Saturday, 20 May 2023 07:07

The Long Campaign to Turn Birth Control Into the New Abortion

Credit: Photo collage by Sarah Mirk for Reveal. Photo credits: SSPL, Justin Sullivan and Drew Angerer via Getty Images

Now that the fall of Roe v. Wade has ended the constitutional right to abortion, many in the religious right have a new goal: undermining trust in, and limiting access to, hormonal contraception – including the pill.

When the Supreme Court’s decision undoing Roe v. Wade came down, anti-abortion groups were jubilant – but far from satisfied. Many in the movement have a new target: hormonal birth control. It seems contradictory; doesn’t preventing unwanted pregnancies also prevent abortions? But anti-abortion groups don’t see it that way. They claim that hormonal contraceptives like IUDs and the pill can actually cause abortions.

One prominent group making this claim is Students for Life of America, whose president has said she wants such contraceptives to be illegal. The fast-growing group has built a social media campaign spreading the false idea that hormonal birth control is an abortifacient. Reporter and producer Alaa Mostafa teams up with UC Berkeley journalism and law students to dig into the world of young anti-abortion influencers and how medical misinformation gains traction on TikTok, Instagram and YouTube, with far-reaching consequences.

Tens of millions of Americans use hormonal contraceptives to prevent pregnancy and regulate their health. And many have well-founded complaints about side effects, from nausea to depression – not to mention well-justified anger about how the medical establishment often pooh-poohs those concerns. Anti-abortion and religious activists have jumped into the fray, urging people to reject hormonal birth control as “toxic” and promoting nonhormonal “fertility awareness” methods – a movement they’re trying to rebrand as “green sex.” Mother Jones Senior Editor Kiera Butler explains how secular wellness influencers such as Jolene Brighten, who sells a $300 birth control “hormone reset,” are having their messages adopted by anti-abortion influencers, many of them with deep ties to Catholic institutions.

The end of Roe triggered a Missouri law that immediately banned almost all abortions. Many were shocked when a major health care provider in the state announced it would also no longer offer emergency contraception pills – Plan B – because of a false belief that it could cause an abortion. While the health system soon reversed its policy, it wasn’t the first time Missouri policymakers have been roiled by the myth that emergency contraception can prevent a fertilized egg from implanting and cause an abortion. Reveal senior reporter and producer Katharine Mieszkowski tracks how lawmakers in the state have been confronting this misinformation campaign and looks to the future of how conservatives are aiming to use birth control as their new wedge issue.

This episode first aired in October 2022.

Dig Deeper

Read: Transcript of the FDA’s 2003 joint advisory committee meeting to consider making Plan B available over the counter

Read: Inside Anti-Abortion Groups’ Campaign to Sell Women on Unreliable Birth Control ‘Alternatives’ (Mother Jones)

Credits

mother jones logo

Reporters: Alaa Mostafa, Kiera Butler and Katharine Mieszkowski | Lead producer: Katharine Mieszkowski | Producers: Alaa Mostafa and Richard Yeh | Editor: Cynthia Rodriguez | Fact checker: Nikki Frick | Production manager: Steven Rascón | Digital producer: Nikki Frick | Original score and sound design: Jim Briggs and Fernando Arruda, with help from Kathryn Styer Martínez and Claire Mullen | Interim executive producers: Brett Myers and Taki Telonidis | Host: Al Letson

This episode was a collaboration with UC Berkeley’s Human Rights Center and Investigative Reporting Program, including Leah Roemer, Emma MacPhee, Elizabeth Moss, Anabel Sosa, Zhe Wu, Gisela Pérez de Acha, Brian Nguyen, Eliza Partika and Eleonora Bianchi. Special thanks to Reveal Features Editor Nina Martin and 2021-22 Roy W. Howard investigative reporting fellow Grace Oldham.

Transcript

Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.

