Marcia G. Yerman

Marcia G. Yerman
New York, New York, USA
February 10
Marcia G. Yerman is based in New York City. Her writings – profiles, interviews, essays, and articles – focus on women’s issues, the environment, politics, culture and the arts, and can be found at She has been published by The New York Times, Women News Network, AlterNet, RH Reality Check, AlterNet, The Raw Story, and the Women's Media Center. She also writes for Moms Clean Air Force, a site bringing visibility to the issue of clean air and environmental concerns. Yerman was a co-founder of cultureID, an online platform that was dedicated to the nexus of culture and activism.


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MARCH 7, 2012 2:59PM

The Birth Control Conundrum

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BC Image 

The image of a table of men—primarily from religious organizations— comprising a hearing devoted to birth control, became a snapshot emblematic of problems to follow. Rep. Carolyn Maloney (D-NY) asked the obvious question when she inquired incredulously, “Where are the women?”

Attempts by Sandra Fluke, a college student that had hoped to speak about the wide role of birth control medicine in women’s health, had been rebuffed with the statement that she wasn’t “qualified to testify.” She has since been publicly vilified by Rush Limbaugh.

For many, there was confusion about the whole conversation. Religious freedom was being pitted against women’s rights to basic health care. What exactly did it all mean for those of childbearing age?

In August 2011, a panel of experts from the Institute of Medicine had addressed how making contraception available would help impact the high rate of unplanned pregnancy. Congress enacted a women’s preventative services coverage requirement as part of the Affordable Care Act.

Studies have shown that women with private insurance were paying approximately 50 percent of their total cost for oral contraceptives, compared to 33 percent for usual out-of-pocket costs for other drugs. In addition, women of reproductive age spend 68 percent more on out-of-pocket costs than men.

I contacted a range of professionals in the areas of medicine, law, and policy to get a clearer picture of the issues involved. Along the way, I learned a number of surprising statistics, including the high number of unplanned pregnancies in the United States—49 percent.

My first two inquiries were with medical practitioners, located in disparate parts of the country.

Dr. Ringland S. Murray, a Reproductive Endocrinologist who is Board Certified in Obstetrics and Gynecology, practices in Tennessee. He told me, “I don’t have a political axe to grind, but I don’t get it from an economic standpoint. It’s bewildering that this would be a battle. It’s a lot more expensive to have a baby than for pills to be supplied to women.”

He continued, “If this is a question of holding down health care costs, it's more cost effective to prevent pregnancy, especially in high risk groups such as those who are economically disadvantaged. These individuals frequently have higher risk pregnancies with more complications and therefore, more costs."

Outlining the numerous health benefits of oral contraceptives Murray explained, “There are lots of health care reasons to prescribe birth control. For endometriosis pain, it prevents the loss of workdays. It reduces the risk of ovarian cancer by 40 percent as opposed to non-users. The protection lasts for up to twenty years, even if the pills are used for as few as three to six months. It has been used safely by women with BRCA mutations. Birth control pills have been associated with a 40 percent reduced risk of colorectal cancer. They can be used in a diversity of ways. It depends on the women and her medical condition.”

Noting the high cost of purchasing birth control, Murray said, “Brand name birth control pills are very expensive, approximately $50 to $60 per month. They are not real affordable for a lot of women. There is tighter control over these, whereas the generic low-dose pills—which can run $25 per month—may be less effective. If you are not willing to pay for birth control, you are putting your employees at increased risk for pregnancy.” Murray said, “If it is available and affordable, there are fewer unintended pregnancies—the number one reason women seek abortion. Birth control has a 5 percent failure rate. It is better than condoms. If you are against abortion, you should be pro-birth control.”

Murray reflected, "In some ways, the Affordable Care Act could go farther. Studies have shown that to have the greatest decrease in unintended pregnancies, we should provide three to six months of contraception at a time, so women don't miss days between pill packs. Women who must go to the pharmacy every month are at increased risk for missing pills and getting pregnant. But at the current asking price, how many women can afford three to six months worth of pills at a time?"

