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Contraception

Why can’t women just use the other 16 contraception methods not mentioned in Hobby Lobby ruling?

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I get asked this question a lot.

It gets tweeted, posted on my blog, and I am asked in person.

Sometimes people are really genuine. I understand everyone doesn’t have the same medical background, and so for some it is a legitimate question.

Sometimes the tone is snide. I’m not sure of the agenda then. Sometimes it’s religion. Sometimes it’s the idea that someone should be forced to pay for someone else’s contraception. Sometimes I just don’t know.

So here goes. Once and for all:

Women shouldn’t have their birth control options restricted. Period. By any one. Anywhere. Any time.

Women shouldn’t have the most effective option restricted. No method of birth control is more effective that the two IUDs available in the United States. This is especially important when you consider the teenagers who are also on the health plan in question. Teenagers have the highest contraception failure rate and IUDs are spectacular at reducing unplanned pregnancies for teenagers. In addition, the Copper IUD is hormone free. which matters medically for many women regardless of age.

Contraception allows women to have reproductive control which is good medically. Women bear 100% the medical burden of pregnancy. Spacing pregnancies leads to healthier babies and healthier women. How exactly is that bad thing? It’s also good economically, but I’ma doctor so I’ll stick with what I know.

Allowing 4 methods of birth control to be excluded because of a belief is the thin edge of the wedge for all birth control. A belief is a hypothesis and in this case science has proven the hypothesis wrong. Plan B, ella, and IUDs are not abortifacients. If you allow Plan B to be excluded on this scientifically flawed premise then medically the same argument holds for all forms of hormonal contraception. The 4 methods excluded by the Supreme Court must be our Maginot Line. Want proof? The Supreme Court has already indicated that the ruling covers all 20 forms of contraception protected through the Affordable Care Act. Make no mistake about it, the goal is to get all contraception coverage dropped. And then what? Start to make it illegal one by one? Who knows the ultimate agenda, but I don’t want to find out.

Contraception is medical care. I’m not talking about controlling bleeding or reducing cramps (which Mirena, one of the Hobby Lobby excluded methods does), but it is medical care to prevent pregnancy. We don’t need any other medical reason. Also, the Copper IUD wouldn’t be afforded any protection under that reasoning. While many women do use birth control for off-label indications that is not why they are coming for birth control. No one pushing these lawsuits cares a whiff about the health of your uterus. If they did none of this would be happening. Off-label use is important, but when we rely on that argument it weakens the idea that contraception matters simply for contraception’s sake. An appendectomy is medicine. Treating high blood pressure is medicine. Chemotherapy for breast cancer is medicine. Contraception is medicine.

Pass it on.

 

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Discussion

42 thoughts on “Why can’t women just use the other 16 contraception methods not mentioned in Hobby Lobby ruling?

  1. Amen to that!
    Leslie

    Posted by swo8 | July 9, 2014, 7:31 pm
  2. I wish you were my gyno!

    Posted by Erin Bliss | July 9, 2014, 7:39 pm
  3. iuds are $900 and a 1 time fee. pills and rings as birth control methods are paid on a monthly or quarterly basis when the rx is picked up. i’ve rarely seen a pharmacist hand over $900 worth of birth control pills in one visit. unless hobby lobby employees are signing a 5 year contract to work there , isn’t it reasonable to exclude iuds on that basis? im all for women’s healthcare, fyi, but you should explain and address this aspect of the situation if you really want people to be able to speak intelligently on the issue.

    Posted by Reasonable Person | July 9, 2014, 7:55 pm
    • That makes no sense medically. Much of medical care is to prevent complications that wouldn’t happen for 5, 10 or even more years. The point of everyone having coverage is then everyone contributes to today’s health as well as tomorrow’s

      Posted by Dr. Jen Gunter | July 9, 2014, 8:10 pm
      • it does make no sense medically, I agree. But I didn’t ask if it made sense medically.

        Posted by Reasonable Person | July 11, 2014, 9:41 am
    • No, it is not reasonable to exclude IUDs on that basis.

