Yes, Ted Cruz’s Policies Would Outlaw Some Forms of Birth Control

Does Ted Cruz want to ban birth control? Stated so broadly, the answer obviously is no, he does not wish to ban all forms of birth control. However, if Cruz takes seriously the policies he explicitly endorses, then, yes, he does want to ban some types of birth control.

Cruz’s policies do not imply any restrictions of true contraceptives—forms of birth control that prevent sperm from fertilizing an egg, such as a condom—but they imply that any form of birth control that does or can act as an abortifacient—preventing an embryo from implanting or growing in the uterus—should be banned. That includes the copper IUD, among other things.

Arguably, Cruz’s policies imply that the hormonal birth control pill and hormonal IUD should be banned as well, because those things might sometimes act as abortifacients. It is unclear (to me) whether Cruz thinks the hormonal birth control pill and the hormonal IUD can act as abortifacients. The FDA thinks that they can, and many of Cruz’s allies claim that they can and that therefore they should be banned (details below).

Certainly Cruz’s policies would ban “the abortion pill” RU-486, brand named Mifeprex, which can be used “in the first 49 days of pregnancy.” We can pick nits over whether we should call drug-induced abortion a form of “birth control.” I think the way most people use the term “birth control,” and the most sensible use of that term, is to refer to any method that prevents a pregnancy from occurring or proceeding, except for a surgical abortion. Thus, birth control includes some methods that act exclusively as contraceptives and some methods that do or can act as abortifacients.

There is another problem with the language we must address: Most doctors consider a “pregnancy” to begin after fertilization, when an embryo implants in the uterus. So is it accurate to call a form of birth control that prevents implantation an “abortifacient,” even though pregnancy has not yet begun? I think it makes sense to use the term “abortifacient” in this context; otherwise, there’s no word to describe a form of birth control that acts after fertilization to prevent implantation. Certainly it makes no sense to refer to something that prevents implantation of an embryo as a “contraceptive”; it’s not preventing conception. By my schema, then, “contraception” and “abortifacient” cover all possible types of birth control (where some types can act as either a contraceptive or an abortifacient).

Before picking back up with the technicalities of birth control, let’s turn to recent discussions about Cruz’s views on on the matter. On November 30, someone asked Cruz about birth control. Cruz’s reply was both rhetorically masterful and deeply evasive. Here’s what he said (relying on ABC’s transcription):

Last I checked, we don’t have a rubber shortage in America. Look, when I was in college, we had a machine in the bathroom, you put 50 cents in and voila. So, yes, anyone who wants contraceptives can access them, but it’s an utter made-up nonsense issue.

Now, listen, I have been a conservative my entire life. I have never met anybody, any conservative, who wants to ban contraceptives. As I noted, Heidi and I, we have two little girls. I’m very glad we don’t have 17. . . .

So what do you do [if you’re Hillary Clinton], you go, “Ah ha, the condom police. I’m going to make up a completely made-up threat and try to scare a bunch of folks who are not paying a lot of attention into thinking someone’s going to steal their birth control.” What nonsense.

On December 1, Clinton’s team replied with an article titled, “Ted Cruz says no one’s trying to ban contraception. Here are 5 times Ted Cruz tried to ban contraception.”

Note how both Cruz and Clinton rely on confusion about the terms at hand. Cruz says conservatives don’t want to “ban contraceptives”—ignoring the fact that many conservatives want to ban abortifacients and consider the pill and IUD to be abortifacients. And Clinton misuses the term “contraception” to refer to all types of birth control.

Clinton also promotes the confusion between banning something and declining to subsidize it with tax dollars or otherwise promote it with government force. I agree with Cruz that people should not be forced to subsidize birth control and that government ought not interfere with freedom of contract (which can involve employment policies regarding birth control). Three of Clinton’s five points pertain not to proposed bans but to taxes and employment regulations.

Clinton’s fifth point claims that Cruz wants to “try to ban emergency contraception.” But nothing in Clinton’s piece, or in the Salon article that Clinton references, support her claim.

Clinton’s remaining point, her first one listed, is that Cruz “supported a so-called personhood amendment, which could criminalize abortion and could ban some forms of birth control.” On this score Clinton is absolutely right—except that “personhood” not merely “could” but certainly would ban some forms of birth control (if implemented fully).

