Humanae Vitae and US Health Policy
The Catholic hierarchy has also used the political clout they wield to influence US reproductive health policy by preventing access to affordable, comprehensive choices for family planning despite American women’s nearly universal use of modern contraceptives.
The Catholic bishops demanded a broad exemption to the contraceptive benefit requirement for any faith-based organization, such as Catholic hospitals and universities, which objected to providing contraceptives to their employees, staff and students.
In 2011, the Obama administration announced a plan to require that all health insurance plans sold in the United States include no-cost contraceptive coverage as part of a slate of essential women’s preventive health services that would be covered at no cost. The US Conference of Catholic Bishops, the lobbying arm of the Catholic hierarchy in the United States, was apoplectic. In an effort to allay the concerns expressed by the Catholic bishops, the Obama administration gave churches and houses of worship a narrow exemption when they announced the proposed regulation for the contraceptive benefit. Two state supreme court cases in New York and California had upheld a similar exemption. But the bishops were not satisfied. Faced with overwhelming public opinion in support of the contraceptive benefit, they changed tactics.
In September 2011, the USCCB announced the formation of an Ad Hoc Committee on Religious Liberty to answer several “threats” to religious liberty they perceived on the horizon, linking the contraceptive benefit to a number of other policies, including the push to recognize same-sex marriage, which the Catholic hierarchy also forbids. Under the guise of this “religious liberty” fight, the bishops claimed that the government was forcing Catholics, and Catholic institutions, to violate their consciences with the contraceptive benefit and the recognition of same-sex marriage.[i] Over the next few years, the committee became a platform for the USCCB to stake its positions on these issues, despite not having the backing of the majority of voters, Catholic or otherwise.
The Catholic bishops did have some allies in this fight, however. Groups associated with the Christian right, such as the National Association of Evangelicals and evangelical universities such as Colorado Christian University, took up the mantle of “religious liberty” to argue that they too should be allowed to deny contraceptive coverage, even though no Protestant faith has a ban on contraceptive use. Albert Mohler, president of the Southern Baptist Theological Seminary, the closest thing evangelicals have to a Vatican-like teaching authority, noted how influential Humanae Vitae had become in evangelicals’ growing hostility to contraception. He urged conservative Protestant evangelicals to reject a “contraceptive mentality” and said they should “look closely at the Catholic moral argument found in Humanae Vitae” in assessing whether contraceptive use was moral.[ii] As the Christian right became more radicalized on contraception, the Republican Party in 2011 tried, unsuccessfully, to defund the Title X family planning program, which provides family planning services to some 4 million clients annually.[iii] Ultraconservatives also sought to limit reproductive care through attempts to defund Planned Parenthood across 15 states.
The USCCB became a key player in the fight to roll back the contraceptive benefit. The Catholic bishops demanded a broad exemption to the contraceptive benefit requirement for any faith-based organization, such as Catholic hospitals and universities, which objected to providing contraceptives to their employees, staff and students. With Catholic hospitals alone employing more than 750,000 people, many of whom are not Catholic, such a broad exemption was clearly a ploy to impose Humanae Vitae and its ban on contraception on the population at large.[iv] Again, the Obama administration attempted to appease the Catholic bishops by proposing an accommodation that offered a workaround to allow a broader range of religiously affiliated nonprofits to bypass direct provision of the benefit with a simple declaration of their objections. Still the Catholic bishops balked.
Bishop David Zubik of Pittsburgh, under direct orders from the USCCB, led several Catholic entities to sue the federal government because the workaround was not good enough—claiming that filing a form or another declaration indicating their objection to the contraceptive coverage was a violation of their religious freedom. In short, the goal was a complete exemption for every nonprofit organization even loosely affiliated with religious bodies, imposing one set of religious views on millions of employees and essentially codifying Humanae Vitae into public law. The cases eventually were consolidated under the Zubik v. Burwell case, which made its way to the US Supreme Court in 2016.
