Let me make something clear. I’m pro-contraceptives. When I arrived in Kenya, fresh out of my residency, the country had the highest population growth rate in the world, which was causing numerous health and socioeconomic problems. The nation’s family planning program was not working, and I quickly found out the reasons behind its failure. Women were embarrassed to stand in line for hours at a family planning clinic. The cultural barrier was just as daunting. A woman’s worth in the community was based on how many children she birthed.
In reality, the most dangerous thing a woman in Africa could do was to constantly be pregnant. To deal with this cultural issue, we began emphasizing child spacing to help improve the children’s health by using stories and cultural beliefs that supported it. We went from a handful of family planning users to thousands in our service area.
I also did a research project to show that volunteer community health workers could safely dispense birth control pills using a 10-point screening questionnaire in a country where women did not smoke, have migraines, or other risk factors. The Kenyan government used our results to institute a national program using the questionnaire. Kenya’s population growth rate has since dropped from more than 4 percent to under 2.5 percent a year.
Yet, I’m opposed to the recent contraceptive mandate issued under the authority of the Patient Protection and Affordable Care Act (PPACA) by the Secretary of Health and Human Services (HHS) that requires insurance companies to cover all FDA-approved “contraceptives” with no co-pay or deductible. At the same time, it requires almost all employers to buy these policies. Here’s why I’m opposed:
- Pregnancy is not a disease. – Congress gave HHS the authority to define preventive services that insurance must cover to prevent pathology. Using the cover of an Institute of Medicine committee stacked with ideologues, HHS essentially defined pregnancy as a disease. The highly controversial PPACA would not have passed if a contraceptive mandate had originally been written into the bill.
- Contraceptives are widely available. – Proponents of the mandate have themselves claimed that 99 percent of women in the U.S. have used contraceptives. Though I question the accuracy of that figure, their assertion makes my point that the mandate has not been driven by the inability of women to get contraceptives. In 2006, our government spent $1.85 billion to provide contraceptive services through Medicaid, Title X, state, and other programs.
The real issue is religious freedom. The contraceptive mandate contains the most narrow conscience objection clause ever written into federal law. Its only deviation from the rule allows churches to opt out, leaving all other institutions and individual employers with no right to exercise their religious freedom. This exemption is so limited that Jesus Christ and His disciples would not have qualified for the exemption.
There are huge problems with this:
- · The mandate violates the First Amendment of the Constitution. Congress shall make no law respecting religion or prohibiting the free exercise thereof. Before it was made more concise, James Madison’s initial version of this amendment made Congress’ intent even clearer. He wrote, “The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed.” Yes, family planning is a good thing, but Supreme Court Justice Louis D. Brandeis reminded us that good things can be used as pretexts to abridge our freedoms, “Experience should teach us to be most on our guard to protect liberty when the Government’s purposes are beneficent.”
- This is not just a Catholic issue. Many pro-life proponents also oppose the mandate since it includes all FDA-approved “contraceptives” including “ella” and “Plan B,” two drugs that at times work by destroying the embryo through post-fertilization effects. In a larger sense, this is an issue that touches us all. If the government can force any American to violate their deeply held religious or moral beliefs, it violates each one of us. We must pay special attention to protecting the religious rights of others, especially when we don’t support them. German Martin Niemoller (1892-1944) made this point well when he said, “First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me.”
This is not an issue about contraception, health, women’s rights, or politics, though some would like you to think so. It is an issue about civil liberties, democracy, and religious freedom. If the government can fine employers $600,000 for following the same religious beliefs that have been lawful for more than 200 years, what can’t they do?
Dr. Crispin Sartwell, a self-described “pro-choice atheist” college professor, summed this issue up well in a letter to the LA Times a few years ago, “The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history.”
If we are to protect the individual rights upon which our country is based, everyone must resist the loss of the fundamental freedoms of any single person. Otherwise, we should all be prepared to lose our rights one by one. Which freedom are you willing to give up next?
Check out Freedom2Care.org for more info or to easily speak out on right of conscience issues.
David Stevens, MD, MA (Ethics), is CEO of the Christian Medical & Dental Associations. For more information, please visit their Web site at
 Mosher WD and Jones J, Use of contraception in the United States: 1982–2008, Vital and Health Statistics, 2010, Series 23, No. 29
 Religious institution: (a) Whose purpose is the inculcation of religious values; (b) That primarily employs persons who share the religious tenets of the employer; (c) That primarily serves persons who share the religious tenets of the employer; and (d) That is a nonprofit organization under section 6033(a)(2)(A)(i) or (iii) of the IRS Code