Women’s wombs are ground zero in the Washington’s culture wars, and the casualties are the communities that are systematically denied even the most basic forms of reproductive healthcare. The clash between science and religious zealotry exploded this year with the Hobby Lobby case, in which a company’s religious objection to IUD birth control led the Supreme Court to side with the employer and potentially impede contraceptive insurance coverage under the Affordable Care Act (ACA). At the same time, the highly effective IUD, along with similar hormonal implants are becoming widely available. The expansion of these contraceptive methods, collectively known as long-acting reversible contraceptives (LARC), could dramatically improve contraceptive care—if only politicians could stop panicking at the mere notion of women controlling their reproductive futures.
Compared to birth control pills, the IUD is far much more cost-effective and medically effective: according to the research group Guttmacher Institute, the rate of unintended pregnancy over one year on the pill is forty-five times greater than that on the IUD, a device that can last several years after insertion.
The ACA was supposed to expand access to LARC by ensuring coverage for a full range of birth control options. But the barriers of cost and lack of awareness still keep poor women from getting the best possible care.
Much of the problem comes from the entanglement of science with cultural warfare: IUD opponents erroneously believe it’s designed to terminate, rather than prevent, pregnancy, arguing that fertilization per se is the moment “when life begins.” Actually, the medical consensus is that pregnancy begins at implantation of a fertilized egg, but that has not stopped the Hobby Lobbyists from derailing the IUD policy discussion into another abortion battle.
Yet the real dilemma facing women and the IUD is a classic reproductive justice question—how to ensure choice, access and equity. As with many other social barriers to healthcare, these structural limitations acutely affect poor and marginalized women.
As Rachel Benson Gold writes in the Guttmacher Policy Review, “Starting an implant or IUD can cost a month’s salary for a woman working full time at minimum wage.” Additionally, healthcare providers often lack the “training and experience” needed to provide comprehensive LARC services. The devices can also be prohibitively costly for patients and providers.
However, although the science on LARC is straightforward, the politics of equal access, as Gold points out, is complicated by a history of reproductive injustice: while disadvantaged women have been economically deprived of access to contraception and abortion services, they were in the past systematically denied their right to independent reproductive and sexual decision-making, on their own terms.