One of the many benefits of the Affordable Care Act, the new health reform law, is a "preventive care" provision that requires that insured patients have access to evidence-based preventive services at no additional cost. Expensive co-payments or deductibles often discourage people from obtaining necessary health care services, including preventive care. Many vaccines, for instance, will be considered as preventive care under the new law, along with cancer screenings and counseling to help patients manage certain health conditions. As a result of the ACA, the Department of Health and Human Services is also compiling an additional set of preventive services that would be covered for women. Most would agree this would include contraception, a common basic practice that helps families be stable, healthy, and secure.
What’s not to like about this picture?
It turns out that the U. S. Conference of Catholic Bishops objects to this picture. Despite the fact that more than 99 percent of sexually active women have used contraception, the bishops say that contraception should not be included in the preventive care package. The bishops cite conscience and religious belief as the reason for wanting to shape regulations in this realm. One problem with their thinking is that their religious beliefs regarding contraception are in conflict with the religious beliefs and conscience of millions of Americans. There’s nothing wrong with advocating one’s doctrinal views in the public square. But it is something else entirely to seek to impose one’s doctrinal views on those with different beliefs.
Reams of studies have consistently demonstrated that contraception is a safe and cost-effective way to reduce unintended pregnancies and a host of preventable health problems affecting both women and children. Even so, there is still political debate as to whether to include contraception in the list of approved preventive services for women. The Department of Health and Human Services—which is responsible for issuing the final rules—has charged the independent, nonpartisan Institute of Medicine to examine the evidence and recommend whether or not contraception should be included in the list of health services that count as "preventive care."
Perhaps it should come as no surprise that the bishops submitted a letter arguing that contraception should not be included. They say that allowing contraception to be covered is tantamount to calling pregnancy a "disease condition" because many of the other services covered are related to disease prevention, such as colorectal and HIV screenings. What’s more, according to a 1968 papal encyclical that is likely the basis for this letter, "The Church teaches that each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life." This understanding of the purpose of marriage should not be generalized as public policy for all Americans, many of whom have much more complicated or completely different understandings of the purpose of marriage beyond procreation.
The Catholic bishops singled out abortion as their most important issue during the health care debate, and eventually opposed the bill because its abortion restrictions were not stringent enough to suit them. Given such fervent opposition to abortion, the bishop’s opposition to contraception is somewhat ironic. Common sense tells us and research proves that increased access to contraception reduces the number of abortions—especially among teenagers.
Nearly all other religions support improving access to contraception. Protestant theologians have long affirmed the primacy of the individual conscience in deciding whether or not to use contraception. In fact, Protestant churches believe that contraception can lead to "stronger families and better marriages." Most branches of Judaism also teach that certain forms of birth control are acceptable; some more conservative Jews believe that contraception is acceptable once a Jewish couple has already had children, but there is no strict admonition against responsible family planning in terms of spacing and timing.
And most U.S. Catholics agree contraception is an important tool most Americans have incorporated into their lives as responsible adults. In a study by Catholics for Choice, 90 percent of American Catholic women supported access to contraception at community hospitals. In another survey cited in the same report, 60 percent of American Catholics agreed that it was even acceptable to offer birth control pills to teenagers. What’s more, a recent poll showed that most women—and the majority of the American public in general—see the invention of the birth control pill as one of the most significant medical breakthroughs in the last 50 years.
Contraception is a family planning choice that should be available to all Americans, regardless of income. Contraception provides the best way for most Americans to make responsible decisions about when to start, or increase, one’s family, depending on financial, emotional, spiritual, and other factors.
The newly passed Affordable Care Act will improve access to health care and transform our nation’s health care system from one based on sick care to one focusing on prevention and wellness. Providing more Americans with access to a full range of preventive services is crucial to this transformation. The bishops’ opposition to contraception would threaten this goal—and it would deny much needed contraceptive services to millions of women who do not share their religious beliefs. In a diverse, pluralistic democracy, that is not how public policy should be shaped.