Pursuing Health in an Anxious Age by Bob Cutillo, Free for CAPC Members
Dr. Cutillo seeks to engage readers in rethinking, and re-engaging, health and care from a redemptive approach.
I appreciate the irony of writing about birth control while six months pregnant; I keep imagining the looks I might get when I pick up my research from the library. A bit late for this sort of reading, no? But the recent controversy over birth control in the Obama administration’s healthcare reforms illustrates that birth control is about far more than whether or when women get pregnant. The current issue is fraught with legal and religious ideologies that are difficult, if not impossible, to untangle. For many conservative believers, the difference between abortion, abortifacient, and contraception is murky at best, and yet there cannot be a thoughtful Christian response to this healthcare mandate without a thoughtful consideration of what contraception does—and doesn’t—signify. Taking that line of reason further, I believe it is essential to ask for whom contraception is significant, but the “religious freedom” debate and governmental panels seem to have removed women from the picture entirely.
The original mandate required employers to pay for insurance plans that include free birth control, though that plan has since shifted to offer religious organizations an alternative where employees could obtain birth control through insurance companies rather than employers. What happens when the employer is also the insurer remains to be seen, and that exception is one of a number of issues cropping up as the conversation over contraception continues. Responses to the policy shift tend to fall into one of three categories: those who feel the concession violates women’s rights, those who find the compromise acceptable, and those who reject the compromise for the limitations it still promises for parachurch organizations. If this issue were easily divisible between women’s rights and religious freedom, it would perhaps seem simpler to solve, but it’s not. It’s both.
Both supporters and opponents invoke the First Amendment, albeit different clauses. Consider the amendment’s first line: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” Typically, those who support universal access to contraception feel that the faith of employers or insurers should have nothing to do with the medical care available to employees, a position based on the anti-establishment clause. People of faith who oppose the distribution of contraception, meanwhile, invoke the “free exercise” component and claim that the government’s mandate interferes with the practice of their religion; some religious leaders are calling for civil disobedience, though the penalties to employers and their missions would be costly. Even with the compromise to allow insurance companies to pick up the tab instead of employers, questions still remain about the status of faith-based insurance companies and companies who serve as both employer and insurer. At the heart of this issue is a fundamental problem in the ideology of natural rights. What happens when two parties, both appealing to Constitutional rights, conflict? Whose rights predominate?
Neither of the groups discussed above necessarily includes the actual women who may want or need access to contraception. Although controversial since its inception, the pill provides medical benefits beyond contraception and it seems fair to ask what will happen to women who use it for reasons other than birth control if their employers or insurers refuse them access because of faith. There are also important distinctions between kinds of contraception, which fall into four main categories. The least controversial for religious conservatives is Natural Family Planning (an updated rhythm method) where tracking a woman’s cycle and physical symptoms can predict ovulation—to prevent or achieve pregnancy. There are “barrier” methods like condoms and the sponge that work by preventing sperm from accessing the egg, thus eliminating the opportunity for fertilization. Then there are hormonal methods like the pill and the IUD that work by suppressing ovulation and creating a uterine environment hostile to implantation. This third category tends to be more controversial to religious groups; some call hormonal birth control “abortifacients,” or abortion-inducing drugs because it is still possible for egg and sperm to meet, but unlikely to thrive given the uterine conditions. The fourth, and most controversial, method is known as “emergency” contraception, including drugs like Plan B, which is intended to prevent pregnancy if taken within seventy-two hours of intercourse.
Once more the religious and legal worlds collide (all played out within women’s potentially pregnant bodies) and grapple with definitions. Drugs like Plan B are classed by the FDA as contraceptives because pregnancy is not a legal state until implantation, whereas many Christians view the beginning of life at conception. But while conception may be obvious to God, there are no signs for humans (unlike the slight bleeding that sometimes occurs with implantation) to discern that point of origin—making contraception that allows the egg and sperm to meet theologically slippery territory. Given different beliefs about when life begins (not to mention from whom it comes), it’s easy to see how conservative Christians clash with the current administration’s birth control agenda: there are different definitions of contraception, abortion, and life itself at stake.
