Birth control access is now the latest casualty in the Trump administration’s attacks on science. Last Friday, the administration issued rules that roll back the birth control mandate of the Affordable Care Act, i.e. the guarantee that insurance companies cover birth control whether they like it or not.
This means that companies can now more easily refuse to cover birth control costs for their employees. The administration claimed that scientific evidence supported their decision, but like many things with this administration, they got the science all wrong.
Here is a sampling of the actual science that the administration questioned or misrepresented
1) Birth control works and access to it reduces unwanted pregnancy. The administration’s rules question this long understood science. Since the introduction of the pill decades ago, medical professionals have documented the effectiveness of contraceptives in preventing pregnancy.
At the community scale, scientists also observe that access to birth control reduces rates of unwanted pregnancies, births, and abortions. One important study known as the Choice Project gave free contraceptives to teenagers in St Louis. The results showed that pregnancies, births, and abortions reported were half compared to the national average.
2) Contraceptives have many health benefits. The administration misrepresented the science on the benefits and risks of birth control, claiming that use of contraceptives may lead to riskier sexual behavior. But scientific evidence doesn’t support this.
Studies have not found increases in riskier sexual behavior following access to free birth control. In the Choice study mentioned above, participants reported no change in their sexual activities after receiving contraceptives. It is also worth mentioning the myriad reasons that women are on birth control. In addition to the benefit of having control over family planning, contraceptives are also used to treat other medical conditions, such as excessive menstrual bleeding and pre-menstrual syndrome symptoms.
3) Health risk from contraceptive use is extraordinarily low. The Trump administration emphasized risks and downplayed benefits of birth control, a key tactic often used by those who want to disparage scientific evidence. For example, the administration’s rules emphasized the risk of blood clots from birth control use. This risk does exist (on the order of 5-12 cases per 10,000 births) but scientists point out that your risk of blood clots during pregnancy is higher. And of course, this risk is far lower than risks involved in other things people regularly engage in, like riding in a car, taking a flight, and living with a city with air pollution. Emphasizing this risk as a justification for restricting access to the birth control is disingenuous.
A history of politicization of the science on birth control
Unfortunately, the Trump administration isn’t the first to politicize birth control. In the modern era, several presidential administrations have inserted politics into what should have been science-based decisions on birth control access.
Under the George W Bush Administration, political officials went against the scientific community and restricted access to the emergency contraceptive Plan B One-Step. While the product was shown to be safe and FDA scientific advisory committee members overwhelmingly recommended (23 to 4) that the drug be available over the counter, FDA officials, with involvement of the Bush White House, failed to take the scientific advice and kept access to the drug restricted.
Despite public outcry and legal challenges, the administration continued to delay making a science-based decision, ultimately resulting in the resignation of the FDA director of the Office of Women’s Health Susan Wood. In a resignation email, Wood wrote “I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.”
Under the Obama Administration, too, we again saw political interference in contraceptive science. President Obama’s Health and Human Services (HHS) Secretary Kathleen Sebelius failed to make Plan B emergency contraceptive available over-the-counter for all ages despite science demonstrating it was safe. The FDA’s own scientists made clear the drug was safe and FDA commissioner Margaret Hamburg agreed. But in a bold and unprecedented move, the HHS secretary publicly overruled the FDA commissioner. Shockingly, Secretary Sebelius and the administration claimed that it was uncertainty in the science showing how safe the drug was that caused the political move.
President Obama was quoted, “As I understand it, the reason Kathleen made this decision was she could not be confident that a 10-year-old or an 11-year-old … should be able to buy a medication that potentially … could end up having an adverse effect.” This of course is out of context, as medications with far worse potential side effects are already widely available over the counter in drug stores across the country. Court battles ensued and Plan B One-Step was made available over the counter for all ages in 2013.
Dismissing the science, harming public health
In many ways, it’s strange that birth control has long been a victim of politicization. It is not only widely popular but the science is very clear. This is something we know very well. The health effects are minimal and the benefits are tremendous. This is a no-brainer.
If we’d like to improve public health outcomes, evidence tells us that we should make birth control widely available. Indeed, this is what many countries have chosen to do. Yet the Trump administration has chosen to sideline science at nearly every turn. Unfortunately, birth control is now joining the ranks.
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