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For Me, Birth Control is Medicine First, Contraceptive Second

Issues other than sex rarely come up when we talk about birth control, but that is only part of the picture


I am a woman. I live in America. I’m on birth control. I’m a medical patient, who gets my prescription through a doctor’s office, and I depend on my employer-supplied insurance for it.

So the Supreme Court’s decision in the Hobby Lobby case shocked me. But more than anything, it scared me. Because in all the justifications I’ve heard for the decision, there’s an ugly notion resting underneath. Medically speaking, the court has implied, birth control is different from other medication. 

On the SCOTUS live blog, here’s how it was phrased: “This decision concerns only the contraceptive mandate and should not be understood to mean that all insurance mandates, that is for blood transfusions or vaccinations, necessarily fail if they conflict with an employer's religious beliefs.” 

In other words, this decision was intended to have no bearing on other, more “legitimate” medical needs. Things like transfusions and shots are safe, because it’s generally accepted that these are good medicine, and you’d be crazy to deny someone access to them. But contraceptives are a squishier subject. Because they are closely aligned with sex, they’re tainted.

It hurts me to hear this, because I remember a time when I believed it. When I was diagnosed, as a young teen, with Polycystic Ovary Syndrome, or PCOS, a condition with a wide range of reproductive symptoms. When I learned that, in my case, my body holds on to the endometrium instead of shedding it, leaving me at heightened risk for disease. When I was told, in no uncertain terms, that oral contraceptives were the only option to help my reproductive system function close to normally, and thus keep me healthy in the long run. When I was first put on birth control, long before I became sexually active. 

I had only ever heard of birth control in the context of sex. And so I was bewildered and upset. Here was birth control, being prescribed dryly and seriously as a medication to combat a chronic illness. Why hadn’t I ever heard of it being used this way? If I associated birth control with promiscuity, and I was taking it for medical reasons rather than sexual ones, what sort of woman did that make me?

Over the years, I’ve come to see birth control as a medicine first, and a contraceptive second. I’ve tried other medication regimens, to see if I could perhaps wean myself off the pill; none have worked. For me, oral contraceptives are the key to a body that functions almost as it should. 

This isn’t an uncommon story. On a regular basis, I encounter women with PCOS who rely on oral contraceptives to keep their reproductive organs in check. And even beyond our experience, there are a host of medical issues, tangentially or completely unrelated to reproduction, for which birth control serves serious medical uses. I’ve known women who take birth control to limit pain from endometriosis, to stave off migraines, to address skin-scarring cases of acne. 

These issues almost never come up in discussions about access to birth control, because the conversation is so dominated by sex, and by extension, pregnancy. Even when it does come up, the debate immediately gets redirected back. Witness Sandra Fluke’s passionate defense of contraceptives on behalf of her friend, who lost an ovary to PCOS. The loudest shouters in the public discourse immediately turned the conversation to her own sexual proclivities, accused her of agitating for consequence-free sex, and the point was completely lost. I watched that spectacle play out, raged over it, and cried quietly when my rage was spent. I could have been Sandra Fluke’s friend. My friends could have been her. 

Let me be clear: Just because birth control is often used therapeutically, that doesn’t mean that its contraceptive uses are any less legitimate. What it does mean is that a wide range of medical concerns are being dismissed as irrelevant or nonexistent. An entire realm of treatment, relied upon by scores of women, is diminished.

It’s a distasteful kind of theater, bringing all kinds of birth control users under the same black umbrella and then painting them with the same dirty brush. By highlighting religious discomfort first and foremost, without any acknowledgement of birth control’s medical importance, this case communicated loud and clear that women like me are collateral damage.