Al Letson : From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. When Roe v. Wade was overturned last June, there was a group of teens and 20 somethings outside the Supreme Court celebrating. They called themselves the post-Roe generation. They were unapologetically antiabortion and very well organized. Many were a part of a group called Students for Life of America.
Speaker 2: I drove down here for Students for Life and I’m excited. You could see the celebration, but we all know this is not where the work ends. This is where it begins.
Al Letson : For many in the antiabortion movement, overturning Roe v. Wade isn’t enough. They want to restrict access even in states where abortion remains legal. Right now in federal court, there’s a fight over the abortion pill mifepristone and whether the Food and Drug Administration’s approval of it, an approval that’s existed for decades, is legal. But the attacks go beyond abortion. Groups like Students for Life have been targeting other forms of reproductive healthcare, including something millions of people rely on every day, hormonal birth control. It seems, well, contradictory. If you’re opposed to abortion, why would you also be against the most effective forms of contraception? But groups like Students for Life don’t see it that way. They see things like IUDs, emergency contraception, and even the pill as causing abortion. Kristan Hawkins is the president of Students for Life. Back in 2017, MSNBC’s Joy Reid prodded Kristan on her position on birth control.
Joy Reid: Do you think IUD should be illegal?
Kristan Hawkins: I don’t think they should be legal.
Joy Reid: Interesting. All right, well, we’ll-
Kristan Hawkins: They put women at risk and they kill children.
Joy Reid: Wow. What about the birth control pill?
Kristan Hawkins: I do not think it should be legal. I actually think that it shouldn’t be legal, but that’s not what we’re talking about [inaudible].
Joy Reid: No, no, no, no. But-
Kristan Hawkins: Nobody in the [inaudible].
Al Letson : Kristan doesn’t really want to talk about birth control and tries to change the subject. Joy keeps pushing.
Joy Reid: Kristan, Kristan, Kristan, Kristan, Kristan, Kristan, we can’t talk at the same time. I just wanted to get just clarity. You think that the pill and the IUD should be illegal, right?
Kristan Hawkins: In my ideal world, yes,-
Joy Reid: Wow.
Kristan Hawkins: … but I don’t think that’s actually something we’re working towards in the pro-life movement.
Al Letson : But that was six years ago. More recently, Students for Life has gone on social media doubling down on the idea that birth control is harmful and can cause abortions. Today, we’re revisiting a show we first brought you last fall. Reporter Ala Mustafa starts us off digging into where this medical misinformation got started and how it’s spreading.
Ala Mustafa: Students for Life is becoming the new face of the antiabortion movement. The group has a large staff and a bigger budget than many other antiabortion organizations. Students for Life has a large social media following. To understand what makes the group popular, it’s important to meet influencer Autumn Higashi.
Autumn Higashi : I was 16 years old when I first began in the pro-life movement. I saw a Teen Vogue article pop up on my Facebook feed one day titled, What To Get A Friend Post-Abortion. I sat down and I wrote a 10-minute response video because I was furious [inaudible] –
Ala Mustafa: The video looks like it was shot in a dark room. Autumn is dramatically lit from behind. She criticizes Teen Vogue for suggesting gifts like a heating pad, a Ruth Bader Ginsburg coloring book or a funny movie.
Autumn Higashi : You know when this would be appropriate? After your friend got their wisdom teeth taken out, not after they’ve had an abortion.
Ala Mustafa: Students for Life picked up that video and it has over 400,000 views. Today, Autumn is a spokesperson for the group.
Anabel Sosa: It didn’t take that long for me to find these videos.
Ala Mustafa: That’s Anabel Sosa. She’s part of a team of UC Berkeley law and journalism students who’ve been helping Reveal report on reproductive rights. She says, “Students for Life strategy involves reaching out to a younger demographic on TikTok and Instagram.”
Anabel Sosa: It’s really smart. You wanted to reach high schoolers because they’re most impressionable and also, they are going to repost and they’re going to engage with social media.
Ala Mustafa: The group also recruits young people on school campuses, from graduate schools all the way down to middle schools. Students for Life got its start on a school campus decades ago.
Elizabeth Moss: They were founded in 1988 at Georgetown University.
Ala Mustafa: That’s Elizabeth Moss who goes by Moss. She’s part of the Berkeley team helping with research. Moss points out that Students for Life isn’t just a tiny student-run organization.
Elizabeth Moss: There’s also Students for Life Action, which is a 501(c)4, meaning, they can lobby our legislatures. Through Students for Life Action, they also are responsible for writing some like a conception bills.
Ala Mustafa: The state laws that were passed ban abortion from the moment of fertilization. Students for Life also has built some serious political clout like the Federalist Society’s Leonard Leo, who handpicked Donald Trump’s three conservative Supreme Court justices. He’s on the board of Students for Life. Moss says it took a while for the group to gain this kind of power though and it really coincided with them recruiting one of today’s antiabortion movement superstars.
Elizabeth Moss: The organization they are today really starts with Kristan Hawkins when she joins in 2006.
Ala Mustafa: Okay. Moss pulls up the nonprofit’s 990 tax form on her computer to show me how the organization begins to increase its revenue once Kristan joins. In 2006, they made just shy of 200,000, and by 2008, it’s $1 million.
Elizabeth Moss: Then they are doubling their revenue to just under $12 million a year.
Ala Mustafa: It’s not just about revenue growth.
Elizabeth Moss: Kristan Hawkins is Students for Life.
Ala Mustafa: Kristan knows how to draw a crowd on social media. Anabel plays me this viral video. It’s called Pro-Choicer Defeated By Simple Logic, and it has 2.6 million views on YouTube.
Kristan Hawkins: When does the fetus become living?
Speaker 33: When it’s born.
Speaker 8: That’s actually a good question, but that line?
Kristan Hawkins: Yeah, of course, because you don’t know it, because it’s living.
Speaker 8: Oh, you actively deny science, ma’am.
Kristan Hawkins: What science did I deny?
Speaker 8: That it’s a child inside of you.
Ala Mustafa: The student describes that child as a clump of cells.
Kristan Hawkins: When does this clump of cells or fetus become living?
Speaker 8: When it can sustain its own life.
Kristan Hawkins: But when is the sustainability? My newborns aren’t sustainable.
