Birth rights

It is well past time to recognize that contraception is a basic medical need

It didn't take long for people to assert that men have a "right" to Viagra. Soon after the impotence drug was approved by the FDA, Capitol Hill was filled with talk of requiring health insurers to cover Viagra prescriptions, and men were filing lawsuits against insurers that were refusing to go along.

To be sure, Viagra is an important drug that meets a huge need -- mental, physical, and procreative. But now women are beginning to ask an important question: why hasn't insurance coverage of contraceptives -- just as basic a health need -- been taken as seriously? It is a question that shows just how backward the nation remains when it comes to women.

Even today, many health plans treat contraceptives as an extra. According to a study from the Alan Guttmacher Institute, a nonprofit research organization, only one-third of traditional health plans cover the Pill. Yet, perversely, 86 percent of those plans will pay to have a women permanently sterilized. HMOs have been doing a better job (84 percent cover the Pill), but even they have failed: only 15 percent of HMOs give women access to all five prescription contraceptive methods (the Pill, diaphragms, IUDs, Norplant, and Depo-Provera).

The situation, ignored by most men and grudgingly accepted by most women, is deeply hypocritical. Polls show that a majority of Americans think abortion should be "legal but rare." But instead of making contraceptives widely and cheaply available, the nation has been consumed by a bitter, divisive abortion debate that, in all likelihood, will never be finished. Most Americans would also agree that unwanted pregnancies tear at the social fabric. Everyone is familiar with the problem of young, single mothers, themselves not far from childhood. They can weigh down the government's safety net and feed the cycle of poverty (not to mention the potentially devastating personal consequences). Making contraceptives readily available does not guarantee that they will be used, but that does not mean that they should be treated as some kind of "luxury."

Yet a spokesman for the Health Insurance Association of America, which represents insurers in Washington, recently called contraceptives a "lifestyle drug."

That is an incredibly patronizing, but disturbingly common, notion. Contraception gives women the same sexual freedom that men already have. In this day and age, contraceptives are a societal necessity. They allow women to decide for themselves when to have a family and how large that family might be. They grant a woman, in other words, control over fundamental life choices. This debate isn't about lifestyle; it's about liberty.

Exactly 150 years ago, a small group gathered in the quiet town of Seneca Falls, New York, to begin what has since become known as the American women's movement. They declared, in echoes of the Declaration of Independence, that "all men and women are created equal."

Yet, 15 decades later, women are still not equal. Two senators, Olympia Snowe of Maine and Harry Reid of Nevada, have been trying to pass a federal law that would require insurance plans that cover prescriptions to include contraceptives. The provision would add only $21 annually to the total cost of coverage per person. It is still stuck in Congress. If men were the ones who got pregnant, this wouldn't even be an issue.

It is sad and telling that it took a new drug for male impotence to begin a discussion of something that has been an issue for women for many decades. But it's also not surprising. Ours is a society in which women who take control of their lives are still viewed with a measure of suspicion. Where female sexuality is still taboo.

It's time to grow up.

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