JUNE 2022 | FACT SHEET
Don’t Be Fooled: Birth Control Is
Already at Risk
In the wake of a recently leaked draft Supreme Court opinion that indicated the Court is poised to overturn
Roe v. Wade and the constitutional right to abortion,
1
there has been speculation about whether the right
to birth control is also in jeopardy. There is no need to speculate: Access to birth control is already under
threat and the constitutional right to birth control is already being targeted by a range of policymakers
who are opposed to reproductive health care.
But because birth control is widely popular, basic health care that enables people to exercise autonomy
and self-determination and is essential to people’s health, lives, and futures,
2
those who are attacking birth
control are deliberately using tactics that hide their true motives. They lie and conlate birth control with
abortion–falsely conlating emergency contraceptives and intrauterine devices with abortion or listing
these methods of birth control alongside abortion in legislation that restricts or bans it. They hide their
attempts to go after birth control, using purposely vague or misleading language. And at the same time,
some policymakers are undertaking a frontal assault on the constitutional right to birth control.
Anti-reproductive health policymakers are purposely conflating birth
control and abortion
Lawmakers opposed to reproductive health are claiming that some forms of birth control cause abortions
(are “abortifacients”) and should therefore be restricted. Apart from the fact that abortion care–like
birth control–is necessary health care that should not be restricted, it is also a fact that birth control is
not abortion. Birth control is “any method, medicine, or device used to prevent pregnancy.”
3
By its very
deinition, birth control does not cause abortion, because it is eective prior to pregnancy.
In some cases, this tactic being used by anti-reproductive health policymakers involves making false
and inlammatory statements about birth control being abortion, and in others, lawmakers are explicitly
including certain methods of birth control in policy measures restricting or banning access to abortion.
Legislators conlating abortion and certain methods of birth control–in particular intrauterine devices
(IUDs) and emergency contraception (EC)–are taking advantage of a lack of knowledge about these
methods, and people’s understanding of how birth control works.
4
These policymakers are preying upon
abortion stigma, believing that if they can convince people that birth control methods are abortion, they
can successfully restrict access to birth control–or ban it altogether.
1
THIS IS HAPPENING RIGHT NOW, IN CONGRESS
In the past year, several members of Congress have spoken
on the record falsely equating birth control and abortion.
They have also introduced amendments to bills, such as
those for health and military spending, that conlate birth
control and abortion.
• In June 2021, when the House of Representatives
considered the Equal Access to Contraception for
Veterans Act, a bill that would allow veterans access to
no-cost contraception, Rep. Rosendale went on record
saying, “Let me be clear, drugs like Plan B and ella are
not contraception, they are abortifacients.”
5
This is
patently false. He made this statement as part of his
opposition to the bill, attempting to invoke harmful
claims around federal programs paying for abortion
care.
6
Rep. Marjorie Taylor Greene made similar claims
about Plan B working as an abortifacient.
7
The bill
ultimately passed the House, but these falsehoods were
included in the debate and the record.
• In September 2021, when the House Armed Services
Committee considered the National Defense
Authorization Act (NDAA), Rep. Jackie Speier introduced
an amendment that would provide no-cost access
to birth control for military servicemembers and
military families. In opposition to this amendment,
some members of Congress claimed that emergency
contraception caused an abortion.
8
Other members
of the committee repeatedly refuted these false
statements, and the amendment passed out of
committee and ultimately was included in the House-
passed NDAA. However, these harmful falsities were
included in the record.
• Throughout the iscal year 2022 appropriations process,
Rep. Lauren Boebert oered amendments that would
restrict federal funds from being spent on “abortifacient
contraceptive drugs.”
9
While these amendments have
been unsuccessful thus far, their very existence is
problematic since the term is unscientiic and made-
up, meant to mischaracterize birth control, and prey
on abortion stigma. Rep. Matt Rosendale oered a
failed amendment with a similar goal of conlating
birth control and abortion when he tried to add Plan B
and ella, both forms of emergency contraception, to
a section that bans federal funds from being spent on
abortions.
