Nos. 19-431 and 19-454
In the

Supreme Court of the United States
THE LITTLE SISTERS OF THE POOR SAINTS
PETER AND PAUL HOME,
Petitioner,
v.
THE COMMONWEALTH OF PENNSYLVANIA
AND THE STATE OF NEW JERSEY, et al.,
Respondents.
DONALD J. TRUMP, PRESIDENT OF
THE UNITED STATES, et al.,
Petitioners,
v.
THE COMMONWEALTH OF PENNSYLVANIA
AND THE STATE OF NEW JERSEY, et al.,
Respondents.
On Writ of Certiorari to the United States
Court of A ppeals for the Third Circuit
BRIEF OF U.S. WOMEN’S CHAMBER OF
COMMERCE, NATIONAL ASSOCIATION FOR
FEMALE EXECUTIVES AND BUSINESSES AS AMICI
CURIAE IN SUPPORT OF RESPONDENTS

Leah R. Bruno
Counsel of Record
Joanne Caceres
Jacqueline A. Giannini
Dentons US LLP
233 South Wacker Drive,
Suite 5900
Chicago, Illinois 60606
(312) 876-8000
leah.bruno@dentons.com
Attorneys for Amici Curiae
April 8, 2020
294933

 i
TABLE OF CONTENTS
Page
TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . i
TABLE OF CITED AUTHORITIES . . . . . . . . . . . . . .  iii
STATEMENT OF INTEREST OF AMICI
 CURIAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
SUMMARY OF ARGUMENT  . . . . . . . . . . . . . . . . . . . . 2
ARGUMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
I. The Contraceptive Benefit Provides a
Crucial Health Benefit that Allows Women
Control over Their Lives, Their Education,
 
and Their Careers  . . . . . . . . . . . . . . . . . . . . . . . . 7
A.  Contraception Enhances Women’s
Education And Workforce Participation
A nd T he Wel l-Bei ng Of Women
 
And Families . . . . . . . . . . . . . . . . . . . . . . . . . . 9
B.  The Contraceptive Benefit Enhances
The Proven Benefits Of Access To
 Contraceptives . . . . . . . . . . . . . . . . . . . . . . . 16
II. The Contraceptive Benefit Facilitates
Business Growth B y A llowing Women
to Play a Critical Role in The National
 Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

 ii
Table of Contents
Page
A.  When Women Are Empowered To
Control Their Own Reproductive
Lives, Businesses And The National
 
Economy Benefit Too . . . . . . . . . . . . . . . . . . 21
B.  Decreased Access To Contraception
Ne g a t i v e l y I m p a c t s Wo m e n ’s
Well-Being, Businesses, And The
 Economy  . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
CONCLUSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
APPENDIX  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1a

 iii
TABLE OF CITED AUTHORITIES
Page
CASES
Eisenstadt v. Baird,
  405 U.S. 438 (1972) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Griswold v. Connecticut,
  410 U.S. 113 (1965)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Pennsylvania v. Trump,
  351 F. Supp. 3d 791 (E.D. Pa. 2019) . . . . . . . . . . . . . . 16
Planned Parenthood of Se. Pa. v. Casey,
  505 U.S. 833 (1992) . . . . . . . . . . . . . . . . . . . . . . . . . 2, 28
Weinberger v. Wiesenfeld,
  420 U.S. 636 (1975) . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
OTHER AUTHORITIES
Adam Sonfield, Beyond Preventing Unplanned
Pregnancy: The Broader Benefits of Publicly
Funded Family Planning Services, 17 Policy
Review 2 (2014), available at https://www.
guttmacher.org/sites/default/files/article_files
 /gpr170402.pdf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Adam Sonfield et al., Guttmacher Inst., The
Social and Economic Benefits of Women’s
Ability to Determine Whether and When
to Have Children (Mar. 2013), available at
https://www.guttmacher.org/pubs/social  economic-benefits.pdf . . . . . . . . . . . . . . . . . . . . . passim

 iv
Cited Authorities
Page
Adam Sonfield et al., Impact of the Federal
Contraceptive Coverage Guarantee on Outof-Pocket Payments for Contraceptives: 2014
Update, 91 Contraception 44 (Sept. 2015),
available at https://www.contraceptionjournal.
 org/article/0010-7824(14)00687-8/pdf . . . . . . . . . . . .  17
Amalia R. Miller, The Effects of Motherhood
Timing on Career Path, 24 J. Population
  Econ. 1071 (July 2011) . . . . . . . . . . . . . . . . . . . . . . . . . 14
American Express, The 2019 State of WomenOwned Businesses Report (2019), available at
about.americanexpress.com/files/doc_library/
file/2019-state-of-women-owned-businesses report.pdf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 21
Amy Richman et al., Corporate Voices for
Working Families, Business Impacts of
Flexibility: An Imperative for Expansion 13
(Feb. 2011), available at https://www.wfd.com/
PDFS/BusinessImpactsofFlexibility_
 March2011.pdf . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25, 26
Anna Bernstein and Kelly M. Jones, Inst. for
Women’s Pol’y Res., The Economic Effects
of Contraceptive Access: A Review of the
Evidence (Sept. 2019), available at https://
iwpr.org/publications/economic-contraceptive access-review/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  7, 17

 v
Cited Authorities
Page
Anna Bernstein and Lindsey Reichlin Cruse,
Inst. for Women’s Pol’y Res., Improving
Success in Higher Education through
Increased Access to Reproductive Health
Services (Jan. 2020), available at https://iwpr.
org/publications/improving-higher-education access-reproductive-health/ . . . . . . . . . . . . . . . . . . 8, 12
Ashley M. Snyder et al., The Impact of the
Affordable Care Act on Contraceptive Use
and Costs among Privately Insured Women,
28(3) Women’s Health Issues 219 (March
2018), available at https://www.whijournal.
 com/article/S1049-3867(17)30527-3/pdf . . . . . . . . . . 19
Carly Sitrin, Teen Birth Rates Just Hit An
All-Time Low, Vox (June 30, 2017), available
at https://www.vox.com/science-andhealth/2017/6/30/15894750/teen-birth-rates hit-all-time-low  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17
Caroline S. Carlin et al, Affordable Care Act’s
Mandate Eliminating Contraceptive Cost
Sharing Influenced Choices of Women with
Employer Coverage, 35 Health Affairs 1608
  (Sept. 2016) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Cathleen Clerkin, Ctr. for Creative Leadership,
What Women Want—And Why You Want
Women—In The Workplace (2017), available at
https://www.ccl.org/wp-content/uploads/
  2017/07/WhatWomenWant.FINAL_.pdf  . . . . . . . . . 22

 vi
Cited Authorities
Page
Ctr. for Disease Control & Prevention,
Pregnancy-Related Deaths (Feb. 2019),
available at https://www.cdc.gov/
reproductivehealth/maternalinfanthealth/
 pregnancy-relatedmortality.htm; . . . . . . . . . . . . . . . 16
Chris Bart, Why Women Make Better
Directors, 8 Int’l J. of Bus. Governance and
Ethics 93 (2013), available at https://pdfs.
semanticscholar.org/a7db/04f990334daf8f0c47
 e587f61055b16518d0.pdf . . . . . . . . . . . . . . . . . . . . . . . 22
Christine Lagarde and Jonathan D. Ostry, World
Econ. Forum, When more women join the
workforce, everyone benefits. Here’s why (Dec.
2018), available at https://www.weforum.org/
agenda/2018/12/economic-gains-from-gender inclusion-even-greater-than-you-thought/ . . . . . . . . 21
David Lee, Managing Employee Stress and
Safety: A Guide to Minimizing Stress-Related
Cost While Maximizing Employee
 Productivity (2000) . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Diane Whitmore Schanzenbach and Ryan Nunn,
The Hamilton Project, The 51%: Driving
Growth Through Women’s Economic
Participation (Oct. 2017), available at
https://www.brookings.edu/wp-content/
uploads/2017/10/es_121917_the51percent_
 ebook.pdf  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

