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The Bishops v. Birth Control: It’s Not About the Money

11:45 am in Uncategorized by RH Reality Check

Birth control pills

Religion, birth control, and Obamacare — it’s not about the money.

In announcing its final rule concerning the Affordable Care Act’s guarantee of access to birth control without a co-pay for all American women—including the Catholics and non-Catholics who work in religiously sponsored schools, hospitals, and social service agencies—the Obama administration bent over backwards to accommodate the Church’s concerns. The goal was to spare Church fathers from the anguish of getting their pristine hands dirty by, as the Bishops charged, being forced to sell, buy or broker birth control coverage for women, including students. The final rule allows that either the insurance company used by the institution—or, if it is self-insured, its plan administrator—will have to pay, with reimbursement coming through a series of convoluted steps.

In a repeat of the Church battle over the Affordable Care Act, Sister Carol Keehan, head of the Catholic Health Association, last week publicly approved the administration’s final rule, issuing an explanation for the association’s members about how to implement it. Not so the U.S. Conference of Catholic Bishops. The week before, its head, Cardinal Timothy Dolan, released his statement expressing dissatisfaction with the compromise, saying that the bishops are subjecting it to further “analysis,” feel their “religious freedom” is still under threat, and plan to continue “defending our rights in Congress and in the courts.” Count on the 60+ lawsuits by Catholic diocese and universities around the country, joined by secular employers who also don’t like birth control and want to exclude it from their insurance policies, proceeding apace.

It is maddening that the Administration had to go to such extremes to placate the Church fathers, who dare to put “moral” and “money” as it applies to this deeply compromised institution in the same sentence. How pure, really, were the hands of the Church fathers who began decades ago to secretly spend millions of dollars in hush money to silence child victims of clergy rape and sodomy, and rid themselves of the evidence of their paternal crimes? Hush money that came from the faithful in the pews, who paid for all those ever-escalating insurance premiums, and from selling the churches and schools out from under those same working-class Catholics? The victims merited all the compensation they got and more, but the Church fathers literally stole that money from the Catholics they served and lied about it.

When the Bishops realized how much money they had to lose by even these secret settlements, hiding the goods from the victims became the next best strategy. So how pure, really, are the hands of Cardinal Dolan, the leading voice claiming the moral high ground in the battle to keep any of the church coffers from supporting birth control for women? Files just released by the Roman Catholic Archdiocese of Milwaukee turned up a letter showing that when Dolan served as the Archbishop of that diocese, he secretly and successfully, and even as the Archdiocese was preparing to file for bankruptcy, petitioned the Vatican to bury nearly $57 million in a cemetery trust fund in order to protect those assets “from legal claim and liability,” aka, child abuse victim compensation. And this was on top of his paying off some priest child sex abusers $20,000 a piece to leave the priesthood, reportedly defended by Dolan in one case as “an act of charity,” so that, irony of ironies, the priest “could pay for health insurance.”

And how pure, really, are the hands of the Church fathers regarding money when we look at the shenanigans at the Vatican bank? Still laughably named the “Institute for the Works of Religion,” the Vatican Bank is literally drowning in mounting accusations of money laundering and mobster connections. Most recently, Monsignor Nunzio Scarano, an accountant for the Administration of the Patrimony of the Apostolic See, which manages the Vatican’s property and investments (and a Vatican account-holder himself), was arrested and charged with conspiring to transfer some $26 million from Switzerland to Italy to dole out to his rich friends.

Given this sad financial state of affairs, how does paying for a health service like birth control for women become such a threat to Church fathers that they’ve made a major campaign out of it?

The bishops claim this mandate violates church teaching that artificial birth control is “intrinsically evil, “despite the fact that nearly 100 percent of Catholics don’t believe there is anything “intrinsically evil” about birth control and use it. The bishops claim birth control is the same as abortion; it isn’t. They claim to be protecting the institution’s “conscience,” thereby stepping all over Catholic Church teaching that defines conscience as “the most secret core and sanctuary” of a person, not an institution, and the Church not as the “men of God” but as “the people of God,” which would seem to include women. They claim the money at issue is “their” money, even though employees earn their health insurance as part of their compensation package, and many have to contribute to or pay the full amount of their health insurance premiums so this is at base a labor issue. And their claim that birth control is not a “health” service, in the face of current scientific knowledge and medical opinion, is tantamount to insisting that the sun revolves around the earth.

A hint of a far deeper motivator lies in a rarely regarded passage from Humanae Vitae, Pope Paul VI’s 1969 Encyclical letter, “On the Regulation of Birth,” which cemented the Church’s current intransigent opposition to birth control. The section on “Grave Consequences on Methods of Artificial Contraception” reads in part:

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Silencing Debate on Women’s Lives: It’s Happening In Wisconsin, Too, and the Catholic Church Is an Accomplice

11:37 am in Uncategorized by RH Reality Check

Written by Lon Newman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Redux – The personal is political

Wisconsin State Senator Mike Ellis (R)

Teaching children to understand and cope with bullies is essential, but bullying isn’t limited to elementary school. Bullying may not be physical or direct. It is persistent, intimidating, and it flourishes when victims and witnesses are afraid to speak up or speak out. It is time to identify reproductive coercion for what it is and call the bullies what they are.

