Access to Birth Control Versus Affordable Birth Control- Choose Wisely…

Okay, get ready for some real talk. I’ve been hearing a lot about birth control in the last few days- understandably so, given that it’s now easier for companies to opt out of including zero-copay birth control in their employee insurance plans. (Note that I chose my words carefully, whereas the headline did not. More on that at the end.) For the sake of both my sanity and the underlying debate, I am imploring all of you to properly distinguish between “access” and “affordability.” Like, pretty please with some sprinkles of Ortho Tri-Cyclen on top.

To see why the distinction is important, let’s suppose that my employer opts out of providing birth-control coverage in my insurance plan. (Perhaps because they prefer paying for maternity leave, I don’t know their life.) Do I (personally) still have access to birth control? Sure, I just go to the doctor and pay for it myself. I’m told this would cost me between $20 and $50 per month, plus the cost of the initial visit if that too was excluded from coverage. Annoying, but not a huge problem. For me. (hashtag humblebrag)

When I step away from my personal situation, however, the increase in cost could be a limiting factor for many people, or, at the very least, could cause people to decide that forgoing birth control is worth the risk. I get that, I’m not a total monster. Instead, I’m pointing out that, for the most part, the problem is an affordability one and not an access one. To see why the distinction matters, allow me to play devil’s advocate in a couple of scenarios:

Scenario 1:
you: the policy change results in women losing access to birth control
me: no it doesn’t there is nothing preventing them from buying it so there’s really no problem

Scenario 2:
you: the policy change results in birth control becoming unaffordable for many women*
me: well…uh…*tries fruitlessly to convince you that $50 per month is affordable for everyone*
* this is technically predicated on the loss in health coverage not being made up for in higher wages to keep total compensation const…HAHAHAHAHA, yeah I see it now.

Words matter. They change the conversation, and using them precisely can prevent them from being co-opted by adversaries. In this case, the distinction between “affordability” and “access” matters because access affects everyone whereas affordability affects mainly lower-income people. Saying you’re for “access” actually means that you’re cool with only higher-income people purchasing birth control, and, in context, I’m pretty sure that that is not the point that many who use the word are trying to make. Unfortunately, it allows their opponents to (disingenuously) say that they want the same thing so there’s no need for discussion.

Furthermore, framing “affordability” as “access” kind of dilutes the notion of access in cases where access really is a direct issue. Take abortion services, for example- in many areas, abortion providers are so few and far between that access, taken literally, can reasonably be seen as a limiting factor. Sure, I could make the argument that this too is under the heading of “affordability” since I can always pay to rent a car, drive 700 miles, stay in a hotel, etc., but even I have my limits when it comes to semantic precision. In other words, no Twitter, I don’t also see coat-hanger proximity as access to abortion. (That actually happened.)

I’m not advocating for any particular policy here, though I do think that most economists would point out that there are positive externalities (i.e. spillover benefits for society as a whole) to women being able to plan when to have children. Economically speaking, these societal benefits- women completing their education and staying in the work force, for example- do in fact help make the case that a government has a vested interest in women being able to use birth control if they want to. And before I get all the angry emails, allow me to clarify that this doesn’t mean that economists think children are bad, just that they are less disruptive if they can be conceived strategically. (Very romantic, I know.)

In related news, I also argue that people can in fact choose how many children to have without involving birth control. (Note I’m not saying it’s a fun idea, just possible.) And don’t get me started on “if your employer pays you and you buy birth control, aren’t they still indirectly paying for birth control?” It goes about as well as you would expect. :)