You're probably one of the 99 percenters. Meaning, one of the 99 percent of American women who are or have been sexually active and have used some sort of birth control.

Maybe it's daily pills or monthly shots or some other form of pregnancy prevention. Maybe you already have all the kids you want, or you're waiting until you're ready to have a baby, or you've decided you'll never be ready. And perhaps your contraceptive of choice also eases a medical problem—whether it's painful endometriosis or scary ovarian cysts or disabling pelvic cramps—or helps stave off a new one, such as ovarian or uterine cancer. When it comes to controlling your reproductive health and destiny, birth control has always been there for you and always will be, right?

In a word, no. Because today, there's a national discourse raging around access to birth control—40 years after the Supreme Court legalized contraception for all women, irrespective of marital status, and five decades after the birth-control pill's introduction. And while fringy far-right extremists have always blasted away at contraceptive use, they have now infiltrated the mainstream—in the form of Tea Party Republicans and GOP presidential candidates. "It is shocking to see the vehemence of the attacks on contraception that we are facing these days," says Marcia Greenberger, copresident of the National Women's Law Center.

All of this has left young women around the country fretting about what a conservative-crafted future would mean for them. Take Chris Mascaro, a 29-year-old graphic designer in Rockford, Michigan, who earns $35,000 a year working for an employer who doesn't offer health coverage. Rent, student loans, groceries . . . they gobble up her paycheck, leaving nothing—certainly not the more than $150 she would need to pay a private ob-gyn for a Depo-Provera shot, which she has used in the past not only to help her put off having kids until she can afford them but also to treat her debilitating and painful endometriosis. Thankfully, she had access to a Planned Parenthood clinic, where she paid $59 to cover this basic health need. But she worries, constantly, that women's health programs will lose their funding and shut down.

Her fear is well founded. Some of the recent attacks launched by staunch conservatives are chillingly retro and misogynistic: Rick Santorum's financial backer pining for the days when a woman stuck an aspirin between her knees to avoid pregnancy; a GOP legislator in New Hampshire, Lynne Blankenbeker, proposing that married—married!—couples could practice abstinence unless they want to conceive; a panel of all-male House Republican legislators and religious leaders debating contraceptive coverage at a House Committee meeting; conservative radio host Rush Limbaugh going on a three-day on-air tirade against law student Sandra Fluke, calling her a slut and a prostitute for speaking up in favor of birth-control coverage. And, particularly scary for Chris, Republican presidential candidate Mitt Romney pledging to defund Planned Parenthood if elected. Also out of luck if Romney wins: the one in five women in the U.S. who have received basic health care and disease screenings at one of Planned Parenthood's more than 800 clinics.

Next page: Fanning the Flames

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Fanning the Flames

The attacks grew fiercer immediately after President Obama announced last year that all FDA-approved contraceptives would be a required benefit of employer-sponsored health insurance, with no copay, as part of the Affordable Care Act. That was the recommendation of a panel of women's-health experts at the nonpartisan Institute of Medicine (IOM), which determined, after a year of analyzing the data, that family planning should be considered preventive medicine.

"There is extraordinary evidence, a wealth of scientific literature, that shows that family planning works," says Linda Rosenstock, M.D., the dean of UCLA's Fielding School of Public Health and the chair of the IOM panel. "Contraception helps women avoid unintended pregnancy—which accounts for nearly half of all pregnancies in this country—and improve birth spacing, with substantial positive consequences for infants, women, families, and society. It was an easy pick for us as a committee of experts."

Easy, given that the average woman who wants two children spends three decades trying to avoid pregnancy and only five years pregnant, postpartum, or trying to conceive. That's 30 years in which, unless she wants to pop kids out Duggar-style, a woman (and don't forget about her man!) needs access to birth control. Without it, her very future—whether she wants to have children or not; whether she's able to build her pregnancies on the shifting sands of work, finances, and relationships—will be like playing a game of Russian roulette . . . for three decades. "Controlling our reproductive destinies is a pretty fundamental part of who we are as women," says Susan Cohen, the director of government affairs at the Guttmacher Institute, the nation's premier reproductive-health research group. "It's a prerequisite to being able to have control over our own lives, our autonomy."

