Does the Obama Mandate Force You to Pay for Abortions?

By James D. Agresti
February 26, 2013
Revised 2/28/13

In a recent National Public Radio broadcast and accompanying article entitled “Morning-After Pills Don’t Cause Abortion, Studies Say,” NPR journalist Julie Rovner reported that the Obama administration’s contraceptive mandate doesn’t force people to pay for abortion-inducing drugs. The article focuses on drugs commonly known as “morning-after” pills, which actually can be used to stop pregnancy for up to three-to-five days after unprotected sex.

Rovner’s argument consists of two major points: the first is that blocking the implantation of fertilized eggs does not constitute abortion, and the second is that morning-after pills do not block the implantation of fertilized eggs. Both of these claims are built upon half-truths and outright falsehoods that become evident through a comprehensive look at the scientific facts.

When does life begin?

Rovner supports her first point simply by quoting Susan F. Wood, an associate professor of health policy at George Washington University and a former assistant commissioner for women’s health at the FDA. Rovner sets the stage for this by stating that scientists thought morning-after pills “might make it more difficult for a fertilized egg to implant in a woman’s uterus,” but:

Technically, that’s not an abortion, says Wood. “We know that about half of fertilized eggs never stick around. They just pass out of the woman’s body,” she says. “An abortifacient is something that interrupts an established pregnancy.”

This claim, which NPR reports as a fact, stands in stark contrast to medical literature and the wide-ranging views of physicians, which reveal that what constitutes an abortifacient is a matter of great dispute. This is because the start of pregnancy typically is defined in two ways: either fertilization (when sperm unites with egg to form an embryo) or implantation (when the embryo implants in the uterus).

Medical literature abounds with the use of both definitions, and a 1998 survey published in the Journal of Maternal-Fetal and Neonatal Medicine found that obstetricians/gynecologists were evenly split on this issue, with 50% stating that pregnancy begins at fertilization, and 48% stating that pregnancy begins at implantation. The Encyclopedia of Birth Control aptly summarizes the situation:

Abortifacients, whether chemicals or objects, cause abortions, the termination of a pregnancy. However, because the definition of pregnancy varies, opinions vary greatly over just which contraceptives or fertility control methods involves abortifacients.

Although views about when pregnancy begins vary among medical professionals, the science of embryology is clear that the genetic composition of preborn humans is formed at the point of fertilization, and as the textbook Molecular Biology explains, this genetic information is “the very basis of life itself.” It also determines gender, eye color, hair color, facial features, and it influences characteristics such as intelligence and personality. Hence, a unique human life is formed at fertilization, and Wood’s point that “half of fertilized eggs never stick around” is as relevant to the issue of abortion as the statement that “all people eventually die” is relevant to the issue of homicide. At its core, this is about the difference between actively ending a life and nature taking its course.

NPR also neglects to report that Wood is an active political donor to Barack Obama and EMILY’s List, a political action committee “dedicated to electing pro-choice Democratic women to office.” From 2008 through 2012, Wood’s donations to EMILY’s List totaled $6,100, which was the most she gave to any candidate or political action committee. Throughout the article, it is clear when Rovner is citing someone who is pro-life, but she leaves Wood’s ideology unmentioned while uncritically accepting her claim that blocking the implantation of embryos does not constitute abortion.
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Do the drugs destroy embryos?

Next, Rovner states that “people like” Gene Rudd, senior vice president of the Christian Medical and Dental Associations and a practicing OB-GYN, “worry that even if what the drugs do is not technically abortion, it’s still objectionable if it happens after fertilization.” Rovner then proceeds to argue that science doesn’t support the notion that “emergency contraceptives” block implantation. This second major point is also deceptively argued.

The manufacturers of all the pills in question have been required by the FDA to affirm that the drugs may block implantation. As such, the official company website for ella states that the drug “may also work by preventing attachment to the uterus.” The website for Plan B One-Step states, “It is possible that Plan B One-Step® may also work by … preventing attachment (implantation) to the uterus (womb).” And the website for Next Choice states that the drug “works by preventing … attachment of the egg (implantation) to the uterus (womb).”

However, in June 2012, the New York Times published an article claiming that these labels “do not reflect what the science shows.” NPR cites this Times article as “fairly definitive research” showing that the Plan B drug only works “by preventing ovulation, and therefore, fertilization.” The article, written by Pam Belluck, asserts that “studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say.” Who are these leading scientists?

One of them is Susan Wood, the same professor quoted by NPR. Like NPR, the Times fails to reveal that she is an active political donor to Barack Obama and EMILY’S list. Another key authority quoted in both of these articles is Diana Blithe, a biochemist and contraceptive researcher at the National Institute of Child Health and Human Development. As it turns out, she also is an active political donor to Barack Obama and gave him $2,500 in 2012. Naturally, political associations don’t determine whether someone is right or wrong, but both articles rely upon the assertions of these individuals to make key points and quote them as if they were neutral scientific authorities.

The Times quotes several other authorities to support its claims, but the only clinical evidence presented in either of these articles are three studies conducted in Australia and Chile. The Times describes all of the studies with a combined total of five sentences that provide a short synopsis, the years the studies were conducted, the name of one of the researchers, and a quote from Blithe. No data is presented, no links to the studies are provided, no titles are revealed, and no journals are cited. Just Facts identified two of the studies, one of which is also cited by NPR, which in contrast to the Times, does provide a link to it. However, the details of these two studies actually undermine the central narratives of NPR and the Times.

