In Context: Sandra Fluke on contraceptives and women's health

In the latest installment of our In Context feature, here are the full remarks of Georgetown University law student Sandra Fluke, testifying before a Democratic congressional panel convened by Minority Leader Nancy Pelosi, on contraception coverage and women's health.

Leader Pelosi, members of Congress, good morning, and thank you for calling this hearing on women's health and for allowing me to testify on behalf of the women who will benefit from the Affordable Care Act contraceptive coverage regulation.

My name is Sandra Fluke, and I'm a third-year student at Georgetown Law School. I'm also a past president of Georgetown Law Students for Reproductive Justice, or LSRJ. And I'd like to acknowledge my fellow LSRJ members and allies, and all of the student activists with us, and thank them so much for being here today.

We, as Georgetown LSRJ, are here today because we're so grateful that this regulation implements the nonpartisan medical advice of the Institute of Medicine. I attend a Jesuit law school that does not provide contraceptive coverage in its student health plan. And just as we students have faced financial, emotional and medical burdens as a result, employees at religiously affiliated hospitals and institutions and universities across the country have suffered similar burdens. We are all grateful for the new regulation that will meet the critical health care needs of so many women. Simultaneously, the recently announced adjustment addresses any potential conflict with the religious identity of Catholic and Jesuit institutions.

When I look around my campus, I see the faces of the women affected by this lack of contraceptive coverage. And especially in the last week, I have heard more and more of their stories. On a daily basis, I hear from yet another woman from Georgetown or from another school or who works for a religiously affiliated employer, and they tell me that they have suffered financially, emotionally and medically, because of this lack of coverage. And so I'm here today to share their voices, and I want to thank you for allowing them -- them, not me -- to be heard.

Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that's practically an entire summer's salary. Forty percent of the female students at Georgetown Law reported to us that they've struggled financially as a result of this policy.

One told us of how embarrassed and just powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance, and she had to turn and walk away because she couldn't afford that prescription. Women like her have no choice but to go without contraception.

Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn't fit it into their budget any more. Women employed in low-wage jobs without contraceptive coverage face this same choice.

And some might respond that contraception is accessible in lots of other ways. Unfortunately, that's just not true. Women's health clinics provide a vital medical service, but, as the Guttmacher Institute has definitively documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing, and women are being forced to go without the medical care they need.

How can Congress consider the Fortenberry, Rubio and Blunt legislation, that would allow even more employers and institutions to refuse contraception coverage, and then respond that the nonprofit clinics should step up to take care of the resulting medical crisis; particularly when so many legislators are attempting to defund those very same clinics?

These denials of contraceptive coverage impact real people. In the worst cases, women who need this medication for other medical reasons suffer very dire consequences. A friend of mine, for example, has polycystic ovarian syndrome, and she has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown's insurance, because it's not intended to prevent pregnancy. Unfortunately, under many religious institutions' insurance plans, it wouldn't be. There would be no exception for other medical needs. And under Senator Blunt's amendment, Senator Rubio's bill or Representative Fortenberry's bill, there's no requirement that such an exception be made for these medical needs.

When this exception does exist, these exceptions don't accomplish their well-intended goals, because when you let university administrators or other employers, rather than women and their doctors, dictate whose medical needs are legitimate and whose are not, a woman's health takes a backseat to a bureaucracy focused on policing her body. In 65 percent of the cases at our school, our female students were interrogated by insurance representatives and university medical staff about why they needed prescriptions and whether they were lying about their symptoms. For my friend, and 20 percent of the women in her situation, she never got the insurance company to cover her prescription. Despite verification of her illness from her doctor, her claim was denied repeatedly on the assumption that she really wanted birth control to prevent pregnancy. She's gay -- so clearly, polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her.

After months of paying over $100 out of pocket, she just couldn't afford her medication anymore, and she had to stop taking it. I learned about all of this when I walked out of a test and got a message from her that, in the middle of the night in her final-exam period, she'd been in the emergency room. She'd been there all night in just terrible, excruciating pain. She wrote to me: "It was so painful I woke up thinking I'd been shot." Without her taking the birth control, a massive cyst the size of a tennis ball had grown on her ovary. She had to have surgery to remove her entire ovary as a result. On the morning I was originally scheduled to give this testimony, she was sitting in a doctor's office trying to cope with the consequences of this medical catastrophe.

Since last year's surgery, she's been experiencing night sweats and awaking and other symptoms of early menopause as a result of the removal of her ovary. She's 32 years old. As she put it: If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no choice at giving my mother her desperately desired grandbabies, simply because the insurance policy -- that I paid for, totally unsubsidized by my school -- wouldn't cover my prescription for birth control when I needed it. Now, in addition to potentially facing the health complications that come with having menopause at such an early age -- increased risk of cancer, heart disease, osteoporosis -- she may never be able to conceive a child.

Some may say that my friend's tragic story is rare. It's not. I wish it were. One woman told us doctors believe she has endometriosis, but that can't be proven without surgery. So the insurance has not been willing to cover her medication, the contraception she needs to treat her endometriosis. Recently, another woman told me that she also has polycystic ovarian syndrome, and she's struggling to pay for her medication and is terrified not to have access to it. Due to the barriers erected by Georgetown's policy, she hasn't been reimbursed for her medication since last August. I sincerely pray that we don't have to wait until she loses an ovary or is diagnosed with cancer before her needs and the needs of all of these women are taken seriously, because this is the message that not requiring coverage of contraception sends: A woman's reproductive health care isn't a necessity, isn't a priority.

One woman told us that she knew birth control wasn't covered on the insurance, and she assumed that that's how Georgetown's insurance handled all of women's reproductive and sexual health care. So when she was raped, she didn't go to the doctor, even to be examined or tested for sexually transmitted infections, because she thought insurance wasn't going to cover something like that, something that was related to a woman's reproductive health.

As one other student put it, this policy communicates to female students that our school doesn't understand our needs. These are not feelings that male fellow students experience, and they're not burdens that male students must shoulder.

In the media lately, some conservative Catholic organizations have been asking, what did we expect when we enrolled at a Catholic school? We can only answer that we expected women to be treated equally, to not have our school create untenable burdens that impede our academic success. We expected that our schools would live up the Jesuit creed of "cura personalis," to care for the whole person by meeting all of our medical needs. We expected that when we told our universities of the problems this policy created for us as students, they would help us. We expected that when 94 percent of students opposed the policy, the university would respect our choices regarding insurance students pay for completely unsubsidized by the university.

We did not expect that women would be told in the national media that we should have gone to school elsewhere and -- even if that meant going to a less prestigious university. We refuse to pick between a quality education and our health, and we resent that in the 21st century anyone thinks it's acceptable to ask us to make this choice simply because we are women.

Many of the women whose stories I've shared today are Catholic women. So ours is not a war against the church. It is a struggle for access to the health care we need. The president of the Association of Jesuit Colleges has shared that Jesuit colleges and universities appreciate the modification to the rule announced recently. Religious concerns are addressed, and women get the health care they need. And I sincerely hope that that is something we can all agree upon.

Thank you very much.