I probably have a condition called endometriosis. I say probably because a conclusive diagnosis requires laparoscopic surgery , and my symptoms have not justified such a procedure thus far, because they are more moderate than those of many with the condition. Those symptoms have affected my life heavily since I was young – excruciating, sometimes immobilizing pain for a day or two a month. It’s caused me to miss days of school and work sometimes directly, sometimes indirectly, when the intense twisting in my pelvis has left me unable to concentrate. I’ve vomited because of it, spent hours on a bathroom floor unmoving because of it, and driven home a scant four miles terrified that I wouldn’t make it safely, so distracted due to agonizing abdominal pain as to be barely capable of focusing on the road. I’ve taken hospital dosages of over-the-counter pain medications for several days of every month just to be able to function. Again, my symptoms are mild to moderate on the spectrum of endometriosis  – many women are unable to treat their symptoms with easily available medication, even if taken 800 mg at a time.
The most common first treatment for this condition is to be put on some form of hormonal birth control. My practitioner suggested either an intrauterine device or a standard dual hormone oral contraceptive, when I went in a little over a year ago after almost fainting at work. I’ve been on the latter since that time, and my symptoms have dramatically decreased. I don’t often require ibuprofen to get through the work day, and I have not experienced pain which prevented me from going to work or school since I began taking it.
This post begins with the hope of broadening our understanding of the reasons women require hormonal birth control – the kind religious objectors often find most unacceptable, believing it to cause the loss of fertilized eggs , . Many studies have confirmed the effectiveness of hormonal contraception for non-contraceptive purposes, including polycystic ovarian syndrome, primary dysmenorrhea, endometriosis, and other hormone-related irregularities , , . I’m not remotely unusual in taking advantage of these benefits – a 2011 study found that “more than half of pill users, 58%, rely on the method at least in part for purposes other than pregnancy prevention.” 
Clearly relevant is the current effort to roll back the portion of the Affordable Care Act mandating that contraceptives be covered without copay . I understand and am receptive to arguments against the constitutionality of this provision . However, I would point to the 2013 Burwell v. Hobby Lobby Case, which applied the accommodation for religious institutions and religious nonprofits to closely held for-profit companies: “Under this accommodation, the insurance issuer must exclude contraceptive coverage from the employer’s plan and provide plan participants with separate payments for contraceptive services without imposing any costsharing requirements on the employer, its insurance plan, or its employee beneficiaries.” 
It’s critical to understand precisely what was ruled in this case – that such companies were afforded the right of exemption to providing contraception or paying for it for their employees. Those companies filed paperwork stating their refusal, and the insurance issuer paid for and provided the contraception. These companies were no longer paying for their employees’ contraception. This compromise was insufficient for a number of organizations, who protested that filing paperwork allowed their employees to receive contraception and thus still constituted a burden upon the religious rights of the employer. The Supreme Court in this case requested a new accommodation be found , but the Obama administration concluded without a new accommodation acceptable to both parties.
I may not be significantly affected by the new, considerably broader exemption for the ACA contraceptive provision: as a grad student with healthcare through my university, I am unlikely to lose access to birth control, and as my stipend is over 200% of the poverty line , I might be able to justify the cost out of pocket . I’d probably, however, assume that going through a few bottles of ibuprofen a year was cheaper, despite the potential for high-dosage use to do long-term damage to my stomach  and stop using the prescription.
This change will, however, significantly influence the lives of women poorer than myself. If I had to pay $50 a month not to be in pain, I might fork it out, but I’d think twice about it on my salary. A stipend with a few thousand dollars less a year and I can guarantee that there would be no contest – the cost wouldn’t justify it. This extends beyond the net of women taking contraceptives to address medical issues: those who wish to decrease the rate of abortion would do well to understand that one of the strongest correlations for abortion is that of low income – a 2014 study found that 75% of women who received abortions fit this description, to wit: “49% living at less than the federal poverty level, and 26% living at 100–199% of the poverty level.”  Abortion rates are currently at a low not seen prior to Roe v. Wade , and although there is dispute as to why , the correlation between access to no-cost-to-consumer birth control and fewer unintended pregnancies is difficult to ignore .
We may not agree that there is a compelling government interest to ensure that women receive contraception without a copay, but surely anyone who wishes to see the number of abortions decrease (and pro-life or pro-choice, that describes a majority of views) should think carefully before knowingly increasing the cost of birth control for at least some women, especially when economics have a strong correlation to a woman’s choice to terminate a pregnancy. This is particularly true when the exemption is broad enough to be applied to any company with a “moral objection”, not just a provable religious one .
I don’t write to provide a full-throated rebuttal of the newer, broader contraception exemption. Reasonable minds may conclude that the government interest in assuring accessible, free-to-the-consumer contraception is not outweighed by its interest in protecting the right of companies to refuse to provide insurance coverage for it, whether their objections are personal or demonstrably religious, without guaranteeing a workaround. I do, however, wish to see this debate held with several facts understood:
– Many women take contraception for reasons unrelated to their personal life choices
– An accommodation has previously existed which allowed companies to be exempted from providing their employees with contraception or paying for the same, while ensuring that women maintained the same access to contraception
– Proper contraceptive use is one of the best insurances against abortion
– Women in indigent circumstances are most likely to receive an abortion, and most likely to struggle to pay for birth control without this provision.
I believe that the better we understand the nuances of the problem, and the more honest we are of the costs in both directions for our solutions, the better our solutions can be.
 The Mayo Clinic: Endometriosis – Diagnosis & treatment
 The Guardian: Women discuss endometriosis: ‘No one believed I could be in such pain from a period’
 Life Site News: All the pro-life facts about hormonal contraception (that you probably don’t want to hear) – Part I
 Document: Kathleen Sebelius Secretary of Health and Human Services, et al., Petitioners v. Hobby Lobby Stores, Inc., et al.
 Int J Endocrinol Metab. 2013 Winter; Non-Contraceptive Benefits of Oral Hormonal Contraceptives
 Minerva Ginecol. 2010 Aug; Non-contraceptive benefits of hormonal contraceptives.
 Panminerva Med. 2014 Sep; Combined oral contraceptives: health benefits beyond contraception.
 The Guttmacher Institute, Nov. 2011; Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills
 The New York Times: Trump Administration Rolls Back Birth Control Mandate
 The Federalist: Ham: Contraception Isn’t In The Constitution But Religious Freedom Is
 Document: Burwell, Secretary of Health and Human Service, et al. v. Hobby Lobby Stores, Inc., et al.
 Document: Supreme Court Decision, multiple cases including Zubik v. Burwell
 US Dept. of Health and Human Services: Federal Poverty Guidelines
 CostHelper Health: Birth Control Pills Cost
 Science Daily: High Doses Of Ibuprofen Cause Significant GI Bleeding, Despite Safety Profile
 The Guttmacher Institute: Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008
 The Guttmacher Institute: U.S. Abortion Rate Continues to Decline, Hits Historic Low
 The LA Times: U.S. abortion rate drops to a new low, but there’s a fight over why
 National Women’s Law Center: The Affordable Care Act’s Birth Control Benefit Is Working for Women
 NPR: Trump Guts Requirement That Employer Health Plans Pay For Birth Control