Contraception ≠ Abortion: How Birth Control Works
On June 30, the U.S. Supreme Court ruled in Burwell v. Hobby Lobby that closely held, for-profit organizations could prevent their employees from accessing birth control through their insurance. David Green, the CEO of Hobby Lobby, cited his family’s objection to “abortion-causing” drugs and devices. In the lawsuit, members of the Green family, who posit that life begins at conception, singled out two types of birth control: emergency contraceptives (or “morning-after” pills) Plan B and Ella and intrauterine devices (IUDs) ParaGard, Mirena, and Skyla.
The Hobby Lobby ruling sent a shockwave through the women’s rights, health, and legal communities, especially because the objected-to contraceptives don’t actually cause abortion. Doctors, including those at the American Congress of Obstetricians and Gynecologists, say that, medically, pregnancy starts when a fertilized egg implants in the uterus — not when sperm meets egg, as some religions dictate. Hobby Lobby argued that IUDs and morning-after pills were “abortifacients” because they could, potentially, prevent a fertilized egg from implanting. As ACOG said in one of several statements about the case, “Contraceptives that prevent fertilization from occurring, or even prevent implantation, are simply not abortifacients, regardless of an individual’s personal or religious beliefs or mores.”
In her dissenting remarks, Justice Ruth Bader Ginsburg called the court’s decision one of “startling breadth” and said it could open the door for companies to claim a religious exemption from almost any federal law. She also noted that while Hobby Lobby operates its business according to a Christian belief system, its employees are “not drawn from the same religious community.”
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The lawsuit itself and the Supreme Court’s ruling reflect a profound misunderstanding about what birth control does, but they are also symptoms of a larger, stereotypical cultural perception. Birth control is still perceived by many as the province of “sluts,” as Rush Limbaugh’s infamous remarks about Sandra Fluke reminded us all two years ago. Never mind that 99 percent of sexually active women in the United States have used birth control or that contraceptive use is linked to healthier pregnancies, greater educational achievement, higher income levels, and better mental health. The fact is, in a country that still pushes abstinence-only sex education, birth control remains shrouded in secrecy and misinformation.
What Morning-After Pills and IUDs Actually Do
Plan B One-Step, commonly known as the morning-after pill, is an oral emergency contraceptive available without a prescription that contains a higher dose of a synthetic hormone found in many common birth control pills. If taken after unprotected sex or the failure of another birth control mechanism (such as a condom), Plan B prevents pregnancy. Like most hormonal birth control, it does so by preventing ovulation. Because sperm can live in a women’s body for three to five days after ejaculation, it could fertilize an egg release during that time. Plan B tried to stop that, but it also might prevent the union and implementation of sperm and egg. These pills are up to 89 percent effective at preventing pregnancy when taken between one and three days after unprotected sex. They cannot, however, end an active, implanted pregnancy.
Unlike Plan B, Ella, an emergency contraceptive pill approved for use in 2010, is not available over the counter. However, it works the same way, by delaying or inhibiting ovulation. Ella has been shown to be more effective than Plan B when taken later after intercourse.
lntrauterine devices, or lUDs, are inserted into the uterus by a physician. Two types of lUDs are currently available in the United States: hormonal lUDs (such as Mirena and Skyla) and copper lUDs (such as ParaGard). Both types can prevent fertilization and implantation. ParaGard can also serve as emergency birth control: When inserted up to five days after unprotected sex, copper lUDs can be even more effective than oral emergency contraceptives.
ln spite of the Hobby Lobby plaintiffs’ objections, these methods of contraception are just that-contraception. The way they work isn’t significantly different from the way most other forms of birth control work. But the bottom line is, when lUDs and morning-after pills are used correctly, there is no pregnancy to abort.
Abortion pills do exist, and they work differently. Mifepristone is a steroid, administered in a doctor’s office, that causes an implanted, fertilized egg to detach from the lining of the uterus and the uterus to contract and end the pregnancy. Differences in timing make another obvious distinction between preventing pregnancy and terminating it: Emergency contraception is taken within days of having sex, whereas mifepristone can be administered up to nine weeks after sex.
The True Cost of Birth Control Not Covered by Insurance
These biological details can be difficult to parse, but their meaning couldn’t be more important. The advent of reliable, affordable contraception ignited a social revolution for women. But because Hobby Lobby’s owners incorrectly conflate contraception with abortion, thousands of workers are seeing their reproductive rights rolled back. Families have lost the right to make health care decisions that are, frankly, none of their bosses’ business.
The implications are serious. As Ginsburg said in her dissent, “The court’s reasoning appears to permit commercial enterprises like Hobby Lobby and [fellow plaintiff] Conestoga to exclude from their group health plans all forms of contraceptives.” That’s because most hormonal birth control primarily prevents ovulation but, just like lUDs and Plan B, could also prevent fertilization and implantation. Other widely used contraceptives that do the same thing include the pill, the vaginal ring, and birth control injections, implants, and patches. ls all birth control now up for debate by our bosses?
AAUW and other groups object to the Hobby Lobby decision because it sacrifices the privacy and health care choices of employees and their families. After decades of seeing the cultural, economic, and health benefits that abound when women are able to control when and whether they have children, we’re experiencing a dramatic rollback in access to one of the most important tools ever created for women’s empowerment.
Share this information with everyone who is trying to understand the implications of this disastrous decision. And, most important, urge your members of Congress to pursue a legislative solution that reverses the ruling’s harmful effects on women and their families.
Co-written by Rachel Adams, a Washington, D.C.-based editor and writer who focuses on art, literature, education, and the social sciences.
This article originally appeared in the Fall 2014 issue of AAUW Outlook magazine.