A friend of mine directed me to this article about the Little Sisters of the Poor’s refusal to both cover birth control in their health insurance policy and to complete the paperwork that would exempt them from doing so since that paperwork ensures their employees will get coverage for their birth control from other sources. The Little Sisters are not on solid ground here. They might have a case for not covering it themselves (and here I mean a moral case, as they clearly have a legal one), but the moral ground they stand on by not allowing their employees to be covered by other means is shaky, to say the least.
There are a few problems with the article, but I wish to address one in particular: the claim that contraception is “a preventive measure used by 99 percent of women.” For this claim, they cite the Guttmacher Institute’s Fact Sheet on Contraceptive Use. A cursory inspection of the fact sheet and underlying studies shows just how dishonest this figure is in this context.
I understand that the main thrust of the article is that the fight to control the sex lives of women is here part of a larger battle around freedom for employees from their employers’ beliefs. However, intellectual honesty is always a virtue and responsible reporting is the duty of publications on all sides of an issue. I think we should hold our ideological allies to as high a factual standard as we hold our opponents and in that spirit, here are some of the reasons I think the 99% citation is problematic:
It’s so unrealistic as to be unfeminist:
Claiming that 99% of women are currently using birth control paints women as a monolithic entity whose members don’t change their minds over time, who all want the same things out of sex and all go about getting those things the same way. The fact of the matter is that there are women who believe that sex is solely for procreation and live those beliefs. Furthermore, about 10% of American women have various fertility issues (including the 6% of married women who are infertile) and those women are completely erased by claims of almost universal current contraceptive use.
It’s shady on what is meant by birth control:
The kind of birth control that the Little Sisters don’t want their employees to have access to is the kind that prevents ovulation or implantation, or prevents sperm from entering a woman. However, the CDC studies that the Guttmacher Institute cites (linked below) include periodic abstinence (rhythm method and calendar method) as a form of contraception. About 22% of the women in that 99% figure used periodic abstinence as a method of contraception, some as one method among others during their life, some not. So more than 1/5 of sexually active women believe at some point in their sexually active lives that barrier and hormonal contraception are not for them. The Little Sisters of the Poor have no objection to access to those methods of contraception.
It’s either astonishingly lazy or intentionally misleading:
Go look at the Guttmacher fact sheet. Read where it says “More than 99% of women aged 15–44 who have ever had sexual intercourse have used at least one contraceptive method.” Then look at the next point. The very next one. It reads “Some 62% of all women of reproductive age are currently using a contraceptive method.” And don’t tell me that the number of women in that age range and the number of sexually active women in that age range are practically identical, because the study from which the 62% figure is quoted found that about 20% of respondents had either never had sex, or hadn’t in the 3 months preceding the study.
These last two are less important, because, frankly, I believe in my heart of hearts that at least one woman in the US would like to be on a long-acting, reversible method of birth control and isn’t because she can’t get access to it and I believe that even if it’s only that one woman, we should fight to get her affordable contraception because it’s the morally right thing to do (not to mention sound economic policy). However, intellectual dishonesty is something to confront wherever we find it.
It distorts the scale of the problem:
Looking at the numbers of women who have ever used an IUD or hormonal form of birth control of the kind the Little Sisters don’t want to cover or be exempt from covering, we see it’s about 87.5% of women who have ever been sexually active. That’s a lot of women! However, if we look at the numbers for all women 15-44 (the age range for which the CDC collects contraceptive use information), the percentage of women who are currently using an IUD or hormonal form of birth control is more like 25% of all women in that age range (sexually active or not). That’s still a non-trivial number of women! We should stand up for these women, regardless of where they work. And we should fight for the uncounted women who would like to be using these methods but can’t for financial or bureaucratic reasons. (See below.) But we should recognize that those groups don’t cover all women, all of the time, rather, they include most women, at least one time.
It assumes knowledge of the origin of the problem:
Would more women use these methods of contraception if they had no co-pay and lower deductibles? I think so, but it’s not all that clear. As far as I can tell, nobody has done any kind of study on the number of women who would use an IUD or hormonal form of birth control if it were readily and affordably available. Only about 2.6% of women who had once used the pill and then stopped said they discontinued using the pill because it wasn’t covered and 3.5% said it was too expensive. (Note: there could be overlap in those groups. Women were allowed to list more than one reason for discontinuing.) That gives us some indication that expense isn’t a barrier to people who are already on the pill, but it is probably still a barrier to people who would like to start, but can’t.
The misrepresentation of research is a really, really bad thing. It undermines the discussion of proposed public policy in a way that affects us all in imminent, tangible ways. And it’s bad even if it slants the data to appear to back policies we support.
Contraceptive Methods Women Have Ever Used: United States, 1982–2010 :
Current Contraceptive Use in the United States, 2006–2010, and Changes in Patterns of Use Since 1995: