Traywick 1

Zachary Traywick

Professor Kjirsten Goeller

English Composition II

7 July 2019

Birth-Control for the Masses

While perusing the nonsense that is political discourse on social media. it is not uncommon to

find oneself reading a meme that bluntly, and usually inaccurately, sums up the effect of Colorado's

long-acting reversible contraceptive (LARC) program (Lacapria). This meme will generally state that as

a result of the program unintended pregnancies dropped by forty percent, the number of abortions has

fallen by forty-two percent, and that millions of dollars in public health coverage has been saved. This

meme has circulated the familiar social space for years at this point, and while it does represent the

general consensus (even that of it's initial political opposition) surrounding the state-based program, a

bigger question arises from the data. Should a similar policy be adopted by the federal government?

(Snopes)

Making contraceptives widely accessible, free, and easy to obtain is an idea that has far more
 Traywick 2

benefits than liabilities. In addition to saving the tax-payers millions of dollars by reducing the state's

financial liabilities regarding housing, food, healthcare, education, and many others, it also creates more

opportunities for people in poverty to build independence, self-reliance, and plan for their futures. It

alleviates the potential burdens that are associated with parenthood (especially single-parenthood) and

will ultimately make our country more free for everyone. However, the challenges such a program faces

in execution are formidable enough to potentially prevent the idea from ever actually coming to fruition

as a result of the deeply divisive and galvanized political nature of the United States of America.

In 2008, the Colorado Department of Public Health and Environment received financial support

from a private donor to launch an expansion of the Family Planning Program, established after the

passing of Title X in 1970 (Lacapria). This new program, along with some infrastructure from the

previously established program worked with state and county run clinics to reduce the cost, mostly or

entirely depending on the specific clinic and how its funding was appropriated, of patients purchasing

and using intrauterine devices (IUDs) (LARC4CO). The usual cost of these devices would normally put

them out of financial reach of women living in poverty until this program was expanded. After the

program was executed and these devices became widely available for anyone who would want one the

areas surrounding these clinics quickly and definitively started to improve. After demonstrating with the

expansion that such a program had instant and effective repercussions the program evolved again,

became the previously mentioned LARC program, and started to receive more consistent funding and

support from the state government. LARC reports that between 2009 and 2017 teen birth rates and

abortion rates have plummeted by as much as sixty-percent and for adult women the decline in abortions

and pregnancies is as much as forty percent (LARC4CO). This number was later confirmed and repeated

in an independent study commissioned by the state's Department of Public Health and Environment.

Despite its success, however, it has faced political opposition many times over in its decade long

experiment.
 Traywick 3

In a study conducted in St. Louis nine-thousand-two-hundred-and-fifty-six adolescents and

women at risk for unintended pregnancy were enrolled into the Contraceptive C.H.O.I.C.E. Program.

This study was commissioned to examine specifically why the number of unintended pregnancies,

especially among teens and impoverished women, were so much higher in the United States of America

when compared to most other developed nations. The program was a smaller scale model of Colorado's

LARC program and provided the same intrauterine devices (IUDs) free of charge in addition to

contraceptive counseling and referrals (Peipert). The study primarily focused on the effects of the

program on teen pregnancy, percentage of abortions, and repeat abortions and compared the data to

Kansas City and non-metropolitan Missouri. The study found that in all its areas of focus it found a

significant drop and drastically lower rates than that of the national average (Peipert). Those enrolled in

the CHOICE program that resulted in teenage pregnancy were about 6.4 out of 1000, while the national

average at the time was 34.1 out of 1000. The study's conclusion was mirrored by the similar study that

looked at Colorado's LARC program (Peipert).

In the UK and the Netherlands they have similar nationalized systems tied in with their

nationalized healthcare systems. In one instance, a specific study in 1996 was run just to determine the

effects of only one aspect of their nationalized family planning initiatives: post-coital emergency

contraception (the morning after pill). Just studying this one aspect of an expansive and complex

national program it was found that the cost of the PC4 dose ranged from nineteen to seventy-four

dollars, but the cost that is averted by the unwanted pregnancy could range from seven-hundred-and-

twenty-seven to eight-hundred-and-six dollars (Glasier). While the data gathered by Anna Glasier and

her team was focused, careful, and objective even if their estimates are off by fifty-percent, which would

be dramatically inaccurate, that would still mean that the cost of the morning after pill was anywhere

from one-twentieth to one-fourth the cost of an unintended pregnancy. This research also gathered data

on the different demographics of those likely to use emergency post-coital contraception and found that
 Traywick 4

it was predominantly used by those living in poverty and/or younger citizens (Glasier). Just studying one

very specific part of a very large program has yielded positive results, and was an important piece of

research in discussing the nationalized system.

