Tag Archives: reproductive

Supreme Court sends birth control case back to lower courts

When it comes to the issue of religious rights versus no-cost contraception, the only thing the Supreme Court could agree on was not to decide the case.

In an unsigned opinion issued Monday, the court sent a series of cases back to a raft of federal appeals courts, with instructions for those courts and the parties in the lawsuits to try harder to work things out. “The Court expresses no view on the merits of the cases,” the opinion said.

At issue is the extent to which religiously affiliated employers (such as universities or hospitals) need to participate in the requirement under the Affordable Care Act for most employer health plans to provide no-cost contraception for women.

The government made several changes to the rules over the past four years in an attempt to accommodate the religious employers’ objections while still ensuring that female employees would get contraceptive coverage. But dozens of religious nonprofit employers sued anyway, claiming that even the act of notifying the government of their objections (which would, in turn, trigger a requirement for the government to arrange coverage) made them “complicit” in providing a service they see as sinful.

The court’s opinion, and an accompanying order on several similar cases that were awaiting a decision on whether the high court would take them up, erased all the lower appeals court rulings, all but one of which had sided with the government. That appeared at first glance to put at risk coverage for contraceptives for tens of thousands of employees of the organizations that filed suit.

However, the court made clear in its opinion that because the employers who have sued have already in effect notified the government of their objections, the government can rely “on this notice, to the extent it considers it necessary, to facilitate the provision of full contraceptive coverage going forward.”

At the same time, however, the opinion said the government “may not impose taxes or penalties on petitioners for failure to provide the relevant notice.”

The goal, the justices wrote, is that both sides “should be afforded an opportunity to arrive at an approach going forward that accommodates petitions’ religious exercise while at the same time ensuring that women covered by petitioners’ health plans ‘receive full and equal health coverage, including contraceptive coverage.’ ”

Both sides in the dispute claimed at least a partial victory.

“From our point of view this is a win for religious liberty,” said Mark Rienzi, a senior counsel for the Becket Fund for Religious Liberty, which is representing the Little Sisters of the Poor, one of the groups that sued the government. “The government can find ways to give out contraception without hassling nuns.”

But at the same time, said Louise Melling, deputy legal director of the Americans Civil Liberties Union, “the opinion states clearly the need for women to receive full and equal coverage.”

Contraceptive advocates also pointed to a concurring opinion from Justices Sonia Sotomayor and Ruth Bader Ginsburg that stressed that the decision should not be read as approving coverage strategies that make it harder for women to get the benefits.

For example, they wrote, “Requiring standalone contraceptive-only coverage would leave in limbo all of the women now guaranteed seamless preventive-care coverage under the Affordable Care Act. And requiring that women affirmatively opt into such coverage would ‘impose precisely the kind of barrier to the delivery of preventive services that Congress sought to eliminate.’ ”

It remains unclear exactly what the lower courts might do. In an effort to break what was clearly a 4-4 deadlock, the court in March asked each side for supplemental material outlining any potential compromises. The decision Monday referred to those new briefs as suggesting that providing contraceptive coverage without requiring notice from religious employers “is feasible.”

But Sotomayor and Ginsburg, in their concurring opinion, noted that “the Courts of Appeals remain free to reach the same conclusion or a different one on each of the questions presented by these cases.”

From  Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

ACLU demands Catholic hospital provide emergency procedure for pregnant woman with brain tumor

The American Civil Liberties Union of Michigan sent a demand letter to a Catholic hospital in Michigan on behalf of a pregnant woman with a life-threatening brain tumor who was denied a request to get her tubes tied at the time of her scheduled C-section next month.

Jessica Mann, who is 34 weeks pregnant, was denied the procedure by Genesys Hospital because of religiously based rules that dictate hospital policy.

Mann’s doctor highly recommends that she has no further children due to the strain the pregnancy will pose to her health because of her brain tumor.

Although her doctor requested a medical exception to the general prohibition on sterilization procedures at Genesys a few months ago, the woman was just informed that the request would not be granted. Having a tubal after Mann recovers from the C-section in several weeks is also not recommended because that would also require another round of life-threatening full anesthesia and surgery. 

“Although everyone has a right to practice their religion as they see fit, religion cannot be used to harm others, which is what is happening here,” said Brooke Tucker, attorney at the ACLU of Michigan. “Jessica Mann and every person who goes into the hospital seeking medical care should not have to worry that religious beliefs rather than medical judgment will dictate what care they receive.”

Genesys Hospital is part of Ascension Health, the largest Catholic healthcare system in the country. The facility is governed by religious rules called the Ethical and Religious Directives, which are written by the U.S. Conference of Catholic Bishops and that classify common reproductive health procedures as “intrinsically evil.”

“I should be able to focus on getting ready for my baby, not having to fight a hospital for treatment in my last trimester of pregnancy,” said Jessica Mann. “I want to make sure that not only myself but that other women are able to get the medical treatment that they need.”

Tubal ligation, known familiarly as “getting one’s tubes tied,” is the contraception method of choice for more than 30 percent of U.S. married women of reproductive age. An estimated 600,000 women undergo this procedure each year. For women who want a tubal ligation, performing it at the time of a C-Section is recommended practice and is the standard of care.