Ala Mustafa: Understanding exactly when Students for Life believes a group of cells becomes a life is really important because it’s the way the group justifies opposing many forms of birth control. Here’s Autumn explaining when she thinks life begins on Students for Life’s TikTok.
Autumn Higashi : An egg, not a human being, a sperm not a human being. They unite at conception and there create a unique life that has never existed before and will never exist again.
Ala Mustafa: For Students for Life and many other antiabortion activists, this moment of conception is when a life begins and therefore, when a pregnancy begins. This is a religious idea, not a medical or scientific one, but for Students for Life, it means that anything that interferes or even has the chance of interfering with a fertilized egg is an abortion. The group explains this line of reasoning in a video about birth control pills and IUDs.
Speaker 9: If you’re using hormonal contraception, you are very likely using an abortifacient. This means that you could actually be causing an abortion without knowing it. The pill is one of the most well-known forms of birth control. The pill can work by making it less likely an egg will be fertilized, but it can also prevent implantation of the fertilized egg. Since life begins in conception, this means it changes the body’s chemistry to reject a fertilized egg, which is the same as an abortion. Surprised? The American [inaudible]-
Elizabeth Moss: Yeah. So I think this is the part of the show where you cue the medical expert to go over this video.
Ala Mustafa: Moss is right. So we called out Diana Blithe.
Speaker 10: Then when did you join NIH?
Diana Blithe: Oh, a long time ago. I joined in 1982.
Ala Mustafa: Blithe works for the National Institute of Child and Human Development, a branch of the NIH or National Institutes of Health. She’s the chief of the contraceptive development program there and she’s been doing government research for decades under both Republican and Democratic administrations.
Diana Blithe: We’re currently developing a male contraceptive gel that’s a combination of two hormones in a single gel.
Ala Mustafa: Now, at this point, I’m definitely imagining Spy Kids level labs and contraptions, but I want to stay focused on the Students for Life video. I played it for Blithe.
Speaker 9: There are other forms of hormonal contraception, but most of them work the same way. While preventing fertilization is one thing, preventing implantation is the same as causing an abortion. Many people don’t know this. Like and share this video to help inform others.
Diana Blithe: Well, it’s not based on scientific data. It’s based on speculation that these things might happen.
Ala Mustafa: Speculation that a fertilized egg might fail to implant. But Blithe tells us that hormonal birth control like the pill and emergency contraception primarily works by preventing ovulation, meaning there’s no egg to fertilize to begin with. Hormonal IUDs also suppress ovulation and block sperm from being able to reach an egg. Does hormonal contraception fail sometimes? Yes, but rarely. The pill is 93% effective even if you forget to take it occasionally. Could an egg get fertilized but be prevented from implanting? Possibly, but there’s no scientific evidence of this. And there’s another thing. Lots of eggs don’t implant even when you’re trying to get pregnant. Take this landmark study done in the late ’90s on women who are not taking birth control.
Diana Blithe: What they found out was that probably half of fertilized eggs that get to the point of beginning implantation, those are lost. We don’t know exactly what’s wrong, why it doesn’t implant normally, but they’re lost before the woman even misses a period. So she would’ve no idea this had occurred.
Ala Mustafa: This is why Blithe says doctors don’t consider someone pregnant until after a successful implantation, not after fertilization. We tried several times to speak to Autumn and Kristan from Students for Life. No one from the group would give an interview or answer email questions, but in a statement, they said they don’t take a position against contraception. This medical misinformation that the group is promoting, the idea that hormonal contraception can cause an abortion by preventing implantation, Students for Life didn’t make it up. In fact, it comes from the language on the packaging of the emergency contraception Plan B. To understand how this happened, I went to Chris ChoGlueck. He’s an assistant professor of ethics at the New Mexico Institute of Mining and Technology.
Chris ChoGlueck: I actually wrote most of my dissertation on the ethics and politics surrounding emergency contraception.
Ala Mustafa: Chris wrote that dissertation after his alma mater, Notre Dame, a Catholic University, sued the federal government. It didn’t want to cover contraceptives for its employees. There was a similar case happening at the same time. The owners of Hobby Lobby, a craft store, also didn’t want to cover contraceptives on religious grounds and claimed that emergency contraception causes abortions. Lots of other conservative groups argued the same thing and the Supreme Court didn’t question it. Chris was intrigued.
Chris ChoGlueck: It’s a really interesting case that exemplifies how values influence scientific judgment, but also how the antiabortion movement has been able to place scientists into very powerful roles to impose their value judgments on everybody.
Ala Mustafa: Chris considers the labeling of emergency contraception a good example of this. I went out and bought it so I could see for myself. So here’s the pill and here’s the leaflet. Okay. I read the leaflet out loud. It works mainly by stopping the release of an egg from the ovary. It is possible that Plan B One-Step may also work by preventing fertilization of an egg, the uniting of sperm with the egg, or by preventing attachment, implantation to the uterus, womb. It’s a version of what Students for Life has been claiming, and it turns out this language goes back to the early 2000s under George W. Bush’s administration. The FDA was trying to decide if Plan B should be sold over the counter, so it put together a joint advisory committee.
Chris ChoGlueck: At the committee meeting, you had several science advisors who, if you look into their background, are staunch antiabortionists.
Ala Mustafa: One of those science advisors stood out to Chris.
Chris ChoGlueck: During the meeting, he in particular argued that it was imperative, ethically imperative that this label, if it is approved for over-the-counter use, if it’s approved that it describes the mechanism,-
Ala Mustafa: Meaning, that language I read earlier, describing the different ways that Plan B could work.
Chris ChoGlueck: … he thought it could provide patients who believe that life begins at fertilization the ability to have informed consent.
