The Contraception Controversy: A Comprehensive Reply (5 of 7)

5) Emergency contraception is essential to women’s health and is not an “abortion drug.”

The Obama Administration’s recently announced policy to require insurers to cover contraception as women’s preventive health care has prompted many over-heated op-eds, editorials on both sides and even a thoroughly one-sided Congressional hearing. The controversy is unlikely to end anytime soon: pending federal legislation and proposed amendments would massively enlarge the scope of insurers’ and business owners’ ability to restrict any type of insurance benefit on either “moral” or “religious” grounds, undermining the very purpose of insurance.  

Below, we take a closer look at the arguments by opponents of the contraception requirement, unpack the legal issues and public health debate, and respond to many erroneous assertions.

Full Introduction

1) Religious liberty and the right of an individual to live according to his or her own religious conscience are supported, not threatened, by this policy.

2) Both the original policy and the accommodation are legally and constitutionally sound.

3) The Administration’s policy accommodation fairly balances the interests of employers and employees and is based on the economic realities of the insurance marketplace.

4) Birth control coverage is a mainstream and commonsense aspect of preventive care for women.

5) Emergency contraception is essential to women’s health and is not an “abortion drug.”

Opponents of the rule, including the USCCBassert that the use of emergency contraception is equivalent to an abortion, and therefore that the requirement for coverage of “all methods” of FDA-approved contraception is objectionable:

The mandate forces coverage of sterilization and abortion-inducing drugs and devices as well as contraception. Though commonly called the "contraceptive mandate," HHS's mandate also forces employers to sponsor and subsidize coverage of sterilization. And by including all drugs approved by the FDA for use as contraceptives, the HHS mandate includes drugs that can induce abortion, such as "Ella," a close cousin of the abortion pill RU-486.

The Bishops’ claim that emergency contraception is abortion inducing does not reflect scientific reality. Emergency contraception works by inhibiting or delaying ovulation or other pre-pregnancy processes. Without a pregnancy, there can be no abortion.

The Bishops and others often assert that not only does emergency contraception inhibit ovulation, it also prevents a fertilized egg from implanting in the uterus. Setting aside whether such a process would be equivalent to abortion (the scientific view is that it would not be, as pregnancy is defined as beginning at implantation), this claim is also contrary to scientific evidence.

The most recent studies conducted on levonorgestrel-based emergency contraception (LNG ECP) confirm that it has no effect on implantation. The Emergency Contraception Statement from the International Federation of Gynecology and Obstetrics (FIGO) affirms that LNG ECP impairs ovulation and might affect sperm function, but that it does not inhibit implantation and has no effect on an existing pregnancy.

Inhibition or delay of ovulation is LNG ECPs principal and possibly only mechanism of action. Review of the evidence suggests that LNG ECPs cannot prevent implantation of a fertilized egg. Language on implantation should not be included in LNG ECP product labeling. The fact that LNG ECPs have no demonstrated effect on implantation explains why they are not 100% effective in preventing pregnancy, and are less effective the later they are taken.

The World Health Organization has also stated that levonorgestrel-alone emergency contraceptive pills (LNG ECP) “[do] not prevent a fertilized egg from attaching to the uterine lining. The primary mechanism of action is to stop or disrupt ovulation; LNG ECP use may also prevent the sperm and egg from meeting.”

Emergency contraception does not harm an established pregnancy, much less terminate it, and is therefore not what would commonly be understood as “abortion-inducing.” Instead, by delaying ovulation, use of emergency contraception can reduce the risk of an unwanted pregnancy by 75 percent or more if used correctly.

The American Academy of Pediatrics Policy Statement on Emergency Contraception finds that use of emergency contraception could prevent half of all unintended pregnancies and abortions in the United States. Given the grave consequences of unintended pregnancy and the narrow window of time in which it is necessary to act to avert a pregnancy, it is essential that women and families receive accurate medical information about the effects of emergency contraception, in order to fully weigh their options.

Distortion of the science makes it more difficult, not easier, to help women avoid unintended pregnancies. It is unfortunate that emergency contraception, which is safe and available without a prescription for women over 17 years of age, and is the most effective way to prevent pregnancy following intercourse, has been politicized. In such an environment, it is essential that public health guidelines reflect the scientific consensus, and allows women and families to make the critical decision regarding whether or not to use emergency contraception.

6) Sterilization is a common form of birth control. Denying access, especially when it is medically recommended, can have devastating consequences.

7) Conclusion

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