Monday, October 16, 2017
Devex (Oct. 3, 2017): In West Africa, youth ambassadors serve as family planning advocates, by Christin Roby:
In West Africa, young people are receiving training from health professionals and becoming community-based family planning advocates. They use their skills to initiate conversations with their local ministries of health to demand access to contraceptives, reproductive health services, and to ensure they each have a voice in future reproductive policies.
West Africa has the world’s lowest contraceptive prevalence rate accompanied by the world’s highest fertility rate. While the world averages 2.4 children per woman, African women average 4.7 children. West Africa surpasses even the African average with five children per woman, and a 17 percent modern contraception prevalence rate as compared to the global rate of 64 percent.
These initiatives are part of a larger project by the nations that make up the Ouagadougou Partnership (Benin, Burkina Faso, Cote d'Ivoire, Guinea, Mali, Mauritania, Niger, Senegal, and Togo). This Partnership has a goal to provide 2.2 million more people in the region better access to family planning methods by 2020. The youth ambassadors especially aim to reach rural communities that don't often have much knowledge about contraception or family planning.
Experts hope that introducing effective family planning methods into more communities will enable young mothers-to-be to space their births, so as to reduce potentially negative health consequences. Young men are important to the conversation as well, and educating them on the risks of un-spaced births and the health complications that young pregnant women face--especially those under 18 years old--is imperative.
By empowering the youth to advocate for themselves and their communities, these groups--such as Strengthening Civil Society Engagement for Family Planning in West Africa--hope to facilitate cooperation between religious and community leaders. Bridging these spheres is important in order to account for various cultural contexts when considering reproductive rights advocacy and establishing new health services programs. Youth ambassadors have effectively organized trainings within mosques and churches and are beginning to open a line of communication about safe sex practices, discussion of which is often considered taboo.
International health experts are optimistic that the West African model will expand contraceptive use and effective family planning and improve reproductive health in the region.
Saturday, October 7, 2017
Washington Post (Oct. 6, 2017): Trump administration narrows Affordable Care Act’s contraception mandate, by Juliet Eilperin, Amy Goldstein and William Wan:
In the next move on Trump's path to dismantle as many Obama-administration initiatives as possible, the Trump administration issued a rule today that many predict will leave hundreds of thousand of women without free access to contraceptives.
The Health and Human Services Department now allows a much wider group of employers and insurers to exempt themselves from covering birth control on religious or moral grounds. Although the administration estimates that "99.9%" of women will still receive free birth control through their insurance, the only basis of that estimate is the finite number of lawsuits that have been filed since Obama introduced the contraceptive mandate provision in 2012. Officials do not know, however, how many employers denied contraceptive coverage on "religious" or "moral" grounds before the ACA, and so an accurate number of women who may lose coverage cannot yet be estimated.
In 2014, the Supreme Court heard the Hobby Lobby case in which the Christian owners of the Hobby Lobby chain craft store objected to providing certain forms of birth control. The court ruled it illegal to impose the provision on "closely held corporations," the definition of which is sure to widen under Trump's provision.
Senior Justice Department officials said the guidance was merely meant to offer interpretation and clarification of existing law. But the interpretation seemed to be particularly favorable to religious entities, possibly at the expense of women, LGBT people and others.
The guidance, for example, said the ACA contraceptive mandate “substantially burdens” employers’ free practice of religion by requiring them to provide insurance coverage for contraceptive drugs in violation of their religious of beliefs or face significant fines.
This new rule will almost certainly prompt fresh litigation against the Trump administration, likely on the grounds of sex discrimination--as the mandate disproportionately affects women--and religious discrimination based on the argument that these exceptions enable employers to impose their religious beliefs on their employees.
Wednesday, August 23, 2017
openDemocracy.net (Aug. 15, 2017): Reproductive Rights on the Move: Refugee Women in Greece Struggle to Access Contraception, by Zoe Holman
Refugee women are struggling to maintain control of their bodies and reproductive choices as a result of practical and cultural challenges within their transitional lives. A recent study has identified that while 60% of women in pre-war Syria used some form of contraception, only 37% of married Syrian women currently living as refugees in Lebanon do the same.
