How does religious affiliation affect women's attitudes toward reproductive health policy? Implications for the Affordable Care Act.

BACKGROUND

Supreme Court cases challenging the Affordable Care Act (ACA) mandate for employer-provided reproductive health care have focused on religiously based opposition to coverage. Little is known about women's perspectives on such reproductive health policies.

STUDY

DESIGN

Data were drawn from the Women's Health Care Experiences and Preferences survey, a randomly selected, nationally representative sample of 1078 US women aged 18-55 years. We examined associations between religious affiliation and attitudes toward employer-provided insurance coverage of contraception and abortion services as well as the exclusion of religious institutions from this coverage. We used chi-square and multivariable logistic regression for analysis.

RESULTS

Respondents self-identified as Baptist (18%), Protestant (Other Mainline, 17%), Catholic (17%), Other Christian (20%), Religious, Non-Christian (7%) or No Affiliation (21%). Religious affiliation was associated with proportions of agreement for contraception (p=.03), abortion (p<.01) and religious exclusion (p<.01) policies. In multivariable models, differences in the odds of agreement varied across religious affiliations and frequency of service attendance. For example, compared to non-affiliated women, Baptists and Other Nondenominational Christians (but not Catholics) had lower odds of agreement with employer coverage of contraception (OR 0.63, 95% CI 0.4-0.1 and OR 0.57, CI 0.4-0.9, respectively); women who attended services weekly or more than weekly had lower odds of agreement (OR 0.53, 95% CI 0.3-0.8 and OR 0.33, CI 0.2-0.6, respectively), compared to less frequent attenders.

CONCLUSIONS

Recent religiously motivated legal challenges to employer-provided reproductive health care coverage may not represent the attitudes of many religious women.

IMPLICATIONS: Recent challenges to the ACA contraceptive mandate appear to equate religious belief with opposition to employer-sponsored reproductive health coverage, but women's views are more complex.