Andrew Haines is president and founder of the Center for Morality in Public Life, and a PhD candidate in the School of Philosophy at The Catholic University of America.
by Andrew Haines
Following the Department of Health & Human Services’ recent move requiring funding for “preventive” contraceptives, pundits have been hard at work sorting through the reasons why such a mandate is either necessarily defensible or unavoidably inane.
Quite frankly, I have yet to encounter any argument that makes a serious, reasonable case for its being defensible.
Still, some folks take up any position they can to try and win the upper ground. A curious case — aired by Fox News contributor, Jehmu Greene, facing off against Sean Hannity — involves comparing access to artificial birth control with subsidized access to the drug Viagra.
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Hannity & Greene on Viagra v. Birth Control:
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Appart from a strange admission by Greene that “a panel of scientists, medical professionals who are much smarter than us [...] made this recommendation,” her position can be summed up in three steps:
- “This is about women’s health.”
- If you care about women’s sexual health, you should care about this.
- Birth control is a medical concern, just like impotence. We fund for the latter, why not the former?
I admit, none of this probably went through Greene’s head as she was speaking. She could hardly get a word in edgewise on Hannity, who felt compelled to respond in full to each utterance she made. Overall, it was a pretty poor exchange — at least from the perspective of allowing viewers to understand what was going on.
Nevertheless, Greene’s case is worth assessing, since it proceeds in a very familiar manner. She starts by identifying the scope of her claims; moves to a quick conclusion based on a simple premise; and then analyzes a state of affairs based on that conclusion. In short, she argues the same way most people argue when speaking of things they don’t really understand.
If Greene’s weird appeal to authority (“medical professionals who are much smarter than us”) doesn’t trigger the bullshit meter, then her absolute reliance on convention should. “This is about women’s health,” plain and simple. And since you, Mr. Hannity, don’t approve of subsidized birth control, you clearly don’t care about women’s health. After all, she says, “why should we pay for a man’s Viagra, when some insurance plans before the Affordable Care Act [...] wouldn’t cover birth control?”
Hannity’s retort that Viagra addresses a medical condition is met with a snarky laugh. Greene already believes that. But she also believes that birth control addresses a medical condition — the quite amorphous medical condition of “good health.”
This basic assumption — that contraceptives benefit women’s health — evidences a fundamental misunderstanding. And what’s more, that contraceptive access should fall under healthcare exacerbates that error. Most simply, viewing contraceptives as items of healthcare confuses actual “preventive services” — services that guard against some illness or disease — with physiological manipulations that “protect” in the event of some free (i.e., otherwise avoidable) action.
For Greene, and countless others, to call contraceptives and sterilization a matter of “women’s health” is nothing more than to set an arbitrary definition of healthcare in order to run with it. The claim demonstrates no deeper thought on the issue, and is pretty easily debased with not a whole lot of effort (e.g., Hannity’s simple distinction between medical and non-medical needs).
Admittedly, things get a bit more complex when psychological health is thrown into the mix — i.e., that since sex is a necessary part of human well-being, its availability ought to be guaranteed, and the devastating consequences of unwanted pregnancy eradicated. This view, though, makes a number of assumptions that are equally indefensible — and to which I offer a short reply, here.
As Christopher Tollefsen explains in a recent article for Public Discourse, what should be included or excluded under healthcare coverage is a matter of prudential judgment, and not of redefinitions and wordsmithing. Certain drugs that respond to actual medical situations, like Viagra (to reply directly to Greene), can justifiably fall under the meaning of “healthcare” — even if we choose not to subsidize them for some other, practical purpose. But artificial birth control doesn’t fit the bill at all. It doesn’t respond to an actual medical need (that is, when being utilized as contraception); and so it isn’t really a prevention of illness or promotion of health — and especially not the sort that ought to be subsidized by government monies.
To allow the HHS mandate to go unchallenged is to concede that there’s nothing wrong with redefining, on a whim, the value of inherently destructive medical practices. With hormonal contraceptives and sterilization, well-ordered natural systems are manipulated — and sometimes even mutilated — in order to respond to an “illness” that doesn’t exist. This sort of fuzzy approach to “healthcare” isn’t tenable for long, since it seeks to shift, at the most basic level, the meaning and role of medical assistance in our society. Indeed, even from a secular perspective, it should strike us that those advocating open access to contraceptives are playing a very dangerous game.