Indeed, numerous research papers have linked the introduction of the birth-control pill with positive social and economic gains for women—from completing higher education to marrying later to narrowing the pay gap. The most recent, out of the National Bureau of Economic Research this year, found that earlier access to the Pill was linked to higher hourly wages later in life—no trifling fact in a sagging economy that's buttressed by roughly 40 percent of working wives outearning their husbands.

And yet here we are, in the throes of a jihad against birth control. "I was surprised by the extent of the firestorm," says Rosenstock. "The degree to which that whole discussion has gotten politicized is not just disappointing but remarkable, as it threatens to swamp years of settled policy and settled science." Unprecedented is the word Cohen slaps on the inflammatory and regressive political attacks of late.

"It does not make any sense to me that certain organizations are trying to limit family planning, because most of the country feels positive about contraception, regardless of religion," says Mark Hathaway, M.D., M.P.H., codirector of Family Planning Fellowship for Women's and Infants' Services at MedStar Washington Hospital Center. "Every day I see a patient who is pregnant and didn't want to be pregnant, or wasn't ready to be pregnant, or didn't plan her pregnancy. It's so sad to me."

Yet if the conservative ranks in today's Republican party have their way, it could get a whole lot worse. And the reproductive rights women have worked so hard to win could be lost.

Next page: The Biggest Battles

THE BIGGEST BATTLES

Today's war against birth control is being waged on three main fronts. What you need to know.

{BATTLE #1} Conscience Clauses

In an attempt to appease those who couched their criticism of the birth-control mandate by claiming it infringed upon their "religious liberty," President Obama announced in February an expanded accommodation: While churches had always been exempt from offering birth control to their employees, now religiously affiliated institutions—such as hospitals, charities, and colleges, which employ workers of all faiths—could have the required benefit for its employees paid by insurers instead of by the institution. It was a brilliant win-win, said many on both sides of the divide: Women could have their IUDs, but religious institutions wouldn't have to pay for them.

And yet, just weeks after Obama announced the compromise, Senator Roy Blunt (R-Mo.) proposed legislation that would allow any employer or insurance company to decline to cover any medical care for any moral or religious reason. Under the law, your boss would have free rein to pick and choose your medical care as he or she saw fit—so if the boss believed that birth control were an affront to God and nature, well, too bad for you; you'd have to shell out the full monthly cost for your pill pack. The Blunt Amendment (which Romney endorsed) was blocked in the Senate with an extremely narrow margin—51 to 48—with Maine's Olympia Snowe (who announced around the same time that she would not be seeking reelection) the only Republican voting against it.

But that didn't stop various states from attempting their own end runs from the flank. Though the Blunt Amendment was defeated by the Senate, the Republican House in Arizona passed a similar—though more extreme—measure: It gives any employer the power to request that women being prescribed birth control provide proof that they're using it for nonsexual reasons. In other words, a woman would have to get a permission slip from her doctor—verifying she was using contraception solely to treat a medical issue such as ovarian cysts, painful periods, or acne—and then share her private medical condition with her boss. (And if she just wanted to avoid getting knocked up, she'd be out of luck.) Soon after that, the Republican-controlled House in New Hampshire passed a bill that gave employers the right to opt out of covering contraception in health insurance if they had a religious objection.

These conscience clauses leave Linda Rosenstock, M.D., the deal of UCLA's Fielding School of Public Health and the chair of the IOM panel disconcerted. "If every employer could decide what services they thought their employees should get, if we all of a sudden opened up our health-care system like that, we'd wreak havoc," she says. "What if an employer didn't like vaccinations? Some of them don't. We can't have employers dictating health care for individuals."

And it's not only employers who could deny you your birth control. Already 12 states have conscience clauses on the books that allow some health-care providers—such as pharmacists—to refuse services related to contraception. In February, a Washington State federal judge, an appointee of George W. Bush, ruled that the state could not force pharmacies or pharmacists to dispense Plan B or other emergency contraception if they had a religious objection to it.

