Across the country, three major well-financed pro-abortion groups—the National Abortion Rights Action League, the National Organization for Women and Planned Parenthood—have teamed up to support projects in twenty-two states seeking to force all health care providers, including Catholic providers, to perform abortion. "The Abortion Access Project," alternatively known as "The Hospital Access Collaborative," is a clearing-house for these projects. Based in Cambridge, Massachusetts, the Project provides organizing kits and fact sheets which attack Catholic hospitals and the Catholic bishops' "Ethical and Religious Directives" that guide them.

Faced with the reality that terminating the lives of unborn children is not a "specialty" attractive to most physicians—there are only 2,042 in the country who do so—pro-abortion groups are seeking first to put political pressure on local health care providers, and then to require by law that Catholic hospitals provide abortions. Currently, most of the groups are engaged in data collection—surveys of Catholic hospitals conducted by anonymous callers who pose as rape victims seeking "emergency contraception," or as pregnant women seeking abortions. But a well organized media campaign is already underway, and the early phases of a public policy and legal strategy have become apparent.

Frances Kissling, president of Catholics for Free Choice ("CFFC"), has appeared on 60 Minutes, attacking Catholic hospitals for not performing abortions. Spinning the same lines that helped galvanize the campaign to legalize abortion in the first place—the "hard cases," rape and supposedly life endangering pregnancies—Kissling argued that Catholic hospitals should provide all reproductive "services," including abortion. During her interview Kissling claimed that "abortion is the least of the services that [CFFC is] worried about." But surely, it is the greatest of her objectives. Kissling herself, prior to leading CFFC, helped found the National Abortion Federation, a trade organization of abortion clinics, and directed one of the first such clinics in the 1970s. In one of its many amicus curiae briefs defending "abortion rights" before the U.S. Supreme Court, CFFC compared abortion to a sacrament. In light of CFFC's history and long-standing mission, the claim that it is least concerned about abortion should be viewed with intense skepticism. It appears to be most concerned with abortion and specifically with building support for the notion that abortion is basic health care. Its other central goal is to marginalize and ultimately eliminate the Catholic Church from the health care system and from influence in society as a whole. Kissling once said, "I spent twenty years looking for a government that I could overthrow without being thrown in jail. I finally found one in the Catholic Church" (Mother Jones, May/June 1991, p. 11).

The public policy and legal strategy has advanced along subtle lines thus far. Presently it involves enacting into law requirements that employers, including Catholic employers, provide contraceptive drug coverage to their employees if they cover other prescription drugs. A parallel strategy involves litigating any failure to cover contraceptive drugs using a legal claim of sex discrimination.

The issue has been framed as a matter of equity, and thus far it appears to have been very effective. Thirteen states have enacted contraceptive coverage mandates. Nine of these have some form of a conscience clause, purporting to exempt religious employers from the mandate–but in almost all cases, these clauses are so narrowly worded that not even the United States Catholic Conference would qualify for protection. Mandates in four states provide no conscience protection. In twenty-one states, contraceptive coverage bills are pending.

On the federal level, a national contraceptive coverage bill has been introduced in Congress. Though this bill remains in committee, a provision requiring contraceptive drug coverage for federal employees has already passed. And on December 13, the Equal Employment Opportunity Commission (EEOC) ruled that under the Pregnancy Discrimination Act, employers who cover surgical methods of contraception must provide contraceptive drug benefits. The EEOC even raised a broader argument that employers covering vaccinations and other "preventive" health care may be guilty of sex discrimination if they refuse to cover drugs to "prevent" pregnancy.

The purpose of these contraceptive coverage initiatives is to establish a legal principle that "equal rights" demands inclusion of reproductive services among basic health care services. From that point, it will be one small step for pro-abortion groups to argue that abortion is basic health care which no health care provider can refuse, even on religious grounds.

This new movement to require Catholic hospitals to provide contraception and abortion is proceeding rapidly. But the movement faces a number of hurdles, forty-six hurdles in fact. Forty-five states and the federal government have enacted laws that protect the rights of conscience of health care providers. The laws vary in the scope of protection they offer but all protect, at a minimum, the right of Catholic health care providers to refuse to participate in abortion. It is no surprise that Planned Parenthood has made the revocation of these laws one of its top legislative priorities.

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(Maureen Kramlich is a public policy analyst with the Secretariat for Pro-Life Activities in the National Conference of Catholic Bishops.)

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