When the American Health Care Act (AHCA), the bill to repeal the current health-care law, passed the U. S. House, my first thought was: Shit, would I have to stop having sex?
Like the AHCA, the U.S. Senate’s bill, the Better Care Reconciliation Act (BCRA), will roll back advances the previous administration made in increasing access to preventive services, including contraception. To name just one, the BCRA does not require states to cover birth control as an essential health benefit.
I have an intrauterine device (IUD) that expires soon. My IUD was covered by my insurance plan under the current health law, commonly called Obamacare. If the BCRA takes effect—or if the administration guts the birth control benefit in Obamacare through regulatory action—it could cost me $1,000 for a replacement.
I feel the opposite of what I felt in January 2013, when I found out my birth control did not require a co-pay. Whereas I was relieved my birth control would finally be affordable, now I am uneasy about affording the birth control of my choice. This discomfort mirrors my apprehension of visiting a doctor and talking to her about birth control in the first place.
There was a time when I was too afraid to ask any doctor about acquiring birth control. As I explained in a previous Rewire article, I grew up in the church and had vowed to remain celibate until marriage. I continued my religious experience by attending seminary and later becoming ordained as a minister in my denomination. Coming of age, mentors and Sunday School teachers encouraged me to “save myself.” I didn’t want to get birth control because for me, it was like admitting I was planning to sin. As a teenager, this made sense; however, as I got older it became less and less reasonable.
After spending a few years poring over theological texts, I realized that sexual sins in Scripture are inconsistent to how we think about sex in the real world. I overcame my anxiety about becoming sexually active despite being religious, and eventually talked to my doctor about birth control.
I initially asked about the pill and ended up with the cheapest option, which cost only $9 a month through my health insurance. Soon after, my doctor switched me to a more expensive brand because I experienced breakthrough bleeding. My monthly co-payment increased from $9 per month to $30 per month.
Thanks to Obamacare, that $30 reduced to $0. I still remember the day I went to the pharmacy to pick up my monthly subscription. When I pulled out my debit card to pay, the register flashed $0.00, a satisfying feeling after years of reproductive rights activism. It also affirmed my choice; having my prescription at no additional co-pay removed a barrier to controlling my own sexuality. Talking to my doctor had given me a new sense of freedom; getting contraception at no extra cost strengthened it.
Three years ago, I got an IUD after trying a couple different brands of the pill. In an era of regressive health-care policy, I’m afraid I may not be able to afford a replacement of my preferred contraceptive method.
Here are my options if the contraception requirement is eliminated:
Use the pill again. It’s cheaper, but I’m forgetful and I would inevitably risk becoming pregnant.
Use condoms. Condom use is a viable option, but pregnancy prevention isn’t the only benefit to hormonal birth control. Condoms won’t help regulate my period so that it’s shorter, lighter, and more predictable, and don’t reduce pain from cramping.
Stop having sex. I even thought about calling my boyfriend and joking that we have to stop having sex in September, when my IUD expires—but that’s not going to happen.
Just plan to get pregnant. It wouldn’t be the worst thing in the world, but I don’t want to parent a child right now. My child deserves a mom who is ready.
Having to rethink my options is unfortunate for a number of reasons, not least of which because it invalidates my choice both to have a sex life in spite of my abstinence-only upbringing and to overcome the shame and stigma of using contraception.
Restricting contraception access is rooted in the notion that women’s sexuality should be limited to marriage and reproduction. If a woman decides to have sex outside of these strict parameters, she doesn’t deserve access to health-care services. I heard this rhetoric frequently as a church girl.
But the truth of the matter is: Religious women of all denominations, single and married, are having sex and using contraception.
Right now, advocacy groups are encouraging their constituents to call their senators and ask them to vote no on the bill. It gives me a sliver of hope that Senate Majority Leader Mitch McConnell (R-KY) delayed the vote on the BCRA and people across the country are rallying against it. But the discussion about restricting contraceptive coverage raises again the stigma that women don’t deserve to have healthy sex lives. We need activists and other leaders to say explicitly: Women need affordable contraceptive coverage because women are having sex—and there’s nothing shameful about that.
These efforts feel like déjà vu, taking me back to the moments when I felt ashamed to ask my doctor about birth control, because I didn’t think I deserved it.
CORRECTION: This piece has been updated to clarify the current bill being debated in the U.S. Senate, the Better Care Reconciliation Act.
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This Rewire piece is published in collaboration with Echoing Ida, a Forward Together project.
Emma Akpan is a member of Echoing Ida, a project of Forward Together. Last year, Emma participated in the Moral Monday protests at the state capitol, offering a closing prayer on Reproductive Rights Advocacy Day. Emma has a master’s degree in divinity from Duke University. She serves on the board of NC Women United as well as the Resource Center for Women in Ministry in the South. In her free time, Emma likes running and starting book clubs. She doesn’t believe a nice day should be wasted inside, and time shouldn’t be wasted eating bad food.