The War on Contraception: Death by a Thousand State Budget Cuts

While media attention has focused on the Congressional debate over a provision in the health care bill mandating that religiously-affiliated universities and hospitals provide access to birth control, there is another front in the war on contraception that is taking place in many states.

By defunding and even eliminating family planning programs, states are putting tens of thousands of poor women and teenagers at risk, and not just for unwanted pregnancies. Many family planning clinics also provide screening tests for diseases like diabetes and offer gynecological exams that can include tests for cervical cancer or sexually transmitted diseases (STDs).

But those options are rapidly shrinking for many women. New Jersey and Montana no longer have family planning programs, while New Hampshire cut funding for its program by 57%. The worst effects have been felt in Texas where massive state funding cuts caused half of state-supported family planning clinics to shut their doors.

A number of Texas representatives pointed to budget shortfalls as a reason to make these cuts, even though the state's budget office predicts that nearly 20,000 more births will result costing the state $98 million in prenatal, maternity and infant care, far more than the cuts are saving.

When these financial implications were brought to the attention of Representative Wayne Christian, a Texas Republican, he responded: "We value a human life more than just the cost."

Tell that to the hundreds of women who canceled appointments at the Parkland Health and Hospital System in Dallas which started charging a $25 co-pay to everyone. How can we expect women who can't afford $25 for a doctor's visit to care for a child?

In addition, Texas has excluded Planned Parenthood from participating in the Women's Health Program, an extension of the Medicaid program that provides $9 in federal funds for every $1 spent by the state of Texas. As a result, the feds have informed Texas that the state is violating federal guidelines, putting this funding at risk and further denying health care and family planning services to an additional 130,000 women.

Only Maryland and Washington expanded funding for family planning services to cover women at 200% of the federal poverty threshold.

Put this together with the fact that 2011 was a record for legislation restricting abortion or putting up roadblocks to the procedure (triple the number enacted in 2010), and it seems no exaggeration to say that a war on women's reproductive rights is heating up again in this country.

We are used to the controversy over abortion, which has raged every since the landmark Roe v. Wade decision. But these new attacks on contraception are even more worrisome. Conservatives are cloaking these funding cuts under the guise of fiscal responsibility, but how responsible is it to put the greatest burden of accessing and paying for birth control on the most vulnerable women in our society -- the poor and the young?

What purpose does it serve to increase the risk of unplanned pregnancies among the very women who are least financially equipped to raise a child? And why would any moral person want to increase the likelihood of women seeking abortions because they cannot access family planning services.

These are questions that need to be raised, particularly as we enter an election season where Republican candidates are attacking women's reproductive rights and calling this "family values." Valuing family means giving people the means to choose if and when to start a family in the first place.

As someone who has supported women's reproductive rights since I was a teenager, it is exhausting and disheartening to have to fight these battles over and over again, but we owe it to those women whose voices are not heard, either by politicians or by those members of society who have the means to plan their own families but are not willing to help others do the same.

If we allow any woman to lose her reproductive rights in this country, all of us suffer with her because these are the most fundamental rights a woman can have.

What Rush Limbaugh's Language Says About Women in our Culture

For days now the blogosphere and every media outlet has been raging with debate over the import of Rush Limbaugh's remarks on Sandra Fluke, the Georgetown law student, who was belatedly allowed to testify about the need for women to have access to contraception at Catholic institutions like hers.

For some this is a matter of "civil" versus "rude" discourse, and certainly Rush Limbaugh has tried to portray his remarks as a matter of "not the best" word choice. Now that's an understatement. But it is not a very convincing argument coming from a man who has been an agent provocateur for the far right ever since he went on the air, and who always chooses his words carefully for maximum shock value.

But this time, Rush's words have cost him far more than negative publicity; his loss of sponsors is at 34 and counting, and some stations have dropped his program altogether.

If he imagined that his vicious rhetoric would fire up his conservative (male) base and then blow over, he underestimated the reactions of women across the political spectrum.

Initially, Republican presidential candidates like Romney and Santorum rushed to play Pontius Pilate as they washed their hands of all responsibility for what Limbaugh said. Romney's response was characteristically faint-hearted: "Ill just say this, which is, it's not the language I would have used," while Santorum issued a blanket denial: "I don't believe it is my job as someone running for office to comment on every talk show host or any talk show host or anybody else out there on the right."

But women would have none of it. Petitions, emails, phone calls have all poured out on behalf of Ms. Fluke and against Mr. Limbaugh, and advertisers, pundits, and politicians paid attention.

The most disturbing aspect of Mr. Limbaugh's "speech" is that it underscores the tendency of our culture to sexualize women, particularly when they enter the public sphere. Women who appear in public fora are constantly scrutinized for what they wear, how they cut their hair, and whether or not their tone is too "strident," all signs of "femininity" that they are expected to comply with, whether they want to or not.

In Ms. Fluke's case, she could have been single and celibate, married, a lesbian, or a woman living with a male partner. None of this should have had the least bearing on the content of her testimony or how it was received.

But when a woman participates in public discourse, particularly when she is the sole woman testifying, her sexuality becomes part of the public exchange, and it is almost impossible for her to insulate herself or her words from this perception.

It's no accident that our culture still thinks of sexually active women as "sluts" and sexually active men as "studs." When an insurance plan covers Viagra, we don't say that as a society we are "paying" men to have sex, but it is all to easy to castigate the woman who uses birth control as a "prostitute," in part because female sexuality that is not directed towards reproduction still elicits a deep-seated anxiety in our culture.

Rick Santorum is more honest than many conservatives when he argues that sex should only take place within the institution of marriage, and with an intention to reproduce. From this perspective, women who have sex to become mothers are held up as icons, whereas women who have sex for pleasure are "sluts," "bitches," and "hos."