Ala Mustafa: In other words, it’s coded language for anyone who’s antiabortion and believes life begins at conception. The committee is asked to vote on whether the drug should be sold over the counter or not. 23 out of 27 say yes. They’re also asked to weigh in on whether the package should include the special language that Plan B could possibly prevent the implantation of a fertilized egg and less than a third believe it’s necessary, but the language makes it into the packaging anyway.
Chris ChoGlueck: The drug company ended up in conversations with the FDA behind closed doors, which we are not privy to to do this in an unprecedented manner.
Ala Mustafa: We reached out to the FDA, but they wouldn’t answer specific questions. They did say that back in 2006, the agency made its decision about Plan B with the information available at the time. Chris believes this was a political compromise to get the drug approved for over-the-counter use more quickly.
Speaker 12: The morning-after contraceptive pill is now being sold over the counter, but there’s more [inaudible]-
Ala Mustafa: He also believes that Plan B is an example of misleading scientific information, making it into the labeling of a drug because of someone’s personal values.
Chris ChoGlueck: The FDA is the ultimate authority for science, and we often think of science as value-free and non-political. So if the FDA approved label says it, then that’s just science. That’s just the facts and that’s been really unfair.
Ala Mustafa: Most people who use Plan B probably don’t realize this language exists, but for Students for Life, the language, even though it’s not backed by science, has helped legitimize their claims.
Autumn Higashi : So Plan B, it can work to prevent fertilization, but it also can prevent a fertilized egg from implanting into the uterus, causing an early abortion.
Ala Mustafa: That’s Autumn again.
Autumn Higashi : If you were to take any amount of time to research this, you would know that. The FDA has published that Plan B can prevent a fertilized egg from implanting, and again, a fertilized egg is a life according to science.
Ala Mustafa: But it’s not science that considers a fertilized egg a life. It’s Autumn and Students for Life and others who believe that’s when life begins.
Al Letson : In December, about two months after we first aired this story, the FDA made a major announcement. It said it would overhaul packaging labels for Plan B. The new labels will make it clear that the drug does not cause an abortion. This story was produced and reported by Ala Mustafa with help from students at UC Berkeley’s Human Rights Center and at Berkeley’s Investigative Reporting Program. Antiabortion activists are finding other ways to target birth control, including adopting the language of wellness influencers who say it’s bad for the body. That’s next on Reveal.
From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Millions of Americans use the pill and IUDs to prevent unwanted pregnancies because both are really effective, but like with any medication, there can be side effects. People complain about everything from nausea to mood changes, and that’s fueled a backlash against hormonal birth control. Wellness influencers on social media call it toxic and recommend people stop using it. These messages are being picked up by another kind of influencer, antiabortion activists. Some even use a term green sex to promote what they consider to be more natural methods of contraception. That’s the topic of our next story, which comes to us from journalist Kiera Butler, senior editor at Mother Jones, who’s been investigating misinformation that targets women. Hey, Kiera.
Kiera Butler: Hi, Al.
Al Letson : So Kiera, what are these more natural methods? Is it the old rhythm method where you track your period to figure out when not to have sex, because isn’t that really ineffective?
Kiera Butler: No. This isn’t a throwback to the rhythm method. These are more complicated methods, which broadly speaking, involve a woman’s observations of her body to predict fertility. To keep it simple, I’m going to refer to this as cycle tracking. I think the easiest way for me to explain it is to tell you the story of a woman named Jessica. We’re only using her first name because she talked to me about personal health information.
Jessica: I’m in California and my kids are eight, five, and almost three.
Kiera Butler: Since her third child was born, she’s been using a cycle tracking method called the Creighton Model created by Catholic medical providers. In 1968, the pope at the time wrote a rule against all artificial contraception. That edict still stands today. While many Catholics ignore it, the most devout don’t, including Jessica.
Al Letson : So Jessica uses this method for religious reasons.
Kiera Butler: Right. And she hires a teacher to coach her in phone sessions on how to use the Creighton Model.
Jessica: It’s a whole process. When you go to the bathroom, you take a tissue, fold it properly and are observing, which is really fun when you have young kids in the house because they’re like, “What are you doing?” My kids are always in my space in the bathroom.
Kiera Butler: What Jessica’s talking about is checking her cervical mucus.
Jessica: There’s a finger test method where basically you take your two fingers and you stretch the mucus to see how far it stretches, anywhere from like a quarter inch, half an inch to an inch. The farther it stretches, generally the more fertile you are.
Kiera Butler: And then, there’s also the process of record keeping.
Jessica: There’s red stickers from when you’re on your menstrual cycle. There’s white babies and green babies, and then there’s green stickers. So essentially for me to avoid pregnancy, I can have sex generally anytime there’s a solid green sticker because that means I’m not fertile.
Al Letson : That sounds like a whole involved process.
Kiera Butler: Yeah, and other methods can get even more complicated. Some involve charting body temperature and hormones in urine to determine when you’re most likely to get pregnant. In the past few years, there’s been an explosion of interest, thanks in part to Silicon Valley companies that have launched cycle tracking apps promising birth control by algorithm. Peter Thiel, the billionaire who co-founded PayPal, he just invested in one. The market for these apps is expected to reach $3.9 billion by 2026, and part of the reason they’ve gotten so popular is because birth control has become a target of some wellness influencers who’ve been promoting the idea that hormonal birth control is harmful to the body.
Al Letson : Give me an example of some of the claims these wellness influencers are making.
Kiera Butler: Here’s Jolene Brighten.
Jolene Brighten: Have you ever heard of post-birth control syndrome? Bet you probably haven’t, and your doctor probably hasn’t either. Hi, I’m Dr. Jolene Brighten. In this video, [inaudible]-
Kiera Butler: Jolene isn’t an MD. She’s an ND, a naturopathic doctor and she specializes in what she calls post-birth control syndrome, which she says is a whole host of health problems associated with the pill.
