Birth Control-Tainted “Ladypee” in our Water: Myth or Menace?

Kimberly Inez McGuire

Claims that birth control pills are the sole or primary source of synthetic estrogen in water and therefore the cause of reproductive problems in fish or people misrepresent the science, plain and simple.

We were sitting on the beach in our brightly colored lounge chairs, sipping piña coladas and enjoying the sun as I reassured my friend Alycia that it was completely okay to use birth control continuously to “skip” your period. I was on vacation, yes, but debunking myths about birth control is not just part of my 9-to-5 job, it’s part of my life.

As a reproductive health and justice advocate, I often find myself answering questions from friends and family about birth control options, fertility, and sexual health. So, I wasn’t surprised when my friend Meghan, a well-informed environmentalist and feminist, asked me—“Is it true that birth control in our water is destroying the environment?”

It’s an unsettling question. Hormonal birth control, like any other modern convenience, carries with it an environmental “footprint.” As a supporter of reproductive health and environmental sustainability, I take the question of birth control’s impact on the environment seriously, as I do with the environmental impact of the food I eat, the transportation I use, and the products I buy. However, I also know that birth control is an easy target: a well-known, unfortunately politicized, and persistently controversial topic that makes for tantalizing headlines even when the evidence backing up a claim is thin.

Navigating the minefield of myths, misinformation, and urban legends surrounding sexuality and contraception can be challenging, especially when the science around an issue is complicated and opponents of birth control use that confusion to their advantage.

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This is a case in point: Claims that birth control pills are the sole or primary source of synthetic estrogen in water and therefore the cause of reproductive problems in fish or people misrepresent the science, plain and simple. New findings from researchers at UCSF help explain why.

For the past several years, scientists have linked reproductive abnormalities in fish to the presence of estrogen-mimicking chemicals in rivers and streams. Over the last few decades, scientists have also found increases in several conditions related to human infertility, and the evidence suggests that estrogen-mimicking chemicals in the environment are at least partially to blame. When these trends are reported to the public, birth control pills (which contain one kind of synthetic estrogen) are frequently singled out as the culprit. National news outlets have reported this, the Vatican has decried it, and Stephen Colbert even joked about it on his show. Just this summer, the anti-choice fringe group American Life League staged protests at Planned Parenthood clinics with the theme—“The Pill Kills the Environment.”

Stephen Colbert talking about intersex fish and “ladypee” filled with birth control hormones may get hits on YouTube—but it does not accurately describe the state of the science. The estrogen found in birth control pills, patches, and rings (known as EE2) is only one of thousands of synthetic estrogens that may be found in our water, and the contribution of EE2 to the total presence of estrogen in water is relatively small. The other sources of synthetic estrogens in our water include industrial chemicals commonly used in manufacturing (like BPA), synthetic estrogens in fertilizer spread over crops, and the synthetic estrogens pumped into livestock, including dairy cows, who are fed hormones to increase milk production. As an example, the volume of veterinary estrogens given to livestock each year in the US is 5 times the volume of synthetic estrogen women who use birth control consume.

Blaming birth control for the presence of estrogen in water is a bit like blaming the mess in the kitchen on your housemate who’s never home. Sure, she may leave a plate on the counter once in a while when she’s in town—but your real problem is your other roommate, the one who has parties every weekend and pizza boxes and beer cans stacked to the ceiling. Blaming birth control is a distraction from the egregious and unchecked use of synthetic estrogens by chemical companies and factory farms. It’s also a ploy to drive a wedge between environmental and reproductive health advocates.

And I’m not buying it.

Demonizing birth control will do nothing to improve our environment or reproductive health outcomes. Yes—we continue to need research and development of safe, effective and environmentally-sound contraceptives, but we also need better water treatment, regulation of farm runoff, and common-sense limits on the use of toxic chemicals in the manufacture of products we use every day.

The best way to protect our environment and reproductive health from chemicals is to tackle industrial and agricultural pollution at the source, and to increase access to safe and effective contraception. After all, when women are able to make their own decisions about whether and when to have children, they, their families, and the environment all reap the benefits.

For more information about synthetic estrogens and water, please visit: http://rhtp.org/contraception/EstrogensInWater.asp.

News Contraception

Maryland Moves to the Forefront in Birth Control Access

Michelle D. Anderson

It aims to prevent insurers, nonprofit health service plans, and health maintenance organizations from requiring "a copayment, coinsurance, or prior authorization requirement" for most contraceptive drugs and services.

Maryland Gov. Larry Hogan (R) this week signed what reproductive rights advocates are calling the nation’s most sweeping and comprehensive birth control access law.

Called the Maryland Contraceptive Equity Act, HB 1005 will require insurance plans regulated by the state to offer birth control with no out-of-pocket costs, starting in January 2018.

First introduced in February, the law was one of 196 bills Hogan signed on Tuesday. It aims to prevent insurers, nonprofit health service plans, and health maintenance organizations from requiring “a copayment, coinsurance, or prior authorization requirement” for most contraceptive drugs and services.

Sponsored by Del. Ariana B. Kelly (D-Montgomery) and state Sen. Delores Kelley (D-Baltimore County), the law requires companies to provide vasectomy coverage and six months of contraception coverage at a time. It also prohibits pre-authorizations for long-acting reversible contraception methods, such as intrauterine devices.

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Maryland is now the first state to require insurers to cover over-the-counter contraceptive medications, including newer options like Plan B.

