Lawmaker’s comments on Plan B create worry other birth control is at risk

BOISE — Abortion rights advocates like Planned Parenthood are raising concerns that Idaho lawmakers could pave the way to ban different forms of birth control. Their fears come after speculation on outlawing emergency contraception.

Earlier this month, Rep. Brent Crane, R-Nampa, said he intends to hold hearings on legislation that could ban emergency contraception and abortion pills. His comments came after a leaked draft opinion from the U.S. Supreme Court showed justices’ intent to overturn Roe v. Wade, which would trigger a statewide abortion ban in Idaho.

Crane initially said on Idaho Public Television that he wasn’t sure where he stood on intrauterine devices, or IUDs, a common birth control device. Crane later walked back those comments but stood firm on his criticisms of abortion pills and emergency contraception, often referred to as the morning-after pill or the brand name Plan B. He said he worried about the pills’ safety, though years of research has shown them to be safe.

Katie Rodihan, spokesperson for Planned Parenthood Great Northwest Hawai‘i, Alaska, Indiana, Kentucky, told the Idaho Statesman in an emailed statement that this is the latest in a series of attempts to restrict reproductive health.

“We are seeing a coordinated and intentional attack, not just on abortion, but also on birth control across the country and in Idaho,” Rodihan said.

How birth control works

To understand abortion rights groups’ concerns, you have to understand how pregnancy occurs and how different types of birth control prevent it. Some prevent fertilization — which occurs when sperm meets egg, and does not necessarily result in pregnancy. Others prevent implantation, when a fertilized egg attaches to the wall of the uterus and begins to grow into an embryo.

Many common forms of birth control prevent fertilization, explained Central District Health nurse practitioners Savannah Klinginsmith and Jaspreet Singh. Along with primary health care, Klinginsmith and Singh provide reproductive health care, including birth control options, emergency contraception and testing for sexually transmitted infections. Central District Health does not perform abortions or provide abortion pills.

Klinginsmith said the window for fertilization is quite narrow — about halfway through a typical 28-day menstrual cycle, an egg is released from the ovary into the fallopian tube, where it remains for about a day. Sperm can reach the egg there, resulting in fertilization. The fertilized egg will continue down the fallopian tube and into the uterus, where it will seek to implant in the uterine wall. That typically takes five to six days after fertilization, but can take longer.

Klinginsmith said up to 50% of the time, fertilized eggs fail to implant in the uterus. Implanted embryos are still at risk for miscarriage.

Birth control pills, patches and more

The nurse practitioners said several birth control products — pills, patches, vaginal rings and Depo injections — prevent fertilization by releasing hormones that stop the ovaries from releasing eggs.

“If there’s no egg to be fertilized, nothing can happen,” Singh told the Statesman in a phone interview.

Long-term birth control

Long-term birth control options work similarly. Nexplanon, a hormonal implant placed in the arm, and hormonal IUDs typically prevent the ovaries from releasing eggs. They also cause mucus in the cervix to thicken, further preventing sperm from reaching any eggs that may reach the fallopian tubes.

Finally, they thin the uterine lining so if an egg does become fertilized and seek to implant, it cannot properly attach to the uterus. Copper IUDs, which do not contain hormones, work by inhibiting sperm movement.

“We provide all of these options to our patients and try to understand what is their ultimate goal in taking (birth control),” Klinginsmith said. “What might fit best with them?”

Emergency contraception

In the event that a woman has unprotected sex or other forms of birth control, like condoms, fail, emergency contraceptives like Plan B can prevent pregnancy.

“Ideally you’re using (emergency contraception) right after intercourse or within a day or two after intercourse,” Klinginsmith said. “It adds a burst of hormones to the body which will most of the time prevent ovulation, fertilization or implantation.”

If a fertilized egg has already implanted in the uterus, emergency contraceptives will not harm the embryo, Singh added.

Abortion pill

The abortion pill, which Central District Health does not prescribe, ends a pregnancy that is already in progress. The pill blocks a hormone necessary for pregnancy to continue and stimulates the uterus to contract. It can be used during the first trimester of pregnancy.

A ban on Roe v. Wade would trigger a total abortion ban in Idaho that would likely make it illegal for health care providers to prescribe this pill.

Advocates worry other contraceptives at risk

Abortion rights advocates said banning Plan B, which can prevent pregnancy at the same stages as many other contraceptives, could open the door for bans on even more forms of birth control.

“Extremist lawmakers are spreading disinformation and trying to blur the lines between contraception and abortion,” Rodihan said. “This is not new, and it’s not hypothetical. We’ve always known that our opponents wouldn’t stop at abortion bans; they’d attack the right to access contraception next.”

Idaho’s legal definition of abortion states that the procedure does not refer to IUDs or birth control that prevents any stage, including implantation. But other definitions in the state’s abortion and contraceptive laws are out of step with most medical definitions. Idaho defines pregnancy as beginning upon fertilization and defines a fetus as any fertilized egg.

The National Institutes of Health and the American College of Obstetricians and Gynecologists define pregnancy as the time when a fetus develops in the uterus, which would be post-implantation. An embryo becomes a fetus after about eight weeks, when major organ systems begin to develop.

Because of these murky definitions, it’s not clear where Idaho lawmakers might draw lines when it comes to contraceptive bans. Crane did not respond to a request for comment.

By next legislative session, there will be no health care professionals serving in the Legislature. The Legislature’s last physician, Fred Wood, retired at the end of this session. Wood served as the chair of the House Health and Welfare committee. He did not respond to requests for comment. Sen. Fred Martin, who was ousted from his seat during last week’s primary, served as the Senate Health and Welfare chair. New chairs won’t be appointed until December.

Rodihan said regardless, Idaho Republican lawmakers have shown they’re not interested in increasing access to contraceptives.

“Just this March, the Idaho House killed a bill that would have made it easier for people to access birth control, on the same day that those exact lawmakers passed a six-week abortion ban,” Rodihan said. “This is not a debate about preventing abortions, and anyone who claims otherwise is lying. This is an issue of control, and these extremist lawmakers won’t stop until they’ve taken away any control you have over your reproductive health.”