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UPDATE: This item prompted debate about whether we correctly interpreted the Guttmacher study. We explored that criticism, and are confident in our original analysis.
The White House, defending a decision requiring many Catholic hospitals, schools and charities to offer contraception coverage to employees, argues that most women — including most Catholic women — use birth control.
Cecilia Muñoz, director of the White House Domestic Policy Council, marshaled this statistic in a Feb. 1, 2012, blog post:
"According to a study by the Guttmacher Institute, most women, including 98 percent of Catholic women, have used contraception."
The Catholic Church doesn’t approve of "contraceptive interventions" to prevent pregnancy. We wondered: Did a reputable study say that most Catholic women have used birth control anyway?
The Obama administration decision, announced by Health and Human Services Department Secretary Kathleen Sebelius on Jan. 20, 2012, addressed which preventive services must be covered by most insurers without a co-pay, co-insurance or a deductible paid by the patient.
Those services include all FDA-approved forms of contraception. For most new and renewed health plans, that requirement kicks in Aug. 1, 2012.
But the rule provides an exemption for "certain non-profit religious employers" -- essentially churches and synagogues, but also some primary and secondary religious schools. That’s far too narrow an exemption, the U.S. Conference of Catholic Bishops argues.
That's because it wouldn't cover religious organizations that don't primarily employ or serve Catholics — ruling out many universities, hospitals and charitable groups.
The government is giving such nonprofit religious groups an extra year to implement the preventive care requirements. But it won't exempt them.
The bishops are leading a charge to reverse the decision, but the administration so far hasn’t budged, instead citing statistics in support of its position, such as from the Guttmacher study.
We found the study. It’s been making the rounds, cited by news organizations when it was released in April 2011, referenced by the deputy legal director of the American Civil Liberties Union in a January column and underpinning talking points for Obama administration officials speaking on background Feb. 2.
(The Guttmacher Institute, named for obstetrician-gynecologist Alan Guttmacher, says it advances sexual and reproductive health and rights with research, policy analysis and education. Not surprisingly, the U.S. Conference of Catholic Bishops routinely objects to its conclusions and analysis, responding on its website, usccb.org.)
The study, "Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use," is based on government data collected in the National Survey of Family Growth.
The survey has been conducted seven times since 1973 by the National Center for Health Statistics, with the most recent cycle in 2006-10. The survey includes women ages 15 to 44. Researchers conduct personal interviews to gather information on marriage, divorce, contraception, infertility and health of women and infants.
The source is regularly used for studies on contraceptives and religion, including one we found published by the Catholic Medical Association. (The 2001 article found the high rate of contraceptive use by Catholic women "not new or surprising.")
Researchers ask women for their religious affiliation, including details about how important a role religion plays in their lives and how often they attend religious services.
Guttmacher’s study relies on data from the survey’s interviews with 7,356 women between June 2006 and December 2008, focusing on those who called themselves Catholic, mainline Protestant and evangelical Protestant.
The numbers are stark, according to the study:
"Among all women who have had sex, 99 percent have ever used a contraceptive method other than natural family planning. This figure is virtually the same, 98 percent, among sexually experienced Catholic women."
(Interestingly, the Guttmacher study noted that "attendance at religious services and importance of religion to daily life are largely unrelated to use of highly effective contraceptive methods.")
The U.S. Conference of Catholic Bishops responded to Muñoz’s blog post with a post of its own Feb. 3, 2012.
It didn’t directly dispute the 98 percent statistic. But the post did argue it was irrelevant and used in a misleading way.
"If a survey found that 98 percent of people had lied, cheated on their taxes, or had sex outside of marriage, would the government claim it can force everyone to do so?" the post said.
The bishops also argued:
• The study says 98 percent of "sexually experienced" women, a distinction Muñoz didn’t make. (Sexually experienced women accounted for most of the women in the sample, including 70 percent of never-married Catholic women.)
• The more relevant Guttmacher statistic would be use of "highly effective" methods of contraception covered by the new rule, such as the pill, IUDs and sterilization, among sexually active women who don’t want to become pregnant — 68 percent for Catholic women and 69 percent for all women.
What the bishops don’t mention is that this statistic looks only at women who have had sex within three months of the survey, and that "highly effective" methods don't include FDA-approved contraception such as condoms, sponges or suppositories. And the number they cite still represents most of the women in that category. But the bishops argued that this smaller group must be a minority of the general public, "yet every man and woman who needs health insurance will have to pay for this coverage."
So the bishops are using a snapshot in time and arguing it’s a minority of women. At any given point, women would be excluded because they’re pregnant, postpartum, trying to get pregnant or not having sex. The same women might not be excluded in a different month or year. That’s why the "ever used" question is relevant.
Muñoz said, "according to a study by the Guttmacher Institute, most women, including 98 percent of Catholic women, have used contraception."
We read the study, which was based on long-collected, frequently cited government survey data. It says essentially that — though the statistic refers specifically to women who have had sex, a distinction Muñoz didn’t make.
But that’s not a large clarification, since most women in the study, including 70 percent of unmarried Catholic women, were sexually experienced.
Catholic bishops argue it’s more relevant to note the percentage of sexually active women who don’t want to become pregnant and who currently use hormones, IUDs or sterilization — since the smaller number would provide smaller justification for spreading the cost of contraceptives to the general public.
But we think it’s reasonable to note that most women have used contraceptives even if they aren’t currently using them. It means most women would find occasion to take advantage of the new co-pay-free contraceptive rule. Meanwhile, Muñoz used the phrase "have used," which made it clear she meant women who had used contraception before, not necessarily now.
It would have been clearest if Muñoz had specified she was talking about women who have had sex — and perhaps that the statistic referred to women ages 15 to 44. But her statement was otherwise accurate. We rate it Mostly True.
Cecilia Muñoz, White House Blog, "Health Reform, Preventive Services, and Religious Institutions," Feb. 1, 2012
Health and Human Services, "A statement by U.S. Department of Health and Human Services Secretary Kathleen Sebelius," Jan. 20, 2012
PolitiFact, "Newt Gingrich says government would impose 'Obamacare' standards on religious institutions," Jan. 31, 2012
Reuters, "Most Catholic women in U.S. use birth control," April 14, 2011
Washington Post, Guest Voices, "Birth control decision defends religious liberty," Jan. 20, 2012
White House, media conference call with senior administration officials to discuss preventive health services and religious institutions, Feb. 2, 2012
Guttmacher Institute, "Contraceptive Use Is The Norm Among Religious Women," April 13, 2011
Guttmacher Institute, "Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use," April 2011
Centers for Disease Control and Prevention, "National Survey of Family Growth," accessed Feb. 2, 2012
Centers for Disease Control and Prevention, "Key Statistics from the National Survey of Family Growth," accessed Feb. 6, 2012
Email interview with Don Clemmer, spokesman for U.S. Conference of Catholic Bishops, Feb. 3, 2012
U.S. Conference of Catholic Bishops, "White House misrepresents its own contraceptive mandate," Feb. 3, 2012
U.S. Conference of Catholic Bishops, "Ethical and Religious Directives for Catholic Health Care Services," Nov. 17, 2009
Studies in Family Planning, "Patterns of Contraceptive Use in the United States: The Importance of Religious Factors," 1991
Studies in Family Planning, "Religious Affiliation and Contraceptive Usage: Changing American Patterns," 1955-82," 1988
Linacre Quarterly, "Trends in Contraceptive Use Among Catholics in the United States: 1988-1995," 2001
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