The U.S. Supreme Court’s 1973 landmark decision in Roe v. Wade was a critical step forward for women’s equality, establishing vital, constitutionally protected privacy rights that enable women to access abortion services. However, the ruling also became a target for anti-choice politicians and advocates to organize around. Since the Supreme Court’s decision, these groups’ attacks on abortion access have become an everyday reality that reproductive health advocates, providers, and patients must face. From targeted regulation of abortion provider (TRAP) laws to mandatory waiting periods and biased counseling, there is a well-organized and widespread effort to limit a woman’s ability to make decisions about her own reproductive health when it comes to pregnancy. What is less visible—but equally as disturbing—is an intentional strategy to attack access to birth control methods that is predicated on conflating abortion and contraception. This strategy of blurring the line between abortion and contraception is part of a radical agenda to assign personhood and constitutional rights at the point of fertilization, thus further imposing limits on reproductive health services.
Anti-choice advocates use junk science and subterfuge to advance their agenda
Many moral arguments against contraception are centered on a contested definition of when a pregnancy begins. Mainstream medicine and medical experts have established that pregnancy begins when a fertilized egg implants in the uterine wall. By contrast, many social conservatives argue that pregnancy begins earlier, at the point of fertilization, or when a sperm joins an egg. By attempting to redefine when a pregnancy starts, anti-choice groups argue that some Food and Drug Administration-approved contraceptives, such as Plan B and ella—both emergency contraceptives—and intrauterine devices, are abortifacients. Anti-choice groups such as Americans United for Life and the American Life League are making a calculated political move in trying to both redefine when a pregnancy begins, as well as use their new definition to advance an anti-choice personhood agenda and claim that fertilized eggs are human beings—and thus have constitutional rights.
Anti-choice groups have been circumspect about this agenda, only airing their views in amicus briefs, statements, and other strategic documents. This may be due to the significant public support for contraception: A May 2017 Gallup poll found that 91 percent of Americans believe that contraception is morally acceptable. In addition, more than 99 percent of women ages 15 through 44 years who have engaged in sexual intercourse report using at least one contraceptive method in their lifetime.
Anti-choice tactics include religious exemptions and Title X attacks
When the Affordable Care Act (ACA) was passed, a coalition of Catholic and Evangelical religious organizations objected to the health care legislation, because, among other things, it contained a mandate that required employers—excluding religious employers and houses of worship—to cover contraception with no out-of-pocket costs. This eventually led to Burwell v. Hobby Lobby, in which the U.S. Supreme Court ruled that closely held corporations—companies with a limited number of shareholders—that claim religious objections can be exempted from the contraceptive mandate. In addition to dramatically changing the landscape of religious liberty law, the case was troubling, because the Supreme Court’s ruling neglected to address the inaccuracy of the assertion that certain contraceptives are abortifacients.
In a more recent case, the University of Notre Dame, a private Catholic university that sued the Obama administration over the contraceptive coverage mandate in the ACA, made a final decision about its contraception coverage under school health insurance plans. In a letter to faculty and staff, the university’s president stated that while it would include “simple contraception (i.e., drugs designed to prevent conception)” as part of the university’s insurance coverage for students and employees, it drew the line at what it calls “abortion-inducing drugs.”
Given this fierce antipathy toward the contraceptive coverage mandate, in October 2017, the Trump administration issued two rules expanding exemptions for employers who claim religious or moral objections to the legal provision. In keeping with this trend, the Trump administration then created the Conscience and Religious Freedom Division under the Office for Civil Rights at the Department of Health and Human Services (HHS). The division was created to dramatically expand religious exemptions specifically around abortion and transgender health care and has since been used to apply religious and moral exemptions to a host of other reproductive health services, including contraception.
The Trump administration is also attempting to reshape the reproductive health care landscape by diverting federal dollars to facilities that provide so-called natural family planning and education—which have been proven to be less effective compared with mainstream contraceptive methods—and away from evidence-based family planning policies and programs. In March 2017, Vice President Mike Pence cast the tiebreaking vote on a bill that allows states to block Title X funding to providers that perform abortions. This bill will affect low-income patients who rely on comprehensive Title X providers for a range of reproductive health services, including contraception. Meanwhile, in its recent Title X funding opportunity announcement , HHS’ Office of Population Affairs deprioritized contraceptive care in its grant guidance and placed a strong emphasis on natural family planning techniques.
Low-income women and women of color are most affected
Attempts to restrict access to and, in some cases, outright ban contraception will fall most heavily on groups of women who already face barriers to accessing contraception, particularly low-income women and women of color. Low-income women experience numerous obstacles to obtaining contraception and are greatly dependent on family planning and public health clinics, whose funding is under repeated legislative attack. Women of color also face systemic barriers to reproductive health care access. For instance, black and Hispanic women are more likely to have Medicaid coverage—31 percent and 28 percent of black and Hispanic women, respectively, in 2016—and less likely to have private health insurance coverage compared with white women. Women of color also experience poorer reproductive and sexual health outcomes compared with white women, with higher rates of maternal mortality, sexually transmitted infections, and unintended pregnancies. It is well-documented that access to contraception leads to a host of social and economic benefits, including the ability to complete postsecondary education, pursue full-time employment, increase earning power, and improve health outcomes. By making contraception more difficult to access, black and Hispanic women will be less able to control their reproductive health and improve the lives of themselves and their families.
The movement by anti-choice advocates to redefine the concept of personhood and to blur the lines between contraception and abortion is long-standing and strategic. Its goal—to use restrictive sexual mores to drive public policy decisions around contraception—is both radical and dangerous. An awareness of these strategies and their indirect nature is key. Pro-choice legislators at the federal and state level must monitor legislation for any language that attempts to obfuscate the line between contraception and abortion and subversively advance an anti-choice agenda. Providers also must understand how attacks on abortion are becoming increasingly conflated with fights against contraception—and how that can affect the services that providers are trying to administer. Most importantly, the general public must become aware of efforts by anti-choice advocates, despite mainstream opinion that contraception is morally acceptable. In order to stem and hopefully reverse this trend, reproductive rights advocates, providers, and legislators must remain vigilant, watchful, and ready to correct the narrative about contraception.
Osub Ahmed is a policy analyst for the Women’s Initiative at the Center for American Progress.