The Hobby Lobby decision exempted the corporation from providing insurance coverage for contraceptives it believed to be abortifacients. But is that belief true? And should it matter, especially as Catholic institutions decide whether to raise similar objections?
First, a clarification: two different definitions of what counts as an abortion are in play. In medical terminology, a woman is not considered pregnant until the developing embryo implants in the uterine wall, approximately a week after fertilization, (so on average about 7-10 days after ovulation.) Since one can’t have an abortion until one is pregnant, by medical standards contraceptives that block implantation by changing the uterine lining are not abortifacient. Roman Catholic magisterial teaching, on the other hand, holds that the developing embryo should be treated as a person from conception. Anything that blocks implantation would be considered abortifacient by those who believe that personhood starts with conception. In short, in medicine, “pregnancy” is a term that refers to the woman, while for many pro-life people and groups, it refers to the presence of an embryo.
The Hobby Lobby case focused on 4 means of contraception: Plan B and Ella, both forms of emergency contraception (EC) for use after unprotected sex, and two forms of the IUD, the copper-coated IUD and a hormone-releasing IUD called Mirena.The literature is complex and developing, and I hasten to state at the outset that I'm not a pharmacologist or an MD. But here goes:
How does Plan B (levonorgestrel) work? Clearly its principal mode of action is to inhibit ovulation. Studies here and here indicate no effect on implantation or endometrial thickness (which might affect implantation.) This was controversial early on, but the most recent studies indicate no effect on implantation. Similar pregnancy rates from use of Plan B after ovulation vs. placebo also support the conclusion that Plan B does not affect implantation. Indeed, a number of studies of implantation in vitro, in animal models, and reflecting clinical efficacy state confidently that there is no effect on implantation. (The German bishops also have given their thumbs-up to EC that doesn't block implantation. The USCCB links to statements on EC are broken.)
The principal mechanism of action of Ella (Ulipristal acetate) is also inhibition of ovulation. This drug has a longer window of efficacy than Plan B, and is approved for use up to 5 days after unprotected sex. (This is because it can block ovulation closer to follicular rupture than Plan B does.) In higher doses, Ella could affect uterine lining, but at the doses used for EC appears to have no such effect. Other studies note the pharmacological similarity of ulipristal to mifepristone, (which does terminate pregnancy.) If administered after ovulation, Ella might inhibit implantation. However, there are also indications that people who take Ella after they ovulate become pregnant at a similar rate to those who take placebo, implying that any effect on the endometrium is not enough to significantly impair implantation. In sum--the scientific jury still seems to be out on Ella and implantation, as far as I can tell.
The hormone-coated IUD releases levonorgestrel (the active ingredient of Plan B), so can act to inhibit ovulation, and to thicken cervical mucus to impede sperm movement. The copper-coated IUD impairs sperm motility. Both forms of the IUD impair implantation according to most--but not all--of the sources I checked.
It seems that Hobby Lobby cast its net too broadly, and ruled out a form of emergency contraception that is effective ONLY pre-fertilization, Plan B. It is not abortifacient by any definition. The mechanism of action of Ella on this point seems unclear so far, while most sources agree that the IUD affects implantation.
Why does this matter? In making religious liberty-based claims, it seems to me, truth counts. It is one thing to say that the law should respect freedom of people to believe or not believe what cannot be empirically proven. (The existence of God, e.g., pace Thomas Aquinas.) It is quite another matter for laws that put significant burdens on individuals (here, women whose contraceptive choices are limited,) in the face of data that shows that the religiously-based claims are demonstrably wrong. Obviously, reliigious liberty means that people are free to believe things that are just wrong--anti-evolutionists, young-earthers and their ilk--but surely there must be a limit to how much a person's fallacious belief can be invoked to justify limiting others' freedoms.
Beyond the law, there is a question of scandal. The image of religious institutions is affected in matters like this, and here is where Catholic institutions should tread carefully. If Catholic institutions jump on the Hobby Lobby bandwagon, they should do so only in ways that reflect the current state of biological understanding on these questions, and they should be prepared to revise as necessary. Otherwise, the banner of religious liberty will come to seem like a right to persistent and harmful ignorance. This is truly scandalous--it would imply, contrary to the best of Catholic tradition, that faith requires rejection of reason.
