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Steve Heilig

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Contraception: What the Doctor(s) Ordered

Posted: 02/17/2012 5:33 pm

Contraception exploded onto the front pages this month. That might seem strange to most people -- what is controversial about contraception at this late date? One headline read "Changes to Contraceptive Coverage Rules Draw Mixed Reaction" and that one wins the 'understatement' award on this topic.

"Conservatives" seized on the issue as a good wedge to attack Obama on many fronts, and hoped that it would somehow awaken some version of a moral majority to political action. Yet almost all women, including Catholics, ignore their putative religious leaders on this issue, and always have -- when they have a choice. In letters and online comments, the most incisive perspectives seem to come mostly from women -- political leaders, doctors, nurses, social workers, and just plain folks. The New York Times editors noted that Catholic authorities were trying to have it both ways, claiming all the special financial privileges of a church but wanting to ignore any strings that might be attached, however compassionate those might be. Others observed that behind this debate was specter of abortion politics -- even though the one proven way to reduce abortions is to make contraception as easily available as possible.

Amongst politicos, the gender split seemed to hold true as well. Three female senators wrote to the Wall Street Journal defending the contraceptive mandate. Some female politicians even felt compelled to boycott the male-dominated House hearing on the topic. In the GOP candidate's race, Romney sought whatever position he could sell to the most people, Santorum at least already opposes contraception, not surprising for a guy who thinks women working is a radical feminist plot. Irrelevant crank Ron Paul and Newt Gingrich were aptly ignored. Kris Long, a nurse writing in the New York Times had it best: "As a former employee of a Catholic-run hospital, I find it appalling that the party of 'individual rights' would stand up for a religious bias rather than for the non-Catholic employees who are deprived of the right to choose health insurance commensurate with the private needs and beliefs. Why should I not be allowed birth control through my insurance because my boss has a problem with it?"

Strangely enough, organized medical voices have been muted in this heated debate. But the contraceptive mandate did not spring anew out of the nefarious White House health reform plan. It is an old idea, long supported among health care policy wonks and, last summer, given strong endorsement by the highest medical authority in the land, the Institute of Medicine of the National Academy of Sciences. Their report, "Clinical Preventive Services for Women: Closing the Gaps," focuses on preventive care for women, including but not limited to contraception. In medical circles it was hardly controversial and seemed to be greeted in the clinical trenches with an "OK, now make it happen" sentiment, as is often the case with rational, evidence-based medical recommendations.

Given that, and sensing that the IOM recommendations might be more controversial in non-scientific arenas, I thought it might be good to have a strong statement of support from the medical organizations I work with, and drafted the statement below for the San Francisco Medical Society's policymaking body:

CONTRACEPTION AS A FULLY-COVERED HEALTH INSURANCE BENEFIT
San Francisco Medical Society

Whereas, the United States Institute of Medicine in July 2011 strongly recommended that "the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity" be a fully covered benefit of all health insurance plans; and

Whereas, the costs of contraception have long been identified as a barrier to many women's optimal use of contraception, with negative impacts on their health and in terms of unwanted pregnancies, as well as discriminatory implications; and

Whereas, The Federal administration has just mandated that contraception be a covered benefit, but health insurance industry representatives have voiced their opposition to this measure and might try to repeal it; now be it

RESOLVED: That the CMA supports the coverage, without co-payments, of all FDA-approved contraception methods as a mandated health benefit of all health plans.

--True to form, this statement was noncontroversial among the 20-plus physicians of various specialties who reviewed it and three physicians signed on as co-authors -- all of them women (I am omitting their names here to protect them from the scary minority), but we could have added men as well. The statement then went to the annual policy-making meeting of the California Medical Association -- a much larger and often more conservative bunch, made up of hundreds of doctors from all over the state. We thought there might be some opposition, but no, in the open debate, the CMA physicians even strengthened the final statement to include voluntary sterilization. Thus, here is the nation's largest state medical association's concise position on this matter:

RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods and sterilization as a mandated health benefit of all health plans.

