Sandra Fluke, Advocate
“With this common sense bill, we can ensure that Arizona women have access to the health services they need and religious institutions have their faith and freedom protected.”
With these words, Arizona Governor Jan Brewer signed legislation into law permitting any religiously affiliated employer to deny its employees coverage of any contraception used to prevent pregnancy. Sadly, the Governor’s words reflect a wave of anti-contraception state legislation. It is hard to believe we are having this conversation today, the 47th anniversary of Griswold v. Connecticut, the case that decriminalized contraception. And it is hard to know where to begin unpacking the misinformation contained in Gov. Brewer’s short quote. Three problems are immediately evident:
1. “Common sense.” A law that allows any employer to determine what benefits to provide – irrespective of the insurance company’s actual policy – is not common sense. In fact, given insurers’ eagerness to provide contraception and other preventive care coverage because it saves money in the long-run, this law is the very opposite of common sense. Common sense would be to focus on meeting a woman’s health needs without interference by her employer.
2. “Access.” The Governor claims that this law actually bolsters access to the health services women need because it requires coverage when the contraceptive method is used for other medical reasons. But based on my classmates’ experiences at Georgetown University, I know that contraception policies covering only “medical necessities” simply don’t work. Why? Because even for women who have qualifying medical needs, they require extra burdensome steps. In a survey of my fellow students, 65% had difficulty getting their contraceptive coverage, including facing accusations that they were lying about their symptoms even when a health care provider certified a qualifying medical necessity like polycystic ovarian syndrome or painful menstrual cramps.
Just as importantly, science shows that timely access to contraceptive services vastly improves maternal and child health. Planning and spacing pregnancy is in fact a medical necessity for healthy women and healthy families. But instead of recognizing this fact, this law divides reproductive health care into pregnancy prevention versus everything else – a dangerous method of restricting access to a critical health care need.
3. “Protecting institutions’ faith and freedom.” Religious liberty must protect the freedom of faith of individual people, not of institutions. Religiously affiliated employers such as hospitals and universities often employ people of many different faiths. Religious freedom must ensure that each of these employees is able to make her own choices regarding her personal faith – and her personal health care – without interference from someone else’s religion. Asserting an institution’s right to interfere to deny healthcare is not the kind of protection our government should be providing. If religiously affiliated organizations choose to become employers in secular industries, they should be required to abide by the same employment laws applicable to everyone else – laws like unemployment insurance, workplace safety regulations, and the Affordable Care Act’s contraceptive coverage requirement.
There is a ray of hope on the horizon: if the Supreme Court upholds the Affordable Care Act this month, harmful state laws like Arizona’s will not go into effect. The federal regulations issued by the Department of Health and Human Services making preventive care, including contraception, available without copays or deductibles will trump any state law that says otherwise. For this and so many other reasons, we should all be extremely concerned about the impending decision from the Court.
But even if the federal health reform law is upheld and these harmful state laws fall, the political moment we are living through right now is telling – and troubling. Contraception coverage opponents are pushing harmful laws across the country.
In Kansas, the governor has recently signed a bill expanding refusal provisions to allow doctors and hospitals as well as many non-hospital facilities to deny drugs that they believe may cause abortions. The language of the bill may even be broad enough for providers to refuse to provide birth control – and a provider would not be required to refer a patient to a provider who would help her.
In Missouri, the legislature has passed a bill that would allow employers to refuse to provide health coverage for services, including contraception and abortion, that conflict with their religious or moral beliefs.
And North Dakota is putting women’s health up for a vote: a ballot measure includes language so broad that potentially anyone – including employers, landlords and medical providers – could refuse to follow any law based on their religious views.
These are not isolated incidents. According to the Guttmacher Institute, 13 states allow some health care providers to refuse to provide services related to contraception and 18 states allow some health care providers to refuse to provide sterilization services.
It’s not all bad news. In New Hampshire the Senate appears to have shelved a bill that would have allowed employers with religious objections to refuse to provide coverage of birth control.
And the Colorado Senate rejected a symbolic measure expressing support for the Blunt Amendment, a provision rejected by the U.S. Senate that would have allowed employers and insurers to refuse to cover health care services based on the employer’s religious or moral beliefs.
