Birth control needs to be accessible

Few people could have predicted that contraception would be a flash point in an election year that was supposed to be all about the economy. But in just the latest illustration of the mercurial nature of this campaign season, precious little has unfolded as anticipated.

President Barack Obama seemed to have settled on a reasonable middle course Friday, adapting what’s been described as the "Hawaii solution" to a conflict over coverage of birth-control services under the nation’s new health care reform law.

In his explanation of his "accommodation," Obama said that religious institutions that object to contraception won’t have to pay for it for their employees, but those employees would access that coverage through a rider from the insurance company. It was loosely modeled on a provision in Hawaii’s own health care statutes.

This compromise followed several days of turmoil after the president made an unforced political error by issuing a ruling while his rivals floundered in search of partisan consensus.

He handed them their consensus with an announcement: While churches themselves would be exempt from the rule, any health insurance plan offered to employees of religious-run institutions — such as hospitals, universities and charities — would have to cover contraception, with no co-pay.

This enraged leaders of the U.S. Conference of Catholic Bishops, among other religious entities, primarily of the Roman Catholic faith, which officially bars artificial contraception of any kind. What the administration had failed to grasp was that for many leaders of these institutions, there was no real boundary between their work in medicine, education or social work and the church itself.

Most of them are run by religious orders. In Hawaii, for example, the Franciscans operated one of its oldest hospitals for decades, and Chaminade University is a private institution founded by the Marianists. For members of these orders, their work is part and parcel of their religious mission.

Supporters of the original rule are right when they say that providing contraception available to all is a crucial part of any rational health care system in which both public health and costs are concerns. Preventing an unwanted pregnancy is healthier and far less expensive than childbirth or an abortion in its later stages.

Even in the 21st century, that need, in Hawaii and elsewhere, is still acute. The Guttmacher Institute, a research group that specializes in studies of sexual and reproductive rights, reported in 2006 that 59 percent of all pregnancies in Hawaii were unintended that year and that every year, nearly 150,000 women here seek access to birth control. Slightly less than half of them require financial assistance to obtain contraception.

Clearly, equal access to birth-control is a much-needed advancement made by health care reform and deserving of support.

Further, supporters are correct when they cite statistics showing the vast majority of American Catholic women break with Catholic dogma and use the artificial means of birth control that the church officially abhors.

This, however, doesn’t negate the right of church leadership to affirm its teachings. In the past week many Catholic advocates of women’s health converged on the White House to assert that it’s possible to preserve health access without forcing any employer to enable a practice they believed to be wrong.

It was that act of compulsion — threats of fines to religious institutions that didn’t fall in line — that rubbed people the wrong way, even those who support health services, in a country that values religious freedom.

"Under this compromise, women who work for religious organizations are not charged for these critical services, and the employers with conscience concerns are not required to discuss these options with their employees," U.S. Sen. Daniel Akaka said in a statement Friday. "In our experience in Hawaii, our contraceptive equity law does not appear to have impacted any insurance costs or coverage."

Religious institutions are woven into the fabric of American educational and health systems, and their concerns need to be respected. Democracy is complicated by such realities, and on the strength of the points Akaka raised, Obama seems to have struck the right posture in a difficult balancing act. It’s time to move on to other matters.