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WASHINGTON — The Obama administration, reeling from back-to-back blows from the Supreme Court this week, is weighing options that would provide contraceptive coverage to thousands of women who are about to lose it or never had it because of their employers’ religious objections.

The administration must move fast. Legal and health care experts expect a rush to court involving scores of employers seeking to take advantage of the two decisions, one involving Hobby Lobby Stores, which affects for-profit businesses, and the other on Wheaton College that concerns religiously affiliated nonprofit groups. About 100 cases are pending.

One proposal the White House is studying would put companies’ insurers or health plan administrators on the spot for contraceptive coverage, with details of reimbursement to be worked out later.

Another would give the administration itself a larger role in offering cost-free coverage to women who cannot get it through their employers, although the option for a new government entitlement appears unrealistic for financial and political reasons.

The White House is under such pressure that no one has been able to work out details of how the alternatives would be financed or administered.

Administration officials said they were determined to ensure the broadest possible coverage of contraceptives for the largest number of women without requiring employers to violate their religious beliefs.

Mark L. Rienzi, a lawyer who represented both Hobby Lobby and Wheaton College, said the administration had the tools to make an alternative solution work. “The government can find other ways to deliver contraceptives to people without forcing nuns and religious colleges to participate,” he said.

That is not the way Justice Sonia Sotomayor looks at it. In her dissent in the Wheaton College case on Thursday, she said the challenge facing the government was “daunting — if not impossible.”

Still, the administration has another motivation to act as quickly as possible: It is eager to court the votes of women dismayed by the rulings. The Democratic National Committee is already urging voters to fight back against the Hobby Lobby decision and to “stand up for Obamacare” in the November elections. The Supreme Court said that family-owned for-profit corporations like Hobby Lobby were not required to provide coverage of contraceptives if they objected on religious grounds.

Whatever the choice, no plan can be turned around in two weeks, or two months. It took more than two years for the administration to figure out how to provide contraceptive coverage for women at nonprofit groups that have religious objections. That arrangement allowed religious organizations to fill out a form that would transfer the delivery of free coverage under the Affordable Care Act to others.

But many of the nonprofit groups say that even notifying an insurer of their objections through the opt-out form would make them complicit in a moral wrong. Some consider all contraception to be wrong; others object only to devices and drugs like the so-called morning-after pill that they believe may cause abortions. One such objector was Wheaton College, a Christian liberal arts school in Illinois, and the Supreme Court granted it a temporary exemption in the ruling on Thursday.

That move divided the court along gender lines, with Justices Ruth Bader Ginsburg and Elena Kagan joining Justice Sotomayor’s unsparing dissent. They said the court majority had endorsed the opt-out form just three days earlier in the Hobby Lobby case, in which Justice Stephen G. Breyer joined the three female justices in dissent in the 5-to-4 ruling.

The court’s conservative majority — all men — was sanguine about the availability of other ways for the administration to deliver coverage for every form of birth control approved by the Food and Drug Administration.

Yet officials are struggling to make sense of a sunny sentence in the court’s order on Thursday exempting Wheaton from the opt-out form. “Nothing in this interim order affects the ability of the applicant’s employees and students to obtain, without cost, the full range of F.D.A.-approved contraceptives,” the majority said in the unsigned opinion.

It said Wheaton could merely notify the government of its religious objections in writing rather than send the opt-out form to its coverage providers.

The difference sounds trivial. But it could create quite a roadblock for the Department of Health and Human Services, Justice Sotomayor wrote in dissent. “Does the court intend for H.H.S. to rely on the filing of lawsuits by every entity claiming an exemption?” she asked. She questioned whether the government was supposed to create “a database that tracks every employer’s insurer or third-party administrator nationwide.”

Wheaton said it would have no difficulty sending a notice to the secretary of Health and Human Services.

The contraceptive coverage requirement is just one of many provisions in rules adopted under the Affordable Care Act, but it has become one of the most significant, both politically and symbolically, overshadowing many other important provisions.

In early 2011, Obama administration officials said they wanted to require insurers to offer contraceptives to women free of charge.

The administration has made progress toward its goal, as millions of women have gained access to birth control without co-payments or other charges. But in the process, the administration has become entangled in scores of court cases, fighting with priests and nuns and other religious believers over details of the health insurance coverage they provide and receive.

The battles are sure to continue for a year or more, with religious objectors emboldened by victories this week. Justice Samuel A. Alito Jr., in writing the majority opinion in the Hobby Lobby case, said it seemed likely that the cost of providing the four drugs and devices that many religious groups object to “would be minor when compared with the overall cost” of the health care law.

Justice Alito wrote approvingly of the idea of shifting contraceptive costs to insurance companies, calling it “an approach that is less restrictive than requiring employers to fund contraceptive methods that violate their religious beliefs.”

But on Thursday the majority made the cost-shifting much harder to accomplish. The general idea is to require insurance companies and plan administrators to deliver coverage when they are told about an employer’s religious objections. They would bear the costs or receive reimbursement from the government.

The situation is more complicated when employers self-insure. There, the administration says, outside plan administrators may obtain a “compensating reduction” in the fees paid by insurers to participate in the insurance exchanges established by the health care law. Those adjustments, the administration has said, will not cost much.

Some religious organizations are using that arrangement. But employee benefits experts said it was not working well, in part because insurers and third-party administrators have had to foot the bill for contraceptive coverage without any immediate offset or reimbursement.

“They are not being paid, and they have no prospect of being reimbursed,” said Christopher E. Condeluci, a lawyer for the Self-Insurance Institute of America.

The Obama administration says the cost of providing contraceptives will be offset by savings that result from greater use of birth control, “fewer unplanned pregnancies” and improvement in women’s health. But, Mr. Condeluci said, “It may be years before the savings are realized.”

A version of this article appears in print on July 5, 2014,
on page A1 of the New York edition with the headline:
Obama Weighs Steps to Cover Contraception.

Obama Weighs Steps to Cover Contraception,
NYT,
4.7.2014,
http://www.nytimes.com/2014/07/05/us/
politics/obama-weighs-steps-to-cover-contraception.html

The Contraception Battle

July 1, 2013

The New York Times

By THE EDITORIAL BOARD

Last week saw two major developments in the legal and political battle over the Obama administration’s sound decision to require most employers to provide free insurance coverage of contraceptives for women under the new health care law — one of them positive and the other a blow to the mandate and to religious liberty.

The contraceptive coverage is an important advance in public health. Standing up to resistance from religious organizations, the Obama administration issued a final, simplified rule on Friday that allows houses of worship to exclude contraceptive coverage from their health plans for employees and their dependents. Other nonprofit religious and church-affiliated organizations like hospitals, universities and charities that object to contraceptive coverage on religious grounds will not have to contract, arrange or pay for the coverage. Instead, insurance companies or third-party administrators will have to arrange separate no-payment plans for contraceptive services.

Details of how this will work remain to be ironed out. But the administration has gone further than fairness or the First Amendment require to reach a compromise that respects the concerns of some religious entities without sacrificing an employee’s right to make her own decisions regarding contraceptives and not to conform to the religious beliefs of her employer.

Unfortunately, that vital principle of individual religious liberty was lost on the United States Court of Appeals for the 10th Circuit, in Denver. In a ruling issued on Thursday, it bought the argument that requiring the health plan of a private for-profit employer to cover birth control without a co-pay violated the employer’s freedom.

The case was brought by the owners of Hobby Lobby, a craft store chain that describes itself as “a faith-based company.” The First Amendment does not exempt religious entities from complying with neutral laws of general applicability, like the contraceptive mandate, much less private profit-making corporations. Yet, in an en banc ruling, the appellate court blocked the government from imposing fines on Hobby Lobby for not complying and allowed its challenge to the mandate to proceed, finding merit in its religious freedom claim.

