The cost of being a woman


Two headlines caught my attention this week. One focused on the luxury tax for tampons that is part of the law in 46 of the 50 states. The other headline was buried in all of the news about the Republican sponsored Health Care Act.  Tom Price, head of HHS, would like to see the co-pay for contraception reinstated. As part of the ACA, contraception is free under the majority of health care plans. Both of these costs are charged to women. On a monthly basis this may not seem too costly. But let’s look at the average sum that a woman would need to pay over her lifetime for both tampons and contraception.

Tampons: an average woman uses 30 tampons for each menstruation. A box of 36 tampons costs $7 at Target. That amounts to 360 tampons per year or $70. When multiplied x 35 years that costs a woman $2450.

Contraception: Prior to the ACA, an average co-pay per month for birth control pills was $30. If a woman were to start pills at age 20 and continue to age 45 it would cost $9000 for contraception.  The average family size is 2 children, so you could subtract $1000 for the time it takes to become pregnant and the pregnancy itself. I would argue that there are other costs during that time that offset the $1000 (maternity clothes, nursing bras etc…) but those are probably considered “luxury items” by society standards.

$10,450 is the total cost of tampons and contraception for a woman during her lifetime. But some of our lawmakers want to extend this burden even further, questioning why men should have to help pay for maternity care as part of health insurance. Despite the backing of Ivanka Trump, I doubt that the current legislature will approve any bill that provides for paid maternity leave. Women caregivers are the norm for elderly parents who need assistance and many choose to decrease their paid work commitments to provide this care.

At what point will our society honestly discuss the financial inequalities that exist between men and women?  Male partners should share the finances of contraception – much cheaper than the cost of supporting  a child to age 18.  Women should not be the only members of society that are burdened with the cost of maternity care.  Removing the luxury tax on tampons is a no-brainer as I have never heard any woman describe her period with the work luxury.  And I have heard many words used to describe periods! Paid maternity leave is present in  every  country in the world other than the US and Papua New Guinea. If we want to make this country great, maybe we should start with the women.



The Contraception Debate

As a physician who provides birth control counseling to women, I feel that we (physicians) need to speak out louder about the current argument before the Supreme Court. My own life serves as an example to how well birth control has benefitted my career. My husband and I were married for 6 years before our first child was born, planned near the end of my residency. During medical school, we did not have insurance that provided for birth control so we relied on the services of Planned Parenthood for birth control pills. Providing contraception still remains the primary service of Planned Parenthood. Child #2 and #3 were equally planned, using various forms of contraception between each pregnancy. Since 40% of pregnancies in the US are unplanned, I was fortunate to not only have access to birth control but to also be able to afford it. Many women have not been so lucky. This is why the Affordable Care Act, as it pertains to contraception, is so important and needs to be universal. Women should not have to worry about who they work for, how much money they have left at the end of the month, or what their religion dictates. If they need to use birth control for either contraception or medical reasons, it should be a discussion between a woman and her medical provider.

During my medical career I have seen a woman die from post-partum hemorrhage, leaving her newborn infant and other two children motherless. There were simple medical resources available to save her life, but because she was a Jehovah’s Witness she refused a blood transfusion. Another woman refused a life saving cesarean delivery for her infant due to her religious beliefs, and delivered a stillborn infant. Both times the decisions these women and their families made was against my medical training. But I was powerless to intervene as they had the right to exercise their religious beliefs. The owners of Hobby Lobby also have the right to exercise their religious beliefs in regards to their own immediate family. They do not have the right to extend their religious beliefs to their employees when it comes to what type of health care benefits their employees can choose. Jehovah’s Witness employers do not have the right to decline any type of blood product for their employees. Christian Scientist employers cannot refuse to provide traditional western medical treatment.

This country was founded on the seperation of church and state. How does it seem that we are going backwards when it comes to minority religious groups dictating what is best for the rest of the country. Since the overwhelming majority of adult Americans have used some form of birth control, why are we not becoming more vocal in our opposition? Contraception makes sense from a financial, economic and health viewpoint. In fact, a recent study demonstrated that there are more benefits than drawbacks from providing birth control pills over the counter. I hope that the Supreme Court will use the interests of the majority of Americans when they make their final decision.