Immaculate Contraception (Condensed Version)
A quarter century after Roe v. Wade codified a woman's right to reproductive freedom, abortion-rights activists are grappling with a new and unexpected foe, one whom Roe-attorney Sarah Weddington could hardly have predicted: Nuns who run hospital chains.Catholic HMOs, hospitals and affiliates, which together play an ever-larger role in healthcare delivery, are effectively nullifying the tenets of the last thirty years of reproductive law. The "Ethical and Religious Directives" -- Catholic health care's seventy commandments -- prohibit abortion, birth control, vasectomies, tubal ligation and the morning-after pill even for rape victims. The result is healthcare that bypasses not just Roe v. Wade but Griswold v. Connecticut, the 1965 Supreme Court decision allowing married couples to seek contraception. Catholic hospitals are the largest nonprofit healthcare providers in the United States. The Catholic Church currently owns five of the ten largest hospital corporations -- amounting to more than 800 hospitals and healthcare systems which together care for more than 70 million patients. What's more, in the past few years, some 2,200 nonfederal hospitals have either merged or entered into an agreement to do so, with Catholic hospital networks expanding the most rapidly. One survey noted a 12 percent growth rate among participating systems in 1997. And, after these mergers, the new entity frequently adopts the Catholic hospital's restrictive reproductive policies. A reproductive health ideology that refuses to care for sexually active women might seem a bit out of touch with reality, but women can always go somewhere else, right? Wrong. Especially if the woman in question is poor. Many low-income women have few other options in their communities but to depend on Catholic hospital care since, in many places, these are the only accessible facilities. In addition, the roll-over of Medicaid recipients into managed care is creating a situation where people can be auto-assigned into managed care plans that don't directly provide contraception or basic family-planning services. Although there have been gains in some state courts -- as in the recent New Mexico Supreme Court decision that medically necessary abortions for Medicaid recipients must be covered because of the state's Equal Rights Amendment -- there is no legal precedent for protesting denial of access on the basis of the US Constitution. If anything, legislative tolerance of such restrictions is growing. The 1997 Balanced Budget Act applies the "conscience clause" -- which originally meant that individuals would not have to perform procedures (such as abortions) to which they have moral objections -- to the institution of managed care. As a result, health plans for federal employees may opt not to include reproductive care on religious or moral grounds. Bring up women's rights, and many defenders of Catholic hospitals respond with blank stares. It isn't about choice, they say, it's about cost-containment. For the sake of argument, are basic health services such as contraception, tubal ligation, vasectomy and abortion cost-effective? According to a 1997 study by Planned Parenthood, the money saved by offering these services in terms of prevention is enormous. Among the findings are that for every 1,000 members who receive contraception, the managed-care organization will save $1.2 million annually on pregnancy-related care. (Birth control pills and exams cost between $285 and $804 per patient per year, while the average cost of delivering an unintended pregnancy is $3,200.) It's ultimately quite costly for insurers if women don't receive these services and the companies end up paying for unintended pregnancy and sexually transmitted diseases. Feminists of the second wave declared that women would never be free until they could control their own bodies, a fierce belief that became law in 1973. But Congress doesn't have to ban abortions if the American Medical Association treats the procedure as beyond the bounds of medical training. And the Catholic Church doesn't have to bother swaying the opinion of the majority of Americans who believe in a woman's right to choose if it owns the hospital they go to. Jennifer Baumgardner has written for Ms., Out, Jane, and Bust. "Girl, You'll be a Woman Soon," a book on feminism co-written with Amelia Richards is forthcoming from Farrar, Straus & Giroux.This article originally appeared in The Nation (www.thenation.com).