      From an insurance point of view, insurers can pay for 10 1-time IUD insertion fees at $900 and STILL pay less money out of the risk pool than the same insurance would pay for exactly one uncomplicated pregnancy (including prenatal care, prenatal vitamins, and a vaginal delivery at a birthing centre). In Houston, the 4th largest city in the country so a useful benchmark, the going rate for an uncomplicated vaginal delivery only (so, no prenatal care) is about $10,000. The going rate for a caesarean section is about $20,000. A vaginal delivery with some moderate complications may be $15,000-$25,000. Serious complications will easily run into hundreds of thousands of dollars.

      From an insurance point of view, it does not matter if a person (read: covered employee) is part of the pool for one year or five years–what matters is keeping the pool solvent. If pregnancy is one of the most expensive “common” costs to the pool, and that cost to the pool can be dramatically reduced by taking steps to prevent that cost, then it is an insurance no-brainer to cover a $900 device that has a 99% chance of preventing a $10,000+ bill….even if the covered person is only in the pool for a year.

      Posted by Skada | July 10, 2014, 7:18 am
      • I think you are being unreasonably generous with your comparison of 1 year to 5 years. What this law would allow is for a woman to work at Hobby Lobby for the minimum amount of time necessary to get benefits (I believe that is less than 1 year) and then quit immediately after getting the IUD. Rational people would take that route, and that leaves Hobby Lobby and other companies footing their bill for a former employee that is no longer a risk to them for higher potential costs (like unplanned pregnancy). the only way your argument works is if you agree employees at Hobby Lobby getting IUDS should sign 5 year contracts to work there.

        Posted by Reasonable Person | July 11, 2014, 9:44 am
      • So if a Hobby Lobby employee needs a kidney transplant does she have to sign a contract to work there for life? What about an insulin pump? What about the 1 year treatment for Hep C? What about a valve replacement? Why about the contraceptive implant Implanon? If you’re going to design an actuarial table for paying off an IUD you have to include everything.

        The point is if everyone carries the insurance the risk is evening distributed. That was part of the point of the ACA in the 1st place.

        Regardless, health care is health care and contraception is part of that.

        Posted by Dr. Jen Gunter | July 11, 2014, 9:53 am
    • There is an 85% percent chance of pregnancy when no birth control at all is used. Therefore a woman could easily cost an insurance company 10,000 during here first year of employment. Gee whiz, then I guess she might even be more likely to quit, since low-wage jobs such as those available at Hobby Lobby barely (if at all) barely (if at all) cover child care.

      Posted by Mary Petrak | July 11, 2014, 10:48 am
    • Having a perfectly normal, uncomplicated vaginal birth costs a bit over $9,000. Then there are maternal leave, adding a child to the healthcare insurance….. I’d rather pay the $900.

      Posted by Coaster | July 15, 2014, 8:56 am
  4. Reblogged this on ohyesjulesdid and commented:
    Thanks to the Good Doctor for explaining in layman’s terms what many of us have been saying all along about the IUD’s , Plan B, and Ella contraceptives mentioned in the Hobby Lobby case.

    Posted by ohyesjulesdid | July 9, 2014, 9:14 pm
  5. Thank you for writing this! I continue to be amazed at the number of people who think that all forms of contraception are “one size fits all,” and women should just stop whining about the cost because it’s “free at Planned Parenthood” or “just $10 at Wal-Mart.” Hopefully hearing from a medical professional will enlighten a few people.

    Posted by Brita | July 10, 2014, 7:54 am
  6. Reblogged this on Bonjour, Y'all and commented:
    This well-published OBGYN explains simply and medically why women need access to all forms of contraception so we can make the best medical choices for our bodies. I hope this clears up any misconceptions some people have about why not all women can just take the cheapest form of contraception available. On a personal note, the monthly out-of-pocket cost for my preferred form of contraception is about $130.

    Posted by Brita | July 10, 2014, 7:58 am
  7. I find it curiouis that so many so called “experts” are convinced that Plan B cannot act as an abortifacient, when the company’s own website, and own research, indicates clearly that Plan B may prevent implantation of a fertilized embryo. The company that, you know, invented, sells, markets, and bears liability for the drug?