Jolene Brighten: If you’re taking hormonal contraceptives, you are losing antioxidants. It is causing oxidative stress, so it is busting up your cells like crazy and you need to be replenishing those every day as long as you stay on that medication.
Al Letson : Busting up your cells like crazy doesn’t sound very scientific.
Kiera Butler: Right. So of course, there’s absolutely no science to back up those claims or even the existence of post-birth control syndrome. Like many influencers, she sells merchandise and in her case, a special detox program for about $300.
Jolene Brighten: I’m the first doctor to develop, document, and test clinical protocols to help women transition off of hormonal contraceptives and to support them while they’re on it.
Kiera Butler: I asked Jolene to see her studies, but she never got back to me and she also didn’t respond to my questions via email.
Al Letson : How popular are her videos? Does she have a big following?
Kiera Butler: Yes. Jolene has a massive social media following. Her popularity has to do with the fact that a lot of women really do have bad side effects from hormonal contraception like migraines and depression, and there are specific warnings around these methods for some women. Smokers, for example, can have a higher risk of blood clots and it can be incredibly frustrating when physicians don’t listen to women’s very real complaints.
Al Letson : That’s totally understandable that they would seek out alternatives. So what do doctors say about the negative effects of birth control?
Kiera Butler: I ask that question to Dr. Jenny Villavicencio, an OB-GYN and complex family planning specialist.
Dr. Jenny Villa…: What I hope is that healthcare providers can really understand that while the side effects that people may be describing may not be born out in the literature, that person’s experience is their experience and we need to honor that and respect that and let’s work with that person and find a birth control that works for them.
Kiera Butler: Something Dr. Villavicencio also points out is that the side effects and risks of pregnancy are actually much greater than being on hormonal birth control.
Dr. Jenny Villa…: Pregnancy always has more risk than birth control, and it also potentially has more side effects than birth control. It has the same hormones at much higher levels and certainly has different consequences as we know.
Kiera Butler: But that hasn’t stopped many antiabortion groups from promoting misinformation about the harms of hormonal birth control, including Live Action. Here’s a YouTube video of its founder, Lila Rose, speaking to conservative pundit, Candace Owens.
Lila Rose: Sex is supposed to be something safe as far as vulnerable where you can be vulnerable, but it’s not supposed to be something where you have to protect yourself from your partner with some latex or with a pill that sterilizes you or shuts down your hormones. How is that really self-giving and feeling vulnerable and free with them?
Candace Owens: It always freaks me out.
Lila Rose: It’s not. It’s not.
Candace Owens: Just instinctually always freaks me out where I would just say, why would any person want to just put hormones in their body every single day?
Al Letson : A pill that sterilizes you? That word choice is just striking.
Kiera Butler: For the record, the pill does not sterilize a person. I emailed Lila to ask about her comments and she stuck to her incorrect claim and said the pill does temporarily sterilize you. And Lila isn’t the only antiabortion activist adopting the idea that hormonal birth control is unhealthy. Take the Guiding Star project for example. It’s a network of women’s health clinics founded by Leah Jacobson.
Leah Jacobson: We believe that women’s bodies naturally do three unique things, and that’s ovulate, gestate, and lactate.
Kiera Butler: Guiding Star promotes itself as a network of health centers that empower women to love their natural bodies. At this 2012 company dinner, Leah is explaining how the organization was trying to gain a foothold in the wellness industry. The tape’s a little noisy.
Leah Jacobson: We’ve recognized that there is a really strong enthusiasm growing among women for things such as breastfeeding and natural childbirth and some of these things, but it’s typically among women that don’t identify as pro-life. A lot of them identify as strongly pro-choice.
Kiera Butler: She sees these more liberal women as potential opportunities.
Leah Jacobson: We’d love to get them into our building because not only does their financial support being paid to the birthing space help to support all the other organizations in the building, but with time, we believe that it’s going to start to soften their heart and change their mind a little bit about the pro-life movement.
Kiera Butler: Leah considers Guiding Star to be part of the pro-life movement, but when I asked her how abortion factors into her group’s work, here’s what she said.
Leah Jacobson: Abortion is really not the issue that we’re focused on. It’s we’re focused much more on a general women’s health and we tend to view that any unnatural interruption of a woman’s natural body and what it’s doing that that is a trauma against what her body is capable of. It’s a trauma that you’re internalizing deeply that my body did something wrong, and in fact, getting pregnant means everything went tremendously right.
Al Letson : I guess you would consider hormonal birth control one of those traumas against a woman’s body.
Kiera Butler: Yes, that’s right. Guiding Star promotes cycle tracking and even has a special program that teaches the method to preteens. Leah told me in an email that she doesn’t try to hide the fact that she believes, as she put it, that abortion is a poor substitute for women’s healthcare services and she said she’s spoken publicly about that. But if you just stumbled upon the organization either in person or on the web, you wouldn’t know it’s affiliated with the antiabortion movement. You would probably think it’s maybe like a naturopathic clinic or something.
Al Letson : Okay, so Guiding Star may not be transparent about its antiabortion stance, but what’s wrong with teaching cycle tracking?
Kiera Butler: The problem is that anti-birth control and antiabortion activists are promoting these cycle tracking methods as being nearly as effective as hormonal birth control, but it depends on how you use them. Tracking your body can be way more complicated than taking the pill, for example. Let me take a step back and give you rates for how often contraception fails, and let’s start with IUDs. Once it’s inserted, there’s nothing to do and the failure rate is less than 1%. The pill’s failure rate is also 1% if you take it every day. If you miss here and there, the failure rate is 7%.
Al Letson : And how about cycle tracking methods?
Kiera Butler: The CDC used to give them a 24% failure rate, but in 2019, that changed to a range between 2% and 23%. Here’s a webinar from 2019 hosted by the Department of Health and Human Services about FABMs or fertility awareness-based methods. That’s the same as cycle tracking.
