Apologists for the Supreme Court’s controversial ruling this week in Burwell v. Hobby Lobby Stores are fond of pointing out that the arts and crafts retail chain includes 16 forms of contraception under its health insurance plan and excludes only four. And by framing this as corporate benevolence, Hobby Lobby and the court have effectively opened the door to “method discrimination”—by which employers can limit their employees’ contraceptive choices to those that align with their beliefs.
This form of discrimination, drawing a line between “acceptable” birth control and contraceptive methods that Hobby Lobby’s owners object to on nonscientific, religious grounds, is a particularly dangerous line for black women. Black women have a number of special considerations because of our common health challenges and lower rates of access to routine medical care, as well as the intertwined histories of public health and state-sponsored racism.
So let’s dispense with the “Hobby Lobby does fund contraceptives” argument. Yes, the company’s health plan funds some contraceptives with no copay; methods include birth control pills, female and male condoms, vaginal rings and vasectomies.
But then there are the four: Hobby Lobby won’t cover Plan B, commonly known as the “morning-after pill”; Ella, another form of emergency contraception; copper intrauterine devices; and certain types of IUDs with hormones. The company equates these methods with abortion, even though medical consensus generally holds that emergency contraception works by preventing ovulation or implantation of eggs, not ending an existing pregnancy.
As Justice Ruth Bader Ginsburg warned in her dissenting opinion, the decision of the court’s five most conservative members is “startling in its breadth.” And while the proof will eventually be in the interpretation and implementation, there’s nothing in the high court’s opinion to suggest that the religious beliefs of the owners of “closely held corporations” won’t lead to the withholding of coverage for other medical treatment deemed objectionable by various religions—from blood transfusions to antidepressants to vaccinations to medications derived from pigs.
Not to mention the possibility of other companies saying no to select or all contraceptives. Though organizations such as Planned Parenthood are moving away from the vocabulary of “choice,” Hobby Lobby undermines the choices that all women should have when it comes to making decisions about if, when and how they become parents.
Health disparities play a role in what birth control women will and can use. A litany of statistics underline that black women are at high risk for unintended pregnancies and, it must be said, at high risk for social stigma about their fertility (too much of it) and mothering (too little or the “wrong” kind). But black women have less insurance and less preventative care, and though some 83 percent of sexually active black girls and women ages 15-44 use some form of birth control, black women overall remain behind their white and Latina peers in contraceptive use.
Hobby Lobby, then, is a renewed reason for black women to fly the flag for a more expansive array of contraceptive choices. For the large number of black women who have high blood pressure or are obese, certain contraceptives are not recommended. Hormonal methods, like the many variations of the pill, often exacerbate hypertension in women with these pre-existing conditions.
And that may not sound like a big problem until you see the numbers. According to 2009-2012 statistics from the Centers for Disease Control and Prevention, 58 percent of non-Hispanic black women 20 years and older are considered obese. Of that same population demographic, some 44 percent have high blood pressure. Those women probably shouldn’t access some of the most popular forms of hormonal contraception or should do so under a doctor’s care. Either way, they need a full slate of contraceptive choices, and men and women who are happy with their contraceptive choices are more likely to use them correctly.
On another level, high rates of sexual violence experienced by black women and girls make the availability of contraception—especially emergency contraception that can be taken after unplanned sexual encounters—an absolute necessity. And, in our society, women often cannot negotiate the terms of sex or even whether they will use birth control. In the wake of social norms that privilege male control of women’s sexuality and reproduction, a woman must have access to contraceptive forms that are long-lasting and less visible to hostile partners or those not in sync with her fertility goals.
Lastly, there are many reasons that black women would reject one method and pick another—cost ranks high among them. Given the long span of women’s reproductive lives, women can spend up to 30 years on and off birth control, if it’s available and affordable at all.
There’s also a thick history of black women’s conflicts over contraception and birth control, and that history lives in the way black communities talk about birth control. We know that the pill was tested with the incomplete consent of Puerto Rican subjects, and black nationalists have argued over whether abortion and birth control constitute racial genocide by culling the fruit of our collective loins. In the 1990s, reproductive-justice and civil liberty activists decried the use of the implant Norplant, saying that it was disproportionately and coercively prescribed for poor women using government assistance and could not be easily removed.
So if the Supreme Court’s decision, upholding Hobby Lobby’s “right” to dictate to its employees what kind of contraception they do and don’t have access to, seems distant and reproductive-justice activists’ complaints seem a little shrill, just remember that your employer could be a closely held corporation, and its owners might not like that pill you’re taking.
Cynthia Greenlee is a doctoral candidate at Duke University and a member of the Echoing Ida black women’s writing collective. Follow her on Twitter.
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