NCHR Comments to HHS on Religious Exemptions and Contraceptives

Acting Secretary Eric Hargan
Department of Health and Human Services
Hubert H. Humphrey Building
200 Independence Avenue SW., Room 445
Washington, DC 20201

Dear Acting Secretary Hargan,

Thank you for the opportunity to provide comments on the Departments of Health and Human Services, Labor and Treasury October 6, 2017 Interim Final Rules (IFR). The National Center for Health Research (NCHR) is a research center that is focused on policies and programs that affect public health. Our Center analyzes scientific and medical data and provides objective health information to patients, providers, and policymakers. We strongly oppose rules that expand exemptions to contraceptive coverage because they harm women’s health.

We strongly oppose the IFR’s use of religious objections to undermine essential health care for millions of women in our country. The HHS must ensure the health of all our citizens by implementing policies based on sound medical and public health science. We urge that HHS bring evidenced-based practice into the forefront of health policies, as it has for decades.

Access to free contraception has enabled 62.4 million women to stay healthy using affordable contraceptive care. The CDC estimates that the 2016 teen pregnancy rates dropped by 9 percent, and the Guttmacher Institute found that the abortion rate in 2014 had dropped by 14% since 2011. These trends are often attributed to free contraception that became available as a result of the Affordable Care Act.  For these trends to continue, continued free access to contraception for those who want it cannot be denied.

By encouraging employers and universities to deprive women of free contraceptive coverage, the IFR will harm women’s health and increase the rates of abortion, single mothers, financial strains on families, and possibly abused and neglected children. The IFR is not based in the scientific evidence supporting contraception. For all of these reasons, the National Center for Health Research respectfully urges that you rescind the IFR.

#1. Birth control is an essential preventive health service.

Preventive healthcare promotes health and well-being through disease prevention, management of disease to prevent long-term complications, and screening for conditions which threaten health. Pregnancy is a medical condition, and it increases women’s risk for serious health problems,  including potentially fatal blood clots, bleeding, anemia, high blood pressure, gestational diabetes, and death. Pregnancy can also worsens chronic medical conditions, such as high blood pressure or clotting disorders, which can have significant impacts on health. Prevention of pregnancy is as essential as prevention of diabetes and cancer, and much easier and less expensive to accomplish. In addition, unintended pregnancy can affect women’s psychosocial health, increasing mental health disorders and threatening financial security. Women with unplanned pregnancies are more likely to delay prenatal care, which increases risk for infant death, birth defects, low birth weight, and preterm birth.

#2. Birth control is critical to women’s socioeconomic well-being and in turn that affects their health.

The Department of Health and Human Services has previously acknowledged that the contraceptive coverage benefit enables “women to achieve equal status as healthy and productive members of the job force.” (77 Fed. Reg. 8725, 8728). Lower education, career level, and earnings are important social determinants of health, and can be considered social risk factors for poor health outcomes. Access to effective birth control enables women to be more financially secure, which mitigate social risk factors and improve health.

#3. The Rule rejects scientific evidence in favor of “beliefs.”

As the nation’s health policy center, the Department of Health and Human Services (HHS) policies and activities must be firmly based on scientifically valid and appropriate terms and evidence. The IFR does not meet the high standard of scientific evidence used by the National Academy of Medicine and federally supported Women’s Preventive Services Initiative. The Rule’s statement that “many persons and organizations” are against “contraceptive methods… [they] believe are abortifacient” is not scientifically based (82 FR 47841). FDA-approved contraceptives act before implantation and therefore are never abortifacients. While all Americans are entitled to their religious beliefs, such beliefs are not appropriate as a basis to wrongfully deny women access to potentially life-saving services. Given the separation of Church and State that our country is based on, it is inappropriate to exempt contraceptive coverage based on religious beliefs rather than science-based evidence.

#4. Contraceptives are not a “gateway drug.”

The Rule suggests the contraceptive coverage benefit could “affect risky sexual behavior in a negative way.” (82 FR 47841). Increased access to contraception is not associated with increased unsafe sexual behavior or increased sexual activity. In fact, student health centers that provide access to contraceptives increase use of contraceptives by students who are already sexually active. Providing birth control is not a gateway to an earlier sexual debut or sexual risk taking. Conversely, denying birth control will likely increase the incidence of teen pregnancy, which can post a serious physical and mental health risk to young females, and often results in abortion.

We appreciate your consideration of our views and urge you to strike the IFR and focus on strategies based on sound science and medical evidence.

Diana Zuckerman, PhD
National Center for Health Research