Often, statistics like this exist because refugee women are not comfortable or reasonably able to use the common forms of contraception available in their relocated states. Injectable contraceptives are popular among refugee women, as they're more conducive to women on the move, but they are not always widely available in every country. Contraceptive pills--often more easily accessible--are not always a realistic choice for a woman without a regular routine or stability.
The lack of contraception among refugee populations can lead to more unwanted and challenging pregnancies as well as dangerous, often illicit, attempts at abortion. Seeking an abortion in a foreign country, even where it is legal, is an intimidating prospect for a refugee woman and often logistically prohibitive.
Of particular concern to many migrating women is the exacerbated risk of sexual violence and the resulting threat to a woman's reproductive autonomy.
The director of the Eritrean Initiative on Refugee Rights says that women emigrating from Eritrea can expect to be raped at least twice before reaching Europe. With this known risk in mind, many women take potent doses of contraceptive before starting their journey to lessen the risk of an unwanted pregnancy from sexual violence. This can lead to longterm damage and reproductive difficulties in the future.
In Greece, a study of nine refugee camps found that insecure conditions left many women at constant risk of sexual and gender-based violence, including rape, forced prostitution, forced marriage and trafficking. Perpetrators, it said, have included volunteers and fellow refugees.
Despite the UN noting that reproductive health is a crucial element to mental and social well-being, conflict-ridden regions still receive 50% less funding for reproductive services than non-conflict zones. Thus far, the international outcry to increase funding for safe contraception and sexual healthcare for refugee and migrant women has gone largely unanswered.
Tuesday, July 18, 2017
Nashville Public Radio (Jul. 17, 2017): Why Women Still Must See A Doctor For The Pill, A Year After Tennessee Law Changed, by Chas Sisk
Early last year, Democrats and Republicans in the Tennessee Legislature co-sponsored and passed legislation that would allow pharmacists to prescribe birth control. Over a year later, pharmacists in Tennessee are still waiting on finalized rules from the Tennessee Department of Health.
State health officials say that final rule drafting has been "complicated." Originally scheduled to be published this summer, the Department has struggled to balance federal regulations with existing law.
The bill had widespread bipartisan support in Tennessee and the backing of major medical associations, pharmacist groups, and reproductive rights organizations. In the face of federal inaction on the issue and the FDA's resistance to over-the-counter birth control, Tennessee took matters into its own hands.
Under the law, women will still have to answer questions about their health before they can receive birth control pills at the pharmacy, and they'll have to be warned of potential side effects. Pharmacists are also required to write out the prescriptions, primarily for record-keeping purposes.
Tennessee will be just the fourth state to allow pharmacists to prescribe birth control, after California, Oregon, and Colorado. California's law spent 18 months in the rulemaking process, and Tennessee officials now expect the same for their own law.
Thursday, July 13, 2017
Human Rights Watch (July 10, 2017): Contraception is Lifesaving but Often Out of Reach, by Nisha Varia
This week, the Family Planning Summit met in London. The goal of this annual meeting is to bring governments, donors, and civil society together to discuss progress and future goals in expanding access to modern contraception for millions of women globally.
Family planning and effective contraception saves lives.
Complications from pregnancy and childbirth are the second leading cause of death for adolescents ages 15 to 19 globally and cause 800 women and girls to die each day. The World Health Organization estimates that at least 22,000 women die from abortion-related complications each year.
This year, many lobbied for the Summit to include conversations on the effects of the Trump administration's reimplementation of the "Global Gag Rule." The controversial policy prohibits foreign nongovernmental organizations from receiving any U.S. health funding if they use funds from any source to provide information about abortions, advocate for or provide abortions.
The policy affects $8.8 billion of foreign assistance. The anticipated consequences of the Gag Rule include increases in unplanned pregnancies and dangerous abortions as well as a higher maternal death rate.
Saturday, June 24, 2017
TIME (Jun. 22, 2017): 4 Ways the Senate Health Care Bill Would Hurt Women, by Amanda MacMillan
The newly unveiled Senate health care bill intended to repeal the Affordable Care Act has a name: the Better Care Reconciliation Act of 2017. The Senate bill looks very similar to the American Health Care Act passed by the House of Representatives earlier this year, with a few changes. What hasn't changed much is the debilitating effects the legislation could have on women and families, and especially low-income Americans and those with pre-existing conditions.
