How Government and Religious Organizations Can Affect Your Birth Control Options

Contraception devices include any medication, device, or surgery used to prevent pregnancy.

Attitudes toward contraception vary across religious communities and belief systems.

Some religious leaders and community members consider contraception in general or specific types of contraception to be unethical. For example, leaders of the Roman Catholic Church and some other religious denominations discourage community members from using any form of birth control.

This has led some politicians, lawmakers, and community activists to support laws that limit contraception access on religious grounds.

Under the Affordable Care Act, most private health insurance plans must cover certain preventive health services with no co-pay to enrollees. This includes employer- and school-sponsored health insurance plans.

The preventive health services that require coverage usually include contraception services. This is sometimes known as the “contraception mandate.”

However, some exemptions have been made to the contraception mandate for organizations that object to providing contraception coverage due to religious or moral beliefs.

We outline the gradual expansion of contraception mandate exemptions below.

Initial exemptions for religious organizations

In 2011, the U.S. Department of Health and Human Services (HHS) excluded churches and similar organizations from the requirement to provide contraception coverage in health insurance plans.

In 2013, the HHS expanded the contraception mandate exemptions to include not only churches and other houses of worship but also religiously affiliated schools and hospitals.

If any of these organizations objected to providing contraception coverage to health insurance enrollees, it had to certify its objections with its health insurer or third-party health plan administrator.

The insurer or administrator was then required to provide enrollees with separate insurance coverage for contraception. This ensured that enrollees could still access contraception through their health insurance, but their employer would not bear any of the financial cost.

Expanded exemptions for non-publicly traded companies

After the HHS exempted religious organizations from the contraception mandate, multiple for-profit businesses sued the government to be exempted as well.

Business owners argued that they shouldn’t be required to pay for health insurance that covers services that conflict with their religious beliefs.

The Supreme Court ruled on the first of these cases in 2014 — Burwell v. Hobby Lobby.

The Supreme Court found that non-publicly traded businesses that object to providing contraception coverage on religious grounds must be accommodated. As a result, such businesses gained the right to deny birth control coverage to their employees for religious reasons.

Following this ruling, the HHS adopted an interim rule that required such businesses to notify the government of their objection to covering contraception. The government could then make arrangements with the health insurer or health plan administrator to ensure enrollees received separate contraception coverage.

Current exemptions for non-profit and for-profit organizations

In 2018, the Trump administration implemented new rules to expand exemptions from the contraception mandate.

These new rules apply to:

• nonprofit employers
• for-profit employers, including non-publicly traded and publicly traded companies
• religiously affiliated institutions of higher education that provide insurance to students

Under the new rules, eligible organizations that object to providing contraception coverage on religious or moral grounds are exempt from doing so.

They’re not required to certify their objections with their health insurer or health plan administrator or notify the government of their objections. Their health insurer or health plan administrator isn’t required to provide separate contraception coverage for enrollees.

This means that thousands of people have lost insurance coverage for contraception.

The Supreme Court upheld these new rules in a case decided in 2020.

Exemptions to the contraception mandate prioritize employers’ and schools’ religious principles over workers’ and students’ access to comprehensive health services that include birth control.

When the federal government implemented new rules to expand exemptions from the contraception mandate, it became harder for many people to access contraception services.

According to estimates from the government, the new rules deprive up to 126,400 women per year of contraception coverage through employer-sponsored health insurance.

Some commentators, such as the Commonwealth Fund, have suggested that the impact could be much larger, potentially affecting millions of individuals with employer- or school-sponsored insurance.

People who lose access to contraception coverage must pay out of pocket for contraception services or go without. This may affect their ability to prevent unintended pregnancy or manage certain health conditions treated with contraceptives.

Preventing pregnancy

Sexually active people who can’t afford or access contraception face an increased risk of unintended pregnancy.

Pregnancy carries multiple health risks, such as the risk of:

• bleeding
• blood clots
• high blood pressure
• gestational diabetes

Some complications of pregnancy are potentially fatal.

There are also high financial costs associated with pregnancy and childbirth.

The risks of unintended pregnancy are harder to manage in states where abortion is illegal or difficult to access.

Managing health conditions

Certain types of contraceptives are used to treat certain medical conditions, such as:

• premenstrual dysphoric disorder (PMDD)
• polycystic ovarian syndrome (PCOS)
• pelvic inflammatory disease (PID)
• hormonal acne
• migraine

Barriers to accessing contraception services can make it harder for people to manage these conditions.

If you work for a religious organization or a company owned by people with religious or moral objections to contraception, you might be denied contraception coverage through your employer-sponsored health insurance.

You might also be denied contraception coverage if you’re a student with school-sponsored health insurance through a religiously affiliated university.

You can learn whether your insurance plan covers contraception by reviewing your insurance policy or contacting your insurance provider. Some insurance plans may cover certain types of contraception services but not others.

Let your doctor know if your insurance provider doesn’t cover your prescribed or preferred form of contraception. They can help you learn about your family planning and treatment options, including low cost birth control.

In some cases, you might qualify for government or community programs that help cover the cost of contraception services for uninsured or underinsured people. For example, many Planned Parenthood health centers offer contraception services at a reduced cost to people facing financial barriers.

To learn more about your rights to contraception coverage, visit ReproductiveRights.gov.