Cracking the Code: When “Access” Means “Mandated”

By Rebecca Oas, Ph.D. | July 3, 2014

NEW YORK, July 4 (C-FAM) “On Monday, the Supreme Court will decide whether corporations can deny women access to contraception.”

So said a tweet from Sandra Fluke, the attorney who achieved infamy for demanding her Catholic-affiliated law school pay for her contraceptives – a view backed by the Obama administration and reflected in foreign aid efforts.

Instead, the U.S. Supreme Court upheld the right of employers to refrain from providing abortifacient contraceptives on religious grounds. News reports noted Sandra’s easy access to contraceptives – at $9 a month within blocks of Sandra’s university – without requiring others to pay for it. 

Family planning and pro-abortion advocates frequently use the notion of access to justify forcing employers, healthcare providers, and taxpayers to comply.  To some, access is paramount and no dissent is tolerated.

“The exercise of [conscientious objection] can exacerbate the lack of access to abortion care by further reducing the pool of providers,” write Christian Fiala and Joyce Arthur in a recent article attacking doctors’ conscience rights.  They argue that because of stigma, even doctors who support legal abortions refuse to commit them. “[A]llowing any degree” of conscientious objection for doctors would exacerbate the shortage of providers. 

In other words, a woman’s right to access an abortion on demand includes compelling any doctor to provide it, without exception.

The Obama administration places a high priority on ensuring access to contraceptives in the U.S. and abroad.  Earlier this year, President Obama presented his budget for global health programs for fiscal year 2015. Family planning was one of only two areas the requested funding was increased.

The head of abortion giant Planned Parenthood welcomed the budget announcement, framing it in terms of access. “To strengthen our working relationships with partners around the world, as well as our image, the United States must increase access to family planning,” said Cecile Richards, whose group profits from government funded or mandated contraceptives.

The salvo to demand more funding is an often-cited statistic of 222 million women in the developing world with an “unmet need” for modern contraceptives.  Advocacy groups equate this to lack of access. Yet reports from the Guttmacher Institute reveal that only 8% or fewer of women described as having an “unmet need” cite lack of access or cost as their reason for not using modern contraceptives.

Although near-universal access to family planning has been achieved in even the poorest countries, the useful “unmet need” concept is far from being retired.  “Policy declarations typically assume that lack of access to services is the root cause of unmet need,” write John Cleland, Sarah Harbison, and Iqbal Shah in a recent Studies in Family Planning paper, citing the Millennium Development Goal calling for “universal access to reproductive health” as an example.  However, “physical proximity is only one component of access and is probably not the most important one.”

The data increasingly show that “unmet need” more accurately reflects the views of family planning advocates than the women themselves. Despite the availability of contraceptives, women choose not to use them, often citing concerns about side effects.  While Cleland and his colleagues attribute some fears to misinformation, they admit that in countries where contraceptive use is prevalent, “these concerns are more likely to be based on personal experience than on perceptions.”

With physical access to contraceptives virtually universal, advocates are now shifting to what they call “psychosocial access (that is, the acceptability of contraception and associated services).”  This focus is on a collision course with those in foreign countries who deem abortion unacceptable for cultural or religious reasons.

Their leaders may follow the example of the U.S. Supreme Court and declare religious freedom cannot be tossed aside in the name of access at any cost.