Earlier this month, the Ninth Circuit heard oral arguments in a case challenging the Trump administration’s broad exemption for employers from the Affordable Care Act’s contraceptive coverage mandates.
Trump’s rules allow any employer to gain an exemption to federally required coverage of birth control in employee health insurance plans by claiming that contraception violates their religious beliefs or their “non-religious moral convictions,” vastly expanding earlier exceptions for religious organizations. The current administration’s policy also goes beyond the Supreme Court’s 2014 ruling in Burwell v. Hobby Lobby that applied to closely-held private corporations by allowing any employer, on the ground of any “moral conviction,” to claim an exemption—potentially depriving hundreds of thousands of women from obtaining medically necessary and life-saving contraception.
In January, a judge in Oakland granted a preliminary injunction blocking enforcement of the rules. California was joined in the case by four other states—Delaware, Virginia, Maryland and New York. The plaintiffs also have the support of organizations including Planned Parenthood, ACLU, Center for Reproductive Rights, National Women’s Law Center and American Association for University Women.
“The law couldn’t be clearer,” said Xavier Becerra, then the Attorney General of California. “Employers have no business interfering in women’s health care decisions.”
But the Trump administration has continued to defend the rules, joined by Catholic and anti-abortion groups. And on June 6—almost 54 years to the day after the Supreme Court legalized contraception in the United States in the case of Griswold v. Connecticut—they argued their case in court. During the oral arguments, doctors spoke out about the importance of contraception for women’s lives and health.
“Birth control is basic health care that should be covered,” Physicians for Reproductive Health tweeted, adding the hashtags #HandsOffMyBC and #ThxBirthControl. “Access to contraception improves health by helping people prevent [and] space their pregnancies.” PRH then asked doctors why they think birth control is necessary, eliciting an entire thread of responses.
Doctors tweeted about how birth control is critical for their patients’ health, safety and well-being. “Some patients have medical conditions that are exacerbated by pregnancy,” Dr. Elissa tweeted, “and these patients can have such a high risk of dying if they ever became pregnant. Birth control saves lives.” Dr. Narges echoed the sentiment. “Access to birth control helps to reduce rates of maternal and infant mortality,” they posted on Twitter. “It enhances educational attainment and employment opportunities for women by allowing them to plan their families.”
In another post, Dr. Jonas added that contraception “is the normal part of the lives of many individuals and families,” and pointed out that nine out of 10 women will use birth control in their lifetimes. “Birth control is fundamental, basic, preventive care,” Jonas added. “Access to ALL methods of birth control through the #ACA allows my patients to make the choices they want for their lives.”
Contraception also empowers women to resist abusive partners, according to another doctor. “A patient of mine once told me that she was trying to escape her abusive boyfriend,” they explained, “but that getting pregnant by him would inexorably tie them together. Birth control was her shield.”
But access—and the urgency of covering contraception costs—was also an issue that took center-stage. One doctor explained that trying different birth control methods to gauge which works best is “impossible without access and coverage.” Another added that “we need contraceptive coverage for all of our patients so that cost isn’t the deciding factor on who gets to plan their pregnancies!”
“Affordable access to contraception has been a game changer!” Dr. Glenna Martin exclaimed. “When I talk to my patients about what method they’d like to use, cost doesn’t have to be an issue.…”
Dr. Maya Bass credited contraception for her own work: “Thanks birth control,” she posted, “for allowing me to focus on my medical training without worrying about an unintended pregnancy!” Dr. Ellen also thanked contraception—“for letting me space my children so that I could continue my career and be present for my children.”
“Every day I see the benefits of birth control,” Dr. Zia Okocha, a family physician practicing in Minnesota and a PRH Fellow, told Ms., specifying that patients at the intersections will suffer most from these challenges to access. “For a lot of folks who are affluent and who can afford to pay for birth control out of pocket, this isn’t going to affect them. But for so many people and for so many of the people that I take care of, if their employer decided to no longer cover birth control, this could be devastating for their life.”
The 1965 ruling in Griswold established a fundamental right to contraception without government interference. We can only hope that the Ninth Circuit will not reverse this important protection for women’s health, lives and well-being.