Feminism

hormone therapy and abortifacients aren't the same thing

SuperUterus-big

I have a problem with the fact that Hobby Lobby was able to get away with this because pro-life advocates are either a) misinformed about hormone therapy or b) they knowingly lie about it.

So I’m writing about how hormone therapy functions in the bodies of people who have vaginas, uteri, and ovaries.  In order to know how hormone therapy works, we have to understand how the ‘female’ reproductive system works.

Menstruation is a cycle, which begins when the ovaries do what they do and ovulate. This happens through the development of an ovarian cyst, which creates an oocyte that will eventually mature and become an ovum. This part of the cycle is the follicular phase. During the follicular phase, the uterine lining (the endometrium)  is not conducive to implantation.

Once the ovum has matured, the ovary releases it to travel through the fallopian tubes to the uterus. This begins the luteal phase, and the endometirum begins forming secretions and blood vessels in anticipation of implantation. Once the ovum has been released, it can be fertilized by sperm, and this is when it becomes a zygote; the fertlized ovum begins going through stages until it eventually forms a conceptus that attaches to the uterine lining, which at this point must transform the base endometrium into the decidua and placenta. This is when pregnancy officially begins. Many pregnancies fail during the first few weeks– this failure is known as a miscarriage or spontaneous abortion, and most women do not even know they were ever pregnant. If the ovum is not fertilized or the zygote fails to implant, the uterus begins to shed the luteal phase lining. In humans, this is menstruation (some mammals absorb the lining instead of excreting it through the vaginal canal).

Hormone therapy– which has many uses– can be used as an effective form of birth control because it prevents ovulation. It also has the secondary effect of thickening mucus, making it more difficult for the sperm to travel beyond the cervix, through the uterus, and into the fallopian tubes. On top of that, it changes the outer portion of the ovum, making it slightly more resistant to penetration by the sperm.

Every single step of hormonal birth control prevents ovulation, which is why it is an effective treatment for some people who suffer with PCOS, like me. In the event that ovulation has occurred (which rarely happens, otherwise it would be a useless treatment), the secondary effects prevent fertilization.

If the ovary releases a mature ovum, it has also released a hormonal trigger for the endometrium to begin forming the luteal phase secretions. Without a mature ovum, nothing happens to the uterine lining, which is why hormone therapy is said to “thin” the uterine lining, although that description is misleading and deceptive. Hormonal birth control– even emergency contraception— cannot affect implantation for this reason.

This information is not controversial. It is well established, and can be found in any medical textbook concerning reproductive biology.

Hobby Lobby argued that four of the HHS-mandated contraceptives violated their religious beliefs (which is hypocritical and deceptive in the extreme, since they fund the manufactures of these contraceptives and their health plan covered all 20 FDA-approved contraceptives up until two years ago); they argued this based on outdated information concerning how emergency contraception and other forms of hormonal therapy operate that manufactures were required to place in their inserts.

Considering that the hormonal contraception Hobby Lobby opposed– Plan B, ella, and Mirena– functions exactly the same way as all other hormone contraceptive options, their opposition to these in particular is largely ridiculous. The only possible exception is the copper intrauterine device. The copper it releases acts as a spermicide and inhibits sperm mobility.  I could find no medical study concerning copper IUDs and its ability to affect implantation– just a lot of speculation– but it is within the realm of how the device works. If you believe that a blastocyst is fully human (a position I believe involves a lot of cognitive dissonance and a lack of intellectual honesty and rigor), then the copper IUD might not be a good option for you.

That doesn’t mean any employer has the right to dictate what their employees use their healthcare for. Healthcare, typically classed as a “benefit,” is part of the financial contract between corporations and employees; laborers agree to sell their labor in exchange for taxed financial compensation as well as non-taxed “benefits” such as healthcare. The reason why healthcare is a separate area of compensation is that the United States government incentivizes employers to provide mass-negotiated sponsored healthcare to their workers without that part of the financial compensation being taxed. Healthcare benefits appear as a subtraction on the employee’s paycheck: it is a service I am contractually guaranteed (part of the reason why I agreed to labor for a particular corporation was to receive it) as well as a service I pay for. Employers have no business telling their laborers how they spend their own money. There is no difference from me handing my insurance card or my credit card to my pharmacist.