Hobby Lobby argued that the contraception mandate violates the Religious Freedom Restoration Act, a 1993 federal statute that bars the federal government from taking actions that “substantially burden a person’s exercise of religion” unless that action advances a compelling government interest and is the “least restrictive means” of achieving it. The mandate’s promotion of women’s health and autonomy is plainly a compelling interest.

But the court should never have reached that question. Contrary to the majority opinion, a corporation like Hobby Lobby is plainly not a “person” covered by the Restoration Act. In any case, the contraceptive rule still leaves the company’s owners free to rail about the different forms of birth control to which they object and to try to convince employees not to use them. As the Justice Department cogently argued, the burden imposed on any religion is trivial in allowing employees to make their own independent decisions to obtain free contraceptives.

Marci Hamilton, a professor at Cardozo School of Law and an expert on the Restoration Act, rightly called the 10th Circuit’s interpretation of the law “a fantasy” that badly undermines rules forbidding corporations from discriminating on the basis of religion.

The Contraception Battle,
NYT,
1.7.2013,
http://www.nytimes.com/2013/07/02/
opinion/the-contraception-battle.html

Contraception Compromise

February 1, 2013

6:07 pm

The New York Times

Taking Note - The Editorial Page Editor's Blog

By DAVID FIRESTONE

The Obama administration has tried everything it can think of to accommodate religious groups that don't want to pay for their employees' birth control.

First, it eliminated the requirement for churches. Then church-affiliated groups like universities and hospitals said they didn't want to pay for birth control either, so last year the administration said insurance companies would have to foot the bill. Next the groups said they didn't want even a dollar of their insurance premiums to go toward contraception, so on Friday the administration announced a new plan to make sure that won't happen.

The plan is based around the idea that insurance companies benefit from increased use of contraception, because they don't have to pay for as many births or the complications of pregnancy. Several studies have found that there is virtually no cost to an insurance company of paying for birth control because of those offsetting reductions.

Under the plan, insurance companies must offer separate policies, covering only birth control, directly to employees of religious non-profits, free of charge.

In the case of religious affiliates that self-insure, a third-party administrator will arrange for the birth-control-only policies. Insurance companies that participate will get a break on the fees they have to pay to sell their policies in national health insurance exchanges.

The danger in the third-party scenario is that taxpayers or others paying insurance premiums might wind up subsidizing a few religious employers who want to impose their own doctrines on their employees, whether or not the employees agree. That's not an issue of religious freedom; if anything, some groups want to restrict the freedoms of their employees, who may be of a different religion.

What's clear, though, is that the administration has gone far enough in its accommodations. Now the test will be put to the religious groups: was their objection really about who pays a few extra dollars to insurance companies? Or did they simply object to the administration's demand for widespread, free access to birth control? Their response to today's plan will provide the answer.

Contraception Compromise, NYT, 1.2.2013,
http://takingnote.blogs.nytimes.com/2013/02/01/contraception-compromise/

A Flood of Suits

Fights Coverage of Birth Control

January 26, 2013
The New York Times
By ETHAN BRONNER

In a flood of lawsuits, Roman Catholics, evangelicals and Mennonites are challenging a provision in the new health care law that requires employers to cover birth control in employee health plans — a high-stakes clash between religious freedom and health care access that appears headed to the Supreme Court.

In recent months, federal courts have seen dozens of lawsuits brought not only by religious institutions like Catholic dioceses but also by private employers ranging from a pizza mogul to produce transporters who say the government is forcing them to violate core tenets of their faith. Some have been turned away by judges convinced that access to contraception is a vital health need and a compelling state interest. Others have been told that their beliefs appear to outweigh any state interest and that they may hold off complying with the law until their cases have been judged. New suits are filed nearly weekly.

“This is highly likely to end up at the Supreme Court,” said Douglas Laycock, a law professor at the University of Virginia and one of the country’s top scholars on church-state conflicts. “There are so many cases, and we are already getting strong disagreements among the circuit courts.”

President Obama’s health care law, known as the Affordable Care Act, was the most fought-over piece of legislation in his first term and was the focus of a highly contentious Supreme Court decision last year that found it to be constitutional.

