Battles over contraception spread, and both sides frame the struggle differently

Kaiser Health NewsApril 18, 2012 

— Opponents of the Obama administration’s contraceptive coverage mandate - including likely GOP presidential nominee Mitt Romney - invoke “religious freedom.” But women’s groups and family planning organizations are convinced that the real objective is to limit access to birth control.

The administration’s policy — which was crafted to fulfill certain provisions of the 2010 health care law — requires all insurance plans to provide no-cost birth control to women members. While churches are excluded from the mandate, religious hospitals, colleges and social service agencies are not. Attempts to strike a compromise have so far proved unsuccessful.

Battles over contraception are also being fought in the states. Five states (Arizona, Georgia, New Hampshire, New Jersey and New York) are considering bills that would give religious employers, broadly defined, greater freedom to opt out of contraceptive coverage mandates. Similar “refusal” legislation is being advanced in Idaho and Oklahoma, although neither state has a mandate.

Catholic bishops make no bones about their church’s condemnation of birth control, but other organizations that oppose the Obama administration’s contraceptive policy haven’t embraced that position.

Particularly noteworthy is the stance of groups that have led the nation’s decades-long fight against abortion. Publicly, these groups say they are against the coverage mandate because it violates religious freedoms and claim they don’t take a stand on contraception.

But that doesn’t tell the whole story. Without much fanfare, anti-abortion organizations often link some kinds of birth control with abortion, the issue that most inflames social conservatives, and discourage the use of some types of contraception.

In a Feb. 10 statement, the conservative Family Research Council decried the contraceptive mandate for being “fundamentally anti-religious, anti-conscience and anti-life.”

Asked to elaborate, Jeanne Monahan, director of the group’s Center for Human Dignity, said, “We are 100 percent pro-life from the moment of fertilization or conception and we are opposed to any contraceptive that would have an abortion-inducing mode of action.”

In the view of the Family Research Council, this includes certain intrauterine devices and emergency contraception products known as Plan B and Ella. In late February, Monahan testified against “drugs and devices that destroy, rather than prevent life” before the House Judiciary Committee _ a reference to products that keep a fertilized embryo from implanting in or being retained by a woman’s uterus.

Although the Family Research Council hasn’t specifically said this applies to the birth control pill, other anti-contraception activists argue that the pills might occasionally interfere with implantation by altering the lining of the uterus. While this effect hasn’t been proved and is questioned by many scientists, it is mentioned as a possibility on the label of products such as Yaz, a popular version of the pill.

Family-planning advocates feel under attack.

“There is a lot of deliberate obfuscation going on with the purpose of pretending that this debate is not really about birth control, when it most definitely is,” said Susan Cohen, director of government affairs for the Guttmacher Institute, a family planning research and policy institute.

Cohen points to efforts in Congress over the past year to defund Planned Parenthood and eliminate funding for Title X family planning services for low-income women as further evidence of social conservatives’ increasingly public antagonism to birth control.

“I’ve been doing this for over three decades and I don’t remember such overt attacks on contraception in all that time,” she said.

No other health care service mandated under state or federal law has provoked a similarly furious response, and that’s not accidental, said Marcia Greenberger, co-president of the National Women’s Law Center.

“Much of the opposition being voiced is, in fact, being driven by opposition to contraception,” she said.

The National Right to Life Committee and other anti-abortion organizations do not accept the notion that pregnancy begins when a fertilized egg successfully implants in a woman’s uterus _ the definition advanced by the American College of Obstetricians and Gynecologists and other medical authorities. Instead, they believe life begins at the moment of conception, an idea being advanced through so-called “personhood” legislation being promoted across the country.

“No one is advocating that birth control be eliminated or made more difficult to get,” said Carol Tobias, president of the committee. But she acknowledged that “if there is a method of contraception that may also be an abortifacient, we encourage women not to use it.”

Her group worries that if the contraceptive coverage mandate is enacted and President Barack Obama wins the election in November, “he’s going to include abortion in the mandate,” Tobias said.

One conservative group, Focus on the Family, said in a statement from Carrie Gordon Earll, senior director of issues analysis, that it “views the role of contraception as one to be determined in marriage between a husband and wife in accordance to their faith.”

The organization gives more details on its website, where it affirms its conviction that “life begins with fertilization (the union of sperm and egg).” While agents that prevent fertilization from occurring are acceptable, those that act after fertilization are not, it states. Pills that include progesterone only and Norplant, a progesterone-releasing implant placed under the skin, fall in this suspect category and should be avoided, but those including both progesterone and estrogen — the most common variety — appear to be acceptable, it suggests.

Another conservative group, Concerned Women for America, takes no official position on birth control, communications coordinator Alison Howard said in an e-mail. But in a statement about the contraception mandate on its website, the group says, “Requiring employers affiliated with the Christian faith, like Concerned Women for America, to include free abortion-inducing drugs in their health insurance plans is contrary to both Christian doctrine and constitutional guarantees of religious freedom.”

How the public understands the forces at play in the ongoing debate over the contraceptive coverage mandate may well determine its political resolution and resulting public policy.

An overwhelming majority of Americans strongly support access to birth control and appear poised to reject any attempt to limit it, according to multiple polls.

For the moment, it appears that reproductive health advocates have gained an advantage: 62 percent of people responding to a recent Bloomberg poll said they believe the controversy is about women’s health and access to contraception, while 33 percent said it was about “religious liberty.”

The nation shouldn’t even be having this discussion, according to 77 percent of the poll’s respondents, who said that “birth control should not be part of the national political debate.”

(Kaiser Health News is an editorially independent news service of the Kaiser Family Foundation, a nonpartisan health care policy organization that isn’t affiliated with Kaiser Permanente.)

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