    Check their own literature. Their words, not mine.

    http://planbonestep.com/faqs.aspx

    Click under “How does Plan B work?” You can also find a more detailed response in the literature that comes with the drug.

    WR

    Posted by Well Read | July 10, 2014, 8:00 am
    • Dear Well Read,

      I find it curious that you chose such a nom de plume considering how poorly read you are.

      In 2008 (so 6 years ago, perhaps you are behind on your reading?) FIGO issued a statement that levonorgestrel methods of post coital contraception cannot interfere with implantation and that all references to such an impossibility be removed from the package labeling. The FIGO statement is actually the hyperlink on the word Plan B in my post. That paper contains a myriad of references. In addition, the hyperlink for ella is an excellent review article detailing the research published since the FIGO statement.

      Perhaps you are not well read enough. If you were you would have checked out a post I wrote on Plan B that explains how product labeling works.
      http://drjengunter.wordpress.com/2014/07/04/how-does-plan-b-really-work-dont-ask-the-supreme-court-ask-an-obgyn/

      Instead of regurgitating tripe laden sound bites from people that clearly haven’t read/understood the research or have a religious bias to believe otherwise, read up on the subject a little before you A) consider your self well read and B) troll my blog.

      Posted by Dr. Jen Gunter | July 10, 2014, 1:18 pm
      • I was just about to type a response to WR, and then I saw yours. I wish I could upvote/like/recommend it 1000 times over.

        Posted by Darwy | July 11, 2014, 7:27 am
    • you are assuming that prevention and post implantation are the same thing. They are NOT!
      actually when plan b is taken within 48 hours (i think thats the right time) of the unprotected sex. it just prevents that implantation. its sends hormones that are basically the same as period hormones. thats not abortion. abortion is the removal of a fetus. in fact if a fertilized embryo is existent before the plan b is used. it will not work. so it is not an abortion pill. many just dont understand the female workings down there. they assume its all the same. it is not. it even tells you on the box. will not work if you are already pregnant. plus the pill that is sometimes used for abortion (you’d have to go to a clinic and be within a 2-4 span of pregnancy) is a different chemical makeup then plan b. implantation of embryos take days to implant. all plan b does is signal the hormones so it will not implant.

      Posted by Amanda White | July 14, 2014, 8:21 am
  8. These are just statements. Albeit they’re from an MD, and granted I agree with all of them, but exactly zero people will be convinced or persuaded by these billboards. Not to get too religious on anyone, but this is just preaching to the choir (that’s me in the front row).

    Posted by R. Schulman | July 10, 2014, 8:08 am
  9. I could never safely take the pill, Reasonable Person. IF a safe IUD had been available during my fertile years, I could have used that instead. It would have saved me risking my life more with every pregnancy and likely saved me the heart-break of three miscarriages.

    It isn’t reasonable to assume any method work well for all women.

    Posted by syrbal-labrys | July 10, 2014, 9:38 am
  10. I could simply say I don’t work at HOBBY LOBBY (HL) so why should I care? I think I care about this issue because it IS about women’s rights that are being controlled and shut down. Why can’t Plan B, Ella and IUDs be accepted as the non-abortifacients that they are? What (or who) stops this education about basic science? And back to HL, if they are a business, isn’t anyone who works for them under their complete control? Aren’t we all indentured servants having to obediently obey the rules of corporations because we are owned, until we aren’t … until we find a better company — a master we like better until we are able to start our own company (if we ever are) and control our own masses by imposing our own judgment, religious and/or philosophical beliefs on others … aren’t workers simply property to be maintained?

    Until you are the owner, the business owner, the 1%, aren’t you owned and controlled until your death? Isn’t the mantra of “it’s my company, I made it, I control it, I control all the beings to be the best of my ability and to hell with them if they don’t conform to MY belief system”? (I’m being facetious here — THIS IS NOT MY BELIEF SYSTEM.) Isn’t that the beautiful thing about having a company so large — you get the financial profit AND you get to project your belief system in the form of power — becoming MONEY and POWER and CONTROL? And if the workers stop reproducing I will have less “slaves” in the system if I provide them birth control!

