Faithful Catholic feminists, discussing tough issues.

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Recently the Trump Administration rolled back the Affordable Care Act’s birth control mandate - allowing organizations to refuse “no questions asked” coverage of birth control on the grounds of religious freedom. The University of Notre Dame is among the most prominent organizations to announce it will be utilizing this religious exemption, and dropping birth control coverage for women without a medical need.

THE PRO SIDE: Agreeing with Notre Dame's decision to drop contraception coverage

By Samantha Povlock

To start off, it’s important to note that there are a whole list of reasons why the so-called ACA “Contraceptive Mandate” is ineffective at promoting women’s freedom and health.

But as a feminist, a Catholic, and an alumna of Notre Dame myself, I wanted to respond specifically to the discussion I’ve seen around the University’s decision, and to challenge the most common claims I’ve seen for why this decision is an attack on women.

1. Women need birth control to address chronic health conditions

Women who use birth control to treat medical conditions will still be covered. Got it.

How about

We mandate treatments that actually heal women’s chronic health conditions? The pill and other forms of birth control are commonly prescribed to women as a treatment, but they don’t actually heal anything. The pill, for example, supplies a woman’s body with a synthetic state of pregnancy hormones, so that she doesn’t ovulate. While this certainly can alleviate symptoms of hormonal issues, it doesn’t treat the underlying issues, which basically just forces women to become dependent on birth control for life.

2. Wait, but health conditions! (again).

"No woman should ever be denied health care because her employer or university's religious views are prioritized over her serious medical needs," said Rochat - one of three Notre Dame students who joined the ACLU in suing the Trump Administration over the new religious exemption.

To reiterate - any woman filling a prescription for birth control to treat a medical condition will still be covered under the University plan.

Let’s move on.

How about

We address the real issue here: women’s sexual autonomy. If we’re referring to ongoing reproductive medical issues, then once again - birth control is still covered. But if by “serious medical needs” we’re referring to pregnancy, then let’s at least acknowledge that: because that argument is more about freeing women from nature’s rules about sex, and less about women’s health generally. (Refer back to #1).

3. Without the mandated coverage, women cannot access birth control

Quick clarification: without the mandate, women cannot access birth control for free - at least not from the University.

A quick google search lists plenty of other options for obtaining free or low-cost birth control, including buying it from Wal-mart or Target for $9 a month.

How about

There are hundreds of drugs that people - including women - need to take to manage chronic conditions or life threatening illnesses. Why should birth control trump free access to those?

4. Women need birth control to be successful

"We shouldn't be materially disadvantaged because we have women's bodies," said Kate Bermingham, a PhD student at chose Notre Dame.

I agree - and I actually wrote a piece on this right after graduating from Notre Dame. The premise is that “... as long as childbirth is understood as contrary to women’s success, abortion and birth control do remain the sole foundation for women’s equal opportunity to thrive.”

“For when has a woman reached sufficient “success” to deem it acceptable to be a mother? Once a mother, is additional success rendered impossible?”

How about

We enact change and create policies that provide realistic options for women - including mothers - to pursue “successful” paths, rather than mandating temporary sterilization as her “terms” of agreement for equal access to these things?

5. It’s discrimination against women not to provide us with birth control

This is the heart of the issue, I think.

.“Blocking access to basic health care that 99 percent of women use at some point in their lives is unlawful, discriminatory and harmful,” Fatima Goss Graves said in a statement (She’s the CEO of the Women’s Law Center - one of the organizations filing the lawsuit against President Trump). “Everyone deserves birth control coverage, no matter where they work, how they are insured, or where they go to school. Our lawsuit aims to shut down this latest assault by President Trump on women’s health, equality, and economic security.”

Reminder: we’re not talking about birth control to treat medical conditions, we’re talking about free unrestricted birth control for the purposes of pregnancy prevention. This is a complicated, and multi-dimensional topic.

As I can personally attest, pregnancy has an incredible, permanent impact on a woman’s life. So by no means do I think we should take it lightly. Yet I think we do a disservice to women when we don’t talk about the real root of these issues: sex.