Meanwhile, for-profit-companies took a page from the Catholic bishops to claim that their consciences as employers would be violated if they provided birth control coverage for their employees. The owners of Hobby Lobby, a chain of craft stores, and Conestoga Wood Specialties, a cabinet manufacturer, argued in the courts that providing insurance coverage for contraception to their employees violated their beliefs that certain kinds of contraceptives were immoral. In June 2014, this argument was upheld by the US Supreme Court in the Burwell v. Hobby Lobby decision, which found that closely held private companies had a right to deny contraception to their employees.
The USCCB not only wielded influence in the courts, but in the private sector too. They began a crackdown on the provision of contraception by healthcare providers affiliated with the Catholic church. The Affordable Care Act (ACA) provided incentives for hospitals to buy up physicians’ practices and integrate them into healthcare systems to restrain costs. The breadth of Catholic hospitals across the country meant that many secular physicians’ practices have become integrated into Catholic healthcare systems. When these doctors’ practices are merged with Catholic hospitals, their care falls under the Ethical and Religious Directives for Catholic Health Care Services (the Directives)—a set of guidelines written and enforced by Catholic bishops that ban the provision of certain types of healthcare, including contraception. The Directives serve as a policy manual for implementing Humanae Vitae in US healthcare provision.
As a result of these mergers, the number of Catholic hospitals increased by 22 percent between 2001 and 2016.[v] Today, one in six hospital beds in America is Catholic-owned or -affiliated.[vi]
In 2018, Ascension Health, a Catholic system, announced plans to purchase Providence St. Joseph Health in a merger that would create the single largest health system in the United States, encompassing 200 hospitals in 27 states and numerous ancillary services like doctors’ offices.
As a result of these mergers, increasingly more Americans are denied family planning services banned by Humanae Vitae. For instance, a woman named Angela Valavanis in Evanston, Illinois, was told by her OB/GYN that she could no longer prescribe contraception after she sold her practice to Presence Health, a large regional Catholic hospital system that owns dozens of doctors’ offices. Valavanis was shocked when her doctor gave her the news that Catholic doctrine was affecting her reproductive health choices, calling the doctrine “medieval.” A short time later, her husband was denied a vasectomy by a doctor affiliated with the same system.[vii]
With the inauguration of President Trump, the USCCB and Catholic-owned hospitals, schools and social service agencies, found the president’s ultraconservative religious appointees to be powerful allies in implementing their agenda on religious refusals and contraception. On October 2017, the Trump administration issued an executive order that allows any employer—for-profit or nonprofit, faith-based or not—to opt out of the ACA contraceptive benefit due to religious or vaguely defined “moral” objections. The American College of Obstetricians and Gynecologists called the rollback of a benefit that had helped an estimated 55 million women access no-cost contraceptives “damaging” to “public health and women’s health.”[viii]
Through court battles, executive orders and private mergers, we continue to see how the Catholic hierarchy in the United States has imposed its ban on contraception on non-Catholics and Catholics alike, despite public opinion on these issues. Humanae Vitae may be 50 years old, but its consequences seem to be more widespread and consequential than ever before.
[i] Laurie Goodstein, “Bishops Open ‘Religious Liberty’ Drive,” New York Times, November 14, 2011.
[ii] Albert Mohler, “Can Christians Use Birth Control?” AlbertMohler.com, May 8, 2006.
[iii] Title X Family Planning Annual Report 2016 Summary, U.S. Department of Health and Human Services, https://www.hhs.gov/opa/title-x-family-planning/fp-annual-report/fpar-2016/index.html.
[iv] “U.S. Catholic Health Care” fact sheet, Catholic Health Association of the United States, 2018, https://www.chausa.org/docs/default-source/default-document-library/cha_2018_miniprofile7aa087f4dff26ff58685ff00005b1bf3.pdf?sfvrsn=2
[v] Lois Uttley and Christine Khaikin, Growth of Catholic Hospital Systems, New York, MergerWatch, 2016.
[vi] Is Your Healthcare Compromised? How the Catholic Directives Make for Unhealthy Choices. Catholics for Choice. 2017. http://issuu.com/catholicsforchoice/docs/2017_catholic_healthcare_report?e=31036955/53427854.
[vii] Patricia Miller, “When the Catholic Church Owns Your Doctor,” Salon, May 11, 2015.
[viii] Brianna Ehley, “Trump Rolls Back Obamacare Birth Control Mandate,” Politico, October 6, 2017.