Contraception Coverage Policy in Congress

Chapter 4 traces the trajectory of competing policy frames in congressional debates over the Affordable Care Act (ACA). Although the ACA was not the first attempt to ensure contraceptive coverage, it was easily the most visible, sweeping, and significant. Utilizing content analysis and in-depth interviews with policymakers, this chapter shows that the debate over contraceptive regulation in the ACA shifted course over time—from being predominantly about health care at the start to being predominantly about religious freedom after the law’s passage. Additionally, the analyses presented in this chapter suggest that a policymaker’s gender was far more important than their partisanship in shaping how they chose to frame issues related to contraception under the ACA. Taken together, these findings reveal the dramatic extent to which rhetoric about the ACA’s contraception requirements was dynamic (rather than static) and shaped by gender.

Public Opinion

Chapter 8 describes the contours of public support for access to birth control over the last 60 years and for the contraceptive mandate of the Affordable Care Act (ACA) between 2011 and 2014. Drawing on data from numerous polling organizations, this chapter shows that majorities of both political parties, both genders, and all races and religious affiliations have had stable and supportive opinions on whether women should have access to birth control and whether contraceptives are morally acceptable since at least the 1950s. Our analysis also reveals, however, that large partisan, gender, and “God-based” gaps in public support for requiring health insurance coverage of contraceptives developed as a result of the 2012 debate over the ACA’s birth control mandate. The divisions in public opinion driven by the competing accusations of a “war on women” and a “war on religion” persist today.

Media Frames

Chapter 7 explores the ways in which the Affordable Care Act’s contraceptive mandate was framed in newspaper coverage between August 1, 2011, and August 1, 2012. After demonstrating that news reports framed the birth control mandate as a religious issue more frequently than an economic, women’s rights, or health issue, this chapter then assesses the impact that an author’s gender and the gender of quoted sources had on an article’s dominant frame. The chapter demonstrates that female journalists employed gendered frames (i.e., women’s health, reproductive rights, and morality) in their reporting far more often than male journalists. Additionally, this chapter shows that female reporting exerted an indirect influence on news frames by increasing the proportion of women quoted in articles about the contraception mandate. Put simply, allowing women to write and speak made a profound difference in how the media covered contraception policy.

Contraception Coverage Policy in the States

Chapter 3 analyzes the dynamics of contraceptive policymaking at the state level. Long before the federal government required health insurance providers to cover the costs of birth control under the Affordable Care Act, twenty-eight states adopted their own policies mandating coverage of prescription contraceptives. This chapter considers the political, religious, and ideological factors that shaped the passage and content of this diverse group of state-level policies, with a particular focus on the impact of women officeholders. The analyses reveal that the gender and partisan composition of state legislatures exerted a strong influence on whether state governments enacted contraceptive mandates between 1998 and 2009. The chapter also shows, however, that women’s power to shape state-level contraceptive mandates was not consistent across institutions or across different aspects of the policymaking process. Having a woman governor, for example, had no effect on the passage or content of laws requiring insurance coverage of contraception.

Introduction: Where Are the Women?

Chapter 1 argues for the necessity of an in-depth analysis of contemporary birth control politics in the United States. First, this chapter details the ways in which contraception issues are uniquely significant for the quality of women’s lives. Among many other things, expanding access to and insurance coverage of contraception is linked to women’s economic prosperity, political empowerment, and personal well-being. Second, this chapter situates the project in existing literature on gender, framing, representation, policymaking, and political communication. Specifically, in arguing for a link between descriptive representation and policy framing, it makes the case that birth control provides a high-leverage litmus test for evaluating women’s influence in the political process. Finally, the chapter describes the contours of the book, summarizes its methodological approach, and explains why a cross-venue, over-time assessment of framing choices is the most fruitful approach for identifying gender’s role in controversies over contraception.

The History of the Pill

Chapter 2 places current debates about contraception policy in a broader historical context. By examining Margaret Sanger’s and Katherine McCormick’s advocacy, John Rock’s and Gregory Pincus’s development of hormonal birth control, and the Supreme Court’s assertion of a constitutional right to privacy, this chapter highlights the ways in which legal regulation of reproduction is rooted in more fundamental struggles over whose expertise is valued and whose voice is heard. More generally, the analysis presented in this chapter illustrates that religion, economics, race, and women’s autonomy have informed public discourse surrounding reproductive issues since the earliest days of America’s long national conversation about birth control. In short, this chapter lays the foundation that animates the rest of the book: Who speaks? What do they say? Does it matter?

The Politics of the Pill: Looking Forward

Chapter 10 synthesizes the empirical evidence presented in preceding chapters and explains the significance of these findings for women’s voices in political debate more broadly. More specifically, this chapter marshals the data described in chapters 2 through 9 to answer the three central questions posed in the beginning book: Who speaks? What do they say? Does it matter? This chapter argues that the presence or absence of female politicians, reporters, activists, and judges has dramatic consequences for the timing, tone, and trajectory of public debates and policy outcomes on birth control. Additionally, this chapter considers how lingering debates over contraception coverage, and the persistent disparities in who speaks and who is heard, will inform our expectations about gender and politics in the years to come.

Experiment

Chapter 9 assesses the effects of exposure to different author bylines and frames in news coverage of birth control policy. Using a series of survey experiments, this chapter identifies how exposure to the kinds of articles typically produced by male and female reporters influences media trust, political cynicism, and opinions about contraception. The results show that women asked to read articles on the contraceptive mandate written by other women viewed the media as more credible than women asked to read articles written by men. In addition, the results demonstrate that exposure to strategic game coverage significantly decreased perceptions of media credibility, enhanced feelings of political cynicism, reduced issue-specific information retention, and encouraged more frequent expressions of negativity among experimental participants. In line with previous research, the experimental results also show that support for the contraceptive mandate increased after reading an article framed around women’s health, reproductive rights, and sexual morality.

Media Sourcing

Chapter 6 examines how the presence of female reporters and gender-balanced newsrooms shaped sourcing patterns in the media’s coverage of the Affordable Care Act’s contraceptive mandate. Drawing on an extensive analysis of newspaper articles between August 1, 2011, and August 1, 2012, this chapter offers strong evidence that gender mattered for the substance of the media’s reporting. Specifically, men and official sources were quoted more frequently than women and unofficial sources. More importantly, this chapter demonstrates that the tendency to rely on men was significantly dampened in reports written by female authors and in reports appearing in newspapers with more gender-balanced staffs. These findings provide support for the increasingly vocal concerns of media watchdog organizations that lobby for increased newsroom diversity and offer a clear answer to the oft-repeated question of whether having more women in the media leads to a qualitatively different kind of reporting on issues affecting women.

Contraception Coverage in the Courts

Chapter 5 examines how the issue of contraceptive coverage under the Affordable Care Act (ACA) was debated in the Supreme Court. Relying on a detailed content analysis of the amici curiae briefs, oral arguments, decisions and dissents presented during Burwell v. Hobby Lobby, Inc. and Zubik v. Burwell, this chapter shows that while “religious freedom” frames were almost entirely absent in the initial debates over the ACA, they became the dominant approach to understanding the contraception issue during litigation. Moreover, the evidence presented here demonstrates that the gender of the participants in these cases shaped their framing choices in ways that transcended their support or opposition for the ACA’s contraceptive mandate. In other words, the dominant frame of the debate over contraception coverage evolved considerably over time, and gender considerations were paramount in dictating how different actors chose to frame their discussions of the birth control mandate.