The Supreme Court ruled Monday in Burwell v. Hobby Lobby Stores that family-owned companies are not required to cover some types of contraceptives for employees.
The full consequences of the ruling have yet to be unraveled, but one thing is clear: It could have grave consequences for girls, women and families throughout the developing world.
At issue is the IUD, or intrauterine device, which the defendants in the case — Hobby Lobby Stores and Conestoga Wood Specialties — specifically resisted covering in employee health plans. The IUD is one of the most effective forms of contraception and has spared millions in the developing world from lives of crushing poverty, sickness and early death.
By giving credence to the religious view that IUD use is controversial, the Supreme Court may have inadvertently opened a door for attacks on federal support for IUDs and other lifesaving family-planning options that can affect women’s health beyond the United States’ borders.
The gospel of contraception
In the low-income Guatemalan neighborhood where Ingrid Alvarado lives, chances are that neither she nor her neighbors have heard of Hobby Lobby or the Affordable Care Act.
A mother of seven, Alvarado and her husband, a day laborer, knew that another child would stretch them past the breaking point. “Each child is beautiful. They are all so beautiful,” Alvarado said. “But when one gets sick, sometimes you don’t have what you need to take care of them. Sometimes there’s not even enough bread or water to give them.”
Alvarado is lucky to be alive. In the developing world, lack of access to contraception is a health crisis affecting 222 million women and girls. Every two minutes, a woman dies of pregnancy- or childbirth-related complications.
The unmet need for contraception is a social and economic crisis as well. Young mothers usually cannot go to school, carrying the cycle of poverty forward to the next generation.
It is time to lift the controversial veil from the word ‘contraception’ and put the issue squarely where it belongs: at the center of the global health, economic, environmental and human rights agenda.
It was not until PASMO, the Central American member of the international health organization Population Services International, made available a range of contraceptives — including long-acting reversible contraceptives such as the IUD — in Alvarado’s community starting in 2008 that she and her husband were able to make informed decisions about their family’s future, based on an understanding that only they have of their household’s capacity to care for more children.
Today Alvarado preaches the gospel of contraception and family-size choice to her daughters.
"I told my daughter to have two children,” she said. “Have two until they’re 10 or a certain age, and then you can decide if you’re going to have more.”
Human rights issue
In my role as a board member of PSI, I shared in the joy and hope of lives transformed where appropriate contraception options — as determined by the individuals they affect — are available.
U.S. assistance for family-planning services has been under attack for years. Today only two cents of every development dollar goes to support programs for girls, such as those that provide access to contraception. This, even though evidence shows that every dollar invested in contraception saves $4 in other areas, such as education, public health and water and sanitation.
Funding has stagnated while a raft of ideologically driven restrictions has hampered efforts to get family-planning services to support the world’s poorest women and the children they already have and desperately struggle to care for. These are services women and couples want. In the last few years, attacks on contraception have expanded. My colleagues at PSI and I are concerned that the Hobby Lobby decision could give rise to a newly invigorated round of restrictions on access to contraception everywhere.
It is time to lift the controversial veil from the word “contraception” and put the issue squarely where it belongs: at the center of the global health, economic, environmental and human rights agenda. In doing so, we will give women in every country the opportunity to become the next great leader, doctor, mom or teacher — wherever their dreams lie.
We simply cannot let this Supreme Court decision set the clock back even further.