Reproductive rights have been a topic for policy making and legal jurisprudence throughout much of the past century. As the healthcare system of the United States continues to evolve, women’s health and reproductive rights remain central to the debate.
A recent policy update by Aishwarya Rajagopalan and Lisa Lines here at The Medical Care Blog discusses the draft of an interim final rule by the Trump Administration, which would likely result in loss of contraceptive coverage for millions of women in the United States.
Also earlier this month, Timothy Jost wrote in the Health Affairs Blog that the draft interim final rule would expand the earlier exemption to the contraceptive mandate present under the Obama Administration, such that “all employers that have a religious or moral objection to the provision of all or a subset of contraceptives, or to sterilization or related patient education and counseling,” are exempt from providing contraceptive coverage to their employees (or students, in the case of universities), including for-profit corporations. The Trump Administration will accept comments on the draft interim final rule for sixty days, after which the rule will be effective upon publication.
Burwell v. Hobby Lobby is a landmark United States Supreme Court case from 2014 in which the majority ruled in Hobby Lobby’s favor:
“finding that ‘closely held’ for-profit employers had religious free exercise rights, that the contraceptive mandate substantially burdened these rights, and that — although the contraceptive rule might serve a compelling governmental interest — the religious organization accommodation rule demonstrated that the federal government could in fact accommodate the interest of for-profit employers.”
Religious organizations that are anti-contraception often claim this on the basis that some, or all, forms of contraception are abortifacients, and that this goes against a religious or moral belief. This was indeed the argument in the case of Hobby Lobby.
However, such organizations seem to contravene scientific research and medical facts in their arguments. Emergency contraception and intrauterine devices (IUDs) are the forms of contraception most often claimed to act as abortifacients. However, the primary mechanism of action for emergency contraception (also known as Plan B) is to inhibit ovulation, an analogous mechanism of action to that of most other estrogen-progesterone and progestin-only oral contraceptives. Note that inhibition of ovulation occurs prior to fertilization.
The primary mechanism of action for the hormonal IUD is to thicken cervical mucus, thereby acting as a physical barrier to prevent sperm from reaching an oocyte. Hormonal contraception has mechanisms of action that occur prior to fertilization and thus, is not in conflict with even the most conservative beliefs of when life begins.
Next, access to reproductive healthcare is key to the social and economic empowerment of women in society.
- Women are empowered in society through education; access to contraception plays a significant role in this empowerment, as it increases the odds that women will graduate from high school, college, and professional programs.
- The Guttmacher Institute reports that access to contraception has resulted in more women pursuing and graduating from college, which results in increased earning power and a decreased gender pay gap.
- Access to contraception has also been found to be a catalyst for women pursuing careers in dentistry, medicine, and law.
- Financial and geographic access to contraception is widely accepted as the primary mechanism for reduction and prevention of adolescent pregnancy.
- The Centers for Disease Control and Prevention (CDC) states that adolescent pregnancy is a significant contributor to high school dropout rates for young women.
- CDC states that approximately 50% of adolescent mothers achieve a high school diploma by the age of 22 years old, whereas 90% of female students who are not adolescent mothers graduate from high school.
Importantly, the American Public Health Association supports “protection and fulfillment of universal rights to safe, voluntary, confidential access to the full range of contraceptive methods” and “urges governments and international organizations to respect, protect, and fulfill sexual and reproductive health and rights.”
Reproductive health has been the subject of debate by politicians and religious leaders alike for much of the past century. However, we must consider the ethics of the restrictive measures often placed on reproductive rights. The guiding principles of bioethics include autonomy, beneficence, utility, and justice. With these principles in mind, I argue that the interim final rule is another step towards further oppression of women, as well as ideologically and economically hurtful to society. Access to reproductive healthcare affects all genders; reproductive freedom is a human rights issue.