human conditions, medicine, politics

The Hobby Lobby Ruling: Contraceptives and Abortifacients

Last week, the Supreme Court ruled that, due to religious objections, Hobby Lobby (and other for-profit companies) does not have to provide health insurance coverage for contraceptives that are part of the Affordable Care Act. Specifically, Hobby Lobby objected to four contraceptive methods – Plan B, Ella, and two intrauterine devices (IUDs) – because Hobby Lobby’s owners “believe” that these contraceptives cause abortions, calling them abortifacients. But, this just isn’t true.

human blastocyst embryo
This ball of cells is a human blastocyst, or a human embryo about 5–9 days old, which is made up of about 150–300 cells. (Image credit: J. Conaghan)

Despite Hobby Lobby’s owners’ beliefs, scientific evidence shows that these contraceptives don’t actually cause abortions. Instead, they primarily work by preventing fertilization, which happens before a woman is even technically pregnant. Furthermore, these contraceptives cannot terminate a pregnancy once it is established. Consequently, these contraceptives do not cause abortions. To understand this, a brief refresher on reproductive biology helps.

Most of these contraceptives work by disrupting a woman’s ovulation. Once during a woman’s menstrual cycle (which is roughly 28 days long), she ovulates. When this happens, an egg is released from her ovaries and it needs to be fertilized within a short window of time (about 24 hours) or it will degenerate. If a sperm encounters an egg during ovulation (which has more of a 3–5 day time window since that’s how long sperm can survive in a woman’s body) and they successfully join together, a fertilized egg is formed. It divides itself into multiple cells over the next several days, reaching a stage called the blastocyst at five days after fertilization — at this point it’s made up of about 150–300 cells. The blastocyst does not implant itself into the uterine wall until about 6–9 days after fertilization. If the blastocyst isn’t implanted, a woman isn’t technically pregnant.

human egg fertilization blastocyst
This illustration shows how human fertilization progresses (in the fallopian tube and uterus). (Image credit: Ttrue12)

As mentioned above, most of these contraceptives disrupt a woman’s ovulation, specifically delaying it. Plan B, also known as “the morning after pill,” uses the hormone levonorgestrel as an oral contraceptive. It’s an emergency contraceptive pill that should be taken within 3–5 days of unprotected sex, and the sooner it’s taken the more effective it is. It’s thought to work by preventing fertilization by delaying ovulation (it stops the ovaries from releasing an egg). While there’s been some controversy over whether Plan B may also affect implantation (after fertilization), recent studies have shown that it most likely only prevents fertilization (but not implantation). Also, it does not work if a woman is already pregnant (and has not been found to cause birth defects if taken while pregnant).

Studies have shown that Ella works similarly to Plan B — Ella also likely affects ovulation but doesn’t block implantation. As for the IUDs, one is thought to work by preventing ovulation, while the other may also prevent implantation. But none have been shown to abort a pregnancy once it is established.

As a side note, it’s worth mentioning that “about half of fertilized eggs never stick around. They just pass out of the woman’s body.” And if companies seriously want to “save” fertilized eggs, they will need to fight the in vitro fertilization industry, which utilizes a very common infertility treatment — responsible for more than 1% of U.S. births — where eggs are fertilized with sperm outside of a woman’s body, and extra fertilized eggs are often discarded (some of which have been used to make human embryonic stem cells). Additionally, possibly up to 50% of all pregnancies end in spontaneous miscarriages, most (about 80%) in the first trimester, with many women being unaware that they were even pregnant (since they may not have even missed a period).

In order to ensure that rational decisions are being made to govern our lives, it’s important to take a moment to look at the real scientific facts behind the topics at hand — we now understand so much about the world around us that we have the ability to make very informed choices. Let’s not take that for granted. For example, if a goal is to limit the number of abortions that women have, it’d be good to keep in mind that women who are not using contraceptives are much more likely to get an abortion.

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