By June Carbone*
As the Supreme Court considered Roe v. Wade, my generation debated abortion. For many college-aged women, it was a rallying cry. We heard tales of deaths in back alley rooms. We struggled with the mixed messages of the early sexual revolution – good girls don’t, but how good are co-eds supposed to be? We were mystified by the advice on contraception. The pill was rumored to cause cancer, diaphragms were not completely reliable, men supposedly didn’t like condoms, and we learned to be wary of what might be in the drinks at late night parties. Few women of that era did not have at least a restless night or two contemplating the prospect of an unplanned pregnancy and what it might mean for the children we would have. Many of us came to the conclusion that the decision to have or not have a child was a profoundly moral decision and one we were not ready to entrust to anyone but ourselves.
Today, women’s lives are different. Over the course of the last thirty years, I have often thought about contraception and almost never about abortion. The difference between the two is why the fight to insure health care coverage of abortion is likely to be a losing issue, and why we should make contraceptive coverage the new rallying cry in the fight to preserve reproductive rights.
For most women, contraception is the daily decision, abortion the fallback we hope never to use. For those on the other side of the sexual revolution, contraception is part of the rite of passage to adulthood and an integral part of married, even more than unmarried, life. The changes in contraceptive effectiveness from my college years are subtle, but important. Where before the pill was the great innovation, today it is the availability of long-term injectibles you don’t have to think about. IUD’s have become safer; condoms more important for preventing disease. And for the not entirely intended or sometimes unconsented encounter, the morning after pill is the first line of defense. Unintended pregnancies and abortions dropped significantly for the college educated in the nineties and more effective contraception was the biggest reason. Yet, effective contraception can be expensive; an IUD can cost as much as an abortion and many health plans don’t cover them. Today, unintended pregnancy is a marker of race and class; unintended pregnancy rates for college grads dropped in the nineties by twenty percent while rising for the least educated women by 29%.
These changes in unintended pregnancies change the meaning of abortion. Those of us who are pro-choice appreciate the fact that it is legal and available, but we rarely think about using it for ourselves or our daughters. Since the publication of my book with Naomi Cahn, Red Families v. Blue Families, many women have shared their stories with us and most of those stories are about a single, difficult decision over the course of a lifetime – the wanted pregnancy that threatened the mother’s life, the unintended pregnancy at the worst possible moment, the hereditary disease that would give the affected fetus a short, painful existence. In the face of these decisions, cost – and health care coverage — was never mentioned.
The sad story underlying the abortion issue in the U.S. is the women who have abortion coverage now are the ones who can afford an abortion without medical coverage. Taking away or expanding that coverage will not make a difference in the decisions they make, and they will not take to the streets to preserve health care coverage of an expense they hope never to incur.
We should be worried, however, that the most effective contraceptives may be unaffordable for the women who need them most. After all, taxpayer dollars already pay for 40% of all births in the U.S. because of the incredibly high rate of unintended pregnancy among the women eligible for Medicaid assistance. It is time to make universal contraceptive coverage at least as important as the effort to deny women coverage of abortion. After all, even the new Miss USA agrees with us. During the interview portion of the pageant, the winner, Rima Fakih, was asked whether she believed birth control should be covered by health insurance, and she said yes, pointing to its high cost. She emphasized that “birth control is just like every other medication,” and that it’s amazing that it is not covered by insurance even though Viagra prescriptions are. Most of us know where our Congressman stands on abortion rights; let us make sure we are equally aware of where our representatives’ position on contraceptive coverage.
*CoAuthor of RED FAMILIES v BLUE FAMILIES: Legal Polarization and the Creation of Culture (Oxford 03/10)