The Birth Control Debate

Methods of birth control have always been controversial, but the introduction of contraception legislation in the late 19th Century moved this social issue into the realm of politics. Since then, cases including Griswold v. Connecticut, Eisenstadt v. Baird, Carey v. Population Services International, and Roe v. Wade clearly established contraceptive rights of the patient (131). Yet, controversy still rages around the issue of birth control, as its very existence is against fundamental beliefs of many conservative and religious groups. But the legality of contraceptive methods is at this point, virtually irreversible. Widely accepted by the American people, the Center for Disease Control and Prevention reported in December of 2004 that more than 98 percent of sexually active women of reproductive age had used at least one contraceptive method (120). Thus, the birth control debate is not one of legality, but rather, pandering to interests, specifically, whose. It is a question of weighing the rights of the medical care provider, ranging from hospitals to pharmacists, against those of the patient. Constitutionally, it has become a battle between the rights to religious freedom and privacy. However, although health care providers have a right to express their religious ideals, it cannot infringe on their professional responsibilities to the patient. Religious freedom is not all inclusive, and personal liberties cannot violate another person's rights.

In spite of the overwhelming acceptance of birth control, the advocacy coalition surrounding the conservative objections is increasingly strong. Including specific interest groups such as the Christian Medical and Dental Association, Pharmacists for Life International, and Catholic Health Association, it is also made up of more broadly, proponents from the Catholic Church and other religious organizations, and more conservative Republicans. Although the issue of birth control is not clearly divided by party lines, as many moderate GOP legislatures agree with a more liberal contraceptive agenda, those opposed to this legislation are making their power evident (137). The current Bush administration is prescribing to an abstinence based sexual education, limiting government provided contraceptive information on almost all fronts (136). This "Don't ask, don't tell" approach seems like a step backwards in the fight for contraceptive rights (136). Yet, with the recent advent of emergency contraception, a clash between the extreme right and birth control advocates is inevitable.

This triggering event moved birth control concerns to the forefront of the governmental agenda, as emergency contraception introduced a plethora of new issues, in addition to renewing traditional arguments against birth control. The Food and Drug Administration overruled its own scientific advisory panel to prevent over the counter availability of Plan B in May of 2004 (121). Although the FDA claimed that this decision was based on the risk to under aged girls, this debate between experts and elites is moving further from the scientific world as the FDA continues to delay in making Plan B available without a prescription for women over 16. Birth Control advocates include many medical associations such as sexual assault centers, the American College of Emergency Physicians, and even the American Medical Association, whose "position is on behalf of the patient" (123). Democrats, specifically Senators Hilary Rodham Clinton and Patty Murray, announced that they would hold up the confirmation of FDA Commissioner Lester Crawford until the FDA acts upon the application allowing Plan B over the counter to women over 16 (123). This conservative opposition is adversely affecting the usage of birth control.

The economics of birth control are essentially based on fundamental ideas of supply and demand. Carole Hogue of Emory University's Rollin's School of Public Health claims that "the demand for contraceptives is elastic," meaning that the usage depends on the cost and difficulty of obtaining it (130). Political moves, including President Bush's proposed budget cuts to federal family planning programs and broad conscience clauses for pharmacists, could severely affect the ready availability of birth control, and thus, its usage. As the United States is composed primarily of private health care providers, including hospitals and insurance, the costs of medical treatment become a part of the capitalist economy. Yet, the government is inevitably tied to certain medical issues, as it simultaneously provides funding for low income patients and limits medical usage of controversial products. The birth control debate is one of political controversy impacting capitalism. Advocates of contraceptives imply that birth control should be readily available to the public, instead of depending on the whims of supply and demand. Conservatives, however, skew the policy image to better fit their negative description of contraceptives.

