What to know about birth control as Supreme Court overturns Roe v. Wade

The Supreme Court reached a final ruling on Roe v. Wade Friday, overturning the 1973 landmark case that constitutionally established the right to abortion in the U.S.

With this decision, abortion will likely be banned or greatly restricted in at least 22 states, according to the Guttmacher Institute. Some experts worry these bans could trickle down to restrict the use of emergency contraception and birth control.

“The rhetoric has been really increasing over the last several years,” Mara Gandal-Power, director of birth control access at the National Women’s Law Center, said before the ruling. “There’s definitely a domino effect which I think people are really starting to wake up to.

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Health experts say what's partly driving this legislation is the misconception that emergency contraceptives are able to terminate a pregnancy.

“The medications don’t work to abort a pregnancy,” said Dr. Mary Jacobson, an OB-GYN and chief medical officer at Alpha Medical, a telemedicine site for women’s health and sex differences. “If the patient were pregnant and took Plan B it doesn’t increase abortion and it doesn’t have any effects on the ongoing pregnancy.”

Here’s the difference between medical abortion and emergency contraception, and what health experts say Americans should know about birth control:

How do you medicinally terminate a pregnancy?

The most common type of medicinal abortion by pill uses the drugs mifepristone and misoprostol, according to the Mayo Clinic, which can be taken up to 10 weeks of pregnancy.

Mifepristone blocks the hormone progesterone, causing the lining of the uterus to thin, preventing the embryo from staying implanted and growing. Misoprostol causes the uterus to contract and expel the embryo.

People who choose this type of abortion typically take the first medication in the doctor’s office and the second one at home a few days later.

Vaginal bleeding and cramping may start one to four hours after taking the first medication, Jacobson said. Cramping may last one to two days whereas the bleeding could last up to 14 days.

The Guttmacher Institute estimates medicinal abortions account for more than half of all abortions.

“It’s highly effective,” Jacobson said. “The failure rate – meaning an ongoing pregnancy – is .4 to 3%.”

What is the most common emergency contraception?

Nine states have adopted restrictions on emergency contraceptives, according to the Guttmacher Institute, with some excluding it from their contraceptive coverage mandates and others allowing pharmacists to refuse to dispense the medication.

Emergency contraception is a form of birth control a person can use within three to five days of having unprotected sex, according to the Cleveland Clinic. People can take a pill or go to their doctor to have an intrauterine device inserted.

The over-the-counter pill, commonly known as the “morning-after pill,” is a hormone-based contraceptive that prevents or delays ovulation, which is when an egg is released from the ovary. The emergency contraceptive pill is like a highly concentrated birth control pill, Jacobson said.

“You would have to take like 14 (birth control) pills in one day” to have the same effect as the emergency contraceptive pill, she said. “That’s the only difference.”

The other less common form of emergency contraception is the copper intrauterine device, or IUD, which contains no hormones and prevents pregnancy for up to 10 years, according to the Mayo Clinic.

Although it’s considered long-term birth control, it was also approved as an emergency contraceptive to prevent fertilization up to five days after unprotected sex, Jacobson said.

The copper releases ions into the uterus, changing the fluids in the fallopian tube and uterus to make an inhospitable environment for sperm. If fertilization occurs, the copper IUD also works to prevent implantation, said Dr. Kathryn Fay, an OB-GYN and complex family planning specialist at Brigham and Women’s Hospital in Boston.

“It takes at least six days for (the egg and sperm) to unite in the fallopian tube and get to the uterus and implant,” she said. “The IUD will work at some point between ovulation and implantation to alter the uterine environment to prevent establishment of a pregnancy.”

Health experts don’t recommend emergency contraception as a form of contraception in general. While emergency contraception may be up to 95% effective in preventing pregnancy if taken within five days of unprotected sex, proper use of other birth control methods can be up to 99% effective.

Nine states have adopted restrictions on emergency contraceptives, according to the Guttmacher Institute, with some excluding it from their contraceptive coverage mandates and others allowing pharmacists to refuse to dispense the medication.