The lack of information concerning the cisgender female body is the single most important reason why Hobby Lobby was able to argue for their position. The Supreme Court majority decision specified that it wasn’t the medical legitimacy of the belief, but merely having the belief that made the HHS mandate a “burden” on Hobby Lobby and the hundreds of other companies that are affected by this decision; however, Hobby Lobby is capable of having this “sincerely held religious belief” (coughbullshitcough) because people do not understand how hormonal therapy works. At least part of the reason why this can be considered a “sincerely held religious belief” at all is that so many people are so wrongly informed. Without this traction, Hobby Lobby could never have made an argument in the first place.

I find that particularly laughable, especially since there is more research that says Advil can prevent implantation and cause abortion than hormonal therapy options.

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  • Marsha Byers

    Thank you! Great piece!!!!!!

  • DCFem

    They don’t know how it really works because their goal is to dismantle the Affordable Care Act bit by bit the same way they’re dismantling Roe v. Wade. Knowledge, science, truth and reason aren’t important to them — just winning at all costs and making the lives of women (especially poor ones) as burdensome as possible. One conservative said on twitter yesterday that employers shouldn’t have to pay for “consequence free sex”. Meaning, women who want to have sex without the risk of pregnancy are sluts.

    Many conservatives have total disdain for their audience as evidenced by the B-S they spout on fox and the radio. But Hobby Lobby is taking an even greater risk by insulting the intelligence of their overwhelmingly female customer base by feigning ignorance of how hormonal birth control works. I can’t help but think that this is going to backfire as women find other stores or order craft supplies from the internet.

    • I’m certainly never darkening their doors for any reason.

  • Elmo

    I vote for “knowingly lie”. Once again, any pretext will serve as long as it justifies your intent. This whole thing is not about religious liberty. It’s not about contraception or any other facts which they (and the 5 amigos) find it convenient to ignore. It’s about power, and patriarchal control of women, and its about money and politics.

  • This is about politics for sure. The company didn’t even know its health plan covered contraceptives until the ACA made it a requirement. Then, suddenly, it was a huge problem. This is all about “winning” a “battle” against Obama to “ensure our freedoms.” But Obama orders the death of an American citizen by drone strike on foreign soil? NSA wiretapping run amok? Not a word from these clowns.

  • Thank you for delving into this current topic. For those of us who were raised in IFB churches, home schooled using fundamentalist curricula, and graduated from fundamentalist colleges (because they were the only colleges we could get into without having gone to high school), we’re still trying to sort out the science from what we were brainwashed to believe.

    It would be nice if you would further elaborate on HL’s argument “based on outdated information concerning how emergency contraception and other forms of hormonal therapy operate that manufactures were required to place in their inserts.”

    Is the FDA-mandated info now on birth control pill inserts scientifically correct or is it still misleading?
    Are there online scientific sources you could provide for us “trust AND verify” types?

    • Ok, so old studies about endometrial/uterine linings measured for “thickness” (which isn’t the only factor involved in a viable decidua, but it is measurable). We didn’t actually know much about the follicular/luteal phases at the time, so when researchers started looking at the lining of women on hormone therapy, they realized that the lining was thinner than they were expecting it to be. Turns out, “thinner” just means “follicular phases lining,” but that’s not what was understood at the time. It’s also possible that hormone therapy makes the follicular phase-lining even thinner, but considering that linings can vary for woman to woman, that’s not certain. In any rate, it still wouldn’t affect implantation.

      The FDA changed their requirements about what was necessary information to include in inserts, but some of the inserts I’ve read in the past few years still include a caveat about possible effects concerning implantation. However, the hormonal therapy I use, NuvaRing, does not.

