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Abortion rights advocates fear access to birth control could be curtailed

(iStock/Washington Post illustration)

This story has been updated.

The Supreme Court’s decision to overturn the fundamental right to abortion is stoking fears among some Americans that curbing access to contraceptives could be next.

Birth control remains legal in the United States, but abortion rights advocates and medical providers have warned that a reversal of Roe could be applied to curtailing contraception access. For many, that fear was confirmed by Justice Clarence Thomas’s concurring opinion, in which he said the high court should revisit past decisions, including one that protected the right to obtain contraception.

Some state legislators may seek to curb birth control access, too. Most medical providers agree that birth control methods only act to prevent a pregnancy before it starts, but some antiabortion organizations are opposed to particular methods of birth control, saying that they can end a pregnancy, rather than preventing it.

With Roe v. Wade overturned, the legality of abortion has been left to the states. Some worry that access to certain types of contraception could be next. (Video: Julie Yoon, Hadley Green, Sarah Hashemi/The Washington Post)

Reacting to the reversal of Roe, Jennifer Lincoln, a board-certified OB/GYN in Portland, Ore., said: “Next will be emergency contraception and IUDs, then all of hormonal birth control. It’s about complete reproductive control, so this is just the next logical step for [conservatives].”

Since Politico published a leaked draft opinion suggesting Roe would be overturned, Lincoln said she has received an influx of questions over social media about how to access long-acting birth control methods such as IUDs — and how much longer that access might last. Google searches for IUD, Plan B and contraception have increased in recent weeks, and many people on social media have questioned whether they should start stockpiling emergency contraception or Plan B in case they stop being available.

Anne Cavett, a nurse practitioner and clinical services coordinator at Planned Parenthood of Metropolitan Washington, thinks those fears are founded: “I don’t think it’s alarmist to worry it may get worse,” she said.

Cavett added that in recent weeks, more people have been asking for long-acting contraceptives at her clinic and that many patients have expressed anxiety about how much longer they’ll be available. Some patients, she said, have come in to replace their IUD before the expiration date; they’re scared it will be their last chance.

“I think, overwhelmingly, when someone hears that the right to an abortion has been removed, there is a fear that you are losing the right to your bodily autonomy and the ability to make your own decisions,” Cavett said.

Some antiabortion organizations oppose certain birth-control methods. Most medical professionals believe a pregnancy starts when a fertilized egg implants itself in the uterus, but some opponents of abortion believe it starts as soon as an egg is fertilized by sperm.

“We do not take a position on contraception — which prevents pregnancy — but do on abortifacients that have as a deliberate part of their design the capacity and goal of ending a preborn baby’s life,” said Kristi Hamrick, a spokesperson for the antiabortion organization Students for Life of America.

The list of “abortifacients” that Students for Life of America opposes includes birth-control pills, IUDs and Plan B. They do not take a stance on condoms, sterilization (tubal ligation or vasectomies) or the rhythm method — which involves tracking menstrual cycles and monitoring body temperature and is about 76 percent effective at preventing pregnancy.

According to the American College of Obstetricians and Gynecologists, emergency contraception like Plan B is sometimes confused with medication abortion. But “medical abortion is used to terminate an existing pregnancy, whereas emergency contraception is effective only before a pregnancy is established.” The organization also says that the copper IUD functions by “affecting sperm viability and function,” not preventing implantation.

“This misinformation is what legislators are using to base their arguments on — that IUDs and emergency contraceptive pills are abortifacients,” Lincoln said. “They are directly using it as a way to then write laws to ban access to these medications. This will lead to decreased access and as a result, more unplanned pregnancies and people seeking abortions.”

