One Size Doesn’t Fit All

Kathryn Joyce

In 1968, Catholic Church doctrine forbade the use of contraception. Forty years later, the Church's teachings are irrelevant at best to American Catholics, but outright dangerous for those living in the developing world.

In the midst of the wall-to-wall press coverage of Pope Benedict XVI's visit to the U.S. last week, The New York Times paused to note that many American Catholics pay little heed to papal authority, and instead bestow on the pope a particularly American commendation: they'd love to sit down and chat with the man, Catholic to Catholic. However homey the image, a stained-glass rendition of the favored American method of choosing a president (sans beer), the Times also pointed out, in explaining the lack of official Church data on how Americans really feel about the authority of this or any pope, that the Church is not a democracy. And, despite how nonchalantly many Americans speak about the relevance of the Vatican on their lives, the effect of a hierarchy headed by a man who built his career on opposition to liberation and feminist theology is real, and renders liberal or pro-choice Catholics today dissenters criticizing doctrine from outside the Church.

While Benedict pointedly neglected to address the issues those dissenters press on – the bans on contraception, condom use, gay and lesbian rights, and ordination of women – the unbending position of the Vatican was made clear during a 60,000-person mass at Yankee Stadium on Sunday, where he reminded the throngs of faithful that obedience as a Catholic is non-optional.

"Authority. Obedience. To be frank, these are not easy words to speak nowadays, especially in a society which rightly places a high value on personal freedom," he told the crowd, continuing to cite the scriptural lesson that "true freedom" comes from turning from sin, from "self-surrender" and "losing ourselves": an emphasis on hierarchy and submission more common to fundamentalist Christianity and orthodox doctrine across denominations than within the heterogeneous Catholic church itself.

It's also an unsubtle reminder that, however much American Catholics may disdain the 40-year old order of Humane Vitae — that "each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life" — following their own consciences on matters of artificial contraception is still an act of rebellion.

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An immediate outpouring of dissent greeted the document in 1968, when 600 theologians protested the ruling, Rosemary Radford Ruether, a feminist theologian at the Pacific School of Religion, recalled on a conference call convened by Catholics for Choice to commemorate the document's fortieth anniversary. These theologians, she explains, were responding to the real consequences of Natural Family Planning — the only method of birth control the Church had allowed since 1930, when it banned condoms and diaphragms in a renewed emphasis on Augustine's anti-contraception teachings — in Catholics' family life, where the anti-contraceptive emphasis "almost began to seem the point of being a Catholic." As representatives of lay Catholic couples testified to the 1966 Catholic Commission on Birth Control, the pressures of following NFP, and abstaining during infertile periods, led to great marital discord for Catholic couples. The priests on the Commission were shocked by the experiences of the laity, and voted overwhelmingly to recommend that birth control be allowed for married couples. A small group of anti-contraception dissenters created a second "minority report" for the pope, calling the Commission's conclusions threatening to the Church's authority, as the Church could not admit to having "so wrongly erred during all those centuries of history." Four years later, it was this dissenting point of view that was reinforced in Humanae Vitae.

Today 97% of sexually active Catholic women use some form of contraception at some point, and, Radford Ruether says, many Catholic priests don't press the issue, considering it a "teaching that has not been received" by the people. Indeed, in 1974, 83% of Catholics said they disagreed with Humanae Vitae, and in 1999, according to the National Catholic Reporter, 80% of Catholics said they believed they could practice birth control and remain "good Catholics" (presumably leaving the remaining 17% guiltily disobedient). But despite this 40-year disconnect, which many theologians agree has led to greater skepticism about Church infallibility than acceptance of contraception ever could have, calls to liberalize the doctrine are repeatedly shot down with what theologian Anthony Padovano calls "incredibly inflated language," such as Pope John Paul II's assertion that questioning the ban on contraception was equivalent to questioning the holiness of God.

How this plays out in day-to-day life, explains Mary Hunt, of the Women's Alliance for Theology, Ethics and Ritual, is that many Catholic women who approach their priests about contraception are given personal exemptions, while the same priests or bishops continue to preach against it in public. "Many Catholics are disgusted by the duplicity, or at best they're confused," said Hunt. There is "little evidence that those who believe contraception is healthy, good, natural and holy, as I do, have any input into Catholic theology."

Or, if they have a vote, it's one that can only be used once, in leaving the church. "The Catholic hierarchy holds its power," says Hunt, "and laypeople, many of them women, are walking away." Or, as Daniel Maguire, a professor of Moral Theological Ethics at Marquette University who laments that the public face of the Church excludes dissenting theologians and laity, jokes, "The current teaching of Catholic bishops is the making of Unitarians." On the eve of the Pope's visit, Catholics for Choice issued a publication studying the full impact of the contraceptive ban, Truth and Consequences: A Look Behind the Vatican's Ban on Contraception (PDF).

