In the midst of the wall-to-wall press coverage of Pope Benedict XVI's visit to the U.S. last week, The New York Times paused to note that many American Catholics pay little heed to papal authority, and instead bestow on the pope a particularly American commendation: they'd love to sit down and chat with the man, Catholic to Catholic. However homey the image, a stained-glass rendition of the favored American method of choosing a president (sans beer), the Times also pointed out, in explaining the lack of official Church data on how Americans really feel about the authority of this or any pope, that the Church is not a democracy. And, despite how nonchalantly many Americans speak about the relevance of the Vatican on their lives, the effect of a hierarchy headed by a man who built his career on opposition to liberation and feminist theology is real, and renders liberal or pro-choice Catholics today dissenters criticizing doctrine from outside the Church.

While Benedict pointedly neglected to address the issues those dissenters press on – the bans on contraception, condom use, gay and lesbian rights, and ordination of women – the unbending position of the Vatican was made clear during a 60,000-person mass at Yankee Stadium on Sunday, where he reminded the throngs of faithful that obedience as a Catholic is non-optional.

"Authority. Obedience. To be frank, these are not easy words to speak nowadays, especially in a society which rightly places a high value on personal freedom," he told the crowd, continuing to cite the scriptural lesson that "true freedom" comes from turning from sin, from "self-surrender" and "losing ourselves": an emphasis on hierarchy and submission more common to fundamentalist Christianity and orthodox doctrine across denominations than within the heterogeneous Catholic church itself.

It's also an unsubtle reminder that, however much American Catholics may disdain the 40-year old order of Humane Vitae — that "each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life" — following their own consciences on matters of artificial contraception is still an act of rebellion.

An immediate outpouring of dissent greeted the document in 1968, when 600 theologians protested the ruling, Rosemary Radford Ruether, a feminist theologian at the Pacific School of Religion, recalled on a conference call convened by Catholics for Choice to commemorate the document's fortieth anniversary. These theologians, she explains, were responding to the real consequences of Natural Family Planning — the only method of birth control the Church had allowed since 1930, when it banned condoms and diaphragms in a renewed emphasis on Augustine's anti-contraception teachings — in Catholics' family life, where the anti-contraceptive emphasis "almost began to seem the point of being a Catholic." As representatives of lay Catholic couples testified to the 1966 Catholic Commission on Birth Control, the pressures of following NFP, and abstaining during infertile periods, led to great marital discord for Catholic couples. The priests on the Commission were shocked by the experiences of the laity, and voted overwhelmingly to recommend that birth control be allowed for married couples. A small group of anti-contraception dissenters created a second "minority report" for the pope, calling the Commission's conclusions threatening to the Church's authority, as the Church could not admit to having "so wrongly erred during all those centuries of history." Four years later, it was this dissenting point of view that was reinforced in Humanae Vitae.

Today 97% of sexually active Catholic women use some form of contraception at some point, and, Radford Ruether says, many Catholic priests don't press the issue, considering it a "teaching that has not been received" by the people. Indeed, in 1974, 83% of Catholics said they disagreed with Humanae Vitae, and in 1999, according to the National Catholic Reporter, 80% of Catholics said they believed they could practice birth control and remain "good Catholics" (presumably leaving the remaining 17% guiltily disobedient). But despite this 40-year disconnect, which many theologians agree has led to greater skepticism about Church infallibility than acceptance of contraception ever could have, calls to liberalize the doctrine are repeatedly shot down with what theologian Anthony Padovano calls "incredibly inflated language," such as Pope John Paul II's assertion that questioning the ban on contraception was equivalent to questioning the holiness of God.

How this plays out in day-to-day life, explains Mary Hunt, of the Women's Alliance for Theology, Ethics and Ritual, is that many Catholic women who approach their priests about contraception are given personal exemptions, while the same priests or bishops continue to preach against it in public. "Many Catholics are disgusted by the duplicity, or at best they're confused," said Hunt. There is "little evidence that those who believe contraception is healthy, good, natural and holy, as I do, have any input into Catholic theology."

Or, if they have a vote, it's one that can only be used once, in leaving the church. "The Catholic hierarchy holds its power," says Hunt, "and laypeople, many of them women, are walking away." Or, as Daniel Maguire, a professor of Moral Theological Ethics at Marquette University who laments that the public face of the Church excludes dissenting theologians and laity, jokes, "The current teaching of Catholic bishops is the making of Unitarians." On the eve of the Pope's visit, Catholics for Choice issued a publication studying the full impact of the contraceptive ban, Truth and Consequences: A Look Behind the Vatican's Ban on Contraception (PDF).

Perhaps the exodus of those Catholics who feel strongly about reproductive health and rights explains the sometimes confusing poll numbers attached to American Catholicism. For all that people obviously reject Catholic hierarchical teachings in practice, and tell pollsters the Church is "out of touch" on modern issues, there's a conflicting rise of believers who say they support the traditionalist path Pope Benedict XVI represents. According to a poll conducted by The Washington Post, over the past five years, the percentage of Catholics who supported modernized doctrine from the Vatican has dwindled from 66% to 45%, and those who wanted the pope to "emphasize Catholicism's traditional teachings and customs" rose from one-third to one-half.

Maybe that rise in appreciation for tradition, even among believers who are flouting the doctrine, is because the impact of Vatican teachings is far less consequential in the U.S. than in developing nations where the Catholic hierarchy has a heavy hand in public policy, hampering condom distribution in Africa, emergency contraception availability in South America, and family planning options for women in countries with high rates of maternal mortality. In Yankee Stadium, the pope's words on obedience may be a plea to a rich nation, but elsewhere, it's an enforceable demand.

"The tragedy is that those of us in the Global North can circumvent any restrictions on contraception," says Catholics for Choice President Jon O'Brien, reflecting a Vatican recognition that they've "lost the battle for our hearts and minds." Instead, the Vatican has taken their argument to the level of global public policy at the U.N., and exerts its influence most immediately on the developing nations of the Global South. There, says Mary Hunt, "Anti-contraceptive theology, implemented in public policy, results in a lack of available, affordable birth control, and this plays a significant role in [maternal] deaths" — even as vast majorities of Latin American Catholics, including 87% of Colombian Catholics, 84% of Mexican Catholics, and 81% of Bolivian Catholics, believe you can use contraception and still be a good Catholic.

Perhaps a greater awareness among the majority of Catholic laity who disagree with Vatican teaching on contraception – whether they voice that disagreement in words, with their feet, or through the quiet example of their private lives – of how such "irrelevant" teachings play out in the lives of their poorer sisters, would make the issue of Vatican authority relevant again. It certainly is for those who don't have the freedom, "true" or otherwise, to disregard an authority that directs the healthcare they can receive.