News Maternity and Birthing

Inter-American Court Approves Access to IVF in Costa Rica

Jacqueline Nolley Echegaray

Last month, the Inter-American Court of Human Rights issued a final ruling in favor of the right to access in vitro fertilization (IVF) in Costa Rica. This is a win for women and Catholics and a blow to the bishops and conservatives who want to deny individuals the right to decide whether and when to have children.

Last month, the Inter-American Court of Human Rights issued a final ruling in favor of the right to access in vitro fertilization (IVF) in Costa Rica. This is a win for women and Catholics and a blow to the bishops and conservatives who want to deny individuals the right to decide whether and when to have children. As the highest human rights court in the Americas, the court’s binding decision has ramifications for the 25 countries that have ratified the American Convention on Human Rights. This includes many where the Catholic hierarchy has an often overwhelming influence on civil law. Today’s decision rectified a situation where, despite having ratified numerous treaties guaranteeing women’s rights, Costa Rica declared IVF unconstitutional in the year 2000.

In Costa Rica, a democratic country where three out of four people claim Catholicism as their faith, the church has had a profound effect on laws and policies involving many aspects of sexuality and reproduction. Church leaders have notably been active in opposing the easing of Costa Rica’s absolute prohibition of in vitro fertilization.

However, the teachings of the Catholic church leave room for women to follow their own consciences regarding fertility treatments. The hierarchy has presented an erroneous picture of IVF as somehow anti-Catholic, when in reality, many Catholics use IVF and other assisted reproductive health technologies to help them have children. The institutional church may turn its back on those struggling with infertility, but it is in keeping with the Catholic social justice tradition to make IVF available to all, not just those who can afford to travel outside the country at great expense.

A survey commissioned by the newspaper La Nación in 2012 found that 55 percent of the Costa Rican population, the majority of which is Catholic, supports legislation allowing IVF. Catholics support IVF because of their faith, not in spite of it. We celebrate parenthood as a generous desire to share the gift of life with a new generation.

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In 2011, Costa Rica’s bishops complained that a government commission studying the IVF law “has not considered our participation necessary.” The truth is that the Constitution of 1949 guarantees freedom of religion—just not the freedom of religious leaders to steer the political process against the will of the people. Catholics can and do embrace IVF as part of comprehensive reproductive health care for a pluralistic society.

The ruling is a step forward for Costa Rica’s public health, and will give more women more choices for their families.

Catholics for Choice submitted an amicus curiae brief to the Inter-American Court in this case.  

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.

Roundups Politics

Campaign Week in Review: Cruz Likens His Supreme Court Pick to ‘Lord of the Rings’ Character

Ally Boguhn

This week on the campaign trail, Donald Trump and Ted Cruz spoke about whom they would nominate for the vacant Supreme Court seat, and Trump saw his favorability plummet among women.

This week on the campaign trail, Donald Trump and Ted Cruz spoke about whom they would nominate for the vacant Supreme Court seat, and Trump saw his favorability plummet among women.

Cruz, Trump Discuss Their Supreme Court Nominations

Republican presidential candidates Sen. Ted Cruz (R-TX) and Donald Trump were hard at work dreaming up possibilities for a Supreme Court nominee should the Senate obstruct Obama’s pick for the vacancy.

Appearing at a rally over the weekend for Sen. Mike Lee’s (R-UT) bid for re-election, Cruz commented that Lee “would look good” on the Supreme Court. Cruz compared Lee to Gollum, a character from Lord of the Rings, claiming that “For Mike, the Constitution is ‘my precious,'” according to the Salt Lake Tribune. 

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Lee’s work opposing abortion during his time in Congress earned him a 100 percent rating from the anti-choice National Right to Life Committee. The Republican senator has supported several measures attempting to limit access to or outright ban abortion, including a 2013 bill to investigate all abortion clinics and extend “personhood” rights beginning at the moment of fertilization, which could outlaw many forms of birth control in addition to abortion.