Perhaps the exodus of those Catholics who feel strongly about reproductive health and rights explains the sometimes confusing poll numbers attached to American Catholicism. For all that people obviously reject Catholic hierarchical teachings in practice, and tell pollsters the Church is "out of touch" on modern issues, there's a conflicting rise of believers who say they support the traditionalist path Pope Benedict XVI represents. According to a poll conducted by The Washington Post, over the past five years, the percentage of Catholics who supported modernized doctrine from the Vatican has dwindled from 66% to 45%, and those who wanted the pope to "emphasize Catholicism's traditional teachings and customs" rose from one-third to one-half.

Maybe that rise in appreciation for tradition, even among believers who are flouting the doctrine, is because the impact of Vatican teachings is far less consequential in the U.S. than in developing nations where the Catholic hierarchy has a heavy hand in public policy, hampering condom distribution in Africa, emergency contraception availability in South America, and family planning options for women in countries with high rates of maternal mortality. In Yankee Stadium, the pope's words on obedience may be a plea to a rich nation, but elsewhere, it's an enforceable demand.

"The tragedy is that those of us in the Global North can circumvent any restrictions on contraception," says Catholics for Choice President Jon O'Brien, reflecting a Vatican recognition that they've "lost the battle for our hearts and minds." Instead, the Vatican has taken their argument to the level of global public policy at the U.N., and exerts its influence most immediately on the developing nations of the Global South. There, says Mary Hunt, "Anti-contraceptive theology, implemented in public policy, results in a lack of available, affordable birth control, and this plays a significant role in [maternal] deaths" — even as vast majorities of Latin American Catholics, including 87% of Colombian Catholics, 84% of Mexican Catholics, and 81% of Bolivian Catholics, believe you can use contraception and still be a good Catholic.

Perhaps a greater awareness among the majority of Catholic laity who disagree with Vatican teaching on contraception – whether they voice that disagreement in words, with their feet, or through the quiet example of their private lives – of how such "irrelevant" teachings play out in the lives of their poorer sisters, would make the issue of Vatican authority relevant again. It certainly is for those who don't have the freedom, "true" or otherwise, to disregard an authority that directs the healthcare they can receive.

Commentary Contraception

For Students at Religious Universities, Contraception Coverage Isn’t an Academic Debate

Alison Tanner

When the U.S. Supreme Court sent a case about faith-based objections to the Affordable Care Act's contraceptive mandate back to lower courts, it left students at religious colleges and universities with continuing uncertainty about getting essential health care. And that's not what religious freedom is about.

Read more of our articles on challenges to the Affordable Care Act’s birth control benefit here.

Students choose which university to attend for a variety of reasons: the programs offered, the proximity of campus to home, the institution’s reputation, the financial assistance available, and so on. But young people may need to ask whether their school is likely to discriminate in the provision of health insurance, including contraceptive coverage.

In Zubik v. Burwell, a group of cases sent back to the lower courts by the U.S. Supreme Court in May, a handful of religiously affiliated universities sought the right to deny their students, faculty, and staff access to health insurance coverage for contraception.

This isn’t just a legal debate for me. It’s personal. The private university where I attend law school, Georgetown University in Washington, D.C., currently complies with provisions in the Affordable Care Act that make it possible for a third-party insurer to provide contraceptive access to those who want it. But some hope that these legal challenges to the ACA’s birth control rule will reverse that.

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Georgetown University Law Center refused to provide insurance coverage for contraception before the accommodation was created in 2012. Without a real decision by the Supreme Court, my access to contraception insurance will continue to be at risk while I’m in school.

I’m not alone. Approximately 1.9 million students attend religiously affiliated universities in the United States, according to the Council for Christian Colleges and Universities. We students chose to attend these institutions for lots of reasons, many of which having nothing to do with religion. I decided to attend Georgetown University Law Center because I felt it was the right school for me to pursue my academic and professional goals, it’s in a great city, it has an excellent faculty, and it has a vibrant public-interest law community.

Like many of my fellow students, I am not Catholic and do not share my university’s views on contraception and abortion. Although I was aware of Georgetown’s history of denying students’ essential health-care benefits, I did not think I should have to sacrifice the opportunity to attend an elite law school because I am a woman of reproductive age.