Reproductive coercion” includes sabotage of birth control by abusive partners and occurs in all social and economic groups and most frequently to unmarried sexually active women. Male partners seek control over their partner’s reproductive options, even whether and when to have sex, to assert and maintain power.

Just as the pattern of intimidation, harassment, aggression and control is not limited to schools, reproductive coercion is not limited to interpersonal relations. It is ubiquitous at public forums, health care settings, legislative discourse, and campaign politics. This bullying is intended to intimidate, to silence people who disagree, to deny people access to health care they want or need, to pass legislation that denies reproductive justice, and to maintain power by opposing reproductive rights and justice.

Last week, one of Family Planning Health Services’ (FPHS) employees was participating in a health fair sponsored by our local United Way and county health department. It happened to be hosted at a Catholic hospital. One of the medical directors required the employee to remove information on emergency contraception. The doctor then used post-it notes to obscure “prescription contraception” and “non-prescription contraception” on the FPHS display.

The hospital has been recognized for its work with sexual assault victims and the hospital president is on the state attorney general’s sexual assault task force. We can assume the hospital is in compliance with state law to provide emergency contraception in the emergency room and we know that many of the physicians provide prescription and non-prescription contraception to their patients. But, like the classic elementary school bully, the physician used position and status to censor and deny information to participants.

Victims and bystanders might excuse the bully; “I should have known this would provoke him,” or “I should have known better than to be in this neighborhood,” but motivation does not excuse intimidation, bullying and harassment.  On a public level we may understand religious objections, but using status, position, power, volume or force to control someone else’s reproductive health and behavior must be challenged and condemned if the culture of sexual coercion is to change.

Several days ago, Wisconsin’s State Senator Mike Ellis used the power of the majority and the gavel to silence debate and fast-track a bill that requires women to undergo a medically unnecessary ultrasound procedure and morality message before they can have an abortion. In our state assembly, our state representative shared her experience as a child rape victim and spoke very personally to how she felt as a victim and as the mother of three daughters, to a law requiring victims to undergo a re-invasion of privacy and self-control. On-line bullies vilified and harassed her for speaking out as a victim against the “pro-life” legislation.

There are self-styled “prayer warriors” standing outside our family planning clinics for a few months each year. They know that many of our patients and WIC participants/children are intimidated by their presence, but they justify the bullying on the basis of their religious beliefs about abortion, which we do not provide.

Victims and witnesses to reproductive coercion, intimidation and bullying must try to speak up, seek help, or intervene as the situation requires. When it comes to public and political behavior, calling reproductive coercion what it is the first step to ending it.

Griswold v. Connecticut and the Evolution of Personal Privacy Rights

8:16 am in Uncategorized by RH Reality Check

Written by Jessica Mason Pieklo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Birth control pills

How the fight for contraceptive freedom & LGBTQ rights sheds light on privacy protections.

Over the past three years, more than 60 lawsuits have been filed in federal court challenging the Affordable Care Act contraceptive coverage benefit. These legal challenges are based on a central theme of today’s conservative movement, which argues contraception is immoral, and that the Supreme Court decision preventing states from criminalizing birth control was wrongly decided. That’s where things stand on the 48th anniversary of Griswold v. Connecticut.

Why now? Why is the right gunning so hard to take down Griswold and gut individuals’ rights to privacy that include keeping the government out of their most intimate decisions? And what has changed legally, to bring this issue to a boil now? As it turns out, the answer has very little to do with contraception and more to do with same-sex marriage. At its core, the legal foundation of personal privacy rights rests in the institution of marriage and family. As older definitions of “traditional families” give way to more expansive realities, including same-sex partnerships, single-parenting, co-parenting, and myriad family arrangements today, conservatives must face a stark legal reality: Without drastically changing the way the courts define issues that once were simply matters of privacy, they will have lost the culture wars. It’s now or never.

The Supreme Court first laid the foundation for an individual right to privacy early in the 20th century in Lochner v. New York, a case that has become synonymous with activist judges looking for any means to support and expand corporate, monied interests. In Lochner the majority relied on the reference to “liberty” in the 14th Amendment’s Due Process Clause to support striking down a New York state law that restricted the number of hours bakers could work each week. The 14th Amendment states that no person “shall be deprived of life, liberty or property, without due process of law.” According to the court majority, the law was an unconstitutional violation of an individual’s privacy rights because the Due Process Clause implicitly guarantees citizens the “fundamental” right to enter into employment arrangements free from state intrusion in this “liberty” interest.

From Lochner, privacy rights more clearly became associated with the home and traditional, patriarchal constructions of family. In Pierce v. Society of Sisters (1925), the court ruled that an Oregon law banning all private education violated the Due Process Clause because it directed how parents may educate their children, infringing upon parents’ fundamental right to rear their children as they see fit. The majority opinion in Pierce lists a series of other privacy rights guaranteed by the Due Process Clause, including “the right of the individual … to marry, establish a home and bring up children … and generally to enjoy those privileges long recognized at common law as essential to the orderly pursuit of happiness by free men.”

