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There’s a battle being waged across the country between people who see birth control as essential for women’s health, self-determination and to avoid abortions ‒ and those who claim some forms of contraception cause abortions and should not be funded by taxpayers.
Birth control remains legal in all 50 states and can be purchased over-the-counter with no age limit. But lawmakers in at least seven states have attempted to cut off funding or scuttle bills that ensure access to some popular forms of birth control.
Major medical groups and ten health researchers interviewed by USA TODAY say there is no evidence that any of the popular forms of birth control end human lives. And some groups that oppose abortion still support the wide availability of birth control to help prevent unwanted pregnancies.
But opposition to birth control has made contraception harder to access in many places and, experts say, unnecessarily scared women away from safe, effective methods for preventing pregnancy.
“There’s no question that there’s a war on contraceptives,” said Dr. Dan Grossman, a professor of medicine at the University of California, San Francisco, and director of the school’s Advancing New Standards in Reproductive Health program.
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“There’s been a lot of rhetoric and misinformation coming from anti-abortion groups alleging that contraceptive methods do cause abortions, which seem to be an attempt to set them up for further restriction,” he said.
On Monday the White House proposed new rules under the Affordable Care Act that would require private insurers to cover the cost of over-the-counter birth control – including emergency contraception pills, non-prescription birth control pills, spermicides and condoms – without additional cost to patients.
The proposed rule, which comes two weeks before the election, requires a 60-day comment period. If finalized, it would bring free birth control to 52 million American women who have private health care insurance.
“At a time when contraception access is under attack, Vice President Harris and I are resolute in our commitment to expanding access to quality, affordable contraception,” President Joe Biden said in a statement.
The conservative concern about contraceptives
The anti-contraceptive push is being led by groups that say birth control methods such as IUDs and “the morning-after pill,” which includes popular brands such as Plan B and ella, cause abortions and should not be funded by taxpayer money.
A group called Students for Life goes further, calling birth control pills, IUDs, birth control implants and emergency contraception all abortifacients, saying only condoms, diaphragms, vaginal sponges, spermicide and “natural family planning” (i.e. the rhythm method) are acceptable forms of birth control.
At the state level, lawmakers have based a number of legislative efforts on these beliefs:
- In Colorado in 2015, some conservative lawmakers tried to stop a program that provided free IUDs because they said the devices could cause abortions.
- In Idaho, since 2022, public college and university health clinics have only been allowed to provide condoms, “to protect against disease.” No other method of birth control may be offered.
- In Louisiana, a bill this spring to protect access to contraceptives was derailed because lawmakers were concerned some types caused abortions.
- In 2022 some Missouri lawmakers wanted to stop the state’s Medicaid agency from paying for IUDs and emergency contraceptives because they said they caused abortions.
- In February Oklahoma lawmakers proposed a bill that would ban the morning-after pill and some IUDs.
- In 2023, Oregon Right to Life, a group opposed to abortion, asked to be exempted from a state law requiring health insurance plans to cover birth control so that it doesn’t have to fund IUDs and “morning after” pills.
- In May, Virginia Governor Glenn Youngkin vetoed a bill protecting access to contraception, saying because some Virginians believed it causes abortions, their religious freedoms could not be trampled by such a requirement.
In the U.S. Senate, a bill introduced in June called the Right to Contraception Act, which would have protected birth control access, failed when all but two Republicans voted against it.
Not all abortion opponents are anti-contraception.
In Idaho, which has some of the most restrictive laws governing abortion and access to contraception, three Republican women, two of them lawmakers, came together to found the Idaho Contraceptive Education Network.
“The fact of the matter is that all birth control methods are essential tools to prevent pregnancy; they do not terminate existing pregnancies,” said board member Tara Malek. “We know that the majority of Republicans in Idaho support access to birth
The biology of pregnancy
Doctors and reproductive health experts say opposition to birth control is based on a misunderstanding of biology.
According to the medical definition, pregnancy occurs when a fertilized egg implants into the uterus, said Dr. Beverly Gray, a professor of obstetrics and gynecology at Duke University in Durham, North Carolina. This is accepted medical understanding according to the American College of Obstetricians and Gynecologists.
But even for those who believe fertilization, not implantation, is the beginning of life, doctors say opposition to contraception is based on a misunderstanding of how it works.
Birth control methods do not threaten human life, they say, because in almost every case egg and sperm never meet, so fertilization cannot happen.
“Contraception by definition is prevention of pregnancy, not the interruption of pregnancy,” Emma Chew Murphy, a doctor in the University of California, San Francisco Department of Obstetrics, Gynecology & Reproductive Sciences. “Birth control does not cause abortion.”
Misinformation is keeping women from using birth control
The public debate over birth control has consequences, data shows. Especially in the 13 states that have total abortion bans, many women think they no longer can access some forms of birth control.
“A survey in 2023 found that almost half of women in full-ban states believe Plan B is illegal in their states,” said Dima Qato, a professor of pharmacology at the University of Southern California who studies access to emergency contraception.
There’s also significant misinformation about emergency contraception circulating online, falsely claiming it is dangerous to women or that it causes abortions, said Qato.
For young women, who are more likely to use the morning-after pill, the misinformation can keep them from accessing it.