Andrew Haines is president of the Center for Morality in Public Life, and a leading contributor at Ethika Politika. He is currently working to complete his PhD in philosophy at The Catholic University of America. Andrew lives in Virginia with his wife, Kathleen, and their son.
Copyright © 2011 Center for Morality in Public Life. All Rights Reserved.
13 Responses to Viagra v. Birth Control: What’s the Difference?
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It is YOUR basic assumption, that birth control pills do NOT benefit women’s health, that evidences a fundamental misunderstanding about the health risks of pregnancy, unless you are taking “women” to mean “women who are not having and never will have vaginal intercourse with fertile men.” (In that case, I would suggest that that is an extraordinarily narrow definition of “woman.”) Assuming, however, that some–or even many, or even most–women have vaginal intercourse with fertile men, it is safe to say that some–or even many, or even most–women face the real and often significant health risks and complications of pregnancy, child birth, and motherhood. That some women voluntarily choose to become pregnant, despite the risks, in no way negates the frequently deleterious impact that pregnancy has on a woman’s well-being–physical and emotional. Preventing pregnancy–the function of contraceptive medicine–does, by definition, also prevent such risks.
Those risks include (and this is by no means an exhaustive list): nausea, vomiting, heartburn and indigestion, constipation, weight gain (with all of its concomitant health risks), yeast infections, mild to severe backache and strain, migraine headaches, anxiety, insomnia, urinary incontinence, higher blood pressure, hair loss, anemia, increased risk of general infections, increased risk for osteoporosis later in life, pre-eclampsia and eclampsia, ectopic pregnancy, gestational diabetes, anemia, thrombocytopic purpura, embolisms, torn abdominal muscles, mitrial valve stenosis, broken bones (ribcage and/or tailbone, typically), hormonal imbalances, hemorrhage, refractory gastroesohpageal reflux disease, aggravation of pre-pregnancy diseases and conditions (especially epilepsy and depression, which can be life-threatening), spinal headaches, fatal reactions or allergies to anesthesia used during labor, severe post-partum depression and psychosis, coronary and cardiovascular disease (for women having six or more pregnancies, according to recent research), postpartum cardiomyopathy, cardiopulmonary arrest, magnesium toxicity, severe hypoxemia/acidosis, massive embolism, increased intracranial pressure, brainstem infarction, molar pregnancy, malignant arrhythmia, circulatory collapse, placental abruption, obstetric fistula, future infertility, permanent disability, and death. After a baby is born, breastfeeding (should a woman choose to) comes with a range of its own health risks, including bacterial and fungal infections of the breasts and nipples, as well as an increased incidence of postpartum depression for mothers who experience difficulties with breastfeeding. Mothers in general are more than two-and-a-half times more likely than men to suffer from depression, according to a well-regarded 2005 study conducted by researchers in Europe. Pregnancy and motherhood, clearly, put women’s health and even lives at risk in a number of ways; effective and available contraception allows women to choose how, when, and under what circumstances they are willing to assume these risks.
Incidentally, there are also (perhaps counterintuitively) health benefits for children of mothers who plan their pregnancies and use contraception except when trying to become pregnant. A planned pregnancy is one in which the mother is much more likely to receive good prenatal care, and avoid behaviors, such as drinking alcohol or using drugs, that might put her pregnancy at risk or cause health, emotional, and behavioral problems for her child in the future.
It is truly fascinating to me that medical professionals–doctors and researchers who have spent their lives studying the impact of pregnancy and childbirth on women’s health–generally seem to agree that legitimate access to contraception is essential for women’s well-being, and those who disagree, generally speaking, have little to no medical training .
It seems to me that what you really mean in this post is that contraception (when used as a contraceptive, and not, as birth control pills frequently are, as a treatment for other purposes, such as a treatment for polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, menstruation-related anemia and painful menstruation (dysmenorrhea), doesn’t provide any health benefits not also provided by simply choosing not to have sex. If we apply your argument to the actual lives of real women, it means that unless a woman is ready, willing, and able to be pregnant and give birth to a baby, she shouldn’t have sex she otherwise wants to have.
