Was Hobby Lobby All Wrong About Emergency Contraceptives?

The Supreme Court’s decision in favor of Hobby Lobby had nothing to do with the rights or wrongs of contraceptives. The morality of abortion and abortifacient drugs was not the issue. Neither was the scientific debate about how emergency contraceptives prevent pregnancy. The Supreme Court came down in support of Hobby Lobby, Conestoga, and Mandel because it concluded they were protected under the Religious Freedom Restoration Act passed unanimously by the House, 97-3 by the Senate, and signed into law by President Clinton in 1993. The Greens could be mistaken in their beliefs about emergency contraceptives and still have the legal right not to be forced to violate their consciences and give up their religious liberty.

But, of course, the debate about contraception–what it does and how it works–matters a great deal in the court public opinion. So it’s not surprising that many media outlets are suggesting Hobby Lobby had its “facts” all wrong about how emergency contraceptives actually prevent pregnancy.

In the New Republic piece “The Medical Facts About Birth Control and Hobby Lobby–From an OB/GYN”, Dr. Jen Gunter argues, “There is no evidence that Plan B, Ella, or the Mirena cause abortion by any definition.” She acknowledges that under a “religious” definition of pregnancy, anything that prevents implantation or terminates an implanted embryo constitutes a form of abortion. But in her “summary of the best available medical evidence” she concludes that of the four contraceptives objected to by Hobby Lobby, three (Plan B, Ella, Mirena) definitely do not prevent implantation and the fourth (Copper IUD) most likely does not. Thus, if conservatives would only look at the scientific facts, they would see that there is no “rational basis for refusing to pay for these contraceptives.”

But what do the contraceptives say about themselves? Each of the four pills or devices in question have their own websites full of medical information provided by the manufacturer and/or the Food and Drug Administration.

Plan B

Although Plan B is the most widespread of the four contraceptives, its website provides the least amount of precise medical information. In the “About” section, we find that Plan B “is a backup plan that helps prevent pregnancy,” but is not an abortion pill like RU-486 and will not affect an existing pregnancy. There is no detailed scientific information on the website about how Plan B works. Instead, there are links to several external websites for further information.

The paucity of information is probably intentional. In 2012, the New York Times ran an extensive article about the efforts of the maker of Plan B to have the FDA remove from the Plan B label the implantation effect as one of the possible means of preventing pregnancy. To be fair, the article presents several pieces of evidence suggesting that Plan B may not adversely affect the chances of implantation. But it also notes the FDA’s continuing refusal to remove the implantation language from Plan B’s label, which reads in section 12.1 “Mechanism of Action”:

Emergency contraceptive pills are not effective if a woman is already pregnant.Plan B One-Step is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun. (emphasis added).

Some have argued that the implantation language is based on inferior science and should be removed. But considering the maker of Plan B has been lobbying since the drug’s approval in 1999 to have the language removed, it’s not too hard to imagine that at least part of the effort to change the label is to boost sales and remove possible objections religious persons may have about using Plan B. There’s a reason the Plan B website does not link to its own label.

Ella

Ulipristal acetate (or Ella, actually ella with a lowercase “e”) is a progesterone receptor modulator, which means it fools the women’s body into thinking its pregnant. It works differently than Plan B and has been shown (section 8.1) to cause “embryofetal loss” in pregnant rats and pregnant rabbits. In 12.1 of the Ella label, in the section entitled “Mechanism of Action,” we read:

When taken immediately before ovulation is to occur, ella postpones follicular rupture. The likely primary mechanism of action of ulipristal acetate for emergency contraception is therefore inhibition or delay of ovulation; however, alterations to the endometrium that may affect implantation may also contribute to efficacy. (emphasis added)

According to its own information, Ella should not be used by nursing or pregnant women and it may prevent pregnancy by adversely affecting the implantation of a fertilized egg (see also “Does the Drug ‘ella’ Cause Abortions?”).

Mirena

Mirena is an intrauterine device (IUD) designed to prevent pregnancy for up to five years. According to its own website, Mirena “prevents pregnancy, most likely in several ways:”

• Thickens cervical mucus to prevent sperm from entering your uterus
• Inhibits sperm from reaching or fertilizing your egg
• Thins the lining of your uterus

Immediately following these bullet points, we read:

Mirena may stop the release of your egg from your ovary, but this is not the way it works in most cases. While there’s no single explanation for how Mirena works, most likely, the above actions work together to prevent pregnancy for up to 5 years. (emphasis added)

By its own admission, Mirena does not normally work by preventing ovulation, but from a combination of three factors, one of which is making the uterus inhospitable for a fertilized egg.

Paragard (Copper IUD)

Paragard is a copper intrauterine device designed to prevent pregnancy for up to ten years. On the Paragard website, the first sentence under “How Does It Work?” reads:

The copper in Paragard^® (intrauterine copper contraceptive) interferes with sperm movement and egg fertilization. Paragard^® may prevent implantation. (emphasis added)

Again, the implantation language is up front and explicit.

Conclusion

Some may argue that the FDA labels should be changed, or that recent tests suggest none of these pills/devices work as abortifacients. And yet, that’s not what the contraceptives say about themselves. At best, the way in which these pills and devices work is disputed and uncertain. But if all four contraceptives, in their official information, are explicitly said to adversely affect implantation, how can Hobby Lobby’s objections to providing these contraceptives be considered unscientific or irrational? If one has a moral objection to providing pills and devices which may terminate nascent life, the contraceptives themselves do nothing to allay these fears. In fact, a careful reading of their medical information suggests the concerns are well founded.