News Contraception

Obama and the Bishops: Is the White House Caving on Birth Control Coverage?

Jodi Jacobson

The Bishops are lobbying hard for the Obama Administration to effectively excuse any and all "religious" entities from covering contraceptives without a co-pay. Last week Archbishop Dolan paid a private visit to President Obama and word on the street is that the White House may cave. This would be a grave mistake.

See all our coverage of the Birth Control Mandate 2011 here

This week, the United States Conference of Catholic Bishops (USCCB) threw itself a pity party in Baltimore. According to the bishops, their “religious liberty” is threatened unless they are able to ensure that every single person in the United States (well, actually the world) is made to follow Catholic canon law to the letter. According to the New York Times, the bishops are “recasting their opposition” to same-sex marriage, birth control, and other fundamental aspects of public health and human rights, because they view both government and culture as infringing on the church’s rights.

“We see in our culture a drive to neuter religion,” Archbishop Timothy M. Dolan of New York, president of the bishops conference, said in a news conference Monday at the bishops’ annual meeting in Baltimore. He added that “well-financed, well-oiled sectors” were trying “to push religion back into the sacristy.”

But the sacristy is where the vast majority of Catholics appear to believe the bishops should be focusing their efforts. The Times notes that in light of the ongoing evidence of massive cover-ups by the Vatican and the USCCB of the priest pedophilia scandal, the bishops’ “pronouncements on politics and morality have been met with indifference even by many of their own flock.”

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The bishops issue guidelines for Catholic voters every election season, a document known as “Forming Consciences for Faithful Citizenship,” which is distributed in many parishes. But the bishops were informed at their meeting on Monday that a recent study commissioned by Fordham University in New York found that only 16 percent of Catholics had heard of the document, and only 3 percent had read it.

Nonetheless, the Bishops believe their own right to practice their religion is threatened by your right to practice yours or to act as a moral agent in your own life. Their freedom of religion is threatened unless they can ensure that all LGBT persons are denied the right to marry or adopt children. It is threatened unless all women are denied the rights to decide whether and when to have children. It is threatened unless a Catholic hospital can let a woman die from complications of pregnancy rather than provide her with or even refer her on an emergency basis for a life-saving abortion. It is threatened unless a two-celled fertilized egg has more rights than the living, breathing woman in whose body it floats.

They are not “free” until you are not free.

And they certainly are not “free” unless women are denied access to affordable birth control. 

An integral part of the Affordable Care Act is the new benefit requiring health plans to cover preventive health care, including cancer screenings, immunizations, and birth control, with no co-pays.  Inclusion of these benefits came about through dogged efforts by female legislators, including an amendment authored by Senator Barbara Mikulski (D-MD), known as the Women’s Health Amendment. The Department of Health and Human Services, tasked with implementing health reform through regulations and oversight, took the advice of an expert panel of the Institute of Medicine (IOM) and recommended birth control be covered as a women’s preventive service because it is basic health care, and because it improves health outcomes for women and their families. Research shows that improved access to birth control is directly linked to declines in maternal and infant mortality among other health benefits. The IOM recommendations are supported by a vast amount of research and affirmed by the World Health Organization, the International College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Public Health Association among many other medical and public health bodies.

Regulations promulgated by HHS this summer mandate coverage in all employee-based health plans of contraceptive methods without a co-pay. The current provision includes what many already consider to be a sweeping refusal clause, exempting certain religious organizations for which religious values are their primary purpose; that primarily employ persons who share the religious tenets of the organization; that primarily serve persons who share the religious tenets of the organization; and that are nonprofit organizations. The regulations would still require institutions such as Catholic hospitals–for which one assumes the primary purpose is evidence-based health care–and universities (primary purpose, education?) to offer insurance that covers contraception without a co-pay. Nothing (repeat: NOTHING) in this new benefit requires an organization to dispense birth control, or an individual to take it. This is simply a matter of ensuring women have access to affordable preventive care by providing it with no co-pays. For an excellent and thorough review of this issue, read the testimony of Catholics for Choice President Jon O’Brien.

Still, this has so riled the USCCB that Archbishop Timothy Dolan took his lobbying straight to President Obama, with whom he met privately at the White House last week. In what I take to be a somewhat ominous comment, Dolan stated at a news conference that he “found the president of the United States to be very open to the sensitivities of the Catholic community.”

“I left there feeling a bit more at peace about this issue than when I entered.”

