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The respectability politics of birth control

Talking about the medical uses of contraception is important, but it won't stop anyone from being called a slut.
Demonstrators cheer as the ruling for Hobby Lobby was announced outside the U.S. Supreme Court in Washington
Demonstrators cheer as the ruling for Hobby Lobby was announced outside the U.S. Supreme Court in Washington on June 30, 2014.

In March 2012, Liza Love of Glendale, Arizona had to testify before her state’s Senate Judiciary Committee about why she takes birth control pills. 

The country was awash in talk of birth control after new regulations in the Affordable Care Act required contraception coverage in insurance plans without a co-pay. In fact, Arizona state law had been requiring plans to cover contraception for years. But the politics had changed, it was an election year, and suddenly the existing religious opt-out wasn’t enough. As Majority Whip Debbie Lesko put it at the time, “I believe we live in America. We don’t live in the Soviet Union.” 

Love explained to lawmakers that birth control had ended years of pain, easing her struggle with polycystic ovary syndrome and endometriosis. 

The committee listened. The final version of the bill, signed into law by Jan Brewer that year, provided reimbursement if an employee provided written proof that there were “medical indications other than for contraceptive, abortifacient, or sterilization purposes.” Only upon protest did legislators include language that pointed out that employment discrimination law exists – i.e., you can’t be fired for using birth control.  

So what if an employee who got that reimbursement had sex without intending to have a baby? Would she have to give the money back? Unclear. As for employees of religious objectors who simply wanted to have sex without getting pregnant, well, those strumpets were out of luck.

In the wake of the Supreme Court recognizing an even broader right to refuse contraceptive coverage last week, the conversation about the medical uses of contraception has been revisited. That information is important; it affects millions of women like Love, who was brave to share her personal medical information in service of other women.

But as the Arizona example shows, it won’t get the even greater number of women who use birth control as, well, birth control very far. And it certainly won’t stave off the rank misogyny that surrounds so many discussions of women’s health. In fact, treating medically-indicated contraception as a trump card only risks perpetuating the stigma that already surrounds sexuality in general — and female sexuality in particular. 

Take a recent National Journal piece entitled “One Big Thing Everyone Is Missing In Hobby Lobby” -- that one big thing being that many women take birth control for medical reasons. Well, not everyone missed it, since, as author Lucia Graves notes at the outset, medically-indicated usage was pointed out in Ruth Bader Ginsburg’s widely-shared dissent. In fact, it was in the federal government’s brief to the court (on page 47), not to mention an entire amicus brief from the Ovarian Cancer National Alliance.

"We've tried to recast that debate to orient the Court to the fact that there's more going on here than pregnancy and contraception, but ultimately the Court went with the way Hobby Lobby had characterized it," an attorney who co-wrote that brief told Graves.

But a member of the Court’s majority in Hobby Lobby did note medical necessity: “There are many medical conditions for which pregnancy is contraindicated,” wrote Justice Anthony Kennedy in his concurrence, adding that he agreed that the coverage requirement “furthers a legitimate and compelling interest in the health of female employees.” That recognition still didn't stop him from voting in favor Hobby Lobby. 

As it turns out, some advocates have been trying to “recast that debate” for years. The most famous person to do it was Sandra Fluke, an attorney and activist now running for state Senate in California. As Graves points out in a second story, few people remember that her testimony focused on a friend with polycystic ovarian syndrome; they remember Rush Limbaugh calling her a slut. Even fewer people remember that the Georgetown plan Fluke’s friend was on actually had a medical exception and she still couldn’t get the coverage she needed. 

“Despite verification of her illness from her doctor, her claim was denied repeatedly on the assumption that she really wanted birth control to prevent pregnancy,” Fluke said then. “She's gay -- so clearly, polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her.” Unable to pay for the medication herself, Fluke's friend lost an ovary and began showing signs of early menopause.

Nonetheless, there was Rush Limbaugh devoting days of commentary to Fluke's own sexuality, declaring, "She's having so much sex she can't afford contraception. She wants you and me and the taxpayers to pay her to have sex." A few months later, at the Republican National Convention, a grandmotherly Michigan delegate said of Fluke, “She’s a grown woman. We shouldn’t have to pay for her stupid birth control. She could cross her legs.” When told that Fluke never said anything about being unable to pay for her own birth control, “She did so,” the delegate insisted. “She said that she couldn’t afford as a student to pay for birth control. She said that. I heard her.” (You can read Fluke’s prepared testimony here. She didn’t say that.)

All this is not proof that if we all talked more about medically-indicated birth control, no one would be called a slut and the court would rule on the side of broader contraceptive access, which is the implication of the latest round of commentary. It’s proof that even if a well-educated, soft-spoken white woman with an advanced degree never talks about her own sex life -- not once -- certain powerful members of the right will make it about her sex life.

This is a reality where women cannot win by talking politely about medical necessity or another person who didn't require birth control for fun, consensual sex, like the rape survivor whom Fluke also included in her testimony. It’s a reality where just commenting about the decision can get you called a whore.

As for said fun, consensual sex, as writer Jessica Valenti pointed out recently, it shouldn’t be revelatory to say women like it too, regardless of whether they’re ready to be pregnant. But focusing so much on medical reasons for contraception too easily veers into apologizing for using birth control for its main purpose. And it ignores the fact that for millions of women, simply being able to decide if and when they get pregnant has liberated them to pursue their dreams on their own terms – along with protecting their health in a variety of ways. That's why when the Obama administration argued for its "compelling interest" in the regulation, it specifically said it furthered "gender equality."  

 When women are shamed just for talking about birth control — for whatever purpose — it underscores the backlash is also about women's equal status, and how threatening that can be. As Fluke's experience shows, it doesn't matter why women take birth control — in the end, they're all sluts.