Speaker 19: We’re excited to host this webinar in the wake of the CDC updating the effectiveness rating for FABMs, recognizing that some of these natural methods are up to 98% effective for avoiding pregnancy.
Kiera Butler: That language is misleading because for the vast majority of these methods, you can only get to 98% if you use them perfectly. This new range is considered a victory by proponents of cycle tracking who’ve been pushing the CDC to give these methods a better effectiveness rating. That includes Dr. Marguerite Duane, who spoke at that HHS webinar. She’s an MD, an adjunct professor at Georgetown University, and the head of a group called FACTS, which offers courses that doctors can take to maintain their medical licenses. Here she is talking about her group’s efforts to a gathering of Catholic healthcare providers in 2018.
Dr. Marguerite …: It’s important we set the record straight. To do this, FACTS has partnered with an organization called Natural Womanhood to ask the CDC to update and report accurate data.
Kiera Butler: Natural Womanhood is another pro-cycle tracking group. Dr. Duane tells this audience her story about what inspired her to embrace what she calls natural family planning.
Dr. Marguerite …: It is drilled into you as a medical student. You do not let a woman leave the hospital with a baby without birth control on board, and that is what I was doing. Thankfully, this lovely woman here, Dr. Pearl Huang-Ramirez, who’s holding my youngest baby, Gianna, said to me, “You don’t have to prescribe the birth control pill if it violates your conscience.”
Kiera Butler: That’s Dr. Duane talking to a group of Catholic doctors. Now, Dr. Duane herself is a devout Catholic, but I’ve seen her talk in other professional settings and she doesn’t explain like she does here that her personal beliefs are part of why she promotes cycle tracking over hormonal methods.
Al Letson : I can see how that’s problematic if she’s not transparent.
Kiera Butler: Right, and I haven’t seen her mention that she speaks at antiabortion conferences or her involvement with an antiabortion think tank or that she sits on the board of a foundation that funds antiabortion activists.
Al Letson : So did you try and talk to Dr. Duane about any of this?
Kiera Butler: Yes. I asked why she doesn’t mention her full background when she presents. A spokesperson, didn’t answer that question and instead just said, Dr. Duane welcomes the opportunity to present her work to audiences that support or oppose abortion.
Al Letson : So the bottom line here is that if you’re going to use cycle tracking, you really need to understand that there’s a range of effectiveness that depends on how closely you’re able to monitor your body.
Kiera Butler: Yes, that’s right. I think Jessica is a good example of that. She used cycle tracking for about three years without getting pregnant, but then she got comfortable and she stopped being so rigorous. Earlier this year, she says she was feeling out of it, so she gets a pregnancy test and it comes back positive. For the first month, she doesn’t tell anyone.
Jessica: I was just in my head about how scary things were going to be, how we were going to care for this baby financially, and so when I get pregnant, I got very, very sick. I basically can’t move. I just have to lay flat so that I’m not throwing up.
Kiera Butler: And here’s where her story gets even heavier. At Jessica’s first prenatal appointment, she found out that there was no heartbeat and that she was going to miscarry.
Jessica: And I just sat in my car and I just cried and I cried because one, it’s a loss, but two, I felt so guilty and shameful like I caused it because I’m like, “Oh, I can’t have this baby. Oh, my gosh. Maybe I’ll miscarry,” as awful as that sounds, but it was a thought in my head.
Al Letson : All those conflicting emotions, it must have been so hard.
Kiera Butler: Yes. She definitely found herself in a really difficult situation both physically and emotionally, but Jessica isn’t giving up. She says she’s found another cycle tracking method that she hopes will be more effective. It’s important to remember that even though Jessica was using these methods mostly because of her faith, there are millions of women who turn to cycle tracking often because they really don’t like their experience of hormonal birth control and they’re worried about the potential health effects of using it for years. They’re being told that these natural family planning systems work just as well as hormonal birth control, and that’s in part because of this concerted effort by antiabortion groups to convince women that the pill is bad.
Al Letson : Thanks so much for your reporting and bringing us this story.
Kiera Butler: Thank you, Al.
Al Letson : Kiera Butler is a senior editor at Mother Jones. It’s one thing to circulate misinformation about birth control online, but what happens when politicians start using it to try and pass bills? That’s next on Reveal. From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. Last summer when the Supreme Court overturned Roe v. Wade, Missouri’s attorney general at the time, Eric Schmitt, was ready. He raced to put the state’s trigger ban on abortion into effect.
Eric Schmitt : I am humbled to be a part of this and the first attorney general in the country to effectively end abortion.
Al Letson : Abortion was now outlawed except in medical emergencies. Schmitt, who has since been elected to the US Senate, scored big points with his conservative base, but just days into the ban, some unexpected news broke.
Speaker 22: Saint Luke’s Health System is no longer offering emergency contraception at its Missouri locations that says the Missouri law is ambiguous but may be interpreted as criminalizing emergency contraception.
Al Letson : Saint Luke’s is a major healthcare provider in the region and it was concerned that emergency contraception could be considered an abortion under the state’s ban.
Speaker 22: We simply cannot put our clinicians in a position that might result in criminal prosecution.
Al Letson : Let’s just be clear. When you’re using emergency contraception, time is not on your side. That’s why it’s often called the morning-after pill because you have to take it soon after having sex to prevent a pregnancy. Suddenly, the state’s abortion ban was also limiting access to birth control, which could lead to more unwanted pregnancies. Soon, Missouri officials were trying to reassure the public that all forms of birth control were still legal.
Speaker 23: Missouri’s Attorney General Eric Schmitt clarifies this law saying that use of these drugs is not against the law in Missouri after all.
Al Letson : And Saint Luke’s started offering emergency contraception in Missouri again, but this confusion didn’t come out of nowhere. In 2021, Missouri lawmakers spent months fighting over whether birth control can cause an abortion. In a story that first aired last fall, Reveal’s Katharine Mieszkowski explains how misinformation about birth control made its way into state politics.
