Access to affordable birth control — just what the doctor ordered

As a doctor and a researcher, I spend my days working with women in St. Louis as they navigate some of the most important decisions of their lives, including their reproductive decisions. I see the impact of political decisions — decisions that are disconnected from the lived experiences of women — in my daily work as I talk to women about finding the best contraceptive method for them. That is why I am so concerned about the Zubik v. Burwell case currently at the Supreme Court.

Birth control gives women the agency to determine if and when to have children. But as a doctor who works with women every day, I know that it provides women with more than that. Women also need contraceptive care for other medical reasons, including preventing ovarian or uterine cancers and regulating painful periods. That’s why the Affordable Care Act covers contraceptive care with no co-pay. Birth control is fundamental basic health care that every woman — regardless of where she works — should have access to.

Decisions about reproductive care are not just health decisions; they are economic as well. An IUD can cost up to $1,000. That’s more than a minimum wage worker would earn in an entire month. Without insurance, an IUD would be a totally inaccessible option for those women.

In fact, nearly one in three women said they would change their contraception method if cost were not an issue. One of the greatest contributions the ACA’s contraception benefit has offered to women is the ability to remove cost from the equation when determining the best method of contraception for them so they can focus on their health and wellness without exception.

I have seen firsthand the benefits of providing women with the contraceptive method of their choice at no cost — which is what the ACA contraceptive benefit does. My colleagues and I recently concluded a multiyear study on the impact of long-acting reversible contraception on decreasing rates of unintended pregnancy. We offered over 9,000 St. Louis women the reversible contraception method of their choice at no cost, along with education about the different methods. The results were not surprising. With education and access, most women chose long-acting reversible contraceptive methods like the IUD or implant, and ultimately demonstrated a significant reduction in the rate of unintended pregnancy.

The findings of our study, the Contraceptive CHOICE Project, showed that user-independent methods of birth control are more effective than others. Effective use of an IUD or implant is not reliant on a woman’s memory, or a trip to the pharmacy or a visit to the doctor, and therefore does a better job at preventing unintended pregnancies. We found that easing access to these methods of contraception results in a decrease of unintended pregnancies, which in turn means that women have control over their lives and better social, financial, economic and educational outcomes.

It is clear that women succeed when they are able to access contraception with no obstacle. And yet, the case at the Supreme Court threatens to reintroduce obstacles as women seek to access contraceptive care. The Supreme Court will soon hear oral arguments in Zubik v. Burwell, a case that would dramatically and seismically expand the ability of people to use their religion to harm a woman’s capacity to make smart medical decisions for herself.

The Zubik case follows on the heels of Burwell v. Hobby Lobby Stores Inc., which came to the conclusion that closely held religious for-profit employers could refuse to provide contraception coverage required by the ACA. However, in its decision, the court pointed to an “accommodation” offered to religious nonprofits, which allows them to opt out of providing contraception coverage by filling out a one-page form. After the employer opts out, the insurance company provides contraception coverage directly to the employees. The court recognized that this accommodation ensures that women would still get the health care they need as promised under federal law. After Hobby Lobby, the federal government extended the opt-out to closely held for-profit companies with religious objections to providing contraception.

But in the case now before the court, religious nonprofit organizations claim that their religion is burdened by the solution that the Supreme Court pointed to two years ago in Hobby Lobby.

We need to recognize these lawsuits for what they are: continued attacks on women’s access to contraception. Religious employers’ attempts to prevent women from accessing the health care they need have real world implications that play out every day, and will have a direct effect on women’s health and lives.

This case threatens to take choice away from women and make the most effective methods of contraception inaccessible, simply based on where they work. As a doctor, I know that’s not how these decisions should be made. I hope the Supreme Court will agree.

Access to affordable birth control — just what the doctor ordered