“They’re being told by state officials or their friends and family that it’s illegal when it’s not,” said Qato, noting the Internet is filled with such misinformation.
Logically, people who think abortion is murder should be supporting birth control, said Dana Singiser, co-founder of Contraceptive Access Initiative.
“The opposite is happening,” she said.
The central conundrum is that while medical science says a pregnancy begins at implantation, a substantial portion of Americans believe life begins at fertilization. The question for them is then whether IUDs and emergency contraception can harm a fertilized egg.
Doctors say in almost every instance the answer is no, because the egg is never fertilized.
How IUDs work
To better understand why popular birth control methods don’t cause abortions, it helps to learn exactly how they work, several doctors told USA TODAY.
An intrauterine device is a piece of thin, flexible plastic about one inch long that is inserted long-term into the uterus. Some contain copper, some contain tiny amounts of hormones. They last between three and 10 years depending on type.
They are more than 99% effective in preventing pregnancy. About 14% of women of reproductive age in the U.S. use them as birth control – more than 9 million American women.
Slightly more than two-thirds of the IUDs used in America contain small amounts of progestin, according to the National Institutes of Health. These work primarily by thickening the mucus at the mouth of the cervix so that sperm cannot get to the egg.
“It almost makes it like cement,” said Gray, of Duke.
IUDs also inhibit ovulation in about 12% of women, meaning the women don’t produce an egg for a sperm to fertilize.
The second form of IUD contains a small bit of copper. When these are used, sperm and egg do not meet because the copper harms sperm’s ability to swim so they can’t get through the vagina, uterus and Fallopian tubes to where the egg is.
“It mainly works as a spermicide,” said Amy Alspaugh, a professor in the College of Nursing at the University of Tennessee who studies reproductive health.
It can also make an egg nonviable. Even if a sperm reaches it, the egg cannot be fertilized.
The IUD can also make it less likely the recently released egg could accept a sperm, said Dr. Deborah Bartz, a professor of obstetrics, gynecology and reproductive health at Harvard Medical School.
“If for whatever reason some rogue sperm were able to swim up to get to the egg that had gone through the ovulation process, it also changes the egg,” making fertilization impossible, she said.
In very rare instances, an IUD might keep a fertilized egg from implanting. Research done 28 years ago did find that, in a very small number of cases it was possible, though not proven, that a sperm might manage to reach an egg and fertilize it. However, due to changes in the Fallopian tubes, it would be unable to travel down to the uterus to implant.
The overall finding was that in IUD users, embryos are formed at a significantly lower rate. “Therefore, the common belief that the major mechanism of action of IUDs in women is through destruction of embryos in the uterus (i.e., abortion) is not supported by the available evidence,” the paper stated.
IUDs can also work as emergency contraception
IUDs can also be used as a type of emergency contraception if they are inserted within five days of unprotected sex. However, a pregnancy test is done beforehand to ensure a pregnancy has not already been established.
Using IUDs this way is still relatively rare but highly effective, with a failure rate of only 1 in 1,000, said Dr. Mitchell Creinin, a professor of obstetrics and gynecology at the University of California-Davis.
The IUD could also affect contractions in the Fallopian tubes that move the egg down towards the uterus and the cilia that waft the sperm up towards the egg, said Dr. David Turok, a professor of obstetrics and gynecology at the University of Utah who studies the use of IUDs as emergency contraception.
Using IUDs as emergency contraception is still very rare. In a tiny number of instances, it is possible that a fertilized egg could be created, said Turok.
However, the chance of this happening are very low due to the other ways in which the IUD functions to prevent egg and sperm from meeting and the pregnancy tests done before insertion, he said.
The use of IUDS as emergency contraception, while effective, is limited in part because in most healthcare systems it’s not possible to get an appointment to have an IUD inserted within the necessary five-day window after unprotected sex, as well as because many women don’t yet realize it’s an option, said Turok.
How emergency contraception (the morning after pill) works
Sometimes called “the morning-after pill,” emergency contraception is sold as Plan B or ella, among other brands. It is a single pill containing hormones that delay or prevent the release of an egg from the ovaries. It is not the same thing as the abortion pill.
If a woman is already pregnant, emergency contraception will not stop or harm the pregnancy, according to the U.S. Office of Women’s Health.
Americans United for Life, a group opposed to abortion, believes that in some cases the morning-after pill might destroy an egg that has been fertilized. Carolyn McDonnell, litigation counsel at the group, noted that the FDA information for Plan B states that “it may inhibit implantation.”
Because of that, the group opposes the method. “We defend the conscience rights of healthcare professionals who are concerned about the potential abortion-inducing effects of emergency contraceptives in a minority of case,” said McDonnell.
However, medical experts told USA TODAY that there is no egg present for the sperm to fertilize and that emergency contraception is over 99% effective at preventing fertilization when taken within 24 hours of unprotected sex.
Emergency contraception has been used by about one-quarter of American women of reproductive age, or more than 15 million U.S. women.
“Emergency contraception does thin the lining of the uterus – but that’s not the mechanism” by which it works to prevent pregnancy, Gray said. Instead, it delays the release of an egg until after the sperm are no longer viable.