 vii
Cited Authorities
Page
Donna Allen et al., Four-year review of
presenteeism data among employees of a
large United States health care system: a
retrospective prevalence study, Human
  Resources for Health 16:59 (2018) . . . . . . . . . . . . 25, 26
Eileen Appelbaum et al., Ctr. for Am. Progress
and the Ctr. for Econ. and Pol’y Res., The
Economic Importance of Women’s Rising
Hours of Work: Time to Update Employment
Standards (Apr. 2014), available at https://cdn.
americanprogress.org/wp-content/uploads
 /2014/04/WomensRisingWorkv2.pdf . . . . . . . . . . . . . . 5
Executive Office of the President, Council of
Economic Advisers, The Annual Report
158 (Feb. 2015), available at https://
obamawhitehouse.archives.gov/sites/default/
  files/docs/cea_2015_erp_complete.pdf . . . . . . . . . . . 21
Executive Office of the President, Council of
Economic Advisers, Women’s Participation
in Education and the Workforce 9 (Oct. 14,
2014), available at https://obamawhitehouse.
archives.gov/sites/default/files/docs/
  womens_slides_final.pdf  . . . . . . . . . . . . . . . . . . . . . . 13
Guttmacher Inst., Fact Sheet: Contraceptive Use
in the United States (July 2018), available at
https://www.guttmacher.org/fact-sheet/
 contraceptive-use-united-states . . . . . . . . . . . . .  10, 19

 viii
Cited Authorities
Page
Guttmacher Inst., Fact Sheet: Unintended
Pregnancy in the United States (Jan. 2019),
available at https://www.guttmacher.org/fact sheet/unintended-pregnancy-united-states . . . . . . . 10
Heinrich Hock, The Pill and the College
Attainment of American Women and Men,
Dep’t of Economics, Florida State University
Working Papers (Sept. 2005), available at
  http://paa2006.princeton.edu/papers/61745 . . . . . 9, 12
Inst. of Med. of the Nat’l Academies, Clinical
Prevention Services for Women:
  Closing the Gaps (2011)  . . . . . . . . . . . . . . . . . . . .  10, 19
Integrated Benefits Institute, Making Health
the CFO’s Business: Findings From the
Integrated Benefits Institute’s 2011 CFO
Survey (Feb. 2012), available at https://www.
ibiweb.org/wp-content/uploads/2018/01/
  2011_CFO_Survey_Full.pdf . . . . . . . . . . . . . . . . . . . 27
Jennifer J. Frost and Laura Duberstein
Lindberg, Reasons for Using Contraception:
Perspectives of US Women Seeking Care at
Specialized Family Planning Clinics, 87
  Contraception 465 (Sept. 2012) . . . . . . . . . . . . . . . . . . 9
Jess Huang et al., McKinsey & Co., Women in
the Workplace 2019 (Oct. 2019), available at
https://wiw-report.s3.amazonaws.com/
  Women_in_the_Workplace_2019.pdf . . . . . . . . 5-6, 23

 ix
Cited Authorities
Page
Joanna Barsh and Lareina Yee, McKinsey &
Company, Unlocking the Full Potential of
Women in the US Economy (Apr. 2011),
available at https://www.mckinsey.com/
business-functions/organization/our-insights/
 unlocking-the-full-potential-of-women . . . . . . . . . . . 23
Jonathan M. Bearak et al., Changes in Outof-Pocket Costs for Hormonal IUDs After
Implementation of the Affordable Care Act:
An Analysis of Insurance Benefit Inquiries,
93 Contraception 139 (Feb. 2016), available at
https://www.ncbi.nlm.nih.gov/pmc/articles/
 PMC4780678/pdf/nihms-756929.pdf . . . . . . . . . . . . . 19
Kate Bahn et al., Ctr. for Am. Progress, Linking
Reproductive Health Care Access to Labor
Market Opportunities for Women (Nov. 2017),
available at https://www.americanprogress.
org/issues/women/reports/2017/11/21/442653/
linking-reproductive-health-care-access labor-market-opportunities-women/  . . . . . . . . . . . . . 8
Kate Bahn et al., Feminist Economics, Do US
TRAP Laws Trap Women Into Bad Jobs?
  (Aug. 2019) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

 x
Cited Authorities
Page
Kate Bahn and Annie McGrew, Ctr. for Am.
Progress, A Day in the U.S. Economy
Without Women (Mar. 2017), available at
https://www.americanprogress.org/issues/
economy/news/2017/03/07/427556/
 a-day-in-the-u-s-economy-without-women/ . . . . . . . . 6
Kelleen Kaye et al., The Nat’l Campaign to
Prevent Teen and Unplanned Pregnancy,
The Benefits of Birth Control in America:
Getting the Facts Straight (2014), available at
https://powertodecide.org/sites/default/files/
resources/primary-download/benefits of-birth-control-in-america.pdf . . . . . . . . . . . . . . . 8, 24
Kimberly Daniels et al., Contraceptive methods
women have ever used: United States, 1982–
2010, 62 National Health Statistics Reports 1
(Feb. 2013), available at https://
 www.ncbi.nlm.nih.gov/pubmed/24988816  . . . . . . . . . 6
Lindsay E. Sears et al., Overall Well-Being as a
Predictor of Health Care, Productivity and
Retention Outcomes in a Large Employer,
16(6) Population Health Management 397
(Dec. 2013), available at https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC3870481/pdf/
 pop.2012.0114.pdf  . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

 xi
Cited Authorities
Page
Lydia E. Pace et al., Early Impact of the
Affordable Care Act on Oral Contraceptive
Cost Sharing, Discontinuation, and
Nonadherence, 35(9) Health Affairs 1616
  (Sept. 2016) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Marianne Bertrand et al., Dynamics of the
Gender Gap for Young Professionals in the
Financial and Corporate Sectors, 2
  Am. Econ. J. Applied Econ. 228 (July 2010)  . . . . . . 23
Martha J. Bailey, Fifty Years of Family
Planning: New Evidence on the Long-Run
Effects of Increasing Access to Contraception,
  Brookings Pap Econ Act. 341 (Oct. 2013) . . . . . . . . . 15
Martha J. Bailey et al., The Opt-In Revolution?
Contraception and the Gender Gap in Wages,
4(3) Am. Econ. J. of Applied Econ. 225 (Jul.
2012), available at https://www.ncbi.nlm.nih.
 gov/pmc/articles/PMC3684076/ . . . . . . . . . . . . . .  11, 14
Martha J. Bailey et al., Recent Evidence on the
Broad Benefits of Reproductive Health Policy,
J. of Pol’y Analysis and Management 888
  (July 2013)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

 xii
Cited Authorities
Page
Martha J. Bailey et al., Do Family Planning
Programs Decrease Poverty? Evidence from
Public Census Data, 60 CESifo Economic
Studies 312 (June 2014), available at https://
www.ncbi.nlm.nih.gov/pmc/articles/
 PMC4206087/pdf/nihms602597.pdf . . . . . . . . . . . . . 14
Martha J. Bailey et al., Nat’l Bureau of Econ.
Res., Does Parents’ Access to Family
Planning Increase Children’s Opportunities?
Evidence From the War on Poverty and
  Early Years of Title X (2018) . . . . . . . . . . . . . . . . . . . 15
Matthias Doepke et al., Nat’l Bureau of Econ.
Res. Working Paper 17672, The Economics
and Politics of Women’s Rights 21
  (Dec. 2011)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15-16, 21
Meghan L. Kavanaugh and Ragnar M. Anderson,
Guttmacher Inst., Contraception and Beyond
(July 2013), available at https://www.
  guttmacher.org/pubs/health-benefits.pdf  . . 15, 16, 25
MetLife, Thriving in the New Work-Life World:
MetLife’s 17th Annual U.S. Employee
  Benefit Trends Study 2019 . . . . . . . . . . . . . . . . . . . . . 26

 xiii
Cited Authorities
Page
Nat’l Ctr. for Ed. Statistics, Bachelor’s,
master’s, and doctor’s degrees conferred by
postsecondary institutions, by sex of student
and discipline division: 2016-17, available at
https://nces.ed.gov/programs/digest/d18/
  tables/dt18_318.30.asp . . . . . . . . . . . . . . . . . . . . .  12-13
Nat’l Women’s Law Ctr., Fact Sheet:
Reproductive Health is Part of the Economic
Health of Women and Their Families
(Feb. 2016), available at https://nwlcciw49tixgw5lbab.stackpathdns.com/wpcontent/uploads/2017/02/Reproductive-Healthis-Part-of-the-Economic-Health-of Women-2.19.166.pdf  . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Nat’l Women’s Law Ctr., New Data Estimates
61.4 Million Women Have Coverage of
Birth Control Without Out-of-Pocket Costs
(Dec. 2019), available at https://nwlcciw49tixgw5lbab.stackpathdns.com/wpcontent/uploads/2019/12/
 preventativeservices2019.pdf  . . . . . . . . . . . . . . . . . . . 6
Nicholas J. Kassebaum et al., Global, Regional,
and National Levels of Maternal Mortality,
1990-2015: A Systematic Analysis for the
Global Burden of Disease Study 2015, 388 The
Lancet 1775 (Oct. 2016), available at https://
www.thelancet.com/journals/lancet/article/
 PIIS0140-6736(16)31470-2/fulltext . . . . . . . . . . . . . . 16