Because of the uniformity surrounding the efficacy of these types of programs other countries

have not only adopted the policy but are looking to expand on it. In France in 2012 the country

expanded their existing infrastructure to not only allow teen-aged girls from ages fifteen to eighteen

years of age (Beardsly). In addition to the state handling the consultation fee as well as the cost of the

contraceptive itself, it also worked to protect the youths efforts in obtaining it by guaranteeing

anonymity and accessibility. As a result of this measure one study found that teen pregnancy and

abortion rates also fail (Sedgh). This same study compared the data from various countries and found

that of the sixteen countries that showed a decline in teen pregnancy rates all sixteen of them have

adopted nationalized contraceptive systems (Sedgh). This same study was funded by the Center for

Disease Control and Prevention in 2016 at the request of the Obama administration in an effort to

understand and potentially learn how to reduce the tax burden created by unintended pregnancies.

Another study conducted in 2011 focused on the effect of a effort passed federally in 1970. Title

X was introduced in 1970 as the first, and last, federal attempt at providing all citizens with voluntary

and confidential services in regards to family planning, sexual health, and contraception. Title X

contained close to two-hundred-and-ninety-three federal bills that were proposed to be passed at a later

date after investigation and logistical developments (Vamos). Of the two-hundred-and-ninety-three bills

only twenty (6.8%) were enacted into law. Of the small percentage of bills that were eventually passed

the majority were specifically in regards to restrictions and inhibitions in the process of gaining, using,

and interacting with the same aspects that the law sought to protect (Vamos). In addition the original

budget proposed for enacting the family-planning measures laid out in the legislation was one out of

every two dollars of public expenditures on family-planning. This number decreased to one in ten by
 Traywick 5

2006. Because of it's ever decreasing budget it has now been outpaced by Medicaid and most women,

even in poverty, will not meet the eligibility requirements to enroll in Medicaid (Vamos). This means that

of the almost two-billion-dollars our country spends publicly on family planning slightly more than

seventy-percent of that funding is inaccessible for youth and women in poverty. However this doesn't

mean that Title X's efforts did not achieve anything. It still managed to secure funding for clinics across

the United States, in 2004 was found to have prevented 1.4 million unintended pregnancies with almost

a fifth of those among teenagers, and also prevented over six-hundred-thousand abortions. Title X can

be attributed for all these achievements, and also expanding efforts to reduce infant mortality, cervical

cancer, and other sexual-health concerns.

However, the discussion around contraceptives isn't just a matter of public cost reductions. The

effects of contraception on women's health and the quality of their lives matters greatly too. A study

published in 2016 sought to gain a deeper understanding of the many different factors surrounding the

use of contraceptives. The study focused on women's sexual health, behaviors and moods. The study

found that while the side effects of birth control range from drastic mood shifts, bleeding, insomnia, and

several other the ability to engage in safe sexual relationships generally provided enough of a counter

balance to decrease the detriment of the side effects (Higgins). This same alleviation of the risks was

also found in men who had received vasectomies (Higgins). The study concluded that men and women

who can safely engage in sexual relationships without the fear of pregnancy are less likely to suffer

depression, anxiety related disorders, mood disorders and personality disorders. Making it as widely

accessible and available could potentially expand these benefits for anyone to enjoy and reduce costs in

other areas as well.

Despite the data surrounding contraceptive programs the opposition to a nationalized system

aren't just derived from cost reduction analysis. The laws surrounding the consultation and prescription

of birth-control vary in complexity from state to state to such a degree that the organization Planned
 Traywick 6

Parenthood offers legal consultations and guides to assist teens and women living in poverty on where,

when, and how to get birth-control as well as how to pay for it. They actively work to lobby against

restrictive laws that may make getting access to contraceptives difficult, and when lobbying fails they

work to advertise any new changes to the law that could impact the process of getting contraceptives. In

2016, Maryland passed the Contraceptive Equity Act. This bill ingrained into law a mandate that

eliminates most co-payments for birth-control, removes barriers for obtaining IUDs, mandates insurance

coverage for over the counter birth-control like post-coital emergency contraception (the morning after

pill), and increases the allotted prescription sizes of birth-control able to be received at one time

(Parenthood). While the measures make it more accessible and widely available most of the bill's

language is reliant on the individual's insurer making getting access still contingent on one's financial

ability. No studies are available as of yet on the effects of the legislation.