Katharine Mies…: In Missouri, even a tax that’s been around for decades can get caught up in abortion politics. The Federal Reimbursement Allowance or FRA helps fund the state’s Medicaid program. The Missouri state legislature just has to extend the FRA to keep the billions flowing.
Senator Jill Sc…: A lot of discussion goes around it, but it is, in a sense, a no-brainer. We’re going to pass that bill because we need those dollars in the state.
Katharine Mies…: State Senator Jill Schupp is a Democrat. She tells me about how this must pass bill got complicated.
Senator Jill Sc…: In 2021, one of our colleagues, a male colleague Republican, stood up and offered an amendment to the FRA.
Senator Paul Wi…: Madam President, my amendment’s a simple amendment.
Katharine Mies…: That male colleague was Senator Paul Wieland from Jefferson County.
Senator Paul Wi…: What it does is it addresses the situation we have in Medicaid to where currently, the state of Missouri is funding drugs that are [inaudible]. So this basically [inaudible]-
Katharine Mies…: That’s something that causes an abortion.
Senator Paul Wi…: … any drug or device approved by the Federal Food and Drug Administration that may cause the destruction or prevent the implantation of an unborn child defined in Section 188.015.
Katharine Mies…: Implantation of an unborn child, what is Senator Wieland talking about? Well, in Missouri state law, even a fertilized human egg is defined as an unborn child. It’s that Catholic idea again that life begins at conception and it’s been in the law here for more than 40 years. So for Senator Wieland, anything that could interfere with a fertilized egg developing is an abortifacient.
Senator Paul Wi…: It’s just going along and making our pro-life state even more pro-life in saying that state of Missouri will not pay for these [inaudible] drugs. Happy to answer any questions.
Katharine Mies…: There are no questions. Nobody even asks exactly what drugs or devices Wieland is trying to stop the state from funding, but on his list are IUDs, which are among the most popular forms of birth control, and emergency contraceptives like Plan B. The amendment goes to a roll call vote and it passes.
Speaker 26: By a vote of 21 aye and 12 no, the amendment has been adopted.
Katharine Mies…: But it isn’t that simple. Under the Affordable Care Act, birth control is an essential health benefit. Failing to provide it to Medicaid patients could put the state out of compliance with federal law, risking billions of dollars. As the legislature grapples with this, the critical bill stalls. The stalemate goes on for months and the legislative session ends. This bill is so essential to the state’s budget that members have to return to the Capitol to try to get it passed.
Speaker 27: That the Senate is duly convened in the first extraordinary session of the first regular session and is ready [inaudible]-
Katharine Mies…: Governor Michael Parson, a Republican, is worried. He puts out a statement begging the members of the legislature to pass the bill. “Let me be clear, I am pro-life,” he writes. “I have supported pro-life measures my whole career and I always will. However, we cannot allow narrow political interests to hold hostage vital healthcare funding and the success of our economy. He’s talking about Wieland’s initiative and an effort to defund Planned Parenthood, which is also holding up the bill. But Wieland isn’t giving up. Here he is being questioned by Senator Doug Beck, a Democrat who wants to protect funding for birth control.
Senator Doug Be…: Do you believe Plan B induces an abortion?
Senator Paul Wi…: I believe it does, yes.
Senator Doug Be…: Okay, but it doesn’t. Medically and scientifically, it doesn’t.
Senator Paul Wi…: Okay, so if it doesn’t induce an abortion, then it would be paid for by the Medicare program.
Senator Doug Be…: Is Plan B-
Katharine Mies…: Here’s that same misinformation again now playing out in the Missouri Senate. The idea that even though Plan B works by preventing ovulation, you just never know when it might keep a fertilized egg from implanting in the uterus. Missouri right to life compares using Plan B to playing Russian roulette.
Senator Doug Be…: Is Plan B a part of what you’re trying to get banned?
Senator Paul Wi…: It is listed as one of those drugs, correct. And it says-
Senator Doug Be…: I’m not sure what we’re talking about.
Senator Paul Wi…: … when used to induce an abortion. It doesn’t say when used for birth control. It says when used to induce an abortion.
Senator Doug Be…: I disagree with you that this is about abortion. This is about birth control.
Senator Jill Sc…: So we were in a standoff.
Katharine Mies…: That’s Senator Jill Schupp again.
Senator Jill Sc…: We were actually in recess for hours. One of my male counterparts, a Democratic colleague, came to me and said, “You have a good relationship with the Republican senators, the women senators. What do you think about going and talking to them?” And I said, “You know what? That’s a great idea.”
Katharine Mies…: For the first time, women represented nearly a third of the state senate.
Senator Jill Sc…: 11 women in Missouri Senate is more than we’ve ever had in Missouri’s history.
Katharine Mies…: And the women had already bonded. It started with a dinner party hosted by a government official.
Senator Jill Sc…: The head of the Department of Conservation invited us to her husband’s amazing man cave to just get away from the Senate chamber one night.
Katharine Mies…: The women senators cooked up a literacy initiative to educate kids about the history of women in Missouri politics for the state’s bicentennial. They even published a children’s book called You Can Too. Working together on that uncontroversial project paved the way for them to bridge partisan divides and they found on birth control they could also agree. So they sat down with Senator Wieland.
Senator Jill Sc…: And we explained to him that most of these methods he was talking about were actually birth control methods and we said, “We are not going to support your amendment. Please remove it.” He sat down in the room with all of us and he said, “Let me talk to some people,” and he came back and he said, “Okay, I will remove my amendment.”
Katharine Mies…: The bill ends up passing without any restrictions on contraception. Wieland does manage to get a line put in there that says the state won’t pay for any drug or device that causes an abortion, but that doesn’t actually change anything in Missouri. The state already banned using public funds to pay for abortions, but this idea that some contraceptives cause abortions, it doesn’t just go away.
Speaker 22: Saint Luke’s Health System is no longer offering emergency contraception at its Missouri location.
Speaker 23: Missouri’s Attorney General Eric Schmitt clarifies this law saying that use of these drugs is not against the law in Missouri after all.