Confronted with these attacks on women’s health care access, women, and the men who support them, realize that we must stand up and amplify our voices – not just in Washington but also at home. I firmly believe that speaking out is something millions of women across this country can, and ultimately must, do to protect our sisters today and our daughters tomorrow.
We can and must write to our legislators, call their offices, author letters to the editor, and spread the word about this dangerous wave of legislation. We must also turn out to vote this year and every year. Our legislators must be held accountable, and we have the responsibility to ensure that they are! What’s at stake is our health and our rights – and we will be heard.For more information, go to www.ReproHealthWatch.org
I have mixed feelings over this difficult issue. I agree absolutely that women should have control over their own bodies. However, I find it somewhat disturbing that if contraception, sterilization or abortion is against the deeply held religious beliefs of the person paying for it then it seems only equitable that the payer should be able to opt out. And then of course every adult knows of some women and girls who really should use birth control.
It seems very simple to me.
In the United States, a religious institution may dictate behavior to its followers. A religion’s followers may choose to behave as dictated by that religion. If a religious institution engages in an activity, and that activity is subject to laws it finds objectionable, then it is free to withdraw from that activity. It is free to practice religion as it sees fit, not change the law to fit its religion.
I think it is despicable that religious institutions attempt to impose their dogma by proxy.
And I think it’s despicable to impose yours on them. The difference is, people who want abortions can work elsewhere if they don’t like the coverage provided. Company owners who believe abetting abortion is a mortal sin are the ones being compelled by law, not employees.
In the United States, a political institution may dictate behavior to its followers. A politics followers may choose to behave as dictated by that political institution. If a political institution engages in an activity, and that activity is subject to laws the follower finds objectionable, then they is free to withdraw from that activity. They are free to practice politics as they sees fit, not change the law to fit their politics.
I think it is despicable that political institutions attempt to impose their dogma by proxy.
N.D. Fay if a person pays for her own health insurance why should someone else dictate how she should use it? just because your boss says i shouldnt pay for your birth control so you shouldnt have it? also, abortion is not paid for by any employer or govt entity becasue of the Hyde amendment. The only way the hyde amendment is overridden and paid for is if it is a case of rape or incest.
As far as sterilization; there are many medical reasons why women get their tubes tied. If the woman has had a ruptured uterus in the past for example, it is more likely to happen again. If the womans’ health is at risk to have any further pregnancies such as type one diabetes(preganacy can lead to kidney failure in the mother for example)in which the mom is dependent on insulin, or a woman with heart disease after one pregnancy or a woman with lupus or cancer. All of these might be a reason a woman has her tubes tied. Also, Why is it religiously wrong to have a woman’s tubes tied but not for a man to have a veasectom? also, what if a husband and wife just feel like they cant afford anymore children?
Agreed with David. Also, there are religious groups out there who don’t believe in taxes, or government at all. For example, think of the extremist Fundamentalist Mormons (not the Mitt Romney kind) who have multiple wives and dozens of children all on welfare. They do it on purpose to “milk the beast” as they call it, since they don’t agree with the government. Should they also be permitted to not pay certain things their religion is against, like taxes?
Deeply held religious beliefs include Christian Science followers who don’t believe in medicine or hospitals. Should Christian Scientists business owners be exempted from participating in Medicaid/Medicare?
The First Amendment states “Congress shall pass no law Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;…” We are all able to follow the dictates of our religious beliefs, but we do not have the right to impose them upon others.
” And then of course every adult knows of some women and girls who really should use birth control.” what does this mean?
Republicans would like everyone to believe that the issue is over WHO pays for these services for American women, as a whole. The real issue is that Republicans want to ABOLISH all contraceptives, abortions rights, reproductive rights and clinics and services and force women to give birth to children they can’t afford. The publicly stated years ago, that they knew they couldn’t get rid of Roe vs. Wade on the spot … that their plan was to chip away at it little by little, state by state. Since the Republicans gained control more of our states AND the majority in the House, they have done even MORE than what they threatened. Every single right that women have right now is “on the line” including our right to vote and our rights to work outside the home and our right to NOT BE ABUSED by a husband or partner. We need to fight against this. If people had “deeply held religious beliefs” against abortion or contraception, they would be willing to help ALL children from the day they are born, including food, shelter, education, clothing, etc. These “people of conscience” are pro-life only until the moment of birth. That’s where the hypocrisy lies. And that’s what exposes them as manipulators and liars, and using the “abortion” issue in order to buy votes as a religious issue, etc.
