The first time I used hormonal birth control was in college at the University of California. I procured it from my university health center and charged it to my student account. I wasn't entirely sure if my dad would notice the $50 monthly charge (with insurance) for my Nuvaring, but the price was more than I could afford out of pocket. So each month, feeling infantilized and slightly guilty for putting contraception on my parents’ tab, I did what I had to do to avoid pregnancy.
That sinking feeling was nowhere to be found the next time I'd go on birth control.
While living in London after I graduated, I turned up to a sexual health clinic in Soho with no appointment. I filled out some light paperwork and waited in a room filled with copies of Vogue and bowls of sweets. I paused when they asked me what I’d like to be tested for; nearly 21 years of U.S. health insurance had instilled in me a fear of “routine" $400 blood tests. But my fears were unfounded. After being tested for the full gamut of potential ailments free of charge, a nurse practitioner talked to me about what kind of contraceptives I wanted. She then handed me a year’s worth of birth control in a brown paper bag, also completely free. A week later, the clinic sent me my results via text message.
I’ve repeated the same routine every year since, and each time I leave the clinic thinking: “I’ve had hair appointments that were more complicated.”
As a feminist and an American citizen, I’ve always been infuriated by conservative lawmakers’ fixation on legislating my vagina. Now, as a British citizen who has spent the last five years getting acquainted with this nation’s government-funded National Health Service (NHS), I’m baffled by it, too. Having lived in a country where reproductive health care—including abortions—is free, accessible, and far less politicized, it’s never been clearer to me just how regressive the U.S really is.
In 2012, the Affordable Care Act’s birth control provision went into effect. It mandated that employers must provide insurance that includes free access to certain forms of contraceptives, and it appeared to signal America’s move out of the reproductive dark ages. But it hasn’t exactly been smooth sailing since then. That same birth control mandate has had the highest number of lawsuits challenging its validity than any other provision of the ACA, one of which was the high-profile Burwell vs. Hobby Lobby Supreme Court case in 2014.
Last month, SCOTUS agreed to hear a new bundle of seven cases in March 2016. The claimants’ beef is with the government’s workaround: They say the requirement that employers provide written notification of their religious objection—which allows the government to work with the insurance company to provide an alternative for a female employee—is a contraceptive “trigger” and forces objectors to “[violate] their religious beliefs or [pay] the heavy fines.” Apparently the federal government’s concession to religious objectors was not enough; those same objectors now want to prevent the government itself from providing birth control to employees in their stead.
As the highest court in the land ponders whether to give the archaic whims of a tiny slice of religious objectors more influence than laws passed by the democratically-elected government, it’s worth considering what it’s like to live in a country where these all are moot points. If nothing else, it serves as a good reminder for reproductive health advocates that all hope is not lost.
My first seamless experience at a NHS-funded sexual health clinic was not a fluke. In a report on contraception access in the EU, the Center for Reproductive Rights considers the UK a leader in terms of best practice, and according to UN data, the UK has one of the highest rates of contraceptive usage in Northern Europe (84%). According to Ann Furedi, the chief executive of the British Pregnancy Advisory Service, it’s because the NHS goes out of its way to make contraception free and accessible to UK women. They start by waiving the flat fee applied to all prescriptions in Britain (a mere £8.20, or just over $12). Many clinics like the one I visited in Soho operate on a convenient walk-in basis, and appointments—whether with a woman’s regular doctor or at a walk-in clinic—are always free.
“In the UK, what politicians really want is for people to be using contraception and to be using it well,” Furedi told me. “Especially political conservatives, who are wary of benefit culture, believe that family planning is a very good thing.” She chalks this up to “the whole British idea of restraint,” the idea that it’s “responsible to have only as many children as you can care for properly.”
Furedi says from the UK government’s perspective, both contraception and abortion fall squarely in the realm of public health, not ideology or ethics. It isn’t that Britain is free of bitter partisan divides. It’s also not a particularly progressive nation when it comes to gender equality (just look at the gender ratio of Parliament or the topless, scantily clad women on Page 3 of the nation’s most-read newspaper, The Sun). It’s just that my reproductive system is, quite rightly, not a point of political contention.
Abortion is a little murkier than birth control in terms of public perception, but still unambiguous when it comes to the law. Abortion has been legal and free in the first 24 weeks of pregnancy on the NHS since 1967 in England, Scotland and Wales.* Though there are still practitioners who may refuse to perform a later-term abortion on grounds of competency or conscience, the general attitude is one of neutrality. (For proof, look no further than the NHS’s webpage on the topic. It includes “personal circumstances” as first on a list of reasons why a woman might choose to end a pregnancy.) When stigmatization or “conscientious objection” does happen, they’re more localized and don’t come from a top-down, institutional level like they do in America.
Bottom line, Furedi says, is that while access is not perfect, “it’s fair to say that if you have an unwanted pregnancy…you can get an abortion on the NHS.”
Lorraine Hosie is 37 and has had two abortions on the NHS, one early in her twenties and one just recently. She says that the second time, she was impressed by the non-judgmental, caring approach of the NHS doctors and felt that any questioning about her choice was only to ensure she was not being pressured into it by someone else.
“The doctor mentioned to me that, at 37, I'm running out of years to have a baby,” Hosie told me. But “[s]he wasn't warning me—I really felt that it all came back to it being about my welfare and my well being.”
Hosie was given an option of which type of procedure she preferred, and what hospital would be most convenient. And of course, the entire thing was free.
It’s not that some abortion providers and doctors in the U.S. don’t also offer the same kind of practical and compassionate care Hosie received on the NHS. It’s just that they are forced to operate under a federal system that legislates to please religious minorities at the expense of women. Even the Supreme Court’s decision to hear religious objectors’ cases validates the notion that a woman’s access to contraception and her choice of whether or not to have a baby is a privilege, not a right.
Living in the UK, I’ve learned what it feels like when free, unimpeded access reproductive health is considered my basic human right. So to the American feminists fighting this battle across the pond, take it from me: You shouldn't be settling for anything less.
*Northern Ireland, though it is part of the United Kingdom and covered by the NHS, still considers abortion illegal, though a high court ruling last month hinted at change.