10
Ovulation: Ovulation is the time during the
menstrual cycle when an egg is released
from an ovary. There is a short time frame of
a couple of days around ovulation that can
lead to pregnancy. This depends on many
factors including whether there is sperm
present in the reproductive tract at the time
of ovulation.
11
Fertilization: This is the process that occurs
when an egg that has been released during
ovulation meets sperm, and usually occurs
in the fallopian tubes.
12,13
Implantation: Implantation is when
a fertilized egg becomes embedded
(implanted) in the lining of the uterus
(endometrium). Implantation deines the
beginning of pregnancy.
14
PREGNANCY 101
THIS IS HAPPENING RIGHT NOW, IN STATE
LEGISLATURES
In the last year, lawmakers in several states tried to ban
access to some or all birth control.
• In 2021, Idaho passed a law banning public funding for
abortion.
15
The bill included a ban on access to EC, in
a section titled “Abortion-Related Activities Prohibited
in School-Based Health Clinics.” Speciically, this law
prohibits health clinics at public schools, including
higher education institutions, from counseling or
referring for abortion services or dispensing emergency
contraception. This is a stark departure from routine
care, as 73% of college health centers report providing
access to Plan B emergency contraception,
16
which is an
important option for students who may experience birth
control failure, sexual assault, or unprotected sex.
• Arizona has had a law in eect for many years that
prohibits discrimination against health care entities that
do not assist in “causing the death of any individual”
including “assisted suicide, euthanasia, or mercy
killing.”
21
In 2021, legislation was introduced that
2
would have amended this law to include “means of
abortion” and “emergency contraception” in the list of
actions causing the death of an individual.
22
By listing
emergency contraception alongside abortion, the
legislators sought to falsely equate them, in stigma and
outcome. Ultimately this law passed in the state Senate
but failed in the House.
• Texas has banned coverage of abortion services and
emergency contraceptives from state funded family
planning programming for over a decade.
23
When Texas
applied to the federal government in 2017 for a waiver
for its Medicaid program to operate its Healthy Texas
Women program, which includes the state funded
family planning services, it carried forward this ban.
This means emergency contraception is not a covered
beneit under its family planning program, denying it
as an option to those who are enrolled. Texas estimates
that over 750,000 women are eligible for services under
its Healthy Texas Women program which shows the
magnitude the eect of this birth control restriction has
on patients in Texas.
24
• In 2021, a Missouri state senator successfully amended
a state Medicaid funding bill to ban funding for “any
drug or device approved by the federal Food and Drug
Administration that may cause the destruction of, or
prevent the implantation of, an unborn child.”
25
Because
of harmful and misleading language on the labels for
some methods of EC, this amendment could have been
interpreted to deny coverage of those birth control
methods. The legislator said he was trying to prevent
Missouri from paying for abortions and argued that
some methods of birth control may cause abortions.
26
An alternative amendment was also considered, and
rejected, that would explicitly bar Medicaid coverage
of emergency contraceptive pills and IUDs “when used
to induce an abortion,”
27
despite the fact that EC and
IUDs can only be used to prevent pregnancy. Ultimately,
after state advocates and other legislators highlighted
the harm of these amendments, the Missouri legislator
dropped the amendment before the bill passed.
Had either amendment been included in the inal
legislation, it could have been used to prevent Medicaid
participants from accessing birth control.
Anti-reproductive health policymakers
are purposely hiding birth control
restrictions
Some policymakers are trying to incorrectly re-deine
pregnancy in law in an eort to ban abortion and birth
During the Food and Drug Administration’s (FDA) approval of over-the counter sales
of Plan B emergency contraception (levonorgestrel) in 2006, there was a problematic
conlation of birth control and abortion, and its impact is still felt today. A minority
of the advisory committee was concerned that Plan B may work by preventing
implantation, which they considered akin to abortion, despite no evidence to support
this mechanism of action.