Some conservatives are also emphasizing a patient's interests over that of the health care provider, specifically protection of their personal health and security. Representative Dave Weldon appeals to emotions as he describes 16 year old Melissa Anspach "writhing" in pain as a result of Plan B (135). She becomes a symbol representing the horrible failure of emergency contraception, an image of pain to be linked permanently to Plan B. Yet, his arguments lack factual detail and are driven more by emotional appeal and stories than scientific data. Weldon implies that allowing Plan B to be available over the counter is irresponsible and an endangerment to the personal securities of teenage girls, which take precedence over their personal liberties. Relying on low teen birth and pregnancy rates, he bolsters support for abstinence education, rather than birth control. Weldon emphasizes the vulnerability of teenaged girls, and claims that problems such as unwanted pregnancies and increased levels of STDs are actually caused by the ready availability of birth control. Yet, Marjorie Signer of the Religious Coalition for Reproductive Choice uses these same problems to emphasize the necessity of birth control.

Signer also attempts to manipulate the policy image surrounding emergency contraception, similarly emphasizing responsibility. Yet, unlike Weldon, she focuses on the responsibility of the patient to make decisions, as opposed to a responsibility to protect them. She also relies on emotional appeal, as she introduces the idea of sexual assault, creating an atmosphere of pity for these victims who are unable to obtain emergency contraceptives. But, instead of telling a story of one victim, Signer tends to be broader, and appeals to the idea of many women suffering from the lack of birth control. Signer emphasizes the equity of all women, their personal liberties, and the inefficiency of prescribing Plan B in a limited time frame. She downplays their personal securities and risks, focusing instead on their right to make their own decisions. It is the very lack of birth control and inaccurate sexual education that is the cause for most problems. It is ironic that the opposition claims that the dependence and sometimes failure of birth control can result in abortion and unwanted births. Birth control advocates depend on statistics to prove a link between decreased abortion rates and increased contraceptive use (130). Although it is important to acknowledge the risks to personal security, the right to make decisions concerning personal security should lay with the person. Unless a ban is issues on every over the counter medication that could pose a potential risk to a child, the government has no right to interfere in a person's ability to obtain emergency contraceptive.

Yet, the issue of birth control is not as much one of national debate as a decision for the states. In spite of the executive branch's staunch opposition to contraceptives, the legislation is more varied in other institutional venues. At least seven states have legalized non prescription sales of Plan B, while as many as four states explicitly allow pharmacists to decline to dispense birth control (121, 132). Yet, many states are pulled in both directions, and have enacted policies that seem to be in conflict with each other as they strive to please both the patient and the health care provider. Illinois has the nation's broadest conscience law for health care providers, in addition to the most liberal contraceptive legislation, in requiring all pharmacies to dispense emergency contraceptives (134). The debate is one of honoring interests, either those of health care providers or patients. Constitutionally, the courts must decide whose rights triumph over the others. Or, if it is possible to balance their rights without infringing upon another's liberties.

Both health care providers and patients have inherent rights to, respectively, religious freedom and privacy. While some conservatives are opposed to birth control because of an interest for the security of the patient, a patient's right to personal autonomy trumps a general regard for their security. Patients have liberties to make their own decisions, and essentially they have a right to privacy. Although health care providers have a right to religious freedom, this should not infringe upon the patient's right to privacy. Coming from a religious background, I sympathize with a health care provider's moral inability to dispense products or services which come into conflict with their religious beliefs.

But just as I am personally pro-life, but pro-choice for others, I believe that no person has a right to inhibit another's personal autonomy. In a nation where the demand for sex and abortion are inelastic, birth control is a necessity. The political culture is conflicted when it comes to sexuality, promoting abstinence through sexual education, yet pushing overt sexuality in the media. The sexual promiscuity of which so many conservatives complain is not caused by ready access to birth control, but rather this confusing sexual culture, which simultaneously prohibits and promotes sexuality. Birth control should be readily available for everyone, regardless of a health care provider's religious beliefs, because their personal morality should not impact another's personal liberty. The focus should not be contraceptives, but rather, a reformation of public sexual education and awareness. Instead of an abstinence based system, it should focus more holistically on sexuality. Unfortunately, sexual abuse and carelessness will always exist, and ready access to contraceptives is necessary.