  • Don Johnson

    From the ella official lit and I quote: “What is ulipristal (Ella)?
    Ulipristal is an emergency contraceptive. It works by stopping or delaying the release of an egg from an ovary. Ulipristal may also make it harder for a fertilized egg to attach to the uterus.”

    • That’s outdated information that is not supported by current medical research. Some companies are electing to still include the disclaimer.

      • Don

        In addition, once a pharmaceutical company has settled on its label claims, dosage & administration, side-effects, and all the other very tiny print that can be found on the package insert (if your pharmacist deigns to include it with your prescription meds), it is very very difficult to change the wording. Even when it is outdated and no longer matches the latest scientific evidence. This is why it is very very useful to have a good relationship with both your personal physician and your local pharmacist. To be sure the modern multi-physician group practice makes having either a personal physician or a good relationship with any of the rotating P.A.’s and the push toward centralized mega-pharmacies also makes having a local pharmacist difficult. I’m fortunate to have both.

        • Furthermore, because of the way science works, you’ll rarely get statements that aren’t hedged or caveated in some way. Science is very conservative about making claims. If you asked a scientist if the sun would explode tomorrow, they wouldn’t say no, because they can’t absolutely rule out the possibility of some bizarre, previously unknown cosmological phenomenon causing the sun to supernova. This is related to the “but it’s just a theory” anti-evolution argument. People read a modifying phrase of some kind and read into it information that isn’t there. “Ulipristal may also make it harder for a fertilized egg to attach to the uterus” doesn’t mean “Ulipristal WILL sooner or later make a fertilized egg fail to attach”; it means that (at the time, given the current research) “We can’t rule out absolutely the possibility that somehow this may have an affect we don’t believe it has.”

  • The Supreme Court majority decision specified that it wasn’t the medical legitimacy of the belief, but merely having the belief that made the HHS mandate a “burden” on Hobby Lobby

    This is unfortunately the only way that SCOTUS could have read this requirement. The Religious Freedom Restoration Act passed in 1993 enshrined that requirement into law. It’s not legal for SCOTUS to evaluate a religious hardship claim any other way.

    • I understand that, but there is plenty of legal precedent for determining whether or not a belief is “sincerely held,” based on a variety of factors, including length of time.

      I spent a lot of time digging through case law today.

      • I agree with you that I don’t believe Hobby Lobby’s belief is “sincerely held”. I worked for Hobby Lobby for five years and quite frankly, I believe the only belief that family sincerely holds is making all the money they possibly can.

        I would have liked to see a deeper dive during oral arguments about how their beliefs weren’t strongly held (previously purchasing those same drugs, continuing to invest in the companies which manufacture them). Unfortunately, that isn’t the argument we got. 🙁

        • Jeff

          “I would have liked to see a deeper dive during oral arguments about how their beliefs weren’t strongly held”

          But don’t you think, ultimately, a dismissal of the case or finding against HL on those grounds would have been a disappointing waste of time? HL notwithstanding, the question before the court was an interesting one: can the government compel a closely-held corporation to act in a way that violates a sincerely held religious belief of its owners? And it’s interesting that we got neither a resounding “No!” nor a resounding “Yes!” as the answer, but more of a nuanced “no”. I think it’s better for us that the justices wrestled with this, and that we got a ruling and a couple of opinions written, than if the court had punted and said “oh, HL doesn’t seem sufficiently sincere in its belief, so, case dismissed”.

          • BBRAB

            I agree Jeff. SCOTUS never issues an opinion that everyone agrees with — there is always someone on both sides. That’s one reason we even need a high court. I think it’s good that they wrestled with it, and good that they issued a ruling.

  • I the USA you go to court when you don’t have the votes. If most people really had seen ACA as fascist erosion of freedom, they would have voted for Romney. Back when ACA was created Catholic church threw a temper tantrum about contraception, and then organized something called “fortnight for freedom” and only two men and a dog showed up. Recent Gallup poll shows 90% acceptability of contraception http://www.gallup.com/poll/170789/new-record-highs-moral-acceptability.aspx . I find this fascinating since I didn’t believe 90% Americans agreed on anything.