With a touch of irony, Murray related that birth control pills work similarly to breast-feeding, a natural form of contraception for about eight weeks after a woman delivers a baby. After birth, when a woman breast-feeds, her prolactin is high. This does not always prevent ovulation or fertilization of an egg, yet still offers contraceptive protection. He added dryly, “Are you going to legislate breast feeding?”

Barbara Dehn, a Registered Nurse and Nurse Practitioner based in San Francisco, also pointed to the use of birth control pills for health maintenance. “I’m caring for older women using birth control to stabilize hormone levels as they enter perimenopause, with its attendant wide hormonal swings,” she informed me. She also prescribes birth control pills for acne, dysmenorrhea, irregular periods, PMS, and to help prevent migraines that accompany hormonal headaches. She has to be very clear how she is prescribing the medicine, as her charts can be audited and she has to stay within the letter of the law.

What Dehn has been hearing from her patients is complaints about bearing the burden of birth control and what they perceive as a double standard. She related the story of a patient in her late 20s who objected, “I pay for my health insurance. It should cover my birth control. Men with the same insurance at work get Viagra with no co-pay.”

Reiterating the concerns of Murray, Dehn underscored, “Co-pays are onerous. Women struggling financially can’t afford co-pays for birth control or to manage their symptoms. Women aren’t using their pills consistently. They may skip a couple of months. During that time, they may not use a backup method.”

Citing the obvious, Dehn said, “Men can make any decision they want because they don’t carry a baby.” She observed, “It’s maddening. We have a hyper-sexualized society, [yet] there is a small vocal minority that only wants women to have sex to procreate.”

On Thursday, March 1, a showdown on the Blunt Amendment took place with a vote in the Senate. It sought “To amend the Patient Protection and Affordable Care Act to protect rights of conscience with regard to requirements for coverage of specific items and services.” In essence, it meant that an employer would be allowed to refuse coverage on any medical service they had a moral or religious objection to. It would allow health insurance plans to deny coverage of care if it was against the policy issuer’s beliefs.

I contacted Laura MacCleery, the Director of Government Relations at the Center for Reproductive Rights for her thoughts on the proposed legislation. MacCleery was clear about her concerns. “People should realize that many of the rights women thought were settled in the past are up for grabs. There is a well-funded coordinated effort on this. The fact that this is 2012 is astonishing.” She continued, “Women aren’t aware of the threat to services they take for granted. The mantle of religious liberty is being used to deny women access to public health.”

The Director of the Women’s Health and Rights Program at the Center for American Progress, Jessica Arons, characterized the amendment with the assertion, “It’s out of step with the times.” Echoing the concerns of those in the health field, Arons said, “The Affordable Care Act guarantees women birth control access without cost sharing. Women know that birth control can be very expensive. The Guttmacher Institute has shown that women have used their prescriptions inconsistently to save money. Often, they choose less reliable methods—based not on medical decisions but on cost factors.”

Accessibility and affordability is key. Betsy Havens, an attorney and Equal Justice Works fellow at Florida Legal Services in Miami, sees this first hand.  She is a founding member of the Miami Health Equity Project. She said, “Women and families deserve access to quality, affordable health care including preventive services and birth control.  For many women in Miami and across the United States, financial barriers and co-pays often inhibit the ability to regularly access birth control and other essential medical needs. The Affordable Care Act helps women of all incomes, but it is especially important for low-income women. This is essential to the health of our nation, where approximately half of all pregnancies are unintended, in part, due to lack of access to affordable birth control.”

Havens mentioned the proposal put forth by Sen. Marco Rubio (R-FL), the “Religious Freedom Restoration Act,” that would allow any institution or corporation to cut off birth control coverage by citing religious grounds. Figures show that in 2006, 59 percent of pregnancies in Florida were unintended.

There have been a number of polls trying to tap the pulse of the American public on opinions related to the birth control question. A CBS/New York Times Poll (Feb. 8-13, 2012) showed in response to the question, "Do you support or oppose a recent federal requirement that private health insurance plans cover the full cost of birth control for their female patients?" that 66 percent were in support and 26 percent opposed. When queried about “for religiously-affiliated employers, such as a hospital or university?” the response was 61 percent in support and 26 percent opposed. The Quinnipiac University Poll (Feb. 14-20, 2012) asked, “Do you think that health insurance plans should cover birth control as preventative care for women or not?” and found that 71 percent felt it should and 24 percent felt it should not. When asked if the “federal government should require private employers to offer free birth control coverage as part of their health insurance benefit plans or not?” 47 percent felt employers should, while 48 percent felt employers should not.

