Editor’s Note: The so-called HHS Mandate, enacted by the United States Department of Health and Human Services in January 2012, has been the subject of growing controversy and pending lawsuits. It requires nearly all private health insurance plans to include coverage for all FDA-approved prescription contraceptive drugs and devices, surgical sterilizations, and abortion-inducing drugs. The USCCB has opposed the law in its present form because it forces citizens to deny their religious and moral convictions in order to purchase health care coverage for themselves—and businesses for their employees. It defies the freedom of conscience and the freedom of religion as guaranteed in The Bill of Rights, and it violates Catholic social teaching concerning the dignity of human life.
In the following hypothetical “dialogue,” a Catholic employer asks for clarification of the HHS Mandate, and the Mandate responds.
The Catholic Employer: Why am I being forced, against my conscience, to provide my employees with contraception?
The HHS Mandate: “PHS Act section 2713 reflects a determination by Congress that coverage of recommended preventive services by non-grandfathered group health plans and health insurance issuers without cost sharing is necessary to achieve basic health care coverage for more Americans.”
The Catholic Employer: Why are preventive services necessary for basic health care coverage?
The HHS Mandate: “Use of preventive services results in a healthier population and reduces health care costs by helping individuals avoid preventable conditions and receive treatment earlier.”
The Catholic Employer: And these services include contraception?
The HHS Mandate: “Further, Congress, by amending the Affordable Care Act during the Senate debate to ensure that recommended preventive services for women are covered adequately by non-grandfathered group health plans and group health insurance coverage, recognized that women have unique health care needs and burdens. Such needs include contraceptive services.”
The Catholic Employer: I just read on your website, www.healthcare.gov, that contraception can have health benefits that have nothing to do with preventing conception. Are these, perhaps, the benefits you have in mind?
The HHS Mandate: “Studies show a greater risk of preterm birth and low birth weight among unintended pregnancies compared with pregnancies that were planned.”
The Catholic Employer: Studies?
The HHS Mandate: “Gipson, J.D., et al., ‘The Effects of Unintended Pregnancy on Infant, Child and Parental Health: A Review of the Literature,’ Studies on Family Planning, 2008, 39(1):18-38.”
The Catholic Employer: I’ve read that study. I gather, then, that you think, like Gipson and colleagues, that the mother’s health and well-being, is inextricably bound up with the health and well-being of her child, and that this is why you view unplanned pregnancy as a health risk for which preventive treatment is appropriate. Why is unplanned pregnancy so risky?
The HHS Mandate: “Women experiencing an unintended pregnancy may not immediately be aware that they are pregnant, and thus delay prenatal care.”
The Catholic Employer: But the only excuse for such ignorance is the very use of contraception! Why else would a woman believe pregnancy so unlikely that she doesn’t even need to test for it after she’s had sex? Surely you don’t mean us to believe that most women who have unprotected sex actually think that they won’t get pregnant unless they want to?! This is an argument for free pregnancy tests, not free contraceptives!
Right, well, are there any other risks?
The HHS Mandate: “They also may not be as motivated to discontinue behaviors that pose pregnancy-related risks (e.g., smoking, consumption of alcohol).”
The Catholic Employer: Well, perhaps the study you cited will motivate them! After all, it takes note of the real risks both of abortion and of stymied prenatal development, leaving the reasonable mother without any option but to take responsibility for the child, and stop endangering it. They don’t need to wait until they know they are pregnant, either! If a woman is having frequent, unprotected sex, she should be able to see pregnancy as a real possibility and refrain from these risky behaviors.
Now, I see that these are the only pretensions you make at outlining health risks. Well, if I may:
Neither of these “risks” has anything to do with unplanned pregnancy precisely as unplanned pregnancy. The woman who delays prenatal care because she doesn’t know that she is pregnant, after she has had unprotected sex, is not a victim of circumstance; rather, she has, in a real way, failed to take responsibility for her actions. Equally to blame, of course, is her male companion; whether he is predatory or just indifferent, he, too, acts as if he bears no responsibility for his actions.
Let’s assume that a woman (A), who has unprotected sex with the intention of becoming pregnant and that a woman (B), who has unprotected sex because Roger has seduced her are both equally aware that they have had unprotected sex. What about (A)’s circumstances makes it any easier for her to become aware that she is pregnant than it is for (B)? Do (A)’s pregnancy tests work better because she wants to have a child? Does (B)’s will not to conceive, or ambivalence about the question, alter her body chemistry to the point that medical science is deceived? Of course not!
The only reason (A) is likely to be better off than (B) is because (A) tests herself frequently for pregnancy, since she wants a child. If (B) were ready to take responsibility for her actions, she would, perhaps less enthusiastically, be equally able to test for pregnancy with the same frequency, to avail herself of prenatal care, and thus to give birth to as healthy a child as (A).
The same argument works a fortiori as far as the second “risk” is concerned. Both (A) and (B) will, in fact, desist from risky behaviors during pregnancy only inasmuch as they value the life and well-being of themselves and their children. (B) is in no way put at a disadvantage or prevented from so desisting by the bare fact that her pregnancy was unplanned. She is just statistically more likely than (A) to be morally bankrupt, along with her male companion, or at least clueless, neither of these parents apparently caring about any potential child’s well-being. So are we compelled to act against our conscience, to fund contraception, just because some people cannot be compelled to have a conscience?
The HHS Mandate: “The contraceptive coverage is generally applicable and designed to serve the compelling public health and gender equity goals described above and is in no way specially targeted at religion or religious practices.”
The Catholic Employer: I thought so! I’d prefer the persecution.