But a provision requiring the full coverage of contraception remains a matter of fierce controversy. The law says that companies must fully cover all “contraceptive methods and sterilization procedures” approved by the Food and Drug Administration, including “morning-after pills” and intrauterine devices whose effects some contend are akin to abortion.

As applied by the Health and Human Services Department, the law offers an exemption for “religious employers,” meaning those who meet a four-part test: that their purpose is to inculcate religious values, that they primarily employ and serve people who share their religious tenets, and that they are nonprofit groups under federal tax law.

But many institutions, including religious schools and colleges, do not meet those criteria because they employ and teach members of other religions and have a broader purpose than inculcating religious values.

“We represent a Catholic college founded by Benedictine monks,” said Kyle Duncan, general counsel of the Becket Fund for Religious Liberty, which has brought a number of the cases to court. “They don’t qualify as a house of worship and don’t turn away people in hiring or as students because they are not Catholic.”

In that case, involving Belmont Abbey College in North Carolina, a federal appeals court panel in Washington told the college last month that it could hold off on complying with the law while the federal government works on a promised exemption for religiously-affiliated institutions. The court told the government that it wanted an update by mid-February.

Defenders of the provision say employers may not be permitted to impose their views on employees, especially when something so central as health care is concerned.

“Ninety-nine percent of women use contraceptives at some time in their lives,” said Judy Waxman, a vice president of the National Women’s Law Center, which filed a brief supporting the government in one of the cases. “There is a strong and legitimate government interest because it affects the health of women and babies.”

She added, referring to the Centers for Disease Control and Prevention, “Contraception was declared by the C.D.C. to be one of the 10 greatest public health achievements of the 20th century.”

Officials at the Justice Department and the Health and Human Services Department declined to comment, saying the cases were pending.

A compromise for religious institutions may be worked out. The government hopes that by placing the burden on insurance companies rather than on the organizations, the objections will be overcome. Even more challenging cases involve private companies run by people who reject all or many forms of contraception.

The Alliance Defending Freedom — like Becket, a conservative group — has brought a case on behalf of Hercules Industries, a company in Denver that makes sheet metal products. It was granted an injunction by a judge in Colorado who said the religious values of the family owners were infringed by the law.

“Two-thirds of the cases have had injunctions against Obamacare, and most are headed to courts of appeals,” said Matt Bowman, senior legal counsel for the alliance. “It is clear that a substantial number of these cases will vindicate religious freedom over Obamacare. But it seems likely that the Supreme Court will ultimately resolve the dispute.”

The timing of these cases remains in flux. Half a dozen will probably be argued by this summer, perhaps in time for inclusion on the Supreme Court’s docket next term. So far, two- and three-judge panels on four federal appeals courts have weighed in, granting some injunctions while denying others.

One of the biggest cases involves Hobby Lobby, which started as a picture framing shop in an Oklahoma City garage with $600 and is now one of the country’s largest arts and crafts retailers, with more than 500 stores in 41 states.

David Green, the company’s founder, is an evangelical Christian who says he runs his company on biblical principles, including closing on Sunday so employees can be with their families, paying nearly double the minimum wage and providing employees with comprehensive health insurance.

Mr. Green does not object to covering contraception but considers morning-after pills to be abortion-inducing and therefore wrong.

“Our family is now being forced to choose between following the laws of the land that we love or maintaining the religious beliefs that have made our business successful and have supported our family and thousands of our employees and their families,” Mr. Green said in a statement. “We simply cannot abandon our religious beliefs to comply with this mandate.”

The United States Court of Appeals for the 10th Circuit last month turned down his family’s request for a preliminary injunction, but the company has found a legal way to delay compliance for some months.

These cases pit the First Amendment and a religious liberty law against the central domestic policy of the Obama administration, likely affecting many tens of thousands of employees. The First Amendment says that “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof,” and much attention has been focused in the past two decades on the issue of “free exercise,” meaning preventing governmental interference with religious practices.