The vote on tabling the Blunt Amendment resulted in the bill being defeated by a vote of 51-48.

Wondering if this was the beginning of the end of a prolonged conflict about health coverage for birth control, I reached out to Lisa Maatz, Director of Public Policy and Government Relations for the American Association of Universiy Women. She responded via e-mail, "In a perfect world, the defeat of the Blunt Amendment wouldput an end to this nonsense. However, not only are we not living in a perfect world, we appear to have entered a time warp back to the 1950s. AAUW believess strongly in balancing freedom of religion with the separation of church and state. The accommodation recently made by the Obama Administration regarding birth control struck that balance. Other bills want to tip the scales so far that women's health care is compromised, and that's simply unacceptable."

In this volatile election year, it looks as if the story is far from over.


Image courtesy of RVR Associates

This article originally appeared on the women's health site EmpowHER.











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Thank you so much for doing all this research and these interviews, Marcia. It is heartening to hear how many concerned and informed people are advocating for access to affordable health services and birth control. "Balancing freedom of religion with the separation of church and state" would be a good thing to keep in mind on many issues these days.
Awesome article, thank you. I've been firmly of the belief that contraception should be covered without co-pay (it's revenue neutral to do so anyway) but I had no clue as to the wide range of benefits.

This is the information people should be discussing, not someone's sex life!
As always, great research. We Americans (and I don't include most of this group) seem more willing to sit in judgment, which after all doesn't cost anything, than to look at risks and benefits relative to bringing into this world an unwanted child and caring for him. Far too many men in power also fail (deliberately) to acknowledge how unequally this falls on young, poor and single women.

I suspect they simply don't care.
The thing that gets me, is that the attitude of these people is "if you can't afford birth control, just don't have sex." That sex is a privilege that people should pay for.

Do they REALLY think sex works like that? Really? Really really? Can all those men sitting on that congressional panel honestly say that they have never, not once in their lives, had sex for fun, with a woman who was taking birth control? That every single time, it was for the express purpose of making a baby, within the confines of holy matrimony? Really?

Or maybe they're saying that only rich people GET to have sex. Only people with jobs. Only people who can afford it. Everyone else? Just close your legs.

But future lives are future taxpayers, so net, it could in the long run cost lots more to have contraception made super available at zero cost, from the government's point of view. Of course, that depends on who is being born that wouldn't be to a certain extent too.
But look at Boomer retirement now, and what's the issue? Future taxpayers not being large enough in number to pay the bills without a lot higher taxes and/or lower benefits.
And there you have it: comprehensive, clear, reasonable, relevant and exceptionally informative article. The only thing left is for everyone to read this. I have many opinions on different issues here, but I will defer to this post; it is complete. Again, an excellent piece, Marcia. R
Time to have a woman only panel decide whether Obamacare will cover Viagara.
What gives is that some people don't want to pay for something they believe is wrong. (Whether they are correct in that is not the issue.) And don't give me the Iraq war bit - the constitution at least mandates that the government provide for the common defense. (Whether Iraq is correct or not is NOT the issue.) The constitution does not provide for a national health/insurance program. IF you want this fight on EVERY SINGLE ISSUE of our health - liberals will not want to pay for smokers perhaps and conservatives won't want to pay for abortion, for example - then support "Obamacare". If not, don't.

This is what you get - constant arguments about other people's health and private medical decisions - when you put politics in medicine/insurance. You get politicized health care.

As to the philosophical arguments - which I don't say I necessarily support - against artificial birth control - I commend to you "The Human Life Review". (Not to convert your ideas, but you asked the question "What is it With" etc., and you'll get some of the reasoning there.)