While you might think, Big whoop—a woman could just cruise down to a more liberal pharmacy to have her prescription filled (that is, if she doesn't live in a rural one-pharmacy county), the psychological impact is harder to overcome. "Shame is powerful," says 26-year-old Rhiannon Andreini, a case manager in Seattle who also works as a waitress to cover her graduate-school costs. "I felt this paralysis." Rhiannon was visiting her parents' new home in Edmonds, Washington, during Thanksgiving break a few years ago when she had unprotected sex. Angry with herself—"I should have known better," she says—she drove to the local Albertsons to get Plan B. The older man at the pharmacy counter told her, disdainfully, that they didn't have that there.

Feeling "judged and small and red-faced," she cut short her vacation with her parents and fled, crying, an hour and a half back to her college town, where she knew she could get emergency contraception without an extra dose of shame. "I'm a politically charged, educated adult of means," she says. "I think about what that refusal would mean to my clients—dispossessed students at an alternative high school without much, if any, material means or psychological fortitude to overcome the humiliation." Precisely the women who need timely, judgment-free access to emergency contraception.

Next page: BATTLE #2: Personhood Amendments

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{BATTLE #2} Personhood Amendments

Even if folks have long debated when life begins, it's been well established when pregnancy begins. Until now. There's a burgeoning national movement underfoot, called Personhood USA, that seeks to upend the definition of pregnancy as beginning with the implantation of a fertilized egg in the uterus. The Personhood movement not only proposes to redefine pregnancy as occurring at the moment of fertilization (even though up to half of fertilized eggs don't result in a sustainable pregnancy) but also wants that sperm-hitting-egg mash-up—still weeks away from a potential pink plus sign on a stick—to be recognized as a complete human being. With legal rights.

If zygotes were people too, Personhood laws would, of course, criminalize all abortion. But—and here's the rub—they would also probably outlaw some forms of birth control (not to mention IVF treatments and stem-cell research), as well as complicate the legality of medical interventions in the event of a life-threatening ectopic pregnancy or a pregnant woman's cancer diagnosis.

Here's the slippery slope: "The main target of Personhood is emergency contraception," says Susan Cohen, the director of government affairs at the Guttmacher Institute, with Personhood proponents claiming that emergency contraception is an abortifacient since, they say, it could theoretically prevent an already fertilized egg from implanting. (Medical experts, however, vehemently disagree, stating that emergency contraception actually works before pregnancy begins, with no effect on a fertilized egg once it implants.) "And since emergency contraception is only a higher dose of the birth-control pill, then they're effectively going after the Pill as well. So that's their goal." In other words, that little pill could, in the world of Personhood, be deemed a lethal weapon, an instrument of homicide.

So far, Personhood legislation has been defeated in Colorado (twice) and Mississippi, but bills or initiatives are being considered in at least 17 other states, including Florida, Alabama, Montana, Ohio, and Wisconsin. The House in Virginia passed a Personhood bill earlier this year, but the Senate decided to defer voting on it until 2013.

Next page: BATTLE #3: Family-Planning Services

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{BATTLE #3} Family-Planning Services

Given the astonishing fact that the United States has a higher rate of unintended pregnancy than most other industrialized countries—again, that would be nearly half of all pregnancies in this country—one would think that ensuring access to affordable birth control would be a humongous national priority (especially for those who are against abortion and single parenthood). That, however, is not the case: Instead, federally funded family-planning services are under siege like never before.

Title X, the only federal grant program devoted solely to family planning and related preventive health services, offers its services (including birth control) to more than 5 million low-income people. Planned Parenthood, the leading provider of reproductive-health services in the country, provides contraception to 2.2 million patients every year, as well as screenings and other basic health care for women of all socioeconomic backgrounds. According to the Guttmacher Institute, publicly funded family-planning services help women avoid 1.94 million unintended pregnancies each year, which would result in 860,000 unintended births and 810,000 abortions. Without those services? The number of abortions would be two-thirds higher than it is today. Quite simply, family planning works.

And yet, when Tea Party Republicans in the House were seated in 2011, they worked overtime trying to eradicate the very programs that reduce abortion and single parenthood. Democrats managed to squash the relentless and sustained blitzkrieg on family planning—including the Pence Amendment, which would have eliminated all funding for Planned Parenthood, and the budget bill, which would have eliminated all funding to Title X. Regardless, Mitt Romney has promised to "get rid of " Planned Parenthood if he is elected.