By the way, what is the “medical condition” treated by Viagra, again? An inability to achieve or maintain an erection? Exactly how does that problem impact a man’s health? Because it prevents him from having sex he wants to have? Changes in erectile function are part of the “natural, well-ordered system” of aging in men, but you apparently don’t apply your no-maniuplation-allowed rule in that case.
Please, leave the medical analysis to the professionals.
I’m just happy that after all that, you really got to what I was trying to say: “unless a woman is ready, willing, and able to be pregnant and give birth to a baby, she shouldn’t have sex she otherwise wants to have.” That’s it.
Appealing to doctors and scientists insofar as they’re able to offer practical solutions to problems of unhealthiness, etc., is quite fine. But appealing to them to offer us a definition of “health”—of “essential well-being” as you say—isn’t justified. In fact, I’d challenge you to present a case for its justification, other than the ho-hum “they’ve spent their entire lives researching things” and, in Greene’s words, they’re “much smarter than us.” (It might be the case that some doctor *is* qualified to speak on those things; but it’s not going to be because he’s a doctor. Doctor’s also kill living people via euthanasia and abortion, so I’m leery to fall back on their medical knowledge as a de facto source of “essential” definitions.)
Viagra, unlike birth control, makes functional a bodily process that—in healthy situations—normally works. As it turns out, sexual vigor is natural. Eliminating or drastically altering ovulation or some such thing is not. I’m not saying people should run out and purchase Viagra; it might even be a bad prudential decision in many cases. (As you say, there does seem to be a time and place for just letting aging do its work—that’s not bad.) But the idea that Viagra and birth control are on the same level in terms of their “medicinal” output is, I think, pretty demonstrably false.
Hi Andrew, I have some questions about your article, as well as your response to Kelly:
1) First, I’m curious why you put quotes around the word “preventive” in your first sentence when you referred to preventive contraceptives. Do you not actually believe that they are preventive?
2) You said: “I’m just happy that after all that, you really got to what I was trying to say: ‘unless a woman is ready, willing, and able to be pregnant and give birth to a baby, she shouldn’t have sex she otherwise wants to have.’ That’s it.”
I’m wondering where men fall into this equation. Do you believe that a man should be equally ready and willing to take part in the birth and upbringing of a child every time he has sex?
3) You also said: “Viagra, unlike birth control, makes functional a bodily process that—in healthy situations—normally works. As it turns out, sexual vigor is natural. Eliminating or drastically altering ovulation or some such thing is not.”
As I understand it, Kelly is correct in her assessment that “changes in erectile function are part of the ‘natural, well-ordered system’ of aging in men.” Sexual vigor may be natural, but it becomes less natural with age for both men and women. And aren’t the majority of men who use Viagra using it because of these age-related issues, and thus attempting to counter a natural bodily progression? That seems to be the general understanding based on the age demographics that Viagra is marketed to, but if you could provide any statistics counter to that, I would appreciate it. I guess I’m just not seeing how Viagra is any more “medicinal” than birth control pills.
4) You make a distinction between birth control uses when you say that “It doesn’t respond to an actual medical need (that is, when being utilized as contraception),” so would you be okay with government funding for birth control only when it is used for an expressly medical purpose? How would you distinguish this? What about women (like me) who use it for both medical reasons and contraception?
5) Based on what you’ve written here, I’m guessing you don’t agree with contraception (in any form) or abortion, correct? I just wanted to clarify that.
These are just some questions that were running through my mind as I read your article. I’d appreciate a response if you have time, but if not I understand. Thanks!
If only everyone were as gentle and articulate a commenter as you, Sara! The world (and this blog) would be a better place…
I really don’t know if I can address every sub-point to your satisfaction, but I’ll try.
(1) is easy: the word was used in almost every media report I came across. I opted to highlight it, though, precisely because I don’t agree that contraceptives are preventive in a medically relevant sense of the term. (Check out other pieces here on why contraception isn’t healthcare for more on that.)
