One of the many critical Internet threads emerging from Burwell v Hobby Lobby has been the accusation that the owners of Hobby Lobby and Conestoga Wood Specialties have based their objection to certain FDA-approved contraceptives on a false understanding of how they work. Here’s an excerpt from Daily Kos:
“Hobby Lobby LIED about the science of birth control and won.”
At issue is this simple claim: the four methods of contraception to which these company owners objected in the court filing may function to terminate (or, in more politically charged language, abort) a pregnancy, not prevent it.
This would seem to be a simple and straight-forward factual claim that can be demonstrated either to be true or to be false.
But this proves to be more complicated than it seems.
To determine whether or not a particular method may work by terminating pregnancies, one first must know what it means to be pregnant.
I can hear you laughing . . .
No, seriously, this is an important and controversial point. Indeed, there are three common ways in which even medical professionals talk about pregnancy. As discussed by Kerry Grens for Reuters in the fall of 2011, pregnancy can be understood as:
- Beginning with fertilization (when the egg and sperm unite to form a single cell)
- Beginning at implantation (roughly a week after fertilization, when the blastocyst attaches to the lining of the uterus)
- Beginning at the end of the woman’s last menstrual cycle (the baseline against which the medical profession and folk wisdom alike measure the progress of a pregnancy)
Without question, the third definition isn’t meant to tell us when the woman actually became pregnant. It’s just that, unlike fertilization or implantation, the event it relies upon is readily observable and has been for time out of mind.
But the other two . . . you’d think the medical profession would have resolved this issue, right? Is it fertilization, or implantation (or some other event, for that matter)?
But as the Reuters story reports, a majority of ob-gyns in a scientific survey chose “conception” (generally associated with fertilization, though there is some ambiguity in the term) as the beginning of a pregnancy, while less than a third chose the alternative, implantation.
Yet the American College of Obstetrics and Gynecology, the leading professional association for ob-gyns, is said to have defined pregnancy as beginning with implantation. At least, this is what has been reported by various sources, including the Reuters story mentioned above and The Guttmacher Institute (I have been unable to find this definition on the ACOG website). Yet what the Guttmacher Institute quotes from ACOG isn’t exactly a simple statement of when pregnancy begins; the quote refers to pregnancy being “established.”
A little research into the field of treatments for infertility seems to support those who anchor pregnancy to fertilization, rather than implantation. For example, the Center for Research in Reproduction and Infertility at the University of Illinois explains its purpose in these terms:
“Failure of the fertilized embryo to implant into the uterine wall is a major cause of early pregnancy loss and infertility.”
So, if we are looking for a definitive scientific answer to the question, When does pregnancy begin, we’re simply not going to find it. Not just because ordinary folks are confused or uninformed, but because the experts themselves disagree.
Why does this matter? Because whether or not a particular method of preventing pregnancy terminates a pregnancy or prevents one from starting could depend on when one says pregnancy begins.
If pregnancy begins with fertilization, then any method that acts after that point in time is terminating a pregnancy, rather than preventing it. That may be a fine point to many individuals and couples (who may care only about whether or not they remain pregnant), but not to those who are deeply opposed to abortion.
So how do these methods work?
Though recent research into how Plan B, for example, works suggests that it may work exclusively by preventing ovulation and fertilization, the company’s own website FAQs indicates that Plan B “may also work . . . by preventing attachment (implantation) to the uterus (womb).” Similarly, Mirena, a hormone-releasing IUD, is said by the company to work by a combination of effects, including that it “thins the lining of your uterus” (the effect of which would be to inhibit implantation).
The summary here is simple, though the issue is complex.
Informed opinions both with regard to when pregnancy begins and with regard to how some of these methods work can and do vary legitimately. Even the fact that so many medical associations joined an amicus brief in support of the federal government in these cases doesn’t address the question of whether or not these methods cause abortions (reading the amicus brief, there is very little discussion of this point, though there is reference to an earlier amicus brief addressing it). There’s a broader agenda at work (and I don’t use the term “agenda” here pejoratively), probably having much more to do with the future state of health care and professional medical practice in the U.S. than with interveners’ opinions about when pregnancy begins and how these methods work.
So when next we read either that the liberals or the conservatives are lying about the issues, perhaps we should step back and acknowledge that there really is a debate under way here. And real debates require evidence and reasoning, not vitriol and accusation.