care treatments that should be decided upon by an individual and his or her doctor. Talking about coverage for preventative treatments is an important part of our ongoing healthcare debate. But no one should use a debate about coverage to launch into a debate on the acceptability of contraception as such a medical treatment.
Furthermore, attacks on contraception are dangerous to women, to the right of privacy and to the right of families to decide their own trajectory. Women and men have long had the right to privacy and to the decision in the privacy of their own homes of whether or not to use contraceptives. Attacks on the acceptability of contraception erode these constitutionally given and Supreme Court upheld rights.
Additionally, over 99% of women who have ever had sexual intercourse have used at least one contraceptive method. This makes contraception, in reality, an incredibly uncontroversial preventative care practice. Contraceptives also have important, beneficial effects on our society. The numbers are in and no matter how you personally feel about them contraceptives do save taxpayers money.
In the future, when we debate contraception, let’s be clear about the issue we’re discussing and focus on the cost and coverage of preventative service. This does not have an easy answer and there’s plenty for us to debate but the fundamental issue we should keep coming back to is the coverage of contraceptives, not its acceptability as preventative care.