Lee’s 2010 campaign website included a section noting his opposition to legal abortion and Roe v. Wade:

The Constitution says nothing that can plausibly be read to suggest—as the Supreme Court concluded in Roe v. Wade—that States are essentially powerless to protect unborn human life. This power to protect the most vulnerable members of society needs to be returned to the States.

Donald Trump also signaled he was mulling over potential picks for the Court’s vacancy, promising during a Monday press conference in Washington, D.C., to release a list of seven to ten potential picks. If elected, Trump vowed to choose nominees exclusively from the list, which he said will be created by the “Heritage Foundation and others.”

But as ThinkProgress reported, the Heritage Foundation “is an odd place for a presidential candidate to seek advice on any topic” given its history of discriminatory politics:

Heritage is a think tank known for its stridently conservative views and its unorthodox approach to mathematics. They oppose marriage equality, defend discrimination against LGBT Americans, and they have a surprisingly long history of reversing their own stances on health policy when doing so is useful to opponents of Obamacare. Their former chief “economist” is an ex-newspaper columnist and anti-tax activist with no doctorate in economics.

In 2013, Heritage released a widely criticized report claiming that immigration reform would cost an eye-popping $6.3 trillion. One of the co-authors of that report resigned four days later after news broke that “his graduate dissertation on immigration was premised on the idea that Latinos were less intelligent than whites.”

The Heritage Foundation is vehemently anti-choice, a position that could inform its picks for the Court. The organization’s “Solutions 2016” policy recommendations include calls to expand bans on using federal funding for abortion, redirect funding for reproductive health away from Planned Parenthood to community health centers, and codify protections for “medical personnel who decline to provide, pay for, provide coverage of, or refer for abortions.” Its website also details the organization’s opposition to Roe v. Wade, dismissing the decision as “judicial activism.”

Poll: 74 Percent of Women Registered to Vote Hold Unfavorable Views of Trump

A CNN/ORC International poll released Thursday found that Donald Trump is viewed unfavorably by 74 percent of registered women voters and 81 percent of people of color.

The poll, which asked registered voters whether they “have a favorable or unfavorable opinion” of presidential candidates, shows potentially major hurdles for the Republican front-runner moving into the general election. Comparably, 50 percent of women and 36 percent of “non-white” people polled said they had an “unfavorable” view of Hillary Clinton.

Polling from the Washington Post similarly found that Trump’s favorability among women has been steadily decliningjeopardizing the Republican Party’s already tumultuous relationship with women. “Trump’s favorability numbers have decreased 10 points among women nationwide since November, to 23 percent, while his unfavorable number among women has jumped to 75 percent from 64 percent, according to a Washington Post-ABC News poll taken this month,” reported the Post.

What Else We’re Reading

Franklin Foer explained for Slate that “there’s one ideology that [Trump] does hold with sincerity and practices with unwavering fervor: misogyny.”

The Washington Post’s Karen Attiah wrote about the sexism she experienced from Donald Trump after asking him a policy question during his sit-down with the paper’s editorial board.

ThinkProgress’ Aaron Rupar explains how the Republican presidential race has turned into a “sexist competition over whose wife is hotter.”

Voters in Arizona had to wait in line as long as five hours to cast a ballot in their state’s Tuesday primary thanks to a Supreme Court decision that “gutted” the Voting Rights Act (VRA) and “an ill-conceived decision” to cut polling locations in order to save money. As the Nation reported, “Phoenix’s Maricopa County, the largest in the state, reduced the number of polling places by 70 percent from 2012 to 2016, from 200 to just 60—one polling place per every 21,000 voters”a change that “would very likely have been blocked” had the VRA’s protections remained intact.

Bernie Sanders applauded Phoenix Mayor Greg Stanton’s request for a Department of Justice investigation into voting delays in Maricopa County.

Dark money groups in Wisconsin are outspending candidates on ads for the Wisconsin Supreme Court race. When voters head to the polls for the April 5 judicial elections, “they won’t know who funded most of the ad spending around this race,” said the Sunlight Foundation’s Libby Watson.