 xiv
Cited Authorities
Page
Nora V. Becker and Daniel Polsky, Women Saw
Large Decreases in Out-of-Pocket Spending
for Contraceptives After ACA Mandate
Removed Cost Sharing, 34 Health Affairs
  (July 2015)  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Rachel Siegel, Women outnumber men in the
American workforce for only the second
time, The Washington Post (Jan. 10, 2020),
available at https://www.washingtonpost.com/
business/2020/01/10/january-2020 jobs-report/  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Sarah Jane Glynn, Ctr. for Am. Progress,
Breadwinning Mothers Continue To Be the
U.S. Norm (May 2019), available at https://
www.americanprogress.org/issues/women/
reports/2019/05/10/469739/breadwinning mothers-continue-u-s-norm/ . . . . . . . . . . . . . . . . . . . 13
Sean Nicholson et al., How to Present the
Business Case for Healthcare Quality to
Employers (Nov. 2005), available at http://
knowledge.wharton.upenn.edu/wp-content/
 uploads/2013/09/1303.pdf . . . . . . . . . . . . . . . . . . . . . . 27
Shelley Alpern et al., Rhia Ventures, Hidden
Value: The Business Case for Reproductive
Health (Jan. 2020), available at https://
rhiaventures.org/wp-content/uploads/2020/01/
Hidden-Value_The-Business-Case-for Reproductive-Health.pdf . . . . . . . . . . . . . . . . . . . . . . . 9

 xv
Cited Authorities
Page
Sue Ricketts et al., Game Change in Colorado:
Widespread Use of Long-Acting Reversible
Contraceptives and Rapid Decline in Births
Among Young, Low-Income Women, 46
Perspective on Sexual & Reproductive
Health 125 (Sept. 2014), available at https://
onlinelibrary.wiley.com/doi/
 epdf/10.1363/46e1714 . . . . . . . . . . . . . . . . . . . . . . . . . . 18
The 85 Most Disruptive Ideas in Our History,
Bloomberg Businessweek, available at https://
 www.bloomberg.com/businessweek/85ideas/ . . . . . 20
Thomas F. Mahan et al., 2019 Retention Report,
  Work Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
U.S. Women’s Chamber of Commerce, Women’s
Economic Priorities: Fundamental budget
and policy priorities that support women’s
economic opportunities, security and family
well-being (July 2014), available at
 https://www.swipe.to/0814q . . . . . . . . . . . . . . . . . . 5, 17
Vivian Hunt et al., McKinsey & Co., Delivering
through Diversity (Jan. 2018), available
at https://www.mckinsey.com/~/media/
McKinsey/Business%20Functions/
Organization/Our%20Insights/Delivering%20
through%20diversity/Delivering-through  diversity_full-report.ashx . . . . . . . . . . . . . . . . . . . . . 22

 xvi
Cited Authorities
Page
World Health Organization, High rates of
unintended pregnancies linked to gaps in
family planning services: New WHO study
(Oct. 2019), available at https://www.who.int/
news-room/detail/25-10-2019-high-rates-ofunintended-pregnancies-linked-to-gaps-in family-planning-services-new-who-study  . . . . . . . . 10

 1
STATEMENT OF INTEREST OF AMICI CURIAE1
Amici curiae comprise national organizations and
businesses focused on the advancement of women in business
and are committed to the well-being of women and families.
Amicus U.S. Women’s Chamber of Commerce (“USWCC”)
is a national organization with more than 500,000 members
that seeks to increase economic growth opportunities for
women. Amicus National Association for Female Executives
(“NAFE”) is a national organization with more than 60,000
members that works to empower women to achieve career
and personal success and to recognize corporations and
organizations that expand opportunities for women in
business. The 21 individual amici businesses range from
small companies with a few employees to national household
brands with thousands of employees. They are businesses
that represent multiple industries and are located around
the country. Uniting all of these varied businesses is the
commitment to supporting and promoting women in the
workplace. Amici have a strong interest in this case as the
regulations at issue operate to defeat the goals of these
organizations and businesses and harm women in business.
A complete listing of amici is set forth in the Appendix,
attached hereto.
The regulations in this case would allow nearly any
private employer, university, or health insurer to invoke
1.  Counsel for amici represent that none of the parties or
their counsel authored this brief in whole or in part and that none
of the parties or their counsel, nor any other person or entity
other than amici or their counsel, made a monetary contribution
intended to fund the preparation or submission of this brief.
Counsel for amici represent that all parties have consented to
the filing of this brief.

 2
religion or morality as a basis for stopping contraceptive
coverage under the A ffordable Care Act (“ACA”).
Amici are committed to gender equality, which includes
supporting women’s healthcare that allows women to
make choices about how to plan and care for their families.
Amici offer this brief to assist the Court in understanding
the importance to the national economy and business
community of providing contraceptive coverage to all
women.
SUMMARY OF ARGUMENT
“The ability of women to participate equally in the
economic and social life of the Nation has been facilitated
by their ability to control their reproductive lives.”
Planned Parenthood of Se. Pa. v. Casey, 505 U.S. 833,
856 (1992) (citation omitted).
As employees, managers, executives, and customers,
women are essential to building thriving businesses
and sustaining a modern economy. Supporting women
in business includes supporting access to contraception
– a crucial health benefit that provides women greater
control over their education, their careers, and their
lives. By helping women 2 avoid unintended pregnancy,
contraception facilitates women’s participation and
advancement in the workforce, which in turn supports
business and economic growth.
2.  While this brief uses “woman” and “women” to describe
those in need of contraceptive and abortion services, we note
that not all those who can become pregnant, such as trans men,
nonbinary, and gender nonconforming individuals, identify as
women. Employers should implement policies that are sensitive
to the needs of anyone who can become pregnant.

 3
The ACA’s contraceptive coverage benefit provides
women with meaningful access to a full array of contraceptive
services. Since the contraceptive benefit was instituted,
women’s health has improved, rates of unintended
pregnancies have decreased, women are more consistently
obtaining the most effective contraceptive methods and the
forms most appropriate for their needs. The contraceptive
benefit is important throughout women’s reproductive lives;
contraception is used by young women, by mothers, and by
women at various life and career stages. As set forth below,
contraception has a positive impact not only on women, but
also on their children and families. Yet contraception, and
in particular the most effective forms of contraception, can
be expensive. The ACA’s contraceptive benefit has allowed
millions of women to save billions of dollars in out-ofpocket costs for contraception, while helping them to more
effectively avoid unintended pregnancy.
The rules at issue in this case (the “Rules”) threaten
these vital advancements and will harm American women,
families, and the economy. The Rules represent a major
step backward for the millions of women who rely upon
contraceptive care while pursuing their educations
and careers during their childbearing years and for
businesses that value gender equality and diversity and
the contributions of female employees, executives, and
customers. By establishing obstructions to meaningful
access to contraception, the Rules will negatively affect
women’s ability to balance their personal lives and their
educational and professional advancement.
Providing women with the resources to make informed
decisions regarding how many children to have, and
when, and the ability to make plans about their work and

 4
life responsibilities is essential to a thriving economy.
Businesses and the national economy benefit when working
women know they have meaningful access to preventive
healthcare, including contraception. Unintended pregnancy
can derail women’s efforts to obtain education and advance
professionally, and women unable to afford effective
contraception may be limited in their career choices. Loss
of meaningful access to contraception can increase levels
of stress, distraction, absenteeism, and turnover, decrease
overall productivity, and stall career opportunities – all
of which are detrimental to businesses and the national
economy. The ACA’s contraceptive benefit gives women
the confidence of knowing they will have coverage for
contraception if they change jobs or insurance companies.
The ACA’s contraceptive benefit thus provides a crucial
health benefit that promotes three important and connected
goals: (1) it provides women control over their lives, (2)
it contributes to gender equality and inclusion, and (3) it
facilitates economic growth. The Rules undermine each of
these goals.
The Rules’ inevitable reduction in the number of
women obtaining contraceptive coverage without costsharing will limit the ability of the affected women to
advance professionally. This will directly affect businesses
nationwide by reducing the number of qualified women
available to work at their companies, and will have a
negative impact on the national economy.
For these and the reasons set forth more fully below,
amici urge this Court to affirm the Third Circuit’s
decision and uphold the nationwide injunction prohibiting
the Rules from taking effect.