Under the Senate plan, women could lose essential benefits like cervical cancer screenings, breast pumps, contraception, and domestic violence screening and counseling, and prescription drug coverage could be severely limited. The bill also slashes Medicaid, which currently funds half of all childbirths in the United States, and includes language that allows states to impose employment requirements for Medicaid eligibility.
The Senate plan eliminates Medicaid reimbursements to Planned Parenthood for one year, which would further limit access to essential services like well-woman visits, cancer screenings, and STI testing. Finally, the Republican plan repeals the individual mandate and the requirement that employers with 50 or more employees provide health coverage. Without these requirements, many women will lose their health insurance and face unique challenges, particularly regarding childbirth. With the U.S.'s maternal mortality rate already the highest among the developed world, both the House and Senate bills are likely to make a bad problem worse.
Thursday, April 6, 2017
New York Times (Apr. 4, 2017): Does Birth Control Cause Depression? by Aaron E. Carroll:
A study published in the Journal of the American Medical Association Psychiatry suggests that hormonal contraceptive use may trigger depression. The study examined all women and adolescent females in Denmark from 2000 through 2014. It found that those who used hormonal contraceptives "had significantly higher risks of also taking an antidepressant." The risks were higher in adolescents than in women and decreased as the subjects aged.
Placed in the context of other studies that have examined hormonal contraceptive use, the study comes up short. It's not a controlled trial and does not even remotely establish causation. It is also easy to criticize it on the basis that "anti-depressant use isn't the best measure of new-onset depression."
Data from other studies appear to contradict the JAMA study: "the data that do exist show that most women don't show any effect from hormonal birth control, or actually had their mood improve. Moreover, "women who have underlying mood disorders were more predisposed to have mood-related side effects." The JAMA introduces intriguing and "newsy" findings into the mix, but is by no means the last word on the subject. The topic of hormonal birth control and mood is best explored in the context of the patient-physician relationship. When viewed up against the fact that birth control is "[o]ne of the biggest American victories of the last decade," the fact that it may contribute to depression may be a risk worth taking.
Thursday, February 9, 2017
New York Times (Jan. 27, 2017): Duterte’s Free Birth-Control Order Is Latest Skirmish With Catholic Church, by Aurora Almendral:
The Philippines, where six million women have no access to contraceptives, delivers free birth control to indigent women through a program that also offers prenatal care and mandates that sex education be taught in schools and that companies provide reproductive health services to their employees. The program has been billed as "pro-life, pro-women, pro-children and pro-economic development."
But the Catholic Church has long fought the implementation of the program, going so far as to block key components of it via petitions filed in the Supreme Court. Unable to implement the program, the Health Department's budget has been slashed. Sex education in schools remains substandard, based in abstinence-only rhetoric. The Philippines is the only country in Asia where rates of pregnancy among teenagers increased.
President Duterte's administration is coming back strong against the court's decisions, vowing to uphold the law and eliminating some of the decisions' ambiguous wording. Two archbishops have acknowledged defeat.
One commentator, contrasting Duterte's clash with the church with President Donald Trump's reinstatement of the Reagan-era global "gag rule" forbidding foreign NGOs from receiving U.S. family planning funds if they perform, counsel or refer women for abortion services or advocate for the liberalization of abortion laws where they work, sees the policy of the United States, not the Philippines, as the real threat to women's health.
Tuesday, September 27, 2016
IrishCentral (Sept. 19, 2016): Former Irish President McAleese Calls on Pope to End Contraception Ban, by James O'Shea:
A "Scholars Statement" that includes the signature of former president of Ireland Mary McAleese (1997-2011) calls on Pope Francis and the Catholic Church to bring its ban on contraception to an end. The statement cites the "[t]he damage inflicted particularly on the poor, on women, on children, on relationships, on health, on society and not least on the church itself" as a compelling reason to end the ban but more importantly notes that the ban has no basis in divine law.
McAleese's participation in the statement stems in part from her upbringing. She has eight siblings and at least 60 cousins, all 69 produced by her mother and her mother's siblings. Growing up, McAleese and her siblings were dissuaded by her parents from having such a large family. Her parents, she concludes, and all Catholics who have blindly followed the 1969 encyclical to be fruitful and multiply, have been "infantilized and robbed" by the church.
Today, the vast majority of Catholics worldwide ignore the contraception ban.
