Commentary: Religious Exemption For Contraception Is Bad Medicine

This is a guest post by Paula A. Johnson, MD, MPH, Executive Director of the Connors Center for Women’s Health and Gender Biology, and Chief of the Division of Women’s Health at Brigham and Women’s Hospital.

Lost in the war of words over religious liberty and the morality of contraception are the significant health benefits for women and families of birth control itself.  A new measure by Senator Roy Blunt (R-Mo.), aimed at excluding contraceptive coverage for women, would amend the Affordable Care Act to allow any employer to exclude any health service coverage by claiming that it violates their religious or moral convictions.  When asked about the issue, Senator Marco Rubio, co-sponsor of the Blunt measure, stated, “It is very simple. This is a straightforward concept. It’s not about medicine. It’s about constitutional rights.”

The message from Washington politicians that contraception access has nothing to do with medicine is news to the 99% of women in the U.S. who are or have been sexually active at some point in their lives and who have used birth control, including 98% of sexually active Catholic women. It is news to the women who use contraceptives to manage menstrual complications, avoid unintended pregnancy, and ensure the social and economic stability of their families. It is a shocking concept for millions of physicians who prescribe contraception to treat health conditions like polycystic ovarian syndrome and reduce the risk of developing ovarian cancer. It is bad news for the 1.5 million women nationwide who use contraceptives only as treatment for serious medical conditions.

Given the recent public opinion poll conducted for Fox News, the public understands that contraceptives are good medicine while certain members of Congress remain out of touch. According to the poll, the majority (61%) of Americans approve of requiring employer health plans to cover birth control for women. A separate survey by Hart Research found that more than two-thirds of American voters (71%) and Catholic women voters (77%) support broadening access to birth control.

As for Congress, members and their families have had access to contraceptive care since 1998 when Congress voted to ensure that all Federal Employees Health Benefit Program (FEHBP) have access to comprehensive contraceptive coverage in the FY 1999 Treasury, Postal Service and General Government Appropriations Bill. Language included in the appropriations bill ensures that federal employees participating in FEHBP have insurance coverage of FDA-approved prescription contraceptives and related services.

How is No-Cost Contraception Good Medicine?

The decision to include no-cost preventive services for women in the ACA was reached by a panel assembled by the Institute of Medicine and included physicians, clinicians and scientists who are experts in providing evidence-based care for tens of thousands of women. Their advice was based on a foundation of scientific, medical evidence supporting the effectiveness of family planning services and rooted in the knowledge that family planning services are essential to the health of U.S. society. Family planning services can prevent millions of unintended pregnancies. Nearly one out of every two U.S. pregnancies is unintended, or an estimated 3 million pregnancies each year.  The health benefits associated with preventing unintended pregnancies are numerous.

  • Child health:  Family planning services save infant lives by allowing for spacing of planned births and limiting unintended births. Globally contraceptive use averts 1.2 million infant deaths per year. Researchers estimate that an additional 640,000 newborn deaths would be prevented if we could meet unmet contraceptive needs. Unintended pregnancies are also linked to maternal health behaviors during pregnancy that are associated with adverse effects on child development including delays in prenatal care and increased tobacco use and alcohol consumption. Additional research has shown that the children born from unintended pregnancies are at increased risk of child abuse and neglect, poor mother-child attachment, and cognitive and physical deficits.
  • Maternal health:  Given that unintended pregnancies result in increased risk of morbidity for the mother, preventing unintended pregnancies will help save women’s lives. According to 2010 data from the United Nations, women in the U.S. have a greater risk of dying of pregnancy related causes than women in 49 other countries. Our nation’s underserved women are particularly vulnerable given that poor women and women of color are more likely to die in pregnancy or childbirth than women from other sections of the population. Unintended pregnancies contribute to the risk of unsafe abortions that are among the main causes of maternal death in young women. For women continuing the pregnancy, in low-resource settings without safe delivery services, the risks of maternal mortality are particularly high. Since as many as four out of ten unplanned pregnancies result in abortion, access to family planning would lead to a reduction in abortion rates which currently stand at about 1.2 million abortions per year in the U.S.
  • Decline in the health and well-being of families:  Family discord is often the result of unplanned pregnancies as unintended pregnancy are associated with increased parental depression; behavioral problems and cognitive deficits in children; economic hardship; chaos and turmoil in family interactions and; less happiness and more conflict in parents’ relationship.

Contraceptives:  A Tool to Combat Rising Costs

Preventing unintended pregnancies provides us with the unique opportunity to use our finite health care resources more effectively. There is ample evidence that family planning services are cost-effective providing significant savings to our health care system.  Contraceptive use saves the United States nearly $19 billion in direct medical costs each year.

Not only is it important to preserve contraceptive coverage for our nation’s women, the need to waive co-pays and deductibles is crucial given the huge economic burden these costs have on women in the United States. For example, research has shown that both unplanned pregnancies and abortions in the United States are closely linked to women’s socioeconomic status. A survey completed in 2010 by Hart Survey Research demonstrates that more than one-third of women have reported having difficulty affording birth control. A fact that is not surprising given prescription contraceptives can cost $600 a year.

The cost to employers, the very same group this amendment purports to benefit are considerable as well. According to the National Business Group on Health, it cost employers an estimated 15% to 17% more to exclude birth-control coverage for their employees due to the resultant rise in medical costs and lost productivity.”

