By Jessica Blakemore
While much of the debate surrounding the Affordable Care Act’s (ACA) contraceptive mandate is focused on the fight over religious exceptions, little attention has been brought to the fact that the mandate does not go far enough to protect women’s reproductive autonomy. While the ACA recognized the importance of family planning by considering it preventative care and ensuring access to contraceptive options for all women (except those whose employers don’t believe in the right to reproductive self-determination, that is), it failed to recognize that men are active participants in reproduction.
By excluding vasectomies, condoms, and other male contraceptive services (including prescriptions for emergency contraceptives), the Department of Health and Human Services (DHHS) signaled that the role of men in regards to contraception is tangential at best. Further, HIV screening and counseling on HIV and other STIs is not required coverage for all adult males, only those deemed to be “high-risk.”
The exclusion of men’s services from the contraceptive mandate harms women. It harms us by ensuring that women will continue to assume most of the burden of contraception and STI prevention, places all responsibility for unintended outcomes on women, and reinforces the nation’s current view of family planning as a “women’s issue.”
Women already assume most of the burden of contraception. Twenty-seven percent of reproductive-aged women rely on female sterilization for pregnancy prevention, compared to only 10 percent who rely on their partner’s vasectomy, though vasectomy is more effective than female sterilization at preventing pregnancy. What’s more, women of color in the United States are far more likely to rely on tubal sterilization as a method of contraception than white women, and partners of black women and Hispanic women have particularly low rates of vasectomy.
Female sterilization is considerably more invasive than vasectomy, and considerably more expensive. Vasectomy is one of the most cost-effective contraceptive methods available and is 20 times less likely to cause any post-operative complication. Vasectomy is safe, relatively low-cost, and extremely effective.
The ACA’s recognition of contraceptive services as essential preventative care is a huge step toward ensuring that all women are free to make reproductive choices that that are appropriate for them. But the exclusion of coverage for male contraceptive services is a major oversight that denies the responsibility of men in reproductive outcomes and further solidifies the discriminatory and harmful idea that women should be totally responsible for family planning while paradoxically stigmatizing women, especially low-income and minority women, for demanding access to comprehensive reproductive healthcare.
Exclusion of coverage for male contraceptive services is discriminatory and increases the risk of further diminution of male involvement in contraception by increasing the comparative cost of vasectomy and providing an economic incentive for couples to chose female sterilization.
The DHHS’s oversight is economically costly, inequitable and socially irresponsible. The contraceptive mandate should be amended to require coverage of male contraceptive options and STI counseling and preventative services to establish family planning as the responsibility of both men and women.
 Department of the Treasury, Department of Labor and DHHS, Certain preventive services under the Affordable Care Act, Federal Register, 2013, 78(127): http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf, accessed March 5, 2014.
 Brian T Nguyen, Grace Shih and David K Turok, ‘Putting the Man in Contraceptive Mandate’, Contraception, 89 (2014), 3–5 https://www.arhp.org/Publications-and-Resources/Contraception-Journal/January-2014.
 Sonya Borrero, Charity G. Moore, Li Qin, Eleanor B. Schwarz, Aletha Akers, Mitchell D. Creinin, Said A. Ibrahim J Gen Intern Med. 2010 February; 25(2): 122–128. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837493/
 James Trussell and others, ‘Cost Effectiveness of Contraceptives in the United States’, Contraception, 79 (2009), 5–14.
 Nguyen, Shih and Turok, 2014.
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