And, by the way, it really does crack me up when liberals do the "it is cheaper than unwanted children and better than abortion". The former because, oh you great lovers of humanity, you all seem extraordinarily concerned with money over people - I mean money as THE bottom line - and the second because when we are morally consistent, once we say better than abortion UNLESS we want less abortion for the SAKE of the WOMAN OR because it is expensive for example, you have to, logically, come down to thinking it troublesome because it takes a nascent human life. There IS no other reason - absent the "sake of the woman" (i.e. it bothers her) or the financial one. If those are not your reasons AND you think it morally okay in all other cases, then you should not give a rip if there is one a day or a trillion a day. If it is a zygote only, it is a zygote only.
a real "just the facts ma'am" post, but thats the real problem about conservatives. its not about the facts, its not about reason, its not about logic. the whole idea of contraception opens up the concept of sex for pleasure, which is a deep, deep forbidden apple that goes all the way back to adam and eve, or at least whoever invented that story, which is millenia old. the real 3rd rail issue is "sex for pleasure" which actually even a lot of liberals are not totally comfortable with. notice how few programs on sex ed actually address the PLEASURE issue. tons of factoids except for that. its astonishing and bizarre in a way. its the elephant in the room.
It is amazing we're arguing this in 2012 instead of 1912.
The people have a right to set the conditions of the marketplace and have for every day the Constitution has been in force.

Lest anyone be confused by Barbra's assertion that the Constitution doesn't provide for a healthcare plan, the Founding Fathers would disagree.
The first federal single payer health insurance and hospital system plan (for privately employed citizens) was passed in 1798 and signed into law by President Adams. But hey, what would they know? They only wrote and ratified the Constitution.
Very thoughtful,, well-informed post. This issue reminds us once again "there are no final victories" in the political realm. Rights have to be fought for, over and over again. [r]
Sorry, but this is lame.

All the arguments about this seem to be about framing a wedge issue for political purposes instead of dealing with a bona fide, widespread and serious problem.

When pressed, everyone seems to more or less concede that it is a matter of principle.

More specifically, they say "this isn't about the cost of name brand, patented oral contraceptives" -- "this is about much, much more." And the much, much more turns out to be something entirely different.

I find both the 'freedom of conscious" arguments and the affordability arguments very unconvincing.

And, anyway, Obama has created a non solution to the non problem. So no Catholic will pay for birth control pills. He will just stick the insurance companies with the bill.

The primary left argument tends to quickly shift to the notion of fairness. That is, even if it isn't a huge financial burden, it just isn't fair.

OK. but drop the pretense that there are hoards of women suffering from this financial injustice.
Paul - I read your link. Maybe you should read it again. You talk about competition. Single payer is exactly not competition.

"Those saying the Constitution doesn't allow the citizens to provide for themselves are obviously wrong. What I have written about here is a prescription to cure that strain of ignorance. "

Try again. Read your own words. The Constitution certainly allow the citizens to provide for themselves. I think that is exactly what conservatives want. Provide for themselves.

But I will take it for what I assume you mean. Allow a group citizens to provide for themselves as a group. Yes that is constitutional. But "allow " and "require" are not the same.

As you point out it was a tax. That is where Obamacare fails and Obama himself failed. Congress failed to make it a tax. They made it a required purchase.

SCOTUS may uphold this just because it will cause to much upset to reverse it. But it makes me wonder why Obama and congress were too stupid not to make it a tax. Or was it because Obama made his ridiculous campaign promise not to raise tax on the "new" middle class that makes up to $250K.
I really don't want to engage you in yet another round of "explain the obvious to Cole," which is always followed by another round of "explain the obvious to Cole." Your comment makes no sense, but it would be better if it made no sense on my blog instead of wasting space here.
The money issue isn't as straightforward as you outline. In the absence of subsidies for the pill, most women and couples will pay for some form of birth control themselves.

Further, economic theory suggests that free or discounted birth control would cause women to substitute the expensive pill for a cheaper form of birth control. A decline in the number of vasectomies might be one result of the pill being much cheaper.

Next, you need to consider to what extent an unplanned birth substitutes for a later planned birth. Had I got pregnant in grad school, it would have been an unplanned pregnancy. However, since my boyfriend and I were planning to marry and have a couple of kids, (which we did) it would not have resulted in a net increase in our family size, merely our first child would have been born sooner.

The problem with most analyses of this sort is that they assume that people don't respond to changes in incentives.

I'm not arguing against subsidizing birth control, merely pointing out that it's not at all clear that it will result in a net savings of money.

