Church Stance on Birth Control, Public and “Private”

Deseret Mutual Benefit Administrators (DMBA), the Church’s insurance company, does not cover prescriptive contraception, for any reason that relates to (“voluntary”) contraception. That is, any Church employee or covered spouse (including BYU employees) that wants contraception requiring a prescription must pay for it entirely out of pocket. The only exceptions for this relate to the physical (not mental) health of the woman: endometriosis, ovarian cysts, etc. Postpartum depression is not a valid medical issue that would result in an exception to this exclusion. This is clearly not an economically motivated decision.

This is not a post meant to criticize the Church; rather it is to ask about the extent to which public discourse matches the “private” (that is, non-Church-wide) practices controlled directly by the Church. As far as I know, recent discussions of this matter in public venues by General Authorities have stressed the private nature of reproductive decisions within marriage. The Church Handbook of Instructions very clearly takes this stance, using words like extremely intimate, and admonishes Church members not to judge one another on this matter.

So whence the insurance policy? Surely DMBA and its board (which includes representatives of BYU and the Corporation of the Presiding Bishop) can take the same stance that the Church articulates. Does it speak to the resilience of decades-old mentalities in Church governance even while leaders have publicly moved on from those positions? Does this stance create a hierarchy of practice, even implicitly, like the multiple honor codes of Church schools? Is it similar to the Church requiring its male employees (not BYU) to wear shirt and tie and its female employees to wear skirts and hose?

How is one to read the difference?

35 Replies to “Church Stance on Birth Control, Public and “Private””

  1. I can understand the question, but I think it’s worth considering that this policy may not be tied to doctrine at all. It may simply be a financial decision.

  2. Yes, that is a very common exclusion among health insurance policies all around the countries.

    Thus the outrage from women’s groups when these same insurers started covering Viagara.

  3. I agree with the above comments that the practice is a common one in the insurance industry. Yet, this is to say it is a common injustice. Not sure if “that is how the world does it” is a great excuse.

    We have decided to stick with abstinence (sp?) only.

  4. It would be interesting to ask the General Authorities if they practice (or practiced) birth control. Some of them have suspiciously small families.

  5. I’m a physician practicing in Utah. DMBA has the same coverage for birth control pills and other contraceptives as all the other insurance companies. I don’t think it has anything to do with “the church’s position” on birth control.

  6. On another front, DMBA will not cover a women getting permanent birth control (i.e. her tubes tied) unless she has a documented medical need or has had at least four children. I’m not sure how that compares to other insurance companies.

  7. I went to one of the DMBA ‘open enrollment’ information sessions this year for BYU employees, and a gentleman asked why DMBA doesn’t cover birth control. The DMBA representative seemed quite uncomfortable and her response was that the reason birth control wasn’t covered was because of who the ‘parent company’ is. Of course the implication is that the Church frowns on elective birth control, therefore there is no coverage. No mention of prohibitive cost, no mention of being consistent with other insurance companies. The number of insurance companies that are covering birth control nationwide is growing, partly because many states have passed legislation requiring companies that provide prescription drug coverage to also cover contraception.

  8. I’m not affected personally by the DMBA policy, but I was bothered by its inconsistency with the most recent public pronouncements from Church leaders and newsroom as noted in the post. Of course, the DMBA representative might have been giving her own opinion which may have nothing to do with anything.

  9. Re #10: At least one Humana drug plan very recently started covering Viagra as a 2nd tier drug (no generic available). The specific plan requires a $40 co-pay.

    I haven’t had a health insurance policy that wouldn’t cover birth control since the late 70’s. Sadly, the policy did cover elective abortion. Most of the policies I’ve had since have been with major carriers, such as United Health Care and various state BC/BS plans.

  10. You’ve run across an interesting question. Should health insurance be insurance against unusual expenses or should it be the funding for all your health care expenses?

    Many people seem to be taking the approach that health insurance should cover all health care expenses or things that might be considered expenses rather than insure against specific problems. Much like the question of whether or not my dental insurance should pay for my toothpaste. In some places, the answer is yes, btw.

  11. I am not buying the toothpaste parallel since I can get one without a prescription. However, toothpaste is a central feature of dental health in the way that brth control is a central part of female reproductive health (and the use of both does keep overall healthcare costs down). Maybe there is something there after all.