 5
ARGUMENT
Women’s pursuit of educational and professional
goals is intrinsically tied to their ability to determine
whether and when to have children. Since the Supreme
Court recognized in Griswold v. Connecticut, 410 U.S.
113 (1965), and Eisenstadt v. Baird, 405 U.S. 438 (1972),
that the constitutionally protected right to privacy
encompasses the right to access contraception, the number
of working women in the U.S. has grown considerably, and
the U.S. economy has grown alongside. 3
Today, women comprise more than half of U.S.
jobholders, with 76 million women working in full- or parttime roles, and their labor accounted for $7.6 trillion—or
40% of annual U.S. gross domestic product in 2017.4 In
3.  Eileen Appelbaum et al., Ctr. for Am. Progress and Ctr.
for Econ. and Pol’y Res., The Economic Importance of Women’s
Rising Hours of Work: Time to Update Employment Standards
1 (Apr. 2014), available at https://cdn.americanprogress.org/wpcontent/uploads/2014/04/WomensRisingWorkv2.pdf (explaining
that if women’s employment patterns had remained as they were
before the Supreme Court recognized a constitutional right to
access contraception, the gross domestic product of the United
States would have been roughly $1.7 trillion lower in 2012); see
also U.S. Women’s Chamber of Commerce, Women’s Economic
Priorities: Fundamental budget and policy priorities that
support women’s economic opportunities, security and family
well-being 16 (July 2014), available at https://www.swipe.to/0814q
(“USWCC, Women’s Economic Priorities”) (“If no additional
women had joined the paid economy since 1970, U.S. Gross
Domestic Product (GDP) would be 75% of its current size.”).
4.  Jess Huang et al., McKinsey & Co., Women in the Workplace
2019 (Oct. 2019), available at https://wiw-report.s3.amazonaws.
com/Women_in_the_Workplace_2019.pdf (“McKinsey, Women

 6
2019, women-owned businesses generated $1.9 trillion
in sales and employed 9.4 million people. 5 American
women contribute to economic innovation, productivity,
and growth. These outcomes would not be possible
without women’s ability to control their own reproductive
health, including access to contraception. In fact, a study
reviewing contraceptive methods in the U.S. from 19822010 reports that 99 percent of sexually active women
have used contraception at least once in their lifetimes.6
That access was meaningfully expanded through the
ACA, which eliminated cost-sharing obligations for an
array of crucial preventative medicine and health services,
including contraceptive services. As of December 2019,
61.4 million women now have insurance that covers
contraception without having to pay out of pocket.7 The
in the Workplace”); Kate Bahn and Annie McGrew, Ctr. for Am.
Progress, A Day in the U.S. Economy Without Women (Mar.
2017), available at https://www.americanprogress.org/issues/
economy/news/2017/03/07/427556/a-day-in-the-u-s-economywithout-women/.
5.  American Express, The 2019 State of Women-Owned
Businesses Report 3 (2019), available at about.americanexpress.
com/files/doc_library/file/2019-state-of-women-owned-businessesreport.pdf (“American Express”).
6.  Kimberly Daniels et al., Contraceptive methods women
have ever used: United States, 1982–2010, 62 National Health
Statistics Reports 1 (Feb. 2013), available at https://www.ncbi.
nlm.nih.gov/pubmed/24988816.
7.  Nat’l Women’s Law Ctr., New Data Estimates 61.4
Million Women Have Coverage of Birth Control Without
Out-of-Pocket Costs (Dec. 2019), available at https://nwlcciw49tixgw5lbab.stackpathdns.com/wp-content/uploads/2019/12/
preventativeservices2019.pdf.

 7
Rules will reverse this progress by decreasing access
to contraception and thus making it harder for women
to balance life choices with educational and professional
goals.
I. T he Contraceptive Benefit Provides a Crucial
Health Benefit that A llows Women Control over
Their Lives, Their Education, and Their Careers.
Contraception allows women to make significant
decisions in their personal, educational, and professional
lives without fear of unintended pregnancy. 8 Women’s
ability to effectuate these decisions has had a profound
effect on their own economic well-being as well as that of
their families.9 Indeed, “[f]ive decades after the [birth
8.  Anna Bernstein and Kelly M. Jones, Inst. for Women’s
Pol’y Res., The Economic Effects of Contraceptive Access:
A Review of the Evidence (Sept. 2019), available at https://
iwpr.org/publications/economic-contraceptive-access-review/
(“Bernstein & Jones, Economic Effects”) (summarizing the ways
that contraception affected women’s economic outcomes); Nat’l
Women’s Law Ctr., Fact Sheet: Reproductive Health is Part of
the Economic Health of Women and Their Families (Feb. 2016),
available at https://nwlc-ciw49tixgw5lbab.stackpathdns.com/
wp-content/uploads/2017/02/Reproductive-Health-is-Part-of-theEconomic-Health-of-Women-2.19.166.pdf.
9.  Adam Sonfield et al., Guttmacher Inst., The Social and
Economic Benefits of Women’s Ability to Determine Whether and
When to Have Children at 29 (Mar. 2013), available at https://www.
guttmacher.org/pubs/social-economic-benefits.pdf (“Sonfield,
Social and Economic Benefits”) (“Planning, delaying and spacing
one’s children generally appear to help women achieve their career
goals”); Martha J. Bailey et al., Recent Evidence on the Broad
Benefits of Reproductive Health Policy, J. Pol’y Analysis & Mgmt.
888, 894 (July 2013) (“[I]ncreasing access to contraception and

 8
control] pill was introduced, it is clear that consistent
access to effective and affordable contraception has
served as a catalyst of opportunity” and revolutionized
expectations about women’s “educational and career
prospects and their roles in the home and workplace.”10
The “weight of the evidence across numerous studies
shows significant employment and educational gains have
followed directly from women’s ability to better time their
entry into parenthood[.]”11

legal abortion has had large and enduring effects on the material
resources of families and children and has promoted the economic
equality of women.”).
10.  Sonfield, Social and Economic Benefits, supra note 9,
at 4; see also Anna Bernstein and Lindsey Reichlin Cruse, Inst.
for Women’s Pol’y Res., Improving Success in Higher Education
through Increased Access to Reproductive Health Services 9
(Jan. 2020), available at https://iwpr.org/publications/improvinghigher-education-access-reproductive-health/ (Bernstein &
Cruse, Improving Success”) (“the ability to plan when and whether
to have children has significant implications for young women’s
abilities to persist in and complete college”).
11.  Kelleen Kaye et al., The Nat’l Campaign to Prevent
Teen and Unplanned Pregnancy, The Benefits of Birth Control
in America: Getting the Facts Straight 29 (2014), available at
https://powertodecide.org/sites/default/files/resources/primarydownload/benefits-of-birth-control-in-america.pdf (“Kaye”); Kate
Bahn et al., Ctr. for Am. Progress, Linking Reproductive Health
Care Access to Labor Market Opportunities for Women (Nov.
2017), available at https://www.americanprogress.org/issues/
women/reports/2017/11/21/442653/linking-reproductive-healthcare-access-labor-market-opportunities-women/ (“Bahn, Labor
Market”).