The legal complexities surrounding contraception also encouraged those at Freethepill.org. They

seek to do something similar to Planned Parenthood in that they work to inform citizens of what is

required to gain a prescription for contraception. Additionally, they seek to inform others of different

state and federal initiatives that seek to make contraceptives either easier or harder to get. They even go

so far as to provide a simplified list for on hand reference when talking to doctors, insurers, or

pharmacists. Because their goals are so closely related in ideology to Planned Parenthood they

frequently work in conjunction.

The data gathered from many of these sources show overwhelmingly that when a country adopts

a nationalized contraceptive program societal costs and liabilities are significantly reduced. However, in

all of these examples despite the cost-reduction trend these programs still have their political opposition.

The program in France that created infrastructure and path ways for minors to acquire birth control was

strongly opposed by a Catholic group known as CLER, a group that specifically counsels youth on

matters of sexuality and relationships with the purpose of suggesting abstinence (Beardsly). While the
 Traywick 7

group was representative of a political minority in France, the United States of America has similar

groups that will behave similarly in regards to state-funded contraceptive programs. In one documentary

created and published by Steven L. Anderson , a Baptist pastor of a small church in Tempe Arizona, pre-

coital contraception is referred to as an “abortifacient” (Vimeo). The documentary explicitly works in

Biblical scripture to reaffirm this point and additionally uses dire language to describe and discuss birth

control. The documentary works to draw a direct line from pre-coital contraception to infanticide and

murder (Vimeo). While this pastor's flock is small, the documentary has millions of views. Religious

fundamentalists may not be the biggest political opposition to the hypothetical initiative, but it will

certainly be one of the loudest. Steven L. Anderson alone has organized events that invite thousands to

protest abortion initiatives on both federal and state levels.

In addition to the religious-fundamentalists political fundamentalists also pose an obstacle to the

passing of a nationalized contraceptive program. In response to a rise in the topic in fall 2018 author,

and conservative commentator Matt Walsh published a short opinion piece that outlined his problem

with a taxpayer funded state birth control initiative. In it he outlines his opposition to the idea as

predominantly consisting of two points: Birth control is already easy to get in the United States and does

not need a new system to be made more accessible, and his political rivals are simply obsessed with “free

stuff” (Walsh). Matt Walsh has an audience and his the video he uploaded covering this topic also has

thirty thousand views. He works for the Daily Wire, a predominantly conservative media source that

doesn't delve into the presenters individual religious beliefs as an opposition, but focuses more on the

politically idealistic aspects. As a conservative Matt Walsh doesn't believe that the government should be

involved in the prescribing and funding of an individuals health care (Walsh). This opinion is seen among

several other conservatives like him and has been echoed by others like Tucker Carlson, Bill O'Reilly,

Sean Hannity, and many other conservative commentators. This idealism is similar to the religious-

fundamentalist idealism in that it is unmovable. In Walsh's rant he specifically says “I don't want to be
 Traywick 8

involved in your sex life” multiple times over. He does nothing to comment on the efficacy of any of the

programs or the logistics of the question, he just simply out right refuses to consider it.

These two different groups, religious-fundamentalists and political-fundamentalists, pose the

greatest challenge for anyone attempting to pass a nationalized contraception program and will

adamantly work and lobby together to achieve their goals, albeit for entirely different reasons. They are

currently the loudest in regards to several topics and generally agree on far more than they disagree.

During the several pushes from the Republican party from 2015 to 2018 to “defund” Planned

Parenthood these two different groups were the ones primarily responsible for the constant out cry and

organized efforts. While the pushes to “defund” Planned Parenthood were predominantly centered

around the issue of abortion, that same fervor and ire will also be present when pushing for a

nationalized contraceptive program (Williams). That in addition to how the entirety topic surrounding

sexual health is generally also focused on abortion and its legality has also worked in attacking the

Affordable Healthcare Act's efforts at mandating companies to pay for contraception like in the famous

Hobby Lobby lawsuit of 2014 where the Supreme Court, in a five to four ruling, ruled that the

contraception mandate inside the Affordable Healthcare Act violates the Religious Freedom Restoration

Act (ABC News). This was both a win for the idealistic conservatives like Matt Walsh as well as the

religious-fundamentalists like Steven L. Anderson, despite the fact they favor the ruling for entirely

different reasons.