Free-exercise cases in recent years have been about the practices of small groups — the use of a hallucinogen by a religious group, for example — rather than something as central as the Affordable Care Act.

The cases also test the contours of a 1993 law known as the Religious Freedom Restoration Act. The law prohibits the federal government from imposing a “substantial burden” on any religious practice without a “compelling state interest.” The burden must also be the least restrictive possible.

Professor Laycock of the University of Virginia said: “The burden is clear especially for religious organizations, which ought to be able to run themselves in accordance with their religious teachings. They are being asked to pay for medications they view as evil.” He added that because the health care law had many exceptions, including for very small companies, the government might find it hard to convince the courts that contraception coverage is, in fact, a compelling interest.

But William Marshall, a First Amendment scholar at the University of North Carolina Law School, said the Supreme Court asserted in a 1990 opinion by Justice Antonin Scalia that religious groups had a big burden in overcoming “a valid and neutral law of general applicability.”

“You could have an objection of conscience to anything the government wants you to do — pay taxes because they will go to war or to capital punishment, or having your picture on your driver’s license,” Mr. Marshall said. “The court has made clear that religious groups have no broad right for such exceptions.”

Mr. Laycock said that while judges are supposed to be neutral, they too can get caught up in the culture wars. Judges sympathetic to women’s sexual autonomy would probably come down on one side of the dispute, and those more concerned with religious liberty on the other, he said.

“There is a lot of political freight on this issue,” he said.

    A Flood of Suits Fights Coverage of Birth Control, NYT, 26.1.2013,
    http://www.nytimes.com/2013/01/27/health/
    religious-groups-and-employers-battle-contraception-mandate.html

Women’s Health Care at Risk

February 28, 2012
The New York Times

A wave of mergers between Roman Catholic and secular hospitals is threatening to deprive women in many areas of the country of ready access to important reproductive services. Catholic hospitals that merge or form partnerships with secular hospitals often try to impose religious restrictions against abortions, contraception and sterilization on the whole system.

This can put an unacceptable burden on women, especially low-income women and those who live in smaller communities where there are fewer health care options. State regulators should closely examine such mergers and use whatever powers they have to block those that diminish women’s access to medical care.

Gov. Steve Beshear of Kentucky, for example, recently turned down a bid by a Catholic health system to merge with a public hospital that is the chief provider of indigent care in Louisville. He cited concerns about loss of control of a public asset and restrictions on reproductive services.

The nation’s 600 Catholic hospitals are an important part of the health care system. They treat one-sixth of all hospital patients, and are sometimes the only hospital in a small community. They receive most of their operating income from public insurance programs like Medicare and Medicaid and from private insurers, not from the Catholic Church. They are free to deliver care in accord with their religious principles, but states and communities have an obligation to make sure that reproductive care remains available. This should be a central goal for government officials who have a role in approving such consolidations.

As Reed Abelson wrote in a recent report in The Times, these mergers are driven by shifts in health care economics. Some secular hospitals are struggling to survive and eager to be rescued by financially stronger institutions, which in many cases may be Catholic-affiliated. By one estimate, 20 mergers between Catholic and non-Catholic hospitals have been announced over the past three years and more can be expected.

The 2009 “Ethical and Religious Directives” issued by the United States Conference of Catholic Bishops warns that Catholic institutions should avoid entering into partnerships “that would involve them in cooperation with the wrongdoing of other providers.” Catholic hospitals have refused to terminate pregnancies, provide contraceptive services, offer a standard treatment for ectopic pregnancies, or allow sterilization after caesarean sections (women seeking tubal ligations are then forced to have a second operation elsewhere, exposing them to additional risks).

In one case, the sole hospital in a rural area in southeastern Arizona announced in 2010 that it would partner with an out-of-state Catholic health system, and would immediately adhere to Catholic directives that forbid certain reproductive health services. As a result, a woman whose doctors wanted to terminate a pregnancy to save her life had to be sent 80 miles away for treatment. A coalition of residents, physicians and activists campaigned against the merger and it was called off before it was finalized.