To (2): yes, men should be ready and willing to partake in the creation and rearing of a child every time they have sex. (That doesn’t mean they have to intend it, or be hoping for it. But the possibility should always be a live one; and that means both men and women should be prepared for it to become actual.)
(3) is trickier. I’m fully ready to admit (and I said as much) that Viagra might not be a good decision in many cases—precisely because of the point Kelly raised. (If it were only possible that Viagra be used by the elderly, I might even go as far as to say I wish it *weren’t* included under healthcare coverage.) But the fact is the drug isn’t relegated to use by only the old and past-their-prime. And in a properly functioning, healthy male body, erection is a natural act. It’s conceivable that some folks who would otherwise be able to experience this simply don’t, for non-age-related reasons. Therefore, since Viagra can work to resolve a problem with an otherwise-healthy and natural bodily function, it counts as medicine. Again, prudential factors aside (since they don’t bear on a definition, anyway).
On (4), I do think that birth control used to treat gynecological disorders is quite fine. I don’t think I’d support government funding for it; but that’s more a question of my economic principles, once moral qualms are removed from the picture. If the woman using it in such a situation were not married, the contraceptive quality (in my view) is irrelevant, since I’d also object to pre-marital sex. If she were married, though, I would say that since the intention would not be to contracept but to treat a disease, having sex would be morally okay. (This falls under the “principle of double effect” in natural law theory; worth checking out, if you’re interested.) Of course, if the woman—or the man, or both—were relishing the convenience of having an “excuse” to use contraception, while it might not render the act of intercourse de facto bad, the mindset would evidence (again, in my view) a less-than-morally-mature understanding of the situation. But that deviates from contraception, per se.
(5) you’re right on: no contraception or abortion.
I can probably guess where you come down on most of those points, given your initial responses. I’d welcome any objections or comments you might have to mine.
Thanks for your response and the kind words. I do think civil discussions tend to be much more productive so I appreciate that we are able to discuss this politely.
As far as your responses to #3 and #4, I guess what we are coming down to is the usage of Viagra versus birth control pills. You seem to be saying that since Viagra is not relegated to use by only the elderly, you are fine with healthcare coverage for it because presumably there are people out their using it for legitimate medical reasons (those that are not related to the natural hormonal changes that come with age). Couldn’t the same argument be applied to birth control? It is not relegated to use only by those who need it solely for contraceptive purposes, and many women use it for a variety of medical reasons (endometriosis, skin conditions, hormonal imbalances, menstrual pain, etc.)
Sara, that’s exactly why I qualified my claims in the article to speak only of birth control when “utilized as a contraceptive.” I do think that there are legitimate medical applications of the same drugs. (Of course, I think that prescribing any drug requires prudential judgments, and assigning birth control pills to treat mild skin irritation probably wouldn’t be wise. But it wouldn’t necessarily be unethical, in my mind. And of course, when it comes to endometriosis, etc., there’s definitely something medically significant at stake.)
I think we can both agree, though, that when folks are talking about providing coverage for such drugs, they don’t have in mind their benefits as such. The IOM recommendation treats birth control specifically as contraceptive. Planned Parenthood isn’t lobbying for access on the basis of patients with endometriosis. It’s more than obvious that what’s at stake is funding of contraceptives as contraceptive. And that, I think, is indefensible.
If there were a way—and likely there is—to separate out legitimate medical applications from illegitimate, then I don’t think I’d oppose the drugs falling under standard insurance coverage.
Sara: After reading your last comment again, I realize that I missed part of its nuance. I would add, that the case can’t be so easily extended as you suggest (i.e., if Viagra is okay just in case some are using it legitimately, then birth control would be too). The fact is that Viagra simply *doesn’t* (if consumed as recommended and not intravenously, for example) destroy a healthy, natural function of the body. (Again, it can be used imprudently and even foolishly; but the effect of the drug itself isn’t destructive.)
On the other hand, while birth control can work medically, the same drug—taken as recommended and given its intended effects—*does always* destroy a healthy, natural function of the body. (Again, the reason why it’s tolerable at all in the first place—for endometriosis, for example—is because of the principle of double effect; the same reason chemotherapy and salpingectomy are legitimate treatments for cancer and ectopic pregnancy, respectively.)