Thank you. This is truly wonderful. A splendid job of rational argument, relevant fact, much hard work; but oh! how it begs the question. All this talk an work about what really doesn’t matter. No rational person could argue against your reasonableness and therein lies the problem. Rational? Reasonable? You are dealing with irrational mammals with testicles taking orders from a clericy that is essentially childless and has nary a clue what it’s like to have a family (especially the poor) and a clerics who should be the LAST one’s to lecture others on morality and the welfare of children! Many of whom you’d never trust as a baby sitter.

This is not about money. It's not about WHAT they’d have to pay but WHY. Money is irrelevant. After all, unborn human souls are involved. Interfering with God’s will you see. When will people wake up to the poison in the well? Anyone who thinks this is about paying for birth control must also think same-gender marriage is about ‘traditional’ marriage. Sorry. It just looks that way. And that’s why it’s so diabolically clever. A perfect subterfuge for a hidden agenda.

Think about this now: Democracy? The vast majority of women and men, especially Roman Catholic women in America practice and approve of birth control. I won’t go into legal exegesis but, suffice to say, the State has a clear Constitutional right to make this legislation. Yet one small faction (overwhelmingly mammals with testicles) insists their religious beliefs trump all matters of law and public policy. Democracy? Fuggetaboutit. But it’s axiomatic that NO right is absolute. Not even the ‘free exercise’ of religion. The State clearly has a right to enforce this narrowly drawn legislation and there is a compelling governmental and public interest to which the Church must, in all human decency, accede.

But please notice: when President Obama rendered all such objections moot by his magnanimous compromise (a gift outright actually!), when he let them all off the hook, when he relieved them of all and any expense, that was still not sufficient! They still, with no beef left, tried to pass unconstitutional legislation sure to be defeated after years of expansive litigation. Clearly they do NOT care about money.

This, like marriage equality, is really about one thing: pulling infamous stones from Jefferson’s proverbial ‘wall of separation’. It’s about imposing one particular religious faction’s religious values on the rest. Making the rest pay for, suffer the consequence of, that faction’s dogma. It is about imposing religious values over a secular Constitution. It’s about ‘making laws respecting the establishment of an religion.’

It does not surprise me in the least. I am only surprised people act so surprised for it’s all entirely in character. And how telling it is THEY who shout religious persecution. THEY are suffering you see. Not that’s rich. When we think of the suffering and hardship they seek to impose on others reasonable people can ask: Have you no sense of decency? Well I hate to say is but I hope they keep on pushing for we are clearly reaching a tipping point.
Perhaps it’s time for a bit of secular backlash in America?
Interesting- for a fiscal conservative it would make sense but seems as though social conservatism is holding sway. It just irks me when they try to present a socially conservative stance as logical- why not call a spade a spade?
The money issue is such a red herring. It's about power and control and, as vzn said, OMG, sex for pleasure.

Imagine if Obama were to compromise (and who'd be surprised if he did) and changed the mandate simply to state that birth control has to be covered, but insurers could charge a reasonable co-pay in accordance with co-pays for other medications? Do you think that would solve the problem? Do you think the Catholic Church and all these other men would suddenly say, "okay, well then, that works"?

The point is they don't want contraception at all. The insurance thing is simply the first step because it sounds almost semi-reasonable to say that if women want birth control they should pay for it themselves. But just like with abortion, they'll find other ways to keep chipping away at contraception until it's only available to the rich (because, after all, just like abortion, the real issue isn't the immorality, it's the power and control, which rightly belongs to the rich).

First, how did the issue morph from birth control pills to abortion?

More importantly, the Catholic Church conducts activities directly associated with worship. In addition, it has become a large employer, running schools, hospitals, etc. As such, it is required to follow regulations associated with its role as an employer.
This is the type of professionalism in writing that truly merits an OS EP, thank you for your excellent work.

The Founding Fathers and religion issue is moot when the facts come out- what exactly do today's Catholic men or Christian fanatics have to say about the Jefferson Bible?

It wasn't enough for our hero to simply state separation of church and state (for reasons simply to obvious after any even cursory review of Europe's herstory to that point), but the great white wigged one went on to eviscerate everything today's flat earth society holds dear, simply laughing in the face of any who would imply that the laws of physics could ever be broken by humans or some, also white wigged and bearded, apparently, God.

