You’re probably sick of hearing about the war over insurance coverage for contraception under the Affordable Care Act, but I think I have a few useful points to make that haven’t been brought up elsewhere.
For those of you who live elsewhere, let me catch you up on this only-in-America craziness. The Affordable Care Act, otherwise known as the health care reform law, mandates that contraception must be covered by insurers without co-pays (direct costs at the time of service) to the patient, and that employee health plans must provide this coverage. While there is an exception for employees of churches and other places of worship, hospitals, universities, and other institutions owned by religious sects are included in this mandate. A number of right-wing forces have complained that this tramples upon religious freedom. After being thoroughly raked over the coals, the President and his advisors worked out a compromise: the religious groups would not have to pay for the coverage, and it would be provided directly by the insurance companies, so that those who object could keep their sense of purity. Insurers have agreed to this because providing contraception saves them money (and is expected to save money for the entire health-care system as well as for individual families). The war is still raging as I write this, with the self-styled guardians of freedom insisting that the government is still overstepping its bounds.
On the front lines of this trumped-up battle, we find none other than the Conference of Catholic Bishops, the same fine folks who protected us from the evil, dangerous practice of Reiki by banning it in all Catholic hospitals and other institutions. (See my post “Attack of the Bishops.”) Need I state the obvious? These ideas are being promulgated largely by partnerless elderly men. These are not people who have any need to prevent pregnancy or any understanding of what that issue is like for those who do, including the 98% of Catholic women who use birth control at some point in their lives. This outrage is compounded by the fact that Viagra is covered and the bishops have no problem with that.
A letter I wrote about this recently was published in the Albuquerque Journal on Sunday 2/12/12, before the President backpedaled, and before Rep. Darrell Issa convened a panel of ALL MALE religious leaders, Catholic and otherwise, to testify before Congress. Issa and his Religious Right cohorts have managed to make it crystal clear that their agenda has little or nothing to do with religious freedom, and is really about a) attacking the president and killing the Affordable Care Act any way they can, and b) controlling women. They’ve abundantly shown that they want to get rid of not only abortion but all forms of contraception. And while wailing about the government infringing upon their freedom, they’ve shown that they have no problem with curtailing the freedom of others– especially if those others happen to have pairs of X chromosomes.
Here’s my letter:
“In all the indignation-filled rants I’ve heard about the Obama administration requiring religious institutions to include contraception in employees’ health insurance coverage, there has been one glaring omission: No one has mentioned the fact that quite often, hormonal contraceptives (the Pill, patches, or implants) are used for medical reasons that have nothing to do with birth control. Many women take the Pill, etc. for conditions like polycystic ovary syndrome or severely painful periods. Many of those women are not even sexually active, or not sexually active with men. I’ve seen this quite a bit with my own patients. Whatever one thinks about contraception, it’s hard to imagine even the staunchest Catholic objecting to legitimate medical treatment for such conditions.
“I’d just as soon see women use natural alternatives, but in many cases hormonal birth control really changes their lives for the better. The costs of these medications can be quite substantial, however, and that can put them out of reach for students and low-paid workers. The costs of the conditions they treat can be substantial, too, as when a woman must miss work because of debilitating pain. We would not ask an employee to forgo painkillers for arthritis or inhalers for asthma. How is this different?
“The President may have lost some votes with this decision, but there are quite a few of us who are relieved to see him standing up for women and for what makes medical sense. Try as I might, I can’t see this as primarily an issue of religious freedom or of morality. Women who object to contraceptives are still free not to use them. Morality means doing the best we can for everyone in our society, and that includes medical care, which includes birth control.”
I didn’t want to get all confessional in the newspaper, and I wanted to focus on a single point for impact, without bringing in other aspects of the situation, but I have a personal story that I think sheds particular light on the complexity of this issue and the reasons a total ban by religious “authorities” is not only ludicrous but cruel.
When I was about 25, I developed severe cervical dysplasia, well on the way toward cancer. This was treated with cryosurgery to remove the diseased cells, which was a standard treatment back then; no one realized at the time that cryosurgery would only mask the problem, which would resurface later on. My primary care doctor told me I should have a hysterectomy, which showed a remarkable ignorance on his part, it seemed to me, as the precancerous cells were not invasive and might never be. I had not yet had a child, and was determined to be able to do so. After I healed from the cryosurgery, I did get pregnant, and my daughter was born when I was 27. Over the next couple of years I became allergic to or unable to tolerate most forms of birth control, and so, with my husband and my very small daughter in agreement (Lenore’s opinion was “We have enough babies around”), I had a tubal ligation. Which was covered by insurance, by the way, because my husband is one of those awful, greedy public employees, a teacher that is, and he gets all those totally undeserved benefits.
