Even more out of (birth) control

Two years ago, I wrote that “each woman’s experience navigating an insurance and medical system [to access birth control] that demonstrates anywhere from casual disregard to active hatred of women falls along a dramatic spectrum. In some cases, access is circumstantial, stressful, or unduly expensive.” Last week, the Supreme Court in Little Sisters of the Poor v. Pennsylvania granted employers a broad moral exemption to providing contraceptives, limiting that spectrum of access even further. This decision makes clear the necessity of understanding how women’s positionality impact their ability to access medication.

In 2018, I was already concerned that Supreme Court nominee Brett Kavanaugh seemed to believe that mandating birth control coverage in health insurance plans infringed on religious freedom. How prescient. This is precisely what the Court held in Little Sisters, upholding a Trump administration regulation that lets employers with religious or moral objections limit women’s access to birth control coverage under the Affordable Care Act (ACA). This decision means that as many as 126,000 women could immediately lose contraceptive coverage from their employers, adding another layer of complication and burden for those seeking medication.

People who take birth control lose time, money, and mental/physical energy trying to get medication, and that burden acts as yet another barrier to equitable success. How is a woman earning an hourly wage supposed to earn as much as a man if she is spending time at the pharmacy instead? How can she save for her education if she’s paying for additional hours of childcare instead? This barrier is manufactured by people in power — it doesn’t have to exist. Yet, once in place, it acts like an anchor, dragging women backwards as they push for equality.

Many women — myself included — have to struggle with their pharmacies and doctors for access. This occurs both legally and interpersonally, as in the case of women living in states allowing pharmacists to deny prescriptions over moral or religious concerns. Accessing birth control in smaller communities comes with the additional fight against social judgement and stigma.

The ACA saved women an estimated $1.4 billion on birth control pills in 2013 alone. Birth control pills can cost women anywhere from $240 to $600 a year. The people who will be hardest hit by this new expense are women of color. The amici curiae brief filed for this case found that one in three Latina and four in ten Black women cannot afford to pay more than $10 a month for contraception.

Even for women who can afford this additional burden, we should still ask — why are we spending $600 on our medication when the male erectile dysfunction drug Viagra is covered by health insurance and subsidized by the American government?

Ultimately, the decision affirms my belief that birth control access falls across a spectrum, and women exist along that spectrum based on existing disadvantages and intersectionally marginalized identities. Women of color — who are already pushed away from decent housing, fair-paying jobs, and affordable and respectful health care — will be the most likely to lose their employer-provided coverage of birth control and be unable to meet the costs out of pocket. Those who identify as women are not the only people taking birth control, and those people will be additionally burdened as well.

Any conversation we have about birth control must acknowledge, in order to accurately reflect the reality of the situation, that the battle is being fought in the grey areas of access. We should not be looking to well-off white women as our benchmark of whether birth control is “accessible” — we need to listen to the women who are already at the margins and follow where they lead. The recent Supreme Court decision indicates that the steps that are being taken to restrict women’s freedom are occurring within marginalized communities, and are working subtly to build up the burdens placed on women trying to access a (still) tiny, legal pill.