There are also judicial precedents that protect individual privacy with regard to reproductive rights. I don’t underestimate the controversial nature of Roe v. Wade, yet it has remained the law of the land since 1973, allowing women access to legal abortions. I don’t endorse that case’s decision or the practice it legalizes, but any discussion of legality needs to consider the standing precedents; I also find it dangerous to conflate abortion and contraception, when the latter at least exists in a spectrum of technologies and practices. In addition to Roe V. Wade, there is also the lesser known and at least somewhat less controversial 1965 Supreme Court case of Griswold v. Connecticut, where the court overturned a state law banning the use of contraceptives on the basis of the right to marital privacy. Neither of these cases is a direct parallel to the current situation, yet each demonstrates the range of possibilities for interpretation on issues of reproductive rights. I make no attempt here to mandate what the position ought to be, but instead try to illustrate the complexity of reaching agreement, within secular or faith-based communities, on any kind of mandate. What seems to me to be getting lost in this conversation is the fact that all of these legal, theological, and social issues involve real women, real men, and real (potential) children.
Perhaps because I am currently pregnant I overvalue the embodied reality of using birth control (or not). The difference is that I chose Natural Family Planning with the hope of conceiving, not because it was the only option available to me. I made that decision with my husband, prayerfully, taking into account the calling we feel God has made on our family as well as the wisest route for stewarding our resources of spiritual gifts, attention, time, and money. Some might call my refusal to utterly surrender my fertility to God a lack of faith, but I see it as faith coupled with discernment, sought through the Spirit, however imperfectly I may interpret its whispers. I don’t envision my method of birth control as a universal solution because I cannot possibly understand the nuances of each family’s situation. Whether because of strained resources or health concerns with continued pregnancies or non-birth control related use of contraception, there are a lot of reasons why women choose to use birth control. And while I think the ideal is for sexually-active women to be engaged in healthy marital relationships where contraception usage (or refusal) is a mutual decision between husband and wife, the reality is that women and women’s bodies tend to bear the primary responsibility for using birth control. So while I understand this healthcare mandate as a serious issue of religious freedom, fraught with definitional conflicts between theology and religion, those facts are inseparable from women and women’s bodies. And maybe it’s because I can feel my second daughter kicking me in the bladder that I feel like female bodies ought to matter more in this conversation—whatever the conclusion.
Pregnancy complicates the western notion of individualism, and, for me, raises issues with the kind of “keep your laws off my body”-style feminism that resists any legislation of women’s reproductive rights. Right now, it’s not just my body. It’s my unborn daughter’s body, too. I am responsible for her survival, her nurturance, as well as my own. I am also the primary caregiver for an only slightly-less-dependent toddler who makes a myriad of demands on my emotional, intellectual, and physical resources. My life is not solely mine and neither is my body, as a simple observation of our breakfast makes clear. I don’t even get to eat my own cereal by myself. As a visibly pregnant woman, I am subject to all kinds of social critiques—from comments about how much I exercise to attempts to touch my pregnant belly to questions about my plans to breastfeed (or not). All of these responses indicate the assumption that a pregnant woman belongs not to herself or even her own family unit or her God, but to society, and the underlying message is that we women cannot be trusted to carry our babies, even though we do it every day in a way that even the most sympathetic man can never understand.
When Representative Darrell Issa was questioned about his birth control access panel’s utter absence of women, he responded: “We heard from religious leaders whose positions might not be popular, like MLK’s position was not so long ago.” It’s not the first time that discussion of civil rights has excluded women; long before Issa or his appropriation of MLK, abolitionist Sojourner Truth told a women’s rights convention “Then that little man in black there, he says women can’t have as much rights as men, ’cause Christ wasn’t a woman! Where did your Christ come from? Where did your Christ come from? From God and a woman! Man had nothing to do with Him.” I don’t know what God’s ultimate position on contraception is, or where it fits into the current climate of theological and legal jockeying, but I do know from the Incarnation that God cares deeply about women and women’s bodies, and a Godly discussion of contraception needs to take that into account.
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