Here's what the latest decision means for your pack of pills.

By Rainesford Stauffer
Jul 08, 2020 @ 11:57 am
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Credit: Eric Jeon

Generations of women fought for us to be able to do it casually: walk over to the cabinet where we keep our vitamins, or dig into our nightstand drawer, and take our birth control pills, or make appointments, stride confidently into the doctor’s office, and get our shot or IUD. It’s not a secret that abortion access feels precarious at best these days. Still, it’s nearly impossible to fathom birth control suffering a similar fate. Birth control, for countless people who use it, feels like a necessity so embedded in society now, we can’t imagine a world without it; whether pill or ring or IUD, birth control feels like a given.

It isn’t.

On July 8th, the Supreme Court of the United States reached a decision on Trump v. Pennsylvania, allowing that employers can deny employees health insurance coverage of birth control on the grounds of employers’ personal, religious, and other objections to birth control. It’s a blow to a continuing battle for reproductive health care. As Planned Parenthood tweeted in response to the decision, the individuals who benefit most from guaranteed birth control coverage are young people and people of color; the decision stands to strip them of health care based on the personal preferences of someone else. 

“As an ob/gyn providing the full spectrum of reproductive health care, I see every single day how contraception is a critical part of our collective health and wellbeing,” Dr. Kristyn Brandi, board chair of Physicians for Reproductive Health, tells InStyle. “Today’s decision is especially egregious coming amidst a global pandemic and economic uncertainty.”

The birth control battle isn’t new: Since the Affordable Care Act passed back in 2010, employers were required to provide healthcare coverage for birth control for employees on their insurance plans, and under the Obama administration, the government guaranteed birth control coverage for employees even if employers objected. Then, the Trump administration offered up regulations that would make it significantly easier for employers and workplaces who object to birth control to opt out of providing it. 

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The impact is tangible: According to reporting by Kate Smith of CBS News, Pennsylvania and New Jersey challenged Trump’s exemptions, and the three-judge panel, who blocked the regulation from being enacted, wrote that 126,000 people would lose access to birth control covered by their insurance if the regulation was allowed to take effect. Meanwhile, reporting from Vox cited Justice Sonia Sotomayor’s note during the hearing in May, in which she noted that between 75,000 and 125,000 women could gain or lose birth control coverage depending on the Supreme Court’s decision. And now here we are. 

Not only does the decision stand to make birth control more expensive and thus inaccessible for people whose insurance no longer covers it, it also puts contraceptive access at the whim of employers: Should your boss decide birth control violates their personal religious beliefs, or if they believe birth control isn’t moral, you could lose your birth control access. Justice Clarence Thomas authored the opinion of the court, and was joined by Chief Justice John Roberts and Justices Samuel Alito, Neil Gorsuch, and Brett Kavanaugh, who had already argued against the Obamacare mandate. 

But the issue of accessible birth control is currently playing out in communities across America, even beyond the Supreme Court decision. That’s why the importance of the ruling can’t be overstated. Dr. Brandi tells InStyle that contraception is health care, and work has to be done to restore this essential coverage. “I am deeply concerned for my patients who could lose coverage and be unable to afford their birth control because of today’s ruling and know that my patients with low-wage jobs and others struggling to make ends meet, disproportionately people of color, immigrants, and LGBTQ people will suffer,” Dr. Brandi adds.

According to Power to Decide, a non-partisan organization dedicated to ensuring all individuals are able to choose if, when and under what circumstances to get pregnant and have a child, more than 19 million women who need publicly funded contraception live in contraceptive deserts, a term the organization coined. That means areas that lack reasonable access to health centers offering the full range of birth control methods. That could look like individuals traveling extreme distances, or experiencing long wait periods for appointments, which increases the likelihood that they will experience an unplanned pregnancy, explains Power to Decide CEO Gillian Sealy, PhD, MPH. In these circumstances, it isn’t a matter of deciding whether to use birth control or what type to use. It’s not having the resources to make a decision on birth control at all.