Ten of the 25 largest hospital systems in the United States are Catholic-sponsored, and nearly one of nine hospital beds in the country is in a Catholic facility.

Iowa board moves to limit abortion access for patients in remote areas

Iowa’s medical board has moved to end a system in which doctors use a video-conferencing system to distribute abortion-inducing pills to patients at clinics in remote areas across the state.

The system allows Planned Parenthood of the Heartland to offer the pills at clinics in 15 remote locations where the organization doesn’t have doctors who can meet with patients in person. Instead, a doctor, typically based in Des Moines, meets with patients using an Internet video system before the women receive the drugs.

Planned Parenthood established the Iowa program in 2008, and it was the first such system in the U.S. Several other states have since taken steps to prevent the practice.

Earlier this summer abortion opponents petitioned the Iowa Board of Medicine to halt that state’s program. Efforts to legislate against the practice have failed in Iowa, where the Legislature is politically divided, but the board has the authority to make such policy decisions.

The medical board approved the change on an 8-2 vote in late August. The new rules require that a doctor be physically present with a woman when an abortion-inducing drug is provided, and they earliest they could go into effect would be Nov. 6.

The change puts Iowa in the company of other states with Republican governors or GOP-controlled legislatures that have been passing legislation designed to restrict abortion access in recent years. Since Planned Parenthood began the Iowa telemedicine program, the state has elected a Republican governor who replaced all of the members of the medical board. The GOP also controls the Iowa House, though Democrats control the Senate.

Experts say there appear to be few other programs like this in the U.S. Planned Parenthood in Minnesota has offered a much more limited version since 2010, with women who go to clinic in Rochester able to meet with a doctor in St. Paul.

Since 2011, 16 states have enacted laws barring telemedicine abortions, though not all of those laws are currently in effect, said Elizabeth Nash, state issues manager for the New York-based Guttmacher Institute, a reproductive rights think-tank. The institute said Iowa was the only state where opponents were trying to bar this system through the medical board.

Planned Parenthood says the program benefits women in rural locations and that it’s received no complaints from patients. But board members said they had concerns about the process and the care women were receiving; they said the goal wasn’t to restrict abortion access.

“How can any of us possibly find that a medical abortion performed over the Internet is as safe as one provided by a physician in person?” the board’s chairman, Dr. Greg Hoversten, asked.

A spokesman for Republican Gov. Terry Branstad, an anti-abortion Catholic, praised the board’s decision.

“Women deserve high quality medical care, and a standard of care designed to protect their health regardless of the procedure at issue,” spokesman Tim Albrecht said in an emailed statement. “The board made this decision based on the standard of health care that women deserve.”

Planned Parenthood of the Heartland President Jill June declined to say if the group would sue, saying only that the group is keeping its options open.

“We will not roll over and play dead. The health and welfare of rural women is too precious,” June said.

Planned Parenthood says the Iowa program works like this:

Staff members at the remote clinics perform any necessary testing. A doctor, usually in Des Moines, reviews the patient’s records before talking with her over a video-conferencing system. If the doctor decides the woman is a proper candidate for abortion-inducing medication, he remotely triggers a drawer to open in front of the woman with two sets of pills. She takes the first dose at the clinic and the rest of the pills later at home.

The U.S. Food and Drug Administration approved the use of an abortion drug in 2000. The medication is typically offered to women in the first nine weeks of pregnancy.

Wis. GOP vows to enact bill that would force women to undergo invasive transvaginal ultrasound

Far-right extremists are determined to enact a mandatory ultrasound bill in Wisconsin that would force many women to undergo the ordeal of an invasive transvaginal probe in order to safely and legally terminate an unwanted pregnancy.

At a recent conference of the politically powerful Wisconsin Right to Life group, the state’s top Republican lawmakers assured attendants they would do everything in their power to pass such a law, which would affect women seeking first-trimester abortions.

At that stage of a pregnancy, the uterus is sometimes blocked by the pelvis, which prevents traditional ultrasounds from capturing embryonic images. That situation would mandate use of a transvaginal probe under the terms of a proposed GOP-backed law forcing women to undergo ultrasounds prior to abortion.

“This bill is a priority,” said Wisconsin Senate Majority Leader Scott Fitzgerald, a great favorite of the right-wing tea party, adding, “It is long overdue.”

The so-called “Woman’s Right to Know her Unborn Child Act” would add to current laws intended to discourage woman from ending their pregnancies. State law already requires women to undergo a counseling session with their doctor 24 hours before having an abortion.

At the height of the Republican’s so-called “War on Women” last spring, Virginia Republicans stirred up a media frenzy when they pushed a similar bill through that state’s tea party-controlled legislature. They later sought to distance themselves from the transvaginal probe mandate.

The new Wisconsin law comes at a time when Planned Parenthood of Wisconsin is reeling from Gov. Scott Walker’s defunding of the organization. Between April and July of this year, Planned Parenthood will have to close health clinics in Beaver Dam, Johnson Creek, Chippewa Falls and Shawano – all due to Walker’s stripping of $1.1 million in state funding to the organization in his 2011-2013 budget.

Closing of the clinics will eliminate more than 11,400 critical health services, such as breast and cervical cancer screenings, to 2,000 Wisconsin patients.