By “Catholic community,” Dolan clearly means the USCCB, the Vatican and the male hierarchy, certainly not the community constituted by the people–or the women–of the church.

Word on the street now–through off-the-record conversations with health groups–is that the White House is considering caving on the exemptions for contraceptive coverage.

This would be a grave mistake on Obama’s part.

For women, birth control is about as controversial as toothpaste and as widely used. According to the Centers for Disease Control, between 2006–2008, 99 percent of ALL women who had ever had sexual intercourse had used at least one method of birth control.  This includes, as O’Brien of Catholics for Choice pointed out, the 98 percent of sexually active Catholic women in the US who have used a form of contraception banned by the Vatican.

Moreover, while the most common reason U.S. women use oral contraceptive pills is to prevent pregnancy, 14 percent of pill users—1.5 million women—rely on them exclusively for non-contraceptive purposes, according to a study by the Guttmacher Institute called “Beyond Birth Control: The Overlooked Benefits of Oral Contraceptive Pills,” by Rachel K. Jones. More than half (58 percent) of all pill users rely on the method, at least in part, for purposes other than pregnancy prevention–such as reducing cramps or menstrual pain, to help prevent migraines, for treatment of endometriosis—meaning that only 42 percent use the pill exclusively for contraceptive purposes.

The contraceptive coverage provision under health reform is widely-supported by female voters, a critical constituency in the 2012 election. Public polling shows seventy-one percent of American voters, including 77 percent of Catholic women voters, support covering birth control at no cost.

So caving to the USCCB on something as fundamental to women’s health, lives and pocketbooks as contraception will not sit well with women, as a recent poll by NARAL Pro-Choice America notes.

“There is a group of women who voted for President Obama in 2008 but are not currently supporting him, and these data suggest many of them should be in his camp,” according to Al Quinlan, president of Greenberg Quinlan Rosner Research, a firm that conducted a recent survey for NARAL Pro-Choice America.

“Choice provides an opening for President Obama and other Democrats to create a sharp contrast with anti-choice Republicans,” he continued. The “women defectors” are defined as having voted for President Obama in 2008 but are currently not voting for him, weakly supporting him, or holding back from turning out in 2012.

“While the economy is the dominant issue, this survey shows that choice is a stronger, more persuasive issue for bringing key women voters back to President Obama’s camp,” said Nancy Keenan, president of NARAL Pro-Choice America.

Contraceptive coverage also is an equity issue. As many state contraceptive equity laws make clear and as the Equal Employment Opportunity Commission has ruled, failing to provide women with coverage for contraception in health plans that otherwise cover prescription drugs and devices is sex discrimination.

State supreme courts in California and New York have both found that contraceptive-equity laws with narrower employer exclusions such as the one put forth by HHS, do not substantially burden a religious belief or practice. In a majority opinion in one of the cases, the justices write:

“[W]hen a religious organization chooses to hire nonbelievers it must, at least to some degree, be prepared to accept neutral regulations imposed to protect those employees’ legitimate interests in doing what their own beliefs permit.”  [Catholic Charities of Albany v. Serio, 859 N.E.2d 459, 468 (N.Y. 2006)].

If the requirement for coverage of birth control is weakened, nearly one million people (and their dependents) who work at Catholic hospitals would lose benefits they already have. In addition, the approximately two million students and workers now attending universities that have a religious affiliation would also lose this important benefit.  It would mean a further weakening of women’s health and one more step toward theocracy. And it would raise health care costs and result in more unintended pregnancies.

What the Bishops really want is to strong-arm government into imposing restrictions on people’s choices and lives that they can’t even get Catholics to follow. They want to be able to receive federal funding, federal grants and contracts, get tax breaks and special treatment over other groups for building Catholic hospitals, maintain tax-exempt status while flouting lobbying rules, and play the victim card whenever they can’t avoid laws meant to advance health and human rights.  And they are aided and abetted in their efforts by other far-right my-way-or-the-highway-on-religion organizations like Focus on the Family and the Family Research Council, as well as a considerable number of GOP and Tea Party members of Congress. New efforts by conservatives to pass the Regulatory Accountability Act, for example, also threaten women’s health.  Nothing drives the patriarchy more batty than the notion of women being anything other than breeding cows.