    Completely NOT my opinion ABOVE … and I think that’s what WE think, we think if we had a company we would provide birth control and hormones to women because that’s what we would do and we expect others to think and do as we would.

    Many corporations do NOT want government influence or control of any sort … even if the majority of citizens wants that safety net or benefit from the government … when the 1% have money, they also want control.

    Have you seen the film Park Avenue: Money, Power & the American Dream (2012)? http://www.itvs.org/films/park-avenue

    This is a great film and I highly recommend watching it … it opened my eyes to many things. This is a film that shows how the collective bargaining, unions got shut down in Wisconsin and how money bought the votes and power.

    Another link to the film: http://topdocumentaryfilms.com/park-avenue-money-power-american-dream/

    This really isn’t about women’s rights … the HL owner doesn’t really care about that. He’s a man. He’s a corporate owner. He has little worker bees that need to continue to work. He has his ideals (his religious indoctrination) and now he has the power to control others and put his “best” values on other people as he sees fit.

    FROM WIKIPEDIA:

    David Green (born November 13, 1941) is an American billionaire and the founder of Hobby Lobby, an American chain of arts and crafts stores.

    Religious views —
    Green is the son of an Assemblies of God preacher and comes from a family of preachers.[4] Green claims to have built his business squarely on biblical principles:[2] “We’re Christians, and we run our business on Christian principles.” That claim is disputed by Jonathan Merritt, senior columnist for Religion News Service.[5]

    He attributes his success to his faith in God. He has taken a public stance against the Patient Protection and Affordable Care Act because of its inclusion of a provision mandating that companies provide access to the morning-after pill.[6]

    Green takes half of Hobby Lobby’s total pretax earnings and commits it directly to a portfolio of evangelical ministries and as of 2012 it has donated an estimated $500 million.[7] This includes a $10.5 million gift to Jerry Falwell’s Liberty University in 2004, and $70 million to bail out Oral Roberts University in 2007. He has also put nearly 1.4 billion copies of gospel literature in homes in more than 100 countries, mostly in Africa and Asia.[8]

    ________________________________________

    In conclusion, David Green is the founder of HL — basically HIS business really. He is a 1%er and he will buy votes and control things the way HE wants. I’m not saying that is what is right, but that is what is happening and HL isn’t the only business / corporation in America doing this. If you have the money, the vast amount of wealth you buy votes, senators, lobbyists and congressmen — you get control, plain and simple … and we are the pawns in the way. It is way too simplistic to think that HL is only about women’s (lack of) rights … it’s a bigger picture issue … it’s about money and who is in control.

    Posted by elizabetcetera | July 10, 2014, 10:41 am
  11. Teenagers rarely, if ever, get IUDs. Mod doctors refuse to give them to women who haven’t given birth. New research suggests thatnIUDs are safe for childless women, and a new 3 year, smaller IUD is coming on the market. I have the 5 year Miranda. I don’t have periods with my IUD.

    Posted by SomeMom | July 10, 2014, 6:18 pm
  12. Can we also point out that Emergency Contraception is vital – when your primary birth control method fails (I love people arguing ‘just use condoms!’ who miss the point that condoms have a higher failure rate, especially if users don’t know correct use) then emergency contraception may be the only thing that stops you getting pregnant.

    Posted by Jay | July 10, 2014, 9:12 pm
  13. The court clarified the day after the decision that it affected all contraception, not just the 4 types, and they reopened the other cases where employers are trying to deny all of them. HL was deliberately chosen to be the signature case so as to get the “only 4 kinds!” talking point out there. That was a PR strategy to make it look like it was opposition to “abortion” and not birth control that was at issue.

    Posted by DonnaDiva | July 10, 2014, 11:48 pm
  14. Here’s a much nicer and succinct summary of what I was trying to say (see / read article link) — this HuffPo article says it much better than my long and blathering comment above … way above:

    http://www.huffingtonpost.com/katherine-franke/hobby-lobbys-not-just-abo_b_5575659.html

    And so there is no confusion, I agree with Dr. Jen 100%.

