Iâ€™ve been too bogged down in other work to contribute to the contraceptive benefit debate. I feared I would miss the whole thing. I am pleased, however, with the way it has seems to be playing out.
I am gratified that social liberals are actually winning a health policy debate. I am somewhat astonished that social conservatives are fighting about contraceptives in this day and age.
Liberals have had few such victories after health reform. During the knife fight endgame leading up to ACAâ€™s passage, feminists and the pro-choice coalition often found themselves under the bus for two simple reasons: (1) pro-life Democrats had the marginal votes, and (2) everyone understood that pro-life legislators were ready to bring down the house if they didnâ€™t get their way. Because pro-lifers wanted it more, Nancy Pelosi, Barack Obama, and other liberals gritted their teeth and conceded on many key issues. I believe this was the right political call. It still hurt.Â Itâ€™s nice to play a stronger hand.
I am also gratified that the Obama administration has reached a dignified accommodation with the Catholic Health Association and with other Catholic organizations that do so much every day to help poor people. Like most of my public health colleagues, I myself reject many Catholic teachings in matters of contraception, abortion, and sexuality. I still believe President Obama is smart and wise to avoid measures that gratuitously insult Catholic institutions when this can gracefully be avoided.
If you embrace the ethos of community-based public health, itâ€™s more important to find common ground with the Church in addressing areas of common concern than it is to bluntly repudiate it whenever we disagree.Â These institutions certainly canâ€™t be ignored politically, within the broader American electorate or within many at-risk communities. Catholic Churches, Catholic hospitals, and Catholic Charities on the ground in many embattled communitiesâ€”feeding the hungry, caring for foster children, housing the homeless, and more–after other do-gooders have gone.
Catholic institutions and organizations deserve everyoneâ€™s respect in other ways, too. Aside from its role in service delivery, the Church has stood up for stigmatized and politically weak people who need help. On some issuesâ€”the 1996 welfare reform, matters involving undocumented immigrants todayâ€”the Church stood up when its natural political allies and many Democratic constituencies chose to stay silent. The Catholic Churchâ€”particularly the post-Vatican II Church–is not the enemy of liberal values that many outsiders believe it to be.
I do hope the bishopsâ€™ political embarrassment leads them to take a good hard look at the ways they choose to operate and position themselves within the American political system. Some Catholics suggest that liberals unduly relish the opportunity to confront and to humble the Church. There is some truth to that. Iâ€™ve heard more than a few nasty references to celibate old men who donâ€™t know anything about sex, and so on. Church leaders might wonder why. At least in part, progressive animus is an understandable reaction to the bishopsâ€™ rather open, at-times crude partisanship regarding sensitive issues we liberals care greatly about.
Catholic teachings oppose abortion and contraception. These same teachings pretty much prohibit the death penalty, preventive war, and economic policies which promote undue inequality. In opposing these latter teachings, Rick Santorum is no less the cafeteria Catholic than (say) John Kerry is. Somehow social conservatives seem to receive a free pass.
Church leaders might ponder why they operate with so much greater success and political legitimacy on the issue of abortion than they find on issues of birth control or (increasingly) on issues of equal rights for gay and lesbian Americans. I myself am emphatically pro-choice. I believe abortion is both permissible and justified in many circumstances. Yet as someone who has heard the heartbeat of my two beautiful children in-utero, I canâ€™t really begrudge the Church for taking a contrary view.
One does not need to be Catholicâ€”indeed to hold any religious belief–to appreciate the powerful moral, political, and ethical reasons millions of people have in opposing abortion. Catholicsâ€™ moral views are animated by religious traditions and arguments. Yet these arguments fit broadly within what John Rawls called the â€œoverlapping consensusâ€ of our pluralist liberal democracy. Others of us have equally serious reasons to disagree. Yet itâ€™s hardly surprising or objectionable that the Church feels compelled to enter the political arena on behalf of its views to defend (as it understands the question) unborn life.