IUDs are one of the most effective forms of birth control, lasting for up to a decade, according to the Centers for Disease Control and Prevention. More than 10 percent of American women using contraception rely on long-acting reversible methods like IUDs. They’re also used to treat heavy menstrual bleeding, in some cases even helping prevent the need for a hysterectomy, Lincoln said. There are two types of IUDs: copper, which blocks sperm from being able to reach an egg, and hormonal, which makes cervical mucus thicker and blocks the sperm. In some rare cases, IUDs may prevent implantation of a fertilized egg in the uterine lining. (Lincoln said that she and most OB/GYNs believe “a post-fertilization effect remains hypothetical and is unproven.”)

Emergency contraceptives, meanwhile, delay ovulation after unprotected sex, so there’s no egg to meet the sperm. Almost one in four women between the ages of 20 and 24 have used emergency contraception, according to the Center for Disease Control.

Thomas’s concurring opinion made abortion advocates worry that the right to obtaining birth control could be potentially overturned by the court.

“In future cases, we should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell,” Thomas wrote. Griswold refers to Griswold v. Connecticut, the 1965 ruling that overturned a Connecticut law that prohibited the purchase of anything “preventing contraception,” thus enshrining the right of married couples to purchase and use contraception. In 1972, Eisenstadt v. Baird extended that right to unmarried people. (Lawrence and Obergefell are related to same-sex relationships and marriage.)

But Thomas’s opinion isn’t the first sign to suggest some states may curtail access to contraceptives. In Idaho, House State Affairs Committee Chairman Brent Crane (R) announced his plans shortly after the opinion draft leak to hold hearings on whether emergency contraception, and possibly IUDs, should be banned. He later clarified that he wasn’t talking about IUDs, but that he was open to holding hearings about “the issue of abortifacients.”

Last month, Louisiana lawmakers advanced a bill defining “human personhood” as starting at the moment of fertilization, which some experts believe could be used to target Plan B or IUDs. And last year, in Missouri, lawmakers made an attempt to block Medicaid from covering Plan B and IUDs.

It’s not yet clear whether these efforts will succeed in blocking access to contraception, but medical providers say that birth control is already difficult to access in much of the country.

“There are a ton of challenges and roadblocks that people have in accessing birth control in this country — and it’s horrific,” Cavett said.

Low-income people and people of color are more likely to live in “contraception deserts,” or areas where there are not sufficient clinics to offer contraceptive options, according to one study. For the over 30 million Americans without health insurance, contraceptives can be unaffordable. And even among women with private insurance, one in five are still paying for their contraceptives entirely or partially out of pocket, according to the Kaiser Family Foundation.

It’s important for people to know that all contraceptive methods continue to be legal, Lincoln said. She warned, however, that this might not be the case forever — and encouraged people to consider their birth-control options.

Lincoln started a website where people can order birth control, emergency contraception and medication abortion pills, and other abortion advocates are ramping up efforts to increase access to birth control over the internet.

For the 21 million Americans without broadband connectivity, even this plan, however, may present challenges.

“There is already an inequity of who can and cannot access these methods,” Cavett said. “It is inevitably Black and Brown people, trans and nonbinary folks, people who live in rural areas, people who are low income. These are all the folks who are already overburdened by this.”

Additional reporting by Hadley Green and Julie Yoon.

Roe v. Wade and abortion access in America

Roe v. Wade overturned: The Supreme Court has struck down Roe v. Wade, which for nearly 50 years has protected the right to abortion. Read the full decision here.

What happens next?: The legality of abortion will be left to individual states. That likely will mean 52 percent of women of childbearing age would face new abortion limits. Thirteen states with “trigger bans” will ban abortion within 30 days. Several other states where recent antiabortion legislation has been blocked by the courts are expected to act next.

State legislation: As Republican-led states move to restrict abortion, The Post is tracking legislation across the country on 15-week bans, Texas-style bans, trigger laws and abortion pill bans, as well as Democratic-dominated states that are moving to protect abortion rights enshrined in Roe v. Wade.

How our readers feel: In the hours that followed the ruling in Dobbs v. Jackson Women’s Health Organization, Washington Post readers responded in droves to a callout asking how they felt — and why.