Yes, women experience sex differently than men. We are physically more vulnerable, and birth control can make us feel more “safe” but it doesn’t entirely remove the risk of getting pregnant. So relying on it as a sure thing perpetuates two problems for women: we reiterate the message that equality for women is a privilege for only the child-less (point #4), and we give women a false kind of sexual “freedom,” where if she does get pregnant her only “choice” is abortion.

Further, if women require birth control in order to be “equal” to men, isn’t that fundamentally discriminatory? I can think of nothing more un-Feminist than proposing women must function like men in order to be equal to them.

Think avoiding sex is too hard? It may not be fun, but I also believe women are strong enough to handle it, strong enough to choose what is best for them. Strong enough to require men to do the same.

How about

We refocus feminist efforts to give women the ability to have uninhibited sexual encounters, and work towards REAL equality: like ensuring equal pay, mandated maternity leave, affordable childcare, domestic abuse resources, or an end to sex trafficking, pornography, and poverty.

The only lasting way we’ll make progress in these arenas is when we stop defining “discrimination” as the way women’s bodies work; that would finally require true equality.

THE CON SIDE: Disagreeing with Notre Dame's decision to drop contraception coverage

By Charlene Bader

With birth control coverage as a new “essential health benefit” of the Affordable Care Act, some employers have taken their objections to the Supreme Court, in the name of religious liberty. The University of Notre Dame recently announced its intent to remove contraception from employee and student health plans.

The question isn’t whether employers should have the right to exclude certain medical care in health insurance plans, based on religious reservations, but why the fight over birth control, specifically?

Why is birth control the lynchpin of moral oversight on healthcare, as opposed to other medical coverage that might be morally objectionable, but doesn’t involve women and sexuality?

This wasn’t even an issue until Obamacare re-classified contraception as preventive wellness care, making it available with a $0 co-pay. Plenty of religious employers, Hobby Lobby included, had birth control coverage in their health insurance plans prior to this. It didn’t violate their conscience until the Affordable Care Act became a hot political topic circa 2011. As a result of this new legislation, employers assumed women would have licentious consequence-free sex, with the employers themselves held morally culpable, because they paid into the insurance plan that made it all possible.

Before I go any further, I understand that some forms of birth control are linked to abortion. But this particular issue isn’t an abortion debate; if it were, we would only be addressing the inclusion of abortifacients in health insurance coverage, and not birth control in general. My primary concern, in this article, addresses scrupulosity over women’s reproductive health in employer-sponsored insurance plans, while other healthcare that has potential for moral compromise is ignored.

Most employers who exclude contraception from company health insurance plans fund its therapeutic use, with a prescriber’s prior authorization. Through this process, your doctor signs a form that confirms you will only use the prescribed birth control pills for acne or PCOS or to treat extreme PMS --assuredly not as contraception -- and then insurance covers it.

But why this extra moral checkpoint for contraception? What about all of the other medicines that might enable behavior contrary to ideal Catholic morality?

In Christian thought, lust is accompanied by six other deadly sins, and a myriad of health-related sins. Should acne medicine not be covered, because it could contribute to the sin of pride or vanity? Should Cialis require prior authorization, including a note from one’s wife, confirming it won’t be used to commit adultery? Should hospitalization and recovery for attempted suicide not be covered? After all, it breaks the Sixth Commandment, and including it in coverage might communicate that an employer doesn’t take their faith seriously.

What if Viagara is used by a man who’s had a vasectomy? Should we require prior authorization? Can you imagine THAT conversation with your pharmacist?

“Well, it appears this is a restricted item by your particular health insurance, and we’ll need to do a little more work to get it approved. I have your doctor on the line. He wants to know if you’re free this Thursday for a vasectomy reversal?”

If an employee’s 15-year-old daughter gets pregnant, should the employer’s health insurance plan cover that maternity need? Or would that just enable her to continue in this sinful lifestyle? What if she gets an STD? We shouldn’t have to pay for her stupid, careless life choices.

Could an employer be morally culpable if their health insurance plan covers blood pressure medication that enables a manager to live consequence-free in his unholy rage? Or are the moral issues that lead to this guy’s heart attack none of the employer’s business, and please get the hell out of his man cave?

