Solving our environmental problems without hindering reproductive rights

I read a Forbes article by Tim Worstall recently, where he suggests that women using the contraceptive pill should pay £1105 ($1500) in tax to due to its environmental impact. That’s right: a bank-breaking one thousand pounds per woman. Such a tax would significantly limit access to the pill – I personally would not be able to afford it if I were charged that much. If we allow any form of contraception to be taxed, regardless of the size of the tax, then we make it acceptable to limit access to it. But we can solve our environmental issues without hindering the ability of people to control their own bodies.

The contraceptive pill contains the hormone ethinyl estradiol (EE2), which is not removed by the sewage system, and remains in wastewater. It can lead to intersex changes in fish, causing populations to decline or even collapse as males are eliminated. Mr Worstall bases his tax conclusions on a 2012 paper by Owen and Jobling in Nature. It states that the total cost for the UK to update the sewage system is more than £30bn, and the yearly running cost per plant would be £800,000. Since then, the EU has placed EE2, and other pharmaceuticals, under regulation. To meet the cost, options discussed were an increase in household bills or a tax on pharmaceutical companies. Big Pharma, whose profit margins outstrip those of banks, the media, and oil and gas, claimed they cannot pay the tax due to the cost of R&D. The EU and UK governments plan to upgrade the sewage system to remove a range of chemicals (not only EE2), and, as far as I can tell from research, it is the tax-payer, not Big Pharma, paying.

“The pill is not the only chemical wrecking environmental havoc – antibiotics do too”

Mr Worstall bases his argument on the principle of “polluter should pay”: if you use the pollutant then you ‘should’ be taxed for it. But he does not explore this argument fully. EE2 is not the only chemical wreaking environmental havoc that sewage systems do not remove: antibiotics are not removed by the sewage system, and studies show that this is contributing to antibiotic resistance as the antibiotics interact with bacteria associated with sewage treatment plants. Following his line of argument, we should also tax anyone who uses antibiotics.

Other chemicals not completely removed include pesticides, herbicides, and household chemicals. Pesticides and herbicides impact the growth and reproduction of wildlife, and cause lowered disease resistance and death. Household chemicals – shampoo, detergent, toothpaste – have similar effects. Phosphates in detergent encourage the growth of toxic algae which reduces water oxygen levels, reducing aquatic diversity. Should we tax homeowners for using laundry detergent? We need to be fair if we tax anyone for the associated pollution of the chemicals they use. Otherwise, Mr Worstall seems to be suggesting that we single out women on the pill.

“We must solve our problems without hindering the rights of the 2.5 million UK women who use the pill daily”

The environmental damage caused by EE2 and other chemicals needs to be addressed. But we need to solve our environmental problems without hindering the reproductive rights of the 2.5 million women who use the pill every day in the UK, or the 100 million worldwide. Such a tax essentially removes the choice of using a 99% effective, free from point of service, and mostly side-effect free method of contraception.

Mr Worstall states that women have other options: “…there are a number of alternative methods, various barriers, creams, sponges, IUDs, which do not carry this environmental cost….”

I am not convinced he knows much about female contraception. Choice of contraception is not a flippant decision, given that each option works differently, and women’s bodies respond differently. There is no ‘one size fits all’ method, so it needs to be easy for people to choose the option that suits them.

“While some may experience side-effects, the pill is more accessible than many other forms of contraception”

Sponges fail 9%-24% of the time, depending on whether the woman has already given birth. Spermicide creams have to be used alongside another form of contraception, as alone they fail 30% of the time. A diaphragm (barrier), used with spermicide, has an effectiveness of 92-96% but carries a risk of bladder infection and toxic shock syndrome. A change of weight of only 3kg means a new diaphragm has to be fitted, and while some women may find it simple to place in and remove a sponge or diaphragm before and after sex, others would not. A tax on the pill would leave options which are less effective and more hassle – options which don’t suit a busy lifestyle. Sorry Mr Worstall, I am quite busy working towards a career.

The IUD and implant are 99% effective and preferred if women are likely to forget the pill. However, given that they are invasive, there’s a small risk of infection and the IUD can cause pain or bleeding. Furthermore, the implant can’t be used with certain medications or antibiotics. Condoms are 98% effective, and unlike other methods protect against STIs; but they are much less easy to access for free on the NHS, and in stores they can be expensive. While some women may experience side-effects from the pill, it is less invasive, simpler to use, more effective, and more accessible than other forms. But even these alternatives can have an impact on the environment: latex condoms, for example, contain additives to prevent breakage, but this means they take a long time to break down. Some condoms are non-biodegradable, while the one biodegradable condom is made of natural lambskin, but does not protect from some STIs. Who should we tax for the environmental impact of condoms? Again, Mr Worstall has forgotten about his own ‘polluter should pay’ argument.

From another angle, it would also be unfair to only allow richer women to use the pill. We cannot ignore the fact that unintended pregnancy disproportionately impacts women in poorer communities. Limiting their access to contraception only makes it harder for them to control their lives and invest in their futures.

And, what does Mr Worstall think of the economic and social costs of unintended pregnancy? The environmental impact of unintended extra humans? He doesn’t consider any of this in his article. These are issues that should be considered before placing a tax on contraception.

“Reducing access to the pill would increase healthcare costs overall – it’s illogical”

Regardless of whether one or several contraceptive methods are taxed, taxing any form of contraception turns it into a political, social, and economic issue. Limiting access jeopardizes the health of women by reducing access to basic, preventative healthcare. Contraception reduces unintended pregnancy and abortion; it helps women control their own lives and invest in their futures; it helps couples plan families. It’s not hard to guess that a tax on one of the main forms of contraception may influence numbers of unintended pregnancies.

Contraception saves governments across the world billions in healthcare costs. Women who cannot afford contraception, or to look after a baby, still have sex. An NHS report showed that between 2013 and 2020, unintended pregnancy and STIs will cost between £84.4-127 billion. Continued cuts could increase this by £8.3-10 billion. Improved access, compared to current access, would save £3.7-5 billion. Unintended pregnancy is currently predicted to cost £5.2 billion over this period, and reducing access would increase this by £299 million. Its illogical to reduce access.

Taxing the users of the contraceptive pill to pay for the sewage system upgrade is not an option. It makes sense to upgrade it so that it removes all harmful substances, to prevent other environmental issues, as well as feminisation of fish. Methods that remove EE2, antibiotics, and other substances have been tested. There needs to be a general tax for all upgrades, and either tax payers or relevant companies need to pay. The authors of the main study were concerned the decision would be made behind closed doors and that the government would not engage the public. I don’t know about you, but this article was the first I had heard of it.

I strongly believe that my generation and the generations to come have the capacity, moral sense, and intelligence to solve our environmental problems, but without having to sacrifice what we believe in.