But it wasn’t until 40 years later, in Griswold, that the Supreme Court turned its attention to whether the Constitution implicitly contains fundamental privacy guarantees that are not dependent on the Due Process Clause. Writing for the majority, Justice William O. Douglas departed from the Lochner line of privacy reasoning and held that a right to privacy exists not because of a specific constitutional provision but rather because it flows from several provisions relating to privacy, to create “penumbras”, or shadows, in which “zones of privacy” exist. Within these zones, the court explained, are other rights, including the right of married couples to determine whether or not to have children.

Two years later the court would again reach the issue of privacy rights in Loving v. Virginia, the famous case that challenged a Virginia law banning interracial marriage. In a unanimous decision, the court ruled the Virginia law violated the 14th Amendment’s Equal Protection Clause, which guarantees all citizens equal protection under the law and thus prohibits the government from discriminating on the basis of race. The court could have stopped there with its analysis, but it didn’t. Instead, it pushed further, moving beyond the obvious issues of racial discrimination to hold that the right to marry is itself protected by the Constitution. By the end of the 1960s, and with the civil rights and anti-war movements smoldering in the background, the Supreme Court’s jurisprudence showed both a slow acceptance of racial equality and a preference for the traditional construction of marriage and family.

Griswold v. Connecticut may have recognized a right of married couples to use contraception, but it wasn’t until March of 1972 in Eisenstadt v. Baird that the Court recognized a corresponding privacy right to use contraception for individuals. “If the right of privacy means anything,” Justice William Brennan wrote, “it is the right of the individual, married or single, to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.” The following year, the court famously extended these individual privacy rights even further when, in Roe v. Wade, it established a constitutional right to choose abortion grounded in an individual right to privacy and this legally recognized zone of intimacy that inherently surrounds issues of reproduction but that was no longer immediately anchored in the constructs of traditional marriage.

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Obama Administration Ordered to Make Some Forms of EC Available Without Restrictions

6:38 am in Uncategorized by RH Reality Check

Written by Jessica Mason Pieklo for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Plan B contraceptive wrapper

Judge: Plan B must be available without restrictions.

The Second Circuit Court of Appeals ruled Wednesday that the U.S. Food and Drug Administration (FDA) must immediately comply with an earlier order by U.S. District Court Judge Edward Korman to make some forms of levonorgestrel-based emergency contraception available without a prescription and without point-of-sale or age restrictions.

The ruling came in response to the administration’s request for a stay while it appeals Korman’s order. The Second Circuit’s order, only two pages, is a partial win for women’s health advocates; while it lifts restrictions on two-pill variants of emergency contraception, it grants the Obama administration’s request to stay, or pause, Judge Korman’s order as it applies to one-pill products, such as Plan B One-Step, pending the outcome of the government’s appeal. That appeal will be placed on an expedited schedule as requested by the administration.

In a statement, Nancy Northup, president and CEO of the Center for Reproductive Rights, said: “Today’s decision from the 2nd Circuit marks a historic day for women’s health. Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous, and medically unnecessary restrictions to get emergency contraception.”

The Obama administration appealed Korman’s decision earlier this month, just one day after the Food and Drug Administration (FDA) approved Plan B One-Step to be sold over-the-counter to consumers ages 15 and up. But even that approval was limited, restricting sales to stores that have an on-site pharmacy and only to those with identification. The Plan B approval was in direct conflict with Judge Korman’s April order requiring all emergency contraception be made available over-the-counter and without point-of-sale restrictions.

“Medical experts, the FDA’s own scientists, and a federal court have all agreed: there are no medical grounds to keep emergency contraception behind the counter for any woman” Northrup said. “Expanding access to this safe and effective way of preventing pregnancy after failed birth control or unprotected sex is the among the very best decisions our federal government can make for women’s health.”

A schedule for the full-appeal is not yet available.
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Bishops Tap Veteran of Islamophobic, Homophobic Legal Shop as Top Flack

12:22 pm in Uncategorized by RH Reality Check

Written by Adele Stan for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Whosoever desires constant success must change his conduct with the times. — Niccolo Machiavelli

Timothy M Dolan in his robes

Cardinal Timothy M. Dolan is part of a dangerous reframing of "religious liberty."

At a gathering of Catholics in his archdiocese last year, Cardinal Timothy M. Dolan, the archbishop of New York, uttered a strategic point that would have done Machiavelli proud. The bishops, he said, are perhaps not the church’s best messengers.

“In the public square, I hate to tell you, the days of fat, balding Irish bishops are over,” he told his flock, according to the New York Times, at a diocesan convocation on public policy. Reporting for the Times, Tim Stelloh and Andy Newman wrote of an example he gave the crowd, an apparent reference to the hiring of Helen Alvaré by the National Conference of Catholic Bishops in 1990:

[Dolan] told a story about bishops hiring an “attractive, articulate, intelligent” laywoman to speak against abortion and said it was “the best thing we ever did…”

Dolan, as president of the United States Conference of Catholic Bishops (USCCB), decided this week to operationalize his assessment by hiring Kim Daniels, a former operative for Sarah Palin’s political action committee, as his spokesperson — a new position with a much broader mission than that covered by Alvaré in the 1990s.

An attorney and youthful mother of six who echoes the bishops’ disdain for contraception and abortion, Daniels is a smart cookie with an appealing personality. In other words, an “attractive, articulate, intelligent” laywoman.