    Back in the 1960’s, when liberals couldn’t get the people to agree with their agenda they went to court. Roe vs Wade and Engel v. Vitale became lighting rod for conservatives and forever branded liberals as aloof elitists who hate God and disregard the will of the people. I am not saying that those decisions where right or wrong, just that it is folly to enact agenda without creating consensus first.

    The Right is now in the same position the Left used to be: they scream in impotent rage, most people simply ignore them, so they go to court to get their way. In the end they will end up despised.

  • Another case in the point is gay marriage. Unlike abortion, that was enacted by Supreme Court fiat, gay marriage is gaining ground state by state. Theocrats are outraged, as is natural to them, but they are also getting depressed; they know that there is nowhere to go. People disagree with them and agree with the homosexuals. Had liberals been wiser about abortion, there would be a lot less resistance to it it today.

  • BBRAB

    I believe your science is sound. However, wasn’t that one point of the ruling — that this is about a sincerely held belief and not particularly about science? Isn’t that why the USA even exists (i.e., part of our history is the freedom to have “sincerely held” religious beliefs without the government being able to say we can’t, even if those beliefs are not widely held)? Also — isn’t it hypocritical of the government to ALLOW an exception for some groups (religious in nature) and not for others? If they would have allowed the SAME exception for Hobby Lobby and Conestoga Wood Specialties, there would have never even been a court case.

    • ChrisH

      However these are sincerely held beliefs that enact harm to others, in this case Hobby Lobby employees who are losing part of their insurance benefits package. If I have a sincerely held belief that throwing virgins into volcanos prevents the World-Snake from swallowing the sun, I somehow suspect the Supreme Court would start being more skeptical about the science.

      And isn’t it hypocritical when the court ruling says a sincerely held religious belief against birth control is valid, but one against blood transfusions is not? Where does that logic come from, because it sounds like the Supreme Court said Catholics are right and Jehovah’s Witnesses are wrong.

      • Melissa

        The ruling had nothing to do with the validity or legal defensibility of other sincerely held religious beliefs. The case was about contraceptives and the ruling applies to contraceptives. While the ruling should inform the outcome of cases against blood transfusions or vaccinations, those would be decided by separate rulings, as they were outside the scope of this case.

  • Patrick Prescott

    I shudder for what this court is going to do over the next twenty years.

  • Gram Pol

    I just don’t understand how the “I sincerely believe in this because of my religion despite all evidence to the contrary” can be a valid argument for a business but not for individuals who do things like snake handling or who refuse to allow their children any medical care in favor of laying-on-of-hands. Why the double standard? Why do businesses get preferred treatment rather than the legal censure they deserve?

    (I’m fairly certain the answer is $$$$$ but it doesn’t make me any less angry.)

  • Emily R

    Well, damn. Why couldn’t we have been the mammals that ‘absorb the lining’ instead of having periods?
    (Fantastic post, by the way)

  • Kreine

    Yes, I think people who are saying, “I believe life begins at conception – when the sperm fertilizes the egg” don’t really understand the definition of conception. So a little reproductive ed is good!

    Fertilization == conception. :headdesk:

    • It’s a logical place to put it, since that’s when the dna combines, but yeah.

  • Samantha, Thank you for providing additional explanation on the “outdated” information about hormonal therapies.

    Before this SCOTUS decision, I didn’t know Hobby Lobby purported to be a “Christian company.” I’m reminded of Ambrose Bierce’s famous definition, “Corporation: An ingenious device for obtaining profit without individual responsibility.”

    I quick perusal of executive profiles on HL founder David Green (the most comprehensive one being, “David Green: The Biblical Billionaire Backing The Evangelical Movement,” by Brian Solomon, Forbes, Oct. 8, 2012), suggests Green is a business owner who seems to have “some sense” of responsibility.

