Trump Takes Away Fundamental Health Care for Women

https://www.nytimes.com/2017/10/06/opinion/trump-birth-control-contraception.html

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The average American woman spends just three years pregnant or trying to become pregnant, and a full 30 years trying not to be pregnant. So it’s no surprise that birth control is a standard part of most women’s lives. In fact, roughly nine out of 10 women will use birth control during their lifetime.

On Friday, the Trump administration revealed its disdain for women when it removed the guarantee that health insurance will cover their birth control.

This new policy allows virtually any employer or university to decide to yank contraception coverage from their employees or students. Organizations can point to a religious justification or an amorphous “moral” reason, a standard so vague that it probably covers almost any motive imaginable. This rule eliminates the Affordable Care Act’s provision that ensured that a woman had coverage for birth control even if her religious employer objected to contraception.

As a health care provider and Planned Parenthood’s chief medical officer, I worry that this move will manufacture a medical crisis for millions of women across the country.

It’s ridiculous that it’s even a question as to whether a woman should have access to birth control. Birth control is not controversial: It’s health care that the vast majority of women will use. And they don’t use it just for family planning. According to the Guttmacher Institute, fifty-eight percent of all women who use the pill rely on it, at least in part, for something other than pregnancy prevention, like endometriosis, polycystic ovarian syndrome, fibroids (which are prevalent among women of color) and managing painful periods.

The birth control provision of the Affordable Care Act improved women’s lives. Before the law passed, more than 20 percent had to pay out of pocket for oral birth control. The predicament of women ages 18 to 34 was even worse, according to a survey commissioned by the Planned Parenthood Action Fund: 55 percent of them had difficulty paying for birth control. By 2014, after the law took effect, fewer than 4 percent of American women had to open their wallets.

Thanks to the Affordable Care Act, more women have been able to get the birth control method of their choice, including long-lasting and more effective forms like the intrauterine device. Because of this, the United States is experiencing the lowest rate of unintended pregnancy in 30 years, the lowest rate of pregnancy among teenagers ever and the lowest rate of abortion since Roe v. Wade was decided.

I’ve seen firsthand how increased access to birth control makes a significant difference in the lives of my patients every day.

A few years ago, I had a patient who was a nurse practitioner at a Catholic hospital in Baltimore. She needed an IUD, but her insurance didn’t cover it because her employer objected to contraception. That meant she would have to pay almost $1,000 for the device herself, and with her modest income, that was impossible for her.

Fortunately, Planned Parenthood was able to help her get the basic health care she needed. I remember how grateful she was, and I think of her every time I read about employers refusing to cover birth control. Under the Affordable Care Act provision, she would have still been able to get birth control through her insurer, even though her employer had opted out. Today, she would again be left with no other options.

I also think of the college students who are working hard to build their futures, where the cost of birth control can put textbooks or groceries out of reach. Or moms who are forced to decide between school clothes for their kids or birth control.

And those hardest hit by this policy will be poor women and women of color. According to a survey, 51 percent of African-American women ages 18 to 34 said they have had trouble purchasing birth control, and cost can be one of the most significant barriers for women of color in getting health care. In addition, these women too often suffer higher rates of chronic conditions because of systemic barriers to care. Not all of these diseases are pregnancy-related, but many can be managed by contraception.

Let’s be clear: This change on birth control coverage is not about religious freedom. We know this because, under the Affordable Care Act, organizations that had religious-based objections to providing coverage already had an accommodation that also ensured that their employees could get coverage through other means.

Instead, it’s about taking away women’s right to make basic decisions about their health and their futures. It’s about the Trump administration giving bosses power over their employees’ most personal decisions.

If these politicians truly want to reduce the need for abortion, as they claim they do, they should invest in women’s health and preventive care.

Being able to decide whether and when you have children is a fundamental right, and one that no woman should have made for her by her boss or a politician.