Thursday, July 21, 2016
The Guardian (July 18, 2016): Doctors urged to advise patients about risks of abstinence-centric sex education, by Molly Redden:
In a recently released report, The American Academy of Pediatrics denounced abstinence only education programs, stressing the importance of educating young people about comprehensive approaches to things like STIs and contraception. Some interviewed view this as a triumph for doctors in areas where parents may want to mitigate their children gaining access to this kind of information, viewing the report as a scientifically-sound back up against the arguments of abstinence-focused parents. The report stresses the inadequacy of abstinence-only education and highlights conversations about consent and gender identity as a few of the topics pediatricians should feel encouraged to speak with patients about.
Abstinence-only groups have already taken issue with the report, but many are heralding this as an important step in the right direction for doctors and patients alike:
“This is the mothership telling pediatricians that talking about sex is part of your charge to keep children and adolescents safe,” said Dr Cora Breuner, a professor and pediatrician at Seattle Children’s research hospital and the report’s lead author.
Monday, July 18, 2016
The Atlantic (July 13, 2016): Why the Male Pill Still Doesn't Exist, by Andy Extance
While America was introduced to the female birth control pill, and the first tests in hopes of creating a pill for men were conducted as early as 1957, many lament the fact that a male 'pill' equivalent to that of female hormonal contraception still does not exist. There are a variety of issues that have delayed the development of a male pill - there is a lack of commitment to contraception; pharmaceutical companies are less interested in making a product for men; and dangerous side effects documented from previous drug trials. But studies show that the interest, across gender identities, for a male pill is there. The article highlights the social acceptance of women bearing the responsibility of taking contraception, and researchers' worry that they may not be able to create a product that would be as easy as to administer as the female pill. Over the years, researchers have explored various hormonal and non-hormonal methods. One of the researches believes that the answer is probably out there and the work just needs to be completed:
[Elaine] Lissner is adamant that the ideas that seem to have faltered are not dead, they’re just resting. “We keep collecting new methods and never finish the ones we have,” she fumes. “Pick one and make something! Finish the job!”
Saturday, July 2, 2016
ABC News (June 28, 2016): Supreme Court Rejects Pharmacists' Religious Rights Appeal, by Rachel La Courte:
SCOTUS declined to hear a Washington State appeal regarding a pharmacist's ability to refuse to administer Emergency Contraception (EC) should the have a religious objection. With SCOTUS passing on hearing the appeal, the regulations from 2007 still stand - pharmacists may pass the buck to another pharmacist, in the same store, should they feel religiously opposed to administering EC.
Chief Justice Roberts, along with Justice Alito and Justice Thomas, wanted to hear the appeal:
Calling the court's action an "ominous sign," Alito wrote a stinging 15-page dissent for the three dissenting justices. "If this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern," he wrote.
Wednesday, June 22, 2016
The Atlantic, June 14, 2016 Can the U.S. End Teen Pregnancy?, by Caitlin Cadieux, Olga Khazan, Nicolas Pollock:
An animated video by the Atlantic discusses teen pregnancy in the U.S.:
Teen birth rates in the U.S. are down 9 percent from 2013, and they are the lowest they’ve been since 1940. However, America still has the highest teen pregnancy rate among 21 similar countries. Why is this? In this video, staff writer Olga Khazan explores how poverty, culture, and religion can all play a role.
Tuesday, June 21, 2016
Refinery 29 (June 16, 2016): Denied Birth Control, Teens Still Have Sex — Unsafe Sex, by Hayley MacMillen:
From the 2016 International Conference on Family Planning in Indonesia, Refinery 29 provides first hand accounts of young people denied safe sex options and education. A recent Lancet study has identified unsafe sex as the fastest growing risk factor for ill health for young people around the world. At the conference, attendees stressed the importance of accurate, as well as widespread, sex ed to all adolescents. Haley MacMillen writes:
Birth control fallacies are, of course, not limited to East Africa but crop up wherever medically accurate, comprehensive sex ed is withheld. When I ask Philippines-based journalist and sex columnist Ana Santos, another attendee of the International Conference on Family Planning, about contraception myths in her country, she’s armed with some horrifying ones. People believe that "jumping after sex will prevent pregnancy" — although she notes, drily, that "a jump from what height is never mentioned" — and that "drinking coconut juice laced with bleach or Tide detergent will wash away the spermies." And since condoms can be hard to come by, people, especially young people, wrap Calypso plastic, a brand used to package iced candy, around their penises instead. "Totally ouchy, right?" Santos asks. Yes. And ineffective.
