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Thursday, November 11,2010

Make the pill free

By Pamela White


It’s going to be a battle anyway. A panel of experts meets this month to advise the federal government on what kind of preventative care should be provided to women under the Patient Protection and Affordable Care Act of 2010 (PPACA). On the table is a proposal to include contraception.


Sen. Barbara Mikulski, a Democrat and Maryland’s top vote-getter in last week’s election, wrote the women’s health amendment to the PPACA. She told the Associated Press that intent of the amendment was to ensure that contraception was included as part of women’s preventative health care. Under PPACA preventative care is supposed to be free.

But religious conservatives, in their never-ending quest to control the private lives of others, aren’t likely to agree that birth control counts as preventative medicine. Pregnancy is not a disease, they say, and therefore should not be included as preventative health care.

“It would simply be inappropriate and indefensible for [the Department of Health and Human Services] to require group health plans and health insurance issuers to cover contraceptives, sterilizations, and drugs or devices that induce the expulsion of the human embryo before or after implantation, including the recently approved drug ulipristal acetate [ella, a new form of emergency contraception] or levonorgestrel (Plan B), under the pretext of ‘preventative care and screenings,’” wrote John M. Haas, president of the National Catholic Bioethics Center, in a letter to the Department of the Treasury, the Department of Labor and the Department of Health and Human Services.

Haas expanded on his position in an AP interview when he called pregnancy a “healthy condition.”

Much of his argument is based on the view that changing a woman’s body so that it refuses to accept a fertilized egg is the same thing as causing an abortion, a view shared by many Protestant fundamentalists. This is absurd. As the recent vote on Colorado’s Amendment 62 implies, Americans believe that any drug or device that prevents a woman from ever having a positive pregnancy test is contraception, not abortion. But that’s a topic for another column.

The question before the panel is whether contraception improves women’s health and ought to be considered preventative health care. And the answer is an overwhelming “yes.”

To hear Haas talk about pregnancy, you’d think that bearing children comes as naturally and easily to women as producing apples does to an apple tree.

Women blossom into fertility, are inseminated and bear fruit.

But pregnancy comes with a host of risks and potential health impacts ranging from the mild — nausea, back ache, insomnia — to the potentially fatal — toxemia, HELLP syndrome, postpartum hemorrhage. Childbirth is the leading cause of death among women of childbearing age in developing countries, and most women in developed countries choose to give birth in hospitals precisely because the process entails some risk to them and their babies.

Further, many women emerge from pregnancy with unhealthy changes to their bodies that are permanent or require costly surgical or medical treatment — gestational diabetes that didn’t go away; painful hemorrhoids requiring surgery; bladder problems; uterine prolapse; a tendency toward blood clots; fistula; depression.

No, pregnancy is not a disease, but it can initiate many health problems that are. Contraception is preventative medicine because it enables women to limit the number of times their bodies are placed at risk.

“There is clear and incontrovertible evidence that family planning saves lives and improves health,” Dr. David Grimes, one of a handful of U.S. physicians Board-certified in both obstetrics and gynecology and in preventive medicine, told AP. “Contraception rivals immunization in dollars saved for every dollar invested. Spacing out children allows for optimal pregnancies and optimal child rearing. Contraception is a prototype of preventive medicine.”

This is where Haas would say women can always use natural family planning, timing periods of abstinence to coincide with their fertile days of the month. But most women don’t want to play reproductive roulette and prefer to use a form of contraception that enables them to have sex whenever they choose.

Haas and his fellow religious conservatives aren’t trying to hurt women, though certainly a world without contraception would result in many thousands more birth injuries and maternal deaths each year. They’re simply invested in a religious dogma that binds women to reproduction. They need to believe that pregnancy is benign — or their “theology of the body” crumbles.

But public policy needs to be based on reality, not faith. So while Haas is welcome to his religious point of view, let’s hope the panel skips past the culture war rhetoric and focuses solely on what’s good for women.

One thing is certain: having bushels of babies isn’t.

Respond: letters@boulderweekly.com

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