Over the past 15 years, MergerWatch, an advocacy group based in New York City, has helped block or reverse 37 mergers and reached compromises in 22 others that saved at least some reproductive services. As mergers become more common, state and local leaders would be wise to block proposals that restrict health services.

Women’s Health Care at Risk, NYT, 28.2.2012,
http://www.nytimes.com/2012/02/29/opinion/womens-health-care-at-risk.html

The ‘Safe, Legal, Rare’ Illusion

February 18, 2012
The New York Times
By ROSS DOUTHAT

AMID the sound and fury of the latest culture-war battles — first over breast cancer dollars and Planned Parenthood, and then over the White House’s attempt to require that religious employers cover contraception and potential abortifacients — it’s easy to forget that there is at least some common ground in American politics on sex, pregnancy, marriage and abortion.

Even the most pro-choice politicians, for instance, usually emphasize that they want to reduce the need for abortion, and make the practice rare as well as safe and legal. Even the fiercest conservative critics of the White House’s contraception mandate — yes, Rick Santorum included — agree that artificial birth control should be legal and available. And both Democrats and Republicans generally agree that the country would be better off with fewer pregnant teenagers, fewer unwanted children, fewer absent fathers, fewer out-of-wedlock births.

Where cultural liberals and social conservatives differ is on the means that will achieve these ends. The liberal vision tends to emphasize access to contraception as the surest path to stable families, wanted children and low abortion rates. The more direct control that women have over when and whether sex makes babies, liberals argue, the less likely they’ll be to get pregnant at the wrong time and with the wrong partner — and the less likely they’ll be to even consider having an abortion. (Slate’s Will Saletan has memorably termed this “the pro-life case for Planned Parenthood.”)

The conservative narrative, by contrast, argues that it’s more important to promote chastity, monogamy and fidelity than to worry about whether there’s a prophylactic in every bedroom drawer or bathroom cabinet. To the extent that contraceptive use has a significant role in the conservative vision (and obviously there’s some Catholic-Protestant disagreement), it’s in the context of already stable, already committed relationships. Monogamy, not chemicals or latex, is the main line of defense against unwanted pregnancies.

The problem with the conservative story is that it doesn’t map particularly well onto contemporary mores and life patterns. A successful chastity-centric culture seems to depend on a level of social cohesion, religious intensity and shared values that exists only in small pockets of the country. Mormon Utah, for instance, largely lives up to the conservative ideal, with some of America’s lowest rates of teenage pregnancies, out-of-wedlock births and abortions. But many other socially conservative regions (particularly in the South) feature higher rates of unwed and teenage parenthood than in the country as a whole.

Liberals love to cite these numbers as proof that social conservatism is a flop. But the liberal narrative has glaring problems as well. To begin with, a lack of contraceptive access simply doesn’t seem to be a significant factor in unplanned pregnancy in the United States. When the Alan Guttmacher Institute surveyed more than 10,000 women who had procured abortions in 2000 and 2001, it found that only 12 percent cited problems obtaining birth control as a reason for their pregnancies. A recent Centers for Disease Control and Prevention study of teenage mothers found similar results: Only 13 percent of the teens reported having had trouble getting contraception.

At the same time, if liberal social policies really led inexorably to fewer unplanned pregnancies and thus fewer abortions, you would expect “blue” regions of the country to have lower teen pregnancy rates and fewer abortions per capita than demographically similar “red” regions.

But that isn’t what the data show. Instead, abortion rates are frequently higher in more liberal states, where access is often largely unrestricted, than in more conservative states, which are more likely to have parental consent laws, waiting periods, and so on. “Safe, legal and rare” is a nice slogan, but liberal policies don’t always seem to deliver the “rare” part.

What’s more, another Guttmacher Institute study suggests that liberal states don’t necessarily do better than conservative ones at preventing teenagers from getting pregnant in the first place. Instead, the lower teenage birth rates in many blue states are mostly just a consequence of (again) their higher abortion rates. Liberal California, for instance, has a higher teen pregnancy rate than socially conservative Alabama; the Californian teenage birth rate is only lower because the Californian abortion rate is more than twice as high.