The article emphasizes the need for comprehensive sex ed - both internationally and locally - in order to help young people around the world and around the corner.
Saturday, June 18, 2016
Rewire, June 9, 2016, Here’s What You Need to Know About Your Birth Control Access Post-Supreme Court Ruling, by Bridgette Dunlap
In a well-thought-out and organized article, Bridgette Dunlap looks at the impact the Supreme Court’s “non-decision” in Zubik v. Burwell will actually have on women’s access to contraceptives. Quelling what she assumes to be a reader's ever present worry, Dunlap discusses the current legal mandates in place for employers of all kinds and emphasizes that “the vast majority of people with insurance are currently entitled to contraption without a co-payment – that includes people for the most part, who work for religiously affiliated organizations.” Dunlap emphasizes the importance that coverage of the Supreme Court's ruling in Zubik not not overstate the impact of the non-decision:
The fact that equitable coverage of women’s health care is the new status quo is a very big deal that can be lost in the news about the unprecedented litigation campaign to block access to birth control and attacks on Obamacare more generally. Seriously, tell your friends.
Friday, June 17, 2016
Refinery 29 (May 28, 2016): Unsafe Sex Is Now The Biggest Health Risk Among Women Worldwide, by Sara Coughlin
Researchers tracked health trends of participants for over 23 years in order to determine the causes of death among them. While the prevalence of STI's weren't even ranking as a major risk factor at the time the study commenced, they shot up the scale to the number one cause of death by the end, strikingly. This pattern seems to be a worldwide trend, bolstering the importance of getting tested, as well as communicating frankly and effectively to young people about the risks associated with unprotected sex, and how to stay safe when sexually active.
The report, which was published in theLancet and is the result of a commission to look at health challenges facing young people worldwide, found that today's teens are growing up in a world where preventable and treatable health issues, such as HIV/AIDS and unplanned pregnancy, abound. Among the most shocking findings of the report: For women between the ages of 10 and 24, unsafe sex is the fastest-growing risk factor for illness and death worldwide.
Thursday, May 26, 2016
Local health care providers and wider contraceptive options increase contraceptive use in many countries
Vox (May 20,2016): What the US can learn from Ethiopia about birth control, by Sarah Frostenson:
The use of modern contraceptives has tripled in Ethiopia since 2005, following a government program to train women health workers to go door to door to deliver birth control.
What's more, women in Ethiopia are having fewer children (the fertility rate fell from an average of 6.5 children per woman in 2000 to 4.6 currently), maternal deaths are in decline, and more women are staying in school longer. Plus, more women are opting for long-acting reversible contraceptives (LARCs) instead of more traditional short-term methods like birth control pills or condoms.
Local health care providers can make a big difference in women's access to contraceptives as can providing a range of contraceptive options. Long acting reversible contraceptives (LARCs) play a big part in increasing effective use of contraceptives in many countries. LARC implants last for 3 years and do not require going to a clinic to take medication or remembering to take a pill. They also allow women to keep their contraceptive use secret. However, LARC use can be prohibitively expensive for low-income women who would otherwise choose them. Some poorer countries are able to provide contraceptives that are donated by NGOs and the international community, removing the cost-barrier for many women.
Use of LARCs is increasing at a faster rate in some poorer countries than in the U.S. About 12% of women in the U.S. use LARC methods. Recent cuts to family planning in the U.S. resulting in closure of local family planning clinics decrease women's options of contraceptive methods and make it more difficult and expensive for them to access birth control. For instance in Texas, 82 of family planning clinics closed following a recent drastic cut in family planning funding. A study found the cuts lead to an increased birth rate for low income women and a "sharp decrease " in use of LARCs.
Tuesday, April 19, 2016
Inquisitor (April 10, 2106): California Birth Control Law Allows Pharmacists to Dispense Contraception Practically Over-the-Counter, by John Houck:
Earlier this month a California law went into effect that allows pharmacists to distribute self-administered hormonal contraceptives. The law was passed in 2013, but did not go into effect until April 8, 2016 because of regulatory hurdles.
Although women are not required to get a doctor's prescription, access isn't quite "over-the-counter."
