August 1, 2011 (LifeSiteNews.com) – Last week the Institute of Medicine (IOM) released its report proposing a list of preventive services for women that would be mandated for coverage in all private insurances under the regulations of the Patient Protection and Affordable Care Act (PPACA). Early this morning, the Department of Health and Human Services accepted these recommendations.  Included in this list are all prescription contraceptives, surgical sterilizations, and “education and counseling” to inform women about these options. (At the moment of publication it is still unclear whether the coverage includes Plan B and Ella, which are known abortifacients)

The United States Conference of Catholic Bishops vigorously opposed the inclusion of these elective medical therapies that are contrary to Catholic moral teaching in the mandated coverage requirements. There are no provisions for conscience protection in the PPACA, however, the HHS did propose some limited conscience exemptions with this decision. Initial analysis reveals that the proposed conscience protections exempt Catholic organizations that primarily employ Catholics, serve Catholics, and have as their purpose, the inculcation of religious values. With these criteria in mind, it seems that many Catholic institutions will have to provide coverage for services they find morally reprehensible, including Catholic hospitals and universities. This would be contrary to the Ethical and Religious Directives for Catholic Health Care Services directive number 52:

Catholic health institutions may not promote or condone contraceptive practices but should provide, for married couples and the medical staff who counsel them, instruction both about the Church’s teaching on responsible parenthood and in methods of natural family planning.

Cardinal Daniel DiNardo, chairman of the USCCB Committee on Pro-Life Activities, has appealed to Congress in a formal letter asking for conscience protection.

The IOM’s proposed list of mandated benefits makes it especially urgent for Congress to bring PPACA into line with this unbroken legal tradition of respect for the rights of conscience. Those who sponsor, purchase and issue health plans should not be forced to violate their deeply held moral and religious convictions in order to take part in the health care system or provide for the needs of their families or their employees. To force such an unacceptable choice would be as much a threat to universal access to health care as it is to freedom of conscience.

In addition to conscience protection I would also propose that coverage for training in Natural Family Planning be included in the mandated coverage. Natural Family Planning (NFP) using a symptothermal (SMT) method such as that taught by the Couple to Couple League or the Creighton Method is as effective as oral contraceptives when postponing pregnancy. In February, 2007, Professor Petra Frank-Hermann published a study in the European journal Human Reproduction. She reported the results of a well-designed prospective study that followed over 900 women who used a symptothermal method of NFP for over 20 years and tracked over 17,000 monthly cycles. She stated:

For a contraceptive method to be rated as highly efficient as the hormonal pill, there should be less than one pregnancy per 100 women per year when the method is used correctly. The pregnancy rate for women who used the STM method correctly in our study was 0.4%, which can be interpreted as one pregnancy occurring per 250 women per year. Therefore, we maintain that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.

In addition, the study found that NFP using a symptothermal method was very acceptable to couples.

The drop-out rate from using STM for reasons such as dissatisfaction or difficulties with the method was 9.2 per 100 women and 13 cycles, and compared well with the drop-out rates from other methods of family planning, which can be as high as 30%, although direct comparisons are difficult due to methodological problems. “This demonstrates a fairly good acceptability for this particular FAB method,” said Prof Frank-Herrmann.

Recognizing NFP as a legitimate form of family planning that would be covered by insurance would be of great benefit to Catholic couples and to the many “green-conscious” couples turning to NFP. A Couple to Couple League training class costs around $135.00. The home study version costs $161.00. Physicians who provide patient education on NFP could be reimbursed for this service and have more of an incentive to recommend NFP if it was included as an option for family planning. If education and counseling for chemical and surgical methods of family planning are covered by insurance, it seems only fair that education for Natural Family Planning be covered as well.

For the record, I am uncomfortable lumping NFP with contraceptives, abortifacients, and sterilization. As I wrote in my article “What’s so ‘Natural’ about Natural Family Planning?,” using NFP is in accord with natural law and with Church teachings, if it is used to avoid pregnancy for serious reasons. Avoiding pregnancy is the exception, not the rule. Properly utilized, NFP does not distort or compromise marital intimacy by separating the unitive and procreative aspects of the marital act. This is what distinguishes it from chemical and barrier methods of contraception.

The Institute of Medicine and Department of Health and Human Services made a glaring mistake in declaring contraceptives to be a mandated preventive service, primarily because pregnancy is not a disease that needs to be prevented. Fertility is not a disorder that needs to be “cured.”  My proposal does not right that mistake: it simply prevents the mistake from being compounded by the exclusion of a legitimate and scientifically-based form of family planning. Conscience protection is essential to mitigate the discriminatory nature of this policy and so I echo Cardinal DiNardo’s call to members of congress for robust protections. In addition, education about a reliable, economical, and side-effect-free family planning method like NFP should be included in the array of mandated coverage.

Denise J. Hunnell, MD, is a Fellow of HLI America.  She writes for the Truth and Charity Forum.


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