The Science Behind the Birth Control in the Hobby Lobby Case

The Plan B morning-after pill was one of the contraceptives at issue in the Hobby Lobby case.

If you've read the Supreme Court’s ruling in Hobby Lobby or the reaction to it, then you know what sparked the lawsuit. The Affordable Care Act says that employer-provided insurance must include essential health benefits, including all medically authorized forms of contraception. The owners of Hobby Lobby objected to this requirement, because they believe that four common forms of birth control — two versions of the "morning-after pill" and two kinds of intrauterine devices (IUDs) — are "abortifacients." In other words, the owners of Hobby Lobby think these contraceptives end pregnancies rather than prevent them. And they believe that is tantamount to ending a life.
The claim, which you can find on virtually any conservative website, has been making the rounds for a long time. It's stuck because the science on how these particular drugs and devices work wasn't that great. But recent advances in medical diagnostics and some ingenious studies have changed that. We know a lot more about how the contraceptives work. We can be very confident that three of the four contraceptives do not lead to abortion, even using the conservative definition of when life begins, and we can be almost (although not quite) as sure that the fourth does not, either.
There are essentially six ways to prevent pregnancy:
  2. Inhibit ovulation (prevent the release of an egg)
  4. Affect the fertilized egg (prevent implantation)
  5. Create an inhospitable uterine environment (prevent implantation)
  6. Affect the implanted embryo
As far as the medical establishment is concerned, pregnancy doesn't begin until implantation. (In fact, 80% of fertilized eggs never implant.) So under this "medical" definition of pregnancy, only method number 6 — that is, doing something to the implanted embryo — would constitute a form of abortion. But religious conservatives hold that pregnancy and life itself begin at the moment an egg is fertilized. Under the "religious" definition of pregnancy, methods 4, 5 and 6 would all constitute forms of abortion.
What does that mean for the four types of contraception at issue in the Hobby Lobby case? Let's consider each one.
Birth control chart

Plan B, which is one form of the morning-after pill, clearly wouldn't. It works by inhibiting ovulation when given during a specific 48 hour window of the cycle. It has no other method of action. This is undisputed scientific fact. (Plan B is one of the best studied of all the methods of contraception).
The only caveat is that if either IUD fails (and while rare, they do fail about 1% of the time) the resulting pregnancy has a higher risk of miscarriage.
Is that a rational basis for refusing to pay for these contraceptives — and reducing the reach of a health care initiative that provides enormous benefits? Religious conservatives think so. And thanks to the Supreme Court, they will get their way.

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