As k-salaam has pointed out here, the actual origination of Christianity per se happens through the rejection of "crazy" Jews by "sane" Jews who were not about to, even in 30 something CE, believe any human could be re-animated. Recent further research implies that perhaps even that idea was misunderstood, that they they were, as the Bible and all religious texts actually are, speaking in metaphor and parable, never once meant to be taken literally.

With that as our starting point, another obvious look at US herstory quickly shows that the "Temperance Movement" was quite complicated in both source and implementation, and was actually a feminist movement to begin to challenge the idea that a white man could basically rape his wife, beat his kids and kill his slaves on a drunken whim. Important to note that social causes use the only valves available, with alcohol abuse the tool of the trade of those times.

Anyway, some parts of the Bible specifically refer to sex for gratification, and to birth control- and to what we now call Brazilian waxing- so lets here from the experts on any/all of that!

Outstanding Post rated as such

Auwe (Alas)
Any reason my prior comment was not accepted?
"Attempts by Sandra Fluke, a college student that had hoped to speak about the wide role of birth control medicine in women’s health, had been rebuffed with the statement that she wasn’t “qualified to testify."
Marcia G. Yerman

Marcia, when I read your comment on Sandra Fluke, I immediately was reminded of my daughter starting college, bright eyed, anxious to spread her wings, and full of optimism.

Well, that is not the image of Sandra Fluke I have now after reading about the "fully grown woman" of 31 years of age, who has been an activist for years, who was introduced to the committee staff three days before the appearance date requested by Pelosi.

Now there is nothing wrong with being an "activist", one might actually be President some day. However, Sandra has published essays pushing for not only "gender rights" but also for "sexual reassignment" surgery being paid for by taxpayers.
I had never heard that term "sexual reassignment" but as it turns out it the "grade school law major" at Georgetown wants Americans to pay for "sex change operations." You see, this lady believes that the description of these operations as "cosmetic" should be changed to "medical therapy" or some such description. What is next, paying for nose jobs for deviated septum's?

Sandra, a protestant, knew prior to applying for admission to a Catholic university knew full well that Georgetown student health plans did not cover payment for "birth control pills." Her purpose was attack a force the Administration of the school to deny the principles of Catholicism and demand that Georgetown include coverage of the pill for all female students for birth control.
This "co-ed" than gave a story of a horrible medical experience one of her girlfriend suffered through, but softly added that "technically" the medical purpose of the pills in that regard WERE covered by the school's insurance.

And so, with the economy showing a fragile recovery after three years of Obama's spending, with the waste of billions of taxpayer dollars on idiotic schemes in solar and windmill, turned down by private banks without a government guarantee, with an inept President actually saying that "oil is obsolete", and believing that to be true, and most recently attacking the Catholic Church and the First Amendment, along comes this "college student" we are told who represents all woman.

It's true that most of America rushes home to see American Idol. However, some of us have a bit of brainpower, and if you don't see the set up here by Pelosi and the "West Wing", you are definitely a democrat party voter.
[r] Marcia, am late but thanks for another A+ commentary! Doing all that homework for all of us. It is a grim read for sure. All I can say is Dr. Jill Stein from Green Party for President! best, libby
This is calm and rational. I'm glad you wrote it because when I've tried, I didn't sound very calm. I thank God every day that I was born and came of age in a time when I had at least some control over my own fate and when and how many babies I had. Until men have the experience of worrying every month that their plans for the next year have to be thrown away, they won't understand the need for women to control the timing and frequencies of their own pregnancies.
Given that most women need to be concerned with reproductive choices between the ages of 12 (or thereabouts) to 50 (or thereabouts) and concerned with hormonal cycles and regulation thereof by way of medications within that same time's ridiculous for health insurance companies to be able to ignore women's bodies and lives, especially when we PAY FOR IT (the insurance). I hit my head against the wall with a friend of mine while discussing this issue. She kept framing it as a religious freedom issue and a "free birth control" issue (although she's a Catholic in name only. A slut. Like me and all our other friends) when it's an matter of being afforded the basic medical care that women pay for with their insurance premiums.