Contraceptives: A Panacea for Social Ills

Not only does preventing unintended pregnancies benefit the health and wellness of individual women and their families, but increased access to family planning provides substantial benefits to public health. While America’s politicians debate the merits of contraceptive services for our nation’s women, the international research community recognizes that family-planning promotion is unique among medical interventions in the breadth of its potential benefits. Global health scholars have identified contraception as a panacea for many of the social ills plaguing the globe, including reducing poverty and hunger, decreasing maternal and child mortality, empowering women and increasing gender equality by lightening the burden of excessive childbearing, enhancing environmental sustainability by stabilizing the population of the planet, enhancing educational opportunities for women, improving child and maternal health, and reducing HIV/AIDS transmission from mother to child.

The medical community, based on strong scientific evidence, knows that one of the most essential tools in our arsenal for preserving the health of women and their families is effective contraceptive care. Broadening religious exemptions for family planning services will hinder millions of families from accessing a service that the Centers for Disease Control characterizes as one of the most significant public health achievements of the twentieth century. While legal, religious, and political debates on this issue rage on, it is important to remember that family planning is a preventive service that is crucial to our nation’s health and should be available to families, regardless of their income or the religious beliefs of their employers.

Special thanks to Therese Fitzgerald, Dr. Deborah Bartz, Elizabeth Janiak and Laura Cohen

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  • Katherine Harms

    This article makes it clear that putting the burden of health insurance on employers rather than individuals was a really bad idea. Individuals face a penalty if they don’t buy health insurance, so let’s just leave it at that. Let individuals buy their own health insurance and leave the employers out of it. Let insurance companies compete for business in the normal way a market handles that competition. Individuals will get better coverage at lower cost. They can buy contraception if they want it and refuse it if they don’t want it. Everybody wins. The employers can focus their attention on survival in the marketplace and making profits which will enable them to expand and hire more people, who will be able to buy more things. Good plan for everyone. Employers should not be the ones buying the health insurance in the first place. That was something that evolved as a way to lure scarce skills in a competitive market. It was never a normal part of being an employer. Let’s just stop it now.
    Here’s an idea. If every employer who now provides health insurance simply stops doing it and adds into the employee’s paycheck the amount that was being spent for his health insurance, then employees can have whatever insurance they are willing to pay for. How is that a bad thing? They can have contraception in the package with no deductible or copay, or they can pay for it themselves.
    Oh, I forgot. The government is in the way of creative solutions here. End the ACA and let’s go back to creative solutions in the workplace.

  • Jill

    Allow me to try an analogy here. My health depends upon my exercising discipline in my eating habits. If I spend too much time eating, I cannot expect free coverage to treat all the ensuing health complications.  Exercising discipline in my sexual behavior is also important to my health.  If now is not a good time for me to become pregnant, I should not engage in sexual behavior around the time of ovulation. If I choose to do so anyway, why should others have an obligation to provide free medicine that will prevent any unwanted side effects of my sexual behavior?   
    Medicine may be necessary to help regulate abnormal menstrual/ovulation cycles or other hormonal inbalances. Such medicine would not be contraception per se, and I haven’t heard of anyone objecting to such treatment (though it remains debatable whether or not it should be free).  However, it’s strange that people just assume medicine is needed to prevent conception. Pregnancy doesn’t just happen. Ovulation is not an illness. Women can accurately determine whether or not they may be near the time of ovulation.  (I’m not referring to outdated rhythm methods, but to modern fertility awareness-based methods.  See, for example,  Pallone SR, Bergus GR.  Fertility awareness-based methods: another option for family planning. J Am Board Fam Med. 2009 Mar-Apr;22(2):147-57. See also And when they are near the time of ovulation, women are free to postpone their engagement in intercourse. It’s time to recognize women’s freedom and demand that men respect it.


    • Jill

      I noticed a problem with the link.

      I also noticed a typo in my first paragraph. “If now is not a good time for me to become pregnant, I should not engage in sexual behavior  . . . ” I meant sexual intercourse.

  • BuffaloNative

    Why on earth should women take advice on sex and reproduction from men who belong to a medieval and highly patriarchal society that since its founding has consistently regarded women as secondary subjects.  Additionally, these same individuals have no heterosexual experience – so how can they give advice?

  • Dataylor

    This highly scientific and factual commentary/article by a qualified female speaks on behalf of women throughout the world.   I am a Christian, a female, and try to stay informed on important issues.  This is a critical one, whether male politicians accept that or not.  And, whether hypocritical Christians admit it or not.  They want to protect life – right?   This does it, it even has been proven to reduce abortions, and lift up those in need economically and socially.  They oppose it for what they perceive to be personal benefit – not because they are in the right on this issue.  It is a very sad commentary on politics and equality in the U.S. when high-ranking public officials (predominantly male) have so much power over an issue that predominantly affects women and children.

    • Gibrarian

      I agree. Thoughtful people, religious and otherwise, realize that there are few things in life that are free of ambiguity. Surely even the most conservative among us, if fair-minded, can agree that allowing what is really a pretty minor “moral compromise” is warranted if it does so much to advance those values held to be of paramount importance (eg. “life”, reduced suffering, increased opportunity, etc.).