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Saturday October 25th 2014

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The Case for Birth Control

Why it’s necessary and where to get it
By Jennifer Leigh

Since June 30—when the Supreme Court ruled that companies such as Hobby Lobby could refuse to pay for some forms of contraception that violate the religious tenets of business owners—it seems that you can’t mention birth control without getting an opinion on the giant craft store.

What the case means
Burwell v. Hobby Lobby, or the Hobby Lobby Case as it is often called, has sparked many an op-ed and news story since the chain store filed a suit in the U.S. District Court for the Western District in Oklahoma over the federal mandate to provide specific forms of contraceptives such as Plan B, Ella and IUDs.

Under the Affordable Care Act, all qualified employers (those with 50-plus full-time or full-time equivalent employees) need to provide health care that includes all forms of contraception at no cost.

The evangelical Christian owners of Hobby Lobby—the Green family—aren’t denying coverage of contraception, but more specifically the forms of emergency contraception. The quote used in many stories says their “religious beliefs prohibit them from providing health coverage for contraceptive drugs and devices that end human life after conception.”

Dr. Julie DeCesare, obstetrics and gynecology residency program director and associate professor at Florida State University of College Medicine, said the case doesn’t just make her worry about birth control, but women’s health in general.

“Our health is getting worse, not better,” DeCesare said.

More than birth control
The FSU obstetrics and gynecology residency program is housed at Sacred Heart Hospital in Pensacola.

As a member of the nation’s largest Catholic non-profit health system, the hospital does not offer contraceptive care unless it is needed for a medical purpose, which is then brought to an ethics committee for discussion. DeCesare says she is respectful of the hospital’s beliefs.

Off the top of her head, DeCesare said she believes that of the women that come to the clinic for family planning, about 25 percent do so for are medical needs.

She lists all of the uses that birth control offers beside the self-explanatory one.

“If a woman has irregular bleeding or blot clots, metabolic syndrome, acne—that’s a huge one—or endometrial cancers, birth control can treat it,” she said.

In some cases, IUDs—which Hobby Lobby does not cover—can save a woman from endometrial cancer.

“When we’re limiting availability to treatments that could prevent cancer, we’re taking a step in the wrong direction,” she said.

For 32-year-old Carol Rice, birth control isn’t an elective medicine. It’s an imperative daily routine.

“I was diagnosed with Stage IV endometriosis the beginning of 2012,” she said. “Since then, my doctor has had me on a strict birth control regimen. Birth control helps keep my disease under control—it prevents the disease from spreading, which causes severe pain and possible surgeries.”

DeCesare also mentioned the use of birth control for women with developmental delays. A woman with severe autism, she said, could have hygiene issues during menstruation.

“Birth control offers cycle patrol. Sometimes a woman doesn’t get her period at all,” she said.

As a parent of a mentally handicapped daughter, Janet Castellano sees birth control as a necessity.

“Some parents of handicapped daughters use birth control because if you think of it—if they are in a residence there is always a chance of something happening, and it is used as a protective measure,” Castellano said. “I know of someone whose sister was institutionalized with autism and was raped, so I would venture to say that it’s not just the mainstream girls that the Hobby Lobby case would affect.”

Getting covered
It’s arguable to say that if an employer doesn’t give you the benefits you want, or if the hospital doesn’t offer the care you want, you can just go somewhere else. However, with the U.S. unemployment rate at 6.1 percent and less than half of the country’s states offering Medicaid expansion, it’s hard to be choosy about your job or your doctor.

There are a few options for care for those under insured or without any insurance. Sacred Heart Women’s Clinic, Escambia Community Clinics, Inc. and Florida Department of Health in Escambia County offer care based on ability to pay.

“In this economy, it’s just important for women to know they have access to care,” said Sherri Hutchinson, press secretary for the Florida Department of Health.

The out of pocket cost of birth control can vary. Some prescriptions are as inexpensive as $4. An IUD can cost anywhere from $500 to $1,000 out of pocket.

The health care mandate on birth control has not only provided more access to birth control for employees, but has made it more affordable.

“My birth control would have been $1,800 out of pocket, which I was prepared to pay,” Yasmin Massey said. “Instead, it was covered thanks to ACA and now I can spend that $1,800 in our local economy instead of lining the pockets of the pharmaceutical companies.”

Babies vs. Birth Control
No matter how expensive birth control is (no matter its purpose), giving birth and then raising a child are far more costly. According to the CNN Money website, it costs an estimated $241,080 to raise a child in the United States. The cost is up 3 percent from 2011 and doesn’t include the cost of college.

In 2011 the national average charge of giving birth in a hospital with no complications was $10,657. Medical bills are on a short list of reasons that Americans apply for bankruptcy.

“Fifty-one percent of pregnancies are unplanned [in the United States],” DeCesare said. “It’s appalling.”

Without easy and affordable access to contraceptives, it no longer becomes the patient’s problem, but everyone’s problem.

“Everyone has to take on the burden,” DeCesare said. “It’s not just a women’s issue. It’s a societal issue. Wouldn’t it be better to not have the children you can’t take care of?”

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Birth Control Breakdown
•IUD (Intrauterine Device) is a small “T”-shaped device inserted into the uterus. IUDs work mainly by affecting the way sperm move so they can’t join with an egg. The cost is between $500 and $1,000, but they last up to 12 years.
•Implant The implant is a matchstick rod inserted in the arm releasing progestin. Cost is $400 to $800 and lasts up to three years.
•Patch The small, beige patch sticks to your skin releasing the same hormones as the pill, estrogen and progestin.
•Pill The pill is taken every day to release estrogen and progestin, which keep the eggs from the ovary. Cost varies.
•Shot One shot in the arm prevents pregnancy for three months. Cost $35 to $100 per injection, plus any exam fees.
•Sponge The sponge is made of plastic foam and contains spermicide and inserted deep into the vaginal before intercourse. Cost is $9 to $15 for a pack of three sponges.
•Vaginal Ring The ring is a small, flexible ring a woman inserts into her vagina once a month. The ring contains the same hormones as the pill. Cost is $15 to $80 a month.
•Morning-After Pill You can use the morning-after pill up to five days after unprotected sex. There is also an IUD insertion. Cost is $30 to $65 for the pill and $500 to $900 for the IUD.

Information provided by plannedparenthood.org

Where to go
For comprehensive, low-cost care, these are a few of the clinics you can visit in Pensacola.
•Sacred Heart Women’s Hospital Located at 5045 Carpenter Creek Dr. in Pensacola, directly behind Olive Garden near Cordova Mall. For appointments, call 416-2400 or visit sacred-heart.org.
•Escambia Community Clinics, Inc.There are nine locations in Escambia and Santa Rosa County. Visit ecc-clinic.org or call 436-4630 for more information.
•Florida Department of Health in Escambia County Visit escambiahealth.com for locations or call 484-5040 ext. 1125 to make an appointment.