So it takes some imagination–and I have not mustered anywhere nearly enough–to understand why the Obama Administration would EVEN. THINK. TWICE. about caving to the Bishops. Obama needs women to come out for him in the 2012 election, he campaigned on and promised adherence to science and evidence in the creation of policy, and he promised that under health reform people would not lose benefits they already had, a promise he has already broken once–big time–when it came to women’s health coverage on abortion care.

There is nothing more fundamental to women’s choices than choosing whether, when and with what partner to become pregnant. There is nothing more fundamental to ensuring the best prospects for all children than to work to ensure every child is a wanted child. And there is nothing less controversial for women than birth control.

If the White House does cave to fundamentalist organizations like the USCCB, (led, it should be underscored, by men), it would appear to have an even more fundamental problem with re-electing this President.

[Several calls to the White House on this issue were not returned by time of publication.]

_____________________________________

These groups urge you to take action:

Catholics for Choice

National Women’s Law Center

Physicians for Reproductive Choice and Health

Feminist Majority Foundation

Emily’s List

Planned Parenthood Federation of America

NARAL Pro-Choice America

Physicians for Reproductive Choice and Health

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Follow Jodi Jacobson on Twitter: @jljacobson

News Sexual Health

State with Nation’s Highest Chlamydia Rate Enacts New Restrictions on Sex Ed

Nicole Knight Shine

By requiring sexual education instructors to be certified teachers, the Alaska legislature is targeting Planned Parenthood, which is the largest nonprofit provider of such educational services in the state.

Alaska is imposing a new hurdle on comprehensive sexual health education with a law restricting schools to only hiring certificated school teachers to teach or supervise sex ed classes.

The broad and controversial education bill, HB 156, became law Thursday night without the signature of Gov. Bill Walker, a former Republican who switched his party affiliation to Independent in 2014. HB 156 requires school boards to vet and approve sex ed materials and instructors, making sex ed the “most scrutinized subject in the state,” according to reproductive health advocates.

Republicans hold large majorities in both chambers of Alaska’s legislature.

Championing the restrictions was state Sen. Mike Dunleavy (R-Wasilla), who called sexuality a “new concept” during a Senate Education Committee meeting in April. Dunleavy added the restrictions to HB 156 after the failure of an earlier measure that barred abortion providers—meaning Planned Parenthood—from teaching sex ed.

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Dunleavy has long targeted Planned Parenthood, the state’s largest nonprofit provider of sexual health education, calling its instruction “indoctrination.”

Meanwhile, advocates argue that evidence-based health education is sorely needed in a state that reported 787.5 cases of chlamydia per 100,000 people in 2014—the nation’s highest rate, according to the Centers for Disease Control and Prevention’s Surveillance Survey for that year.

Alaska’s teen pregnancy rate is higher than the national average.

The governor in a statement described his decision as a “very close call.”

“Given that this bill will have a broad and wide-ranging effect on education statewide, I have decided to allow HB 156 to become law without my signature,” Walker said.

Teachers, parents, and advocates had urged Walker to veto HB 156. Alaska’s 2016 Teacher of the Year, Amy Jo Meiners, took to Twitter following Walker’s announcement, writing, as reported by Juneau Empire, “This will cause such a burden on teachers [and] our partners in health education, including parents [and] health [professionals].”

An Anchorage parent and grandparent described her opposition to the bill in an op-ed, writing, “There is no doubt that HB 156 is designed to make it harder to access real sexual health education …. Although our state faces its largest budget crisis in history, certain members of the Legislature spent a lot of time worrying that teenagers are receiving information about their own bodies.”

Jessica Cler, Alaska public affairs manager with Planned Parenthood Votes Northwest and Hawaii, called Walker’s decision a “crushing blow for comprehensive and medically accurate sexual health education” in a statement.

She added that Walker’s “lack of action today has put the education of thousands of teens in Alaska at risk. This is designed to do one thing: Block students from accessing the sex education they need on safe sex and healthy relationships.”

The law follows the 2016 Legislative Round-up released this week by advocacy group Sexuality Information and Education Council of the United States. The report found that 63 percent of bills this year sought to improve sex ed, but more than a quarter undermined student rights or the quality of instruction by various means, including “promoting misinformation and an anti-abortion agenda.”