    While I think that the insurance/risk model is a horrible way to approach health and human well-being, this type of policy (which is not unique to DMBA) seems to even defy that model.

    My understanding is that generic birth control can be obtained for a good price. These policies particularly impact those how may have medical reasons for needing more expensive birth control pills.

  12. It seems it would be cheaper to cover birth control rather than pregnancy and childbirth (and the ensuing cost of a child), so I’m not buying the notion that it’s a financial reason. I also agree with Alex that the woman answering the question was stating her own opinion.
    As long as I’ve had health benefits for the last 12 years, my insurance always covers birth control, no matter where I’ve lived. Right now it would cover Viagra, tubal ligation, vasectomy, abortion, and birth control (as well as ART). Maybe it’s state law in CA. I find it really weird that it doesn’t cover BC, unless it is for the same reasons the Catholics can choose not to cover BC.

  13. BTW, BYU health does not pay for any medications. They absolutely will provide prescriptions for them though, including birth control–to be used as birth control without some other underlying cause, and you can buy it at the BYU pharmacy. So I’m thinking the entire premise of this post is inaccurate.

  14. Stephen M raises the crux of the issue here – insurance for regular and ordinary expenses is artificial, inefficient and unnecessary.

    Is there a market for grocery insurance? One that covers any and all food items reasonably necessary to maintain middle class dining habits? What about gasoline insurance? Wouldn’t it be some sort of cosmic injustice if gasoline insurance only covered 5,000 miles a year? What about all those people that have to commute (by automobile) to work?

    The basic problem here is that coverage for regular, usual, and ordinary health care expenses by health insurance plans is a long standing artifact of government tax policy. Employers can purchase health insurance for their employees completely tax free. With few exceptions, individuals cannot.

    If you are in a typical middle class tax bracket, that means that your employer can purchase health insurance perhaps 40% (marginal rate) cheaper than you can go out and purchase it yourself. This causes a natural expansion of employer provided health care insurance to cover everything under the sun, at a high cost to employers and prohibitive rates to everyone else.

    End or equalize this discriminatory tax policy and ordinary medical expense covering health care policies will survive on their own limited, stultifying, bureaucratic merits and the rest of us can pay for ordinary medical expenses on a non-discriminatory basis and at a significantly lower cost.

  15. I was bothered by its inconsistency with the most recent public pronouncements from Church leaders and newsroom as noted in the post.

    I really think there would have to be absolute proof of the connection between the Church and this policy with DMBA before anyone should get upset. Let’s not CREATE problems that we don’t even know exist.

  16. I’m glad some people got the point of what I was writing about.

    For insurance to cover “ordinary” expenses, the price of it has to go up. On the other hand, if the cost of insurance is subsidized, then it is cheaper through insurance. However, because there is an administrative overhead, and because of the way deductibles work, for it to cover “ordinary” expenses generally means that the price of it has to rise, for the person buying the insurance, by about the price of the service added to the cost of the insurance — like it would work for grocery insurance.

    An interesting result. Now, if you are asking “hey, my insurance company ought to route the cost of this through the insurance plan as well, and just charge me for it” most companies would work with that. But most people are asking for the cost for the ordinary expense to be shared by everyone in the class and/or paid for by the employer. At least when I have seen this in other contexts, that is what they were asking for.

  17. Since DMBA is the Church’s insurance arm for their employees, this is not a stretch.

    To me, though, it is sort of like suggesting that everything you see on KSL or in the Deseret News is somehow tied back to, approved by, or prescribed by the Church. I’m just trying to point out that just because it’s “the Church insurance arm” doesn’t mean that the Church is setting all its policies. That doesn’t mean I’m upset, I just think such an assertion deserves a bit more substantiation.

  18. I also think that even IF Church leaders somehow had a hand in the policies of DMBA, just because financial support isn’t given for birth control doesn’t to me mean that they don’t allow us that choice. I don’t look at a policies of an insurance company as ‘proof’ or lack thereof of Church doctrine.