 9
A.  Contraception Enhances Women’s Education
And Workforce Participation And The WellBeing Of Women And Families.
Meaningful access to contraception ensures that
women can exercise autonomy and control over their
reproductive health, including decisions about when and
whether to have children.12 In a 2019 survey, 86 percent
of women agreed that controlling if and when to have
children has been important to their careers.13 In another
survey, women reported that using birth control allows
them to pursue personal goals, better control their lives
and future, and “better care for themselves and their
families, either directly or indirectly through facilitating
their education and career.”14
12.  Heinrich Hock, The Pill and the College Attainment
of American Women and Men, Dep’t of Econ., Florida State
University Working Papers 1 (Sept. 2005), available at http://
paa2006.princeton.edu/papers/61745 (“Hock”) (noting that what
made oral contraception “so remarkable, and what drove its
rapid diffusion, was the degree of autonomy and control it offered
women over their reproductive lives, especially with respect to
the timing of their fertility”); see also Shelley Alpern et al., Rhia
Ventures, Hidden Value: The Business Case for Reproductive
Health 16 (Jan. 2020), available at https://rhiaventures.org/
wp-content/uploads/2020/01/Hidden-Value_The-Business-Casefor-Reproductive-Health.pdf (“Hidden Value”) (“Recent polling
reveals that 83% of women of reproductive age say they would want
their employers’ insurance to cover the full range of reproductive
health care, including abortion.”).
13.  Hidden Value, supra note 12, at 6.
14.  Jennifer J. Frost and Laura Duberstein Lindberg, Reasons
for Using Contraception: Perspectives of US Women Seeking Care
at Specialized Family Planning Clinics, 87 Contraception 465, 469,

 10
When women lack meaningful access to contraception,
their ability to prevent unintended pregnancies and births
decreases substantially.15 A recent study found that 85
percent of women who stopped using contraception became
pregnant during the first year.16 In the United States,
the 14 percent of women who do not use contraceptives
account for 54 percent of all unintended pregnancies. By
contrast, the 68 percent of women at risk for an unintended
pregnancy who use contraceptives consistently and
correctly account for only 5 percent of all unintended
pregnancies.17
471 (Sept. 2012) (noting the importance of contraception “for women
and couples who are motivated to consciously and carefully plan for
their and their families’ futures”).
15.  Guttmacher Inst., Fact Sheet: Unintended Pregnancy
in the United States 2 (Jan. 2019), available at https://www.
guttmacher.org/fact-sheet/unintended-pregnancy-united-states
(“Guttmacher, Unintended Pregnancy”) (noting an 18 percent
decline in unintended pregnancies between 2008 and 2011 likely
due “to an overall increase in contraceptive use and the use of
highly effective methods”); Inst. of Med. of the Nat’l Academies,
Clinical Preventive Services for Women: Closing the Gaps 104-05,
109 (2011) (“IOM, Closing the Gaps”) (citing reports finding that
progress in reducing unintended pregnancies would be possible by
“making contraceptives more available, accessible, and acceptable
through improved services”).
16.  World Health Organization, High rates of unintended
pregnancies linked to gaps in family planning services: New
WHO study (Oct. 2019), available at https://www.who.int/newsroom/detail/25-10-2019-high-rates-of-unintended-pregnancieslinked-to-gaps-in-family-planning-services-new-who-study.
17.  Guttmacher Inst., Fact Sheet: Contraceptive Use in the
United States (July 2018), available at https://www.guttmacher.
org/fact-sheet/contraceptive-use-united-states (“Guttmacher,
Contraceptive Use”).

 11
Access to contraception enhances women’s ability to
pursue education and increases their participation and
advancement in the workforce by providing them with
the ability to control their reproductive lives and thus
direct their future. As several economic studies have
confirmed, access to contraception has “altered [women’s]
expectations about childbearing during a period critical
to career investment, and reduced the cost of increasing
their early career investments.”18 One study found that
“women living in states with requirements on insurers
to cover contraception are more likely to transition from
unemployment or out of the labor force into employment”
than women living in states without this requirement.19
The ability to avoid unintended pregnancy is vital for
women at all stages of their career paths, beginning with
the bedrock of education. As access to contraception has
increased, women have been able to achieve significant
educational milestones. Women who do not have children
when they are teenagers on average obtain more
education. 20 A recent study found that “just one-third of
18.  See, e.g., Martha J. Bailey et al., The Opt-In Revolution?
Contraception and the Gender Gap in Wages, 4(3) Am. Econ.
J. of Applied Econ. 225, 2 (Jul. 2012), available at https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC3684076/ (“Bailey, The Opt-In
Revolution”); Hidden Value, supra note 12, at 15 (“women in states
with better access to contraception have higher rates of labor force
participation, more frequently pursue full-time positions, more
frequently take roles in traditionally male-dominated industries,
and have higher median wages”).
19.  Kate Bahn et al., Feminist Economics, Do US TRAP
Laws Trap Women Into Bad Jobs? 3 (Aug. 2019).
20.  Sonfield, Social and Economic Benefits, supra note 9,
at 9 (finding that “women who experience teen births complete

 12
all student parents earn a degree or certificate within six
years of enrolling in college, compared with over half of
non-parent students.” 21 One study concluded that access
to oral contraceptives accounted for more than 400,000 of
the college degrees completed by women born between
1939 and 1959. 22 When women are affected by unintended
pregnancy, their educational goals may not only be
delayed, which can have lasting impacts on their overall
career advancement, they may be derailed altogether. 23
Likewise, the availability of contraception has had a
statistically significant impact on the number of women
obtaining the education necessary to enter professional
occupations. “Access to the pill was linked to the increased
numbers of college-educated women pursuing advanced
professional degrees and making up increased proportions
of such degree programs.”24 Today, women earn 57 percent
of bachelor’s degrees, 60 percent of master’s degrees and
just over half of all doctoral degrees.25 In the 1960s, women
approximately two fewer years of formal schooling as compared
with women who wait to have children until age 30 or older”).
at 2.

21.  Bernstein & Cruse, Improving Success, supra note 10,
22.  Hock, supra note 12, at 26.

23.  Sonfield, Social and Economic Benefits, supra note 9,
at 7 (explaining that the ability of young, single women to “obtain
highly effective contraception was a significant factor behind
greater numbers of women investing in higher education”).
24.  Id. at 9.
25.  Nat’l Ctr. for Ed. Statistics, Bachelor’s, master’s, and
doctor’s degrees conferred by postsecondary institutions, by sex
of student and discipline division: 2016-17, available at https://

 13
made up less than 10 percent of students in JD, MBA, and
MD programs, while women now account for just over
half the students in those programs. 26 Absent access to
contraception, these numbers would be much lower.
Women who have more control over their reproductive
lives are better able to enhance their earning potential,
allowing them to provide for themselves and their families.
“Many women are the principal wage earners for their
families, and they participate in the Social Security
system on exactly the same basis as men.” Weinberger
v. Wiesenfeld, 420 U.S. 636, 654 (1975) (Powell, J.,
concurring). In 2017, the latest year with available data, 41
percent of mothers were the sole or primary breadwinners
for their families, earning at least half of their total
household income. 27 This figure has more than doubled
since 1967. 28 This shift is due in part to women’s increased
control over the number and timing of children. A study
nces.ed.gov/programs/digest/d18/tables/dt18_318.30.asp (“NCES
Statistics”).
26.  Executive Office of the President, Council of Economic
Advisers, Women’s Participation in Education and the Workforce
9 (Oct. 14, 2014), available at https://obamawhitehouse.archives.
gov/sites/default/files/docs/womens_slides_final.pdf (“EOP,
Women’s Participation”) (showing that women make up less
than 10 percent of these degrees in the 1960s); NCES Statistics,
supra note 25.
27.  Sarah Jane Glynn, Ctr. for Am. Progress, Breadwinning
Mothers Continue To Be the U.S. Norm (May 2019), available
a t ht t p s : // w w w. a m e r i c a np r o g r e s s . o r g / i s s u e s / w o m e n /
reports/2019/05/10/469739/breadwinning-mothers-continue-u-snorm/ (“Glynn, Breadwinning Mothers”).
28.  Id.

 14
has found that “the Pill-induced effects on wages amount
to roughly one-third of the total wage gains for women
in their forties born from the mid-1940s to early 1950s.” 29
That study concluded that approximately 10 percent of
the narrowing of the wage gap between men and women
during the 1980s and 31 percent during the 1990s can be
attributed to women’s ability to access oral contraceptives
prior to age 21. 30
Simply put, women who have meaningful access to
contraception can better control their reproductive health
and the timing of pregnancy, improving their ability to
shape and reap the rewards of their family lives and
careers.
Beyond allowing women greater control over their
education and careers, access to contraception has a
positive impact on families, especially children. Access
to contraception is associated with significant reductions
in both child and adult poverty rates. 31 By enhancing
29.  Bailey, The Opt-In Revolution, supra note 18, at 17.
30.  Id.; see also Amalia R. Miller, The Effects of Motherhood
Timing on Career Path, 24 J. Population Econ. 1071, 1073 (July
2011) (explaining “deferred motherhood may be a means of
reducing [the economic] inequality” between men and women).
31.  Martha J. Bailey et al., Do Family Planning Programs
Decrease Poverty? Evidence from Public Census Data, 60 CESifo
Econ. Studies 312, 6 (June 2014), available at https://www.ncbi.
nlm.nih.gov/pmc/articles/PMC4206087/pdf/nihms602597.pdf
(noting “by increasing adults’ pre-childbearing human capital . . .
family planning programs [including access to contraception]
may increase children’s economic resources and decrease child
poverty rates,” such access also “increase[s] parental investment