That was not the end of the medical story. I had a number of years of clear Pap smears, then skipped a year, because it didn’t seem critical to have one at that point. The next Pap showed carcinoma in situ. The tissue underneath the layer affected by the cryosurgery had been stealthily developing toward cancer the whole time, and it had simply taken that long to show up on the surface. By that time, most of my cervix consisted of abnormal cells, and I was noticeably ill. To deal with this, my OB-GYN did a cone biopsy to remove all that– they use the word “biopsy,” since it does have a diagnostic aspect, but it’s a far larger matter than the word suggests.
The hospital personnel wanted to do a pregnancy test. I explained that I’d had my tubes tied. They impressed on me repeatedly that after this procedure my cervix could not support a pregnancy, and that I needed to be OK with that. I reassured them again, and the surgery was done. The pathologist found that there were still diseased cells around the edges of the cone, so a few months later I went through the whole thing again, nearly bleeding to death afterward, and ending up with even less of a cervix. I emerged from the process weakened but cancer-free.
I often thought about what would happen if a woman in this condition did get pregnant. Surely it has happened many times. An embryo would start to grow, everything going fine, and at some point it would lose its moorings in its mother’s womb and essentially fall to its death. I wondered how far developed the poor creature would be when that happened. It seems horribly sad, doesn’t it? The child would be doomed from the start. The mother would suffer both mentally and physically for nothing. And all of that could be prevented with the use of reliable contraception, or with my chosen option, sterilization. If it could not be prevented for some reason, it seems very clear to me that abortion would be a far kinder choice than allowing the baby to keep growing until its inevitable demise, possibly till it could begin to feel something, and certainly exposing the mother to greater risks and discomforts.
I have always wondered how very observant Catholics would find their way through this dilemma, since there would be no way to avoid pain and tragedy, only to minimize it.* The Church’s official stance, I suppose, would be simply “Don’t have sex.” Ever again, or at least not until menopause, so that such a tragic pregnancy could never get started.
And of course there are also medical situations where pregnancy would be life-threatening or seriously health-threatening for the mother. These women need their contraception to be as effective as possible, and depriving them of it verges on criminality, I would say. Birth control advocates tend to mean hormonal drugs when they speak of “effective” contraception, and that has been the focus of much of the fighting. I certainly think women should have access to these medications, but I don’t want to come across as a wholehearted fan of the Pill and its cousins. The Pill, patch, and implant can be problematic for many women, and they can have dangerous side effects, especially as women age.
A friend of mine who cannot use these drugs was put in a ludicrous position by our local Presbyterian Health Plan, on purely ideological rather than medical grounds. Having been unable to tolerate the type of IUD that releases hormones into the body, she and her doctor decided that she should try the old-fashioned, non-hormonal IUD. Presbyterian refused to cover that, saying that it’s an abortifacient rather than a contraceptive, and therefore not morally acceptable.** They were happy to cover the hormonal IUD, which they insisted my friend should use despite the fact that it was already proven to be unsuitable and harmful for her. The patient’s medical needs meant absolutely nothing. Let me repeat that, because this is how our system works, and we need to be clear about it: The patient’s medical needs meant absolutely nothing. Her own beliefs and moral convictions also meant absolutely nothing. Fortunately, although she was a college student doing low-paid restaurant work, this young woman was able to get the money together to pay for the IUD herself.
And that is what we face when religion, and only some people’s religion at that, is allowed to determine our medical care. If the bills currently being proposed by certain members of Congress were to become law, any employer could refuse to cover any type of treatment for any reason. I don’t think that will come to pass, but stranger things have happened, and we need to stay on top of this situation. I can only hope that American women will continue to get more and more engaged and will work to hold the ground we’ve gained– and that men have gained along with us– over the past few decades.
I promise to get back to more spiritual matters in my next post.
*Despite 12 years of Catholic school and being good friends with a nun, I still can’t answer this. Odd situations like this never came up in the typical anti-abortion rhetoric. And by the way, I don’t remember Catholics railing against birth control back in the ’70s the way it’s happening now. Maybe I just didn’t notice.
**The common scientific view is that pregnancy begins with implantation, not with conception. The IUD prevents implantation.
For some other current perspectives: