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 The next battle will be at the U.S. Supreme Court, which has agreed
to consider a new religious challenge to contraceptives coverage
under President Barack Obama's healthcare law. Although the case
deals broadly with whether religiously affiliated groups should be
exempt from providing birth control coverage to their employees,
some parties in the case have focused specifically on IUDs.
IUDs work primarily by preventing sperm from reaching an egg. But
they have come under fire from anti-abortion groups because, in rare
instances, they can prevent a fertilized egg from implanting in the
uterus. Those who believe that life begins at conception consider
blocking implantation to be terminating a pregnancy rather than
preventing pregnancy.
"IUDs are a life-ending device," said Mailee Smith, staff counsel
for the Americans United for Life, which filed an amicus brief in
support of the challenge before the high court. "The focus of these
cases is that requiring any life-ending drug is in violation of the
Religious Freedom Act."
IUD use among U.S. women using contraceptives grew to 10.3 percent
in 2012 from 2 percent in 2002, according to the Guttmacher
Institute, making them the fastest growing birth control method.
Their popularity has grown as women recognized that newer versions
of the device don't carry the same safety risks as a 1970s-era IUD
known as the Dalkon Shield.
Now more than 10 percent of U.S. women using contraceptives use
IUDs. Other forms of birth control, such as daily pills, are on the
decline.
Obama's Affordable Care Act has also boosted the use of intrauterine
devices. The law requires insurers to fully cover birth control,
including the entire $800 to $1000 cost for insertion of an IUD.
Should the high court agree with the plaintiffs and rule that they
are exempt from the coverage, IUDs could become much more costly for
women who work at such organizations, some legal experts say. As
many as 3.5 million people worked at public charities with religious
affiliations, according to 2013 data from the National Center for
Charitable Statistics at The Urban Institute.
Planned Parenthood, long a target from religious groups for
providing access to abortions, has also become a significant source
of the devices, with IUD use by its patients up 57 percent between
2009 and 2013.
ACCOMMODATION OR EXEMPTION
The Obama administration created an exemption for houses of worship
and some related organizations that object to funding birth control
for employees, but now other types of religiously affiliated groups
want similar waivers.
In 2014, the Supreme Court accepted the position of Hobby Lobby, a
chain of craft stores owned by religious Christians, ruling that
private companies that are closely-controlled could opt out of
contraception coverage based on the owners' beliefs.
Hobby Lobby, among other things, objected to birth control that
could prevent "an embryo from implanting in the womb," including two
types of IUDs, according to court documents.
The current high court case consolidates seven lawsuits filed by
nonprofit groups with religious affiliations, such as a colleges and
retirement homes run by nuns. The ruling could be applied to more
than 100 similar lawsuits, potentially affecting hundreds of
thousands of women, according to lawyers on both sides of the issue.
Little Sisters of the Poor, one of the plaintiffs, for example has
more than 2,000 employees.
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The Obama administration has already allowed such nonprofit groups
an exemption from providing birth control coverage, but created an
accommodation that would still guarantee benefits to their
employees.
Under the accommodation, nonprofits are required to notify their
insurers, plan administrators or the federal Department of Health
and Human Services that they object to the coverage. The insurance
plan then directly offers employees separate contraceptive coverage.
Organizations that fail to give notice face fines.
The groups that filed the cases now before the Supreme Court,
including Geneva College and Priests for Life, contend that the
notification requirements violate the Religious Freedom Restoration
Act of 1993, which says the government can't burden religious groups
without a compelling reason.
Some of the organizations are challenging coverage for all forms of
birth control while others focus only on methods that potentially
interfere with fertilized eggs, including the so-called
"morning-after pill" and IUDs.
Mark Rienzi, a lawyer with the Becket Fund for Religious Liberty,
which represents the Little Sisters of the Poor, said that his
clients feel that completing the paperwork would make them complicit
in providing birth control. Filing for the accommodation would still
trigger an offer of birth control coverage from an insurer, he said.
Houses of worship, he pointed out, do not need to complete paperwork
or provide the coverage. "No one takes over their health plan and
uses it to distribute the abortion-inducing drugs and
contraceptives," he said.
No matter what happens next year at the Supreme Court, the battle
over the IUD is likely to continue.
"The stakes are very high," said Aram Schvey, senior policy counsel
at the Center for Reproductive Rights. "We know this kind of plan is
effective. When people aren't burdened by cost, they choose more
expensive, more dependable, longer-lasting contraceptives, like
IUDs."
(Reporting by Jilian Mincer; Editing by Michele Gershberg and Sue
Horton)
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