In Objecting to IOM’s Support for Family Planning Services, Bishops Do Not Speak for Catholics

David J. Nolan, Director of Communications

The United States Conference of Catholic Bishops (USCCB) has been one of the most vocal critics of the Institute of Medicine (IOM) report to the Department of Health and Human Services making recommendations for preventive health services for women that should be covered at no cost under the Patient Protection and Affordable Care Act of 2010 (ACA). Women’s health, rights and reproductive justice groups—including Catholics for Choice—and the public health community has been unanimous that this was a step in the right direction.

In lock step with their relentless efforts to eliminate all access to reproductive healthcare services, including contraception, the USCCB continues to chip away at access to these essential health services, limiting the right of every individual to make their own decisions, based on their individual conscience, about whether and when to have children, regardless of their financial circumstances. Just when more US families than ever are relying on insurance coverage and public social safety net programs to help them ride out these difficult economic times, the USCCB is working against more affordability and better access to healthcare, having failed to convince Catholics in the pews to support the bishops’ complete opposition to modern contraception.
In a press statement opposing the report, Cardinal Daniel DiNardo of Galveston-Houston, the chair of the USCCB’s Committee on Pro-Life Activities, denounced the recommendation for insurance coverage of family planning services, claiming that for “those who conscientiously object” to family planning, the IOM’s decision “violates [their]deeply-held moral and religious convictions.”He went so far as to make the wild claim that the recommendation “undermine(s) the good of women and children, the consciences of employers, employees and health plan providers and the common good.”

When Cardinal Daniel DiNardo denounced the Institute of Medicine’s call to include comprehensive family planning services as a preventive benefit for women’s health under the Affordable Care Act, he showed how out of touch the USCCB is with the beliefs, opinions and needs of Catholics, and discounted out of hand the point of the recommendation, made by experts in the field: family planning is preventive healthcare for women.

The bishops are not representing Catholics when they make these claims; in fact they aren’t even representing Catholic teaching very well. Catholic teaching requires due deference to the conscience of others in making decisions—meaning that healthcare providers must not dismiss the conscience of the person seeking care.

In fact, Catholics use family planning at the same rate as do other women in the US —98 percent of sexually active Catholic women report having used a method of contraception that is banned by the Vatican. The majority of Catholics also support coverage for family planning services. In a poll conducted for Catholics for Choice around passage of the ACA, six in ten Catholic voters (63 percent) supported health insurance coverage—whether it is private or government insurance—for contraception, such as birth control pills.

Some believe “conscience rights” must be protected with legal refusal clauses, but these policies (commonly referred to as conscience clauses) often go far beyond protecting the religious and moral beliefs of healthcare providers. Instead, they are effectively used as a means to refuse some treatments and medications to all comers.

Under the guise of protecting religious freedom, the USCCB continues to work to influence the political process, seeking to increase obstacles to reproductive health services through the expansion of refusal clauses in various pieces of legislation. They have sought to expand both those who may claim these protections—refusing to provide services, coverage and in some cases even medical training related to the service in question—and what services they may refuse (for example, contraception or sterilization, as well as abortion). These sweeping refusal clauses restrict patients’ access to critical healthcare services and direct the focus away from the conscience of patients and their individual healthcare providers.

While the USCCB and others claim that refusal clauses balance freedom of conscience for the provider and the patient, most do not provide protection for the freedom of conscience of the patient seeking contraception, sterilization or any other reproductive healthcare services. In fact, the bishops try to block patients from exercising their conscience by seeking permissions for providers to refuse to provide timely referrals to patients whose very lives may depend on them. The result is that women and men seeking legal reproductive healthcare services, particularly the poorest of the poor, are routinely denied access to or encounter overwhelming obstacles in accessing services and finding able providers for those services.

When pharmacists refuse to fill prescriptions for contraception, or insurance companies refuse to cover the costs of reproductive health services, they ignore the conscience of the woman, or man, seeking that service. This certainly does not protect any definition of “conscience rights.” We recognize the right of individual medical professionals to decline to provide services they consider immoral. However, we believe that it goes too far to grant such rights to an entire institution—such as a hospital or managed-care provider—or, for that matter, to allow blanket exclusions of coverage for certain healthcare services, thus impeding access and violating the individual conscience of the patient.

The majority of Catholic voters have rejected the hierarchy’s demands for ever-expanding refusal, or “conscience,” clauses as they lobby to legislate exemptions from services and medications by entities such as hospitals, pharmacies, and health insurance plans that simply do not have a conscience to protect. In a poll conducted by Belden Russonello & Stewart for Catholics for Choice, two-thirds (65%) of American Catholic voters believe that hospitals and clinics that take taxpayer dollars should not be allowed to refuse to provide medical procedures or medications based on religious beliefs. Moreover, 78 percent of Catholic voters oppose allowing pharmacists to refuse to fill prescriptions for birth control. This comes as no surprise when one considers that98% of Catholic women have used a birth control method the bishops find objectionable. Those women want to be able to get the preventive healthcare they need, and the IOM’s recommendation would make it increasingly possible for them to do so by removing unnecessary obstacles based on a minority’s ideological vision about women, sexuality and reproductive health and rights.

The bishops’ disingenuous opposition to the IOM’s recommendations based on the issue of “conscience rights” is simply their usual smokescreen, a means to the bishops’ end goal of eliminating access to reproductive healthcare services, including contraception—even emergency contraception. The bishops employed these same diversionary efforts to derail access to reproductive healthcare in the ACA and continue to do so in the debates surrounding HR3/S877, “The No Taxpayer Funding for Abortion Act,” as well as in numerous attacks on family planning and abortion at the state level.

Catholics for Choice serves as a voice for the great majority of the faithful in the Catholic church who disagree with the bishops on matters related to sexuality, contraception and abortion. On these issues, Catholics are not so different from the rest of Americans—we use birth control at the same rate as other women; we have abortions at the same rate as other women; and we expect our elected officials to listen to what we need, not what the bishops claim to know is best for us. The bishops’ ideas about protecting religious freedom through inappropriate and vague refusal clauses, even when they are called “conscience clauses,” are disrespectful of all of us, including Catholics. We do respect the conscience of healthcare providers. We just expect them to respect our conscience, too.

Please also read In Good Conscience: Respecting the Beliefs of Healthcare Providers and the Needs of Patients, a brochure from Catholics for Choice that outlines the history of refusal clauses in the United States as well as the ways in which these “conscience clauses” are in fact out of line with Catholic teachings on conscience and social justice.

Please don’t hesitate to contact me if your need additional information about what Catholics really think about this issue. You may contact me directly at 202-986-6093 or media [at] The president of Catholics for Choice, Jon O’Brien, and our policy staff will be available to provide comment and analysis as the HHS considers the IOM report as well as when a decision is made.

View this memo as a PDF.

Catholics for Choice