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"If you've read the Supreme Court\u2019s ruling in\u00A0Hobby 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 \u2014 two versions of the \"morning-after pill\" and two kinds of intrauterine devices (IUDs) \u2014 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.\nThe 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.\u00A0We 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.\nThere are essentially six ways to prevent pregnancy:\n\nMake the cervical mucus inhospitable (sperm can\u2019t get to the egg)\nInhibit ovulation (prevent the release of an egg)\nAffect fertilization (the ability of the sperm to meet up with and/or penetrate the egg).\nAffect the fertilized egg (prevent implantation)\nCreate an inhospitable uterine environment (prevent implantation)\nAffect the implanted embryo\n\nAs 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 \u2014 that is, doing something to the implanted embryo \u2014 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.\nWhat does that mean for the four types of contraception at issue in the Hobby Lobby case? Let's consider each one.\n\nImage: Jen Gunter via The New RepublicPlan B,\u00A0which is one form of the morning-after pill, clearly wouldn't. It works by\u00A0inhibiting ovulation\u00A0when 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).\nElla\u00A0(the manufacturer uses a lower case \"e\") is another version of the morning-after pill. It too works by\u00A0inhibiting ovulation, only it is better at it than Plan B. The 30 mg of ulipristal in ella has no effect on sperm quality, a fertilized egg, or the lining of the uterus. Higher doses affect the uterine lining, potentially creating a hostile environment that could stop a fertilized egg from implanting. But a 30 mg dose has the same impact on uterine lining as a placebo \u2014 in other words, it has no effect. The only gray area is if a woman were to take ella not realizing that she is already a few weeks pregnant (an unrecognized pregnancy). The impact of ella in early pregnancy is currently unknown.\nMirena, one of the IUDs,\u00A0changes cervical mucus. It also\u00A0inhibits ovulation\u00A0for a small percentage of women in the first\u00A0year of use, but that is unlikely a major method of action. The Mirena IUD does thin the lining of the uterus, but there is no evidence to suggest this impacts implantation of a fertilized egg.\nThat leaves the\u00A0ParaGard, which is a copper IUD. The\u00A0copper\u00A0in the device damages sperm and eggs, affects how the sperm and egg travel to meet, and\u00A0may\u00A0affect implantation. Some very complex studies\u00A0suggest that a very small percentage\u00A0of cycles with a copper IUD (around 1%) may result in a fertilized egg that fails to implant. But, as physician\u00A0Aaron Carroll\u00A0noted recently at The Upshot, that's also the normal failure rate of the IUD. The bulk of the studies do not support a post-fertilization effect.\nThe 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.\nThe facts are summarized in the table above. There is no evidence that Plan B, Ella, or the Mirena cause abortion by\u00A0any\u00A0definition. The evidence that the ParaGard might affect implantation for a small percentage of women, thus leading to what some conservatives would call abortion, is thin. But we don\u2019t have the information to discount it completely.\nIs that a rational basis for refusing to pay for these contraceptives \u2014 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.\nDr. Jen Gunter is an OB/GYN and a pain medicine physician based in California. She blogs at\u00A0drjengunter.com\u00A0and authored the book,\u00A0The Preemie Primer, a guide for parents of premature babies."^^<http://www.w3.org/2001/XMLSchema#string>
<http://mashable.com/2014/07/07/hobby-lobby-birth-control-facts/>