Contraceptives: The Divide on Politics and Principle

Why eliminating the ACA’s contraceptive mandate harms vulnerable women and counters pro-life principles

Illustrator: Katie Heywood

Politics is the reflection of our principles—which might explain our hyperpolarized contemporary landscape. With renewed controversy on contraceptive use and religious freedom, we see the divide between Americans’ politics and our principles on women’s health care.

Earlier this month, the Trump Administration officially rolled back the ACA’s contraception mandate, which required employer-provided health care plans to cover FDA-approved birth control methods without charging patients. Before the ACA, most employer plans already covered many forms of contraceptives, although women often paid some sort of out-of-pocket costs.

The new rules, put forth by the Department of Health and Human Services, allow employers to claim exemption based on moral convictions, in addition to religious beliefs, making it easier for employers and insurance companies to deny free access to contraceptives. In addition to churches and private religious employers, the decision also expands the number of employers provided exemption, including nonprofit organizations, institutions of higher education, and for-profit companies.

Leaving Vulnerable Women Even More Vulnerable

Many health plans already covered selective forms of contraceptives before the ACA. Yet, women often paid a large share of the costs out-of-pocket—that is, if they could afford to. Highly effective contraceptive methods, such as the IUD, could cost more than $800 upfront. Lower-income women, the population most in need of affordable medical devices, were the ones likely to go without.

The ACA requirement directly benefited 6 million women who gained access to no-cost birth control, according to an Obama administration analysis. A study by the University of Pennsylvania’s Wharton School estimated the contraceptive mandate saved women $1.4 billion on birth control after the first year. According to the Kaiser Family Foundation, 20 percent of women paid for birth control out-of-pocket before the ACA. After, fewer than 4 percent paid costs.

Even after the 2014 Supreme Court ruling in Burwell v. Hobby Lobby Stores, Inc., which allowed churches and private companies to claim exemption based on religious beliefs, “only a few dozen” employers did not cover contraceptives, according to Politico.

Now those protections are gone. Although the exact ramifications are not yet fully known, the decisions open the door for potentially any employer to claim exemption, in turn leaving women on the hook to pay the full cost, or more likely, to not receive the medical devices they need. Essentially, removing the protection denies low-income women medical coverage by way of cost.

A Narrow View of Religious Freedom

The Trump administration’s decision was received with praise from Republican figures and pro-life advocates alike, who claimed it as a win for individuals with religious beliefs. In a statement, Speaker Paul Ryan called it “A landmark day for religious freedom.”

However, this view of religious freedom is overly myopic. Perhaps it would benefit these groups to read the other half of religious freedom, the First Amendment’s establishment clause, which intentionally built what Thomas Jefferson called “a high wall of separation of church and state.”

Could an anti-vaxxer company be able to deny coverage for vaccines? Could a Jehovah’s witness be able to deny coverage for a life-saving blood transfusion? Could a Romani-led business be able to deny coverage to an employee receiving a kidney implant? It is absurd to think an employer has any realm in determining the kind of healthcare employees need. And it’s most likely unconstitutional to create rules clearly favoring Christian businesses.

Republicans may find value in medical professionals’ perspectives: The American College of Obstetricians and Gynecologists and the FDA clearly define contraceptives as a medical device. If they are indeed a medical device, they should be treated as such. Like every other medical decision, contraceptives’ use should be discussed in the doctor’s office, not the boss’s.

According to many religions, contraceptive use is considered a sin; some even consider it comparable to abortion. Yet, religious moral decisions are made by the individual—those who choose to observe their church’s teachings are allowed to do so under the ACA. Individuals are not somehow forced to use contraceptives, they decide on their own. And many religious people choose to use contraceptives. Contraceptive use is prevalent among women of all religious denominations: Among sexually experienced religious women, 99 percent of Catholics and Protestants have used some form of contraception.

In the U.S. nearly nine in 10 women of reproductive age use contraception at some point in their lives—many women use it for medical reasons beyond family planning, such as treating endometriosis. At the end of the day, contraceptive use is an individual choice.

Despite conservatives’ support for individual rights and complete religious freedom, the contraceptive restriction comes with little surprise. President Trump, and Republican leaders, have proven themselves once again keen to advancing short-sighted policy, justified with backward logic.

Since taking power, they have carelessly neglected vital programs—failing to renew the Children’s Health Insurance Program, the program that provides insurance for over a million children—and actively designed policies that energize their right-wing base on contentious cultural issues, while harming vulnerable populations.

As a candidate, President Trump explicitly campaigned on removing the contraceptive mandate. In office, President Trump has done everything in his power to dismantle Obamacare in its entirety. Where Senate Republicans have failed on a full repeal, President Trump has picked up the slack: The Administration recently issued an executive order ending billions of dollars in federal subsidies aimed at lowering out-of-pocket costs for low-income individuals. The contraceptive roll-back exemplifies the worst practice of Republicans’ cynical politics.

Needless to say, Republicans’ values on women’s health care are evident. That is who they are. That is what they belief in. And that’s how they will act.

Pro-Life Principles and Contraceptives

To me, it’s far more confusing to understand pro-life groups’ views on women’s healthcare.

The Little Sisters of the Poor, who have been vocal critics of the ACA, praised the administration’s efforts. They claimed the contraceptive mandate forced the organization to be “morally complicit in grave sin.” Maureen Ferguson, senior policy adviser with The Catholic Association, said, “Today’s action is more than regulatory relief for people of faith, it is a ray of sunshine signaling to faithful Americans that they need not fear government bullying like that endured by the Little Sisters of the Poor.”

However, these political views contradict pro-life principles. Many of these religious groups vigorously oppose abortion, and presumably want fewer abortions in the United States, yet they support policy that does the exact opposite.

Contraceptive use is one of the most effective means of preventing abortion. The Guttmacher Institute, the Brookings Institution, and Kaiser Health have all found contraceptive use to reduce unintended pregnancy, which accounts for more than 90 percent of abortions. A study by Washington University found providing birth control to women at no cost substantially reduces unplanned pregnancies, cutting abortion rates by between 62 to 78 percent.

Unintended pregnancy largely affects poor women and women of color. Poor women are more than five times more likely and women of color are almost twice as likely to experience unintended pregnancy. The Little Sisters of the Poor are particularly strong advocates for the poor. Yet, their values again fail to transfer into their political views.

Americans are understandably divided on the issue of abortion. There are sincere disagreements between pro-choice and pro-life advocates, some of which may not ever be resolved.

Although I am a strong proponent of women’s rights to choose their own medical needs, I can respect the pro-life perspective. The dedication to protecting human life is a noble goal. It’s a value I hold dear and express in every one of my own political views. Regardless of one’s views on the legality of abortion or the definition of a fetus, the protection of humans, what drives pro-life advocates’ stances, is an honorable endeavor. However, taking away healthcare is not.

Eliminating the contraceptive mandate does little to promote women’s health care. It’s even less effective at preventing abortions. Clearly, denying access and increasing burdens to contraceptives runs counter to the beliefs of pro-life advocates and religious groups.

If pro-life groups truly want to act on their principles, they must change their political views. A more pragmatic and effective way of eliminating abortions starts with providing women the healthcare they choose.