Access to safe and effective birth control is part of health care for tens of millions of Americans. The vast majority of Americans view birth control as "morally acceptable," and make sharp distinctions between approval for methods of preventing pregnancy, and methods of terminating it.
Despite this, access to birth control has become politicized. Employee health care plans can be exempt from covering it. Organizations that provide affordable access are under threat. And while Democratic candidates Bernie Sanders and Hillary Clinton support access to contraception, the top three candidates from the Republican Party favor policies that could severely restrict access to contraception.
What the Democratic Candidates Think About Reproductive Health
A 2015 Pew Poll indicates that the positions Bernie Sanders and Hillary Clinton take on birth control and family planning track more closely with public opinion than do the positions articulated by Republican candidates, and by a wide margin.
Both have stated that they view birth control as a right, and as essential health care.
Both see birth control and access to family planning information as keys to achieving gender equality.
Both of their campaigns focus on access to birth control via increased funding for Planned Parenthood, expansion of the Affordable Care Act and their early and sustained support for family planning initiatives like "Prevention First."
Clinton and Sanders have both decried the Supreme Court's ruling in Hobby Lobby, which enables employers to refuse to cover birth control in their employee health plans.
Both favor bills that would make it illegal for pharmacists to refuse to provide access to emergency contraception.
Both support global family planning initiatives through international partnerships.
Though their positions are stunningly similar, Planned Parenthood opted to endorse Hillary Clinton, citing her record of sponsoring bills that expand access in the United States and abroad, and her early and vocal support of the organization.
Trump's Positions Aren't Clear
Donald Trump is the front-runner for the Republican nomination. Though he has proclaimed that he "cherishes women" and "will protect them," he has also been widely criticized for misogynist statements and behaviors.
Trump's anti-woman rhetoric may rightfully concern those who advocate for women's rights. However, it is not clear that Trump's personal opinions about the value and worth of women translate into any coherent policy regarding birth control and family planning.
In fact, it is impossible to know Donald Trump's position on contraception. His campaign website does not have an "Issues" tab for birth control. It does not have a "Position" tab for anything related to contraception, family planning or reproductive health. Trump's campaign website also lacks a search function.
Recently, Trump stated that he is pro-life and would defund "those parts" of Planned Parenthood that perform abortion (in fact no federal funding currently goes to to elective abortion at Planned Parenthood). However, he has acknowledged that Planned Parenthood provides valuable medical help and reproductive care to women who need it, especially in terms of cancer screening.
Though leaders of Planned Parenthood do not believe he would be a friend to their organization, it is unclear that, as president, he would act aggressively to end the organization's existence.
Trump has also stated, repeatedly, that as president he would repeal the Affordable Care Act and replace it with an unspecified plan that will be "terrific," and "much much better." His newly announced seven point plan would rely on market forces across state lines to spur competition among health care providers and insurance companies with an eye to increasing access.
Reducing funding to Planned Parenthood (even if not defunding it completely) and replacing the ACA both have the potential to gravely disrupt access to birth control for millions of women. However, it is absolutely unclear what a Trump presidency would mean for access to contraception.
Cruz and Rubio
Trump's lack of clarity on the issue is disturbing. And it stands in contrast to the rather clear stances held by the the other two Republican candidates still viable in the presidential race: Ted Cruz and Marco Rubio.
Ted Cruz and Marco Rubio have both said in several forums that that they do not support a ban on contraceptives. But the policies that they do support, if enacted, would place significant barriers around access to them.
Both Cruz and Rubio are in favor of repealing the Affordable Care Act. The ACA has greatly expanded access to birth control for Americans, even as implementation varies.
Cruz has said that on "day one" of his presidency, he will order his attorney general to "investigate Planned Parenthood," which he describes as a "national criminal enterprise," and which he and Rubio both favor defunding entirely.
They have both supported "personhood" amendments to state constitutions as well as the federal constitution. These amendments variously state that life begins at fertilization, or conception, and in some cases define the fertilized egg as a person.
Such language could have the effect of banning the intrauterine device (IUD) due to the false belief that it causes abortion, rather than provides contraception - because IUDs in some instances prevent fertilized eggs from implanting. This is troubling because IUDs are the most effective long-term, reversible form of birth control on the market. These "Personhood Amendments" could also limit access to emergency contraception via the Plan B pill.
If access to birth control via state-funded health care, private insurance and Planned Parenthood are dramatically constrained by policies made during a Cruz or Rubio presidency, laws banning contraception would not be necessary.
By creating insurmountable burdens on access, Americans could find themselves living with a de facto ban on access to contraception.