17
In a compromise, the FDA took the extremely unusual
step of including this possible mechanism of action on the drug’s inal label. Under
“Mechanism of Action,” the label for Plan B emergency contraception reads “it may
inhibit implantation (by altering the endometrium).”
18
This is problematic because it
hypothesizes a mechanism of action that has not been proven to exist.
19
Studies in the
intervening years have conirmed Plan B’s mechanism of action, which is preventing
ovulation and fertilization.
20
Even without any evidence to support the hypothesized
mechanism of action, the original labeling remains, and the hypothesized mechanism
of action is referenced by anti-reproductive health advocates making false claims that
emergency contraception is abortion.
THE PROBLEMATIC PLAN B LABEL
3
control. A signiicant number of states have attempted this
through deinitions of “human being” and “person.” Several
have speciically incorporated deinitions that human
life and/or pregnancy begins when a sperm fertilizes an
egg, despite the fact that the medical deinition of when
pregnancy begins is after implantation. This unscientiic
deinition of human life and pregnancy would not only
outlaw abortion, but also could criminalize birth control and
other health care, such as in vitro fertilization.
THIS HAS BEEN HAPPENING AND IS HAPPENING
RIGHT NOW, IN STATES
• A failed Mississippi ballot initiative in 2011 sought
to amend the state’s constitution to deine life as
beginning at the moment of fertilization.
28
Voters
rejected this measure 58%-42%, but this did not stop
groups from attempting to introduce similar measures
in years going forward.
29
• In Texas, SB8, which is now law, bans abortion as early
as six weeks of pregnancy and deines “pregnancy”
in a way that includes “begins with fertilization.”
30
SB8
eectively bans nearly all abortions in the state–and is
designed to intimidate and harm those seeking abortion
or those helping people access this basic health care.
While SB8 has received much public attention, its
deinition of pregnancy has not received much focus
yet and could be very problematic. SB8 could be
utilized against any contraceptive that the state claims,
accurately or not, interferes with implantation.
• In the wake of the leaked Supreme Court draft opinion,
Louisiana legislators attempted to advance a bill to ban
abortion. It would have redeined “person” in the state
code to include “a human being from the moment of
fertilization” and “unborn child” to mean “an individual
human being from fertilization.”
31
Had these deinitions
become law, it could have threatened access to
emergency contraception.
Anti-reproductive health policymakers
are challenging the constitutional right
to birth control
The constitutional right to contraception recognized by
the Supreme Court in 1965, in Griswold v. Connecticut,
32
is
under attack from policymakers.
• Sen. Marsha Blackburn described the decision in
Griswold as “constitutionally unsound”
33
in a video
she made opposing the nomination of Supreme Court
Justice Ketanji Brown Jackson.
• Candidates running for oice in Arizona and Michigan
have said Griswold was wrongly decided.
34
These eorts are fueled further by the leaked draft opinion
in the Dobbs v. Jackson Women’s Health Organization case.
The draft opinion attacks the right to privacy, which is not
only the basis for abortion rights, but also for the right to
contraception and many other rights. The rationale of the
leaked draft puts many of the most fundamental rights
our society is built around—including the right to access
contraception—in jeopardy. While the draft opinion claims
that it will “only” allow states to ban abortion, it provides a
clear blueprint for undermining or overturning the right to
access contraception.
The blatant desire to undermine and, eventually, overturn
the constitutional right to access contraception is
particularly concerning because Griswold is one of the key
protections against the legislative attacks on birth control
that have already been attempted at the state and federal
level described above.
This matters now more than ever.
The volume and tenor of attacks on birth control and
abortion are louder and more aggressive than ever and
will only escalate if the Supreme Court overturns the
constitutional right to abortion or allows increasing
restrictions on the right. At its core, the opposition to
abortion and birth control is very similar: a desire to limit
people’s self-determination, ability to exercise autonomy
over their own bodies, and decision making.