To get birth control, a woman will need to answer some questions about her health as well as consult with a pharmacist to determine the most appropriate contraceptive method. A woman’s blood pressure will have to be measured if the particular method poses a high blood pressure risk.
After the consultation, a woman can request a specific type or ask the pharmacist for a recommendation. Once the method is chosen, instructions for use and information regarding side effects will be explained. Some methods, like implants or intrauterine devices, are only available from a doctor.
Birth control administered in this manner will be covered by insurance plans that include birth control. Oregon and Washington already have similar legislation in place, and Hawaii, New Mexico and Alaska are considering similar measures.
Tuesday, March 29, 2016
Think Progress (March 29, 2016): How to Make Sense of the Baffling Order the Supreme Court Just Handed Down on Birth Control, by Ian Millhiser:
On Tuesday, the Supreme Court handed down an unusual order seeking more briefing in Zubik v. Burwell, a challenge to Obama administration regulations intended to expand access to birth control. Under the regulations at issue in Zubik, most employees must include contraceptive coverage in their employer-provided health plan. Employers who object to birth control as religious groups, however, may either fill out a form or write a brief letter seeking an exemption from this requirement. Once they do so, they are permitted to offer insurance that does not cover birth control, and, in most cases, their insurance provider will offer a separate, contraception-only plan to the employer’s workers.
The Supreme Court's order instructs the parties to “file supplemental briefs that address whether and how contraceptive coverage may be obtained by petitioners’ employees through petitioners’ insurance companies, but in a way that does not require any involvement of petitioners beyond their own decision to provide health insurance without contraceptive coverage to their employees.” The Court appears interested in whether the employer could notify the insurance company that it does not wish to provide birth control when they contract for insurance and the insurance company could then notify employees that it will separately provide contraceptive coverage cost-free separate from the employers' plan. This solution would allow employees to receive coverage from the employer's insurer and avoid the need to purchase a separate policy.
The catch, however, is that it may not be possible for the federal government to put such a solution in place, at least without a change to federal law. Employer benefits are governed by complex federal statutes such as the Employee Retirement Income Security Act (ERISA). The Obama administration found authorization for its current rules in the existing ERISA statute, but it is not entirely clear that current law will enable them to move forward with the idiosyncratic solution described in the Supreme Court’s Tuesday order. Indeed, it is likely that one reason that the Court asked for additional briefing in this case was to determine whether the government has the authority to implement the justices’ preferred solution under ERISA.
Thursday, March 17, 2016
Professor Caroline Mala Corbin has posted to SSRN (here) the issue brief she wrote for the American Constitution Society on why the Religious Freedom Restoration Act does not provide a defense to the contraception mandate under the Affordable Care Act. The issue is presented in the case of Zubik v. Burwell.
Here is the abstract:
The Affordable Care Act requires that health care plans include all FDA-approved contraception without any cost sharing. In Hobby Lobby v. Burwell, for-profit businesses with religious objections successfully challenged this “contraception mandate.” In this term’s Zubik v. Burwell, it is religiously affiliated nonprofits like Baptist universities and Catholic Charities challenging the contraception benefit. But there is a major difference: these religiously affiliated nonprofits are exempt from the contraception mandate. Once they certify that they are religiously opposed to contraception and notify either their insurance carriers or the Department of Health and Human Services, the responsibility for contraception coverage shifts to private insurance companies. The nonprofits do not have to provide, pay for, or even inform their employees or students of the separate coverage.
Despite the ability to opt out of contraception coverage, many nonprofits complain that the religious accommodation itself imposes a substantial religious burden in violation of the Religious Freedom Restoration Act (RFRA). According to these nonprofits, providing notice of their objections triggers the provision of contraception to their employees and students, thus making them complicit in sin. Their RFRA claim cannot succeed. RFRA requires that the contraception regulations impose a substantial religious burden and fail strict scrutiny, and neither requirement is met. First, filing paperwork to receive an exemption is not a substantial burden on the nonprofits’ religious exercise. The nonprofits’ claims to the contrary are based on a mistake of law, and while court must defer to the nonprofits’ interpretation of religious theology, courts should not defer to their interpretation of federal law. Second, the contraception mandate passes strict scrutiny: it advances compelling government interests in women’s health and equality, and the accommodation provided to objecting nonprofits is the least restrictive means of accomplishing those interests.