When the USCCB announced Daniels’s appointment, the thing that grabbed reporters’ attention was her work in 2010 as an operative for Sarah Palin’s political action committee, SarahPAC — a résumé entry conveniently omitted from the bishops’ announcement about their new hire. If there was any doubt remaining of the bishops’ total alignment with the most right-wing part of the Republican Party, that data point should lay it to rest. But the rest of Daniels’ career is far more interesting — and troubling.

The Reframing of Religious Freedom

Over the course of the last several decades, as reasonable people, including most lay Catholics, increasingly rejected the church’s medieval worldview on women’s rights, human sexuality, and LGBTQ rights, the political power of U.S. bishops has been on the wane. During the debate over health-care reform, President Barack Obama went around the prelates in order to confer some Catholic buy-in on the deal, ultimately winning the approval of a number of highly placed nuns, who signed a letter to that effect, as well as the head of the Catholic Health Association, who also happens to be a Catholic sister.

The bishops were incensed. At that moment, their lack of sway over their own people was revealed for all to see. They needed a new angle, one that could also speak to the hearts of those ordinary Americans who, in the wake of the church’s massive child-sex-abuse scandal, now judged them to be mere mortals, and deeply flawed mortals at that. Enter the Red, White, and Blue.

The success of the Tea Party movement, with its bigoted and misogynist underpinnings dressed in the regalia of patriotism, was apparently not lost on the bishops. On the heels of their humiliating defeat with the Affordable Care Act, the bishops found a new, patriotic-sounding cause to wrap around their attempts to codify prejudice and discrimination as secular law: religious freedom, which is guaranteed by the First Amendment to the Constitution. Summon the fife and drum!

Trouble is, the bishops’ notion of religious freedom differs a bit from that of the founders, who sought to avoid the establishment of a state religion by promising Americans freedom of worship. What the bishops seek, on the other hand, is the right to impose their religious views on those who do not subscribe to their theology. Any impediment to their totalitarian view is now framed as a breach of their religious freedom. And Kim Daniels has been deeply involved in the advancement of this strategy.

Media-Friendly and Studio Ready Church Ladies

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Administration Again Fails on Over-the-Counter Emergency Contraception

10:47 am in Uncategorized by RH Reality Check

Editor’s Note: The Justice Department filed suit to block Judge Korman’s ruling.

The Obama administration said Wednesday that girls under 15 should not have access to the most common morning-after contraceptive pill as the Justice Department filed a notice to appeal a judge’s order that would make the drug available without a prescription for girls and women of all ages.

Written by Editor-in-Chief Jodi Jacobson for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

This article was amended at 10:16 am, Wednesday, May 1, to correct the date of the amended application by TEVA to the FDA. It was resubmitted in 2012, not 2011.

See all our coverage of EC Over-the-Counter here.

Plan B contraceptive wrapper

New FDA emergency contraception regulations still do not go far enough.

Today, in a proposal that can best be described as adding insult to injury, the Food and Drug Administration (FDA) approved making emergency contraception (EC) available over-the-counter for teens and women ages 15 and up. This convoluted proposal from the Obama administration comes despite a court order in early April by U.S. District Court Judge Edward R. Korman to make EC available over-the-counter to all ages within 30 days of his decision. It comes from an administration which pledged to make science the cornerstone of public policy and instead has consistently flouted a wealth of accumulated evidence on emergency contraception. It also comes after several studies showing that current policy requiring prescriptions for some groups and not others has confused so many pharmacists that access to EC has been denied to many who were in fact legally eligible to obtain it quickly. In practice, the new policy will almost certainly perpetuate, not resolve, that confusion.

The battle to make EC available over-the-counter has gone on for over a decade and spanned both the Bush and Obama administrations. Judge Korman’s ruling was issued in response to the Center for Reproductive Rights’ (CRR) renewed lawsuit against the FDA seeking to expand over-the-counter access for all women to all brands of the morning-after pill, including Plan B One-Step and Next Choice. The most recent CRR lawsuit was filed after Kathleen Sebelius, secretary of the Department of Health and Human Services, overruled a 2011 FDA decision to make emergency contraception available over-the-counter to all ages, underscoring that the Obama administration, like its predecessor, has difficulties dealing with the realities of sex and pregnancy prevention.

The administration’s newest plan is to make EC available over-the-counter to individuals ages 15 and up, but still require prescriptions for those under age 15. While pharmacies can stock it in the family planning section of main store shelves, people seeking to buy EC will have to show identification with a birth date to a cashier. The plan comes after approval this week by the FDA of an amended application submitted by Teva, the manufacturer of Plan B One-Step, to allow OTC sale to those ages 15 and over, after an earlier request to do so had been denied by FDA in December 2011. The amended application was in any case superceded by the scientific evidence that led the FDA to rule in 2011 on making emergency contraception available OTC to all ages, the decision that was, as noted above, subsequently overturned by Sebelius. So in using the approved Teva application as the reason for this newest decision, the FDA is essentially reversing itself and ignoring the science on which its 2011 decision was based. Confused yet? Me too. It’s a complete circus, and I have no doubt that leadership at the FDA, which tried to make evidence-based policy in 2011, came under pressure from the White House to find the “fix” it announced today.

According to the FDA press release:

The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.