    Politicians are much more interested in serving corporations that provide them with financial kickbacks — putting money in their own accounts, than actually caring about real people or science. It’s amazing what a lack of scientific knowledge politicians have. Astounding, really. But in combination with this the majority of Americans lack basic political knowledge … a very interesting combination to say the least.

    From Wikipedia in regard to congressional educational background:

    The Congressional Research Service notes that the vast majority of Members (95 percent) had an academic degree:

    * 168 Representatives and 57 Senators had a law degree. Of these, five (three Representative and two Senators) also hold a Master of Laws (LL.M.) degree.
    * 83 Representatives and 16 Senators earned a master’s degree – often a Master of Business Administration (M.B.A.) – as their highest educational degree
    * 27 Representatives and one Senator (Mark Begich) have no educational degree beyond a high school diploma.
    * 23 Representatives (but no Senators) have a PhD
    * 17 Representatives and three Senators have a medical degree (this number includes one Senator with a veterinary medicine degree and one Representative with a dental degree).
    * Five Representatives (but no Senators) have an associate’s degree as their highest degree. One House Member has a licensed practical nurse (L.P.N.) degree.

    Here’s an excerpt from that HuffPo article:

    Religious Free Exercise Claims Advance A Larger, Long-Term Effort By Corporations To Escape Governmental Regulation: In important ways, the religion vs. contraception question in the Hobby Lobby case was besides the point. This case ought to be understood as part of a larger assault by corporate-America on any form of governmental regulation. This effort first gained traction in the Reagan years and has been the cause célèbre of the corporate, free-market, right for almost half a century. Pro-business, libertarian advocates such as the Koch Brothers, the American Enterprise Institute and the Heritage Foundation strongly opposed the Affordable Care Act on the ground that it would impose new and costly regulations on businesses that were best left to the free market. They have waged a campaign to pick off, defund, and challenge as much of the law as possible by appealing to familiar conservative/libertarian principles that condemn any regulation of businesses, be it financial regulations, consumer protection, workplace safety laws, non-discrimination laws, or laws protecting workers’ collective bargaining rights – to name just a few. The long-term goal of this conservative effort has been to shrink the scope and power of public regulations that aim to correct for market failures, exploitation of workers, and the unequal leverage that corporations have to ignore public values such as equality, transparency and safety.

    My PERSONAL opinion is what Hobby Lobby is doing is completely unfair, unjust and bordering on corruption and prejudice … but I don’t make the rules, I’m no where close to a one-percenter and I don’t have political influence.

    Posted by elizabetcetera | July 11, 2014, 1:45 pm
  15. OMG the ill-informed misogyny I’ve seen about this from the Right. Always from men. And yet these same people who go nuts if you suggest the slightest restriction of any firearm at all, screaming that Hitler has come for your freedumbz!!! because of any control over deadly weapons, then say this: Why can’t women just use teh other burth kuntrollz? You know, because their freedumbz isn’t as important. Well, first off, doctors will answer that question for you if you care to know anything factual on the matter, which you don’t. And second, no vagina has ever killed anybody by shooting a baby at them, so you really have no reason to make it your business, whereas we kinda have a reason to speak out against being gunned down by patri-idiots. The most likely lethal vaginal thing I’ve ever seen so far is a ping pong ball trick, and that was hardly lethal.

    Posted by thestumblingbl0ck | July 14, 2014, 4:54 pm
  16. because none of them is the TRUTH.
    Living by the Ten Commandments is health care. the most effective health care. when women choose to respect themselves, their bodies and their God-Love, then women shall be the light of the world, as God intended them…spirit is Life. the feminine quality is the intelligence, compassion, reason of the human experience, by divine design. we are spiritual beings. yet, we choose to pass through our experience lower than we are. Our inheritance is Light, Eternity, Purity in intention…we are the light of the world. why would we fight to be less than who we really are? all of the excuse list included in this article makes a woman feel as though she needs something, when in fact she is everything, already…complete.

    Posted by Linda Seaton | July 19, 2014, 4:20 am
    • Honestly, I have no idea what you mean although I’m pretty certain the Ten Commandments isn’t health care.

