By Nicholas D. Kristof, The New York Times, 2/11/2012
I MAY not be as theologically sophisticated as American bishops, but I had thought that Jesus talked more about helping the poor than about banning contraceptives.
The debates about pelvic politics over the last week sometimes had a patronizing tone, as if birth control amounted to a chivalrous handout to women of dubious morals. On the contrary, few areas have more impact on more people than birth control â€” and few are more central to efforts to chip away at poverty.
My well-heeled readers will be furrowing their brows at this point. Birth control is cheap, youâ€™re thinking, and far less expensive than a baby (or an abortion). But for many Americans living on the edge, itâ€™s a borderline luxury.
A 2009 study looked at sexually active American women of modest means, ages 18 to 34, whose economic circumstances had deteriorated. Three-quarters said that they could not afford a baby then. Yet 30 percent had put off a gynecological or family-planning visit to save money. More horrifying, of those using the pill, one-quarter said that they economized by not taking it every day. (My data is from the Guttmacher Institute, a nonpartisan research organization on issues of sexual health.)
One-third of women in another survey said they would switch birth control methods if not for the cost. Nearly half of those women were relying on condoms, and others on nothing more than withdrawal.
The cost of birth control is one reason poor women are more than three times as likely to end up pregnant unintentionally as middle-class women.
In short, birth control is not a frill that can be lightly dropped to avoid offending bishops. Coverage for contraception should be a pillar of our public health policy â€” and, it seems to me, of any faith-based effort to be our brotherâ€™s keeper, or our sisterâ€™s.
To understand the centrality of birth control, consider that every dollar that the United States government spends on family planning reduces Medicaid expenditures by $3.74, according to Guttmacher. Likewise, the National Business Group on Health estimated that it costs employers at least an extra 15 percent if they donâ€™t cover contraception in their health plans.
And of course birth control isnâ€™t just a womenâ€™s issue: men can use contraceptives too, and unwanted pregnancies affect not only mothers but also fathers.
This is the backdrop for the uproar over President Obamaâ€™s requirement that Catholic universities and hospitals include birth control in their health insurance plans. On Friday, the White House backed off a bit â€” forging a compromise so that unwilling religious employers would not pay for contraception, while women would still get the coverage â€” but many administration critics werenâ€™t mollified.
Look, thereâ€™s a genuine conflict here. Many religious believers were sincerely offended that Catholic institutions would have to provide coverage for health interventions that the church hierarchy opposed. That counts in my book: itâ€™s best to avoid forcing people to do things that breach their ethical standards.
Then again, itâ€™s not clear how many people actually are offended. A national survey found that 98 percent of sexually active Catholic women use birth control at some point in their lives. Moreover, a survey by the Public Religion Research Institute reported that even among Catholics, 52 percent back the Obama policy: they believe that religiously affiliated universities and hospitals should be obliged to include birth control coverage in insurance plans.
So, does Americaâ€™s national health policy really need to make a far-reaching exception for Catholic institutions when a majority of Catholics oppose that exception?
I wondered what other religiously affiliated organizations do in this situation. Christian Science traditionally opposed medical care. Does The Christian Science Monitor deny health insurance to employees?
â€œWe offer a standard health insurance package,â€ John Yemma, the editor, told me.
That makes sense. After all, do we really want to make accommodations across the range of faith? What if organizations affiliated with Jehovahâ€™s Witnesses insisted on health insurance that did not cover blood transfusions? What if ultraconservative Muslim or Jewish organizations objected to health care except at sex-segregated clinics?
The basic principle of American life is that we try to respect religious beliefs, and accommodate them where we can. But we ban polygamy, for example, even for the pious. Your freedom to believe does not always give you a freedom to act.
In this case, we should make a good-faith effort to avoid offending Catholic bishops who passionately oppose birth control. Iâ€™m glad that Obama sought a compromise. But letâ€™s remember that there are also other interests at stake. If we have to choose between bishopsâ€™ sensibilities and womenâ€™s health, our national priority must be the female half of our population.