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The Obama Administration’s recently announced policy to require insurers to cover contraception as women’s preventive health care has prompted many over-heated op-eds, editorials on both sides and even a thoroughly one-sided Congressional hearing. The controversy is unlikely to end anytime soon: pending federal legislation and proposed amendments would massively enlarge the scope of insurers’ and business owners’ ability to restrict any type of insurance benefit on either “moral” or “religious” grounds, undermining the very purpose of insurance.
Below, we take a closer look at the arguments by opponents of the contraception requirement, unpack the legal issues and public health debate, and respond to many erroneous assertions.
Responding to the modified policy announced on February 10, the USCCB restated their opposition to the contraception coverage requirement, calling it a “grave moral concern” and suggesting that “pregnancy is not a disease.”
Yet no one is suggesting pregnancy is a disease. Setting aside the fact that many American women – including one third of teen users – use birth control for non-contraceptive reasons, respect for life and the experience of pregnancy demands that we take steps to ensure that pregnancies are healthy and wanted. As an earlier Institute of Medicine panel remarked in 1995:
The committee urges, first and foremost, that the nation adopt a new social norm: All pregnancies should be intended – that is, they should be consciously and clearly desired at the time of conception. This goal has three important attributes. First, it is directed to all Americans and does not target only one group. Second, it emphasizes personal choice and intent. And third, it speaks as much to planning for pregnancy as to avoiding unintended pregnancy. Bearing children and forming families are among the most significant and satisfying tasks of adult life, and it is in that context that encouraging intended pregnancy is so central.[i]
Birth control also prevents unintended pregnancy, and the panoply of negative economic, social, and health outcomes that occur for both mother and child when a pregnancy is unintended. Healthy People 2010 summarizes the grave medical risks of unintended pregnancy:
Medically, unintended pregnancies are serious in terms of the lost opportunity to prepare for an optimal pregnancy, the increased likelihood of infant and maternal illness, and the likelihood of abortion … The mother is less likely to seek prenatal care in the first trimester and more likely not to obtain prenatal care at all. She is less likely to breastfeed and more likely to expose the fetus to harmful substances, such as tobacco or alcohol. The child of such a pregnancy is at greater risk of low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development.
In light of this compelling medical evidence, it is downright insulting for opponents of contraception to argue – as Bishop Lori did before Congress – that it is no more essential to women than a ham sandwich.
Nearly half – 49% – of pregnancies in the U.S. are unintended – a rate far higher than in other developed countries,[ii] and 42% of unintended pregnancies end in abortion. Data from the Guttmacher Institute further underscore the problem:
As preventive health care, birth control works. As noted by Guttmacher:
… publicly funded contraceptive services and supplies alone help women in the United States avoid nearly two million unintended pregnancies each year. In the absence of such services (from family planning centers and from doctors serving Medicaid patients), estimated U.S. levels of unintended pregnancy, abortion and unintended birth would be nearly two-thirds higher among women overall and nearly twice as high among poor women.
Some opponents recently suggested that these statistics prove that women are, as one critic ridiculously asserted, “ lavishly contracepted,” thereby obviating the need for no-copay insurance coverage. It is certainly worth noting that many of the same critics of family planning funding in annual budget fights in Congress are now suggesting that contraception grows on trees. More importantly, these oft-cited statistics do not represent the percentage of women who currently have consistent access to birth control, nor are they the percentage of women currently using birth control. For birth control to be effective at preventing unintended pregnancy, it must be used consistently. Women who can access and pay for birth control outside of their regular health insurance coverage are fortunate – and may not always be so fortunate. An inability to pay or access birth control for just one cycle will undermine its effectiveness.
What the above statistics do indicate is that women, almost universally, accept contraception as an appropriate and approved means of preventing unintended pregnancy. In addition, as Irin Carmon’s article demonstrates, the no-copay coverage will allow women, for the first time, to choose the most effective contraceptive method for them:
Public health experts are also hoping that the new insurance mandates will help women switch to the more effective forms of birth control they have told researchers they’d be interested in, like the IUD, the implant or sterilization. These have far lower failure rates — around 1 percent or less — than typical use of condoms, at 17 percent, or the pill, at 9 percent. (The one method the Catholic Church approves of, officially termed “fertility-awareness-based methods” has a failure rate of 25 percent.)
For a glimpse of what the lives of women and families would look like should the policies of some anti-contraception religious organizations be reflected in law in the U.S., we can look to the Philippines, where a ban on contraception heavily influenced by the Catholic church continues today to result in tragically high unintended pregnancy and unsafe abortion rates, as reported in CRR’s 2010 report on the Philippines,Forsaken Lives. As a 2008 Time magazine article noted:
Archbishop Paciano Aniceto, who chairs the influential Commission on Family and Life for the Catholic Bishop's Conference in the Philippines, calls birth control advocates "propagandists of a culture of death." Sex, he says, is a privilege and should always be open to the transmission of life. Former mayor Atienza agrees. Family planning advocates have been "brainwashed" by the West, he says. His ban succeeded, he adds, by teaching Manila's "innocent and ignorant" women "true" Filipino values.
Time drew out the comparisons between the Philippines and the U.S. in more recent coverage :
The [Philippines’] high unmet need for contraception means that almost half of pregnancies are unwanted and about 500,000 per year result in abortion. All too often, these procedures are unsafe. Every year, an estimated 60,000 Filipinas are injured trying to terminate a pregnancy. About 1,000 die from abortion-related complications. … Behind the Manichaean religious rhetoric espoused by some conservative Catholics hide plain truths about public health: access to contraception decreases maternal mortality and lowers the number of abortions. This is true in the Philippines and it is true in the U.S.
[i] Committee on Unintended Pregnancy, Institute of Medicine, National Academy of Sciences, The Best Intentions: Unintended Pregnancy and the well-being of children and their families (Sarah S. Brown & Leon Eisenberg, eds.,1995).
[ii] For example, the unintended pregnancy rate in France is 33%; in Edinburgh, Scotland, it is only 28%. Association of Reproductive Health Professionals, Reducing Unintended Pregnancy in the United States (2008), available at http://www.arhp.org/publications-and-resources/contraception-journal/january-2008.