Why are we so concerned about prescriptions related to women’s sexuality, but not all of the other medications that might also enable behavior contrary to ideal Catholic morality?

In my wandering through comment threads, I come across this sentiment quite often, regarding mandatory coverage of birth control: "It's a recreational activity for them, so why should we be forced to pay for it? By that logic, Obama should also have to pay for my ski trip."

Is your overeating and excessive TV watching also a recreational activity? Why should I be forced to subsidize your sloth and gluttony by paying  for your cholesterol meds? What about the broken leg you got while showing off on your ski vacation? Why should I be forced to pay for your immodesty?

Look, I get it. Yes, birth control used as contraception IS a lifestyle choice. And if this lifestyle choice violates your religion, and you don’t want to be complicit in it, I can understand that. But please, be consistent.

If we’re going to require an affidavit from female employees that their hormonal birth control will only be used therapeutically and not contraceptively, should we not require the same virtue statement from every other employee regarding any medication or medical treatment with the potential to enable behavior the Church finds sinful?

Even sanctioned Catholic birth control can be used illicitly. If a health insurance plan is generous enough to cover Natural Family Planning education and equipment, perhaps an employer should require value statements from their employees that they will only use NFP licitly, avoiding pregnancy solely for grave reasons. Too far? Too personal? Not necessary? Exactly.

Some suggest this moral predicament is easily resolved by making birth control part of an employee’s self-pay responsibility, similar to how many companies address dental or vision care. Women can just buy it themselves without health insurance. It’s not that expensive.

If our concern, however, is employer culpability, this solution doesn’t exonerate the company at all (based on the assumption that an employer funding a health insurance plan is morally responsible for their employees’ licit use of birth control medication on that plan). The employee could use a Health Savings Account – funded by employer contributions – to purchase birth control, even if it’s not covered by the employer’s health insurance plan. (The IRS mandates what healthcare can be purchased with an HSA, and birth control is included.) The employee could use his or her personal paycheck – funded by the employer – to purchase birth control.

If your response is, “That’s the employee’s personal decision, and it’s against the employer’s beliefs, but they’re not complicit in it,” I would agree. They’re not. Even though their money is paying for it. In the same way, if an employee uses any medication illicitly from an employer-sponsored health insurance plan, the employer is not complicit. There’s no need for the morality police here.

In the very personal nature of this issue, I think it’s easy to overlook the root of Catholic teaching against contraception. It isn’t prudishness or legalism that informs the conscience of those who find moral objection with contraception. It’s a deeper vision for family and society that sees children as always and everywhere a blessing.

If Notre Dame’s well-formed Catholic conscience is so bound by this belief that children are a blessing -- to such an extent that the university cannot, under any circumstances, conscionably fund contraception -- then the natural fruit of this uncompromising worldview will undoubtedly inform Notre Dame’s entire approach to employee and family policies.

As a follow-through from their virtuous health insurance revisions, I expect to read about Notre Dame’s gold standard in family values through free on-site childcare for employees, students, and teachers, fully-paid maternity leave, inclusion of NFP and naprotechnology specialists in comprehensive health insurance plans, generous sick pay and family leave provisions, unparalleled healthcare for employees’ children with special needs, including every type of unlimited therapy, flex scheduling, livable wages that can support stable family life for every single university employee from janitor to food services cashier to professor, college scholarships for employees’ children, and a plethora of innovative pro-family policies that will be held up as an example for conscionable Catholic employers throughout the nation.

Personally, I don’t believe employers should be involved in health care at all. Why are we asking people who specialize in computers or housewares or home improvement or education or religion to also specialize in something as complicated and unrelated as health insurance?

Let’s get employers out of healthcare altogether. Employers could offer employees extra cash to purchase a plan of their choice from an independent insurance company. Why create all of these independent company-based risk pools? Open up the market! Or go single payer, and create one big risk pool. I don’t care!

But please, for the love of God (literally), get employers out of healthcare, especially women’s healthcare.

Editorial Note:

Feminism and Catholicism are complicated, personal subjects. These issues have many  dimensions, and we wanted to create a space to voice some of those pieces here, by women faithful to Church teaching but with a decidedly pro-woman focus in mind.