While these two sects have immense political power, the idea of a nationalized contraception

program is not intrinsically doomed. The previously mentioned sect of purely fiscal conservatives have

already made it a point in a quasi-bipartisan effort to create a program of the sort. Ted Cruz (a

Republican Senator from Texas) and Alexandria Ocasio-Cortez have recently engaged in hopeful

dialogue surrounding the concept in addition to working on other measures to block congressman from

becoming lobbyists after their terms are up (ABC News). While birth-control, women's health, and
 Traywick 9

general sexual health is generally more a talking point for the politically left leaning factions many

contemporary Republicans (pure fiscal conservatives) like Republican Senator Cory Gardner, Senator

Joni Ernst, Congressman Barbara Comstock, and former Louisiana Governor Bobby Jindal have also

shown genuine support for the idea (ABC News). Given the galvanized nature of political discourse in

the United States of America finding such cross party support in regards to most topics is generally rare.

While the bipartisan support is a promising start the political costs are generally more difficult to

estimate. After the initial show of bipartisanship between Ted Cruz and Alexandria Ocasio Cortez back

lash erupted quickly because Cortez's plan would mean that women who currently get their birth control

for free through their insurers would have to start paying out of pocket again. As a result of this

backlash other Democrats began to distance themselves from her idea. Also in the case of Ted Cruz

showing his support for Cotez's plan Cruz was directly targeted by members of the religious-

fundamentalist groups and the idealistic conservatives (ABC News). The Daily Wire, the same

conservative media company that Matt Walsh works for specifically wrote dissenting opinion pieces and

articles critical of his support of his political opponents (Walsh). While Ted Cruz is acting as a pure fiscal

conservative in regards to this issue, he prides himself on his religious beliefs and political ideals both of

which have been argued by his previous political bases to have been abandoned by his recent show of

cross the aisle solidarity. Any effort to enact a nationalized system will require that the political backlash

isn't loud or aggressive enough to make the candidates previously mention fear for their future chances

of getting reelected.

Assuming the initial political backlash isn't too immense to stop the process before it really starts

the next step after building support is for a politician to craft the bill. Usually when crafting legislation

different lobbying groups are included and consulted in the process. After that, the bill is then required to

be sponsored by a specific congressman. There the bill will then be investigated and researched via

organized committee. Once released by the committee(s) that investigated the effort the bill is put on a
 Traywick 10

calendar to be voted on by the House of Representatives only after it has been debated and/or amended

by other members of the House of Representatives. After it has been debated and amended it is then

voted on and to pass it simply requires a majority of the votes which is two-hundred-and-eighteen votes

out of four-hundred-and-thirty-five (house.gov).

This lengthy process is simply to get through the House of Representatives. In the senate almost

the same steps are followed. First in the Senate the bill has to be put on the table by the Senate Majority

Leader, who is currently Mitch McConnell. After being put on the table the bill is then sent to another

set of committees and investigated again by Senate efforts. After leaving the committee the bill is then

debated and amended again by the members of the Senate. After all the amendments and debates are

resolved the bill is then voted on where once again it requires a majority which is fifty-one out of one-

hundred votes. After a majority vote the Senate's version of the bill is then compared by a conference

committee made up of Senators and Congressman to the bill the House approved. The bill then returns

to the House and the Senate for Final approval, and after that the President has ten days to sign or veto

the bill. Signing the bill enacts it into law and vetoing the bill sends the bill back to congress for

modifications (house.gov).

The difficulty through the process is once again political. In order for any bill to get voted on in

the Senate the Senate Majority Leader (and individual selected by the party that holds the majority in the

Senate) must first agree to move the bill forward. If that individual doesn't want to then the bill gets

halted mid-process and can't be pushed via any other means. The current Senate Majority leader, Mitch

McConnell, has actively stated many times over that if he doesn't specifically agree with a bill he won't

let it into the senate. So as of right now he would have to be on board with the measure before it ever

had a chance at passing, or in the future would have either not be selected by his party again or another

party gain the majority in the Senate. If all of these different steps can be adequately processed with

proper support a nationalized contraception program could be enacted into law, but at every step the
 Traywick 11

opposition will be present (house.gove).

