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Tangled Up in Dogma: Religious Freedom, or Reproductive Freedom?

Women's reproductive rights remain under assault, fueled by entrenched religious and right wing ideology.

If there weren't already enough problems involved in the start-up to the Affordable Care Act (ACA), here come the Little Sisters of the Poor to further complicate matters.

Whatever charity work the sisters do, their lawsuit challenging the contraception mandate in the new health care law reveals the fanaticism at work in the group's thinking about reproductive rights for women. Unfortunately, the order of nuns and other religious groups started the New Year with a victory of sorts, winning a temporary U.S. Supreme Court injunction to the ACA's provision that employer health plans cover contraception (with no co-pay) under its preventive medicine requirements.

If you think fanaticism is an unfair description, consider that the ACA already allows for a religious exemption for employee group coverage of contraception and related reproductive services. A religious organization simply has to sign the form, requesting an exemption. But the Little Sisters of the Poor object to even signing the exemption form. That's because employees would need the form if they want to get birth control directly through their insurance provider.

Ironically, the insurance provider for Little Sisters of the Poor, the Christian Brothers Employee Benefit Trust, already excludes contraception as a covered benefit. Such "church plans" are also allowed by law to opt out of contraception coverage. But Little Sisters of the Poor object even to the hypothetical possibility that their third-party insurer might be obligated to provide contraception benefits, which they claim signing the exemption makes possible. Thus, the Little Sisters of the Poor refuses to participate in a health care arrangement they view as ultimately designed to enable the "sin" of artificial contraception to occur.

Miscarriage of Medicine

Importantly, challenges to reproductive health care rights posed by archaic religious ideology are hardly a fringe threat. In a new report, "Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care," the American Civil Liberties Union (ACLU) and the advocacy group MergerWatch document the impact in recent decades of the growth of Catholic health systems on community access to reproductive care.

As the report explains, since the 1980s the days of traditional stand-alone hospitals have mostly gone away, as investor money and market pressures drive new business mergers and affiliations, creating ever-larger health care hospital systems. Catholic health care organizations are very much savvy players in these market rearrangements. Accordingly, 10 of the 25 largest health systems in the United States are now under Catholic management. In Washington State, for example, Catholic health systems now comprise more than a quarter of all health care organizations. In some rural regions, a Catholic-affiliated health care system may be the only health resource serving the public.

While formally "non profit" and excluded from paying taxes, these days religiously-affiliated health care systems operate almost indistinguishably from for-profit health care. They are different, however, in one important aspect of the medicine they deliver - or more accurately, don't deliver. Abortion, assisted suicide, sterilization, contraception, and infertility treatments are all prohibited at Catholic hospitals. These prohibitions are mandated in the "Ethical and Religious Directives for Catholic Healthcare Services" adopted by U.S. Conference of Catholic Bishops.

In some instances, warns the report, health care facilities may not even provide counseling about condom use to prevent transmission of sexually transmitted diseases. Decisions about end-of-life care can also be compromised, such as when religious doctrine won't honor a family's wish to refuse or remove a feeding tube. In the future, treatments derived from embryonic stem cell research could also be banned.

What's insidious about the merger trend is that secular or otherwise affiliated health care systems that join with Catholic health systems are typically expected to adhere to the Church's ethical and religious directives. When Swedish Medical Center's seven hospitals in the Seattle area affiliated with Providence Health & Services, for example, large Catholic health system serving Washington and Oregon, the former was required to discontinue elective abortions.

Nor are the religious objections to abortion or contraceptive care limited to an abstract refusal to offer these services. As "Miscarriage of Justice" documents, it is about the inherent prejudice that Catholic health policy can introduce into the ongoing delivery of health care.

Consider the report's description of the experience of Tamesha Means at Mercy Health Partners in Muskegon, Michigan:

"In 2010, a pregnant mother of three suffered unnecessarily and her health was jeopardized because Mercy Health Partners, a member of Trinity Health, put the Directives above her health needs.

"Tamesha Means arrived at Mercy Health Partners after her water broke and she began having contractions. She was 18-weeks pregnant. The hospital diagnosed her with preterm premature rupture of membranes (PPROM) and sent her home to wait, telling her there was nothing it could do. It did not tell her that, given the stage of her pregnancy and her condition, the fetus she was carrying had almost no chance of survival and that prolonging the pregnancy could put her health and possibly even her life at risk. Nor did the hospital tell her that the safest treatment option was to induce labor and terminate the pregnancy.

"The following morning, Ms. Means returned to the hospital with painful contractions, bleeding, and an elevated temperature. The hospital monitored her contractions and gave her two Tylenol. After Ms. Means' temperature went down, the hospital again sent her home.

"Later that night, Ms. Means returned to the hospital in extreme distress. Hospital staff again told her there was nothing they could do. While staff began preparing the paperwork to send her home yet again, Ms. Means began to deliver. The hospital then began tending to her miscarriage. She gave birth to a very premature son, who died within hours. Ms. Means' medical records show acute chorioamnionitis and acute funistis, infections that Ms. Means developed after her water broke.

"By failing to inform her about her options, the likelihood that her baby would not survive, or the risks of delaying treatment, Mercy Health Partners unnecessarily put Ms. Means' health at grave risk and ultimately, failed to follow medical standards for PPROM with signs of infection."

Notably, Mercy Health Partners was the only nearby hospital for Ms. Means. The ACLU, which has documented a pattern of similar cases across the country, has filed a negligence lawsuit against the U.S. Conference of Catholic Bishops, blaming its Directives for putting patient health at risk. They're also calling for an investigation by the Centers for Medicare and Medicaid Services. Under the law, hospitals receiving government funds cannot deny patients required health care in an emergency.

Such experiences may indeed be just the tip of a larger iceberg. According to a 2012 study in the American Journal of Obstetrics and Gynecology, 52 percent of obstetricians and gynecologists working in Catholic-affiliated institutions report having experienced conflict with their employers over religiously based policies.

Birth Control is a Human Right

It's hard to believe it's been almost 100 years since Margaret Sanger championed birth control as a human right. Yet still advocates of modern reproductive medicine must fight the political battle for the rights of women to such care.

In fact, last year 22 states enacted 70 new provisions to further restrict access to abortion services, according to a recent Guttmacher Institute report. Since 2011 there have been 205 new abortion restrictions passed by state legislatures, more than in all the previous ten years.

Should hospitals run by religious groups using public funds be allowed to impose their religious beliefs on medical staff and patients, regardless of whether they share those beliefs? Should hospitals be allowed for religious reasons not to fully explain to a patient what all of her medical options are? The answer to both questions should be No.

While in recent years there's been something of a sea change for gay and lesbian marriage rights, and evidence of more tolerance and respect in the popular culture for transgendered rights, too. Compared to decades past, women have also made many social advances. There is also widespread public acceptance of the value of contraception, including even among Catholic women.

According to the Centers for Disease Control and Prevention, 88 percent of women of reproductive age between the years 2006 to 2010 have used "a highly effective, reversible method such as birth control pills, an injectable method, a contraceptive patch, or an intrauterine device."

But progress in human rights hardly ever proceeds in clear, straightforward fashion. Women's reproductive rights remain under assault, fueled by entrenched religious and right wing ideology.

There's no irony in this. The war on women's rights has been going on for a long time. There's no end date really, not as long as archaic religious values and the exploitation of medicine for private profit are allowed to continue to have a say in the delivery of health care.

[Mark T. Harris is a Portland, Oregon-based writer who has written for Utne, Dissent, and other magazines. He writes regularly for the blog,]

[Thanks to the author for sending this to Portside.]