The use of contraceptives allows TIME between births enhancing both the new child and the Mother’s quality of life. I guess anything that allows the child to have a better chance of good health and keeping Mom able to care and raise the child is ANATHEMA to men.
I would like to see religious organizations recognize the need for a healthy Mother and a better chance of a healthy child with no complications. Probably not in our lifetimes. Women are still not only expendable but easily replaceable in the eyes of those in power. One notices they do not ask the children who have lost a parent HOW easily they feel accepted and accept the new ‘parent’ If the widow or widower chooses to have one. Vaya con Dios!
Contraception is not abortion. And a zygot has no guarantee it will become ‘plugged’ in and be able to grow. Abortions are doing miscarriages did in my generation in a lot of cases – NOT all.
The use of contraceptives allows Time between births enhancing the quality of life for mother and child.
Men in power appear to strongly believe that a mother can easily be replaced – ask any child whose mother has died how ‘easiy’ it was to accept another ‘mother’ or parent!
I’d like to ask a question:
Isn’t requiring workers to abide by their employer’s religious beliefs flying in the face of “freedom of religion”?
This is an facet of this issue I have not seen mentioned. Everyone talks about the religious freedom of the employer. What about right of the employee to believe and worship as they choose? Because I work for someone of a different faith, should I be forced to follow the tenants of their religion?
In my mind, this enters the realm of forcing the employer’s religious beliefs on employees of both sexes, as well as their spouses and families. If religion can be an excuse to deny coverage, I guess an employer who believes blood transfusions are sinful could deny coverage for that procedure, right?
And, if an employer can deny coverage for contraception or any other health care services because of religion, doesn’t that really mean that they are discriminating against people who do not follow the same beliefs? They may not be denying employment to people of other faiths, but it amounts to the same thing if health care coverage is based on religion!
Well said! Employers are not paying for these health care services out of the goodness of their hearts. These are basic rights for the workers they are employing to work for them!!
Has anybody noticed that we who pay extremely high prices for our health insurance are paying for the coverage of VIAGRA for men (the pleasure drug) and it IS condoned and encouraged by the Catholic Church (I am Catholic). I find it extremely offensive to pay for something so men can have their evenings of pleasure when it IS NOT medically necessary for them NOR is erectile dysfunction a life threatening disorder. This drug, when it first came out, was at LEAST $10.00 a pill. This drug HELPS to enable men to impregnate women. Yet I am paying huge prices to help cover the costs of these drugs. Insurance will also help pay for penile implants for men who have this disorder, in order for them to achieve the same results. Never mind that contraceptives are often medically necessary for women with menstrual irregularities, endometriosis, etc. etc. PLUS it helps prevent unwanted and untimely pregnancy, thus decreasing the need for abortions. I have often heard it said that “if men could get pregnant, contraception would be a Sacrament.” And that is the truth.
Someday, I hope, we’ll get around to addressing the underlying societal problem that underlies the passage of ignorant laws for the satisfaction of ignorant people. We will recreate our educational system such that each child learns to differentiate between those things they know and those things they merely believe.
Within a very few years after adopting such a program, we shall discover that demogoguery has gone out of style!
We’ve seen the attack on women’s reproductive rights, both from the church and government, twice. In both cases, the U.S. Census reported the white population in decline. It took 25 years but in 1905, Teddy Roosevelt finally agreed with the Catholic Church that abortion and all manner of birth control were indeed evil. Whites create wealth. Always follow the money to understand motivation.
Question: Why has the press been mute on theis subject? The difference between 1905 and now is education. More women are educated so why then has there not been more media coverage and/or a demand for coverage?
This attack on women will not go away until women stand in unison and make it go away. Once the scent of money mixes in, sharks go into rampage. Since 2010, over a thousand bills restricting women’s reproductive rights have been introduced; all of them submitted by Republicans. Where is this coverage and how do we demand more of it?
It has always baffled me that the same folks who are so adamant about “right to life” are the same ones who would take the food (WIC) out of the mouths of children, deny children healthcare, etc.
