It has been several weeks since Obama and Secretary Sebelius announced a provision in Obamacare mandating religious organizations or the insurance policies they are required to buy provide birth control pills, abortifacients, sterilization procedures and other contraceptive medical interventions free of charge. The resulting firestorm has not gone unnoticed. Religious leaders of all denominations, politicians, columnists, talk show hosts, lawyers, bloggers and citizens have expressed opinions on the matter. Some see it as an issue solely about women’s health while others dispute this, stating it to be an issue of liberty, especially religious liberty as guaranteed in the Constitution.

So varied are the views on this topic that I can’t summarize them, except to note what is common to them all – the issue of women’s health. Throughout the discussions, whatever the point of view, the unchallenged concept occurs that women, as a distinct group, have special health needs, separate from men and children. Furthermore, there is often the notion that contraception, abortifacients and sterilization are instrumental in preserving and improving women’s health. To that end, the Obama administration feels justified in ordering private companies to offer these “free” to the consumer.

Is it true that women have special, distinct health needs and if so, why and how is that manifest in our society? Health and illness of the reproductive organs and their physiology in women do require medical attention, treatments and intervention that are not applicable in males. Males have their own medical needs in the area of reproduction. This much is undisputable. It is predictable that these differences would be used to draw a barrier around women’s medical needs declaring it an inviolate area of the highest priority, higher than any freedom of discussion, freedom of conscience, scientific objectivity or personal responsibility.

However, there are more differences in men and women than just in the function of procreation. The two are not physically identical except for their reproductive features. Treating them so creates many problems. Men and women are dissimilar in many ways that affect health. To name a few, there are differences in lung capacity, muscle mass, cardiac capacity, sensory nerve function and levels of various hormones. Brain anatomy is different as are the ways of processing data and sensory input. Biological differences in these areas are too often ignored in the name of the politically correct mantra of “equality.” Despite solid scientific evidence supporting this, woe to anyone who even dares bring up for discussion the idea that female and male brains have differing capacities and aptitudes. Former Harvard University president Larry Summers learned the hard way in 2005. He incited such tremendous opposition among the faculty to his ideas about the differences between men and women that he received a vote of no confidence. Within a year, he had resigned. He is far from being the only one so censored.

If women’s health were really the primary concern of those who claim it is, then all the differences in biology, structure and physiology would be investigated in a truly scientific manner, without the overlay of political influence deciding what answers are acceptable. When the complete array of differences in physical and physiological make up between males and females is considered, it is generally found that, despite all the will and wishing to the contrary, women are not as strong as men, have more acute sensory input than men and learn in different ways, just to list a few. So fundamental are such facts that it makes sense they would also affect women’s health. Yet, these very factors are not considered, being sacrificed on the altar of equality über alles.

For example, they are not included in discussions of opportunity in the work place for certain jobs. How healthy is it for a woman to be employed in jobs requiring physical prowess or stamina that is beyond normal female capacity, such as a firefighter or combat soldier? Women just do not have the levels of testosterone necessary to maintain the bone and muscle mass, strength and stamina required in highly physical jobs. As a result, physical standards historically deemed necessary for job performance have too frequently been lowered to accommodate the naturally reduced capacities that women have as compared to men. Even with adjustments, it is highly stressful for women to be engaged in some physically demanding jobs. Since there is not enough testosterone to fuel the physical engine, the stress hormone cortisone takes its place. It is well known that higher than normal cortisone levels chronically cause a variety of long-term health problems, including menstrual irregularities and osteoporosis.

A full survey of the research on physical differences between men and women is beyond the scope of this article. Suffice it to say, there are volumes dedicated to the topic. The point here is that if women have special health needs due to their capacity for reproduction, then all differences in a woman’s body should be equally considered in matters relating to health in all its ramifications.

Another issue that should be examined is the matter of contraception. We have come a long way from former times when birth was universally celebrated. In the tone of some of the articles in the recent debate, it is tacitly or even overtly implied that pregnancy and childbirth are the cause of health deterioration in women, a necessary ordeal to be avoided as long as possible. Sometimes childbirth is even regarded as a disease to be treated.

It should be beyond dispute that the female body is designed to bear children. This is not a design flaw that requires medical treatment; it is a feature, and a very important one at that. Most of the physical differences between men and women can be explained and understood as supportive of this one vital function. To think otherwise is to fly in the face of biology. Acknowledging this does not mean that women are reduced to the role of being solely baby factories. That is equally preposterous. Women are human beings with all the capacities and natural endowments that that entails. However, the ability to bear children is also a natural endowment, one for which women are specifically designed.

