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Health care, religious freedom/liberty, and religious employers

The HHS Mandate and free contraception.
Nitpicking the Catholic prohibition on contraception

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Who wins and who loses in a battle of conflicting religious freedoms and liberties?

For decades, there has been a conflict between employers and employees over the use of contraception medication, devices, and procedures in the U.S. The conflict has been mainly between two groups:

  1. The Roman Catholic hierarchy, most Catholic theologians, & some religious employers: They consider the use of contraceptive methods and devices to be intrinsically evil. When used voluntarily with full consent and awareness, the Catholic Church considers it a "grave matter;" their use rises to the level of a mortal sin. The church teaches that unconfessed mortal sin could send the individual to Hell when they die.

    Section 2370 of the Catechism states:

    "every action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible is intrinsically evil." 1,2,3 [Emphasis not in the original]

    Some non-Catholic employers also abhor the use of emergency contraceptives (EC) -- often referred to inaccurately as the "morning after pill." They believe that EC can prevent the implantation of a zygote (a fertilized ovum) in the wall of the uterus, even though researchers have shown that this does not happen. As a result, some employers believe that EC can cause an abortion, which they equate with murder. Some religious information sources state that they always do.

    In reality, there is some indication that if conception has already occurred, that the use of EC improves the chances of a zygote being implanted.

  2. Employees: About 98% of sexually active Catholic women have used contraceptive methods banned by their church at some time during their lifetime. Unfortunately, this value has been often misquoted in the media to refer to the percentage of Catholic women in the U.S. who currently use one or more "artificial," banned methods of birth control. The correct value for current usage by Catholic women is about 70% -- essentially the same as for the general population. Only about 2% of Catholics currently rely on natural family planning, which is the only method of regulating conception currently approved by the Church -- other than total abstinence. 4,5 Similar percentages apply to non-Catholics, except that their use of natural family planning is lower.

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During 2012, a conflict emerged:

It involved:

  • The religious freedom claimed by the Roman Catholic Church to restrict the use of contraception by the employees and students in the Church's affiliated hospitals, universities, colleges, schools, social service agencies, etc. Typically, these employees and students identify with the Catholic Church, other Christian denominations, non-Christian religions, or have no religious affiliation at all.

  • The religious freedom claimed by those students and employees who have examined their conscience about the use of contraceptives on religious, ethical and moral grounds, and have personally decided that they wish to freely use contraceptives. Some wish to use them in order to regulate or prevent conception and pregnancy; others wish to use them to treat one of many medical problems that are unrelated to conception.

  • The Institute of Medicine advises the federal government on issues of public health, medical care, research, and education. 6 They produced two reports recommending that access to contraceptive materials be included in all health insurance plans without cost to the employee. They concluded that such access would reduce the number of abortions, and unexpected pregnancies.

  • The U.S. Department of Health and Human Services (HHS) issued a mandate in early 2012 which was originally to become effective on 2012-AUG-01. It required all health insurance plans to include access to contraceptive materials without copays, co-insurance, or deductibles. Church employees were exempted from the regulation, but employees of organizations affiliated with the Catholic Church -- such as listed above -- were not.

  • The conflict spread to some evangelical Christian educational facilities, parachurch groups, and secular businesses like Hobby Lobby who do not want to allow their employees free access to birth control devices etc. in their health plans.

To counter objections, the HHS regulations were modified so that religiously affiliated employers would not actually have to pay for an employee's contraceptive materials. Instead, the employer would pay the same amount to the insurance company for all employees -- whether they used contraceptives or not. Also, the date that the regulation becomes effective was delayed by 12 months to allow religiously affiliated employers who applied for a delay time to adapt to the mandate. Fines for non-compliance with the mandate are quite high.

This section of the web site deals primarily with religious freedom and liberty aspects of the conflict. In the past, freedom and liberty conflicts were generally related to  religious beliefs, religious practices, freedom of assembly, and proselytizing. These conflicts sometimes degenerated into open warfare with great loss of life. Concerned that European religious wars might be exported to the New World, the founders of the United States added the First Amendment to the U.S. Constitution to separate religion and government -- often referred to as "the separation of church and state" They hoped that this amendment would result in religious freedom and liberty for all.

However, in recent decades, the term "religious freedom" has been redefined. In many cases, it now refers to the religious freedom of individuals and religious groups to control, denigrate, or oppress others, discriminate against them, or restrict their human or other rights.

In the cases covered by these essays, some religious employers want their religious freedom and liberty to include restricting the choices of their employees. Many feel that if they permit employee choice, then they are actively participating in an intrinsically evil action. This conflicts with the desire of many of those employees to freely decide whether to have access to birth control supplies in accordance with their personal religious, moral and ethical standards. There is no apparent win-win situation here. Either religious employers will lose their freedom to control their employees, or the employees will lose their freedom of free access to contraceptives when they want them.

Over the decades, where a woman employee is fertile, the cost of contraceptives can be substantial -- many thousands or tens of thousands of dollars. Mother Jones Magazine has created a calculator that estimates this cost for a variety of contraceptive methods at: However the cost of abortions due to unwanted and unexpected pregnancies and time off work due to unexpected pregnancies and the resultant care of infants is even greater.

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Confusion over the precise nature of the HHS Mandate:

There is an amazing amount of confusion over the precise nature of the mandate. One example appeared in an interesting article on Scientific American's web site. An article interviewed Jonathan Haidt about his really excellent book "The Righteous Mind." He drew an analogy with the HHS mandate saying:

"It's like forcing synagogues to buy pork lunches for their non-jewish employees."