That’s why, as a former law clerk for Americans United for Separation of Church and State, I helped to organize a brief before the high court on behalf of 240 students, faculty, and staff at religiously affiliated universities including Fordham, Georgetown, Loyola Marymount, and the University of Notre Dame.

Our brief defended the sensible accommodation crafted by the Obama administration. That compromise relieves religiously affiliated nonprofit organizations of any obligation to pay for or otherwise provide contraception coverage; in fact, they don’t have to pay a dime for it. Once the university informs the government that it does not want to pay for birth control, a third-party insurer steps in and provides coverage to the students, faculty, and staff who want it.

Remarkably, officials at the religious colleges still challenging the Affordable Care Act say this deal is not good enough. They’re arguing that the mere act of informing the government that they do not want to do something makes them “complicit” in the private decisions of others.

Such an argument stands religious freedom on its head in an attempt to impose one group’s theological beliefs on others by vetoing the third-party insurance providers’ distribution of essential health coverage to students, faculty, and staff.

This should not be viewed as some academic debate confined to legal textbooks and court chambers. It affects real people—most of them women. Studies by the Guttmacher Institute and other groups that study human sexuality have shown that use of artificial forms of birth control is nearly universal among sexually active women of childbearing years. That includes Catholic women, who use birth control at the same rate as non-Catholics.

Indeed, contraception is essential health care, especially for students. An overwhelming number of young people’s pregnancies are unplanned, and having children while in college or a graduate program typically delays graduation, increases the likelihood that the parent will drop out, and may affect their future professional paths.

Additionally, many menstrual disorders make it difficult to focus in class; contraception alleviates the symptoms of a variety of illnesses, and it can help women actually preserve their long-term fertility. For example, one of the students who signed our brief told the Court that, “Without birth control, I experience menstrual cycles that make it hard to function in everyday life and do things like attend class.” Another woman who signed the brief told the Court, “I have a history of ovarian cysts and twice have required surgery, at ages 8 and 14. After my second surgery, the doctor informed me that I should take contraceptives, because if it happened again, I might be infertile.”

For these and many other reasons, women want and need convenient access to safe, affordable contraceptives. It is time for religiously affiliated institutions—and the Supreme Court—to acknowledge this reality.

Because we still don’t have an ultimate decision from the Supreme Court, incoming students cannot consider ease of access to contraception in deciding where to attend college, and they may risk committing to attend an university that will be legally allowed to discriminate against them. A religiously affiliated university may be in all other regards a perfect fit for a young woman. It’s unfair that she should face have to risk access to essential health care to pursue academic opportunity.

Religious liberty is an important right—and that’s why it should not be misinterpreted. Historically, religious freedom has been defined as the right to make decisions for yourself, not others. Religious freedom gives you have the right to determine where, how, and if you will engage in religious activities.

It does not, nor should it ever, give one person or institution the power to meddle in the personal medical decisions of others.

Commentary Law and Policy

Here’s What You Need to Know About Your Birth Control Access Post-Supreme Court Ruling

Bridgette Dunlap

Yes, the Zubik v. Burwell case challenged the Affordable Care Act's contraceptive coverage mandate. But that shouldn't stop you from getting your reproductive health needs met—without a co-payment.

In May, the Supreme Court issued a sort of non-decision in Zubik v. Burwell, the consolidated case challenging the Affordable Care Act’s mandate that employers provide contraceptive coverage. The ruling leaves some very important legal questions unanswered, but it is imperative that criticism of the Court for “punting” or leaving women in “limbo” not obscure the practical reality: that the vast majority of people with insurance are currently entitled to contraception without a co-payment—that includes people, for the most part, who work for religiously affiliated organizations.

Two years ago, hyperbole in response to the Court’s decision in Burwell v. Hobby Lobby—that, for example, the Court had ruled your boss can block your birth control—led too many people to believe the contraceptive coverage requirement was struck down. It wasn’t. The Zubik decision provides a good opportunity to make sure that is understood.

If people think they don’t have birth control coverage, they won’t use it. And if they don’t know what coverage is legally required, they won’t know when their plans are not in compliance with the law and overcharging them for contraceptives or other covered services, perhaps unintentionally. The point of the contraceptive coverage rule is to make it as easy as possible to access contraceptives—studies show seemingly small obstacles prevent consistent use of the most effective contraceptives. Eliminating financial barriers isn’t enough if informational ones undermine the goal.

