A recent decision by the U.S. Department of Health and Human Services (HHS) has Catholics finding themselves squarely on the side of “choice.” In 2016, HHS had added “instruction in fertility awareness-based methods” to the Affordable Care Act (ACA) requirement that insurance plans not impose any cost-sharing on women seeking “preventative care and screenings.” Last year in December, this addition was unceremoniously removed, so that women will no longer be able to get insurance coverage for this vital option starting December 2022.
Upon hearing of the possibility that HHS would do this, the Catholic Medical Association released a public statement in November 2021 recommending that instruction in fertility awareness-based methods (FABMs) continue to be provided for women desiring an alternative method of family planning.
“Women across the country, who for a variety of reasons choose these healthy methods, are being denied that choice by the U.S. Department of Health and Human Services, which is charged with protecting women’s health,” said President Dr. Craig Treptow. “We must ensure women have access so they can successfully plan for themselves and their families.”
CMA member Cami Jo Tice-Harouff, DNP, APRN, FNP-C took a bold step in defense of her practice and her patients and filed a federal lawsuit against HHS in order to keep the coverage of fertility awareness-based methods. Tice-Harouff is a licensed family nurse practitioner with a practice in Longview, Texas and a thriving telehealth practice in several other states where she is licensed. A sizable part of this practice is instruction in fertility awareness-based methods.
As stated in her lawsuit, “Without insurance coverage and without cost-sharing for fertility-awareness-based methods of family planning, Dr. Tice-Harouff and her patients will suffer both financially and in their health outcomes.” The lawsuit was filed May 25, 2022 in the U.S. District Court for the Eastern District of Texas in the Tyler Division. She is represented by Alliance Defending Freedom, a non-profit “committed to protecting religious freedom, free speech, parental rights, and the sanctity of life.”
The lawsuit makes two simple claims. First, that the HHS did not follow the Administrative Procedure Act by instituting notice-and-comment procedures before removing the language from the ACA. Secondly, that, “the 2021 Guidelines, as to the removal of language requiring coverage of instruction in fertility awareness-based methods of family planning, are arbitrary, capricious, and an abuse of discretion.”
Gerard Migeon, Co-founder and CEO of Natural Womanhood, has been working with his organization to spread awareness of FABMs for years. Its mission is to provide vital, evidence-based information about the real risk of birth control and the benefits of fertility awareness-based methods. This work seemed to be paying off with the 2016 addition to the ACA.
“It is time-consuming work on behalf of a provider to first teach a patient to monitor and record her cycles via a FABM. That is why the changes made to the ACA in 2016 (including FABM instruction coverage) were so encouraging, and a huge step in the right direction for authentic women’s health.” In other words, “the 2016 changes gave women (and couples) meaningful choice when it comes to family planning and the treatment of menstrual disorders.”
This decision of the HHS, made without the normal notice-and-comment process, comes at a time when the issue of women’s health care is at the forefront of American politics due to the Supreme Court’s decision to overturn Roe v. Wade and Planned Parenthood v. Casey. Migeon couldn’t help but note that it’s ironic that, “given the overturning of Roe, organizations like Natural Womanhood have been accused of ‘coming after birth control next.’ In truth, our organization (and the dozens of others that work to promote FABMs) is vying for more choice when it comes to family planning and reproductive health.” He continued, “We know that these methods are as (or more) effective than artificial birth control, and that they provide a desirable, viable alternative for women and couples who do not want to (or can’t) use synthetic hormones or invasive devices for family planning.”
Migeon is not the only one who has noticed the irony. Dr. Marie Hilliard, Co-Chair of CMA’s Ethics Committee, stated, “It is ironic that the current federal administration, which heralds the values of reproductive choice as well as care of the environment, is denying women this choice of family planning coverage. Of all methods of family planning that are available to women, Fertility Awareness-Based Methods are the only ones having no chemical or material-based toxic effects to women and the environment.”
The lawsuit is ongoing and will be followed closely by the CMA. Without insurance coverage of FABMs, unnecessary financial burden is placed on women and couples seeking a natural approach to family planning. Women’s reproductive health care coverage is reduced to chemical and abortifacient options. FABMs not only provide a natural answer for family planning purposes, but they also help as a diagnostic tool.
As Migeon noted, “For a health care provider like Dr. Cami Jo, this information is an essential tool for the diagnosis of reproductive health disorders. FABMs allow health care providers to identify root causes and to treat each patient as a whole, unique individual.”
In a time when women’s health care is so widely politicized, choice seems to be the answer to family planning. Migeon reflected, “For an Administration that prides itself on being ‘pro-choice,’ it is an odd move indeed.”