One Big Thing Everyone Is Missing in Hobby Lobby

The ruling is not just about sex, it's about health.

Justice Ruth Bader Ginsburg, in her scathing dissent of the Supreme Court's 5-4 ruling in the Hobby Lobby case this week, made an important point about women's health that's been almost entirely overlooked elsewhere: For many American women, the birth-control pill has nothing to do with controlling births. It's a life-saving medicine.

"The coverage helps safeguard the health of women for whom pregnancy may be hazardous, even life-threatening," wrote Ginsburg. "And the mandate secures benefits wholly unrelated to pregnancy, preventing certain cancers, menstrual disorders, and pelvic pain."

The decision, which found that closely held corporations may refuse for religious reasons to cover contraceptives in their health plans, may affect millions of women who suffer from a variety of medical conditions. These women depend on the pill to regulate their hormones and do everything from ease pain to reduce the risk of cancer. These medical benefits have nothing to do with sex or the prevention of pregnancy, which have become the sole focus of political debate around the decision. Even if these women never have sex once in their lives, they need to be on birth control.

The pill is a key treatment for at least three major medical problems. First, there are the women with Polycystic Ovary Syndrome. Don't be fooled by the obscure-sounding name—it is the single most frequent endocrine problem in women of reproductive age, affecting 5 to 10 percent of the female population. Hormone regulation, via oral contraceptives, is the best known treatment. Without it, these women—about 5 million American women of reproductive age—may suffer from a range problems, from irregular bleeding and obesity to the development of ovarian cysts and infertility.

Birth control pills are also used to treat endometriosis, which will affect an estimated 11 percent of women in their lifetime, according to the National Institutes of Health. For most of these women, birth control is a way to avoid pain and even surgery or a hysterectomy.

Research has shown taking birth control pills for more than a year reduces the risk of endometrial cancer, which forms in the tissue lining of the uterus and kills thousands of American women each year. For these women, the pill is a potentially life-saving cancer-preventive treatment. The annual incidence of endometrial cancer is roughly 40,000, according to estimates from SEER, a national cancer database.

While a minority of women suffer from these endocrine dysfunctions, every woman is at risk for developing ovarian cancer within her lifetime. Ovarian cancer is one of the most common deadly cancers, killing more than half of victims within five years of diagnosis, and the pill is the best known way to decrease the risk of developing it. Research has shown that taking birth control pills for one year decreases a woman's risk by 10 to 12 percent, and taking them for more than five years reduces risk by approximately 50 percent.

"When a woman is diagnosed, most women are in stage 3 or stage 4," Calaneet Balas, the CEO of the Ovarian Cancer National Alliance told National Journal. "This is a very deadly cancer, so it's really important to our organization that women have every weapon possible against this kind of cancer, because the outcomes are not great right now."

But you would never know any of that from reading the Supreme Court's majority opinion in Burwell v. Hobby Lobby Stores, or from the extensive media debate surrounding the decision. One of the few exceptions was Zoe Fenson's first-person account in The New Republic of her experience with PCOS.

But despite the fact that there are millions in America like Fenson, there was not a single mention of cancer or gynecologic disorders during the Supreme Court's oral arguments (the lead attorneys on both sides were men). Nor was there any mention of them in the Court's majority opinion (all five justices who voted in favor were men).

The problem was not, however, that the justices hadn't been educated on the science. An amicus brief filed on behalf of the Ovarian Cancer National Alliance, one of more than 80 filed to the Court, warned of "wide-reaching medical consequences." Because there is currently no way to reliably detect ovarian cancer at an early stage, the brief explained, prevention remains the primary weapon against this devastating disease.

Michelle Kisloff, a partner at Hogan Lovells who cowrote the brief, said she was disappointed but not surprised that the issue didn't come up—the debate was misframed as a contraceptive debate from the beginning, she said.

"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," she added.