2014 and we are still talking about contraception. Here in the United States where we were FOUNDED on the principal of separation of church and state.
“The Supreme Court on Friday extended a temporary order from Justice Sonia Sotomayor barring the Obama administration from enforcing the contraception coverage requirement of the Affordable Care Act against an order of Roman Catholic nuns.” NYT January 24, 2014
The nuns object because they find the mandate offensive to THEIR beliefs. THEIR beliefs that are now being imposed on others who may not hold those beliefs.
Let us go back in time as to how the contraceptive mandate came about since that seems lost in all the rhetoric and companies discuss the mandate as though President Obama pulled it out of thin air.
July 19, 2011 The Institute of Medicine, an INDEPENDENT advisory board of the National Academies released a report “Clinical Preventive Services for Women: Closing the Gaps” HHS had requested this report as the centerpiece of the 2010 ACA (Patient Protection and Affordable Care Act ) is its focus on preventive services rather than the reactionary health care system in existence. The idea behind the ACA is to foster optimal health and well –being. While both men and women benefit from this, HHS recognized that women would stand to benefit more from expanded preventive services. Thus tasking the IOM with reviewing which preventive services are important for health and well-being and recommend which of these services should be included in the guidelines.
“The IOM defined preventive health services as measures—including medications, procedures, devices, tests, education and counseling—shown to improve well-being, and/or decrease the likelihood or delay the onset of a targeted disease or condition. The IOM recommends that women’s preventive services include:
- improved screening for cervical cancer, counseling for sexually transmitted infections, and counseling and screening for HIV;
- a fuller range of contraceptive education, counseling, methods, and services so that women can better avoid unwanted pregnancies and space their pregnancies to promote optimal birth outcomes;
- services for pregnant women including screening for gestational diabetes and lactation counseling and equipment to help women who choose to breastfeed do so successfully;
- at least one well-woman preventive care visit annually for women to receive comprehensive services; and
- screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.
In the section on contraception they reviewed data on cost sharing and came to the conclusion that it should be available to women WITHOUT any cost sharing.
As a physician what I find most offensive about the arguments against contraceptive coverage is that the vast majority of time women are prescribed hormonal contraception for reasons that have nothing to do with contraception: dysmenorrhea, polycystic ovaries, menorrhagia, metrorrhagia, migraines, endometriosis, luteal cysts and to prevent ovarian cancer. “As the Ovarian Cancer National Alliance notes in its brief supporting the government’s position, “the contraceptive-coverage provision takes an important step forward toward increasing access to treatments that reduce the risk of ovarian and other deadly gynecologic cancers, but the position of the companies and shareholders challenging that provision jeopardizes that access for thousands of women nationwide.” (http://www.religiondispatches.org/dispatches/sarahposner/7542?utm_content=buffera2d66&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer)
Dr. Nancy Stanwood, board chair of Physicians for Reproductive Health, said that hormonal contraceptives such as the pill, the patch, and the ring, “actually decrease the risk of cancers,” including ovarian, uterine, and colon cancers (ibid). IUDs reduce the risk of uterine cancer. Cancer prevention is a reason alone to provide coverage.
Even if we strictly discuss the politics of women’s health, the surest way to reduce the abortion rate is readily available, reliable contraception. From the Guttmacher Institute “access to the range of contraceptive methods without cost sharing can dramatically reduce the rate of unintended pregnancy, with profound consequences for women and society…reducing the rate of unintended pregnancy is by far the most widely accepted and effective means of reducing the need for and incidence of abortion.”
A law or regulation violates the Religious Freedom Restoration Act (RFRA), if it imposes a “substantial burden” on a person’s religious exercise. No one is going to force contraception on the nuns, nor the owners of Hobby Lobby nor anyone else. Their objections to providing it as part of comprehensive preventive services is absolutely ridiculous and I find it incredulous that we are still having this debate in 2014 – IN AMERICA!.
If we allow corporations to opt out of this mandate what is next? Chemotherapy? Surgery? Antibiotics? Legislators need to get out of the exam room and let physicians perform their jobs. We have an extraordinary oversight body in the form of state medical boards in addition to hospital oversight, medical societies, and our colleagues. Interfering with how we practice medicine without knowing the science as we do is dangerous. Treatment decisions are between a patient and physician and no insurer or employer should be intervening with that.