Should Catholic universities be required to offer birth control?



Bridgette Dunlap, a Fordham University law student, knew the school's health plan had to pay for birth control pills, in keeping with New York state law. What she did not find out until she was in an examining room, "in the paper dress," was that the student health service — in keeping with Roman Catholic tenets — would simply refuse to prescribe them.

Bridgette Dunlap organized an off-campus clinic staffed by volunteer doctors to provide prescriptions for birth control because Fordham University's student health service does not do so.

As a result, students have had to go to Planned Parenthood or private doctors to get prescriptions. Some, unable to afford the doctor visits, gave up birth control pills entirely. In November, Dunlap, 31, who was raised a Catholic and educated at parochial schools, organized a one-day, off-campus clinic staffed by volunteer doctors who wrote prescriptions for dozens of women.


"We can't just lie down and die and let religious freedom go," said Sister Mary Ann Walsh, a spokeswoman for the U.S. Conference of Catholic Bishops.


The administration's rule has now run headlong into a dispute over values as Republican contenders compete for the most conservative voters.


The Obama administration relied on the recommendations of the Institute of Medicine, an independent group of doctors and researchers that concluded birth control is not just a convenience, but is medically necessary "to ensure women's health and well being."

About half of pregnancies in the United States are unplanned, and about four out of 10 of those end in abortion, according to the Institute of Medicine report, which was released last July. It noted that providing birth control could lower both pregnancy and abortion rates. It also cited studies showing that women with unintended pregnancies are more likely to be depressed and to smoke, drink and delay or skip prenatal care, potentially harming fetuses and putting babies at increased risk of being born prematurely and having low birth weight.

But the Republican presidential contenders have said moral and religious values weigh heavily in birth control issues. Andrea Saul, a spokeswoman for Mitt Romney, said in an email that he regarded the administration's rule requiring religious employers to furnish birth control as wrong. "This is a direct attack on religious liberty and will not stand in a Romney presidency," she said.

Romney has also pledged to end a federal program, Title X, that provides family planning services to millions of women.

Santorum has taken the position that health insurance plans should not be required to cover birth control. He also favors allowing states to decide whether to ban birth control. He and Gingrich both support "personhood" initiatives that would legally declare fertilized eggs to be persons, effectively banning not just all abortions but also certain contraceptives, including IUDs and some types of birth control pills.


Gingrich wants to withdraw government money from Planned Parenthood because it performs abortions in addition to providing contraceptives, though the federal money cannot be used for abortion.

The Obama administration has itself not been consistent in following expert advice on birth control. In December it overruled scientists at the Food and Drug Administration and blocked increased access to an emergency contraceptive, citing potential risks to young girls who might use them without parental help. The decision was widely seen as an effort to avoid the ire of socially conservative voters and to defuse anger about its pending rule requiring provision of birth control in insurance plans of Catholic institutions.

The Catholic Church considers it morally wrong to prevent conception by any artificial means, including condoms, IUDs, birth control pills and sterilization.

Some Catholic colleges are likely to ask for a yearlong delay in implementing the rule on birth-control coverage, said Michael Galligan-Stierle, president of the Association of Catholic Colleges and Universities. In the longer run, he predicted in a statement that either Congress or the Supreme Court would invalidate the rule. Belmont Abbey College, which is Catholic, and the interdemoninational Colorado Christian University have already sued the Department of Health and Human Services, arguing that the birth-control requirement violates the right to freedom of religion.

Birth control is considered a "preventive service" under the new health care law, but Galligan-Stierle said such services should be limited to preventing disease, not pregnancy.

"We do not happen to think pregnancy is disease," he said. "We think it's a gift of love of two people and our creator."

Despite Catholic teachings, surveys have found that 98 percent of sexually active Catholic women, as in the general population, have used contraceptives.

At Catholic universities, some students support the right of the schools to uphold religious doctrine. But others, particularly professional and graduate students, have found the restrictions on birth-control coverage onerous. Undergraduates are often covered by their parents' insurance, but graduate students are usually on their own and are more likely to be married or in relationships, and in regular need of birth control.

At some schools, students say the rules are so stringent that they have a hard time getting coverage even if they need birth control pills for strictly medical reasons.



"If I want children, I'll need a fertility specialist because I have only one working ovary," she said.


Asked if Georgetown would begin covering birth control under the new rule, she said, "We will be reviewing and evaluating the new regulations, ever mindful of our Catholic and Jesuit identity and mission."

Some Georgetown professors question the wisdom of the university's current policy. "I wish Catholic institutions would have more open conversation about how bans on birth control can increase abortion rates among students," said Robin L. West, a law school professor. "Both are contrary to Catholic teaching, but abortion as I understand it is the graver of the sins, and certainly the greater injury to the fetus and the woman."

The university declined to comment on her remarks.

A 23-year-old, who asked that her name not be used, said she became pregnant while studying at Fordham. In high school, she said, she had taken birth control pills, but gave them up at Fordham because she could not afford the doctor visit needed for a prescription. She and her boyfriend were using condoms when she became pregnant. Though Catholic, she considered abortion, but chose to have the baby. She said she knew six other Fordham students who had become pregnant and had abortions.

Senior Catholic officials said that students at Catholic universities should know what to expect, and that those who disagree with the policies can choose to go elsewhere. "No one would go to a Jewish barbecue and expect pork chops to be served," Galligan-Stierle said.

At Fordham Law School on Tuesday night, Dunlap and five other law students who had worked against the university's birth-control policy sat together at a lecture by Archbishop Timothy Dolan, who had personally asked President Barack Obama to exclude Catholic institutions from the contraception requirement and called the decision against the church "unconscionable."

During his lecture, Dolan criticized people who postponed conception with "chemicals and latex," calling them part of the "culture of death."

Dunlap and her colleagues were feeling proud: They had just won a small victory, persuading Fordham to change its website to explain the birth-control policy more clearly. Now, they wrote down questions on index cards, expecting them to be put to the archbishop after his speech. One concerned contraception.

The moderator read through the questions and deemed some of them too "pointed."

"If I don't ask your question," he said, "I either apologize or I don't care."

Dunlap's queries did not make the cut. Her frustration nearly brought her to tears.

"I can't believe they didn't take our questions," she said, adding that the moderator was trying to silence disagreement. "It dishonors the law school."


When the Obama administration wanted a list of preventive services that women needed to stay healthy and that should be insured with no co-pay, it commissioned a report by the Institute of Medicine, an independent group of doctors and researchers.

Increased access to contraception made the list. The institute's report found the following:

@In 2008, about half of all pregnancies in the United States were unplanned, and 42 percent of the unintended pregnancies ended in abortion.

@When the use of birth control went up, rates of unintended pregnancy and abortion fell. Co-pays prevented some women from using contraception.

@Women with unintended pregnancies were more likely to be depressed and to do things that could harm the fetus, like smoking, drinking and delaying or skipping prenatal care. As a result, babies from unintended pregnancies were at increased risk of prematurity and low birth weight and were less likely to be breastfed. Similar risks occurred when births were too closely spaced. Birth control was important to keep pregnancies at least 18 months apart.

@Birth control pills are also used to treat menstrual problems, some migraine headaches, acne, pelvic pain, excessive hair growth and other conditions. They can also reduce the risk of endometrial cancer, pelvic inflammatory disease and some benign breast diseases.

@Risks and side effects from contraceptives are "minimal." Death rates from pregnancy are higher than those from birth control, except among smokers who take birth control pills.
Last modified: January 30, 2012