By taking Title X money from health providers to fund anti-abortion fake health centers, the government is trying to change the very meaning of contraception.
Hulu’s The Handmaid’s Tale has returned for a second season and it is impossible to watch it and not to notice a number of very pointed moments in June’s pre-Gilead life that foreshadows the country’s descent into Christian theocracy. One of the most glaring—and disturbing—memories portrays June being unable to get her new batch of birth-control pills without her husband’s signature allowing her to access contraception.
For many viewers, that moment was probably a shocking signal of how the patriarchy, even before the terrorist attacks on the nation’s capital, was being put in control of women’s bodies. But for reproductive-justice advocates, there wasn’t shock, but recognition, because this is already happening in our country. It is present in the states that continue to introduce bills asking for spousal consent for abortion despite a Supreme Court ruling stating that it is unconstitutional. It is present in partners who commit birth-control sabotage—hiding pills, poking holes in condoms or refusing to pull out—all in an attempt to get the person they are having sex with pregnant against her will. And it is present when doctors decide to no longer offer birth control to patients who are unmarried or force them to listen to a lecture about “getting right with God” in order to get their prescriptions filled.
Now, the Trump administration is planning to make those situations even worse.
In yet another major policy gift to the religious right, Trump has signaled his plans to remove Title X funding from any health-care provider that also offers abortion services, especially targeting Planned Parenthood. According to Axios, funding would instead go to “Women’s Qualified Health Centers,” apparently the new name for Federally Qualified Health Centers or FQHCs—this despite the fact that a large number of these centers don’t actually offer public health care or full-scale services, and in fact are located in prisons, elementary schools, or dental offices.
This lack of providers doesn’t upset the anti-abortion-movement leaders, though, since they have their own solution: ask to receive the funding themselves instead. Normally, the idea that these “pro-life health centers” would get Title X funds would be laughable. After all, Title X funding is meant for sexual health-care services, especially contraception. With most self-identified pro-life medical centers unwilling to offer hormonal contraception, IUDs, or even barrier methods like condoms, they should be completely out of the picture. But that was before the administration decided to change the meaning of contraception itself.
Peppered all throughout the Health and Human Services Title X funding proposal is references to “natural family planning” as an acceptable, even preferred, form of contraception. Natural family-planning methods are non-hormonal and non-invasive and yes, many people do prefer them to using hormonal means like birth-control pills or implants, the lack of autonomy which can come from an IUD (which requires an office visit to be implanted and removed), or even the feel of condoms.
It is also very, very ineffective. While proponents tout a highly effective rate with “perfect use,” the truth is that perfect use is an infrequent occurrence. Meanwhile, the average user faces a failure rate of about 25 percent. In other words, one in four people solely using methods such as pulling out or charting fertility cycles to prevent pregnancy will still end up pregnant within a year. By comparison, that is nearly three times as many people as would get pregnant with regular use of the pill, 25 times more than would get pregnant on an IUD.
Why are natural family-planning methods so much more ineffective? Mostly it is due to the process itself. The most basic form is simply tracking periods and assuming you are fertile for the five days prior to ovulation, and that you ovulate two weeks before your period. This method is completely unreliable if you have irregular periods, or a shorter luteal phase (the time between ovulation and menstruation), or if your ovulation is off for any reason due to stress or illness or diet. FAM (fertility awareness method) is more effective but requires daily testing of cervical mucus and the need to take your temperature as soon as you wake up before you even sit up, and only after at least four hours of unbroken sleep. Any deviation from that regimen results in false trackings that can make a person appear to have ovulated when they haven’t yet, and poof: accidental pregnancy (I should know, that’s how my youngest son was conceived).
Yet despite the fact that it is clear that this is not an effective form of contraception compared to other methods—especially IUDs—abortion opponents are quick to suggest funneling money away from stand-alone reproductive-health centers that offer evidence-based birth control and allocating more funds to pro-life pregnancy centers and “women’s health” centers, or to community-based health centers where birth-control seekers would need to fight to get onto the schedules of doctors who are already overrun with patients needing to be seen for minor or major health issues. What was once a quick scheduling effort would potentially become weeks of waiting and hours spent in a lobby with exposure to multiple illnesses, all absolutely unnecessary if conservatives weren’t obsessed with defunding Planned Parenthood.
And that’s just the best-case scenario.
Whether or not Title X funding is being steered away from effective, proven birth control options and into programs that are essentially little more than a digital thermometer and a few xeroxed monthly charts, taking funds from reproductive health-care clinics means putting birth control behind the walls of yet another gatekeeper. We’ve already seen employers be able to veto birth control coverage, pharmacists opting out of filling prescriptions because of their religious beliefs, and doctors who won’t do prescriptions for birth control, devices or EC because they belong to organizations with healthcare directives that block them from doing so. Now the Trump administration and its anti-abortion, anti-contraception allies are desperately trying to cut off the only source where a person can easily and affordably walk in, obtain birth control, and walk back out without fear of hassle, denial, or a questioning of her sexual activities or a lecture on morality.
The most frightening thing is just how quickly it happens. After all, it has only been about 53 years since birth control was illegal altogether. The ability to legally use it if you are unmarried has only existed for a mere 45 years. And now we are on the verge of heading right back there, only instead of creating an actual law, the right is making a de facto ban by eliminating any chance of unrestricted access for all users, and instead sanctioning it off into arenas where a physician can pick and choose who exactly is worthy of the right to have sex without a potential pregnancy.
No, we aren’t quite to a place where a husband has to sign off and agree that he wants his wife to remain not pregnant—but the building blocks are already there. They are there in the roughly 20 states that won’t allow a teen access to birth control without parental consent unless she is already married. Or in the new “religious liberty” rules signed by the president that allows medical professionals to sue potential employers if they feel they weren’t hired because of their refusal to provide hormonal contraception. Yes, even at these Federally Qualified Health Centers that are supposed to be replacement for birth-control users who will no longer be able to access Planned Parenthood.
Today, spousal consent for birth control is thankfully fiction. But the GOP has many other ways of keeping a person from effective contraception, and they are putting them in place one by one, starting with dismantling Title X.
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