Demonstrators protest a requirement that most employers provide health care insurance coverage for contraception and sterilization as part of the federal health care overhaul, during a "Stand Up for Religious Freedom" rally, part of what organizers say will be a series of rallies in over 100 US cities on the second anniversary of the signing by US President Barack Obama of the Affordable Care Act, at Federal Hall National Memorial in New York on March 23, 2012.
Credit: Timothy A. Clary

When significant parts of the US Affordable Care Act (ACA) went into effect earlier this year, key among the reforms was the expanded provision of free birth control. While many religious organizations were exempted from this mandate, the legislation has sparked protest and outrage, including litigation at the highest level, the Supreme Court.

But the US is not alone in attempting to strike a balance between offering reproductive health care services and respecting religious organization’s rights. In recent months, Ireland, Argentina, and Israel – three countries with deep-seated religious ties – all have tried to better navigate this thorny space as well. 

The United Nations has declared access to contraception a “human right” but religion and reproductive health remain a contentious issue across the globe, where an estimated 200 million women worldwide do not have access to birth control. 

In Ireland, even priests believe there should be better access to birth control. A recent study showed that twothirds of priests believe that availability of contraception is “extremely” or “somewhat” important to themselves or their communities. Currently, the pill is available but not subsidized by the government.

In this country with a heavy Catholic influence, sex education is offered in some schools but according to The Irish Times, the information may be woefully inaccurate. Many women, including Irish singer Nadine Coyle, who recently announced an unexpected pregnancy, believe they were not given enough information about choosing contraception.

In Pope Francis’ home country, access to reproductive healthcare is hard to come by despite a recent poll showing that over 90 percent of Catholics support contraception. A 2010 Human Rights Watch (HRW) report found a lack of access to contraception contributed to the 40 percent of all pregnancies that end in illegal abortion. A national program to promote reproductive rights launched in 2005, but HRW found that it has been largely unsuccessful in providing contraception services to women due to “erratic implementation” and a lack of political support. Some women report months-long waitlists to get contraception and then receiving expired pills at their appointment.

Earlier this year, Israel granted state-funded abortions to eligible women ages 20 to 33 upon recommendation by the Health Ministry Committee. Previously, only women younger than 19 or older than 40 and women in special circumstances were granted free abortions. The law is expected to cover the costs of the procedure for 6,300 women who otherwise could not afford it. 

Some religious groups protested the decision, such as pro-life group Efrat whose chairman Dr. Eli Schussheim told the Times of Israel the committee is “is stealing… from sick people… and giving the money instead as a prize to 6,000 negligent women.” However, religious opposition to abortion in Israel has not been as strong as in the US, according to an op-ed published in the Daily Beast. One possible explanation, the author, an editor at the Institute for War and Peace Reporting in London, cites for this is that Christianity more explicitly states that life begins at conception whereas Judaism holds that “a fetus only truly became a person” at birth. Still, the Israeli government does not subsidize birth control on the grounds that the cost is not very burdensome to individuals but would be to the government. 

How the US compares
Here in the US, of all the ACA provisions, access to contraception has sparked the most controversy. One of the most vocal opponents has been the Catholic Church, which has encouraged parishioners to share that “pregnancy is not a disease, and drugs and surgeries to prevent it are not basic health care that the government should require all Americans to purchase.” 

Although many religious institutions oppose birth control, a 2012 Guttmacher Institute study found that 98 percent of sexually experienced Catholic women have used a method of contraception other than natural family planning. Planned Parenthood has applauded the ACA’s stance on birth control, calling the bill “the single biggest advancement in women’s health in a generation.” 

Under the ACA, which expands insurance options for many Americans, almost all female employees are guaranteed free contraception coverage under private insurance, said Kaiser Family Foundation senior policy analyst Laurie Sobel at a recent webinar about the new health care law. This means no more co-pays for birth control for previously insured women. An additional 13.8 million women are also expected to be covered under the ACA, added Alina Salganicoff, Kaiser’s vice president and director of women’s health policy. The Kaiser Family Foundation hosted the webinar last month to help journalists understand how the ACA impacted women’s health coverage and care.

“Women who could not previously afford contraceptives can now access the full range, including reliable, long-acting, reversible contraceptives such as IUDS,” Sobel said.

But under the ACA, certain groups are exempt. Nonprofit houses of worship, mainly churches, will not have to provide contraception coverage for their employees or their children, Sobel said. Nor will some religiously affiliated nonprofits, like Notre Dame University, or religiously affiliated hospitals – so long as the nonprofit opposes contraception for religious reasons. In those cases, she said, employees still have options: they can get coverage under the ACA through an insurer or third party administrator.

The ACA covers all FDA-approved contraception methods without cost-sharing including Intrauterine Devices (IUDs) and the morning-after pill. However, abortion coverage is explicitly banned as an essential heath benefit. States can ban abortion coverage in marketplaces, and 24 have already done so, according to Sobel.

As the ACA struggles to get off the ground, several private companies have taken the government to court, arguing that their religious beliefs conflict with newly imposed government regulation.

Hobby Lobby, a national chain of craft stores owned by a Protestant family, is one such company. The Green family opposes emergency contraception and IUDs for religious reasons. But because the store is not a religiously affiliated organization, under the ACA it is required to pay for contraception coverage for its over 13,000 employees, according to Sobel. The Greens believe the new law violates their rights under the First Amendment and the Religious Freedom Restoration Act, which prevents laws that burden a person’s free exercise of religion.

The Hahn family, owner of Conestoga Woods Specialties, has a similar issue with the ACA. They object to providing emergency contraception coverage to their 950 employees on religious grounds.

So both families have taken their pleas to the Supreme Court – along with nearly 50 others.

The rulings of these cases, whose oral arguments will be heard this month, will set a precedent for the future of the ACA. If the Supreme Court decides in these companies’ favor, individual employers who oppose any kind of healthcare coverage for religious reasons, from contraception to blood transfusions, could also be exempt from providing coverage to their employees.

More from GlobalPost: Supreme Court to take up birth control religion case


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