Whether or not they share Santorum's strict religious code, too many Americans still think it's okay for men to have sex without any moral opprobrium attached to it, while the simple idea of a sexuality active woman is morally suspect.

When the birth control pill first came on the market in the 1960s, many worried that it would free women to have sex with anyone without the fear of becoming pregnant, just like men.

Now fifty years later, as a culture, we still exhibit ambivalence and anxiety over the relationship between female sexuality and contraception. When women have access to contraception, they have a choice about if and when to become a mother, and that freedom evokes an almost atavistic cultural fear about the freedom this gives them.

The persistance of this cultural fantasy about contraception unleashing "girls gone wild" comes through loud and clear in Limbaugh's ranting. Having labeled Sandra Fluke a "slut" and a "prostitute," he is off and running with his own pornographic fantasy, demanding that she post videos of herself having sex and claiming that "she's having so much sex it's amazing she can still walk." (A full list of Limbaugh's insults has been recorded by The Washington Post.)

The disgust and anger that so many women expressed over Limbaugh's speech demonstrates once and for all that women are determined to fight any attempt to turn back the clock on their reproductive rights. Nor will they be frightened off the public stage when men try to silence them with sexually demeaning labels.

But I'm still waiting for the day when a woman can engage in public discourse without fear of some guy trying to undermine her words by speculating about her sex life.

Other conservative pundits have tried to frame the controversy as a matter of "free speech" with about as much success as they had trying to spin the initial debate over contraceptive coverage as a matter of "religious liberty." When you have a well-known public figure with an audience numbering in the millions, it's difficult to argue that his words don't carry much louder than the testimony of a private citizen at a Congressional hearing.

The Politics of Contraception: Why Gender Balance Matters in Congress

There are times when the effects of the gender imbalance in Congress really hit home. This week, when House Republicans convened an all male panel to discuss contraception, was one of those times.

It seems almost incredible that we are still arguing over the merits of birth control in 2011 when almost 99% of sexually active women of all ages use at least one method of birth control (Mosher WD and Jones J, "Use of contraception in the United States: 1982-2008, Vital Health and Statistics 2010).

Of those women, nearly a third use oral contraceptives (“the pill”), especially those under 30 years of age, while those over the age of 30 are more likely to choose sterilization than any other form of birth control (Alan Guttmacher Institute, Facts on Contraceptive Use in the United States, 2010).

Yet the male-dominated House and Senate are considering bills that would allow any employer to opt out of covering birth control, and they're discussing this issue as if women had nothing to say about it.

This lack of coverage would, of course, create a disproportionate burden on young women and poor women, two constituencies Republicans apparently care little about. Of the 66 million women of reproductive age, about half (36 million) are in need of contraceptive services, and about a quarter need publicly-funded services because they are poor or under the age of 20. In fact, four in ten poor women of reproductive age have no health insurance at all (Alan Guttmacher Institute, Facts on Publicly Funded Contraceptive Services in the United States, August 2011).

Given these figures, you would think that Congress would be discussing the need to increase financial support for contraception, not talking about taking it away from those women who are fortunate enough to have insurance policies that cover it.

But when you convene a panel of five people, who by definition cannot get pregnant, can we really expect an honest, objective discussion of a resource that allows women to choose whether to get pregnant or not?

Can you imagine what the response of men would be like if Congress put together a panel of five women in order to discuss whether or not insurance should cover medications to address erectile dysfunction?

The cynic in me wonders if this latest fight over contraception is simply a Republican gambit to shift attention away from their embarrassing gaffe in holding up a payroll tax extension for millions of working Americans.

Or it might be a deliberate provocation of the Republican party's base of social conservative base to get them riled up enough to vote, when Mitt Romney seems more and more likely to make them want to stay home on election day.

But I can't help but feel that this fight points to some deeper and more unsettling in our culture. There seems to be an almost atavistic fear of women having control over their own fertility as if it might threaten the very structure of society.

During the Enlightenment, French philosophers from Louis de Jaucourt to Rousseau to Condorcet argued for political liberty for men, but they openly worried about extending the same kinds of liberties to women because it might upset the hierarchical structure of the family.

Indeed, Rousseau's ideal woman was one whose education was limited to her role as wife and mother, and he attacked aristocratic women as selfish and decadent for wanting to control their fertility. “Not content to have ceased breast-feeding their infants, they have ceased to want to have them at all,” he wrote in his novel Émile.

In a similar vein, Pierre Bayle wrote: “It is certain that if women had only consulted reason, they would have renounced the quality of mother, discouraged by the inconvenience of pregnancy, the pains of delivery, and the care that must be taken of the little creatures they produce.”

This fear that if women could control their fertility, they would avoid having children may run deep in a culture where “family values” still connotes a husband who works and a wife who stays home with the kids.

Today the number of households fitting this description is rapidly diminishing, and the number of women who still have no children by the time they reach their mid-40s has doubled since the 1980s (Jane Lawler Dye, "Fertility of American Women, 2006," Current Population Reports).

Is it a coincidence then that Republicans picked five men to talk about one of the important health and life issues a woman can face, i.e. deciding when and if to have a child?

Whatever their motivations, this ongoing debate raises serious issues for women, and it underscores the danger of having so little female representation in bodies like the House and Senate, when a majority of men are writing laws that affect the most important decision a woman can make.

So I urge women not only to write their representatives and let their voices be heard in support of contraceptive health coverage but also to urge their husbands, boyfriends, fathers, sons, and male colleagues to do the same.

And let's start putting at least a few more women in the House and Senate where they belong.