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The Contraception Controversy: A Comprehensive Reply

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. (Click on each title to read the full section.)

Facts About the Contraception Controversy

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Full Introduction

Last August, recommendations for women's preventive care from an Institute of Medicine panel of medical experts made a compelling case for transformative improvements in the availability of contraception that will lead, at last, to measurable improvements in the sky-high rates of unplanned pregnancy in the United States, and will, happily, increase the proportion of planned pregnancies among American women. Read More

1) Religious liberty and the right of an individual to live according to his or her own religious conscience are supported, not threatened, by this policy.

The issue raised in this debate is not whether religious liberty should be protected, but whose religious liberty the law should protect. Conscience rights belong to individuals, not institutions. The new policy accommodation responds to the concerns of religiously-objecting institutions without sacrificing individual workers’ rights, religious liberty or consciences. Read more.

2) Both the original policy and the accommodation are legally and constitutionally sound.

Neither the Administration’s accommodation nor the original policy violates constitutional principles or federal law. Opponents of the contraceptive-coverage requirement lack a robust legal basis for challenging the policy, and they would not be supported in their claims even by conservative justices on the Supreme Court. Read more.

3) The Administration’s policy accommodation fairly balances the interests of employers and employees and is based on the economic realities of the insurance marketplace.

Once paid to the insurer, the funds of an objecting religious employer lose their identity and become those of the insurer. The employer may not direct how the insurer invests, spends or otherwise uses those dollars. The Bishops’ continuing opposition reveals how they have shifted the goalposts over the course of this debate – now it is not only paying for contraceptive coverage that is objectionable, but the very knowledge that an employee might independently obtain a service despite the disapproval of her employer. Read more.

4) Birth control coverage is a mainstream and commonsense aspect of preventive care for women.

Respect for life and the experience of pregnancy demands that we take steps to ensure that pregnancies are healthy and wanted. Birth control 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. Read more.

5) Emergency contraception is essential to women’s health and is not an “abortion drug.”

The Bishops’ claim that emergency contraception is abortion-inducing does not reflect scientific reality. Emergency contraception works by inhibiting or delaying ovulation or other pre-pregnancy processes. Without a pregnancy, there can be no abortion. Read more.

6) Sterilization is a common form of birth control. Denying access, especially when it is medically recommended, can have devastating consequences.

American women increasingly rely on sterilization as a form of contraception as they get older. For many women, a post-partum sterilization is recommended when additional pregnancies are not only undesired but would threaten the woman’s health. Refusing to provide insurance for a sterilization following childbirth in such circumstances may mean denying a patient wanted and needed medical care. It also means that the woman must subject herself to a second, unnecessary surgical procedure and the risks of a second medical intervention. Read more.

7) Conclusion

The U.S. has a proud tradition of defending the right of the individual to moral self-determination in both religious and secular matters. The Obama Administration’s healthcare accommodation allows employers that object to providing coverage for contraception to avoid both paying for and communicating about that coverage, while ensuring that employees of public-facing institutions have the same benefits as everyone else. No one is compelled to use the benefit or pay for contraception under the policy, and no provider is compelled to furnish services. This is a fair and workable balancing of interests and should have ended the controversy. Read more.

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