Ever since 1968, when Pope Paul VI issued his controversial condemnation of the birth control pill, the Roman Catholic Church has struggled to convince American Catholics to follow that edict.
Now church leaders face an even tougher task. They must convince the courts and non-Catholics to take their birth control teachings seriously.
Last week, a state appeals court ordered Catholic Charities of California to abide by a new state law that requires employers to offer contraceptives to female employees covered by health plans with prescription drug benefits.
That ruling, which the church is expected to appeal, was also an early warning signal to Bush administration officials trying to increase the role of tax-supported "faith-based" charities.
And it comes in the wake of the National Conference of Catholic Bishops' controversial crackdown against sterilization last month.
Meeting in Atlanta, the bishops voted 209 to 7 to declare sterilization "intrinsically evil" and put tubal ligation and vasectomy on the same footing as abortion and euthanasia, both already condemned by the church.
That vote was prompted by Vatican objections to loopholes in cooperative agreements with non-Catholic hospitals purchased by Catholic health care chains, and could affect millions of non-Catholic patients.
Liberal Catholics, such as Mountain View City Council member Rosemary Stasek, are outraged.
"Catholics like myself are increasingly alarmed at how the Vatican is asserting itself into the United States," said Stasek, who also serves as the director of California Catholics for Free Choice.
James Sweeney, the lawyer for Catholic Charities in Sacramento, said the birth control issue is a "red herring."
"Planned Parenthood (which backed the state's defense of the new law) realizes that birth control is where the Catholic Church is outside of the mainstream," he said. "The endgame here is forcing the church to perform abortions."
But Stasek sees the Catholic hospital and Catholic Charities battles as part of a broader Vatican intervention, one that includes new guidelines to tighten theological orthodoxy at Catholic colleges and universities.
"This is really being driven by the Vatican," Stasek said. "They are reaching into American institutions and trying to bring them into line with very conservative positions that are not representative of American values."
Stasek acknowledged that there is little that rank-and-file dissenters can do given the strict hierarchy of the Catholic Church.
"We shrug our shoulders, keep going to communion, shake it off and wait for the new pope," she said.
George Wesolek, executive director of the San Francisco Archdiocese's Office of Public Policy and Social Concerns, agrees that there is a common thread running through the controversies over Catholic Charities, Catholic hospitals and Catholic universities.
"These issues all touch on Catholic identity," he said. "But to blame it on Rome is really simplistic. There is real concern among a lot of Catholics about our identity."
While there "are many different camps" in the Catholic Church, Wesolek said it's up to the bishops, the cardinals and the pope to decide what is and what is not Catholic.
"It's not open season on what we believe," he said. "We are a hierarchical church."
Wesolek said the main issue in the Catholic Charities lawsuit is not whether Catholics, non-Catholics or the courts agree as to the wisdom of the church's ban on most forms of birth control.
"We see the real issue as government entanglement in religion," he said.
The disputed law, known as the Women's Contraceptive Equity Act, does offer a "conscience clause" for "religious employers" seeking an exemption.
To qualify as religious, the employer must hire only people who share its beliefs, mainly serve like-minded people, and exist primarily to promote its religious beliefs.
Catholic Charities locations around the state are set up as semi- independent nonprofit corporations. This has allowed them to get government money because they are not seen as agencies of evangelization.
"We help the poor, and we don't ask if they are Catholic," Wesolek said. "Charitable work is an essential part of our ministry, and now the Legislature is telling us that is not Catholic. We define ourselves. We don't let someone else define us."
Catholic Charities statewide spends about $80 million a year on social services. About 60 percent of that money comes from taxpayers.
Wesolek agreed that the California controversy could be a setback for President Bush's attempt to greatly expand the amount of public money going to religious charities.
"It's going to make some people in the religious community nervous. They'll say, 'See how the government intrudes.' But in the end, I think we will win this thing. The higher courts will see this as an intrusion."
Fifteen other states have similar anti-discrimination laws requiring employers to offer contraceptives to women if they provide prescription coverage for men.
Although church leaders insist their ban on birth control pills and devices is "not the real issue" in the Catholic Charities case, they acknowledge they couldn't be promoting a more unpopular church teaching.
Numerous polls have shown that most Catholics ignore Pope Paul VI's 1968 encyclical, Humanae Vitae, even though Pope John Paul II has stridently sought to promote it.
The Rev. Raymond Dennehy, a professor of philosophy at the University of San Francisco, blames the American prelates.
"They are as confused as drunks in a revolving door," Dennehy said of the U. S. bishops. "People don't hear much about Humanae Vitae. There has been no teaching on it."
Dennehy said the condemnation of birth control pills, vasectomies, condoms, diaphragms and other contraceptive devices is based on the long-standing church belief that "sex is not only for fun or love."
"It must be unitive -- open to procreation," he said. "You can't separate the two."
Nevertheless, over the last seven decades, nearly all the world's other Christian churches have embraced birth control -- especially the use of condoms to help slow the global AIDS epidemic.
When the subject is birth control, Dennehy predicts the Catholic Church will have a hard time winning over the country or the courts.
"It's going to be very difficult," he said. "They first have to start convincing their own people."