NPR reported that “the FDA said … Plan B One-Step will be packaged with a product code that prompts the cashier to verify a customer’s age. Anyone who can’t provide such proof as a driver’s license, birth certificate or passport wouldn’t be allowed to complete the purchase. In most states, driver’s licenses, the most common form of identification, are issued at age 16.”

There are several serious problems with this approach, apart from the fact that it ignores scientific and medical findings that call unequivocally for over-the-counter access for all.

First, the policy is not in compliance with the court ruling and therefore may in fact be thrown out. The Department of Justice will have to bring it before Judge Korman for approval and potentially seek a stay of his ruling altogether, throwing EC once again back to the courts.

Second, it still requires a prescription for a subset of the population potentially in need of EC, and therefore creates a significant barrier, especially for low-income teens under 15 years of age or those without ID who “look” younger and are denied access. Emergency contraception is for emergencies. It prevents unintended pregnancy by preventing ovulation, and is therefore most effective when taken within 72 hours of unprotected intercourse (including in cases when another contraceptive method may have failed). The need to see a physician to obtain a prescription that the public health and medical communities have deemed unnecessary is both time-consuming and expensive, and will entail additional indirect costs in terms of loss of time at school and work, likely on the part of both teens and their parents. This requirement serves the interests of no one except anti-choice opponents of birth control, and those in the Obama administration who still seem unable or unwilling to think beyond their own fears of teens and sex, or to go beyond personalizing policy to accommodate their own paternalistic fears of their daughters as sexual beings.

Third, language, lack of identification, and other potential barriers will remain an obstacle for many communities. Many 15- and 16-year-olds do not have IDs that display birth dates, and those who are well above the age limit but “look younger” to a clerk will be required to produce identification, documentation that many people in this country still do not have readily available or that, in a hurry, some might not remember to bring with them to the store.

Latinas, for example, face many of these barriers to access. In reaction to the decision, Jessica González-Rojas, executive director of the National Latina Institute for Reproductive Health, stated:

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The Bishops’ Lawsuit: A Colossal and Purposeful Drain on Public Funds

1:09 pm in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

stack of papers

Government lawyers filed an emergency motion to dismiss lawsuit over contraceptive coverage mandate citing exorbitant costs in responding to document requests.

This week, the government filed an emergency motion in the New York Archdiocese’s lawsuit against the contraceptive coverage mandate, requesting that the court halt proceedings and dismiss the case. The emergency is that the government is hemorrhaging money defending a regulation it will never enforce against the Archdiocese.

Roman Catholic Archdiocese of NY v. Sebelius is the only lawsuit out of the 23 brought by religiously affiliated organizations not to be dismissed at the district court level for lack of standing or ripeness. The cases have been dismissed because religiously affiliated non-profits are currently completely exempt from the contraceptive coverage requirement. They enjoy a one-year safe harbor period provided for the religious accommodation to be finalized. If you haven’t been injured, you can’t sue.

The government swore up and down from the day the case was filed that the rule in its current form would never be enforced against the Archdiocese and its co-plaintiffs and that a new rule with a new religious accommodation was on the way. As promised, the Obama administration released a new proposed rule, is now reviewing comments from the public on it, and will release the final rule by August. However, in the New York Archdiocese case, Judge Brian M. Cogan found that the administration’s assurances were not enough and that the impending threat of the rule was injury enough for the plaintiffs to proceed.

The Archdiocese et al. proceeded to serve the government with requests for every document under the sun. “Discovery” is the process in which litigating parties get evidence by requesting relevant documents from each other. To respond to a document request, a party has to review documents to determine whether they are responsive to the request and make a log of documents that are responsive but won’t be turned over because they are protected by attorney-client or another privilege. Computer searches only get you so far; a human attorney or paralegal has to determine if a document is responsive or privileged.

Plaintiffs in these cases being 1 for 23, the Archdiocese may have sought to make the most of its unique situation. It made discovery requests the government calls “enormously burdensome and irrelevant.” The Archdiocese also noticed a deposition of Health and Human Services (HHS) Secretary Kathleen Sebelius. Lawsuits are brought over regulations all the time — it is pretty audacious to demand a cabinet member show up in person for yours. That was indeed too far, and Judge Cogan granted Sebelius a protective order.

The plaintiffs didn’t stop there. The Archdiocese subpoenaed the Executive Office of the President (EOP), even though it isn’t a party to the lawsuit, many of the requested documents are protected by various privileges, and you must have an extra good reason to get documents from the president. Also, the EOP being in D.C., the subpoena was issued in a district that has thrown out three of these 23 lawsuits for lack of jurisdiction.

The Archdiocese later withdrew the subpoena. We don’t know why. Perhaps it realized it was an unreasonable request. This did not happen, alas, until after our tax dollars were put to work on a very lengthy motion to quash the subpoena. But whatever that cost, it pales in comparison to the expenditures of various agencies on the New York document requests; in the emergency motion, the government estimates completing the requested document production would take eight years and cost over $10 million.

We should take that estimate with a grain of salt, of course, but the government has sought to back it up. Attached to the emergency motion are declarations from officials of various offices and agencies as to what they have spent so far on this one case and what they estimate it will cost to finish. Two-hundred HHS employees have spent have spent over 2,000 hours and located over 7.6 million pages of potentially responsive documents so far. That has cost over $177,000. Those documents haven’t been reviewed by HHS or their Department of Justice counsel yet. The Internal Revenue Service has spent over a quarter of a million dollars.

