Thursday, March 15, 2012

“Contraceptives” and “Birth Control”

In the last post, I noted the lack of women’s voices in the current public debate about employer mandates to cover oral contraceptives.  Because of this critical omission, I think the public debate has been skewed.  I am certainly not an expert on women’s health or oral contraceptive issues.  But because we haven’t heard enough from women, I would like to flag a few facts that don’t seem to get mentioned in the media coverage of this issue.

The debate has focused on insurance coverage of prescription drugs which have been characterized as “oral contraceptives” or “birth control pills.”  But in some ways, I resent those characterizations and believe they are misleading.  I’m not an expert in this area, so I unfortunately don’t know of a better appellation.  But the reality I would like to flag is that the prevention of pregnancy is but one of many uses such prescription medications have. 

It is important to note that in this day and age, birth control pills are like the little black dress of women’s health.  For a variety of health issues, doctors will prescribe birth control pills as a treatment.  Whether that is desirable is another question that can be debated elsewhere.  But in the current state of medicine, that reality should be acknowledged.

When I was in my early 20s, I primarily ran with a pretty tame crowd.  Most of my closest friends were religious Christians.  Sex outside of marriage was not a value embraced by my best friends.  Yet in college, a number of them were taking birth control pills at various times.  They were explicitly not prescribed the pills because of a desire to prevent pregnancy.  Indeed, these friends were unmarried and not even sexually active.  I share this anecdote simply to illustrate the point that this employer mandate is not aimed solely at enabling women to engage in intercourse without becoming pregnancy.  It is a much broader women’s health issue.  Women need access to these prescriptions for many other reasons. 

Moreover, the prevention of pregnancy is itself a health issue.  It is not just a choice about one’s family size.  Pregnancy is a very serious women’s health issue.  For much of human history, child birth was very dangerous; women often died giving birth. 

Thank goodness for the great leaps forward in obstetrics.  In Western countries, women no longer die in childbirth at high rates.  But pregnancy is still life threatening in many poorer countries where medical care is less accessible.  I’m not sure why, but we rarely hear about that in the media.  That is atrocious.  Those are preventable deaths. 

Nonetheless, even in the United States, women do still die in childbirth.  That point was vividly brought home to me several years ago when a colleague’s wife suddenly, unexpectedly and tragically died when she went into labor with her only child.  It was an incredibly heartbreaking loss for her family and friends.  Despite having access to great doctors, no one was aware of a medical condition that made child birth particularly risky for her.  The death of this lovely young woman was a huge shock.

There are plenty of women for whom pregnancy would clearly be life threatening and their doctors strongly advise against getting pregnant.  Diabetics sometimes fall into that category, but there are others.  Years ago, I knew a young woman who nearly died of a food borne pathogen from eating negligently undercooked food at a restaurant.  She was in a coma for weeks, but did eventually recover.  When she was finally recovering and preparing to go home, her doctors were quite clear that if she ever became pregnant, her body was so permanently weakened from the food pathogen that she would surely die.  As a result, her doctors were extremely adamant that she had to be on a highly reliable form of contraception.  Oral contraceptives were a possibility, but they suggested something with an even smaller rate of failure.  This young woman had a baby on the verge of toddlerhood when she became so sick.  She and her husband had dreamed of a large family, so the danger of her becoming pregnant again was very tough news for them.   I share this anecdote to illustrate that pregnancy can have dire health repercussions for some women.  Access to reliable contraception could be a life or death proposition.

Matthew 25:44-45

Then they themselves also will answer, ‘Lord, when did we see You hungry, or thirsty, or a stranger, or naked, or sick, or in prison, and did not take care of You?’ Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’

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