  19. From my comments, I have made it clear that I do not think it is church doctrine but an unjust insurance system. These pokicies have more to with state law than church doctrine (if there ever was den of injustice it would be the Utah State legislature).

    I got a letter from DMBA today. They have approved 10 visits with my therapist during 2009. I am content with them today.

    I actually do not care if you are upset. I was more making fun of that fact that, on what has been a mellow post, you have been using all caps. Take a chill pill (I think DMBA does cover those, but Diet Coke seems to do the trick for me).

  20. wow, chris, you make it sound like i was flying off the handle mad. i capped one word. sorry if that came across wrong, though. i am repenting. all small letters, just for you. 😉

  21. When I got my temple recommend to get married while at BYU the Bishop read a statement from Pres Kimball and signed by the first presidency. It said that family was important and they encouraged proper family planning using prayer and fasting taking into account the health and welfare of the mother. While at Ricks College Pres. McConkie talked and addressed selecting a spouse and having children as both being between you and our Father in heaven. Too many Bishops think they should have some say and it is simply above their pay grade.

    I think there are some strong feelings in the church but no policy for or against birth control. The mixed message results in very high teenage pregnancies in mormon dominated communities.

  22. Steven M. and Mark D. – I agree wholeheartedly that the current system of health insurance is inefficient and takes the consumer out of the question. But to me, that isn’t the point of the post.
    You are “free” to medicate yourself with diet Coke, but you can’t buy it at BYU vending machines (but they will sell you other soda). Just like you are free to choose birth control, but the employee health insurance won’t cover it, even though it will cover other prescriptions.

  23. It may be that this is a church policy, but then why offer birth control to the students at BYU? The contradiction is too big to convince me the church is making the policy for doctrinal reasons.

  24. My guess is that the Church is not making the policy directly, but rather that someone high up at DMBA is implementing a personal view that dthe “higher law” is to not use birth control because of the numerous past statements of prophets condemning it. Institutional inertia or tradition is hard to overcome. If you change a policy like that, it’s almost an admission that the previous policy was perhaps mistaken. So if you are employed by the Church and thus have DMBA health insurance, DMBA (or maybe the Church) would prefer you not be on birth control. If you are still a student, maybe it’s OK. Or it could be that the student health plan is separate from DMBA and maybe run by more progressive people.

  25. “My guess is that the Church is not making the policy directly, but rather that someone high up at DMBA is implementing a personal view that dthe “higher law” is to not use birth control because of the numerous past statements of prophets condemning it. Institutional inertia or tradition is hard to overcome.”

    My guess is that they are trying to pay for as little as possible because of budget reason (like all other insurance companies in Utat) and since they are not required to cover it by law (many states do require it) they are not. The student insurance does not cover it either. It is just available at the pharmacy.

  26. you are free to choose birth control, but the employee health insurance won’t cover it, even though it will cover other prescriptions.

    I guess my perspective is colored by debates on this point in other contexts, having nothing to do with the LDS Church or any other religious body, but where health plans for adjuncts did not cover birth control, but did cover other prescriptions.

    The first time I heard about this was a family who worked for a recycling operation, they were mad that the company paid for pregnancies, but not for birth control. The one was considered not a routine part of life expense, the other was like buying diapers for the babies, not a covered expense.

    I run into the issue from time to time, I don’t see it as particularly LDS or religious in nature, though it is interesting.

  27. Thanks to all for comments. First, let me say that I’d be interested to know which other plans do not cover birth control. I’ve lived in many states and been part of large, small, and government health plans. Never have we run into this. I don’t think it’s a financial decision at its base, and if it is, it’s not a very good one, as many have pointed out.

    Second, to m&m and others who wonder about the connection of the Church to the policy, I spoke to multiple representatives of DMBA. Not one told me that the decision was financial nor that it was something commonly done. They did tell me that it was “just a decision made by our board, which includes representatives from the Corporation of the Presiding Bishop, BYU, and DMBA.” I think the CPB constitutes the Church, if BYU and DMBA aren’t good enough. Whether or not this is a common practice (again, not in my experience), DMBA’s explanation indicates that the policy is not done with that in mind.

    In any case, the bottom line, for me, is that it is deplorable that even with such a policy the mental health of the mother is not a significant enough factor for them to cover it.

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