Access to birth control does not solve the problems created
when abortion access is curtailed. Access to birth control
can, however, help some people prevent pregnancy and
avoid the increasing hurdles in their way to access abortion
care they need. In this moment, it is critical to ensure access
to all reproductive health care–everyone deserves the
freedom to decide when or whether they want to grow a
family.
4
COMMONLY TARGETED BIRTH CONTROL METHODS
Emergency Contraceptive Pills
Emergency contraception (EC) generally refers to pills that can be taken after sexual
intercourse to prevent pregnancy. Nearly 1 in 500 surveyed women who use birth control
report having used emergency contraception.
35,36
The eicacy of emergency contraception
decreases the more time passes between unprotected sex and when it is taken.
• Levonorgestrel: This is the active pharmaceutical ingredient in one form of emergency
contraception (marketed under the brand name Plan B as well as several generic
versions). It prevents pregnancy by preventing ovulation and preventing fertilization.
There are no studies that show it prevents implantation, although at one time that
was a hypothesized mechanism of action. It is eective up to 72 hours after sexual
intercourse. Levonorgestrel is available over the counter (without a prescription) to
people of all ages.
37
• Ulipristal: This is the active pharmaceutical ingredient in another pill form of emergency
contraception marketed under the name ella. Ulipristal also works by preventing
ovulation and fertilization. It is eective up to ive days after sexual intercourse and has
a higher rate of eicacy in people who weigh over 85 kg compared to levonorgestrel.
ella requires a prescription.
Intrauterine Devices (IUD)
IUDs are devices that can be inserted into the uterus to prevent pregnancy. In some cases
they can also be inserted after sexual intercourse to prevent pregnancy.
38
Approximately
13% of people who use contraception use an IUD, and those who use an IUD report very high
rates of satisfaction.
39,40
• Copper IUDs: The copper IUD can be used as a form of emergency contraception
if placed within ive days of sexual intercourse.
41
Copper IUDs aect the motility of
sperm and prevent fertilization. IUDs require a provider to place them. Copper IUDs are
eective for ten years after they are placed.
• Hormonal IUDs: Hormonal IUDs release hormones that prevent pregnancy by
preventing ovulation and fertilization. They are more popular for contraception than
copper IUDs because they can also ease symptoms of heavy periods.
APPENDIX
5
1 Josh Gerstein & Alexander Ward, Supreme Court has voted to overturn abortion rights, draft opinion shows, Politico (May 2, 2022, 8:32 PM), https://www.politico.com/news/2022/05/02/supreme-court-
abortion-draft-opinion-00029473.
2 Adam Sonield et al., The Guttmacher Inst., The Social and Economic Impacts of Women’s Ability to Determine Whether or When to Have Children (2013), available at https://www.guttmacher.org/report/
social-and-economic-beneits-womens-ability-determine-whether-and-when-have-children.
3 U.S. Dep’t of Health & Human Servs, Oice of Women’s Health (Nov. 15 20210), https://www.womenshealth.gov/a-z-topics/birth-control-methods.
4 For example, in a poll conducted by the National Women’s Law Center, 25% of respondents reported not being familiar with emergency contraception, and 10% were not familiar with IUDs. By
comparison, only 2% of respondents said they were not familiar with birth control pills.
5 167 Cong. Rec. H3095 (daily ed. Jun. 24, 2021) (statement of Rep. Rosendale).
6 Tyler Olson, Caroline McKee, GOP rep pushes Biden admin to ensure VA doesn’t start providing abortions, calls Dems ‘party of death’, Fox News (Jun. 16, 2021, 5:04 AM), https://www.foxnews.com/
politics/republican-matt-rosendale-biden-va-abortions-democrats
7 167 Cong. Rec. H3096 (daily ed. Jun. 24, 2021) (statement of Rep. Greene).
