Contraception

Contraception exploded onto the front pages in February. That might seem strange to most people — what is controversial about contraception at this late date? One headline read “Changes to Contraceptive Coverage Rules Draw Mixed Reaction” and that one wins the 'understatement' award on this topic.

“Conservatives” seized on the issue as a good wedge to attack Obama on many fronts, and hoped that it would somehow awaken some version of a moral majority to political action. Yet almost all women, including Catholics, ignore their putative religious leaders on this issue, and always have — when they have a choice. In letters and online comments, the most incisive perspectives seem to come mostly from women — political leaders, doctors, nurses, social workers, and just plain folks. The New York Times editors noted that Catholic authorities were trying to have it both ways, claiming all the special financial privileges of a church but wanting to ignore any strings that might be attached, however compassionate those might be. Others observed that behind this debate was specter of abortion politics — even though the one proven way to reduce abortions is to make contraception as easily available as possible.

Amongst politicos, the gender split seemed to hold true as well. Three female senators wrote to the Wall Street Journal defending the contraceptive mandate. Some female politicians even felt compelled to boycott the male-dominated House hearing on the topic. In the GOP candidate's race, Romney sought whatever position he could sell to the most people, Santorum at least already opposes contraception, not surprising for a guy who thinks women working is a radical feminist plot. Irrelevant crank Ron Paul and Newt Gingrich were aptly ignored. Kris Long, a nurse writing in the New York Times perhaps had it best: “As a former employee of a Catholic-run hospital, I find it appalling that the party of 'individual rights' would stand up for a religious bias rather than for the non-Catholic employees who are deprived of the right to choose health insurance commensurate with the private needs and beliefs. Why should I not be allowed birth control through my insurance because my boss has a problem with it?”

Strangely enough, organized medical voices have been muted in this heated debate, other than some letters from doctors mostly in support of a mandate. But the idea for a contraceptive mandate did not spring anew out of the nefarious White House health reform plan. It is an old idea, long supported among health care policy wonks and, last summer, given strong endorsement by the highest medical authority in the land, the Institute of Medicine of the National Academy of Sciences. Their report, “Clinical Preventive Services for Women: Closing the Gaps,” focused on preventive care for women, including but not limited to contraception. In medical circles it was hardly controversial and seemed to be greeted in the clinical trenches with an “OK, now make it happen” sentiment, as is often the case with rational, evidence-based medical recommendations.

Given that, and sensing that the IOM recommendations might be more controversial in non-scientific arenas, I thought it might be good to have a strong statement of support from the medical organizations I work with, and drafted the statement below for the San Francisco Medical Society's policymaking body:

CONTRACEPTION AS A FULLY-COVERED HEALTH INSURANCE BENEFIT

San Francisco Medical Society

Whereas, the United States Institute of Medicine in July 2011 strongly recommended that “the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity” be a fully covered benefit of all health insurance plans; and

Whereas, the costs of contraception have long been identified as a barrier to many women's optimal use of contraception, with negative impacts on their health and in terms of unwanted pregnancies, as well as discriminatory implications; and

Whereas, The Federal administration has just mandated that contraception be a covered benefit, but health insurance industry representatives have voiced their opposition to this measure and might try to repeal it; now be it

RESOLVED: That the CMA supports the coverage, without co-payments, of all FDA-approved contraception methods as a mandated health benefit of all health plans.

True to form, this statement was noncontroversial among the 20-plus physicians of various specialties who reviewed it and three physicians signed on as co-authors — all of them women (I am omitting their names here to protect them from the scary minority), but we could have added men as well. The statement then went to the annual policy-making meeting of the California Medical Association — a much larger and often more conservative bunch, made up of hundreds of doctors from all over the state. We thought there might be some opposition, but no, in the open debate, the CMA physicians even strengthened the final statement to include voluntary sterilization. Thus, here is the nation's largest state medical association's concise position on this matter:

RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods and sterilization as a mandated health benefit of all health plans.

— Simple, direct, and medically correct, regarding a private medical matter between women and their physicians. As for the rest of those pundits weighing in, mostly male and including religious figures and politicians, I can't help but be again reminded of what pioneering lawyer and yes, feminist Florynce Kennedy once quipped, “If men could get pregnant, abortion would be a sacrament.”

I also can't help but note that around the same time as all this hoopla, a report from the widely-respected group Save the Children confirmed what has long been known — one out of four children already here on this planet are malnourished, and many of them are starving to death around the world, at a rate of one every five minutes. The two issues are related, most would agree. I respectfully wonder if the church and political leaders opposed to contraception could meditate on that ongoing tragedy for a moment, and instead of fulminating against one of the only solutions we have, devote their time and energy towards alleviating this ongoing tragedy of suffering in the world. And perhaps they could listen to what doctors think as well. I won’t hold my breath.