      Posted by Dr. Jen Gunter | July 19, 2014, 3:18 pm
    • Living by the 10 commandment is health care? Thanks for excluding all other religions, atheists and agnostics alike … way to go single-minded person (sarcasm).

      Women DO choose to respect themselves when they take PROACTIVE care to choose the birth control that works best for them and their families. Our inheritance (questioning choice of words) is light? I don’t know … it that true? What does that even MEAN? When someone speaks so esoterically the meaning can be lost on many people … effective communication is key. Ms. Seaton, when you’re ready to make sense I’m ready to listen to your message … besides that what you have to say sounds well, frankly, no meanness intended, but empty and full of tommyrot.

      Ms. Seaton your message seems to be well-meaning, but in reality lacks substance and comes across pseudo-ethereal.

      What we don’t need is any more GYNOTICIANS deciding and ruling on healthcare for women.

      Definition of “gynotician”: A politician who feels more qualified than women and their doctors to make women’s health care decisions. A combination of the words gynecologist and politician.

      And … here’s a nice article to check out from none other than RH Reality Check: http://rhrealitycheck.org/article/2014/06/19/hobby-lobbys-owners-may-sincerely-believe-emergency-contraceptives-cause-abortion-wrong/

      EXCERPT FROM — “Will the Supreme Court Ignore the Evidence? Facts vs. Beliefs in the ‘Hobby Lobby’ Case” (source — Reality Check):

      At what point does this madness end?

      The Greens may be sincere in their religious beliefs, but to the extent that their “religious beliefs” are actually scientific claims, courts should require them to provide evidence to support those claims just like any other factual question. And in this case, the Greens’ supposed religious beliefs are actually no such thing—they are sincerely held, but wrong, scientific views. And should the Supreme Court rule in their favor, it will have signaled to every subsequent litigant that science has no place in the courtroom.

      That should scare us all.

      __________________________

      That’s my comment for today … I’m going to go back to being light right now and enjoying my Saturday night respecting myself … my comment is pure in its intention.

      Posted by elizabetcetera | July 19, 2014, 7:48 pm
  17. You’re the Don Quixote of this stuff.

    Posted by Rowdy McNutt | July 24, 2014, 9:09 pm
  18. I can only hope the satanists can save us:

    Excerpt: Satanists aren’t the only activists fighting back against the junk science used to justify anti-abortion laws. The secular humanist group Center for Inquiry recently launched a “Keep Health Care Safe and Secular” campaign to encourage more Americans to fight back against laws limiting women’s access to health services. Similarly, NARAL Pro-Choice America sometimes uses the slogan “Politicians Make Crappy Doctors.”

    FULL ARTICLE

    http://thinkprogress.org/health/2014/07/28/3464769/satanists-hobby-lobby-abortion/

    Posted by elizabetcetera | August 2, 2014, 9:56 am
  19. Why doesn’t men’s contraception get covered by medical insurance? And how do you explain to all the female players out there they shouldn’t have to use contraception, only the “man” has to? I totally digress. I disagree it affects women’s choices.

    Posted by Charlie Nicholas | August 15, 2014, 4:31 am
  20. Extremely glad I live in the UK. Every time a woman goes to her GP to talk about contraception, she is given a *range* of options to choose from (they’re quite keen on giving women coils here in England, but they’re not that popular with women). I’ve been able to try multiple formulations of hormonal contraceptive, I’m always given the choice to try long-term injectable/inplantable hormonal and non-hormonal contraceptives, GPs will prospectively prescribe the morning-after pill if you’re worried about having a contraceptive failure… And it’s all FREE. Not even a prescription charge. Free for a woman’s entire reproductive life. Men can also get condoms free on prescription. Everyone who earns pays the costs, and everyone in the country shares the benefits.

    Posted by wadhamite | August 15, 2014, 6:14 am
  21. Late to the game here… Minor correction: while iuds are some of the most effective contraceptives, nexplanon is actually more effective (.05% failure rate vs .2 or .8)

    Posted by Fern | September 15, 2014, 1:49 am

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