8 Full Committee Markup of H.R. 4350, 117th Cong. (2021) (https://armedservices.house.gov/2021/9/full-committee-markup).
9 Labor, Health and Human Services, Education, Agriculture, Rural Development, Energy and Water Development, Financial Services and General Government, Interior, Environment, Military
Construction, Veterans Aairs, Transportation, and Housing and Urban Development Appropriations Act, 2022 (H.R. 4502), Division F Amend. 35, available at https://amendments-rules.house.gov/
amendments/BOEBER_111_xml%20TR210721142959013.pdf.
10 Labor, Health and Human Services, Education, Agriculture, Rural Development, Energy and Water Development, Financial Services and General Government, Interior, Environment, Military
Construction, Veterans Aairs, Transportation, and Housing and Urban Development Appropriations Act, 2022 (H.R. 4502), Division F Amend. 48, available at https://amendments-rules.house.gov/
amendments/Revised%20Abortifacient%20Approps%20Amendment210723181619321.pdf
11 Centers for Disease Control and Prevention, Female Reproductive System – Reproductive Health (April 20, 2017), https://www.cdc.gov/niosh/topics/repro/femalereproductivesystem.html.
12 Id.
13 “Conception” is not a medically accurate term. As the American College of Obstetricians and Gynecologists states, “Conception is a lay term that has no scientiic validity and is not generally used in
the medical literature because of its variable deinition and connotation.” Am. College of Obstetricians and Gynecologists, reVITALize: Gynecology Data Deinitions (2018), available at https://www.
acog.org/practice-management/health-it-and-clinical-informatics/revitalize-gynecology-data-deinitions.
14 Implantation is deined as the beginning of pregnancy by a dozen medical professional associations who have endorsed the ACOG deinition. Am. College of Obstetricians and Gynecologists,
reVITALize: Gynecology Data Deinitions (2018), available at https://www.acog.org/practice-management/health-it-and-clinical-informatics/revitalize-gynecology-data-deinitions. The federal
government also deines pregnancy as beginning at implantation. Protection of Human Subjects, Additional Protections for Pregnant Women, Human Fetuses, and Neonates Involved in Research, 42
CFR 46.202 (2021).
15 Public Funds for Abortion – Adds to Existing Law to Prohibit The Use of Public Funds for Abortion, ID H.220, 66th Legislature (2021).
16 American College Health Association, ACHA 2019 Sexual Health Services Survey, Oct 20, 2020. Available at https://www.acha.org/documents/resources/survey_data/Pap_sti/ACHA_CY2019_Sexual_
Health_Services_Survey_fullreport_10-29-20.pdf
17 Christopher ChoGlueck, The FDA Ought to Change Plan B’s Label, Contraception (2021).
18 Plan B One-Step (levonorgestrel) [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021998lbl.pdf. Revised Jul. 2009. Accessed
May 11, 2022.
19 Christopher ChoGlueck, The FDA Ought to Change Plan B’s Label, Contraception (2021). The FDA has experience with products that have an unclear mechanism of action, such as acetaminophen
which is a commonly available drug. The label for acetaminophen reads “The precise mechanism of the analgesic and antipyretic properties of acetaminophen is not established but is thought to
primarily involve central actions.” Fresenius Kabi. Acetaminophen Injection (acetaminophen) [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_
docs/label/2015/204767s000lbl.pdf. Revised Oct. 2015. Accessed May 11, 2022. The Plan B label contains no caveat about the uncertainty of the mechanism at the time of approval and provides a
speciic hypothetical mechanism while the acetaminophen label contains a caveat and provides only a very general sense of how the medication might work. The Plan B label experience, a product
with a much lower risk of toxicity than acetaminophen, underscores the heightened scrutiny and politics surrounding reproductive health care.
20 M Endler, RHW Li, and K Gemzell Danielsson, Eect of levonorgestrel emergency contraception on implantation and fertility: A review, 109 Contraception 8 (2022).
21 Ariz. Stat. §36-1322.
22 <2021> Ariz. Sess. Laws S.B. 1362.
23 1 Tex. Admin. Code §382.113 (2016).