    But Green’s sense of responsibility appears to be narrow, selective, and self-serving much like the so-called “literal” interpretation of the Bible that he adheres to. He donates generously to evangelical causes from profits gained by the work of the very employees he doesn’t want to provide with contraception and the labor of oppressed workers in China and other third-world countries.

    In fact, GREEN IS THE LARGEST INDIVIDUAL DONOR—EVER—TO EVANGELICAL CAUSES, which might explain in part the muted response by prominent evangelicals to the SCOTUS decision.

    I agree with your comments and those of others that Hobby Lobby senior management must know they selected hormonal therapies based more on the analysis that this argument had a good chance of knocking a tooth out of the Affordable Care Act than on the sincere religious beliefs of the company’s owners.

    But based on my own experience with family-owned businesses, I would suggest that it would not be unusual for someone like Green who likely opposes “Obama Care,” to either have not been fully briefed on the legal tactic or to have not fully understood the legal argument. This is not to provide Green with an excuse—he should have known—and if he didn’t know and he truly has Christian convictions, he should take immediate corrective action. Not that he can undo all of the harm—but he can show whether he truly puts Christian principles ahead of financial gain as he claims.

    I’d like to see David Green challenged to apologize and provide suitable contraception to his employees and take responsibility for his company’s contribution to oppressive practices in China and elsewhere. We should hold him personally responsible for the actions of HIS corporation.

  • Excellent post, Samantha. Do you know if Hobby Lobby offers any contraception in its health plan nowadays? I was told by a coworker today that Hobby Lobby only wanted to drop abortifacients and that they still cover 8 different kinds of birth control. (Not that it makes any difference in the wrongness of the decision, IMO.) I seem to remember hearing a long time ago that most abortifacients are basically just superdoses of regular hormonal birth control, so I don’t think Hobby Lobby or any other “religious objector” would stop at getting rid of the 4 methods at the heart of the suit.

    • Well, SUPPOSEDLY they cover a variety of contraception options, but that’s not what concerns me. SCOTUS has already made it clear to 49 other courts that the decision applies to all forms of hormone therapy, and most of the pending court cases pending are from corporations that don’t want to cover ANY.

      Also, I really don’t buy how this decision is “narrow.” If Hobby Lobby can win a court case based on nothing but “religious belief,” than it would be ridiculous for Muslim-held corporations not to be able to stop covering vaccinations because they’re not halal.

      • I totally agree it’s a terrible decision. I’m trying to figure out how to respond to coworkers who are all “it’s OK because Hobby Lobby still provides a choice of birth control options”. To me, that means the company is stepping between its employees and their doctors. As someone who has a weird metabolism, I have to have exactly the drug my doctor prescribes. Biosimilars usually don’t work or actually cause me harm. So if, for instance, my doctor and I discovered that an IUD was the only form of reversible birth control that worked for me, I would be honked off that I would have to pay for it out of pocket because the owner of my company disapproves. Although one coworker told me this week that people who want hormonal birth control should go to Wal-Mart and pay $10 for it instead of expecting their health insurance to cover it.

  • VJ

    I think it’s important to note that progestin-only birth controls, like Mirena, don’t stop ovulation in all, or even most, users. Scientists believe the primary way Mirena works is to thicken the cervical mucus so sperm cannot penetrate the reproductive tract. The Mirena site also notes that it thins the endometrium (and this is regardless of follicular or luteal phases), which also prohibits sperm from reaching the fallopian tubes. The studies they’ve done on women using Mirena show that sperm just don’t reach the places where they normally would fertilize an egg. The Mini-Pill, which Hobby Lobby does cover, is the same hormone as Mirena, administered in only slightly larger doses, and it only stops ovulation in some women as well. Plan B, also progestin-based but in a much larger dose, does delay ovulation in almost all users.

    Signed, a woman whose Mirena is treating her endometriosis and also preventing the birth of a third child.