The anti-birth-control minority controlling our health care
Contraception is a mainstay of modern society. Approximately 70 percent of women of reproductive age are both sexually active and attempting to avoid pregnancy. More than 99 percent of women who have ever been sexually active have used contraception at some point. A majority of all women — approximately 60 percent who are reproductive age — are currently using a contraceptive method, according to Guttmacher.
The public widely supports access to contraception. Nearly eight in 10 adults, and the majority of voters in both main political parties, consider birth control a fundamental part of women’s health care.
Unfortunately, a vocal minority that considers birth control immoral is now setting the nation’s health-care agenda at the Department of Health and Human Services, and we are seeing the impact. Most recently, HHS directed millions of dollars in federal funding for birth control to California-based Obria, a self-described “ministry” that opposes the use of contraception yet purports to be a women’s health-care provider.
Federal funding for family planning was not previously dictated by such ideologues. Title X has operated as the sole federal program dedicated to family planning since 1970 when, recognizing the need of low-income individuals for accessible family planning services, Congress passed, and President Nixon signed, Title X of the Public Health Service Act, with strong bipartisan support.
Since then, it has developed a nationwide network of family planning clinics that provide birth control and other services to low-income individuals throughout the country. Today, more than 4 million women rely on these clinics to access affordable contraception and other family planning services guaranteed by Title X. A quarter of Title X patients live in California.
Over the past year, however, HHS has undertaken a series of legally dubious efforts to change how Title X funds are allocated. California, with dozens of other states, is challenging these changes. Most recently, courts temporarily halted HHS from implementing its desired revisions to the program, with one court stating that HHS’s “Final Rule likely violates the central purpose of Title X, which is to equalize access to comprehensive, evidence-based, and voluntary family planning.”
This is not the only way that HHS is actively working to limit the ability of low-income Americans to obtain family planning services.
In March 2019, despite Title X’s mandated purpose — and for the first time in the grant program’s history — HHS officials approved Title X funding for an Orange County organization that does not provide contraception to its patients. The grantee organization, Obria, has always taken a hard stand against birth control in keeping with the stated Catholic beliefs of its founder and benefactors. HHS simultaneously reduced funding for the California recipient that provides Title X services, including contraception, to a million patients annually.
Obria does not provide any form of hormonal contraception to its patients, such as birth control pills or IUDs. Obria even refuses to provide its family-planning patients with condoms. In fact, Obria only offers “fertility awareness” training, alternatively known as the “rhythm method.” It consists of tracking a woman’s ovulation cycle to determine when she is more or less likely to become pregnant and directing a woman to avoid intercourse when she is most likely to conceive. Neither the American Medical Association nor the FDA consider this to be reliable. By contrast, it is the only form of family planning the Catholic church deems acceptable, though only 2 percent of sexually active Catholic women use this as contraception.
A small group of vocal birth control opponents have expressed concern that Obria is compromising its anti-contraception religious beliefs by participating in the Title X program. These groups understand Title X programming to require grant recipients to provide birth control. In an effort to reassure its prior allies, Obria affirmed that it has no intention of distributing or referring for birth control. Providing access to birth control is, of course, the purpose of the funds.
By refusing to provide contraception to its patients, Obria is refusing to abide by obligations governing its receipt of Title X grant funding. Under the current Title X rule, which applies unless and until the injunction of HHS’s revised rule is lifted, Obria’s project is required to provide a broad range of medically approved family planning services.
At present, Title X services also include access to information, counseling and referrals regarding abortion, upon request. Obria disregards these Title X requirements when it refuses to provide this care to its patients. Instead, Obria seeks to use federal money meant to provide healthcare to low-income individuals to further its anti-contraception “ministry.”
The question at hand is whether HHS may re-direct federal funding to a group like Obria despite its blatant refusal to provide the care for which Congress appropriated federal funds.
Congress, and by extension the taxpaying public, allocated Title X funds to make comprehensive family planning services, including birth control, available to all Americans. The religious beliefs of a small few should not govern public policy for all. Congress should exercise its oversight jurisdiction and demand that HHS officials explain why they are subverting a nearly 50-year-old law to deny critical health-care services valued by the vast majority of Americans.
Alice Huling is counsel for Campaign for Accountability.