Politics & Policy

There’s No Public-Health Case for Making Nuns Provide Free Birth Control


Today, the U.S. Supreme Court will hear oral arguments in a group of cases challenging the Affordable Care Act’s requirement that non-profit employers offer health-care coverage that includes contraception, abortifacients, and sterilization. The challengers in the consolidated cases, captioned Zubik v. Burwell, include Little Sisters of the Poor, Priests for Life, and a variety of religious non-profits. Many of the arguments that have been put forth in support of the plaintiffs involve conscience rights. These are important arguments that certainly deserve attention. However, in the amicus brief I filed in on behalf of the Charlotte Lozier Institute, I emphasized public-health arguments which have received relatively little media attention.

Among many journalists and commentators, there is a real misunderstanding about academic research that has been done on contraception. Many people intuitively think that greater access to contraception will automatically result in lower unintended pregnancy rates and abortions. The Guttmacher Institute, which up until recently was Planned Parenthood’s research arm, often publishes ideologically oriented research arguing for more spending on various contraceptive programs both in the United States and abroad. But a closer look at the research that has appeared in peer-reviewed economics and public-health journals tells a different story. There is a substantial body of peer-reviewed research that demonstrates that programs designed to improve access to contraceptives — through legalization, distribution, or subsidies — are either ineffective at best or counterproductive at worst.

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The best example is a study that appeared in the Quarterly Journal of Economics in 1996 authored by current Federal Reserve chair Janet Yellen, Nobel Prize–winning economist George Akerlof, and Stanford professor Michael Katz. It nicely demonstrates that the availability of oral contraceptives in the early 1960s resulted in increasing out-of-wedlock birthrates. Oral contraceptives encouraged more women to engage in premarital sex and through risk compensation, actually increased the number of unintended pregnancies. Furthermore, men who impregnate women faced considerably less social pressure to marry. The end result was more sexual activity, more abortions, and more out-of-wedlock births.

#share#Other studies have arrived at similar conclusions. Separate studies conducted in Britain, Scotland, and San Francisco have found that free contraceptive programs have been ineffective at lowering both teen-pregnancy rates and abortion rates. Additionally, 23 studies published between 1998 and 2006 all show easier access to emergency contraception fails to achieve any statistically significant reduction in rates of either unintended pregnancy or abortion. Finally, a 2011 study authored by the University of Michigan’s Population Studies Center analyzed how an increase in the price of oral contraceptives impacted the sexual activity of college women. It found that after the price of oral contraceptives increased — there were statistically significant decreases in both the frequency of sexual intercourse and the number of sex partners. The unintended pregnancy rate remained about the same.

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Furthermore, research on contraceptive mandates — the very issue the Supreme Court is considering in Zubik v. Burwell — indicates that these mandates offer no discernible public-health benefit. Since the early 1990s, 28 U.S. states have enacted mandates requiring that some — or in some cases, all — health-insurance plans include contraceptive coverage. In a 2015 study that was published by Ave Maria Law Review, I analyzed the impact of these mandates. I collected public-health data from nearly all 50 states and held constant a range of demographic and economic variables. I found that these contraceptive mandates had no statistically significant impact on either state-level abortion rates or state unintended-pregnancy rates.

When religious freedom has come into conflict with federal or state law, the Supreme Court has often upheld the conscience rights of various religious groups. The Supreme Court in Wisconsin v. Yoder allowed the Amish to remove their children from school before they turned 16. It has also ruled in favor of those who sought exemption from military combat on religious grounds. There have also been instances when federal courts have balanced religious freedom and conscience rights with various policy considerations. In Zubik v. Burwell, however the decision should be easy. Contraception mandates offer no public-health benefit. As such, there is clearly no compelling state interest to burden the conscience of the Little Sisters of the Poor or other religious non-profits.

Michael J. New is a visiting assistant professor of social research and political science at the Catholic University of America and an associate scholar at the Charlotte Lozier Institute in Washington, D.C.

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