I suggest that a better, more precise analogy would be:

"Its like forcing synagogues who give coupons to their Jewish and non-Jewish employees that are good for one meal at a local restaurant, and then letting the employee choose whether to have a pork or kosher chicken meal.

In other words, the individual employee has a choice of what to eat; the employer does not dictate diet. The employer is not aware of what decision the employee makes. The synagogue pays the same amount for each coupon regardless of the employee's choice.

Similarly, the HHS mandate calls on the religious employer to provide health care coverage; it leaves the decision of whether to use birth control up to the employee. The employer pays the same amount, no matter what choice the employee makes. The employer is not involved in the employee's decision and doesn't even know what the employee's decision is. 7

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Nitpicking Section 2370 of the Roman Catholic Catechism:

As noted above, Section 2370 states that:

"every action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible is intrinsically evil." 1,2,3 [Emphasis by us]

This section is generally interpreted by Catholic theologians as banning the use of birth control pills, emergency contraception, condoms, and IUDs, as well as banning surgical procedures such as vasectomies and tubal ligations (a.k.a. "having one's tubes tied"). However, the section is interpreted as allowing natural family planning, which avoids pregnancies by having the couple engage in abstinence during what are probably a woman's most fertile intervals.

A straightforward interpretation of Section 2370 seems to restrict it to only those actions that make a subsequent pregnancy "impossible." However, all of the actions listed above merely make procreation unlikely. None make it "impossible:"

  • Birth control pills can fail, particularly if a women has missed taking a pill.

  • Condoms break, leak, or are sometimes improperly applied.

  • Emergency contraception must be taken within a certain time interval in order to be effective. Even then, it sometimes fails to prevent a pregnancy.

  • Vasectomies have been known to fail about 1% of the time. Also, it takes time for the operation to be effective. Researcher Denise J. Jamieson, of the Center for Disease Control (CDC), and colleagues wrote:

    "Couples considering vasectomy should be counseled about the small, but real risk of pregnancy following the procedure and that men are not sterile immediately after vasectomy." 8

  • As many as 0.1% to 3% of tubal ligations (a.k.a. tubectomy) can fail and allow a pregnancy, depending on the technique used. (sources differ in their estimates) 9,10,11

There is another point to consider. If one partner has a sexually transmitted infection (STI) -- either diagnosed or not -- then there is a strong possibility that they will transmit the STI to the other partner. Using a condom drastically reduces this probability. Since some STIs can cause death, the lack of use of condoms could be considered a form of attempted suicide by the woman, and/or attempted murder by the man. Both are forbidden by the Church. Some might interpret the Church's teachings as implying that the use of condoms is the lesser of the two evils.

Certainly, for an omnipotent deity who wishes to initiate a pregnancy in spite of the use of birth control pills, condoms, an IUD, emergency contraceptives, a vasectomy or a tubal ligation -- would be a trivial task.


  • If Section 2370 is to be interpreted in a straightforward manner, and the word "impossible" actually means "impossible" then it would appear that the six methods mentioned above that do not make pregnancy impossible but merely lower the chances of a pregnancy would not be "intrinsically evil."

  • If one were to interpret the word "impossible" as actually meaning "not very likely" then natural family planning may be closer to being "intrinsically evil" that the use of any of the five "artificial" birth control methods. That is because natural family planning is claimed by many of its promoters as being more reliable than hormonal contraceptive pills.

  • Under some circumstances, the use of condoms could save a life -- an action that is inherently good.

These conclusions may not agree with the commonly understood teachings of the Catholic Church on birth control and natural family planning. If you are as confused as we are on this topic, and you regard it as important in your life, we recommend that you ask one or more Catholic priests for clarification.

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References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. The Catechism of the Catholic Church, Article 6, Section 2370 at:
  2. Pope Paul, "Unlawful Birth Control Methods," Humanae Vitae Section 14, 1968, at:
  3. The authors of the Catechism may have left a certain amount of wiggle room in this section of the Catechism. No birth control method renders "procreation impossible;" conception is merely improbable. Condoms sometimes break or are improperly used; hormone pills sometimes do not suppress ovulation; an IUD sometimes fails to prevent pregnancy; sterilization can sometimes fail. Even if some birth control methods were perfect, since God is omnipotent, he could always cause conception if he was so motivated.
  4. "Most Catholic women use birth control banned by church," Reuters, 2011-APR-13, at: [Interesting observation: on 2012-JUN-24, when we added this reference, Reuters indicated that "666 people recommended this" article.
  5. Rachel K. Jones and Joerg Dreweke, "Countering conventional wisdom: New evidence on religion and contraceptive use," Guttmacher Institute, 2011-APR, at:

  6. Book cover image Board on Population Health and Public Health Practice, "Leading Health Indicators for Healthy People 2020: Letter Report," Page IV, Institute of Medicine, at: This web site provides a free download.
  7. Gareth Cook, "How Science Explains America’s Great Moral Divide," Scientific American, undated, at:
  8. "Vasectomies don't always prevent pregnancy," WebMD, 2004-MAY-05, at:
  9. Charles Monteith, M.D., "Tubal ligation reversal blog," Chapel Hill Tubal Reversal Center, 2010-JUL-05, at:
  10. A Google search for "tubal ligation" fail returns dozens of essays on how the procedure can fail.
  11. Carl T. Hall, "Surprisingly High Failure Rate for Tubal Ligation / The Pill may be almost as effective, study finds," San Francisco Chronicle, 1996-APR-15 at: "

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Copyright © 2012 & 2018 by Ontario Consultants on Religious Tolerance 
Originally written: 2012-JUN-24
Latest update: 2018-AUG-01
Author: B.A. Robinson

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