The Obamacare contraceptive mandate was put into place because providing free contraception provides health benefits to women, families and society. It protected the right of American women to access contraception even if their employers had objections.
Now that President Trump has signed rules expanding who can opt out of providing no-cost contraceptives to their employees, the balance has tipped dramatically in favor of the beliefs of employers at the expense of their staff.
Many women now stand to lose access to free contraception in their health plans. Employers of any size and any type can decline to cover their female employees’ contraception without cost sharing; they must only state that they have a religious or moral objection to doing so.
In research we did at the University of Texas on the impact of religion on women’s contraceptive choices, we found that Texas women negotiate religion and contraception in very personal ways. A Catholic woman who got her tubes tied after giving birth said, “The church is against all that, but I am too old to have [more] children. I had a high-risk pregnancy, and, with the permission of God, we decided to do the surgery.” Another woman who used condoms for contraception recounted, “We are not really allowed to be on birth control. As much as I love my religion and follow up with it, I think that it is up to me to decide my birth control.”
Indeed, religious considerations have very little influence over women’s decisions about whether to use contraception or about which method of birth control to use. In the study, conducted with over 1,000 low-income Hispanic women in Texas, 87 percent were Catholic or of another Christian faith. Among these women, only 6 percent reported that religion influenced their contraceptive choices. And within this small group of women who reported any impact of faith at all, the majority reported that other considerations, including their health or the health of their children, took precedence over their religion’s view of contraception.
Sometimes, women’s religious convictions even compel them to use contraception. A Catholic woman using the pill describes using contraception as a way to help her follow her religious beliefs to avoid unplanned pregnancies and abortion: “If I become pregnant, I can’t get an abortion. It would be a big sin. But, I can try to avoid pregnancy.”
The balance favoring the views of institutions over those of the women they serve is nothing new. Women’s views on contraception — even those of religious women — are often ignored in the U.S. health care system at great cost to women and taxpayers more generally. For example, Catholic ethical and religious directives prohibit elective female sterilizations to be performed at Catholic-run hospitals.
This conflict between access to contraception and Catholic teachings can go to absurd lengths. In Austin, Catholic-owned Seton hospital system took over Brackenridge, the county-owned safety net hospital, when it was in financial trouble in the mid-1990s. Eventually, in order to provide sterilizations and other reproductive health care not allowed by Catholic teachings, the county built a “hospital within a hospital.” Taxpayers were stuck with nearly $7 million of the $9 million remodeling bill. But the hospital-within-a-hospital approach couldn’t survive financially. Women who want a sterilization in the hospital after delivery now must deliver in a nearby for-profit hospital with a doctor on call who they have never met.
Taxpayers foot large bills to support Catholic hospitals. Every year, these institutions receive millions in federal and state funds through Medicaid and Medicare payments.
As taxpayers and Americans who want better health care and want everyone’s religious choices to be respected, we should demand that the Trump administration not cater to the narrow religious views of a few powerful business owners and religious institutions. Instead, our government should protect women’s rights to their own religious beliefs about contraception — and with that, women’s access to critical reproductive health care.
Hopkins is a research assistant professor at the University of Texas and an investigator with the Texas Policy Evaluation Project.