The meme summing up Colorado's LARC program, through various studies and projects, has

been supported time and time again. Multiple studies and investigative efforts have found overwhelming

success in these programs, both here in the United States of America, and abroad in other countries with

differing cultures and societal components. While not technically absolutely accurate it is an entrance

point into the concept of state-based contraception programs that can have tremendously good effects

on the country and its citizens. When accessibility is prioritized the impact is that it will benefit the

individuals taking advantage of the program as well as the society at large in the form of a smaller tax

burden for tax payers.

Works Cited

Anderson, Steven L, director. The Birth Control Pill. Vimeo, 18 July 2019, www.vimeo.com/12090300.

Beardsley, Eleanor. “In France, Free Birth Control For Girls At Age 15.” NPR, NPR, 18 Dec. 2012,

www.npr.org/2012/12/18/167253336/in-france-free-birth-control-for-girls-at-age-15.

Brown, Elizabeth Nolan. “Over-the-Counter Contraception Is Immensely Popular. But Democrats Have

Doomed It.” Reason.com, Reason, 16 Jan. 2019, reason.com/2019/01/16/deregulate-the-pill/.

de Vogue, Ariane. “Hobby Lobby Wins Contraceptive Ruling in Supreme Court.” ABC News, ABC

News Network, 30 June 2014, abcnews.go.com/Politics/hobby-lobby-wins-contraceptive-ruling-

supreme-court/story?id=24364311.

Dibble, Maddison. “AOC Finds Herself Siding With Republicans on Over-the-Counter Birth Control:

Here Are 4 Things to Know.” IJR, IJR, 10 June 2019, ijr.com/ocasio-cortez-sides-gop-over-

 Traywick 12

counter-birth-control/.

Engelman, Peter. History of the Birth Control Movement in America. Praeger, 2011.

Glasier, Anna, et al. “Emergency Contraception in the United Kingdom and the Netherlands.” Family

Planning Perspectives, vol. 28, no. 2, 1996, p. 49., doi:10.2307/2136123.

Grindlay, Kate. “What's the Law in Your State?” Free the Pill, Freethepill.org, 26 June 2019,

freethepill.org/statepolicies/.

Higgins, Jenny A, and Nicole K Smith. “The Sexual Acceptability of Contraception: Reviewing the

Literature and Building a New Concept.” Journal of Sex Research, Routledge, 2016,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4868075/.

Lacapria, Kim. “Colorado Birth Control Facts.” Snopes.com, Nov. 2016, www.snopes.com/fact-

check/colorado-birth-control-facts/.

Madison, James. “The Legislative Process.” The Legislative Process | House.gov, 1991,

www.house.gov/the-house-explained/the-legislative-process.

Parenthood, Planned. “Maryland Contraceptive Equity Act.” Planned Parenthood of Maryland, Inc.,

2018, www.plannedparenthood.org/planned-parenthood-maryland/get-involved-locally/action-

network/maryland-contraceptive-equity-act.

Peipert, Jeffrey F, et al. “Preventing Unintended Pregnancies by Providing No-Cost Contraception.”

Obstetrics and Gynecology, U.S. National Library of Medicine, Dec. 2012,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4000282/.

Sedgh, Gilda, et al. “Adolescent Pregnancy, Birth, and Abortion Rates across Countries: Levels and

Recent Trends.” The Journal of Adolescent Health : Official Publication of the Society for

Adolescent Medicine, U.S. National Library of Medicine, Feb. 2015,

 Traywick 13

www.ncbi.nlm.nih.gov/pmc/articles/PMC4852976/.

State, Colorado. “LARC4CO.” LARC4CO, 2014, www.larc4co.com/.

Vamos, Cheryl A., et al. “Approaching 4 Decades of Legislation in the National Family Planning

Program: An Analysis of Title X's History From 1970 to 2008.” American Journal of Public

Health, vol. 101, no. 11, 2011, pp. 2027–2037., doi:10.2105/ajph.2011.300202.

Walsh, Matt. “WALSH: Nobody Wants To Take Away Your Birth Control, Liberals. We Just Don't Want

To Pay For It.” Daily Wire, The Daily Wire, 14 Nov. 2018,

www.dailywire.com/news/38344/walsh-lefts-most-delusional-scare-tactic-matt-walsh.

Williams, Janice. “Alexandria Ocasio-Cortez Proposes Free, over-the-Counter Birth Control for

Women.” Newsweek, Newsweek, 10 June 2019, www.newsweek.com/alexandria-ocasio-cortez-

birth-control-1442938.