My guess is that pontificating about morality (o, that poor, poor fetus) is cheap, whereas food for children uses tax money. Yet, simply calling yourself anti-abortion makes you seem compassionate.
BTW: in the Old Testament (Exodus 23:24?) if you cause the loss of a fetus by striking the mother you are fined, not executed for murder.
My employer is not allowed to tell me how to spend my paycheck, why should he/she be able to tell me how to use my health insurance. They are both COMPENSATION in exchange for the work I do for the employer. Also, its technically illegal to pay a woman less than a man. And while we know that happens, covering all of his medical needs under the insurance but not mine is paying me less. I have PCOS, my employer does not need to know that and I shouldn’t have to discuss my medical needs with my employer. I pay my premiums, I see my doctor, we make my health decisions.
Ironically, the same people who push religious rights of employers would “have a cow” if a Muslim employer required all female employees to wear hijab and men to wear their pants above their ankles. They would point to it as proof that Muslims are trying to force their beliefs on others.
I’m trying to understand the argument. The law says that religiously-affiliated employers do not have to provide coverage for contraception. “Not provide coverage for contraception” means “not have to pay for insurance coverage for contraception.” How is not paying for insurance coverage for contraception the same as denying access to contraception? If my employer chooses to “not provide coverage for” a sex-change operation, or even more simply, elective procedures such as vision-correcting laser eye surgery, do I now “not have access” to a sex-change operation, or vision-correcting laser eye surgery? Without eye surgery, what if my eye glasses fell off while driving, and I can’t see well enough to drive safely? Then I am risking my health and the health of other people. What if some thug breaks my glasses in a dark alley? Without eye surgery, I wouldn’t be able to see well enough to run for help.
Doug, the issue is fairly simple, if you consider that health plans are part of employee compensation; and further the employee often pays a portion (and these days, it’s usually a large portion) of the premium and usually pays co-pays on their own. Health plans are actually less expensive if they include reproductive care, for lots of reasons. For example, with contraception to space children (and most women who use contraception, already have children) makes for more healthy babies and more healthy mothers. Do you realize that the USA has the infant mortality rates of a third world nation? If an employer has a religious issue, no one makes them use contraception. But, if the employer uses their religious beliefs to deny contraceptives to women is just an example of trying to force religious beliefs on her. That’s just not right. From a medical standpoint, a woman’s reproductive organs are connected to all of her other body parts. It’s certainly reasonable that her health plan cover all of her parts, since they all work together. And, don’t forget the financial side. Reliable contraceptives require check-ups and screenings, along with a prescription from a doctor to obtain. All that costs money. Figure that all out, considering that women make about 67 cents for every dollar a man makes. Health plans through an employer are part of employee compensation, and the last I heard forcing religious dogma on employees sets a bad prescent.
That’s some real spiffy demagoguery you got there, Ms. Fluke.
You never actually make the case as to how your constitutionally unmentioned, penumbral, personal “right to privacy” (under which your similarly fabricated “right to contraception” shelters) morphs into a public obligation or responsibility for your fellow citizens to pay for it. If you want to exercise your penumbral personal right to privacy then you should take personal responsibility for it. And that includes paying for it.
Your fellow students at Georgetown really should take up a collection and pay you to shut up before you eviscerate the value of their law degrees. It’s a tough enough market as it is.
Unless, of course, this is what passes for a reasoned analysis at Georgetown. In which case I, as a prospective employer of Georgetown law school grads, thank you for enlightening me as to the poor quality of the education there.
So, Ankylus, you’re saying that men who have erectile disfunction or prostate cancer or a herniated testicle shouldn’t have it covered under their health plans? After all, it’s a medical problem with a man’s *sexual* organs… and if we’re going to separate out sexual organs from the rest of the human body as a “special category” of coverage via the female’s reproductive system, it’s only fair to apply this special category equally to males.
I take it you’re also saying that an employer has the right to deny a man medical coverage for a Viagra prescription unless and until he submits proof from a doctor that he truly needs it for severe erectile disfunction… and that he’s not just one of those men who wants to get a “hard on” more often… which of course would be a frivolous and immoral use of the medication. Also, you’re saying that the employee has absolutely no right to privacy regarding his prescription, and that it’s perfectly fine for his need for Viagra to become “office joke” fodder when the employers lets it slip to his co-workers.