The most important thing to know is that most health plans are currently required to cover reproductive health services without a co-payment, including:

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  • One version of every kind of FDA-approved contraception—that is, only the generic or the brand-name version of the contraceptive could be covered, but at least one must be. So you shouldn’t be paying a co-payment whether you use the pill, the patch, the shot, or want long-acting reversible contraception (LARC) like an IUD, which is more expensive, but most effective.
  • Screening for HIV and high-risk strains of HPV
  • An annual well-woman visit
  • Breastfeeding counseling and supplies like pumps

There are exceptions, but most plans should be covering these services without a co-payment. Don’t assume that because you work for Hobby Lobby or Notre Dame—or any other religiously affiliated employer—that you don’t currently have coverage.

The original contraceptive coverage rule had an “exemption” for church-type groups (on the somewhat dubious theory that such groups primarily employ individuals who would share their employers’ objection to contraception). When other kinds of organizations, which had religious affiliations but didn’t primarily employ individuals of that same religion, objected to providing contraceptive coverage, the Obama administration came up with a plan to accommodate them while still making sure women get contraceptive coverage.

This “accommodation” is a workaround that transfers the responsibility to provide contraceptive coverage from the employer to the insurance company. After the employer fills out a form noting it objects to providing contraception, the insurance company must reach out to the employee and provide separate coverage that the objecting organization doesn’t pay for or arrange.

This accommodation was originally available only to nonprofit organizations. But dozens of for-profits, like Hobby Lobby, sued under the Religious Freedom Restoration Act (RFRA)—arguing that their owners were religious people whose beliefs were also burdened by the company having to provide coverage.

The Hobby Lobby decision did not say your boss’s religious belief trumps your right to a quality health plan. What the Court did was point to the existence of the accommodation for nonprofits as proof that the government could achieve its goals of ensuring coverage of contraception through a workaround already in place to give greater protection to objectors. Basically, the Court told the government to give the for-profits the same treatment as the nonprofits.

The Hobby Lobby decision states explicitly that the effect of this on women should be “precisely zero.” The Obama administration subsequently amended the contraceptive regulations, making coverage available to employees of companies like Hobby Lobby available through the accommodation. Hobby Lobby added some headaches for administrators and patients, but it did not eliminate the contraceptive coverage rule.

Next, however, the nonprofits went on to argue to the Supreme Court and the public that the accommodation the Court had seemed to bless in Hobby Lobby also violated RFRA—because having to fill out a form, which notified the government that they objected to contraceptive coverage and identifying their insurers, would substantially burden their religious beliefs.

Following oral arguments in Zubik, the eight-member Supreme Court issued a highly unusual order: It asked the parties to respond to its proposed modification of the accommodation, in which the government would not require objecting nonprofits to self-certify that they oppose contraception nor to identify their insurers. The government would take an organization’s decision to contract for a health plan that does not cover contraception to be notice of a religious objection and go ahead with requiring the insurer to provide it instead.

The petitioners’ response to the Court’s proposed solution was “Yes, but…” They said the Court’s plan would be fine so long as the employee had to opt into the coverage, use a separate insurance card, and jump through various other hoops—defeating the goal of providing “seamless” contraceptive coverage through the accommodation.

When the Court issued its decision in Zubik, it ignored the “but.” It characterized the parties as being in agreement and sent the cases back to the lower courts to work out the compromise.

The Court told the government it could consider itself on notice of the petitioners’ objections and move forward with getting separate contraceptive coverage to the petitioners’ employees, through the accommodation process, but without the self-certification form. How the government will change the accommodation process, and whether it will satisfy the petitioners, are open questions. The case could end up back at the Supreme Court if the petitioners won’t compromise and one of the lower courts rules for them again. But for prospective patients, the main takeaway is that the Court ruled the government can move forward now with requiring petitioners’ insurers to provide the coverage that the petitioners won’t.

So—if your plan isn’t grandfathered, and you don’t work for a church or an organization that has sued the government, your insurance should be covering birth control without a co-payment. (If your plan is grandfathered and your employer makes a change to that plan, then those formerly grandfathered plans would be subject to the same contraceptive coverage requirements.) If you do work for one of the nonprofit petitioners, the government should be making contraceptive coverage available even before the litigation is resolved. And in some cases, employees of the petitioners already have coverage. Notre Dame, for example, initially accepted the accommodation before being pressured by off-campus contraception opponents to sue, so its insurer is currently providing Notre Dame students and employees coverage.

Don’t despair about the Supreme Court’s gutting access to contraception. Assume that you have coverage. The National Women’s Law Center has great resources here for finding out if your plan is required to cover contraception and how to address it with your insurance plan if it isn’t in compliance, and a hotline to call if you need help. The fact that equitable coverage of women’s health care is the new status quo is a very big deal that can be lost in the news about the unprecedented litigation campaign to block access to birth control and attacks on Obamacare more generally. Seriously, tell your friends.