Women's Freedom, Redefined

By Richard Doerflinger

April 11, 2014

President Obama met recently with Pope Francis and Vatican officials, and said afterwards that he had explained to them his mandate that employers with religious objections provide coverage of contraceptive and abortifacient drugs: “Most religious organizations are entirely exempt,” he said.  And those not exempt need only “attest that they have a religious objection” and they are “not required to provide contraception," but in their case “employees of theirs who choose are able to obtain it through the insurance company.”

Every part of this description is misleading.  Most religious organizations are not exempt; and the Little Sisters of the Poor and other religious nonprofits have brought 47 law suits saying that the mandate does require them to help provide the coverage they object to.  

But what of that last phrase, about employees who choose it being able to obtain it?  Supporters of the mandate say this is what the debate is really about:  Employers should not cite their own religious freedom to limit the “reproductive freedom” of their female employees.  They claim the mandate is about ensuring women’s freedom of choice.  But that claim is also wrong, for several reasons.

First, the mandate is of course mandatory coverage for sterilization and all FDA-approved contraceptives.  A woman does not “choose” whether to have it.  Even if she chooses not to obtain contraceptives herself, her premiums will buy them for others in her health plan.

Second, she is not able to choose whether her minor adolescent daughter will get the coverage or the contraceptives.  Every dependent on her family health plan will have access to “free” contraceptives, and the private “education and counseling” to promote their use – and given medical confidentiality rules, a mother may not even know that her 13-year-old daughter is receiving prescription hormones so she can have “safe” sex.

Women who want birth control for themselves may value the freedom to choose a method that best suits their own goals.  But that freedom generally does not depend on coercing employers.  For example, oral contraceptives are available at almost any drug store for a few dollars a month; “emergency contraception” is available over the counter for all ages.

Supporters of the mandate reply that the policy is not primarily about such methods, which are inexpensive but can have high failure rates in practice.  Rather, the mandate will get more women to use drugs and devices that are initially more expensive, but more effective: The IUDs, implants and injectables that together are called “long-acting reversible contraceptives” or “LARCs.”  These last for years without any action by the woman, and cannot be removed or reversed without a doctor’s intervention.  The American College of Obstetricians and Gynecologists says that LARCs’ advantage over other contraceptives is that their effectiveness is “independent of user motivation” – that is, it does not depend on the woman’s own choice.  

The model demonstration program here is the “Contraceptive CHOICE” program conducted in St. Louis in recent years.  The program is oddly named.  It abandoned the usual “non-directive” approach to family planning counseling, instead actively encouraging sexually active women to have LARCs inserted into their bodies at no cost; the women were monitored regularly afterwards to make sure they remained committed to the program.  Not surprisingly, they had few pregnancies, as they had effectively been sterilized.

Expanding such a program nationwide may lower pregnancies and births in the United States – though no one has yet explained why that is such a high priority for our government, in an aging society whose population has already dropped below replacement level.  But this is the government’s goal, pursued without much regard for what women themselves might want.  A choice to stop using birth control for a while and be open to having a baby is not part of this agenda.  The methods to be promoted, and the means for promoting them, have little to do with the choices women may otherwise make, and are in part designed to override them.

Is this what women really want: To be “counseled” that their own very human, therefore changeable, decisions about having a child are not measuring up, and need to be adjusted by physicians and government officials with their own agenda who know better?  Why does this new definition of “freedom” look like what feminists used to call male paternalism?

Mr. Doerflinger is Associate Director of the Secretariat of Pro-Life Activities, U.S. Conference of Catholic Bishops.  To learn more about the bishops’ pro-life activities see www.usccb.org/prolife.