Let’s establish the facts showing that Cruz supports “personhood.” Georgia Right to Life PAC endorses Ted Cruz for president. The organization clearly lays out its “criteria for consideration of candidate endorsement” in its “endorsement guidelines.” Candidates must read proclaim that they agree with the organization’s “GRTL PAC Pro-Life Principles.” Those principles state, among other things, that RU-486 should be banned (except for possible “non-abortion related purposes”). This document also states that “personhood begins at the moment of fertilization” and that, by signing the document (as Cruz did), candidates agree to protect the “civil rights” of embryos from fertilization. Thus, the document implies, but does not explicitly state, that any form of birth control that may act as an abortifacient should be banned.

A media release from Georgia Right to Life confirms: “Senator Cruz received the endorsement after reviewing his activities supporting personhood and receiving his signed GRTL PAC Personhood Affirmation, which asks that candidates support a personhood amendment to the U.S. Constitution.”

I don’t think anyone was confused about whether Cruz wants to ban Mifeprex; obviously he does. The major remaining question is whether he wants to ban the birth control pill or IUD.

So far as I’m aware, Cruz has never explicitly stated whether he wants additional legal restrictions or bans on any form of hormonal birth control pill or IUD. (I contacted Cruz’s campaign asking for clarification but never heard back.)

There are two related issues involved. First, does the pill or IUD, in fact, ever act as an abortifacient, or does it always act only as a contraceptive? Second, does Cruz believe that it does? If Cruz doesn’t think the pill or IUD acts as an abortifacient, then he can coherently claim he doesn’t want to ban them as a supporter of “personhood.” On the other hand, if Cruz concludes that the pill or IUD can act as an abortifacient, then, logically, by supporting “personhood” he has committed himself to seeking a ban.

Georgia Right to Life clearly states its view of the matter:

GRTL takes no position on birth control methods, which are contraceptive rather than abortive in their actions. We are opposed to those birth control methods which act as abortifacients. These could include forms of the pill which act to prevent implantation of the newly formed human into the lining of the womb; forms of the IUD, which can act the same; and prostaglandin suppository drugs, which act to cause delivery of whatever size baby the uterus contains.

Georgia Right to Life, then, certainly thinks that the “personhood” statement that Cruz signed does (or at least “could”) entail a ban on the pill and IUD.

Now, some people on the left ridicule conservatives who claim that forms of birth control that prevent implantation are “abortifacients.” For example, the Salon article that Clinton references in turn cites a document published by Princeton and the Association of Reproductive Health Professionals, which says this:

[U]sing emergency contraceptive pills (also called “morning after pills” or “day after pills”) prevents pregnancy after sex. It does not cause an abortion. (In fact, because emergency contraception helps women avoid getting pregnant when they are not ready or able to have children, it can reduce the need for abortion.)

Emergency contraceptive pills work before pregnancy begins. According to leading medical authorities—such as the National Institutes of Health and the American College of Obstetricians and Gynecologists—pregnancy begins when the fertilized egg implants in the lining of a woman’s uterus. Implantation begins five to seven days after sperm fertilizes the egg, and the process is completed several days later. Emergency contraception will not work if a woman is already pregnant.

That line of argument is deeply dishonest (and also deeply stupid, insofar as it ignores the obvious literal meaning of “contraception” as preventing conception). For religious conservatives who care about these issues, the entire discussion hinges on whether a form of birth control prevents fertilization or acts to destroy an embryo—whether or not it has implanted in the uterus. The document cited essentially plays a word game to artificially define “contraceptive” to include something that causes the destruction of a pre-implanted embryo.

The stronger argument is that “emergency contraception” is just that—contraception—and that it acts to prevent fertilization. That’s what Planned Parenthood maintains happens: “Emergency contraception pills work by keeping a woman’s ovary from releasing an egg for longer than usual. Pregnancy cannot happen if there is no egg to join with sperm.”

The main official page for Ella, a major brand of emergency contraception, claims the same thing, that the drug “works by preventing ovulation, even during the time in your cycle when you’re most fertile, for five full days following unprotected sex.” If that’s all that “emergency contraception” does, then there’s no reason to ban it according to to the commitments of “personhood.”

However, the FDA-approved prescription information for Ella claims that its methods of action are broader: “The likely primary mechanism of action of ulipristal acetate for emergency contraception is therefore inhibition or delay of ovulation; however, alterations to the endometrium that may affect implantation may also contribute to efficacy.”