24 Draft Healthy Texas Women Section 1115 Demonstration Waiver Application (Jun. 30, 2017), https://www.hhs.texas.gov/sites/default/iles/documents/laws-regulations/policies-rules/1115-waiver/HTW/
htw-1115-waiver-application-draft.pdf.
25 https://www.senate.mo.gov/21info/BTS_Web/ShowAmendment.aspx?Id=3422
26 Rudi Keller, Abortion Amendment Puts Bill to Finance Missouri Medicaid Program in Limbo, Missouri Independent (March 24, 2021), https://missouriindependent.com/2021/03/24/abortion-amendment-
puts-bill-to-inance-missouri-medicaid-program-in-limbo/.
27 Extends the Sunset on Certain Health Care Provider Federal Reimbursement Allowances, 2021 SB1, https://www.senate.mo.gov/21info/BTS_Web/Bill.aspx?SessionType=R&BillID=54105505.
28 Ballotpedia, https://ballotpedia.org/Mississippi_Life_Begins_at_the_Moment_of_Fertilization_Amendment,_Initiative_26_(2011).
29 Ballotpedia, https://ballotpedia.org/Mississippi_%22Personhood%22_Amendment_(2015).
30 S.B. 8, 87th Tex. Leg. (2021).
31 H.B. 813, 2022 Leg., Reg. Sess. (La. 2022).
32 318 U.S. 479 (1965).
33 Steve Benen, Blackburn denounces Supreme Court contraception ruling from 1965, MSNBC (Mar. 21, 2022, 10:38 AM), https://www.msnbc.com/rachel-maddow-show/maddowblog/blackburn-
denounces-supreme-court-contraception-ruling-1965-rcna20862.
34 Katherine Tangalakis-Lippert, A Republican Senate Candidate endorsed by Peter Thiel is campaigning on a pledge to vote only for judges who oppose the SCOTUS ruling establishing the right to birth
control, Business Insider (May 7, 2022, 9:20 PM), https://www.businessinsider.com/arizona-gop-senate-candidate-blake-masters-campaigning-against-birth-control-2022-5; Dave Boucher, Michigan
GOP AG candidates criticize case that nixed law banning use of birth control, Detroit Free Press (Feb. 21, 2022, 5:47 PM), https://www.freep.com/story/news/politics/2022/02/21/michigan-gop-ag-
hopefuls-criticize-case-nixed-contraception-ban/6877934001/. See also Steve Benen, Asked about contraception case, GOP candidates give the wrong answer, MSNBC (Feb. 21, 2022, 9:36 AM),
https://www.msnbc.com/rachel-maddow-show/maddowblog/asked-contraception-case-gop-candidates-give-wrong-answer-rcna17053.
35 Karen Whalen, Renee Rose, Ulipristal (Ella) for Emergency Contraception, 86 Am. Fam. Physician 365 (2012).
36 Contraceptive use in the United States by Method, Guttmacher Institute (May 2021), https://www.guttmacher.org/fact-sheet/contraceptive-method-use-united-states.
37 Christina Vrettakos & Tushar Bajaj, Levonorgestrel, StatPearls (Jan. 2021), https://www.ncbi.nlm.nih.gov/books/NBK539737/.
38 Emily Lanzola, Kari Ketvertis, Intrauterine Device, StatPearls (Jul. 2021), https://www.ncbi.nlm.nih.gov/books/NBK557403/.
39 Contraceptive use in the United States by Method, Guttmacher Institute (May 2021), https://www.guttmacher.org/fact-sheet/contraceptive-method-use-united-states.
40 Jerey F. Peipert et al. Continuation and Satisfaction of Reversible Contraception. Obstet Gynecol. 2011 May; 117(5): 1105-1113.
41 Copper IUDs lack FDA approval for the indication of emergency contraception, but their use in this manner is widely accepted as standard of care and backed by a wide body of evidence. See Jie Shen
et al., Interventions for emergency contraception, 20 Cochrane Database Syst. Rev. 1 (2019).
FOOTNOTES