Hormone Therapy Treatment (a.k.a. Oral Contraceptives) are a valid part of female healthcare needs, treating everything from severe medical conditions in young women, to menopause and osteoporsis in older women. They also allow a woman to control her own fertility, which doesn’t just benefit the woman’s health, but also her family’s health and economic standing. With the advent of birth control, MEN were able to wait longer before becoming parents (and able to pursue better education/job placement/financial security) just as women were; plus, as it’s been said before here, with birth control women are able to defer a consecutive pregnancy until her body has had time to heal and to replenish vitamins, minerals, and other nutrients from the prior pregnancy. This improves the health of both the mother AND the consecutive baby.
To be blunt, people like you are against health coverage of female hormone therapy for ONE reason: you can’t get over the fact that we’re talking about the health of a woman’s *sexual* organs, and you insist on bringing all kinds of value judgments related to sexual *behavior* into it. And that isn’t just a wrong thing or an unjust thing to do—it’s also downright ignorant to attempt to put limitations on what IS an issue of basic healthcare, just because YOU are uncomfortable or have value judgments about the activity those bodily organs are *sometimes* used for.
Has a single state outlawed contraception?
Ms. Fluke’s concern is a “tempest in a teapot.”
Aren’t you overlooking that, if Griswald and Roe are correct in their assertions of the right to privacy and conscience, then the contraceptive mandate clearly is in VIOLATION of those precedents by interfering with the private right of conscience and forcing individuals to purchase contraception (even if they don’t use it, they will have to purchase it through the qualified health plan under the PPACA – it is a simple fact of economics that any widely utilized service in an insurance plan does not result in payment of a distributed share of risk, but rather payment of the full cost through the premiums). If it is an illegal act to deny one the right to buy contraceptives, why then would it be legal to require them to do so? Ms. Fluke, your assertions on this issue continue to be a) inaccurate and b) illogical.
It’s truly disturbing that the right wing has picked this fight again, more than half a century after Griswold. They can deny that they’re waging a war on women all they want, but the facts speak for themselves. In state after state, GOP-led legislatures are taking aim at women’s reproductive freedom. And the GOP-controlled House and the GOP minority in the Senate are following suit. What exactly would a war on women look like, if not this?
Go Sandra! Thanks for your courage!
Thanks for continuing to stand up for this important issue! I hope more women will be encouraged to speak up and make their voices heard.
Some of the comments on this post are a reminder that Sandra is right, we must speak out to protect our reproductive freedom! And continue doing so until states and the federal government stops passing harmful legislation!
Thank you Ms. Fluke for your thoughtful call to action and for your ongoing efforts to protect so fundamental a right as women’s health. Your well reasoned essay takes all the air out of the heated, baseless rhetoric coming from the other side. Brava!
I would also like to point out that insurance companies *encourage* employees to get contraceptive coverage—because it costs the insurer far less than covering a pregnancy and delivery. The more people who use contraceptives to control getting pregnant and to limit the number of children they have, the more insurance companies save.
Too, patients who use hormone therapy to treat a condition may be able to avoid surgery, delay surgery, or have fewer surgeries—again, saving the insurance company money.
MemyselfandI complained above about being “forced” to purchase hormone therapy/contraceptive coverage in a group plan… since having it as part of the plan actually *lowers* the cost to you (because it drastically lowers the cost to the insurance company, and they actually *do* pass it on as a savings to the customers), I don’t see why you’re unhappy about saving money.
Birth control is not a right, it is a choice. As women, we have plenty of access to birth control. When I made the decision to become sexually active, I went to my doctor asked to be put on the pill and paid for it with my own hard earned money. I’m not sure why this issue keeps coming up and is falsely positioned as an attack on women. Take responsibility for your own health. If you don’t have a doctor, go to planned parenthood. There are so many other issues women face everyday that really require our attention. We should stop depending on others to take care of us, including the insurance companies, and take control of our own bodies. I never expected anyone else to pay for my personal choice to be on the birth control pill and I certainly did not complain about it. It was important to me and I made it a priority. Something to be said about personal responsibility here that is getting lost in the policical discourse. By the way, I went to a Jesuit college too.