The Ohio Legislature is currently considering a measure to ban insurance coverage for abortion care, even in cases of rape, incest and when the pregnancy is life-threatening. A narrow exception in the bill would allow for insurance to cover abortion in cases of ectopic pregnancies. Lawmakers are also maneuvering to ban birth control coverage for public employees and Medicaid recipients. The broadly worded measure would explicitly ban coverage for intrauterine devices, but lawmakers acknowledged that the current language could also be interpreted to include all forms of birth control.
Republican Rep. John Becker, who sponsored the bill, said an amendment would be introduced to clarify that the ban would not apply to all forms of birth control, but remained resolute on his intent to ban IUDs. As the Columbus Dispatch reports, Becker said these devices prevent implantation of a fertilized egg, and that they should be considered abortion. “This is just a personal view. I’m not a medical doctor,” Becker said.
Becker is not a medical doctor (how nice of him to admit that). But Dr. Anne Davis is a medical doctor, and I talked to her a few months ago about how IUDs work. It may be helpful for Becker and his colleagues to review. First, hormonal IUDs and copper IUDs, when used as long-form birth control and not as emergency contraception (more on this in a bit), prevent fertilization. Full stop. There is no implantation possible.
Here's Davis on how that works:
The way it works as birth control for a person who is an established user is that it is a pre-fertilization mechanism. So what it does — both the copper IUD and hormonal IUD — is it prevents the sperm from ever getting into the fallopian tube or to the egg. [People using IUDs] continue to ovulate, so it’s different than other methods that stop ovulation. What it does is interfere with sperm getting there.
With the copper ions in the uterus, that’s an environment that sperm can’t get to. For the Mirena or Skyla — the hormonal IUDs — the cervical mucus gets really thick; it’s like a glue, so the sperm can’t get through it. Normally cervical mucus mid-cycle is very slippery and the sperm can swim right through it. Basically the sperm can’t get past the cervix, and that’s how it works. Ovulation is happening, all of that is going on. It’s just a way of preventing sperm from getting to where it’s going.
The copper IUD -- when used as a form of emergency contraception -- may prevent implantation. Hormonal IUDs are never used in this way and would have no effect on implantation.
Here's Davis on how that works:
In that case [when using the copper IUD as a form of emergency birth control], you put the IUD in right then and it does interfere in some senses with sperm — this is only the copper IUD, by the way.
And here there’s also some effect after fertilization, before implantation. Let’s say fertilization occurred two days ago, and then you put the IUD in. Now what people sometimes forget is that fertilization happens in the fallopian tube. The sperm goes through the tube where the egg is. When a woman ovulates — you can see that little picture in your mind — fertilization occurs in the tube, not the uterus.
What people get confused about sometimes is thinking that the sperm and the egg are in the uterus and stick right there into the uterus, but that’s not what happens. How it works is the egg goes into the tube, the sperm can go through the uterus, up into the tube and then it could take a week to go all the way down the tube into the uterus and maybe implant. There’s at least a week there, so the IUD has an effect in that time — from the time that it’s fertilized until implantation.
And just because it's so rare (and refreshing) to actually have a doctor weigh in on issues of medicine, here's Davis on the difference between pregnancy and fertilization:
An important distinction here is that fertilization is not the same thing as pregnancy for the very, very simple reason that these things take time. There are a lot of steps between fertilization and implantation being successful. For the average woman who is not on any kind of birth control, that process of fertilization is occurring over and over and over again and those women are not getting pregnant over and over and over again because many of those fertilizations never, ever implant.
There are all these things that have to happen for pregnancy to occur. I think if people think about the question of when a woman is pregnant, the answer seems pretty intuitive. When I go to somebody and ask, “How many times have you been pregnant?” I’m not asking, “How many times have you had fertilized eggs?”
Democrats and opponents of the measure in Ohio have denounced the bill and said that these matters should be left up to women and their doctors, not dictated by politicians and insurance providers. But Becker appears unmoved. He said “the right to life” “trumps those other issues."
A similar measure in Michigan -- dubbed "rape insurance" by opponents -- passed earlier this year and went into effect this spring.
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