The lawyers, paralegals, and IT professionals needed to complete discovery are expensive — even those of the lower-paid government variety. Offices that don’t have enough staff for this have hired contract lawyers, but they can’t afford to do that anymore because of the sequester. Lest you think it’s not a big deal to have government lawyers tied up or that the effect is minimal in the scope of things, consider one example contained in the declaration from the Department of Labor (DOL). The DOL’s Plan Benefits Security Division investigates and litigates cases of fraud or mismanagement in employee benefits. The division, which recovered $1.38 billion for U.S. workers in 2011, argues that the impact on the public interest of putting its attorneys on document review will be far greater than the financial loss.

The Archdiocese, which employs 10,000 people in programs receiving many millions of dollars in government grants each year, will never have to provide health plans with contraceptive coverage under the rule as proposed. Despite this, it is waging a legal battle that is imposing significant costs on the taxpayers who fund its work. And this is only one lawsuit. With the additional cases brought by secular for-profit corporations, over 60 lawsuits have been filed in this scorched earth litigation campaign — which we have to pay to defend.

On the same day the emergency motion was filed, Judge Cogan granted it in part, staying all discovery and proceedings until the contraceptive coverage rule is final. So the government lawyers can get back to other business for the moment. But once the rule is final, I expect we will see that some if not all of those 22 dismissed cases (the ones that haven’t already been appealed) will be refiled.

Back in February, with the sequester looming, the U.S. Conference of Catholic Bishops, which, like the Archdiocese of New York, is led by Cardinal Timothy Dolan, signed a statement by religious leaders urging legislators to protect the interests of the poor. The Bishops’ litigiousness does not reflect the same awareness of our limited resources nor concern for those who will be hurt most by the sequester. Instead, the Archdiocese seeks to deprive its employees of affordable contraception — provided by an outside company — that will enable employees to limit their families to the size they want and can support, using up resources that are needed elsewhere in a time of economic distress.

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Why Does the ACGME Want to Eliminate Contraceptive Training for Family Physicians?

12:32 pm in Uncategorized by RH Reality Check


Written by Dr. Linda Prine and Dr. Ruth Lesnewski for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

In one of the clinics where we work, a 16-year-old girl came in with a sprained ankle.  She left with a prescription for birth control.

This turn of events is not as surprising as it seems:  As family physicians, we treat the whole person.  A quick update revealed that our 16-year-old patient had recently begun to have unprotected sex — and had no plan to get birth control. One of the reasons we love practicing family medicine is that we get to know our patients over time and provide the preventive care they need at every possible opportunity.

That is why we are dismayed that the Accreditation Council of Graduate Medical Education (ACGME) has proposed changes to the guidelines for family medicine residency programs removing the requirement that residents learn to provide contraception. These changes will go into effect in 2014 unless the ACGME is convinced otherwise, during an open comment period taking place this week.

A majority of U.S. women get their basic health care from a family physician or other primary care provider, and often that includes reproductive health care. Especially in rural and low-income areas, family physicians do it all! They not only provide birth control but also provide prenatal care, deliver babies, manage miscarriages, counsel patients about unintended pregnancies, and, increasingly, offer pregnancy termination so that their patients do not have to travel long distances and see unfamiliar doctors for these services.

ACGME’s motivations are legitimate:  It seeks to simplify the rules for the nation’s family medicine residency programs — numbering over 450 — and to allow for more creativity and flexibility. In some areas of practice, this makes sense. Many programs will continue to teach contraception; it will depend on the culture of the institution. However, residency programs based in religiously-affiliated hospitals (which operate nearly 20 percent of inpatient community-hospital beds in the U.S.), will most likely drop birth control training immediately.

Because the ACGME currently requires birth control training, religiously-affiliated institutions must figure out a way to comply. Many rotate their residents through external clinics to learn these skills — which are essential since 99 percent of women in the United States who have ever had sexual intercourse have used a method of contraception other than natural family planning at some point in their lives. Without this requirement, residents in religiously-affiliated programs may get no training at all in contraception.

Just last week, we attended a meeting where an assistant residency director expressed satisfaction at the prospect of no longer needing to teach residents how to counsel patients with unintended pregnancies of all of their options. This is our concern: Limiting the training of family medicine residents in birth control will have a disproportionate impact on the millions of low-income and rural women and teens who rely on their family doctors to provide the full-spectrum of reproductive health care. The Affordable Care Act greatly expands access to contraception for millions of women in the United States. But, if clinicians aren’t trained in providing contraception, then that access is meaningless, even if it is covered. We need to make sure all clinicians who provide primary health care for women are trained to provide high-quality contraceptive care.

Our next generation of family physicians must learn and practice more contraception, not less. Otherwise our shamefully high rate of unintended pregnancy (the highest in the developed world) will rise further.

There is time to make a difference. The ACGME is accepting comments on the proposed guidelines until April 25, 2013. Click here to download our suggested version of the official comment form.  Fill in your information and email it to familymedicine@acgme.org.  The Reproductive Health Access Project has an online campaign for all of us to tell the ACGME that their changes affect our health care.

For It Before They Were Against It: Catholic Universities and Birth Control

3:00 pm in Uncategorized by RH Reality Check

Written by Bridgette Dunlap for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Birth control pills

Some Catholic universities were historic supporters of contraception.

