Unless you’ve been living under a rock, you’ve probably heard about the Supreme Court’s ruling in favor of Hobby Lobby. Basically, they were granted religious freedom to deny their female employees insurance coverage on their full choice of birth control methods — specifically IUDs and emergency contraception, which they consider abortifacients. A lot of people (not just pro-choicers) are angry about this ruling. Many consider contraceptive accessibility very beneficial to both individuals and society as a whole. Others are angered over Hobby Lobby’s alleged hypocrisy of investing in the very companies that create the products they are against.
While I’m upset for several reasons, I’m most angered by the fact that a ruling like this upholds ignorance on matters of basic sex education and further perpetuates a confusion between birth control and abortion that is already too prevalent in our society. Although they have a belief that these forms of contraceptives are abortifacients, that does not make it true. In fact, there is strong research-based evidence that makes Hobby Lobby’s argument unsound. First, we have to take a look at how emergency contraception and IUDs actually work.
Emergency Contraception
Emergency contraception is commonly referred to as “the morning after pill” as well as the most popular brand name, Plan B. Other brands sold in the U.S. include Ella, Next Choice, and My Way. Many brands of daily oral contraceptives can also be used as emergency contraception when multiples are taken. (There is a fantastic chart here that shows how many pills of what brands can be taken in this way.) Basically, all methods act by releasing a large dose of synthetic progesterone into the body. Note that these pills should not be confused with Mifepristone, which can be used to induce a medication abortion. The “morning after pill” and “abortion pill” are two different medications, working at two very different times — one before pregnancy and one after. Emergency contraception does not have any effect if the woman is already pregnant.
To understand how a contraceptive method can work after intercourse, we first have to recognize that fertilization of an egg does not happen immediately. At the very least, the sperm have to find their way into the fallopian tubes to fertilize the egg (which can take a few hours). If ovulation/the release of an egg hasn’t yet occurred, the sperm may have to try to survive for a few days in waiting (7 days appears to be the longest observed time). This is the key to how emergency contraception works, and explains why it has to be taken quickly — usually within the first 72 hours. If taken before ovulation occurs, the synthetic progesterone signals to the body not to release an egg, thereby preventing fertilization by keeping the sperm and egg separated.
The once-hypothesized idea that emergency contraceptives can provide a second barrier to pregnancy by preventing implantation is not being supported by scientific studies.1 Instead, what we are finding is that most, if not all, emergency contraceptives are not effective if ovulation has already occurred, meaning that they are not working at the level of implantation. The only brand that seems like it might alter the uterine lining (which is not to say that it necessary would inhibit implantation) is Ella, which uses a different form of synthetic progesterone than levonorgestrel.
IUDs
Although all the details explaining how IUDs work have not been determined yet, we are discovering more as their popularity increases, more research is conducted, and they are better refined. (Being comparable to permanent sterilization in their effectiveness, but still remaining a temporary method, they offer a lot of promise for the fields of reproductive health & family planning.) What research shows is that just like all other methods of contraception, an IUD primarily works by preventing fertilization. Depending on the type of IUD (copper or hormonal), this can occur a number of ways. Copper appears to be a very effective spermicide, killing off sperm as they enter into the uterus, thus preventing them from reaching an egg that may be present in the fallopian tubes. Hormonal IUDs (which contain levonorgestrel) may prevent ovulation for some women, but they also thicken the cervical mucus so that sperm cannot quickly move through it.
It has generally been thought that because hormonal IUDs also thin the uterine lining and copper alters the uterine environment, these methods may also prevent implantation of a fertilized egg. This is still debatable, with some arguing that it explains why IUDs are so greatly effective. However, even from the beginning, the use of IUDs has not shown any greater rate of failed implantations than what occurs naturally.2
Which brings me to my other point: Even if we were to ignore much of the scientific evidence and admit that these methods of contraception may provide a last-ditch effort to prevent pregnancy by blocking implantation of a fertilized egg…
Fertilization and pregnancy are not one and the same.
Pregnancy is a much more complicated process than most people give it credit for, with a lot of room for error. (Although this is very simplified, the basic steps of the process are: ovulation + intercourse + fertilization + implantation = pregnancy.) As far back as 1965, the American College of Obstetricians and Gynecologists recognized this and determined that the very definition of conception (or pregnancy) depended on implantation of a fertilized egg into the uterine wall. Fertilization by itself is simply not enough for your body to be considered pregnant. It is only one step along the way.
When contraception is not being used, at least 50% of fertilized eggs never fully implant and are thus naturally destroyed by the woman’s body before anyone is any wiser.3 This usually happens so quickly that it does not even alter a woman’s menstrual cycle, let alone begin to release pregnancy hormones. In general, because contraceptives reduce the amount of fertilized eggs, they actually help reduce the amount of failed implantations that would otherwise occur naturally. (This article does a fantastic job explaining the basic idea, even though the exact numbers reflect the use of oral contraceptives — not EC or IUDs.)
Beliefs are important to all of us, but we can’t forget to continuously reexamine them in the light of new evidence that speaks to the contrary.
1. http://www.sciencefriday.com/blogs/06/15/2012/emergency-contraception-how-it-works-how-it-doesn-t.html?audience=4
2. http://www.popcouncil.org/uploads/pdfs/Sivin.pdf
3. http://www.ucsfhealth.org/education/conception_how_it_works/