The anti-abortion organization Susan B. Anthony List argued in a statement to USA TODAY that because emergency contraception can "prevent implantation of a new human being post-fertilization" the group considers it "an abortion."

Health experts, however, said that assertion is not based on scientific fact.

“Pregnancy is not fertilization, pregnancy is implantation of a fertilized egg,” Fay said. “That’s very black and white, there’s no ‘ifs, and, or buts’ in medicine.”

Other hormonal contraceptives

Most hormonal contraceptives release a hormone called progestin that prevents pregnancy.

Progestin prevents pregnancy by stopping ovulation, thickening the cervical mucus to keep sperm from entering the uterus and thinning the line of the uterus so that a fertilized egg is less likely to attach.

Potential side effects include breast tenderness or swelling, headaches, irritability or moodiness, nausea and sometimes spotting in between periods.

Hormonal contraceptives consist of short-acting and long-acting methods. Short-acting methods are taken on a daily, weekly, or monthly basis. Long-acting methods can last for years depending on the device.

Birth control pills are considered short-acting and have the potential to be 91% effective if taken every day. Because it’s easy to forget, about 9% of women who use the pill will have an unintended pregnancy every year, according to the Cleveland Clinic.

The birth control patch, shot and vaginal ring are also considered short-acting methods of hormonal contraception. The patch is replaced weekly and is 91% effective, the shot is administered every three months and is 94% effective, and the vaginal ring is taken out once a month and can be 91% effective, according to Planned Parenthood.

The most common methods of long-acting hormonal birth control include the implant and the IUD, which are both 99% effective. The birth control implant is small, thin rod that’s inserted into the arm by a nurse or doctor.

The birth control implant lasts up to five years and the IUD can last three to 12 years.

Barrier methods

The most widely known method of birth control is the male condom.

If worn and used correctly, Planned Parenthood says they can be 85% effective at preventing pregnancy and they’re highly protective against sexually transmitted diseases.

Latex condoms are the most common. Only synthetic condoms – plastic or latex – protect against STDs.

Internal condoms, also known as “female” condoms, are an alternative to male condoms and also can prevent pregnancy and protect against STDs. Planned Parenthood says internal condoms are 79% effective.

Another female method of barrier birth control is the diaphragm, which is 88% effective at preventing pregnancy. Diaphragms are a shallow cup of soft silicone that cover the cervix. Health experts suggest adding spermicide to the diaphragm to make it more effective.

A person can put a diaphragm in up to two hours before having sex and leave it in for at least six hours after having sex, according to Planned Parenthood.

Birth control sponges and cervical caps work similarly to diaphragms in that they cover the cervix to prevent pregnancy. They’re 71% to 86% effective.


A permanent method of birth control is male and female sterilization.

There a few different types of tubal sterilization procedures for women, according to Planned Parenthood.

Tubal litigation permanently closes, cuts, or removes pieces of the fallopian tubes. A bilateral salpingectomy removes the fallopian tubes entirely. Essure sterilization is a tiny coil that a doctor puts in the fallopian tubes to block them.

By blocking, closing or removing the fallopian tubes the sperm can’t get to an egg and cause pregnancy. Female sterilization is 99% effective and is a permanent way to prevent pregnancy. Recovery takes a couple of days and health experts typically recommend women don’t lift anything heavy for a week after the procedure.

A vasectomy, or male sterilization, is a simple surgery where small tubes in the scrotum that carry sperm are cut or blocked off so sperm can’t leave the body and cause pregnancy. Starting about three months after a vasectomy, the patient’s semen won’t contain any sperm.

The procedure is quick, with patients going home the same day, and is nearly 100% effective at preventing pregnancies, according to Planned Parenthood.

Sterilization is meant to be a permanent option, but it can be reversed in some cases. Tubal litigation is harder to reverse; almost all vasectomies can be reversed.

The more time that has passed since the sterilization procedure, the less likely the reversal will work. Health experts say it's also important to keep in mind that although sterilization can be reversed, pregnancy is never guaranteed.

Contributing: Associated Press. Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

This article originally appeared on USA TODAY: Roe v. Wade: What to know about abortion, Plan B, birth control