 15
parents’ ability to invest time, energy, and resources in
their children, 32 access to contraception also has been
linked to improved outcomes for children’s mental and
behavioral development. Studies show that differences
in a mother’s access to birth control predict differences
in the extent and intensity of her children’s labor force
participation, wage earnings, and household incomes. 33
Contraception use also allows women and their families
to avoid the many negative health consequences that are
associated with having pregnancies without optimal time
between them. 34
Unintended pregnancies, which are directly linked to
a lack of access to contraceptives, can erode other aspects
of women’s lives. 35 Unintended pregnancies are linked
in children [and] may improve their lifetime opportunities and
labor market outcomes as adults”); see also Martha J. Bailey et
al., Nat’l Bureau of Econ. Res., Does Parents’ Access to Family
Planning Increase Children’s Opportunities? Evidence From the
War on Poverty and Early Years of Title X 23 (2018) (“children
born after a federal family planning program began were 7 percent
less likely to live in poverty and 12 percent less likely to live in
households receiving public assistance”).
32.  Sonfield, Social and Economic Benefits, supra note 9,
at 24.
33.  Martha J. Bailey, Fifty Years of Family Planning:
New Evidence on the Long-Run Effects of Increasing Access to
Contraception, Brookings Papers on Econ. Activities 341 (2013).
34.  Meghan L. Kavanaugh and Ragnar M. Anderson,
Guttmacher Inst., Contraception and Beyond 8 (July 2013),
available at https://www.guttmacher.org/pubs/health-benefits.
pdf (“Kavanaugh & Anderson”).
35.  Matthias Doepke et al., Nat’l Bureau of Econ. Res.
Working Paper 17672, The Economics and Politics of Women’s

 16
to conflict and decreased satisfaction in relationships,
decreased child well-being, and depression, anxiety,
and overall lower levels of happiness. 36 Unintended
pregnancies are also linked to increased pregnancyrelated morbidity and mortality, which contribute to
the United States having one of the highest maternal
mortality rates in the developed world, with approximately
700 women in the United States dying each year from
pregnancy or childbirth-related causes. 37 Indeed, the
district court in this case found that “[d]isruptions in
contraceptive coverage will lead to women suffering
unintended pregnancies and other medical consequences.”
Pennsylvania v. Trump, 351 F. Supp. 3d 791, 828 (E.D.
Pa. 2019).
B.  The Contraceptive Benefit Enhances The
Proven Benefits Of Access To Contraceptives.
Access to contraceptives has yielded significant gains.
But for many women actual, meaningful access requires
Rights 21 (Dec. 2011) (“Doepke”) (discussing study of European
women indicating that access to “oral contraceptives increased
women’s self-reported life satisfaction”).
36.  See generally Sonfield, Social and Economic Benefits,
supra note 9; see also Kavanaugh & Anderson, supra note 34, at
7-8.
37.  Ctr. For Disease Ctrl. & Prev., Pregnancy Related Deaths
(Feb. 2019), avalable at https://www.cdc.gov/reproductivehealth/
maternalinfanthealth/pregnancy-relatedmortality.htm; See also
Nicholas J. Kassebaum et al., Global, Regional, and National
Levels of Maternal Mortality, 1990-2015: A Systematic Analysis
for the Global Burden of Disease Study 2015, 388 The Lancet
1775, 1784-93 (Oct. 2016), available at https://www.thelancet.com/
journals/lancet/article/PIIS0140-6736(16)31470-2/fulltext.

 17
the elimination of cost-sharing burdens. 38 Studies have
concluded that “[e]ven seemingly small out-of-pocket costs
can reduce use of services and medication.” 39 And recent
studies confirm that the ACA’s contraceptive benefit,
significantly increased women’s ability to access essential
contraceptive services. For example, the teen birth rate
fell to its lowest ever in 2016, a sharp decline attributed in
part to the contraceptive benefit.40 The effectiveness of the
ACA’s Women’s Health Amendment in providing access
to contraceptives is further evidenced by the substantial
decrease in the number of women incurring out-of-pocket
costs for contraception. Before the Women’s Health
Amendment took effect, only 15 percent of privately
insured women had coverage for contraception without
out-of-pocket costs.41 That number rose to 67 percent
about a year after the Women’s Health Amendment took
effect.42 The ACA’s contraception benefit saved women
38.  USWCC, Women’s Economic Priorities, supra note 3,
at 25 (“In 2013, 26% of women had to delay or forgo health care
in the past year due to costs.”).
39.  Bernstein & Jones, Economic Effects, supra note 8, at 23.
40.  Carly Sitrin, Teen Birth Rates Just Hit An All-Time Low,
Vox (June 30, 2017), available at https://www.vox.com/scienceand-health/2017/6/30/15894750/teen-birth-rates-hit-all-time-low
(citing Brady E. Hamilton et al., Births: Provision Data for 2016,
U.S. Dep’t of Health & Human Servs., National Vital Statistics
System (June 2017)).
41.  A d a m S on f ield et a l ., Imp a c t of th e Fe d e r a l
Contraceptive Coverage Guarantee on Out-of-Pocket Payments
for Contraceptives: 2014 Update, 91 Contraception 44, 45 (Sept.
2015), available at https://www.contraceptionjournal.org/article/
S0010-7824(14)00687-8/pdf.
42.  Id.

 18
$1.4 billion in out-of-pocket costs in 2013 alone.43 A study
of more than 600,000 women nationwide concluded that
women were more likely to use oral contraceptives
consistently once the contraceptive benefit removed costsharing obligations.44
In addition to increasing overall access to contraceptives,
the Women’s Health Amendment also eliminated cost as a
reason for women to choose one method of contraception
over another. As a result, more women have been able to
choose more effective forms of contraception.45 For example,
43.  Nora V. Becker and Daniel Polsky, Women Saw Large
Decreases in Out-of-Pocket Spending for Contraceptives After
ACA Mandate Removed Cost Sharing, 34 Health Affairs 104,
1208-09 (July 2015).
44.  Lydia E. Pace et al., Early Impact of the Affordable Care
Act on Oral Contraceptive Cost Sharing, Discontinuation, and
Nonadherence, 35(9) Health Affairs 1616 (Sept. 2016).
45.  See, e.g., Caroline S. Carlin, et al., Affordable Care Act’s
Mandate Eliminating Contraceptive Cost Sharing Influenced
Choices of Women with Employer Coverage, 35 Health Affairs
1608 (2016), available at https://www.healthaffairs.org/doi/
pdf/10.1377/hlthaff.2015.1457 (finding that “when cost sharing for
contraceptives fell to zero for women . . . their rate of choosing
prescription contraceptives rose much more” than women subject
to cost-sharing and “compliance with the [ACA’s] mandate
significantly increased the probability that a woman would chose
a long-term contraceptive method”); Sue Ricketts et al., Game
Change in Colorado: Widespread Use of Long-Acting Reversible
Contraceptives and Rapid Decline in Births Among Young, LowIncome Women, 46 Perspective on Sexual & Reproductive Health
125, 129-130 (Sept. 2014), available at https://onlinelibrary.wiley.
com/doi/epdf/10.1363/46e1714 (reporting results of study finding
that use of long-acting reversible contraceptives quadrupled when,
among other efforts, out-of-pocket costs were eliminated).

