Hobby Lobby and the Rush Limbaugh Effect

We've forgotten Sandra Fluke's message even as she's become a household name.

Georgetown Law student Sandra Fluke.  (National Journal)

It's one of the quirks of the conversation around contraception that hardly anyone recalls what Sandra Fluke was actually saying in the testimony that catapulted her to national attention. What people remember is that, at some point in the course of the 2012 elections, Rush Limbaugh called her a slut.

And just like that, an intelligent conversation about the medical needs of millions of Americans turned into an asinine Internet firestorm over whether the Georgetown University law student could rightfully be called a sexist slur. Fluke appeared on NBC to say she was "stunned" and "outraged." Rush penned a rare mea culpa. And President Obama reached out to her personally, to empathize. The coverage was such that The Week felt the need to run a large graphic entitled "Rush Limbaugh vs. Sandra Fluke: A Timeline."

The outrage was merited, but it was not a replacement for a policy discussion about the point that Fluke was actually making in her testimony: that there are sundry medical reasons women need access to birth control as a matter of routine health, including cyst and cancer prevention. It also, as MSNBC's Benjy Sarlin recently mused, has been almost entirely forgotten.

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So let's set the record straight. Fluke's testimony revolved around women for whom access to contraceptives is a medical imperative, not simply a way to prevent pregnancy. In particular, she focused on a lesbian friend of hers at Georgetown who needed the pill to regulate a common medical condition. "In the worst cases women who need this medication for other medical reasons suffer very dire medical consequences," Fluke said at the time. "A friend of mine, for example, has polycystic ovarian syndrome and she has to take prescription birth control to stop cysts from forming on her ovaries."

While she made a nuanced argument for the medical benefits of birth control, all we remember is later she got labeled a slut. Call it the Rush Limbaugh effect and chalk it up to mistakes made 2012. The trouble is, it's still happening, and the ruling in the Hobby Lobby case last week is a perfect example of how.

The Supreme Court's majority opinion, which found that closely held corporations may for religious reasons deny their employees certain forms of contraceptive coverage, made zero mentions of women who rely on the pill for medical reasons. It's not because it wasn't in any of the legal literature presented to the Court before the decision.

"Polycystic ovarian syndrome" just doesn't have the same ring to it as "slut."

An attorney who cowrote a brief to the Supreme Court on behalf of ovarian-cancer advocates said the justices (to say nothing of the general public) have failed to consider the broader narrative. "The debate was mis-framed as a contraceptive debate from the beginning," Michelle Kisloff, a partner at Hogan Lovells, told me. "We've tried to recast that debate to orient the Court to the fact that there's more going on here than pregnancy and contraception, but ultimately the Court went with the way Hobby Lobby had characterized it."

That's not however, because Fluke's friend is alone in her health problems. PCOS is a common condition. In fact, as I noted in my piece Thursday, PCOS is the single most frequent endocrine problem in women of reproductive age, affecting 5 to 10 percent of the female population. And hormone regulation, via oral contraceptives, is the best known treatment.

That the highly forgettable name makes the condition sound more obscure than it actually is is such a big problem that experts have long recommended renaming the condition, which affects approximately 5 million women of reproductive age in the United States. It's one of a handful of medical conditions — including endometriosis, endometrial cancer, and ovarian cancer — that were ignored in last week's Hobby Lobby decision. Not that you'd know it from the transcript of oral arguments or the coverage of the decision that followed.

The way the Court and the media have been talking about it has more in common with the Limbaugh perspective. "Sex, sex, sex. That's what it's all about," Limbaugh said over the weekend. "Everybody wants it and whatever it takes to make it safe. And if it takes the taxpayer buying women birth control than men are for it too." In another, he claimed women wouldn't need birth control if they simply "didn't do a certain thing."

If Americans have forgotten Fluke's message, they haven't forgotten Fluke. Though her star has faded considerably since the days of Limbaugh labeling her with idiotic epithets, she's back in the news this election cycle — this time as a candidate.