Analysis Law and Policy

After ‘Whole Woman’s Health’ Decision, Advocates Should Fight Ultrasound Laws With Science

Imani Gandy

A return to data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous "informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

Whole Woman’s Health v. Hellerstedt, the landmark U.S. Supreme Court ruling striking down two provisions of Texas’ omnibus anti-abortion law, has changed the reproductive rights landscape in ways that will reverberate in courts around the country for years to come. It is no longer acceptable—at least in theory—for a state to announce that a particular restriction advances an interest in women’s health and to expect courts and the public to take them at their word.

In an opinion driven by science and data, Justice Stephen Breyer, writing for the majority in Whole Woman’s Health, weighed the costs and benefits of the two provisions of HB 2 at issue—the admitting privileges and ambulatory surgical center (ASC) requirements—and found them wanting. Texas had breezed through the Fifth Circuit without facing any real pushback on its manufactured claims that the two provisions advanced women’s health. Finally, Justice Breyer whipped out his figurative calculator and determined that those claims didn’t add up. For starters, Texas admitted that it didn’t know of a single instance where the admitting privileges requirement would have helped a woman get better treatment. And as for Texas’ claim that abortion should be performed in an ASC, Breyer pointed out that the state did not require the same of its midwifery clinics, and that childbirth is 14 times more likely to result in death.

So now, as Justice Ruth Bader Ginsburg pointed out in the case’s concurring opinion, laws that “‘do little or nothing for health, but rather strew impediments to abortion’ cannot survive judicial inspection.” In other words, if a state says a restriction promotes women’s health and safety, that state will now have to prove it to the courts.

With this success under our belts, a similar return to science and data should aid in dismantling other laws ungrounded in any real facts, such as Texas’s onerous “informed consent” law—HB 15—which forces women to get an ultrasound that they may neither need nor afford, and which imposes a 24-hour waiting period.

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In Planned Parenthood v. Casey, the U.S. Supreme Court upheld parts of Pennsylvania’s “informed consent” law requiring abortion patients to receive a pamphlet developed by the state department of health, finding that it did not constitute an “undue burden” on the constitutional right to abortion. The basis? Protecting women’s mental health: “[I]n an attempt to ensure that a woman apprehends the full consequences of her decision, the State furthers the legitimate purpose of reducing the risk that a woman may elect an abortion, only to discover later, with devastating psychological consequences, that her decision was not fully informed.”

Texas took up Casey’s informed consent mantle and ran with it. In 2011, the legislature passed a law that forces patients to undergo a medical exam, whether or not their doctor thinks they need it, and that forces them to listen to information that the state wants them to hear, whether or not their doctor thinks that they need to hear it. The purpose of this law—at least in theory—is, again, to protect patients’ “mental health” by dissuading those who may be unsure about procedure.

The ultra-conservative Fifth Circuit Court of Appeals upheld the law in 2012, in Texas Medical Providers v. Lakey.

And make no mistake: The exam the law requires is invasive, and in some cases, cruelly so. As Beverly McPhail pointed out in the Houston Chronicle in 2011, transvaginal probes will often be necessary to comply with the law up to 10 to 12 weeks of pregnancy—which is when, according to the Guttmacher Institute, 91 percent of abortions take place. “Because the fetus is so small at this stage, traditional ultrasounds performed through the abdominal wall, ‘jelly on the belly,’ often cannot produce a clear image,” McPhail noted.

Instead, a “probe is inserted into the vagina, sending sound waves to reflect off body structures to produce an image of the fetus. Under this new law, a woman’s vagina will be penetrated without an opportunity for her to refuse due to coercion from the so-called ‘public servants’ who passed and signed this bill into law,” McPhail concluded.

There’s a reason why abortion advocates began decrying these laws as “rape by the state.”

If Texas legislators are concerned about the mental health of their citizens, particularly those who may have been the victims of sexual assault—or any woman who does not want a wand forcibly shoved into her body for no medical reason—they have a funny way of showing it.

They don’t seem terribly concerned about the well-being of the woman who wants desperately to be a mother but who decides to terminate a pregnancy that doctors tell her is not viable. Certainly, forcing that woman to undergo the painful experience of having an ultrasound image described to her—which the law mandates for the vast majority of patients—could be psychologically devastating.

But maybe Texas legislators don’t care that forcing a foreign object into a person’s body is the ultimate undue burden.

After all, if foisting ultrasounds onto women who have decided to terminate a pregnancy saves even one woman from a lifetime of “devastating psychologically damaging consequences,” then it will all have been worth it, right? Liberty and bodily autonomy be damned.

But what if there’s very little risk that a woman who gets an abortion experiences those “devastating psychological consequences”?