If you weren’t eagerly checking the bishops’ blog for their feelings on your health insurance, you may not have known last week was Catholic Schools Week! I generally don’t participate in the bishops’ weeks (or fortnights), but I think this is an ideal moment to highlight the proud history of advocacy for contraceptive access at Catholic-affiliated Universities — which is relevant to all those lawsuits that won’t be going away now that His Eminence Timothy Cardinal Dolan has spoken.

We begin at Notre Dame in 1966. Faculty members formed a group to advocate for government funding of family planning programs and advertised a statement of support in Catholic publications. They received over 500 signatures in under a month from Catholic clergy, nuns, lawyers, doctors, and faculty members  at Catholic universities, including the deans of Notre Dame and Santa Clara’s law schools. The Notre Dame professor chairing the committee told the New York Times the group wished to emphasize that “in a pluralistic society, some legislation may be desirable even though it may not be in accord with the moral principles of a minority of the society’s members.”

The chairman explained that the impetus for the group’s formation had been an address by the Rev. Dexter L. Hanley to the American Bar Association arguing for government family planning programs. Father Hanley was a law professor at Georgetown University. Yes, that Georgetown. The same Georgetown that trained a lawyer named Sandra Fluke. Father Hanley also testified before a congressional subcommittee in support of access to contraception. So when Sandra Fluke did the same thing, not only was she acting like a lawyer, which is presumably what one attends Georgetown Law to learn to do, she was following in the footsteps of a revered Georgetown professor and priest who had inspired Catholics across the country to take action.

Though Fluke is regularly accused of demanding government funding for contraception, what she actually testified about was the sub-par plan available to Georgetown students (who are required to have health insurance). Typically, student health plans involve students paying money to a third-party health insurance company; neither government nor university funds are involved in these transactions. Father Hanley, however, was indeed advocating for taxpayer-funded contraception and education. He acknowledged Catholic teaching against contraception but testified that he could firmly maintain his moral positions as a Catholic while supporting a government program that “permits each citizen a fully free moral choice in matters of family planning, and aids him in implementing this choice.”

Today, rather than permitting its students a “fully free moral choice” as Father Hanley advocated, Georgetown has taken advantage of the safe harbor from the contraceptive coverage requirements, claiming it has a religious belief that bars providing insurance that covers contraception. This is hard to believe given that faculty members’ health plans have included contraceptive coverage for years. Also, Georgetown hosted an excellent conference on the Health and Human Services regulation where most scholars rejected the claim that providing coverage violated Catholic doctrine or that requiring it violated the law. The robust defenses of Sandra Fluke from the University President and the law school faculty were lovely, but fixing the problem she testified about is what’s needed.

Let’s return to Notre Dame. From 1963 to 1967 Notre Dame held an annual “Conference on Population.” The conference, organized with the help of the Planned Parenthood Federation of America, was intended from its inception to be a forum to develop a more liberal Catholic position on contraception. In 1965, thirty-seven scholars who attended the conference sent a statement to the Pope that declared “[t]here is dependable evidence that contraception is not intrinsically immoral, and that therefore there are certain circumstances in which it may be permitted or indeed even recommended.” Notre Dame’s President, Father Theodore Hesburgh, later got his friend John D. Rockefeller a secret meeting with the Pope to discuss the problem of overpopulation.

Despite this history, the University has now claimed in its lawsuit that Notre Dame, whoever that is, has a sincere religious belief that the Church’s “centuries’ old teachings” prohibit coverage. This is despite the fact that its own theology students and faculty can’t get their questions answered about what the theological claim for the prohibition of contraceptive coverage is and people like Kathleen Kaveny, a professor of both law and theology at Notre Dame, have argued the legality of the mandate in detail. A further troubling sign from an institution that was once the place for principled discussion of contraception, is that Notre Dame’s website refers students to what appears to be a “Crisis Pregnancy Center.” When I called up the “Women’s Care Center,” they told me they do not actually have doctors on staff or prescribe contraception.

Read the rest of this entry →

The Sliding Scale of Sin: Tyndale Publishers and Contraception Without a Co-Pay

11:41 am in Uncategorized by RH Reality Check

Written by Imani Gandy for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Recently, the district court for District of Columbia granted a request by Tyndale House Publishers to block the Affordable Care Act birth control benefit ensuring that employer-sponsored health insurance include coverage of contraception without a co-pay. (Jessica Mason Pielko wrote about the ruling here.)

Like so many other organizations, both religious and secular, for-profit and non-profit, Tyndale’s complaints are the same: the birth control benefit in the ACA infringes upon their right to religious freedom:

Tyndale and its owners are Christians who are committed to biblical principles, including the belief that all human beings are created in the image and likeness of God from the moment of their conception/fertilization. But Defendants’ recently enacted regulatory mandate under PPACA forces Tyndale to provide and pay for drugs and devices that it and its owners believe can cause the death of human beings created in the image and likeness of God shortly after their conception/fertilization. The government’s mandate exempts what it calls “religious employers,” but denies that status to Tyndale House Publishers through its arbitrary definition.