The study cited by NPR determined how many women became pregnant after having unprotected sex during their fertile cycle and then taking the active ingredient in Plan B/Next Choice. Of 87 women who had not ovulated before taking the drug, none of them became pregnant, although based on the known odds of becoming pregnant, the study estimated that 13 typically would have become pregnant if they had not taken the drug. Conversely, of 35 women who had ovulated before taking the drug, 6 of them became pregnant, which is close to the 7 pregnancies that would be expected if they had not taken the drug.

These pregnancies among the women who ovulated before taking the drug provide a measure of evidence that the drug is not effective if administered after ovulation. Based on this minuscule sample of 6 pregnancies, NPR concluded that Plan B does not block implantation. The logic behind this, to quote NPR, is that the drug “stops an egg from being released from a woman’s ovary and thus prevents any chance of fertilization and pregnancy.” For the drug to be reasonably effective through this mechanism, it should prevent ovulation until six days after intercourse because sperm can live for this long in a women’s body. As explained in the textbook Langman’s Medical Embryology, “sperm deposited in the reproductive tract up to 6 days prior to ovulation can survive to fertilize oocytes [eggs].”

This is where the NPR and Times stories unravel. Although the abstract of study gives no indication of any significant caveats, if one is willing to purchase access to the full study (at a cost of $31.50) and examine its details, vital information is revealed. The study found that at least two thirds of the 87 women who had not yet ovulated before taking the drug actually ovulated within five days of taking the drug. This clashes with NPR’s claim that the drug “stops an egg from being released from a woman’s ovary and thus prevents any chance of fertilization and pregnancy.” Likewise, it undermines the Time’s claim that “scientists say the pills work up to five days after sex, primarily stalling an egg’s release until sperm can no longer fertilize it.”

The study’s authors attempt to explain this result by theorizing that the drug causes “increased cervical mucus viscosity” that “impedes the migration of sperm….” In other words, they say it makes the mucous in a woman’s reproductive tract so thick that sperm can’t swim to the egg. To support this theory, the authors cite a 1974 study in the journal Contraception that found the drug had such an effect, but the authors fail to mention that a 2002 study in the same journal found that the drug “affects sperm function only at high concentration and the contribution of these effects to emergency contraception is unlikely to be significant.”

Even more significantly, a 2007 study in the journal Human Reproduction found that at the dosage used for emergency contraception, “the drug had no effect on the quality of cervical mucus or in the penetration of spermatozoa to the uterine cavity.” The second study identified by Just Facts that was cryptically mentioned in the Times is merely an extension of the first study, with a larger sample size (8 pregnancies instead of 6) and similar results.

So in summation, the scientific evidence is compelling that the active ingredient in Plan B and Next Choice doesn’t delay ovulation beyond the timeframe that egg and sperm can unite to form a human life. Furthermore, the drug does not impair ability of sperm to swim to eggs. This doesn’t mean that a yet unknown mechanism of the drug may prevent sperm and egg from uniting, but it does mean that the principal claims of NPR, the New York Times, and the majority of scientists they cite are not consistent with the known facts of this matter.

What about ella and Italy?

Ella has a different active ingredient than the other two drugs, and the Times and NPR cite no specific clinical evidence to support their assertions that the drug probably does not derail implantation. They merely rely upon claims from scientists about unidentified studies, and both of the articles cite Blithe as their primary authority on this subject.

Both articles also point to the nation of Italy as evidence that ella doesn’t cause abortions. To quote the Times:

European medical authorities have not mentioned an effect on implantation on Ella’s label, and after months of scrutiny, Ella was approved for sale in overwhelmingly Catholic Italy, where laws would have barred it if it could be considered to induce abortion, said Erin Gainer, chief executive of Ella’s manufacturer, Paris-based HRA Pharma.

Based upon the statement above, one would believe that Italy bans abortions and would not have approved this drug unless the government was certain that it did not cause abortions. The reality is that abortion has been legal in Italy since 1978, and in 2009, the Italian agency responsible for approving drugs authorized the of use RU-486, which unambiguously is an abortifacient.

How about IUDs?

In this article, NPR doesn’t mention IUDs or intrauterine devices, which the Obama administration is also forcing insurance plans to cover and to do so without copays. The Times article mentions in passing that “scientists say” IUDs “can work to prevent pregnancy after an egg has been fertilized.” This is borne out by a wealth of evidence including a 2002 paper on the American Journal of Obstetrics and Gynecology, which shows that “both prefertilization and postfertilization mechanisms of action contribute significantly to the effectiveness of all types of intrauterine devices.”

Likewise, the Obama Administration’s Department of Health and Human Services, which is the same department that issued the contraceptive/abortifacient mandate, has published a “Birth control methods fact sheet,” which states that copper IUDs can keep “the fertilized egg from implanting in the lining of the uterus,” and hormonal IUDs affect “the ability of a fertilized egg to successfully implant in the uterus.”

Thus, regardless of whether Plan B, Next Choice, or ella cause abortion, the Obama administration is forcing insurers, and thus, their customers to pay for devices that destroy embryos before they implant, which many doctors, scientists, and citizens consider to be abortion.