As a practicing OB/GYN, I have the privilege of taking care of patients seeking reproductive health care, including birth control. I have patients who have started on birth control pills because they don’t want to be pregnant. I have patients who have decided to get a hormonal IUD to prevent pregnancy and treat heavy bleeding. I have patients with complex medical problems who make decisions that balance the management of their medical problems, consideration of the risks of pregnancy and the impact that different birth control options may have on their care. I have patients who have decided to track their own cycles to control when they get pregnant. The fundamental thread is that these patients have choice.
But my patients’ ability to make those choices is fragile in the face of constant attacks on reproductive health care. If the Supreme Court gives the Trump administration its way, that birth control will be even harder to get for my patients who struggle the most.
In the coming days, the Supreme Court will decide a case determining whether the Trump administration can give employers free rein to deny birth control coverage based on claims of their “religious” or “moral” objections. It’s part of a years-long battle to chip away at the hard-fought birth control coverage provided by the Affordable Care Act. Every lower court has ruled that the Trump administration could not issue these regulations, but that hasn’t deterred them in their relentless effort to deprive people of care. If the Trump administration wins, hundreds of thousands of people could lose their birth control coverage. As is always the case in our health care system steeped in inequity, the people hit hardest by this rule will be the ones who already struggle to get quality, affordable care — low-wage workers, people of color and LGBTQ people.
The Trump-Pence administration’s rule is a violation of human rights and personal autonomy. Access to birth control is a fundamental element of health care and a human right. The Affordable Care Act’s no-cost coverage allows people with insurance to choose birth control from a range of options based on their own personal values. They can decide based on factors including their medical health, plans for future pregnancies and the potential changes in their periods. What they don’t have to base it on is their employers’ irrelevant personal beliefs.
Imagine a world in which your employer can dictate other aspects of your medical care. Some people’s religious beliefs include opposition to blood transfusions. If you get into an accident, have unexpected bleeding during a routine surgery or have bleeding after giving birth to your baby, don’t expect that blood transfusion to be covered by your insurance. This administration has frequently weaponized the idea of “religious liberty” to attempt to legalize blatant discrimination that threatens reproductive and LGBTQ care. Empowering employers to deny birth control coverage sets a dangerous precedent.
The concept of “choice” is all too often not a reality for many of my patients. Do you have choice when your community has daily fears about whether they can make ends meet to take care of themselves and their families? Do you have choice when you have daily fears of police violence? Do you have choice when you have been forcibly separated from your family — at the border, through forced deportation or through incarceration? Do you have choice if your health care system and provider have a precedent of discriminating against you and have the legal protections to do so? Do you have choice if you are dependent on the income from essential work without proper health protections in the midst of the COVID-19 pandemic? Do you have choice if you are a Black or Brown person in a system that was built to uphold the tenets of white supremacy? People have choices, but those choices are constrained by racism, sexism, xenophobia, homophobia, transphobia, classism and other forms of systemic oppression. Taking away the freedom of birth control options based on one’s employer’s beliefs is just another way that the Trump-Pence administration is constricting choice with no regard for the marginalized communities who will bear the burden.
Access to no-cost birth control is one tool that helps the people I care for determine their own future paths. Taking away that choice is an injustice that will have huge repercussions for my patients and my community. Your boss’s personal beliefs should not dictate your health care. Period.
The Supreme Court’s ruling in Trump v. Pennsylvania will send a message about who we are as a country and who we value freedom for. Everyone deserves access to birth control no matter where they work, how much money they make or who they are. The court should put a stop to these attacks on that fundamental right once and for all.
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