In other words, if the prescription information is accurate, then Ella can act either as a contraceptive or as an abortifacient (in the sense that it can prevent implantation of an embryo).

So what about the standard birth control pill and the IUD? Here again, the official prescription information claims that they can act as an abortifacient (as defined here).

For example, the prescription information for Ortho Tri-Cyclen Lo states: “COCs [combined oral contraceptives] lower the risk of becoming pregnant primarily by suppressing ovulation. Other possible mechanisms may include cervical mucus changes that inhibit sperm penetration and endometrial changes that reduce the likelihood of implantation.”

The prescription information for the Mirena IUD states: “Mirena may work in several ways including thickening cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus. It is not known exactly how these actions work together to prevent pregnancy.”

Obviously if the lining of the uterus thins, that could prevent implantation of an embryo. The language that it is “not known exactly” how the device works is not likely to comfort most advocates of “personhood,” who regard a just-fertilized egg as the moral equivalent of a born baby.

Nevertheless, writing for the Federalist, David Harsanyi confidently proclaims that, while “personhood” bans abortion in principle, “it certainly doesn’t ban condoms or the birth control pill.” But, somehow, I suppose that advocates of “personhood” measures will be more impressed with the official, government-approved prescription information than with Harsanyi’s groundless certitude.

But maybe the FDA-approved prescription information is wrong: Maybe the pill and IUD never act by preventing implantation. That’s what many people argue, at least regarding the pill and hormone-based (as opposed to copper) IUD.

Pam Belluck’s 2012 article for the New York Times argues that the pill and hormonal IUD, along with emergency contraception, don’t prevent implantation (or at least that there’s no reason to think they do).

She adds:

By contrast, scientists say, research suggests that the only other officially approved form of emergency contraception, the copper intrauterine device (also a daily birth control method), can work to prevent pregnancy after an egg has been fertilized.

So, by the logic of “personhood,” at least the copper IUD should be banned, along with the abortion pill, even if the regular pill and hormonal IUDs are found not to prevent implantation. (As Belluck adds, “Despite the accumulating evidence” about hormonal pills and IUDs, “several abortion opponents said they remain unpersuaded.”)

Of course, it would be very easy for Cruz to issue a statement along these lines: “I, Ted Cruz, believe that the abortion pill [should / should not] be banned; that emergency contraception [should / should not] be banned; that the hormonal birth control pill [should / should not] be banned; that hormonal IUDs [should / should not] be banned; and that copper IUDs [should / should not] be banned.”

If Cruz would issue such a statement, as I’ve asked him to do, that would count as definitive evidence of his views in these matters. (Of course, depending on Cruz’s answers, one might argue that they either comport or conflict with his stated position on “personhood.”)

I would be shocked if Cruz in fact issued such a clear-cut statement. After all, politics today is not about clearly articulating one’s views on the issues; it is about obfuscating one’s views in order to pander to as many voters as possible. And Cruz can obfuscate with the best of them.

Regardless, given Cruz’s explicit commitment to “personhood,” he has also logically committed himself to trying to ban the abortion pill and copper IUD—and, if they are found to sometimes act as abortifacients (a big “if”), the birth control pill and hormonal IUD.

Let’s see Cruz try to parse all that going into the general election, if he makes it that far.

April 27 Update: Following is my entire “Ted Cruz and Religion” cycle. Please note that my views about Cruz evolved considerably over time. Although I’m still very concerned about Cruz’s positions on abortion (and related matters) and his alliances with theocratic-leaning conservatives, I’ve also come to appreciate more deeply his many virtues, including his partial endorsement of the principle of separation of church and state. I became active in Republican politics toward the end of 2015, and I came to support Cruz over Donald Trump for the nomination.
· Why I Will Vote for Any Democrat over Ted Cruz
· Voting, Political Activism, and Taking a Stand
· Ted Cruz’s Dangerous Pandering to Theocrats
· Yes, Ted Cruz’s Policies Would Outlaw Some Forms of Birth Control
· Ted Cruz Would Ban Abortion Even for Rape Victims
· Ted Cruz Touts Support of Anti-Gay Bigot Phil Robertson
· Republican Religion Undermines Capitalism
· Ted Cruz’s Remarkable Nod to the Separation of Church and State