By Nancy Northup, President and CEO, Center for Reproductive Rights
When the Institute of Medicine’s independent panel of health experts recommended last week that insurers offer preventive services to women without co-payments, the reaction was swift. Despite IOM’s reliance on medical science, its recommendation on contraception, in particular, was greeted with howls of disapproval.
Some of the right-wing’s ravings have been positively unhinged. Jeffrey Kuhner of the Washington Times wrote that contraception “violates the natural moral order” and that the recommendation on birth control is a step toward “forging a pagan society based on consequence-free sex.” Fox host Bill O’Reilly claimed the recommendation would be ineffective because “many women who get pregnant are blasted out of their minds when they have sex and [are] not going to use birth control anyway.” Fox’s Greg Gutfield, bizarrely, argued that eliminating copays would help so many low-income women that it must be part of a plot to “eradicate the poor.”
To listen to the hysteria, you would think that coverage for birth control is divisive. It’s not. Most plans already cover it, and a majority of states – 28, to be precise – require it be covered by insurance. Virtually all women – 99% – have used birth control, and religious adherents, even Catholics and Evangelicals, use birth control at the same rate as the general population. (Ninety-eight percent of sexually active Catholic women have used birth control, the rate is even higher among Evangelicals.) In addition, government insurance plans currently cover contraception, albeit with copays.
This near-universal acceptance of contraception is remarkable. In this age of red and blue states, we may not agree on politics, or even basic scientific truths: half of Americans don’t believe in evolution, and one in three Americans believes in ghosts. Yet Americans are united in their acceptance of birth control, making it as mainstream as anything could be.
At the same time, access to affordable contraception is lacking. The U.S. leads the developed world in unintended pregnancies–a shocking half of all American pregnancies are unplanned. Unintended pregnancy can harm women’s health, and closely spaced pregnancies are associated with low birth weight and prematurity. Cost, sadly, has been the major factor preventing the more widespread use of birth control, particularly in an economic downturn. Moreover, the high cost of long-acting contraceptive options like IUDs places them out of reach for millions, leading to contraceptive failure when antibiotics or mere forgetfulness renders birth control pills less effective. The IOM’s recommendation to eliminate copays for the “full range” of approved contraceptives was grounded in two facts: contraception is non-controversial and has been used by virtually every American woman, and women lack access to affordable contraception.
Yet this common-sense, evidence-based approach is under attack. Not only by the hyperbolic antics of television’s talking heads, but also the misleading statements of the U.S. Conference of Catholic Bishops. Its public statements repeatedly and deliberately conflate contraception with abortion, which is beyond the scope of IOM’s recommendations.
The all-male avowedly celibate Bishops want a heckler’s veto over the entire American healthcare system, including preventive services for women. Sister Mary Ann Walsh, a spokeswoman, has argued for an exception to allow religious insurers to operate under a different, special set of rules. Never mind that Catholics need and use birth control just like everyone else, and that a special rule for some insurers would deny coverage to many non-believers who happen to work for religiously-affiliated hospitals or schools.
When considering religious prohibitions that she does not share, Walsh gets the distinction between what an individual chooses to use under a plan and forcing everyone to forgo it. In the Washington Post’s On Faith blog, she notes that “blood transfusions are not verboten to me, but I respect Jehovah’s Witnesses’ right to refuse them.” The obvious rejoinder, then, is that for the rest of us, “contraceptives are not verboten to us, but we respect Catholics’ right to refuse them.” Religious adherents who object to a particular medical service are under no obligation to use it. Jehovah’s Witnesses are not compelled to get blood transfusions, and Catholics are not compelled to use contraceptives.
Respect for other’s choices isn’t what Walsh and the Bishops want. Instead, they seek a rule that would allow any insurer allied with a set of religious beliefs to deny coverage to everyone they insure. Under this dubious logic, the government couldn’t mandate coverage for any medical service that anyone had a religious objection to, allowing religious dogma to trump sound public health policy.
The purpose of healthcare reform is to make needed medical care practically available and uniform for a much larger group of people, thereby improving health and diminishing costs. (The IOM focused on health, but noted cost savings would be $19 billion).The IOM’s recommendations are a critical step to improve the health of millions. Birth control should finally take its rightful place as an essential medical service. It is medically sound, cost effective, and uncontroversial. Any set of special rules that would reduce access for some would merely diminish the quality of care for everyone.