-- Simple, direct, and medically correct, regarding a private medical matter between women and their physicians. As for the rest of those pundits weighing in, mostly male and including religious figures and politicians, I can't help but be again reminded of what pioneering lawyer and yes, feminist Florynce Kennedy once quipped, "If men could get pregnant, abortion would be a sacrament."

I also can't help but note that just this week, a report from the widely-respected group Save the Children confirmed what has long been known -- one out of four children already here on this planet are malnourished, and many of them are starving to death around the world, at a rate of one every five minutes. I respectfully wonder if the church and political leaders opposed to contraception could meditate on that for a moment, and instead of fulminating against one of the only solutions we have, devote their time and energy towards alleviating this ongoing tragedy of suffering in the world. And perhaps they could listen to what doctors think as well. But I will not hold my breath.

 
 
 
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03:46 PM on 02/19/2012
Churches that meddle in politics should be forced to give up their non profit status.
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cwebster
predominantly exasperated
03:10 AM on 02/19/2012
Now if we can just get the brainless politicians and religious whiners to LISTEN.
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phal4875
The world is run by cats; we just feed them.
06:25 PM on 02/18/2012
One wonders why women seem to be the targets. Why do churches not campaign for coverage of vasectomies? That would reduce the number of unplanned births, child poverty, abortions, and women who are too busy raising children to be able to work outside the home.
06:11 PM on 02/18/2012
Below is an insightful, explanation of the Church's teaching on the issue of contraception. Personally, I think the Church's teaching on marriage, sexuality and the family is incredibly beautiful, dignified, and uplifting. Whether one agrees or disagrees, this short essay provides a succinct and powerful explanation of the teaching, while leaving the open-minded reader with a lot of food for thought.

http://allhands-ondeck.blogspot.com/2012/02/contraception-and-catholicism-what.html
07:41 PM on 02/18/2012
Mister H - With no disrespect for your beliefs or how beautiful they may or may not be; this is not a country governed by religion. You can hold those beliefs and I can hold other beliefs. I am surprised that the Catholic Church itself, if those beliefs are so beautiful is unable to convince the women (or the men for that matter) in its own belief system to stop using contraception.
But all that is beyond the point. In this country we have freedom of religion. And the institutions covered by the law are SECULAR organizations (they accept federal funding & therefore MUST be secular). Therefore, they exist under laws that are not made based in 'beauty' or the desire to have people act one way or another, but in secular thought - actual data etc. That may not seem 'beautiful' to you, but you are free within your own church, or here, or on the street corner, what it is that you believe. But we - are free to follow your belief system or not - regardless of how beautiful it may or may not be.
08:01 PM on 02/18/2012
1. The Church is not asking to govern the country, it is asking to be left alone.

2. 100% of Church members have told lies, but that fact does not invalidate the Church's teaching on honesty.

3. One does not give up one's rights when one accepts federal funds.

4. Contraception is not a right. In fact, contraception is not even health care, it is a lifestyle choice that enables people to have sex without responsibility. Contraception does not treat an illness or disease. In fact, it does the opposite, by inhibiting the normal, healthy functioning of a woman's reproductive system.

5. People are free to use all the contraception the want. There is no "access" crisis; contraceptives are everywhere. The government, though, has no right to to force anybody to provide contraceptive access to others against their religious beliefs.
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Bonsailady
70, sexy, wonderful Wiccan
09:14 PM on 02/18/2012
Great post!
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SmileAndActNice
Utilitarianism, the -ism that works.
08:16 PM on 02/18/2012
And you may not impose those beliefs on your employees.
09:27 PM on 02/18/2012
And we are not imposing our beliefs on anyone. They are free to do what ever they want. However, we are not going to help them do it.
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banana republican
Next in line for crumbs from the King's Table
10:17 PM on 02/18/2012
To smileandact: please add to your sentence: ".......and the employee may not demand that I, as the employer' forsake my belief to cater to his/hers."
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Carl Caroli
I just don't understand people
05:57 PM on 02/18/2012
Both the church and the GOP needs to understand the big difference between being righteous and being self righteous. They've crossed the line.
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Mindy Czech
Cindy's wife for life.
04:13 PM on 02/18/2012
99% of sexually active women use birth control in their lifetime, which includes 98% of Catholic women. Now that the duty of covering the birth control falls entirely on the backs of the insurance company, including the copay, these people have nothing to complain about because they can't claim they're being forced to pay for somethin they don't support. Yet they still are. It's so misogynistic and hypocritical, when you think of how most of these same insurance companies cover Viagra and Cialis without a doctor's note saying that the man taking it is only taking it so he can impregnate his wife. Women get to be punished with a pregnancy they don't want them to be able to prevent or terminate for daring to have sex for pleasure, but men can do whatever they want.

