Abortion, Contraception and the ACA: The Realignment of Women’s Health
41 Pages Posted: 8 Aug 2012 Last revised: 11 Dec 2012
Date Written: August 7, 2012
Abortion and contraception have become the two most highly contested health care services in the ongoing debate over the Patient Protection and Affordable Care Act (ACA). Initial interpretations cast these conflicts as extensions of the abortion wars that have pervaded national politics since the 1970s. That explanation is correct, but incomplete. The abortion wars have drawn a line between reproductive and sexual health, on the one hand, and women’s health, on the other. Yet, the federal government’s efforts to promote health disparities research, as well as the neoliberal framing of health care have also played a role in dislodging women’s health from its experience-based, civil rights foundations.
This article also considers the effects of the ACA’s exclusion of abortion and inclusion of contraception on the understanding of women’s health. Normatively, the segregation and isolation of abortion narrows the scope of women’s health. Materially, the ACA increases barriers to abortion access for women most at risk of unintended pregnancy. This effect will certainly exacerbate social, economic, and health inequalities for low-income women. The 2011 decision by the U.S. Department of Health and Human Services to include coverage for prescription contraceptives without cost-sharing as part of women’s preventive care under the ACA constitutes a victory for women’s health and women’s rights advocates. Yet, coverage of contraception as preventive care, in conjunction with a broad ban on abortion coverage, recasts conception as abortion prevention. That description moves contraception from its autonomy and equality-based foundations to a narrower framing that aligns with the agendas of religious conservatives and neoliberals.
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