Affordable Care Act (ACA)

Beginning last week, August 1, under the Affordable Care Act (ACA), all new insurance policies provided by employers are required to cover contraception without any co-pay or deductibles, making birth control more widely accessible for women around the country.

This mandate comes as part of a larger package of eight new preventive care services for women, including annual well woman visits, domestic and interpersonal violence counseling, sexually transmitted infections counseling, and breastfeeding support and equipment.

Nearly 100 years ago, Margaret Sanger began a global birth control movement, stating famously that “no woman can call herself free who does not own and control her own body” (“A Parents’ Problem or Woman’s?” Birth Control Review, March 1919, 6-7). Today is a clear victory for this movement, though it continues to be challenged. In breaking down the financial barrier between women and their necessary health care, the Affordable Care Act takes in important step in fully granting what Sanger strongly felt was “the means by which woman attains basic freedom.” (“Woman’s Error and Her Debt,” Birth Control Review, Aug. 1921, [MSM S70:0911-2]).

As an activist, Sanger spent much of her time advocating for the poor and working class women who lacked both the education and the money to practice birth control.

“We know that the well-to-do and those able to have a private or family physicians are equipped with knowledge. But the mothers seeking medical advice from hospitals or dispensaries are refused all help even though the life of a woman is endangered by another pregnancy. This can be remedied only when public health policies include this teaching in state programs” (“Birth Control and Civil Liberties,” Community Church of Boston, Oct. 13, 1940, 3-18 [MSM S72:0216]).

Almost a century later, the economic burden of contraception continued to fall on women.  According to a study by the Center for American Progress (CAP), 55 percent of women ages 19 to 34 struggled with the cost of birth control, leading to inconsistent use. CAP also found that women of reproductive age spent 68 percent more on out-of-pocket health care costs than men did, largely due to contraceptive expenses. The ACA mandate reconciles these inequities; it is not only about safe sex and bodily integrity, but also gender equality and fairness. Women’s contraception is not about luxury, as some anti-birth control advocates ignorantly argue, but justice.

Sanger, writing in 1918–even before women achieved the vote–knew this well:

“ Birth control is the first important step woman must take toward the goal of her freedom. It is the first step she must take to be man’s equal” (“Morality and Birth Control,” Birth Control Review, Feb.-Mar. 1918, 11 [MSM S70:793]).

To be sure, yesterday’s mandate does not mark an absolute victory. For one, it only applies to insurance policies that began on or after August 1; many other plans that have been “grandfathered in” are exempt from the law’s requirements to includes these preventive services. In addition, uninsured women who don’t receive Medicaid will have to wait until 2014 to access co-pay free contraception, when the ACA mandates everyone to have insurance (or pay a monetary penalty).

And there is the possibility that the law will be overturned. Extremely dedicated opponents of Obama’s health care reform that continually seek to undo and undermine all that the ACA will accomplish. Some states have already pledged to reject the expansion of Medicaid that the federal government offers, thereby cutting health insurance–and thus accessible contraception–to many of its poorer citizens.

Today, we must all recognize–as Margaret Sanger argued passionately–that everyone benefits from the broad access to contraception. As Amanda Marcotte at Slate notes, if you take the irrational sexual hysteria out of the equation, this contraception mandate is equivalent to the government mandating seatbelts in cars: “Just as people who resisted mandatory seatbelts have benefited along with the rest of us from lower rates of traffic fatalities, they will also benefit from the reduced social and health care costs that stem from reducing unplanned pregnancies.”

As Sanger said, “No adult woman who is ignorant of the means to prevent conception, can call herself free. No woman can call herself free who cannot choose the time to be a mother or not as she sees fit. This should be woman’s first demand” (“Condemnation is Misunderstanding,” Typed draft speech, April-July 1916 [LCM 129:32]). The Affordable Care Act’s contraception mandate finally delivers on Sanger’s demand: removing the barrier of co-pays and deductibles, all women–rather than their insurers–will control the decisions they make about their own bodies.

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