The news that the Institute of Medicine (IOM) has recommended that birth control be covered by all insurance plans, and without co-payment, came just as I was finishing Janet Farrell Brodie’s fascinating Contraception and Abortion in Nineteenth-Century America. You might not think a fine-grained, densely footnoted history of birth control would be an eye-opener and a page-turner, but you’d be wrong. Did you know, for instance, that birth control information and devices were in tremendous demand in antebellum America? Pocket-sized tracts like Charles Knowlton’s Fruits of Philosophy and Robert Dale Owen’s Moral Physiology went through many editions; newspapers carried ads for medications, douches and “womb veils,” early forms of the diaphragm, which some women wore for years at a time. Except in New York and Connecticut, abortion before “quickening” (mid–second trimester) was legal until after the Civil War and widely practiced; abortifacient drugs were easy to find under brand names like The Samaritan’s Gift for Females. Nineteenth-century methods were stressful (withdrawal’s not for everyone), cumbersome (reusable condoms? Yecch! And imagine douching with cold water and baking soda every time you had sex) and some of the information was sketchy (some experts got the rhythm method exactly backward, for instance), but taken together and backed up by abortion they sort of, kind of worked. The average native-born American woman had eight children in 1800 and only four in 1900, despite the clampdown on birth control and information by the Comstock laws of the 1870s.
As Brodie shows, contraception is not some newfangled fad foisted by the cultural elite on decent God-fearing folk. Americans have striven to separate sex from reproduction for more than two centuries. Today 99 percent of women have used birth control at some point. It is lifesaving and health-preserving medicine. And yet the myth that birth control is “controversial” persists. That was the very word applied by Time to the IOM recommendations. How many women equal one bishop?
The IOM asserts that birth control should be included as preventive care for women under the Affordable Care Act, along with annual checkups; mammograms; breast pumps; STD counseling; and screenings for HPV, HIV, gestational diabetes and domestic violence. This means financial relief for women who are paying out of pocket or who have high co-payments—some of whom are forced to skimp on meds or postpone refills, and wind up pregnant. It also means that women can choose the method that works best for their bodies, not their wallets: studies suggest that many would choose long-lasting, highly effective methods like the IUD and implants, which currently can cost up to $1,000 up front. With reproductive counseling, also included, women will get much better information about sex, their bodies and their choices.
It’s hard to imagine anyone opposing broader access to contraception. But it’s lucky that the HHS can accept these recommendations without Congressional approval, because this is America, where anything involving sex and/or women drives some people crazy. How crazy? Two weeks before the recommendations came out, Leonard Blair, the Catholic bishop of Toledo, Ohio, urged Catholic schools and parishes to cease raising money for Susan Komen for The Cure, the country’s largest breast cancer charity, because someday it might fund embryonic stem-cell research. Better actual women should die of breast cancer today than that an embryo be theoretically imperiled in the vague and misty future. Antichoicers have their own theology—not one major so-called prolife organization supports birth control—and their own biology too. An antichoice evangelical tweeted on the hashtag #BCBC that “for every year a woman takes the Pill…her cervix ages 2 yrs.” (But according to the natural-family-planning website she sent me to, for every pregnancy it gets two years younger! Depending on your choices, by the time you’re 40 your cervix could have its own AARP membership or be back in high school.) And let’s not forget the plain old misogynists, like New Hampshire Executive Council member Raymond Wieczorek, who cast a deciding vote to slash funds for Planned Parenthood with the immortal words “If they want to have a good time, why not let them pay for it?”
How about: If people drive cars, let them pay for their own whiplash? If people eat meat, let them pay for their own heart disease? If people fall off a cliff hiking, leave them there! Almost everyone has “good times” that entail risks, but sexually active women—which includes the churchgoing, cake-baking wives antichoicers want us to be—are just about the only ones against whom the “pay to play” argument is marshaled. The great thing about the IOM recommendations is that they acknowledge that sex is part of normal life, not some weird and semi-criminal activity. The Family Research Council claims it’s a violation of conscience to make people pay into plans that cover contraception. But what about the costs of not using contraception? Unwanted babies, stalled educations, poverty, ill health, misery—we all pay for that.
Forty-nine percent of pregnancies in America are unplanned—for teens, it’s 83 percent. Both are by far the highest rates in the developed world. The IOM recommendations would be worth taking even if they had no effect on those statistics—it’s wrong that women are nickel-and-dimed for a medication that only they take, as if preventing pregnancy was like getting a mani-pedi. But it’s hard to believe the new rules won’t help bring the numbers down. In Britain, where contraception has been provided on the National Health Service since 1974, the teen pregnancy rate is just over half ours. Still, 40 percent of pregnancies there are unplanned. It’s rare that technical fixes really solve social problems. But this is a good start. Our nineteenth-century forebears with their douches and womb veils would be cheering for us.