Today’s decision is devastating, Sealy tells InStyle, as, now, access to the full range of contraceptives that is part of women’s healthcare, helps them achieve their goals, and allows them to make decisions for themselves and their families, is in the hands of their employer, allowing employers to cherry-pick what constitutes appropriate health care.

“For women with limited resources, having to pay for contraception limits their access to the full spectrum of reproductive health care as they’re forced to choose only methods they can afford, if any at all,” Sealy continued, noting that without insurance coverage, birth control is likely to be cost-prohibitive for many individuals. It creates a series of impossible choices: For people without accessible clinics or providers in their area, they’re already out transportation costs and childcare costs to make it to the appointment in the first place, if they can get one. Then, should their employer decide not to cover their birth control cost, women in need could be staring down choices between paying for their medical needs, and paying their rent. “Data show uninsured women on average pay $370 for a full year’s worth of contraceptive pills,” Sealy said. “Far too expensive for many, and even more so during the current economic shutdown.” 

Speaking of the pandemic, Sealy points out that it has disproportionately impacted women of color, who have already borne the brunt of health and healthcare disparities. “They want to be in control of the decisions that they make for themselves and their families, but also they want a system of support that helps them make those decisions,” Sealy says, noting that those systems of support could be within their own families, their communities, or where they work. This decision, she says, strips away some of that autonomy and decision-making.

Meanwhile, Power to Decide Senior Policy Director Rachel Fey adds that “all of these women who might lose coverage if their employer decides to take advantage of this exemption pay for that health insurance every month.” Now, they’re paying for health insurance that isn’t going to cover a basic part of their health care, and splashing out for birth control separately. Meanwhile, Power to Decide polling, she says, has found that the vast majority of people in the United States believe contraception is basic health care.

Sealy agrees: “To take away that piece of essentially a woman's health care, it's really hard to comprehend.”

Birth control access isn’t something that can be siloed off to the “contraceptive” category of life: Reproductive freedom affects the health, career trajectories, families, and personal lives of individuals, too. It affects the choices we make about what to do with our lives, and the timelines on which we do it. It also affects economic equality: Research shows that the availability of birth control in the 1980s and 1990s played a role in narrowing the pay gap. Not only that, a number of individuals — including teenagers — take prescribed birth control for non-contraceptive uses, including managing PMS symptoms, acne, and migraines. What is one haughty employer’s “moral objection” is another’s medical issue. 

“Birth control, and which method specifically to use, is a healthcare decision and like other healthcare decisions, it should be solely decided by patients and their healthcare providers,” Sealy said. “Allowing employers to opt out of covering birth control in their insurance plans serves as a barrier for women trying to get the contraceptive method they need.” 

And so what are people to do now? There are multiple services, including Pill Club and Nurx, that allow you to order birth control online. Nurx, specifically, responds to comments on social media that ask why people don’t just go to the pharmacy and collect their birth control monthly by stating that some individuals might live in areas where their local pharmacies or doctors are several hours away. Power to Decide offers Bedsider, an online birth control support network aimed at women ages 18-29, where users can get help finding a health center for birth control, an abortion provider, or getting birth control delivered, all depending on zip code. Since so much is location-based, the options may not be accessible or affordable for everyone, but they’re a sign that the issue of contraceptive deserts, and the true perils a lack of contraceptive access creates, are entering public consciousness and discussion. 

“It is a dangerous course for employers or insurance providers to interfere in these basic healthcare decisions. We have to wonder, in what other areas of health care would they interfere in next?” Sealy asked.

While abortion access and reproductive freedom dominates headlines, contraceptive deserts are silently affecting thousands of Americans every day. Today’s Supreme Court decision further restricts affordable, accessible birth control, making contraceptive deserts an addition to the hundreds of reasons why protecting reproductive freedom is critical to political, economic, and social equality. "The rule will harm women, that harm is real and acute and it’s up to Congress and any future administration to address it,” Fey demands. 

Your income should not determine your birth control, and neither should your geographic location — and certainly not the person who sits at the top of the company where you happen to work.