The current controversy regarding mandated contraceptive coverage for insurance plans has drawn the usual lines in the sand between the extremists on both sides of the issue. I am involved in this issue on a daily basis and would like to give some input from a patient advocate perspective.1. There are accepted limitations to our First Amendment rights — just ask the Mormons and Muslims. We outlaw polygamy and many of the tenets of Sharia law, even though the practitioners of these beliefs may consider them sacred and protected by the First Amendment. There are accepted societal goods that accrue from limiting these practices.2. There are usually unintended consequences that occur after any uprising like this. I see patients daily who are having significant difficulty affording reliable contraception. Not everyone can take the $12 a month birth control pills. Most of these women are economically disadvantaged and will not be able to support an unplanned baby. Their choices will be either abortion (which the bishops and evangelicals really hate) or another baby that will need to be supported by the tax payers (ditto).3. In the 21st Century, it is not likely that sexual prohibition will work any better than alcohol prohibition worked in the 20th century. It seems that it boils down to either accepting the somewhat schizophrenic exclusion for religious institutions that would virtually guarantee a glut in the very behaviors they detest, or allowing there is a positive societal benefit in encouraging women to have control of their reproduction. I know the bishops and evangelicals will be opposed to any challenge to their hegemony, but there is a real benefit to society in allowing full contraceptive coverage for these women.
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