With this in mind, the topic of women’s health is an interesting one. In the usual course of health and illness and in all other areas of medicine, the task is to restore a malfunctioning organ or part to its proper and full functioning. Arthritic joints do not bend as they should and treatment restores this capacity. If the stomach is not digesting as it is designed to do, then treatment will return it to normal. However, women’s health is an area where often normally functioning organs are made to malfunction. Hormones are given to force the ovaries to stop producing mature eggs. Rather than the uterus being a place where a fertilized ovum implants itself for further growth, drugs and other means are used to prevent the normal implantation. Contraceptive pills interfere with the immensely complex cascade of hormones that orchestrates fertility resulting in infertility, otherwise known as birth control.

Nature does not take kindly to amateurs dabbling with its elegantly designed and properly functioning systems, especially one that is as primary and essential as reproduction. Such machinations come at a very high cost. The monetary costs that Obamacare has lifted from the consumer are the very least of the real costs. Though proponents of women’s special standing in health care assert that access to birth control, easy abortion and sterilization promotes women’s health, the reality is very different and so are the costs.

Oral contraception increases the incidence of breast cancer. The largest collaborative reanalysis of individual data was conducted in 1996 on over 150,000 women in 54 studies of breast cancer. An overall 24% higher risk of breast cancer was found among current combined oral contraceptive pill users.¹ Other studies indicate that women who begin using hormonal contraceptives before the age of 20 or before their first full-term pregnancy are at increased risk for breast cancer.

Taking contraceptive pills increases the chances of having one of the most aggressive, difficult to treat breast cancers with a high mortality, called “triple negative breast cancer.” According to a study by Dolle, for women who started their oral contraceptives over the age of 22 the risk increased by 250% and for those who started between ages 18-22 the risk was 270%. However, for those who started oral contraceptives below age 18, the risk was an astounding 540%.² Even taking the pills for as little as a year, dramatically increases the risk of triple negative breast cancer. With girls as young as 13 taking birth control pills, these are sobering statistics.

There are other dangers of oral contraceptives, including strokes, thromboembolism, heart attacks, other cancers, gall bladder disease, elevated blood pressure, permanent infertility and ectopic pregnancy, all of which increase with age and length of pill use. Add in smoking that the risk of heart attacks increases 2 – 6 times for women as young as 35. Studies are often cited that indicate less risk of mortality using birth control methods than going through pregnancy and giving birth. These statistics do not take into account that some serious adverse health consequences of birth control pill use take years to develop and do not occur in the younger age groups.

It is not only active interference with fertility that increases health problems. Women who never bear children and those who do not breast-feed have an increased risk of breast cancer. Having the first live birth after age 30 doubles the risk compared to having the first live birth at age less than 25. Women who give birth and breast-feed before the age of 20 may have even more protection from breast cancer. Having more children also reduces risk. In our era, women’s health is helped by having children, not by interfering with fertility or remaining childless.

Even condoms may pose a problem for women’s health. Condoms have been almost universally acclaimed as the ideal contraceptive because of effectiveness and non-invasiveness as well as being the only birth control method also protecting against sexually transmitted diseases, including HIV. During the 1980s condom sales were surging as fear of AIDS brought this ‘old fashioned’ contraceptive back in vogue. Yet the default assumption that condoms have no side effects may not be true. Pioneering work by Gjorgov has shown a correlative link between long-term marital condom use and an increase in breast cancer.³ Considering the rising incidence of breast cancers in all western societies, this preliminary work warrants serious investigation, as do all aspects of contraception’s role in breast cancer.

The entire issue of the adverse health effects of oral contraceptives, other forms of birth control and abortion is a vast one about which much has been researched, written and discussed. There is still much to learn. I have not even touched the tip of the iceberg, but rather only a snowflake on the iceberg. Yet these few examples should serve to highlight that contraception is not an unalloyed benefit to women’s health. Those claiming it is are seriously misleading women.

Discussing issues and facts relating to the risks and dangers of interfering with fertility should not be misconstrued as not being in favor of birth control. That is not the case. Each woman, preferably with but even without discussions including a spouse, partner, confidant or significant other, is free to make decisions about such personal issues. By contrast, however, I am not in favor of people making medical decisions without being informed truthfully about all sides of the question. Whether or not insurance, Obamacare, taxpayers or a woman herself writes the check for contraception medical services and prescriptions, it is the individual woman who pays the real costs as she faces the risks and problems whenever they may occur in her lifetime.

References

1. Collaborative Group on Hormonal Factors in Breast Cancer (1996). Lancet 347 (9017).

2. J.M. Dolle et al. Cancer Epidemiology, Biomarkers and Prevention 2009;18(4).

3. A. Gjorgov. Barrier Contraception and Breast Cancer; Karger, Basel, 1980.

Feb 19, 2012

© 2012 Linda Johnston, MD