News Religion

Mormons To Church: You Don’t Control My Body!

Robin Marty

When it comes to abortion, birth control, and sterilization, a surprising number of Mormons say the church doesn't need to be involved.

It is by no means a scientifically valid survey, yet it is still surprising how many Mormons responded to an online poll by stating that the church leaders do not need to be consulted when it comes to decisions like birth control, sterilization, or even abortion.

Via the Salt Lake Tribune:

“The notion of having to talk to one’s bishop regarding birth control flies against everything that has been taught over the pulpit and in Ensign articles in the last three decades,” writes one woman, who goes by Naismith. “I had not yet served in a position where I had access to a handbook when we sought sterilization (in our late 30s, after 5 kids), but my husband had. So I asked him why we had not consulted the bishop, and he said that since we were sure, and had prayed and were not doing this on a whim or prematurely, there was no need to consult the bishop.”

Indeed, Naismith wrote, “the confirmation that it was the correct step to take was one of the sweetest spiritual experiences of my life, so I resent having that memory soiled by the implication that I was rebellious in not seeking counsel.”

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According to the online polling results, more than 90 percent of respondents said they would not feel obligated to consult the church bishops before sterilization, and almost 70 percent said they would not talk to them before getting an abortion in the case of rape, incest, or woman’s health.

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.

News Abortion

Why You Won’t Hear About Abortion From Arizona’s Largest OB-GYN Network

Nicole Knight Shine

MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of interviews.

The voice on the other end of the phone is friendly, but unhelpful, when a Rewire reporter says she’s six weeks pregnant and would like an abortion.

“We don’t provide that,” Marie says.

Marie makes appointments for MomDoc, Arizona’s largest women’s health network. MomDoc is owned and run by Mormons who ascribe to a belief that opposes abortion in nearly all cases.

“Can you tell me where I can get an abortion?” the reporter asks.

Marie says she can’t. “I’m sorry,” she adds.

MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of recent interviews by phone and email. What they described affords a window into the workings of a private medical practice, one that opposes abortion care and attempts to suppress abortion access on religious grounds.

What MomDoc represents is a real-life test case pitting the power of religious beliefs against the provision of basic health information about a procedure that, according to the Guttmacher Institute, 30 percent of all U.S. women will have before age 45.

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It’s good business to oppose abortion in the sprawling Phoenix basin, home to the largest concentration of Mormons outside of Utah, according to the most recent U.S. Religion Census.

MomDoc CEO Nick Goodman didn’t respond to repeated requests for interviews and comment.

Started in 1976 by two Mormon OB-GYNs, MomDoc has 21 offices that operate under various names, such as Goodman & Partridge, MomDoc Midwives, MomDoc Women for Women, and Mi Doctora. MomDoc health-care centers offer reproductive services like birth control, and accept Medicaid patients, which means MomDoc is paid with federal dollars.

That Arizona’s largest OB-GYN practice opposes abortion care disturbs pro-choice advocates in a state where reproductive health access is constricted by forced waiting periods, parental consent requirements, and state-directed counseling intended to discourage patients.

Ethical guidelines from the American Congress of Obstetricians and Gynecologists (ACOG), a professional organization of 57,000 members, advise physicians who object to abortion on religious grounds to notify patients beforehand and to refer them to abortion providers.

“You need to give your patients all the options so they can make their own choice,” Julie Kwatra, legislative chair of the Arizona chapter of ACOG, told Rewire in a phone interview. “Not telling a patient information is in opposition to every rule of medicine.”

In 2012, Arizona’s right-leaning legislature instituted a religious privilege law that shields health-care professionals who hold religious beliefs from losing licensure.

These protections, critics argue, further stigmatize a legal medical procedure that’s already under attack in GOP-held legislatures nationwide.

MomDoc’s website and advertisements make no mention of its faith-based opposition to abortion rights, pro-choice advocates note.

“Drive down the freeway and every other billboard will be a MomDoc billboard on how they provide midwife care and how they really care about the family,” Kat Sabine, executive director of NARAL Arizona, said in a phone interview with Rewire. “To me it’s almost like locking down and cordoning off abortion care even more than it is in the community.”