What if the information often provided by states in connection with their “informed consent” protocol does not actually lead to consent that is more informed, either because the information offered is outdated, biased, false, or flatly unnecessary given a particular pregnant person’s circumstance? Texas’ latest edition of its “Woman’s Right to Know” pamphlet, for example, contains even more false information than prior versions, including the medically disproven claim that fetuses can feel pain at 20 weeks gestation.

What if studies show—as they have since the American Psychological Association first conducted one to that effect in 1989—that abortion doesn’t increase the risk of mental health issues?

If the purpose of informed consent laws is to weed out women who have been coerced or who haven’t thought it through, then that purpose collapses if women who get abortions are, by and large, perfectly happy with their decision.

And that’s exactly what research has shown.

Scientific studies indicate that the vast majority of women don’t regret their abortions, and therefore are not devastated psychologically. They don’t fall into drug and alcohol addiction or attempt to kill themselves. But that hasn’t kept anti-choice activists from claiming otherwise.

It’s simply not true that abortion sends mentally healthy patients over the edge. In a study report released in 2008, the APA found that the strongest predictor of post-abortion mental health was prior mental health. In other words, if you’re already suffering from mental health issues before getting an abortion, you’re likely to suffer mental health issues afterward. But the studies most frequently cited in courts around the country prove, at best, an association between mental illness and abortion. When the studies controlled for “prior mental health and violence experience,” “no significant relation was found between abortion history and anxiety disorders.”

But what about forced ultrasound laws, specifically?

Science has its part to play in dismantling those, too.

If Whole Woman’s Health requires the weighing of costs and benefits to ensure that there’s a connection between the claimed purpose of an abortion restriction and the law’s effect, then laws that require a woman to get an ultrasound and to hear a description of it certainly fail that cost-benefit analysis. Science tells us forcing patients to view ultrasound images (as opposed to simply offering the opportunity for a woman to view ultrasound images) in order to give them “information” doesn’t dissuade them from having abortions.

Dr. Jen Gunter made this point in a blog post years ago: One 2009 study found that when given the option to view an ultrasound, nearly 73 percent of women chose to view the ultrasound image, and of those who chose to view it, 85 percent of women felt that it was a positive experience. And here’s the kicker: Not a single woman changed her mind about having an abortion.

Again, if women who choose to see ultrasounds don’t change their minds about getting an abortion, a law mandating that ultrasound in order to dissuade at least some women is, at best, useless. At worst, it’s yet another hurdle patients must leap to get care.

And what of the mandatory waiting period? Texas law requires a 24-hour waiting period—and the Court in Casey upheld a 24-hour waiting period—but states like Louisiana and Florida are increasing the waiting period to 72 hours.

There’s no evidence that forcing women into longer waiting periods has a measurable effect on a woman’s decision to get an abortion. One study conducted in Utah found that 86 percent of women had chosen to get the abortion after the waiting period was over. Eight percent of women chose not to get the abortion, but the most common reason given was that they were already conflicted about abortion in the first place. The author of that study recommended that clinics explore options with women seeking abortion and offer additional counseling to the small percentage of women who are conflicted about it, rather than states imposing a burdensome waiting period.

The bottom line is that the majority of women who choose abortion make up their minds and go through with it, irrespective of the many roadblocks placed in their way by overzealous state governments. And we know that those who cannot overcome those roadblocks—for financial or other reasons—are the ones who experience actual negative effects. As we saw in Whole Woman’s Health, those kinds of studies, when admitted as evidence in the court record, can be critical in striking restrictions down.

Of course, the Supreme Court has not always expressed an affinity for scientific data, as Justice Anthony Kennedy demonstrated in Gonzales v. Carhart, when he announced that “some women come to regret their choice to abort the infant life they once created and sustained,” even though he admitted there was “no reliable data to measure the phenomenon.” It was under Gonzales that so many legislators felt equipped to pass laws backed up by no legitimate scientific evidence in the first place.

Whole Woman’s Health offers reproductive rights advocates an opportunity to revisit a host of anti-choice restrictions that states claim are intended to advance one interest or another—whether it’s the state’s interest in fetal life or the state’s purported interest in the psychological well-being of its citizens. But if the laws don’t have their intended effects, and if they simply throw up obstacles in front of people seeking abortion, then perhaps, Whole Woman’s Health and its focus on scientific data will be the death knell of these laws too.