“Getting an IUD means I have a tool in my body that the government can’t touch": Contraceptive health and the War on Women
In 1989, feminist Andrea Dworkin wrote in a book introduction about a “war on women”; twenty-one years later, the term became common in American political discourse following the 2010 congressional election, in relation to the contraceptive mandate in the Affordable Care Act (Nadler & Lowery, 2018). As the term suggests, women’s bodies have long been a battleground for ill-conceived, unsolicited, and often dangerous political ideologies to be played out. It was largely used to criticize certain Republican Party policies and legislation as a wide-scale effort to restrict women’s rights. But the most important question is perhaps how have women interacted with this war? And how have they come to weaponize emerging contraceptive rights to fight back?
The “War on Women” is hardly the first political trope to use war as a metaphorical placeholder, but many would argue that the reality is not far from the literary device. The term is used to describe legislation regulating workplace discrimination against women, the prosecution of criminal violence against women, and the definition of rape for the purpose of the public funding of abortion, amongst other meddling policies Republicans have entertained (Nadler & Lowery, 2018), but looking at attitudes and policies surrounding reproductive rights alone justifies the term.
Battle #1: Emma Goldman
The history of birth control in the United States largely developed in the interwar period. Perhaps unsurprisingly, as many social movements do, the birth control movement became particularly relevant due to the health concerns of men, despite early feminists having been shunned or imprisoned in the years prior for advocating for birth control. Following World War I, members of the U.S. military were diagnosed with syphilis or gonorrhoea, prompting the military to undertake an extensive education campaign (McCann, 1999). The campaign marked the first time a government institution had engaged in a sustained, public discussion of sexual matters. The public discourse changed sex from a secret topic into a legitimate field of scientific research and transformed contraception from an issue of morals to an issue of public health, but only for men. While protesting World War I, Emma Goldman was arrested; an advocate for birth control, she lost her right to live in the United States (McCann, 1999). The disparity is not a particularly isolated case, as cries of sexual double-standards remain relevant. It does note however, one of the first social casualties of women who somehow lost battles on their very own grounds.
By the mid-1920s, discussions about contraception became more commonplace and clinics began emerging in major cities. Nevertheless, birth control advocates, mainly women, were blacklisted by the radio industry and state and federal laws still outlawed contraception. Unsurprisingly, the most significant opponent to birth control was the Catholic Church, which was able to prevent major advocates from speaking at public events and news companies from covering stories related to birth control (McCann, 1999).
Battle #2: The politics of the pill
In 2013, researcher and obstetrician-gynaecologist Elizabeth Raymond made news when her article published in the Journal of Family Planning and Reproductive Health Care claimed that it was entirely possible for a variation of the birth control pill to be developed that could be taken once a month, called “post-fertilization fertility control agents” (Raymond, Coeytaux, Gemzell-Danielsson et. al, 2013). Biologically, there is some subtlety to their argument. Fertilization occurs when the sperm and egg join, and implantation of the fertilized egg in the uterus wall is considered the instance of pregnancy. In order to be called a contraceptive, a technology needs to work before implantation; a drug capable of disrupting implantation is considered a drug that induces abortion.
The introduction of the birth control pill would have occurred much later than 1960 if it were not for feminist philanthropist Katherine McCormick. She became increasingly frustrated while funding birth control clinics in the 1950s due to the lack of safe, reliable birth control options for women (Kalb, 1997). Early trials did not mention the word “contraceptive”. While the researchers knew it was possible to stop a woman menstruating with the pill, they instead manipulated the regimen so that users would menstruate and have a 28-day cycle. In this sense, the pill’s promoters were able to argue that the hormones in the pill were “mimicking nature”, and were therefore “natural” (Kalb, 1997). This was necessary to convince conservative forces to support its introduction. The pill’s cause was also helped greatly by the Malthusian population control movement, which was concerned about rapidly increasing populations, and the eugenics movement, which was concerned about high fertility rates among the poor. With the increased acceptance of the birth control pill however, the reproductive marginalization of poor and non-white communities escalated (Kalb, 1997). This allowed mostly white women to regain some sense of control over their reproductive selves, largely on the backs of other marginalized groups. Was this battle really won if it was at the expense of someone else?
Battle #3: The Affordable Care Act and the contraceptive mandate
A government regulation requiring health insurers or employers to cover some contraceptive costs in their health insurance plan, the contraceptive mandate of the ACA came into effect in 2011, a full year after it’s initial implementation. Contraception for women was added to a list of preventive services covered by the ACA that would be provided without patient co-payment, applying to all new health insurance plans following the addition (Gostin, 2014). Even before the federal mandate, 28 states had implemented their own mandates requiring health insurance to cover the prescription contraceptives, but the federal mandate went further as to prevent insurance companies from charging part of the cost to patients (Gostin, 2014).
With the exception of churches and houses of worship, the ACA mandates female contraceptive coverage for all employers and educational institutes. It controversially included Christian hospitals, Christian charities, Catholic universities, and other enterprises owned or controlled by religious organizations that oppose contraception on doctrinal grounds (Gostin, 2014). The framing of the issue itself is what largely creates the divide between Republican opponents and the women that the contraceptive mandate affects; asking whether it is an issue of women’s health or religious freedoms has been the central focus of the debate. In this sense, women are essentially tasked with the responsibility to justify their healthcare needs.