These are realities liberals should keep in mind when tempted to rail against conservatives for rejecting the intuitive-seeming promise of “more condoms, fewer abortions.” What’s intuitive isn’t always true, and if social conservatives haven’t figured out how to make all good things go together in post-sexual-revolution America, neither have social liberals.

At the very least, American conservatives are hardly crazy to reject a model for sex, marriage and family that seems to depend heavily on higher-than-average abortion rates. They’ve seen that future in places like liberal, cosmopolitan New York, where two in five pregnancies end in abortion. And it isn’t a pretty sight.

    The ‘Safe, Legal, Rare’ Illusion, NYT, 18.2.2012,
    http://www.nytimes.com/2012/02/19/opinion/sunday/
    douthat-the-safe-legal-rare-illusion.html

The Courts Step In

July 13, 2011

The New York Times

In three new rulings, federal judges in different states have acted to block immediate enforcement of measures that restrict abortion rights and women’s access to affordable contraception, lifesaving cancer screenings and treatment for sexually transmitted diseases. These rulings are important victories for women’s health and reproductive rights.

On June 24, Judge Tanya Pratt of the Federal District Court in Indianapolis issued a preliminary injunction blocking enforcement of a new Indiana law banning the use of Medicaid funds at Planned Parenthood clinics, which provide essential health services to low-income women. The mean-spirited law is part of a Republican-led national campaign to end public financing for Planned Parenthood. The Obama administration promptly told Indiana, and other states weighing similar legislation, that the measure violated federal law by imposing impermissible restrictions on the freedom of Medicaid beneficiaries to choose health care providers. Judge Pratt agreed with that assessment in her decision.

In another ruling six days later, a federal trial judge in South Dakota issued a preliminary injunction blocking, on constitutional grounds, a deeply intrusive state law requiring women to wait at least 72 hours after an initial doctor’s visit before terminating a pregnancy — the longest waiting period in the nation. This law also requires that women seeking abortions endure counseling at so-called pregnancy help centers run by antiabortion activists with the aim of discouraging abortions.

“Forcing a woman to divulge to a stranger at a pregnancy help center the fact that she has chosen to undergo an abortion humiliates and degrades her as a human being,” Judge Karen Schreier wrote in her decision.

On July 1, Judge Carlos Murguia, a federal district judge in Kansas, blocked immediate enforcement of a new Kansas licensing law and health department regulations imposing extensive, medically unnecessary requirements on the state’s three remaining abortion providers — like mandating 50 square feet of storage space for janitorial supplies — with the obvious goal of shutting them down.

While these rulings are preliminary, each is a determination that enforcing the law would cause irreparable harm and that the plaintiffs are likely to prevail at trial. They do not, however, address other threats to women’s health. Those include the slashing of state support for family-planning services by governors like Chris Christie of New Jersey, and attacks from Congress like the bill Republicans pushed through the House in May that would use the nation’s tax system as a weapon to end abortion insurance coverage in the private market.

Still, these rulings serve as a reminder that courts have a vital role to play in blocking the extreme anti-abortion, anti-family-planning movement accelerating in the states and in Washington.

The Courts Step In, R, 13.7.2011,
https://www.nytimes.com/2011/07/14/
opinion/14thurs1.html

Reproductive Choices Women Face

January 8, 2011

The New York Times

To the Editor:

Re “The Unborn Paradox” (column, Jan. 2): Ross Douthat seems to be suggesting that women with unintended pregnancies should bear children rather than have abortions because infertile women want babies. In doing so, Mr. Douthat ignores the serious health risks that pregnancies sometimes incur. Should women with unwanted pregnancies be compelled to take those risks?

Consider New Year’s Eve, a typical night on my obstetrics floor. Several pregnant women were suffering from complications. Two needed emergency surgery. One was 19 years old and 20 weeks pregnant with an abnormal fetus. She had decided to see the pregnancy through. But the amniotic sac ruptured five months early. We had to stop the heavy bleeding and infection that followed. Her baby didn’t survive.