What sets Tyndale apart from other companies challenging the birth control benefit, some of which have been successful in their challenges, and some of which have not, is that Tyndale is self-insured, whereas companies like Hobby Lobby purchase group health insurance plans from a commercial insurance carrier. In other words, Tyndale wholly assumes and underwrites the risk for providing health care to its employees (and pays for it out of its own coffers), while Hobby Lobby pays premiums to an outside insurance company. That it is self-insured means that Tyndale is paying directly for the insurance coverage of the contraception that it views as sinful, and the court found that this distinguishable fact rendered the birth control benefit sufficiently violative of Tyndale’s right to religious freedom.  

Now, the court did not reach this decision in a vacuum, mind you. The Obama Administration’s compromise with the United States Conference of Catholic Bishops (USCCB) paved the way. 

If you recall, the contraception kerfuffle began in February 2012 over one question: should employers be required to offer health insurance plans that cover contraception? In an effort to compromise with the USCCB and other religious organizations that balked at the notion of providing “slut-pills” to women, the Obama Administration allowed religiously-affiliated employers to avoid providing contraception coverage, and instead required health insurance companies to offer it directly. The Obama Administration allowed certain religious employers to keep their fingers entirely out of the contraception pie, and put the onus on insurance companies to fill the contraceptive gap. And in so doing, the Administration ceded that paying for contraception is, in and of itself, participation in sin, thus paving the way for self-insured organizations to raise Establishment Clause and Religious Freedom Restoration Act (RFRA) claims that will be (and are being) analyzed differently than the claims raised by organizations that are commercially insured.

Notwithstanding the distinction between self-insurance and regular commercial insurance, the claims challenging the birth control benefit are specious — both constitutionally and as a matter of church doctrine. Still, women’s rights activists and attorneys must adjust and re-frame the argument to take into account this new development in the birth control benefit lawsuits.  

Rather than focusing on who is paying money for what healthcare services, a better way to look at it — and, indeed, the most sensible way to look at it — is that companies providing a full range of health-care services, including contraception, are offering their employees a choice to participate in sin or not, just as employees who pay wages to their employees are offering employees that same choice.

Imagine if Tyndale filed a lawsuit challenging federal minimum wage laws. Would it make sense to allow Tyndale to argue that it should be exempt from paying its employees a fair wage out of fear that its employees would use that money to purchase contraception? Of course not. The religious nexus between paying employee wages and subsequent employee commission of sin is too great.

It might surprise you that Catholic scholars agree — at least one does. As Dr. Jeff Mirus of CatholicCulture.org notes, sometimes the remote participation in immorality is unavoidable:

In the absence of a contrary declaration by the Magisterium of the Church (to which I would submit immediately), it seems clear to me that the purchase of health insurance which includes some elements of immoral coverage is a matter of remote material cooperation with evil in a situation where it is all but impossible to avoid that remote cooperation. Just as we may morally pay taxes even though some tax money is used immorally and we may morally patronize various business which use a portion of their earnings immorally (and in fact this is inescapable in the modern world), so too I believe that if there is no reasonable way to avoid health insurance with some elements of immoral coverage, then it is not immoral to purchase such coverage.

If purchasing a group health insurance plan that includes contraception constitutes “participation” or “cooperation in evil,” then that participation is remote at best. For example, adhering to a hypothetical regulation requiring religiously-affiliated employers to shove contraception down the throats of female employees would certainly be a direct participation in evil. Requiring religiously-affiliated employers to purchase insurance that includes contraception coverage, on the other hand, is a remote participation in evil. And the Obama administration’s compromise — relieving religiously-affiliated organizations of the obligation to pay for contraception directly, and instead, shifting that burden onto insurance companies — falls somewhere between a remote participation in evil and a direct participation in evil.

It’s a sliding scale of sin.

The question becomes, at what point along the scale between remote participation in evil and direct participation in evil does the balance tip in favor of women and against religious organizations that believe it is their religious duty to ensure that women are stripped of the freedom to choose whether or not they want to use contraception and brand themselves as sinners?

At a certain point, the Catholic Church and other religious organizations must let their flock make their own choices. At a certain point, participation or cooperation in evil becomes far too remote to constitute an infringement on religious liberty. And ultimately, the pseudo-religious complaints about providing contraception, or paying for contraception must give way to common sense, fairness, and justice, whether or not employers pay directly for contraception, or do so through insurance carriers.

Certainly, the distinction between full insurance and self-insurance is an important one, and the religious outcry over the birth control benefit made it necessary for the Obama Administration to compromise, perhaps without giving much thought to how such a compromise would play out in the courts.  But the result of that compromise has paved the way for courts to hang their constitutional hat on the difference between self-insurance and “regular” insurance when it is a distinction without a difference.  

Tyndale claims that paying directly for contraception is a grievous violation of its religious freedom, and as a matter of law, courts are not permitted to nitpick those claims. Tyndale says it’s a sin? Fine. It’s a sin. But realistically, Tyndale could just as easily argue that paying workers a fair wage — or indeed any wage — is a religious violation, and I’m fairly certain that we can all agree that would be an absurd argument.

So what’s the point?

The point is this: We must begin discussion contraception access in terms of fairness. We must view access to contraception for women as being as important as the right to minimum wage.

The argument over contraception is not a religious one. It’s an argument about equality, health care, prevention, and basic human rights. We musn’t lose sight of that.