Monday, July 7, 2014

Hobby Lobby and the Supreme Court Misjudge Emergency Contraceptives

This past week, the US Supreme Court decided that "closely held" companies can opt out of covering particular forms of birth control for their employee insurance based on a "sincere" religious objection.  The sincerely-religious owners of Hobby Lobby objected to the Obamacare requirement of insurance plans to cover birth control for their employees.  To be fair, they did not object to all forms of birth control, just the ones that they felt were the same as causing abortions.  Unfortunately, many people continue to believe that the morning after pill, emergency contraceptive, Plan B, or levonorgestrel is an abortion-causing pill.  The ruling also applied to Inter-Uterine Devices (IUDs) for the same reason.

One problem - these pills do not cause abortions.  An abortion refers to the medical termination of a pregnancy.  Levonorgestrel and IUDs prevent a pregnancy from occurring in the first place.  Thus preventing the potential for an employee to seek an abortion due to an unwanted pregnancy.  Hobby Lobby, and the other conservative companies that will soon be refusing to pay of emergency contraceptives, do provide health insurance plans that cover most of the other forms of oral contraception.  Normal contraceptives must be taken daily and generally at the same time everyday.  Missing a dose can prevent the hormonal control "the pill" is attempting to maintain.  This is were Plan B comes in.  If a woman forgets to take her normal birth control pill, levonorgestrel can help.  And a lot of people forget to take their pills.

So how does Plan B work?  Levonorgestrel is a synthetic version of progestin.  Progestin prevents ovulation.  Pregnancy actually only occurs during a very small window of about 4 or 5 days, sort of.  The sperm can survive for a while waiting for an egg to be released, but the egg lasts for less than a day.  Oral contraceptives prevent the release on an egg over the course of the month.  An emergency contraceptive like levonorgestrel serves as a surge of progestin than prevents ovulation about 72 hours.  To work best, Plan B should be taken as soon as possible after unprotected sex, but it doesn't always work.  Levonorgestrel does not work after ovulation.  So if the egg is out, pregnancy is possible whether you take the pill or not.  If fertilization has already occurred, levonorgestrel will not help either.  Some thought that it could prevent implantation of a fertilized egg, but no evidence supports that mechanism of action.  And one thing that it definitely does not do is terminate a pregnancy.

So here's where I am concerned about the Hobby Lobby ruling.  Forcing employers to cover abortions is controversial, so I am okay with taking that out as a compromise.  But allowing them to object to certain forms of birth control because they believe that they cause an abortion is wrong.  Plan B does not cause abortions (period).  We study the mechanism of action.  We know how it works.  It prevents pregnancy.  This is not about a belief system.  This is an education problem.  They can believe that it causes an abortion, but they are flat out wrong.

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