 19
intrauterine devices (“IUDs”) are one of the most effective
forms of reversible birth control, with fewer than 1 percent
of women who use them becoming pregnant within a year
(compared to 34 percent of women who use condoms to
prevent pregnancy and 7 percent of women who use oral
contraceptives).46 IUDs, however, have high upfront costs,
which can exceed $1,000.47 Prior to the contraceptive benefit,
these one-time, up-front costs often deterred women from
using this highly effective form of contraception.48 In
January 2012 (before implementation of the Women’s Health
Amendment), 58 percent of women were paying out-of-pocket
costs for an IUD, compared to 13 percent by March 2014.49
As a result of these decreased costs for women, there was
a statistically significant increase in IUD insertions within
the first year after the passage of the ACA.50
46.  Guttmacher, Contraceptive Use supra note 17; see also
Jonathan M. Bearak et al., Changes in Out-of-Pocket Costs for
Hormonal IUDs After Implementation of the Affordable Care Act:
An Analysis of Insurance Benefit Inquiries, 93 Contraception 139,
1-2 (Feb. 2016), available at https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC4780678/pdf/nihms-756929.pdf (“Bearak”).
47.  Id., at 1-2.
48.  IOM, Closing the Gaps, supra note 15, at 108 (noting
“greater use of long-acting, reversible contraceptive methods—
including intrauterine devices . . . might help further reduce
unintended pregnancy rates” and noting that “[c]ost barriers to
use of the most effective contraceptive methods are important
because long-acting, reversible contraceptive methods and
sterilization have high up-front costs”).
49.  Bearak, supra note 46, at 1.
50.  Ashley M. Snyder et al., The Impact of the Affordable
Care Act on Contraceptive Use and Costs among Privately
Insured Women, 28(3) Women’s Health Issues 219, 222 (March

 20
The Women’s Health Amendment has ensured access
to the most effective and appropriate contraceptives for
more women than ever before. The Rules eliminate that
access and thereby jeopardize the substantial opportunities
the contraceptive benefit has provided to so many women.
As a result, “more women will likely forgo contraceptive
services or seek out less expensive and less effective types
of contraceptive services in the absence of no-cost insurance
coverage.” Pennsylvania, 351 F. Supp. 3d at 828.
II. The Contraceptive Benefit Facilitates Business
Growth By A llowing Women to Play a Critical
Role in The National Economy.
Barriers to women’s participation in the workforce –
such as hampering access to contraception – “do[] more
than hold back [women’s] careers and aspirations for
a better life,” they also “act as brakes on the national
economy, stif ling the economy’s ability to grow.” 51
Highlighting how important contraception has been for
women’s economic advancement, Bloomberg Businessweek
recently listed contraception as the ninth “most disruptive
innovation” in history, higher on the list than Amazon,
McDonalds, email, and venture capital in terms of its
impact on American businesses. 52
2018), available at https://www.whijournal.com/article/S10493867(17)30527-3/pdf.
51.  Diane Whitmore Schanzenbach and Ryan Nunn, The
Hamilton Project, The 51%: Driving Growth Through Women’s
Economic Participation 1 (Oct. 2017), available at https://
w w w.brookings.edu/wp-content/uploads/2017/10/es_121917_
the51percent_ebook.pdf.
52.  The 85 Most Disruptive Ideas in Our History, Bloomberg
Businessweek, available at https://w w w.bloomberg.com /
businessweek/85ideas/.

 21
A.  When Women Are Empowered To Control
Their Own Reproductive Lives, Businesses And
The National Economy Benefit Too.
For generations of women, access to contraception has
allowed them to gain a stronger foothold in the workforce
and national economy.53 Women now comprise more than
50 percent of the national workforce.54 The evidence shows
that businesses and the economy benefit when women play
a large role in the workforce.55 In fact, one study estimates
that the United States economy is $2 trillion (or 13.5
percent) larger than it otherwise would be due to women’s
increased participation in the labor force since 1970.56
As of 2019, women also own approximately 13 million
privately-held businesses. 57 Those businesses generate
about $1.9 trillion in revenue, and employ about 9.4 million
53.  See Doepke, supra note 35, at 21 (noting “[l]egal access
to oral contraceptives gave women control over the timing of
childbearing, and thus their labor market participation”).
54.  Rachel Siegel, Women outnumber men in the American
workforce for only the second time, The Washington Post
(Jan. 10, 2020), available at https://www.washingtonpost.com/
business/2020/01/10/january-2020-jobs-report/.
55.  Christine Lagarde and Jonathan D. Ostry, World Econ.
Forum, When more women join the workforce, everyone benefits.
Here’s why (Dec. 2018), available at https://www.weforum.org/
agenda/2018/12/economic-gains-from-gender-inclusion-evengreater-than-you-thought/.
56.  Executive Office of the President, Council of Economic
Advisers, The Annual Report 158 (Feb. 2015), available at
https://obamawhitehouse.archives.gov/sites/default/files/docs/
cea_2015_erp_complete.pdf.
57.  American Express, supra note 5, at 3.

 22
people. 58 Combined with firms that are equally owned
by men and women, these businesses employ nearly 16.5
million people and generate $3.2 trillion in revenue. 59
Businesses also benefit from women serving on
their boards of directors and in management roles.
For instance, companies in the top quartile for gender
diversity on executive teams are 21 percent more likely
to experience above-average profitability than companies
in the bottom quartile.60 One study found that having just
one female director on a board cuts the risk of bankruptcy
by 20 percent.61 Having a higher percentage of female
employees also benefits companies in other ways. One
study found that employees who work in organizations with
higher percentages of women have more job satisfaction,
more organizational dedication, more meaningful work
and less burnout.62
58.  Id.
59.  Id.
60.  Vivian Hunt et al., McKinsey & Co., Delivering through
Diversity 13 (2018), available at https://www.mckinsey.com/~/media/
McKinsey/Business%20Functions/Organization/Our%20Insights/
Delivering%20through%20diversity/Delivering-through-diversity_
full-report.ashx (finding “a strong correlation between the presence
of women in company top management and better financial results”).
61.  Chris Bart, Why Women Make Better Directors, 8 Int’l
J. Bus. Governance and Ethics 93, 95 (2013), available at https://
pdfs.semanticscholar.org/a7db/04f990334daf8f0c47e587f61055b
16518d0.pdf.
62.  Cathleen Clerkin, Center for Creative Leadership, What
Women Want—And Why You Want Women—In The Workplace,
available at https://www.ccl.org/wp-content/uploads/2017/07/
WhatWomenWant.FINAL_.pdf.

 23
Even though businesses thrive w ith women’s
active participation and leadership, women are still
underrepresented at every level of the corporate hierarchy.63
Adding barriers like the Rules that disproportionately affect
women will only exacerbate the very real challenges women
in business continue to face. If women are deprived of the
tools they need to effectively support their reproductive
decisions, many people, including women themselves,64 may
decide it is too risky for women to undertake high-achieving
career paths or start businesses. Businesses will lose if the
Rules are allowed to undermine the ACA’s contraceptive
coverage benefit to women in the workplace.

63.  McKinsey, Women in the Workplace, supra note 4, at 8-9;
see also Joanna Barsh and Lareina Yee, McKinsey & Company,
Unlocking the Full Potential of Women in the US Economy
(Apr. 2011), available at https://www.mckinsey.com/businessfunctions/organization/our-insights/unlocking-the-full-potentialof-women (explaining that “[d]espite the sincere efforts of major
corporations, the proportion of women falls quickly as you look
higher in the corporate hierarchy”).
64.  Id. (embedded institutional mindsets and embedded
individual mindsets serve to hold women back in their careers);
see also Marianne Bertrand et al., Dynamics of the Gender Gap
for Young Professionals in the Financial and Corporate Sectors,
2 Am. Econ. J. Applied Econ. 228, 230 (July 2010) (finding “MBA
mothers seem to actively choose jobs that are family friendly,
and avoid jobs with long hours and greater career advancement
possibilities”).

 24
B.  Decreased Access To Contraception Negatively
Impacts Women’s Well-Being, Businesses, And
The Economy.
The Rules undermine women’s ability to consistently
access contraception throughout their careers and inject
uncertainty into the availability of meaningful access to
contraception. As a result, women may opt out of certain
professions or industries due to an increased risk of
decreased access to contraception. Women may also forgo
opportunities for professional growth and development,
making career choices based on access to contraception
instead of what is best for their lives. All businesses suffer
when women are forced to make such choices.
Research shows that lack of access to contraception
contributes to negative health outcomes which can
directly affect businesses that employ women. It is well
documented that “[m]others are healthier when they
are able to control when they become pregnant through
the use of family planning, and their infants benefit as
well.”65 For example, postpartum depression is nearly
twice as high among women whose pregnancies were
unplanned.66 Women whose pregnancies were unplanned
65.  Kaye, supra note 11, at 4-5 (2014) (noting “babies were
two-thirds more likely to be of low birthweight if they followed an
unwanted pregnancy, as compared to a planned pregnancy”); see
also Adam Sonfield, Beyond Preventing Unplanned Pregnancy:
The Broader Benefits of Publicly Funded Family Planning
Services 17 Policy Rev. 2 (2014), available at https://w w w.
guttmacher.org/sites/default/files/article_files/gpr170402.pdf
(noting “[p]regnancy planning . . . has well-documented health
benefits for women and children”).
66.  Kaye, supra note 11, at 4-5.

