Next week, SCOTUS is expected to rule on the Hobby Lobby case, challenging the requirement that private employers that provide insurance to their employees must include contraceptives in the list of services covered with no co-pay. While legal scholars have been watching to see how this decision plays out, women have been taking action, demonstrating their desire to control their own reproductive lives.

First the positive picture.

A report released yesterday by the Department of Health and Human Services [pdf] estimates that because of the ACA and its requirements, more women are using oral contraceptives and more are doing so at no cost to themselves. From 2012 to 2013, almost 10% more women obtained prescriptions for oral contraceptives, and the number of prescriptions filled went up 11%, from 50 million prescriptions to 55.9 million. In 2012, 14% of these women had no co-pay for their medication; in 2013, the figure went up to 56%. As the economics people might put it, the market is speaking: women want control of their reproductive lives, and given greater access to contraception, they are actively taking that control.

Now the less-than-positive picture, painted by Erica Hellerstein in an eye-opening piece at The Atlantic: The Rise of DIY Abortion in Texas:

The Alamo flea market sits right off South Texas’s lengthy Highway 83; a sprawling, dusty, labyrinth of a place. . . .

I’m here to look for a small, white, hexagonal pill called misoprostol. Also known as miso or Cytotec, the drug induces an abortion that appears like a miscarriage during the early stages of a woman’s pregnancy. For women living in Latin America and other countries that have traditionally outlawed abortion, miso has been a lifeline—it’s been called “a noble medication,” “world-shaking” and “revolutionary.” But now, it’s not just an asset of the developing world.

As policies restricting access to abortion roll out in Texas and elsewhere, the use of miso is quickly becoming a part of this country’s story. It has already made its way into the black market here in Texas’s Rio Grande Valley, where abortion restrictions are tightening, and it is likely to continue its trajectory if anti-abortion legislation does not ease up and clinics continue to be closed.

Over the past several years, dozens of states have restricted abortions. Since 2011, at least 73 abortion clinics in the nation have shut down or stopped providing services; and more than 200 abortion restrictions were legislated throughout the nation. Despite the passage of Roe v. Wade more than 40 years ago, states with pro-life politicians are still gunning to reverse the ruling—in the words of Rick Perry in 2012, “my goal is to make abortion, at any stage, a thing of the past.”

Yet these myriad restrictions on women and abortion providers have set the stage for women to skirt medical institutions to take charge of their own health.

That’s the opening, and Hellerstein goes on to speak with women in search of miso, pharmacists, and others involved in this issue on both sides of the border. The overall picture is clear: women want to have control over their reproductive health, they know that options are out there for them, and they will be very creative in trying to obtain use them if safe and legal access is denied them.

Hellerstein ends with a simple and sobering prediction:

Today in Texas things are starting to look a lot like the early years of miso in places like Brazil and Chile: The simple guidelines about miso haven’t yet made it to women in the state. But eventually, in those countries, the Internet and the democratization of information prevailed. Unless, and until, abortion restrictions change again, Latin America’s DIY-abortion culture might be the future of women in South Texas.

Go read the whole thing, to get a vivid image of what women are going through as abortion restrictions take hold.

And how could matters be worse? I’d say cutting off access to contraception — either by economic means or by outright ban  — would do the trick nicely. SCOTUS may open the door to the former next week when the Hobby Lobby ruling comes down, if they eliminate the requirement to provide it as a part of general health services available with no co-pay. As for enacting an outright ban on contraception, that would require a court fight to overturn Griswold v Connecticut and Eisenstadt v Baird, and folks on the far right like the SPLC-designated hate group known as the Family Research Council would be happy to do just that. Dred Scott was a terrible case, they say, and so were Griswold and Eisenstadt. For that matter, they think Marbury v Madison was judicial activism, too, and would love to see that overturned as well.

The Hobby Lobby case is only the next battle. Whether conservatives prevail or not, this war isn’t ending any time soon. Meanwhile, the DIY movement will continue to head north as women take more and more measures to control their own lives.

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h/t for the image above to Guineapigmom, and used under Creative Commons Attribution 2.0 license.