Most importantly perhaps were the Supreme Court cases which further defined the contraceptive mandate as an issue of religious freedoms as opposed to women’s health. In Burwell v. Hobby Lobby (2014), the United States Supreme Court determined that privately held companies would be exempt from a regulation its owners religiously object to, according to the provisions of the Religious Freedom Restoration Act (Chieregato, 2015). The case itself specifically concerned the contraceptive mandate, which the company opposed; it became the first time that the court recognized a for-profit corporation's claim of religious belief (Chieregato, 2015). It is not the decision itself, however damaging to women’s health and the movement for reproductive rights, that concerns the weaponization of birth control. When the framing of a contraceptive mandate is viewed as a dichotomy of women’s health or religious freedoms, Burwell v. Hobby Lobby reaffirms the casual congressional prioritization of all issues and institutions over women’s health. A battle fought about and on women’s bodies, once again, ends on the side of those regulating them. Continuing further, it is also important to consider the demographics of the Supreme Court; all three female Supreme Court justices dissented the majority opinion. In her 35-page dissenting opinion, Supreme Court Justice Ruth Bader Ginsburg described the failure of the decision to ensure that religious beliefs of a company are not imposed on employees.
Birth control as a political act
This is all not to say that the War on Women will be won by those regulating them. During the campaign, Donald Trump has promised to defund Planned Parenthood and dismantle the ACA, threats which prompted many women to seek out time-sensitive and long-lasting contraceptive options. Rather than request the birth control pill, which has been the norm for decades, women more popularly began requesting alternative methods. In the days following the 2016 United States election, Planned Parenthood in Illinois said online appointments for long-acting contraceptives like intrauterine devices (IUDs), rose nearly 50 percent in the past two days compared to the same period the week before, and this trend was documented across the United States (Jaspen, 2016). Online searching for "IUD”, "birth control" and "Planned Parenthood” showed a massive peak on day after the election. Specifically, “birth control Trump” searches increased by 4 700% and “Obama planned parenthood” increased similarly by 3 000% (Google Trends, 2016). This also does not include terms which Google deemed to “breakout”, which they define as having a tremendous increase since the last time period; these terms included “IUD options”, “birth control mandate”, and “ACLU” (referring to the American Civil Liberties Union) (Google Trends, 2016). Similarly, women on Twitter urged one another to consider alternative, long-lasting contraceptive options. More specifically, the choice of long-acting reversible contraceptives in itself was political; women chose IUDs, knowing that their choice (that can last anywhere between five and twelve years) would outlast a Trump presidency (Jaspen, 2016).
Taking active control of the choices available to them will only take women so far in the war that the United States has waged against them. The reality remains that women’s health and, more specifically, women’s contraceptive health is so heavily regulated that any available choices for women have seemingly been chosen for them. Current forms of birth control as tedious, inconvenient, and perhaps dangerous. The birth control pill puts women at an incredibly high risk for stroke. IUDs require a medical procedure and can cost upwards of hundreds of dollars, and women who get them risk perforated uteruses. Many other methods are simply ineffective to a degree of certainty. Continuing research on male birth control pills has stalled; test participants complained of side effects such as weight gain and decreased libido — side effects which women’s contraceptive choices do not come without. Without another Emma Goldman, Katherine McCormick, or Elizabeth Raymond, the war on women’s contraceptive health hinges on lawmakers who have for years claimed they have women’s best interests at heart; perhaps Supreme Court Justice Ginsburg described it best: “The pedestal you put women on is a cage”. And how can anyone win a war while they’re locked up?
Chieregato, E. (2015). The Contraceptive Mandate Controversy and the Future of Religious Accommodations in the United States: A Study of the Supreme Court Case of Burwell v. Hobby Lobby, Inc. Religion & Human Rights, 10, 99-127, DOI:https://doi.org/10.1163/18710328-12341283.
Google Trends. (2016). Google public data. Available at: https://trends.google.com/trends/explore?date=2016-11-08%202016-11-10&geo=US&q=IUD,birth%20control,planned%20parenthood [Accessed 26 Apr. 2018].
Gostin, LO. (2014). The ACA’s Contraceptive Mandate Religious Freedom, Women’s Health, and Corporate Personhood. JAMA. doi:10.1001/jama.2014.9455.
Jaspen, B. (2006, November 25). After Trump Wins, Birth Control Demand Soars At Planned Parenthood. Forbes.com. Retrieved from https://www.forbes.com/sites/brucejapsen/2016/11/25/after-trumps-election-birth-control-demand-soars-at-planned-parenthood/#1982afba7b1e.
Kalb, C. (1997). The pill that transformed America. Newsweek, 130(22), 76.
McCann, C. R. (1999). Birth control politics in the United States, 1916-1945. Ithaca: Cornell University Press.
Nadler, J. T., & Lowery, M. R. (Eds.). (2018). The war on women in the united states: beliefs, tactics, and the best defenses. Retrieved from https://ebookcentral.proquest.com.
Raymond, EG, Coeytaux, F, Gemzell-Danielsson K, et al. (2013). Embracing post-fertilisation methods of family planning: a call to action. Journal of Family Planning and Reproductive Healthcare. 39:244-246.
Tulsi Vyas is a recent graduate of the University of Ottawa and is currently employed in the Canadian federal public service. Her research interests include agricultural economics, natural resource governance, and gendered divisions of labour.