Abortion opponents would impose all the risks of pregnancy on women who wish to end their pregnancies. Instead, let’s make sure that everyone on the socioeconomic ladder can prevent and plan conception.

Anne Davis
New York, Jan. 3, 2011

The writer, an obstetrician, is medical director of Physicians for Reproductive Choice and Health.

•

To the Editor:

I have supported abortion rights for as long as I can remember, but nothing cemented my commitment to women’s reproductive freedom like my own very much wanted pregnancy nine years ago.

As I grew increasingly delighted about both my experience of pregnancy and planning for a life with twin babies, I imagined how differently I would feel in other circumstances. What if I were 14 rather than 34? What if my partner and I had as many children as we could handle, or more? What if one or both of us were unemployed?

How might our thrill at the short-term changes in my body and the long-term changes in our lives transform into dread, depression and anxiety?

Moreover, just because expectant parents are able to think of the fetus as a baby does not mean it actually is one, and that abortion is the same as the taking of an actual life, rather than a fantasized one.

Sarah E. Chinn
Brooklyn, Jan. 3, 2011

•

To the Editor:

Ross Douthat provides an eloquent analysis of the abortion conundrum. We embrace the humanity of our “wanted” babies while we strip the human rights from those whose conception was unplanned and unwanted. And yet, the circumstances of conception don’t change the fact that a child in the womb is a separate and unique human being, morally and ethically entitled to the same rights as you and I.

Mr. Douthat also points out that adoption has become an unlikely choice for young mothers like Markai Durham, the subject of an MTV show, who says she couldn’t bear to give up a child she carried in her womb for nine months, and opts, instead, to kill that child.

Did anyone along the way point out the deadly flaw in her thinking? Markai and the million-plus babies who fall into the “unwanted” category every year deserve to be given a choice that doesn’t involve murder. (Rev.)

Frank Pavone
National Director, Priests for Life
Staten Island, Jan. 3, 2011

•

To the Editor:

What MTV depicted in its documentary “No Easy Decision,” and what Ross Douthat does not acknowledge in his column, is that Markai Durham and thousands of women like her are capable of sensitively and wisely weighing the decisions that have consequences of life or death.

Mr. Douthat offers no evidence that fewer abortions would mitigate complex fertility treatments or the enormous amount of bureaucratic red tape surrounding the adoption process. Many studies in fact suggest that, in a culture that treasures biological children, prospective parents opt first for fertility treatments and then, if at all, pursue adoption.

A thoughtful look at reproductive decision-making is always welcome, but a broadside that once again seeks to demonize and make guilty those women who elect to terminate their pregnancies is not adding to the civil discourse.

Conflating fertility, adoption and abortion in no way alleviates the myriad challenges involved in deciding whether or not to become a parent.

Joan Malin
President and C.E.O.
Planned Parenthood of New York City
New York, Jan. 3, 2011

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To the Editor:

I disagree with Ross Douthat’s appraisal of adoption as an answer to unplanned pregnancies and infertility. I have worked with many pregnant teenagers and young adult women in my 25 years as a director of an adoption agency, and adoption is only a small part of the solution.

While I am obviously sympathetic to the desire of infertile couples to become parents, their needs can never supersede those of pregnant women who are not prepared to be parents.

Research has shown that abortion very rarely leads to long-term negative psychological consequences for those women who choose it (myself included).

Yes, of course there is regret and sadness for some women, but carrying a baby to term and placing him or her for adoption more often than not leads to a lifetime of pain and sadness, regardless of how right the situation may seem. It is the right choice for the very few.

Abortion and adoption are two ends of the same spectrum — women having choices about their reproductive lives. But the agony of a woman placing a child for adoption cannot be understated.

Randie Bencanann
San Francisco, Jan. 3, 2011

Reproductive Choices Women Face,
NYT,
8.1.2011,
https://www.nytimes.com/2011/01/09/
opinion/l09douthat.html

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