Perils in Court for Family Planning: Little Sisters of the Poor v. Pennsylvania

The Supreme Court of the United States at dusk.

On Wednesday, July 8, the Supreme Court ruled in favor of a Trump administration regulation that allows employers with religious or moral objections to limit women’s access to birth control coverage under the Affordable Care Act. While the A.C.A. previously granted religious institutions like churches and synagogues exemption from the birth control insurance mandate, this ruling will now allow the opt-out option to include other institutions such as hospitals, universities, and other nonprofit institutions. The government estimates that 126,400 people will lose access to birth control.

This ruling follows a series of decisions that are determining relationships between church and state, skewing in favor of the church. Just in the span of two weeks, the Supreme Court ruled that federal employment discrimination laws don’t apply to teachers at church-run schools whose responsibilities include religious instruction, which is a large setback for LGBTQ employees. In another case prior, the Court held that states must allow religious schools to access programs that provide scholarships to students attending private school—the dissent argued that this ruling diverts resources from public to private education and further damages the separation between Church and State.

However, the current imbalance in favor of religious groups that was created by these three decisions has intense ramifications, and Little Sisters of the Poor v. Pennsylvania has only intensified such effects. Narrow religious objections do not entirely align with the wide variety of uses for contraceptives like birth control. While yes, birth control does lower the chances of pregnancy, the name is misleading. Often, these hormones are not used as contraceptives at all but rather as a treatment for medical issues, treating a variety of health conditions including endometriosis (which affects 6.5 million women in the United States alone), anovulation, and even acne. People that are chronically ill also find utility in taking birth control since it prevents the pain and mood alterations that menstrual cycles often bring, known as Premenstrual Dysmorphic Disorder (PMDD). About 5% of individuals that menstruate reported having PMDD. Additionally, even those who face menstrual pain which is not categorized as PMDD still frequently utilize birth control as a form of treatment to reduce pain caused by menstruation. 1.5 million women in the United States report using birth control for non-contraceptive use.

Regardless of the intended use, though, individuals who menstruate or use birth control should be allowed to do so without being inhibited by their employers. The Supreme Court argued that the contraceptive mandate violates the Religious Freedom Restoration Act, a 1993 bill aimed at protecting religious freedoms. And while religious freedom is important, this new court ruling severely upsets the balance between church and state by curtailing the rights of many individuals currently using birth control. This allows more organizations and even for-profit companies to benefit from a religious exemption that was previously given exclusively to houses of worship. In other words, rather than striking an appropriate balance, this ruling overstretches a mandate originally created with only purely religious institutions in mind.

Many religiously affiliated nonprofits including schools and hospitals believe that birth control equates to abortion services, although that’s not the case. Supreme Court Justice Brett Kavanaugh, a judge who voted in favor of the plaintiffs, Little Sisters of the Poor, referred to birth control as “abortion-inducing drugs” during his Supreme Court confirmation hearing when referring to another case where a religious group, Priests for Life, argued that providing birth control contested their beliefs. 

However, viewing birth control as abortion-inducing is false. From a biological perspective, birth control like intrauterine devices (IUDs) and combination pills (the pill) are preventative measures; even emergency contraception commonly referred to as the “morning-after pill” actually just prevents pregnancy. It does not end a pregnancy that has already begun. In fact, access to birth control has proven effective at reducing abortion rates. A study at Washington University measured the effects of providing birth control to women, which reduced unplanned pregnancies and reduced abortion rates by a range of 62 to 78 percent compared to the national rate.

The populations that need birth control most will be disproportionately impacted by this court ruling, and they are Black and lower-income workers. Increasing access to birth control decreases one’s of living in poverty. Limiting access to family planning resources is simply going to exacerbate pre-existing racial and gender inequalities. In this context, the recent 7-2 Supreme Court decision is yet another exacerbation of the growing health disparities in the United States, and leaves Black, low-income women and menstruating individuals isolated.

Misogynoir is present in all aspects of health care and access to birth control is just one barrier of many. Decreasing access to birth control specifically targets Black menstruating individuals and women, from both a health and family planning standpoint. For instance, Black women are three times more likely to have uterine fibroids than white women, a condition often treated by hormonal birth control. Since birth control is most accessible to people who have health insurance, this ruling simply targets Black and low-income individuals who rely on insurance for coverage and access.

In her dissent, the late Justice Ruth Bader Ginsburg put it best: “In accommodating claims of religious freedom, this court has taken a balanced approach, one that does not allow the religious beliefs of some to overwhelm the rights and interests of others who do not share those beliefs. Today, for the first time, the court casts totally aside countervailing rights and interests in its zeal to secure religious rights to the nth degree.”

In order to ensure proper access to healthcare, establishing equitable healthcare for all and cheap, easy access to birth control is necessary. The recent appointment of Justice Amy Coney Barrett to Ginsburg’s seat threatens the progress of women’s health protections. We must protect the original intent of the Affordable Care Act, and we must continue to fight to make oral contraceptives and preventative health care services accessible.