In the meantime, the battle rages on at the local level: At least five states—including Arizona, North Carolina, and Kansas--have attempted to either limit or deny funding to Planned Parenthood. Most notably, in March, Texas governor Rick Perry supported legislation that excluded Planned Parenthood from participating in the state's Medicaid program—essentially shuttering the entire enterprise. Planned Parenthood estimates that about 160,000 women per year in Texas will have to do without birth control and other health services—a devastating blow, as Texas has the highest rate of uninsured women in the country.

And the effects are already playing out: Planned Parenthood was forced to close four of its eight clinics (and may have to close another two or three) in two desperately poor counties near the Mexican border; it closed another in Odessa, Texas, in March, forcing women in need of birth control and other services to travel 20 miles to an overburdened affiliate (a particular hardship for those without cars). Worried yet?

Next page: Is Your Medical Care Determined by Religious Doctrines?

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In The Hospital, Out Of Luck

In November 2009, a pregnant 27-year-old woman was brought to the hospital—St. Joseph's Hospital and Medical Center in Phoenix—with pulmonary hypertension. Doctors there determined that if they did not terminate her 11-week pregnancy immediately, her risk for death was nearly 100 percent. They decided to save the young woman's life.

Why is this completely legal—and logical—case even notable? Because it occurred at a hospital affiliated with the Catholic Church, a hospital that was obligated to follow the church's religious directives—which prohibit abortions under any and all circumstances—instead of following the standard of medical care. The hospital was stripped of its church affiliation, and the nun who was involved in the decision was excommunicated.

The Catholic hospital system operates 15 percent of the nation's hospital beds. In 2010, approximately one-sixth of all hospital patients were admitted to a Catholic institution. As these hospitals merge with and take over cash-strapped secular ones, "the restrictions they impose on health care are so severe that in some quite dire circumstances, the actual life of the woman is at stake," says Marcia Greenberger of the National Women's Law Center.

Although these institutions have voluntarily chosen to serve the general public—with a mission that is not primarily religious—the medical care is determined more by religious doctrine than by medical need. And this affects access to birth control: It means no emergency contraception, even after being raped; no tubal ligation, even if that means having to undergo a subsequent surgery at another hospital following a cesarean section; and no contraception, even if you're one of the 98 percent of sexually experienced Catholic women who have used it. Says Susan Cohen of the Guttmacher Institute: "Often, a Catholic hospital is the only one a woman has access to."

Next page: The Perfect Political Storm

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The Perfect Political Storm

While it seems ludicrous that we, as a country, are even having this conversation in 2012, it may well be that now is actually the ideal cultural moment for sexual fundamentalists to strive for something as unfathomable as outlawing—or extremely limiting access to—contraception. "When you merge Republican leaders' opposition to birth control in general with the vehement partisan opposition to the Affordable Care Act, it's just a combustible mix that trivializes women's reproductive health," says Cohen. Throw religion into the tinder and it only fuels today's firestorm.

But, reproductive-health experts say, women do not have to huddle back and wait to get burned; our votes can extinguish this whole mess. "During the midterm elections, a lot of the candidates let voters believe that the economy was going to be their number one priority. But right after they were elected, it became clear that they didn't have any ideas about how to fix the economy, but they had a lot of ideas about how to fix women," says Dawn Laguens, executive vice president for public policy, advocacy, and communications at Planned Parenthood Federation of America, citing the record number of reproductive-rights provisions—1,100 in all—proposed in 2011. "A government that would limit your access to the health care you need and the tools to make healthy decisions for you and your family says something about what they think of you as a citizen."

Conscience clauses, Personhood amendments, defunding family-planning services—these are not mere talking points for those seeking to score votes from a conservative base, and this is not just political shadowboxing. It's actual legislation. "Limiting access to contraception would be devastating," says Greenberger. Adds Laguens, "There are so many worst-case scenarios" that it is hard to envision the fallout. The repercussions—for women, for families, for society—are very real.

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