If a large company that employed hundreds, if not thousands of people was run by Jehovah's Witnesses, and they refused to allow blood transfusions and organ donations to be covered due to it being against their beliefs, would you be singing the same tune of religious freedom? If they hired people of all faiths, including Jehovahs Witnesses that don't go by that rule, would it be okay for them to force their religious beliefs onto their employees, even though they themselves wouldn't be the ones paying for the blood transfusions and organ donations? Something tells me it wouldn't.
07:44 PM on 02/18/2012
Particularly since those organizations that must follow the policy are FEDERALLY FUNDED. That means they must be SECULAR.
08:21 PM on 02/18/2012
1. Not sure what your point about the 98% is. 100% of Catholics have told a lie at some point in their life, but that fact does not invalidate the Church's teaching against lying.

2. It is not about who is paying. Contraceptives, sterilization, and abortifacient pills would be still provided through the Church's insurance policy which means the moral substance of the situation is unchanged.

3. Coverage of Cialis and Viagra is irrelevant to this situation. Cialis and Viagra restore man's sexual function when it has been lost due to illness or disease, which is exactly what health care is supposed to do. Oral contraception on the other hand does not restore healthy function, but rather inhibits the healthy function of the woman's reproductive system. That is not what health care does. Pregnancy is not a disease, nor is it an illness. Thus, contraceptives are not health care. They are a lifestyle choice so that people can have sex without reponsibility.

4. If a person, is not willing to comply with the beliefs of their religious employer, they should not be working their. Let them vote with their feet. That is what we do in a free society. There are plenty of secular organizations they can work for. Plus, you are talking apples and oranges. Blood transfusions are health care. Contraceptives are not.

By the way, you should be aware that inserting name-calling and personal attacks into your comment as you do above significantly weakens your argument.
01:02 PM on 02/18/2012
What if an institution was run by a religion that said allowing women to drive goes against the institution's conscience? (There are large such religions in the world, you know.) If a woman employee of that institution was injured in a car accident, the employer might argue that they should not be required to supply health insurance that would pay for attending to those injuries, since that would just encourage more women to drive. Revoking health insurance for women drivers would support the institution's moral beliefs.
12:52 PM on 02/18/2012
What if an institution was run be a religion that did not believe women should be allowed to drive. They are out there, you know. And what if a woman driver was injured in a car accident. Should that institution be required to pay for health insurance that would attend to her injuries? Wouldn't that just encourage women to drive which violates the institution's religious beliefs?
08:24 PM on 02/18/2012
Your comment is not relevant. The Church is not saying women cannot use contraceptive, they simply do not want to provide access to the contraceptives against their beliefs.

Plus, in your example, why would a woman who wants to drive go to work for such an organization?
10:35 PM on 02/18/2012
The ultimate goal of that church is to ban contraceptives entirely. The reason it hasn't done it so far is because it doesn't have enough political power in this country. In other countries where it does have that kind of political power, people can't get contraceptives or abortions.
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cwebster
predominantly exasperated
03:16 AM on 02/19/2012
His comment is completely relevant. You are insisting on the same thing...he's pointing out the absurdity of your defence of the church's actions.
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Stephen the Grate
There is grandeur in this view of life ...
05:40 AM on 02/18/2012
Great article! Now if we could only get the GOP to listen to the medical professionals as well as the people who these arcane laws affect - women!
08:41 AM on 02/18/2012
The GOP doesn't listen to science, remember?
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giftsthatpurr
zestful life
02:50 AM on 02/19/2012
They don't even listen to (or follow) common sense.
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CalSailor
Christian, therefore liberal
12:58 AM on 02/18/2012
What men who don't get why this battle over contraception sa a medical health care issue is so important is that they don't realize that women who do not have sex also have a need for "contraception". Even nuns living in cloistered convents are subject to reproductive cancers; they, too, have to deal with the effect of menopause and other medical issues, for which contraceptives are the only prescription.

