Little Sisters of the Poor: Battle Against the Contraceptive Mandate

THE LITTLE SISTERS AND THE UNFINISHED WAR ON CONSCIENCE

Federal courts, administrative power, and the persistence of the contraceptive mandate

The Little Sisters of the Poor have once again been compelled to seek protection from the federal judiciary, asking the U.S. Court of Appeals for the Third Circuit to block a nationwide ruling that removes their exemption from the federal contraceptive mandate. The appeal, filed in December 2025, arises from an August district court decision in Pennsylvania that vacated the government’s religious conscience rule, exposing the Sisters and similarly situated religious institutions to renewed coercion under federal health insurance regulations.¹

That this dispute continues at all is itself revealing. For more than a decade, the Little Sisters — a Catholic religious order founded in nineteenth-century France and devoted exclusively to the care of the elderly poor — have stood at the centre of one of the most consequential religious liberty conflicts in modern American law.² Their ministry is not ancillary to Catholic life; it is a direct embodiment of the Church’s corporal works of mercy. Yet it is precisely this institutional visibility, rather than any private belief, that has placed them repeatedly in the state’s crosshairs.

The origins of the conflict
The controversy originates in the Affordable Care Act (ACA) of 2010, which mandated that employer-provided health insurance plans include coverage for contraceptives, sterilisation procedures, and drugs capable of inducing early abortion, without cost-sharing.³ While houses of worship received a narrow exemption, religious orders, charities, and healthcare providers that employed or served non-Catholics were largely excluded.⁴

From the outset, the Little Sisters maintained that even indirect cooperation — such as signing paperwork that would trigger third-party provision of contraceptive coverage — violated their religious convictions.⁵ The federal government, by contrast, adopted an expansive understanding of “least restrictive means,” arguing that administrative accommodation sufficed even where the objecting party remained morally implicated.⁶

Supreme Court intervention — and evasion
The resulting litigation produced two major Supreme Court interventions. In Zubik v. Burwell (2016), the Court declined to issue a merits ruling but vacated adverse lower-court decisions, signalling that the government had failed to adequately respect religious objections.⁷ The case was widely understood as a warning rather than a resolution.

That warning was made explicit in Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania (2020). There, the Court upheld federal regulations recognising broad religious and moral exemptions to the contraceptive mandate. Crucially, the Court affirmed that the Department of Health and Human Services possessed statutory authority to issue such exemptions and that doing so was consistent with the Religious Freedom Restoration Act (RFRA).⁸

At the time, many commentators assumed the matter had reached its legal terminus. The Sisters had prevailed not once, but repeatedly, before the highest court in the United States.

That assumption proved premature.

The return of the mandate through administrative law
Following the change of administration, a coalition of states — led by Pennsylvania and New Jersey — renewed their challenge, this time framing the issue not primarily as a question of religious liberty, but of administrative procedure. Their claim was that the religious conscience rule had been promulgated in violation of the Administrative Procedure Act (APA) and that its scope exceeded lawful agency discretion.⁹

In August 2025, a federal district judge accepted this argument and vacated the rule nationwide. The effect was immediate and sweeping: protections previously upheld by the Supreme Court were stripped away, not through direct constitutional confrontation, but through technical administrative reasoning.¹⁰

It is this decision that the Little Sisters now seek to block on appeal.

RFRA versus the administrative state
At the heart of the present appeal lies a fundamental clash between two legal visions. RFRA, enacted in 1993 with overwhelming bipartisan support, restores a robust standard for protecting religious exercise, requiring the government to demonstrate a compelling interest pursued by the least restrictive means.¹¹ The administrative state, by contrast, operates increasingly through procedural formalism, agency deference, and expansive regulatory authority.¹²

The Little Sisters argue that the district court’s ruling effectively nullifies RFRA’s substantive protections by allowing procedural objections to override settled conscience rights. They further contend that a nationwide injunction is an extraordinary remedy, particularly inappropriate where religious liberty is concerned and where Supreme Court precedent already exists.¹³

This dynamic is no longer confined to contraception. It reflects a broader pattern in which administrative law becomes the preferred mechanism for re-imposing policies that have failed constitutional or moral scrutiny when argued directly.¹⁴

Why this case matters beyond America
For Nuntiatoria’s readership, the significance of this case extends well beyond the United States. It illustrates a wider Western phenomenon: the gradual redefinition of religious liberty from an inherent right to a conditional accommodation. Religious belief is tolerated so long as it remains private, individual, and non-institutional. Once it shapes public service, charitable structures, or moral witness, it is increasingly portrayed as incompatible with modern governance.¹⁵

The Little Sisters’ experience mirrors developments across Europe and the Commonwealth, where faith-based adoption agencies, schools, and healthcare providers have faced similar pressures to conform or withdraw.¹⁶ The legal frameworks differ; the philosophical trajectory does not.

Conclusion
The Little Sisters of the Poor continue to bear a quiet but formidable witness. They do not seek to impose Catholic teaching on others; they seek only the freedom to live and serve in accordance with it. That this modest request has required more than a decade of litigation, multiple Supreme Court victories, and yet another federal appeal is itself a commentary on the moral condition of contemporary liberalism.

Conscience, once understood as a limit on state power, is increasingly treated as an obstacle to be managed. The Sisters’ persistence reminds us that religious liberty, if it is to mean anything, must protect not only belief but embodied fidelity. The unresolved nature of this conflict suggests that the deeper struggle is not merely legal, but civilisational.

OSV News, “Little Sisters of the Poor again appeal for protection from contraceptive rule,” December 2025.
Little Sisters of the Poor, History and Mission of the Congregation, official congregational materials.
Patient Protection and Affordable Care Act, Pub. L. 111–148, §2713 (2010).
U.S. Department of Health and Human Services, “Coverage of Certain Preventive Services Under the Affordable Care Act,” 76 Fed. Reg. 46621 (2011).
Declaration of Sr. Loraine Marie Maguire, Zubik v. Burwell, Supreme Court record (2016).
U.S. Government Brief, Zubik v. Burwell, Nos. 14–1418 et al.
Zubik v. Burwell, 578 U.S. 403 (2016).
Little Sisters of the Poor Saints Peter and Paul Home v. Pennsylvania, 591 U.S. ___ (2020).
Commonwealth of Pennsylvania v. HHS, Complaint and District Court Filings (E.D. Pa., 2024–25).
U.S. District Court for the Eastern District of Pennsylvania, August 2025 opinion vacating religious exemptions.
Religious Freedom Restoration Act of 1993, 42 U.S.C. §2000bb.
Philip Hamburger, Is Administrative Law Unlawful? (University of Chicago Press, 2014).
Becket Fund for Religious Liberty, “Little Sisters Appeal Nationwide Injunction,” legal briefing, December 2025.
Samuel L. Bray, “Multiple Chancellors: Reforming the National Injunction,” Harvard Law Review 131 (2017).
Mary Ann Glendon, Rights Talk: The Impoverishment of Political Discourse (Free Press, 1991).
European Court of Human Rights, Eweida and Others v. United Kingdom (2013); UK Equality and Human Rights Commission guidance on faith-based service provision.

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