The contrast with contraception could hardly be greater. Polls indicate that the dominant majority of American Catholics ignore or reject Church doctrine here. Most Catholics appear to agree with the Obama administrationâ€™s proposed policy. If the Church could find a way to temper its stand or to reverse itself on this issue, I suspect that even most socially-conservative Catholics would breathe a giant sigh of relief.Â
These polls donâ€™t capture an even more important difference between the two social issues. There is, of course a long and deep Catholic moral debate over the nature and expression of human sexuality. The richness and humanity of this tradition is poorly expressed in current Church policies. More than forty years after the disastrous encyclical, Humanae vitae, which inveighed against artificial birth control, Church doctrine on contraception literally makes no sense to most people. Catholics might regard conformity with Church teaching as a good in itselfâ€”like keeping Kosher or getting circumcised, for example. Yet there is no broadly-comprehensible or compelling secular justification for these latter practices. There is even less justification for imposing Catholic beliefs in this area on the non-Catholic woman sweeping the floors in Advocate hospital, or for that matter her Catholic peer who donâ€™t follow these specific teachings.
If contraception were a trivial matter or were less intimate to our humanity, this issue wouldnâ€™t matter one way or the other. No one cares if Mt. Sinai Hospital does or doesnâ€™t serve pork in its cafeteria. But the stakes are higher here. Women encounter many difficulties in using contraceptives consistently and most effectively. Cost is one important obstacle. $30/month for birth control pills or the (slightly lower) annualized cost of an IUD is serious money for millions of low-income women who have the highest rates of unintended pregnancy. Frost and Darroch found that one-third of U.S. women using reversible contraception would switch methods if they did not have to worry about cost. A 2010 study found that two-thirds of women chose long-acting contraceptive methods when offered the choice of any method at no cost. These findings are especially concerning in light of evidence that women who are dissatisfied with their specific contraceptive method are more likely to use it inconsistently.
In nearly every way, women bear the lionâ€™s share of the financial, relational, medical, and psychic costs associated with unintended pregnancies. It seems right to me that womenâ€”particularly young women with limited financial resourcesâ€”should be able to decide whether, when, and how to manage their reproductive choices free from immediate financial pressures, the hassles of insurance copayments, or the need to explain their reproductive and sexual lives to an employer, a nosy pharmacist, or to anyone else on whom they may rely for financial support.
Some Church officials seem strikingly tone-deaf to the moral complexities of sexual life experienced by millions of people. The New York Times reports that â€œArchbishop Dolan criticized people who postponed conception with â€˜chemicals and latex,â€™ calling them part of the â€˜culture of death.â€™â€ At one level, this is simply rude. At another, Iâ€™m at a loss to understand what heâ€™s even saying.
How does it promote the â€œculture of deathâ€ for people to deploy â€œchemicals and latexâ€ to avoid facing the obvious choice in the event of an unintended pregnancy. The Pope himself has acknowledged that condoms may be the lesser evil, as it were, in preventing HIV infection. On other fronts, contraception plays a critical role in creating an environmentally and economically sustainable life for billions of people.
Archbishop Dolan seems equally misguided when casts aside these world-historical issues to consider how we should treat our friends, relatives, and neighbors with dignity closer to home.
I speak with many people who care for adults and children living with intellectual disabilities. One young womanâ€™s child was diagnosed with a serious disorderâ€”at which point she herself discovered that she is a genetic carrier. She visited the archdiocese and asked whether Church teachings would permit her to use artificial birth control. She and her husband were told: No, they cannot. If anything justifies this heartbreaking response, I certainly havenâ€™t heard it.
Fortunately, dogmatic bishops donâ€™t represent the entire Catholic faith or the entire Catholic perspective. Her parish priest–to his creditâ€”provided a more worthy response to a parishioner in pain who approached him seeking consolation and help. In my book, thatâ€™s the true pro-life perspective. If his superiors would do likewise, they would spare themselves much trouble.