By asking its employees to refrain from discussing abortion care, MomDoc runs counter to prevailing professional health-care norms to inform and refer patients, explained Lori Freedman, author of Willing and Unable, a book about doctors’ constraints on abortion.

“I think there’s an ethical problem there—this is information patients would want,” Freedman said a phone interview with Rewire.

It’s impossible to know how many religiously run practices across the country try to silence employees when it comes to abortion care. The executive director of the American Association of Pro-Life Obstetricians and Gynecologists said the group has not polled its 2,500 members on whether they refer patients to abortion providers, but said the organization’s overall position is “abortion hurts women.”

A recent attempt to muzzle a Washington, D.C., OB-GYN grabbed national headlines after her employer told her not to “put a Kmart blue-light special on the fact that we provide abortions.” Although the facility where the provider works doesn’t restrict access to abortion care, the case and MomDoc’s policy are both rooted in a federal measure called the Church Amendment.

Adopted in 1973 shortly after the landmark Supreme Court ruling Roe v. Wade, the Church Amendment offers protections for health-care workers at federally funded institutions who object to participating in abortions for moral or religious reasons. Attorneys for a Washington OB-GYN are arguing in a complaint filed with the Office for Civil Rights that those protections also extend to doctors who wish to speak up in favor of abortion.

MomDoc’s abortion taboo pervades its hiring and employment practices, former employees told Rewire. They asked Rewire not to reveal their names, fearing employment reprisals. Local OB-GYNs familiar with MomDoc, or whose colleagues had interviewed with the practice or work there, helped to corroborate these accounts.

“They brought it up at the [job] interview,” said an OB-GYN who worked for nearly five years in MomDoc clinics in the Arizona towns of Gilbert and Queen Creek. “They said they don’t do abortions, don’t talk about it, don’t refer [patients].”

The OB-GYN and others felt the prohibition was a condition of employment, saying that those who opposed MomDoc’s staunch anti-choice stance “got screened out.”

Once hired, the former OB-GYN said of abortion, “I talked about it, I know other doctors talked about it.”

Indeed, the former MomDoc OB-GYN said of discussing abortion care with patients: “I would always start off telling the patient, ‘I’m not supposed to talk about this, but I will.’” 

The former OB-GYN told Rewire that she’d caution patients to stay mum, and not tell her employer.

“Kind of saying, if you tell them I did [discuss abortion], I’m going to deny it,” the former OB-GYN explained, adding that discussing abortion wasn’t something she felt would lead to her termination.

The day-to-day reality of MomDoc’s abortion taboo seemed to depend on the employee’s position. Support staff described to Rewire how supervisors and team leads imposed an ongoing gag order on abortion.

“I was told in my training that abortion was not something we did, it was not something we promoted, it was not something we referred [patients to],” said an employee who worked in surgery and referrals from 2011 to 2012.

“They told us every conversation was recorded,” said a 72-year-old former appointment setter who worked for six years in MomDoc’s corporate office in Chandler, where she was told not to provide abortion information to callers. She said she’d occasionally “sneak in” a referral to an abortion provider.

“I worked in the medical field for 35 years, and I have never been told I can’t discuss a procedure,” the former scheduler said.

Asked how the policy was enforced, a former OB-GYN said, “I don’t remember anything being in my contract about abortions; it was more of a verbal thing.”

At times, the application of the anti-choice policy seemed uneven. A former nurse practitioner, who worked in Goodman & Partridge and MomDoc facilities from 2013 to 2014, said she was warned in a job interview not to talk about Plan B, emergency contraception that helps prevent pregnancy, rather than abortion.

“I was never told that directly that I couldn’t refer patients to abortion providers,” she recalled in a phone interview. “I had patients that did choose abortion, and I referred them.”

In the end, what the former employees described perhaps exposes the practical limits of imposing a religious gag order on a legal health-care procedure on staff who may not share their employer’s beliefs. Those in a position to do so may merely pay lip service to the prohibition.

“Obviously, when you have a crying teenager in front of you,” a former MomDoc OB-GYN said, “you’re going to help them, you’re going to refer them.”