Missouri Debates Birth Control Ban Without Knowing How Contraception Works

This effort to reduce abortion will lead to more unplanned pregnancies.

Notebook with the words Birth control on the table.Photo: Designer491 Istock/Getty Images

Missouri continues its pattern of the expansion of Government powers over individual liberty. The Legislature is debating a ban on birth control, believing the Government should control women’s lives instead of supporting the rights of individuals.

The problem is the male-dominant Missouri senators did not pay attention during their junior high health class. The Senators who want to control Missouri women seem to have no idea how contraception methods actually work.

The Kansas City Star detailed a heated debate in the Missouri legislature over contraceptive access, causing Obstetrician gynecologists, like me, to shake their heads at the lack of sexual health knowledge.

Here is the background of what triggered this debate.

Like many states, Missouri partially funds Medicaid, a federal program providing health access to low-income people, through a hospital tax. Most funding for Medicaid comes from the Federal Government, but states do have to pay a share.

Missouri’s $4 billion hospital tax is set to expire in September and must be renewed. The renewal of the current hospital tax has nothing to do with contraception coverage. The bill continues the hospital tax already in place, allowing the state to fund Medicaid and receive Federal dollars in return.

So how did access to birth control enter the debate on a bill that has nothing to do with contraception?

A group of senators is withholding support for the hospital tax renewal unless the state bans contraceptive methods that cause abortion. The problem is none of the birth control methods being debating cause abortions. Federal law bars the use of Medicaid funds for abortions through the Hyde Amendment.

Missouri is holding up Medicaid funding to block contraceptive methods that reduce unplanned pregnancies and reduce the number of abortions.

The problem is none of the methods in Missouri’s proposed ban cause abortions. Our views on abortion vary, but we must understand the fundamental science to have a meaningful discussion.

Our country’s public policy and heated social media debates should at least be based on facts.

Plan B is not an abortion pill. Stop calling it that.

Plan B is the brand name of one form of emergency contraception. Emergency birth control prevents pregnancy and is not an abortion medication.

RU486 (Mifepristone) is a medication used to induce abortion. Abortion medication terminates a pregnancy and is not a form of emergency contraception.

Plan B and RU486 are not the same medication. Plan B and RU486 are not the same things at all.

Emergency contraception (EC) contains progesterone, a hormone produced naturally by the ovaries. It is often called “the morning after” pill. Common brands, such as Plan B, are available over the counter without a prescription.

Emergency contraception is formulated with a high dose of progesterone. This hormonal blast disrupts, delays, or prevents ovulation. High-dose progesterone also thickens the cervical mucus creating a toxic environment for sperm. It will not terminate an already established pregnancy.

Progesterone does not cause abortion. Emergency contraception decreases the risk of pregnancy by inhibiting ovulation. If conception has already, then it is too late for emergency contraception.

Once pregnancy occurs, the ovary forms a type of ovary cyst called a corpus luteum. It produces progesterone to support the growing pregnancy. Taking emergency contraception will only add more progesterone to support the developing fetus.

Obstetrician gynecologists and infertility doctors often give extra Progesterone to high-risk pregnancies to help prevent miscarriages.

Banning funding for Plan B will not reduce the number of abortions because it does not cause them in the first place. Plan B will not terminate an already established pregnancy.

When people take Plan B within 72 hours of unprotected intercourse, it reduces the risk of pregnancy by 70–80%. If a woman is already pregnant and takes Plan B, then nothing happens. Emergency contraception is called Plan B and not Plan A for a reason.

IUDs (intrauterine devices) reduce abortions. They do not cause them.

Abortion rates in the United States are at historic lows. The national drop in abortions coincided with the passage of the 2008 Affordable Care Act, which made contraception accessible without a copay.

Access to birth control improved. Unintended pregnancy, teen pregnancy, and abortion rates did not just decrease; they plummeted.

Abortion rates over timeChart CC Gutmacher.org

Many public health experts credit the drop in abortion rates to the increased use of Long-acting reversible contraception methods (LARCS).

Long-acting reversible contraception methods work for an extended period of time after a one-time insertion giving patients the confidence of years of protection. Examples of LARCs are IUDs (Intrauterine Device) and subdermal implants (Nexplanon).

An IUD is a small device inserted into the cavity of the uterus. There are currently five IUDs available in the US — Kyleena, Skyla, Mirena, Paragard, and Liletta. Nexplanon is the only subdermal implant available.

After removing these devices, the return to fertility is almost immediate, with pregnancies seen as early as seven days after removal. LARCS demonstrate the lowest failure rates, highest continuation rates, excellent safety profiles, minimal side effects, and few medical contraindications.

Missouri Senators need to know IUDs do not cause abortions.

Progesterone IUDs have three main mechanisms of action:

1. The progesterone thickens cervical mucous blocking sperm from getting past the first line of defense.
2. Progesterone creates a vaginal environment that kills sperm after ejaculation.
3. These IUDs also reduce fallopian tube motility making it more difficult for an egg to travel from the ovary to the uterus.

Copper IUDs release copper ions that create an inflammatory state. Sperm do not survive in this environment. Sperm dies at the level of the cervix and the endometrium. Copper IUDs kill sperm and inhibit its ability to swim towards the egg.

The idea that IUDs allow pregnancy to occur and then cause an abortion is outdated and not supported by scientific evidence.

How birth control worksChart CC Maternal and Child Survival Program

Missouri Senators owe it to themselves and their constituents to learn contraceptive basics before passing bills that limit individual liberty.

Birth control access has reduced the number of US abortions to historic lows. Pro-life and Pro-choice constituents agree the reduction in the need for abortions is great news for US Women. We are on the same team on this issue.

Missouri Senators may reverse our project in abortion reduction by passing a bill that reduces access to birth control and increases the number of unplanned pregnancies and abortions.

Missouri women should not be punished because the Legislature did not pay attention in Junior High Health classes.

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