 25
are significantly more likely to be hospitalized during
pregnancy. 67 Further, unintended pregnancies may
“present an unacceptably high health risk for women
who have underlying medical conditions, some of which
are exacerbated by pregnancy.” 68 Without access to
contraceptives, women with underlying medical conditions
such as diabetes, seizure disorders, and breast cancer face
great risk due to unintended pregnancies, and lose the
ability to plan ahead for how to manage their conditions
during pregnancy.69 Unintended pregnancies are thus
more likely to lead to health issues for women, which in
turn interferes with education and work goals.
In the same way that access to contraception affects
women’s health outcomes, women’s ability to access
contraception also affects the health of businesses and the
economy. When employees’ well-being is compromised,
businesses suffer concrete economic losses related
to, among other things: (1) reduced productivity and
presenteeism;70 (2) absenteeism; and (3) high rates of
employee turnover.71 Such factors can cost businesses up
67.  Id. at 18.
68.  Kavanaugh & Anderson, supra note 34, at 7.
69.  Id.
70.  Presenteeism refers to “a person who is physically
present at work but performs at reduced capacity with ‘ decreased
productivity and below-normal work quality’ for a variety of
reasons.” Donna Allen et al., Four-year review of presenteeism
data among employees of a large United States health care
system: a retrospective prevalence study, Human Resources for
Health 16:59 at 2 (2018) (“Allen, Presenteeism”).
71.  Amy Richman et al., Corporate Voices for Working
Families, Business Impacts of Flexibility: An Imperative for

 26
to $300 billion annually.72 Calculated another way, a single
employee who faces health issues can cause a business
to incur “an estimated cost of 16 days of [incidental] sick
leave and [loss of] $8,000 . . . per year.” 73 Mental illness
and general anxiety are two of the top three conditions
for highest daily productivity loss per person and highest
annual cost per person.74 Further, one in three employees
admit to being less productive at work because of financial
stress, and two-thirds of employees say they are stressed
about having money to cover out-of-pocket medical costs.75
In addition to health-related losses of productivity,
stress associated with lack of control over reproductive
health also damages businesses. Stress is a leading cause
of employee turnover, which costs employers between 12
percent and 40 percent of their companies’ net earnings
each year.76 Businesses spend an average of $15,000 to
Expansion 13 (Feb. 2011), available at https://www.wfd.com/
PDFS/BusinessImpactsofFlexibility_March2011.pdf. (finding
that stress is responsible for 40 percent of turnover).
72.  Id. (estimating stress-related costs to be around $300
billion per year); David Lee, Managing Employee Stress and
Safety: A Guide to Minimizing Stress-Related Cost While
Maximizing Employee Productivity 3 (2000) (estimating stressrelated costs to be between $50 billion and $150 billion each year).
73.  Id.
74.  Allen, Presenteesim, supra note 70, at 5.
75.  MetLife, Thriving in the New Work-Life World: MetLife’s
17th Annual U.S. Employee Benefit Trends Study 2019 at 11, 40.
76.  Lindsay E. Sears et al., Overall Well-Being as a Predictor
of Health Care, Productivity and Retention Outcomes in a Large
Employer, 16(6) Population Health Management 397, 397 (Dec.

 27
replace each departing worker.77 Preventable turnover
costs companies $475 billion per year.78 In 2018, 8.4 percent
of departing employees cited well-being as the reason for
their departure.79 Another 9.6 percent cited compensation
and benefits as their reason for leaving, with the percentage
citing benefits as their reason for leaving having increased
by 100 percent since 2010. 80 Businesses recognize that
reducing employee stress and increasing overall well-being
can result in financial gains. One study found that “[m]ore
than two-thirds fo the 313 CFOs [Chief Financial Officers]
surveyed agreed that health is a cultural or financial
priority in their organizations.” 81 The CFOs viewed
“health as having an impact on financial performance in
both conventional (e.g., healthcare expenses and sick-day
2013), available at https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC3870481/pdf/pop.2012.0114.pdf.
77.  Thomas F. Mahan et al., 2019 Retention Report, Work
Institute at 10; (“Retention Report”); Sean Nicholson et al., How
to Present the Business Case for Healthcare Quality to Employers
9 (Nov. 2005), available at http://knowledge.wharton.upenn.edu/
wp-content/uploads/2013/09/1303.pdf (finding that a “program
that improves workers’ health could lower the turnover rate by
creating a stronger attachment between the employees and the
company”).
78.  Retention Report, supra note 77, at 10.
79.  Id. at 14. “Well-being” is defined to include general
personal, personal health, caregiver issues, pregnancy and family
issues. Id. at 19.
80.  Id. at 14, 18.
81.  Integrated Benefits Institute, Making Health the CFO’s
Business: Findings From the Integrated Benefits Institute’s 2011
CFO Survey 2 (Feb. 2012), available at https://www.ibiweb.org/
wp-content/uploads/2018/01/2011_CFO_Survey_Full.pdf.

 28
absences) and less conventional ways (e.g., opportunity
costs and requirements for larger-than-optimal staffs).”82
In recognition of the important relationship between
employees’ well-being and businesses’ financial interests,
many companies have implemented various work-life
initiatives. One example is the recent trend of providing
on-site healthcare clinics to employees. By providing
these services, workers experience between 15 and 22
fewer incidental missed workdays than the employees of
companies that lack on-site healthcare providers. These
initiatives enhance the bottom line. The Rules however,
do the opposite. When women suffer negative health
consequences associated with unintended pregnancies or
stress occasioned by lack of control over their reproductive
health, they see their net earnings decline, and the
economy sees overall growth and productivity decline, too.
Women have been able to contribute to the national
economy in large part because access to contraception
has empowered them to make life choices without fear of
unintended pregnancy. Indeed, access to contraception
implicates a woman’s “basic control over her life.” Casey,
505 U.S. at 928 (Blackmun, J., concurring in part and
dissenting in part). Recognizing that women’s ability to
participate “equally in the economic and social life of the
Nation” is “facilitated by their ability to control their
reproductive lives,” this Court should not reverse course
on the substantial economic progress women have made.
Casey, 505 U.S. at 856 (citations omitted).

82.  Id.

 29
CONCLUSION
The nation’s economy is best served when women
can participate fully in education, the workforce, and
the marketplace without the uncertainty of unintended
pregnancy. The Rules threaten businesses and the
national economy by decreasing women’s ability to access
contraception. This loss of control limits women’s ability
to shape and care for their families, their education, and
their careers. The Rules will have adverse consequences
for women’s economic security, equality, opportunity,
and well-being. They will harm women, families, and the
national economy. For these, and the foregoing reasons,
amici respectfully urge this Court to affirm the Third
Circuit’s decision and uphold the nationwide injunction
prohibiting the Rules from taking effect.
    Respectfully, submitted,

Leah R. Bruno
Counsel of Record
Joanne Caceres
Jacqueline A. Giannini
Dentons US LLP
233 South Wacker Drive,
Suite 5900
Chicago, Illinois 60606
(312) 876-8000
leah.bruno@dentons.com
April 8, 2020

Attorneys for Amici Curiae

 APPENDIX

1a
Appendix
APPENDIX — LIST
OF AMICI CURIAE
U.S. Women’s Chamber of Commerce, https://uswcc.org/
National Association for Female Executives, https://
www.nafe.com/
Amalgamated Bank, https://www.amalgamatedbank.com/
Argent, https://argentwork.com/
Atlassian, https://www.atlassian.com/
Bad Robot Productions, https://www.badrobot.com/
Ben & Jerry’s Homemade, Inc., https://www.benjerry.com/
Benevity, https://www.benevity.com/
Bloomberg LP, https://www.bloomberg.com/
The Body Shop US, https://www.thebodyshop.com/en-us/
Box, https://www.box.com/home
Hims, Inc., https://www.forhims.com/ and https://www.
forhers.com/
Jaya Apparel Group, http://www.jayaapparelgroup.com/
Juniper Networks, https://www.juniper.net/us/en/
Lush, https://www.lushusa.com/
Medicines360, https://www.medicines360.org/

 2a
Appendix
Outdoor Voices, https://www.outdoorvoices.com/
Postmates, https://postmates.com/
Refinery29, https://www.refinery29.com/en-us
Seventh Generation, https://www.seventhgeneration.
com/home
The Lede Company, https://ledecompany.com/
The Riveter, https://theriveter.co/
Trillium Asset Management, https://trilliuminvest.com/