Katharine Mies…: When state officials implemented Missouri’s abortion ban a year later, it wasn’t just Saint Luke’s Health System that got confused.
Michelle Trupia…: People were scared. They were confused. We have heard from our health centers across the state that they have been fielding call after call.
Katharine Mies…: Michelle Trupiano is executive director of the Missouri Family Health Council. The group provides funding to reproductive healthcare centers that serve low income people.
Michelle Trupia…: They were confused about whether or not they need to take their IUD out or folks that are wanting to go ahead and get an IUD because they’re fearful about what the legislature may do.
Katharine Mies…: People here are making health decisions based on what they think might happen politically. I wanted to know whether Missouri politicians will keep fighting to restrict contraception. Senator Wieland is term limited out of his seat and he didn’t respond to interview requests, but I was able to catch up with a person who helped write his amendment. His name is Sam Lee.
Sam Lee: I’ve been a lobbyist at the state capitol here in Missouri in Jefferson City for, well, about 37 years full-time. I’m also a deacon in the Catholic Church, married with four children and seven grandchildren.
Katharine Mies…: Even though he helped craft Wieland’s amendment, Sam doesn’t think that limits on contraception are going to happen.
Sam Lee: Senator Paul Wieland, a friend of mine, someone I’ve worked with, and he’s wanted to do this for years. For Wieland, it was a personal thing. Paul’s a Catholic. He didn’t like voting for funding for Medicaid for years because he didn’t like that the state was funding contraceptives and so he put an amendment out and it didn’t pass. That’s nothing out of the ordinary. Lawmakers introduce bills and offer amendments all the time. The question is, does something become law?
Katharine Mies…: So what you’re telling me is there’s not an appetite for that to become law in your state.
Sam Lee: There’s not only not an appetite, there wouldn’t be the votes for it.
Katharine Mies…: But Senator Jill Schupp, who is also term limited out of office, thinks this issue isn’t going away.
Senator Jill Sc…: I believe that in the upcoming legislative session or perhaps the one after, that these will be the topics that the Missouri legislature is talking about.
Katharine Mies…: Now that abortion is banned in Missouri, she predicts conservative candidates will use birth control as a wedge issue to try and win elections.
Senator Jill Sc…: I think in the state of Missouri, year after year after year, we’ve seen the goalpost being moved. It’s not enough to just ban abortion in Missouri. We’re going to see the banning of birth control.
Katharine Mies…: In Congress, birth controllers are already the new political football. Last summer, antiabortion groups were watching when Democratic women unveiled what they called the Right to Contraception Act.
Nancy Pelosi: Let us be clear, we are not going back. For our daughters, our granddaughters, we are not going back.
Katharine Mies…: It was less than a month after the Supreme Court overturned Roe versus Wade and House Speaker Nancy Pelosi said the bill was a response to a serious threat from “radical Republicans” who are going after contraception next.
Nancy Pelosi: This is their moment. Clarence Thomas has made that clear.
Katharine Mies…: She’s referring to Justice Thomas’s concurring opinion. He wrote that the Supreme Court should also take a second look at a decades old decision that protected the right to use contraception.
Representative …: This rallying call by Justice Thomas and the actions of extremist Republican legislators are about one thing, control,-
Katharine Mies…: Representative Kathy Manning from North Carolina sponsored the bill.
Representative …: … and we will not let this happen.
Katharine Mies…: The Right to Contraception Act would do for birth control what Democrats now wish they’d had the foresight to achieve with abortion years ago. It would enshrine in federal law people’s right to use birth control and make it hard for states like Missouri to restrict people’s access to it.
Nancy Pelosi: Eliminate, just remove all doubt that women are in control of their lives.
Katharine Mies…: But opponents rally. One prominent antiabortion group announces it will score against the bill, meaning, ding any politician who votes for it the same way the NRA does with lawmakers when they vote for gun control. The bill passes the house anyway, but then it goes to the Senate where Senator Joni Ernst, a Republican, speaks against it.
Speaker 38: The junior senator from Iowa.
Senator Joni Er…: Reserving the right to object, Madam President. Here we are again, another day, another sympathetically titled bill offered by my Democrat colleagues where the talking points don’t really give you the full story. [inaudible]-
Katharine Mies…: Senator Ernst claims the Democrats are trying to expand the definition of contraception.
Senator Joni Er…: … and defines contraceptive in such a broad way that it could include drugs to induce an abortion weeks or months [inaudible]-
Katharine Mies…: The bill dies in the Senate. Opposing birth control protections is now a way for politicians to prove just how pro-life they are.
Al Letson : That was Reveal’s Katharine Mieszkowski. Since our story first aired, these battles over reproductive health have shifted to the ballot box. In Missouri, abortion rights supporters are trying to restore legal abortion in the state by putting it to the voters in 2024. Also, birth control pills could soon become easier to access nationwide. The FDA is expected to decide this summer whether some birth control pills can be sold over the counter without a prescription. Katharine Mieszkowski was a lead producer for this episode with help from Ala Mustafa and Richard Yeh. Cynthia Rodriguez edited the show. This week’s show was in collaboration with UC Berkeley’s Human Rights Center and Berkeley Journalism’s Investigative Reporting Program including Leah Roemer, Emma MacPhee, Gisela Pérez de Acha, Zhe Wu, Brian Nguyen, Eliza Partika, and Eleonora Bianchi.
Special thanks to Reveal’s Nina Martin and Grace Oldham. Nikki Frick is our fact-checker. Victoria Baranetsky is our general counsel. Our production manager is Steven Rascón. Score and sound design by the dynamic duo, J. Breezy, Mr. Jim Briggs and Fernando, my man, yo Arruda. Our post-production team is the Justice League, and this week, it includes Kathryn Styer Martinez and Claire [inaudible] Mullen. Our COO is Maria Feldman. Our CEO is Robert Rosenthal. Our interim executive producers are Brett Myers and Taki Telonidis. Our theme song is by Camerado, Lightning. Support for Reveal’s provided by the Reva and David Logan Foundation, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Robert Wood Johnson Foundation, the Park Foundation, and the Hellman Foundation. Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson, and remember, there is always more to the story.