So, at bottom of your suggested argument are two totally different products. And that has to be taken into account.
Hi Andrew,
You are differentiating Viagra and birth control based on how they interact with (in your words) “healthy, natural” bodily functions. I would disagree that birth control is “destroying” anything healthy or natural, and I would argue this both in terms of its medical uses and its contraceptive uses. In other words, I don’t think there is a need to separate out these various applications in order for certain usages of birth control to qualify under standard insurance coverage, as you suggest.
I do think that full sexual expression without the fear of an unplanned pregnancy is a critical aspect of health, and based on your other article (which you linked to in this article), I know that you disagree. But after reading your arguments explaining why you disagree, I do not understand how you can apply them uniquely to birth control and not to Viagra. You said the following in response to the idea that “the ability to act freely with regard to one’s natural sexual desires is in fact a matter of health”:
“This way of thinking, popular as it is, assumes a number of things—not the least of which is the idea that proper sexual expression necessarily entails genital sexual expression with another person (or even at all). But for the purpose of our conversation, here, this perspective also assumes that the preclusion of activities, for whatever reason, that could be healthy is tantamount to an illness, in itself. In other words, per the case at hand, something precluding full sexual expression vis-à-vis genital intercourse with another is seen as an inhibition to health; and it is therefore classed and treated as an illness.”
If you believe these assumptions are problematic, then why do you support coverage of Viagra and not birth control? The very purpose of Viagra is to enable genital intercourse. In fact, you could argue that because birth control pills serve a wider variety of medical purposes that are unrelated to genital intercourse, they are more legitimate than Viagra according to these standards.
Also, regarding what you said about how the double effect can be applied to birth control, chemotherapy, etc.: Can you clarify what you meant by how that makes birth control “tolerable at all in the first place”? Tolerable to you, or the medical community, or…? Are you saying that you would rather birth control be treated as an exception to this double effect (to the extent that the double effect is used to delineate “legitimate” medical treatments)? Sorry, I was just a little confused there.
Hi Andrew,
I’m curious about your views: Are you against the use of condoms as well? They don’t interfere with any bodily functions.
I’m so torn on this issue because I don’t believe insurance should have to pay for every cost of routine healthcare, which would include birth control pills in my opinion. I’d rather budget for my predictable costs but know that if and when I incur catastrophic expenses, I’m insured against those. In addition, I don’t think birth control pills are without risk, and I do believe that many more women should be really well-educated in natural family planning because even if it isn’t the right method for them, it’s one of the best ways to understand their own sexual health.
But none of the above is what this debate is about, is it?
A hundred years ago I wouldn’t have had contraceptives, and in the natural order of life I might well have died in my first pregnancy from hyperemesis. If I’d survived, the second would surely have killed me. I wonder how long my husband would have been willing to be celibate in order to prevent another baby. Maybe he would have just gone outside the marriage. That seems like a worse sin than the use of contraception to me, but historically it would have been easily forgiven.
How many husbands are really willing to live in a sexless marriage indefinitely? (It wouldn’t be any picnic for the wife, either, but misconception that women aren’t supposed to need or want sex as much as men is so widespread that I’m not even bothering with that part.) The responsibility can never be equal, because getting a woman pregnant can’t get a man killed except by her father
Ovulation is a normal function, but it’s the only normal function I can think of that has potentially devastating consequences.
If you want to argue that there are non-prescription, equally effective and safer methods of contraception, and therefore we shouldn’t be subsidizing the pill – I get that. I half-agree. But to argue that contraception isn’t a legitimate aspect of women’s health is ignoring every woman throughout history who has suffered through or died from one of the many possible complications of pregnancy.
Im sorry, but you are completely wrong.
I have a 16 year old daughter that was prescribed birth control pills for her unusual menstruations. She was either not having them at all for months, or would bleed for a month at a time.
By the way, she is a virgin. Therefore sex is not the issue here.
Your article is nothing more than fallacious dribble I’m afraid.