The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, October 28, 2013

The Importance Birth Control Access

Birth control has been a controversial political topic for as long as many of us can remember, and it seems like it has gotten more controversial in the last few election cycles.  Although 89% of all Americans think birth control is morally okay (Americans, Including Catholics, Say Birth Control Is Morally OK) and 63% support the federal requirement that all health plans cover birth control (Poll Finds Wide Support for Birth Control Coverage), Congressional Republicans still tried to add a measure that would allow employers and insurers to opt out of covering health services that they object to for religious reasons (House Republicans Target Contraception In Last-Minute Spending Bill).  There are also seven states that allow pharmacists to refuse to fill contraceptive prescriptions for religious reasons, three states have slashed their family planning budgets by more than a half, and six states have tried to block Medicaid funding to Planned Parenthood (Texas was the only state that “succeeded” as it decided not to take any federal funds for its women’s health program).

What Are the Common Arguments Against Birth Control?
1.) Freedom of Religion - the most common argument, as you may have guessed, is that individuals who don’t believe in birth control should not be forced to provide it to others.

2.) Morally Wrong - some believe it is inherently wrong, unnatural and anti life.  They believe it is a form of abortion and prevents potential human beings from being born.

3.) Health Risks - some say that birth control is dangerous to a woman’s health.

4.) Immoral Behavior - another argument is that access to birth control leads to immoral behavior like sex outside of marriage or, in the case of teenagers, leads them to have sex earlier.

Myth V.S. Fact
1.)Religious freedom is important and should be respected; however, the religious (and other) freedoms of both parties are equally important.  Those who do not believe in birth control have the right not to use it, but if we allow insurers, employers and pharmacists to make that decision, then we are allowing them to force their beliefs on others.  These “religious exceptions” would be akin to allowing a doctor who is also a Jehovah’s Witness the option not to give blood transfusions or a Scientologist Pharmacist the right not to fill psychiatric prescriptions.  
2.) If an individual feels that birth control is wrong, she has the right not to use it.  As mentioned before, most do not agree with that and birth control is both legal and medically accepted, so these arguments should not be part of political discourse.
3.) There are some risks to using hormonal birth control as there are with all prescription drugs.  There is some increased chance of stroke and blood clots, especially in women who smoke, but those who say it increases your risk of cancer couldn’t be more wrong as it actually decreases the risk of endometrial and ovarian cancers.  There is also no evidence that it damages fertility. (10 Myths About the Pill Busted).  Compared to some of the other drugs that people take everyday, contraceptives are virtually harmless.
4.) I will not address the religious.individual belief that premarital sex is immoral.  However, the argument that access to contraceptives leads to teenagers having sex earlier is demonstrably false.  Countries vary widely in the average age that a person has sex for the first time, but we can compare the US to the UK to see that access to birth control does not necessarily lead to sex at a younger age.  In the US, the average person has sex at 18 years of age, in UK, where birth control is free, the average age is 18.3 years (Average Age At First Sex By Country).  Some countries with free birth control have younger averages some have older - the same is true for countries with restricted access to birth control.  There is also evidence that teenagers who receive comprehensive sex education, which addresses abstinence and birth control, tend to wait longer to have sex, are more likely to have safe sex when they do, and have healthier relationships (Sex Education Linked to Delay In First Sex).

What Happens When Access to Birth Control Is Unrestricted and Free?
Those who believe in a woman’s right to birth control fight just as hard as those who want to restrict its use.  I could argue extensively about a woman’s right to chose when and how to have children and her right to privately make decisions about her body; however, here I will focus on the societal impacts of birth control.  I do this because although I believe those rights-based reasons are important and valid, they are based on individuals and those who don’t or won’t use birth control are not affected by them.  Societal impacts, however, impact everyone - even those who do not use birth control.
First, the number of unplanned pregnancies and abortions decrease.  This seems obvious, but many who argue against birth control actually believe that without it, people will stop having sex outside of marriage and that all pregnancies within a marriage are planned.  This, however, is not the case which is partly shown through studies of abstinence only sex education (Abstinence-Only Programs Do Not Work - New Study Shows).  
In the US, nearly half of all pregnancies are unplanned and we have the highest rate of births to adolescents in the world (ours is four times higher than in Western Europe).  A study in St. Louis offered women free contraception and counseling about their options from 2007 to 2011.  The abortion rate for the women in the program was between 4.4 to 7.5 per 1,000 women during the study compared to 19.6 per 1000 nationally which is a decrease of between 62 and 78%.  Moreover, the birth rate for women aged 15 to 19 was 6.3 per 1,000 for the study group compared to 34.3 per 1,000 nationally - an 82% decrease.(Free Birth Control Means Drastic Drops In Unplanned Pregnancies).  We can also look to Texas which decided to refuse $30 million in federal funds for family planning because it would require them to continue funding Planned Parenthood.  Fifty clinics shut down.  The Texas Policy Evaluation Project surveyed 300 pregnant women seeking abortions in the state and nearly half said they weren't able to access birth control in the three months before they became pregnant.  The reasons they stated for the lack of access were: cost, lack of insurance, inability to find a clinic and inability to get a prescription. (This Is What Happens When You Defund Planned Parenthood)
Another benefit is that the cost to taxpayers would go down.  As you might have guessed, unplanned pregnancies are expensive.  Two recent studies by the Guttmacher institute found that the cost of unplanned pregnancies for US Taxpayers is on average $11 billion a year and that is a conservative estimate.  The studies only took into account the cost of public insurance and first year infant care.  The estimated savings if those pregnancies were prevented is an average of $5.6 billion a year.  (Nation Pays Steep Price For High Rates of Unintended Pregnancy)
Lastly, there could be positive gains in equity.  Between 1994 and 2006 the total number of unplanned pregnancies fell; however, unplanned pregnancies rates to women up to 199% of the poverty line increased.  The women least able to afford an unplanned pregnancy are more likely to have one (Unintended Pregnancies Are Increasingly Concentrated Among Poor Women Who Lack Birth Control Access).  There is also new paper out that argues that access to birth control, and thus a woman being able to plan her family, increases the educational and economic wellbeing of themselves and the children they chose to have (Access to Family Planning Linked to Higher Incomes Later In Life).

You might be thinking, “well great! the Affordable Care Act requires that health insurance cover birth control at no cost, so all those good things will start happening”.  That’s partly true.  A lot of good things will come from the ACA mandate, but it doesn’t mean we can rest on our laurels.  Many Christian conservatives/Tea Party Republicans still want to fight to restrict birth control and cut funding from Planned Parenthood.  Also, don’t forget those states who already have restrictions in place that the ACA does not affect.  Even if their health insurance covers birth control, women in Arizona, Arkansas, Georgia, Kansas, Idaho, Missouri and South Dakota could find that their pharmacist refuses to fill their prescriptions.  If that is the only pharmacist around, the ACA might not help them at all.  Remember Texas, which gave up all federal funding for family planning services in order to defund Planned Parenthood because they provide abortions (by the way none of the 50 clinics that shut down because of that provided abortions).  Remember that other states like Indiana, Arizona, Kansas, North Carolina, Tennessee, and Arkansas keep trying to defund Planned Parenthood.  

The benefits of increased access to birth control are clear.  Whether you are a democrat, republican, independent, pro-choice or not, help women, children and society by supporting the universal access to birth control.

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