Planned Parenthood is marshalling women to #Fight4BirthControl, because apparently allowing those with moral objections to opt-out of the Obamacare contraception mandate is disastrous for women’s health. I wonder if the women using this hashtag understand how the contraception mandate works. Or how insurance works. Or birth control itself, for that matter.
To recap, the Obama administration’s contraception mandate directed employers to provide insurance coverage for contraception, including embryocidal methods, at no direct cost to employees. Several lawsuits challenged the mandate for violating the religious freedom of religious employers who object to providing birth control, including methods that may result in the loss of an embryo. So the Trump administration released a rule that allows any employer—publicly traded, nonprofit, or otherwise—to opt out of the mandate for religious or moral reasons.
Anyone who has followed the mandate controversy closely know this rollback will likely only affect a small percentage of employers. Birth control is so ingrained in our culture and medical community that the majority of employers already chose to pay for birth control prior to the mandate.
But there is another important conversation to have beyond what the mandate did or didn’t do: whether birth control is “necessary” for women’s health, and whether it should therefore be “free.” As a woman who has taken contraception for health-related reasons and suffers a chronic, life-threatening medical condition, and as a physician with a particular focus on fertility awareness and women’s health, I think the hysteria concerning the contraception opt-out is dishonest about the real answers to these questions.
Birth Control Doesn’t Treat Reproductive Problems Well
I know from personal experience and my medical practice that birth control is not the only, or even the best, way to treat the reproductive issues women experience. I also know as an adult who has paid for health insurance that no insurance is ever expected to cover all aspects of personal health care, even for life-threatening conditions. The treatment I need for my life-threatening asthma requires a substantial co-pay from me, which no “mandate” has been provided to alleviate.
Two medical emergencies in college revealed this tension, which I think deserves more weight in our conversation about the contraception mandate, and what is considered “necessary” in health care. Like many young women, in high school and college I suffered from debilitating menstrual cramps once a month. The pain was intense and seemed to drain me of all my energy such that I couldn’t get out of bed for at least one or two days.
The doctor I saw at the student health center was very kind and eager to help. She decided the best course of action would be to take the birth control pill. The doctor explained that the pill worked by suppressing my normal hormones almost entirely, preventing me from having true menstrual bleeds. Since I wasn’t sexually active, my cramps lasted only a couple days a month, and I worried about the side effects of the pill, I asked if I could take anything else that would eliminate the pain but not interfere with my natural cycle.
Not really, she explained, unless I had a crystal ball and could predict when I would get the cramps again—then, maybe, I could pre-medicate with an anti-inflammatory medication. So I started taking the pill. Thankfully, I did notice a difference right away. However, when my hair started to fall out, to the point that I had a huge bald spot, I decided to stop taking the pill. There had to be a better way!
I later discovered that if I tracked my menstrual cycle, I could better predict when my period would begin, and if I took ibuprofen a day or two before, my period was not nearly as painful. For me, the solution was simple, but I have a close family member who experienced even more severe pain with her periods. So, she started charting too, and consulted with a physician trained in NaPro Technology who discovered endometriosis.
Rather than temporarily suppress symptoms with the pill, the doctor performed the surgery necessary to truly eliminate the disease. My family member and I experienced real relief when charting allowed us to identify and treat the root causes of our pain, all without taking the pill. And the good news is, charting our cycles costs very little and has no harmful side effects.
We Should Focus Resources on Truly Critical Medication
This brings me to my second medical emergency: an asthma attack during a time I could not afford preventive medications.
When I was in college, my medications and doctors’ visits were covered under the student health insurance plan. Yet I still had to pay a significant medication co-pay for my steroid asthma inhalers. So often at the beginning of the school year, after paying tuition and purchasing a semester’s worth of textbooks, I didn’t always have the money to refill my asthma medications, especially for the steroid inhaler designed to prevent asthma attacks.
On one cold fall day in early October, this almost led to my demise. I was literally running late to my English writing seminar. The air was much colder than I expected, and as a result it triggered a severe asthma attack. I was halfway to class and my rescue inhaler did not seem to be working. I decided to walk the rest of the way to my classroom and did my best to not draw attention to my late arrival, but it was obvious I was in severe respiratory distress.
Thankfully, somebody had already called 911. When paramedics placed an oxygen mask over my face, I could feel the relief like a person walking in the desert for days taking her first sip of cold water. The air never tasted so good. And I promised myself that, no matter the cost, even if it meant eating Ramen noodles for a month, I would make sure to purchase my preventive asthma medication.
When I see the hysteria regarding the cost of birth control and women having to pay those fees, I think of that moment. I nearly died because there was no “mandate” that covered the cost of my preventive asthma medicine.
Women deserve relief from the conditions that disrupt their reproductive systems. As a physician with a particular interest in fertility and women’s health, I strongly believe women can learn to better monitor and manage reproductive health issues by charting their cycles and working with physicians trained to use those charts to aid in diagnosing and managing the true underlying causes of gynecological ailments.
As an added bonus, when couples learn to chart from a trained instructor, they can use this information to prevent pregnancy or even plan to have a baby. The birth control pill cannot “cure” anything, from acne to cramps to endometriosis; it simply masks symptoms of underlying hormonal issues. While it can help prevent pregnancy and then only some of the time, it does so by suppressing the normal function of the woman’s reproductive system.
Furthermore, as a patient who suffers from a chronic disease, I would rather see our health care dollars be spent to ensure people like me have access to medications that can truly prevent life-threatening complications. Why do we “fight for birth control,” but not drugs that allow people to breathe?