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Republicans' Curious Ideas About Contraception

So while many women are able to get the birth control that's right for them, with small or no co-pays, too many are still like Alice after her fall in Carroll's first chapter -- lying on one side, peering through a keyhole into a garden of treasures she couldn't quite get to.
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Hormonal pills in female hands isolated on white
Hormonal pills in female hands isolated on white

Trying to follow the logic of certain Republican lawmakers in Congress can make one feel a bit like Alice on a visit to Wonderland. I am hardly the first to suggest the general comparison, but it strikes me as particularly appropriate when it comes to their opposition to making contraception easily available and affordable.

The GOP politicians can be, to use the phrase of Lewis Carroll, author of Alice's Adventures in Wonderland, "entirely bonkers" on the birth control issue. And their arguments get "curiouser and curiouser," leaving an ordinary observer feeling much as Alice did in the first chapter, "falling down a very deep well."

One of their first ideas in this year's Congress was to cut Title X -- the federal funding program providing family planning and other related preventive health services - from any clinics or organizations that also provided abortions. Among the targeted organizations was Planned Parenthood, the best-known, most comprehensive and largest private provider of women's health services, including affordable contraception. Similar, smaller efforts were made locally in Oklahoma and several other red states.

What do these (mostly male) representatives think they're doing? Half of all pregnancies in the United States are reported by women themselves to be unplanned (more than 3 million annually). Moreover, unplanned pregnancies cost taxpayers billions each year and lie behind the vast majority of abortions. Making birth control unaffordable and less accessible will result in more unplanned pregnancies, more abortions, more children born into financially strapped families and, ultimately, higher welfare and health care costs - the very things the lawmakers say they most want to reduce.

Cue the Cheshire Cat: "We're all mad here."

Not all Republican lawmakers are, of course. Oklahoma State Rep. Doug Cox, for example, practices medicine in a state that has dramatically restrained women's ability to obtain contraception and family planning services. It also has the second-highest teen pregnancy rate in the country, according to the Tulsa World . Cox sharply criticized his party's stance on reproductive rights last April in Rolling Stone magazine. The article is worth reading to the end. He said:

Abortion is one thing, but when you start talking about limiting contraceptives, that's going too far. If you truly oppose abortions, you should do everything in your power to prevent unwanted pregnancy - from abstinence, to condoms, to birth control pills, all the way to the IUDs and morning-after pills....
To be able to do something that simple to prevent an unwanted a good thing. ...To require a prescription for a drug that has been determined to be safe and effective by the (Federal Drug Administration) adds basically another $100 to the cost, and to me that discriminates against lower-income women.

He also told Rolling Stone that he opposed a proposed bill making it more difficult for teenagers 16 and younger to obtain the morning-after pill that prevents pregnancy up to five days after sex. The bill, he said, "is prejudiced against women." His best lines were these:

A 14-year-old boy can go to the truck stop and buy all the condoms he wants. He can control his destiny. This bill takes the ability to control their destiny away from women. But that's what we do in the Republican Party these days.

Private consultant Candace Straight, co-chairwoman of Republican Majority for Choice, also took on party leaders on Huffington Post. The leadership, she wrote, needs to work on a common sense policy for increasing access to birth control. "(That) would reduce teen and unintended pregnancy and abortions."

Some support surfaced last year among GOP Senate candidates for an act burdened with the name of (take a breath) Preserving Religious Freedom and a Woman's Access to Contraception. It was hardly exciting news, however; all it would have done was encourage the Federal Drug Administration to study the efficacy and safety of selling birth control over the counter. Even if the FDA agreed to this completely voluntary effort, we all know where most government studies go - down the rabbit hole.

The truth is - and lawmakers know this - contraception is used by almost all American women of childbearing age, including Catholic women. Ninety-nine percent of American women who have ever had sex have used contraception at some point in their lives. So have 98 percent of Catholic women. A Gallup poll found that 88 percent of Republican adults and 93 percent of Democrats said it was morally acceptable to use birth control.

The real issue, then, is not whether it should be available. The debate is over how accessible the newest and most effective methods are, how much they should cost and, in particular, who should pay for them. A survey by the Public Religion Research Institute showed that 8 in 10 Americans - including some Tea Party Republicans - favored expanding access to birth control for women who cannot afford it. In poll after poll on this topic, ordinary citizens appear more generous and smarter than the lawmakers who claim to represent them.

For women who have health insurance, the costs of all methods of contraception approved by the Food and Drug Administration are supposed to be fully covered by their health plans, no co-pay required, thanks to the Affordable Care Act. Some insurers, however, still try to limit what they cover because of cost, even though an unplanned pregnancy would be a lot more expensive than the contraceptive to prevent it. Reporter Michelle Andrews at Kaiser Health News reported this month that "some insurers have refused to cover the contraceptive patch or vaginal ring, claiming those methods use the same hormones as (the less expensive) birth control pills."

In addition, women in certain insurance plans have less choice than it may seem. The regulations allow a plan to charge money for a brand-name contraceptive, for example, if an equivalent generic is available without charge, according to Adam Sonfield, a senior public policy associate at the Guttmacher Institute.

Rules allowing insurers to use "reasonable medical management techniques" to control costs suggests excluding some generic pills from free coverage, Sonfield says. But it shouldn't follow that a plan can charge for most generics as long as it offers some for free, he adds. There's more: The Title X Family Planning Program, which provides contraception to low-income and uninsured women, has suffered millions of dollars' worth of cuts since 2010, and as a result the number of women and men served in 2013 was down by over 600,000 from the 5.2 million served in 2010.

In addition, approximately 100 non-profit organizations and for-profit companies have challenged the Affordable Care Act's provisions, and most of their challenges are still pending, according to the American Civil Liberties Union.

So while many women are able to get the birth control that's right for them, with small or no co-pays, too many are still like Alice after her fall in Carroll's first chapter -- lying on one side, peering through a keyhole into a garden of treasures she couldn't quite get to.