How many of the bishops understand that they have nuns and sisters in their dioceses who need these contraceptons, and for whom these are major components of comprehensive health care coverage.

But others are affected as well. The two hospitals nearest to me are both Catholic related institutions. Founded by nuns nearly a century ago, in a time of great medical need, they are truly a gift to the communities. But why should one of these hospitals hire a third rate radiologist, for example, who is so desperate for a job tha she'll accepts these coverage limits as something she HAS to accept, while a truly first rate physician went elsewhere, somewhere where she can get truly cmprehensive care? And why must women give up their OWN beliefs on this issue because of a lable on the door.

But there's another group affected as well: Patients. How many patients will be harmedby mistakes made by a less than superior employee over decades of employment? You and I are at risk, too.

Pr Chris
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Mindy Czech
Cindy's wife for life.
04:19 PM on 02/18/2012
In the early 1960s, my Busia's uterus prolapsed after having four children. After being sent to the hospital, her (Catholic) doctor, along with Busia, had to confer with a priest before she was allowed to have a hysterectomy. Why? Because they wanted to make sure she wasn't doing it so she could have sex without worrying about getting pregnant. Her uterus fell out, she was at risk of sepsis, yet she had to get permission from a priest? It was insane then, and it's insane now, yet these people want to bring us back to those days.

Also, my parents both work at a Catholic hospital. I have severe PMDD and was having two full periods a month that would only be remedied by me taking hormonal birth control. While under their insurance, I had to have my doctor write the insurance company a special note every time I got my pills, and then my shot, saying that I needed it for medical reasons. It was none of their business why I needed it, yet they made us jump through stupid hoops every single time. How on earth is this acceptable?
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phal4875
The world is run by cats; we just feed them.
06:27 PM on 02/18/2012
Catholic institutions seem to make their own rules and regulations. They can send us to Hell if they wish. Some people must still believe that.
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cwebster
predominantly exasperated
03:18 AM on 02/19/2012
It is not acceptable.
Chauncey1186
EMAILGATE!!!
12:01 AM on 02/18/2012
Bottom line - this is about sl@t-shaming. It has nothing to do with contraception - just as the "pro-life" movement has nothing to do with "life" but everything to do with imposing puritanical religious views on everyone in this country.

Any Republican that tells you otherwise is a liar.
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Mindy Czech
Cindy's wife for life.
04:21 PM on 02/18/2012
So very true. To them, women are supposed to be either madonnas or tr@mps. And only tr@mps take birth control and get abortions, apparently. So I guess that means only 1% of the population qualifies for madonna status. These folks want women to pay for daring to have sex for pleasure either inside or outside of a marriage by getting saddled with a pregnancy they don't want them to be able to prevent, and don't want them to be able to terminate. Absolute insanity.
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phal4875
The world is run by cats; we just feed them.
06:28 PM on 02/18/2012
The 1% consists almost entirely of nuns.
09:33 PM on 02/17/2012
Thank you Mr. Heilig for bringing the weight of your expertise to this topic. You've made an eloquent and powerful argument.

With hope that a practicle view of the topic might resonate with souls caught in the heat of a strangely political fight over a very personal topic - CWF
06:29 PM on 02/17/2012
Issa is the gift that keeps on giving.He exemplifies the values and
beliefs of the republican party.
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Mindy Czech
Cindy's wife for life.
04:24 PM on 02/18/2012
Kind of like when Tom DeLay went to the Mariana Islands, a US territory that holds tons of sweatshops. After touring the sweatshops, there was a big dinner and conference and he said to everyone there how the Mariana Islands were exactly what the republican party was all about.

True story.
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phal4875
The world is run by cats; we just feed them.
06:30 PM on 02/18/2012
Is Issa still stealing cars? Once a thief, always a thief. Now his victims are American voters.