Lawmakers said the law won’t go into effect until 2018 so insurers can prepare for the 2017 open-enrollment season, the Baltimore Sun reported.

Champions of the bill, such as local Planned Parenthood officials, have noted that Maryland has a history of being at the forefront of reproductive health care, telling the Sun that the state first mandated contraceptive coverage in 1998.

Karen Nelson, president and CEO of Planned Parenthood of Maryland, called the law a “bold move” and praised the Democratic-led legislature for passing the bill.

The state’s Planned Parenthood affiliate said in a statement that the law would make Maryland the first to provide equity in contraception access for men by requiring coverage of vasectomies without co-payments.

Prior to Hogan’s signing, other states have been “implementing piecemeal provisions” rather than comprehensive laws that expand birth control access, Nelson said.

Del. Ariana B. Kelly told the Sun that the law would fill in “gaps” left by the Affordable Care Act, which only requires insurers to offer one of 18 categories of contraceptives with no co-payment. That means some people may have to pay up front for their preferred method of birth control if their insurer does not cover it.

Analysis Law and Policy

No Solution in Sight for Supreme Court Birth Control Fight

Jessica Mason Pieklo

With all the legal briefs filed to the Supreme Court and no solutions proposed, it's going to be up to the justices to put an end to the lawsuits swarming the Affordable Care Act.

By late Wednesday evening when the final supplemental briefs were filed in Zubik v. Burwell, the challenge to the Affordable Care Act’s birth control benefit, it was clear this case will not have a clean ending. In fact, it could very well result in a deadlocked U.S. Supreme Court and patchwork contraception insurance coverage across the country.

Almost exactly a week after oral arguments in Zubik, the Court justices ordered attorneys from both sides to file briefs setting out possible paths to resolving the case, in a move signaling they were looking to prevent a tied 4-4 ruling. Specifically, the Court asked the lawyers to address whether religiously affiliated nonprofit hospitals, nursing homes, and colleges could be separated out from a government-administered health insurance plan that would be the source of contraceptives for the nonprofits’ employees and students. In its initial responses, the Obama administration grudgingly admitted the idea proposed by the Court was theoretically possible, but insisted it was both impractical and not currently allowed under the ACA.

The religious objectors, on the other hand, insisted that if the contraception benefit contained an exemption for churches, it should have the same exemption for hospitals and universities. And while the religious objectors didn’t come right out and say so in this latest round of briefs, if they get an exemption then so too, eventually, would secular for-profit companies like Hobby Lobby.

The religious objectors have insisted that the Religious Freedom Restoration Act (RFRA) is broad enough to allow the objectors to interfere with, based on religious principle, third-party insurance companies from offering contraception insurance for their employees and students. But that argument evolved during oral arguments in March—or rather, the religious objectors clarified to the Roberts Court that if the Court was nervous about making such a ruling based on the precedent it would set for future RFRA challenges, then the Court should just grant businesses full exemptions from the law. The effect of such a ruling would be to block, writ large, contraception access for private employees and students altogether unless the government were to step in and provide that coverage directly.

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In its final supplemental briefing to the Roberts Court, the religious objectors finally came clean and made that argument directly. “[I]f the government really believes the only way to accomplish its objectives [of providing seamless contraception coverage] is to force every religious nonprofit to contract for an insured plan so the government will have something suitable to piggyback on, then petitioners’ concerns that the government wants to hijack their plans have been confirmed,” wrote the objectors. They continued, “Petitioners’ alternative—where the separate policies offered by commercial insurers are offered to employees of self-insured objectors as well—would reinforce the true separateness of those policies, rather than just reinforcing the RFRA violation.”

The Obama administration opened its supplemental brief taking this clarified argument by the religious objectors to the woodshed: “In a sharp departure, petitioners now acknowledge that they cannot invoke RFRA to prevent the government from requiring that the insurers with which they contract also provide separate contraceptive coverage to their employees.”

“But petitioners assert that it is not enough that insurers provide that coverage entirely outside petitioners’ health plans and without their involvement, as the accommodation already requires,” it continued. “Petitioners also insist that the coverage must consist of contraceptive-only insurance policies, not direct payments [to anyone] for contraceptives. And they add that women must take affirmative steps to enroll, and cannot be covered automatically.”

In other words, the religious objectors’ legal argument is that they are entitled under RFRA to make accessing contraception coverage in the private marketplace as onerous as possible, the result of which would mean many people would just not get the contraception they need.

This sounds a lot like conservatives’ approaches to abortion restrictions. And it should. The same sense of moral entitlement to regulate ad infinitum women’s bodies, expressed as the state’s interest in promoting fetal “personhood,” is the theoretical precursor to the religious objectors’ arguments in Zubik. In litigating the availability of contraception coverage under the ACA, religious objectors have effectively borrowed the moral justifications anti-choice lawmakers use to restrict abortion access—that women’s health care must always take a back seat to purported claims of religious freedom—and pasted them into their legal arguments as to why the private sector has the right to dictate who can access contraception in this country, and when and how.

With a Supreme Court evenly split ideologically on the contraception benefit and the limits of RFRA, it’s unlikely these latest briefs will do anything to avoid a split decision here. If these challenges are going to get resolved this term, and with them the argument that private employers can block their employees from accessing contraception coverage, then one of the justices is going to have to change their mind. Right now, that seems like a stretch.

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