New research revealed that a significant number of physicians hold erroneous beliefs about how contraceptives work. Many believe emergency contraception (EC) causes abortions, and some doctors believe intrauterine devices (IUDs) and other forms of birth control also work as abortifacients, according to a study of Wisconsin physicians’ beliefs about contraception.1
About one in six OB/GYNs and more physicians in other specialties held misconceptions about IUDs and EC.
“We surveyed 893 Wisconsin physicians and asked how contraception works, and asked them about specific contraceptive methods,” says Laura E. T. Swan, PhD, LCSW, a postdoctoral research associate in the department of population health sciences at the University of Wisconsin-Madison. “For several methods, we found that relatively low numbers of physicians believed these contraceptive methods worked by causing abortions. For implants, pills, patches, rings, and injections, only 6% thought that caused an abortion.”
But for IUD use, 17% incorrectly believed they worked by causing abortion. Thirty-nine percent believed EC causes abortions. The survey was conducted in 2019, before the overturn of Roe v. Wade.
“We had doctors across specialties, including internal medicine, surgery, emergency medicine, family medicine, and OB/GYNs,” Swan says. “The good news is that OB/GYNs were on the lower end of holding these beliefs, which is what one would expect and hope because that’s their specialty. Still, a concerning number of OB/GYNs believed emergency contraception caused abortion [17.9%].”
Researchers found religiosity was associated with the misconceptions about contraceptives, but lack of correct information may have been the driving cause.
Swan and colleagues’ findings are particularly concerning after the U.S. Supreme Court overturned Roe v. Wade in June 2022.
In Wisconsin and many other states, old abortion laws and new laws prohibit physicians from performing abortions, with rare exceptions. For instance, Wisconsin has a statute from 1849 that criminalizes abortion from the time of conception. It is a felony for physicians or anyone else to intentionally end a woman’s pregnancy, except to save the woman’s life. The statute was challenged in court in 1970 and found unconstitutional. It has been challenged now, but providers are left in limbo and state regulators could act against them, according to the State Bar of Wisconsin.2
If physicians believe certain contraceptives are abortifacients, then they may stop prescribing those. Their lack of accurate knowledge could block contraception access and limit patients’ options.
“It’s very concerning,” Swan says. “It’s especially shocking that physicians aren’t immune to these misconceptions.”
The problem may be related to challenges in obtaining adequate contraceptive and abortion training in medical schools, a general lack of sex education in schools, and the public’s misinformation on how contraception works.
“There’s an intentional and unintentional conflation of contraception and abortion in the media and in anti-choice rhetoric,” Swan explains. “It’s no wonder the general public — and even physicians — are conflating those two.”
Swan and colleagues’ survey is a descriptive study and did not include an intervention, such as education for physicians about scientific evidence supporting the consensus that contraceptives, including IUDs and ECs, do not cause abortions.
“We need follow-up research to look at the impact of these beliefs,” Swan notes. “We don’t know how this might impact care delivery and outcomes, but it’s logical to think it might have an impact.”
When investigators compared physicians’ answers about contraception to their demographics, they found that male physicians were more likely than female physicians to hold inaccurate beliefs about contraceptives.
While 48% of male physicians held incorrect beliefs about EC, 29% of female physicians held that same misconception. Fourteen percent of female physicians believed IUDs are an abortifacient, and 20% of male doctors concurred. Also, 4% of female physicians and 7% of male physicians believed implants, injections, and pills/patches/rings cause abortions.
“We found physicians exposed to abortion care during medical education were less likely to hold these incorrect beliefs that contraception causes abortion,” Swan says. “While this study is not an intervention study, and we can’t say exactly what impact these things would have, it implies the findings are showing that exposure to abortion in medical education and beliefs of how contraception work are related.”
Another solution is for reproductive health organizations to send clear messages to physicians and the public about how contraception works and to help people differentiate between the two.
“They need to understand there’s a difference in the way they work, and laws pertaining to abortion do not apply to contraception,” Swan says.
In 2020, the University of Wisconsin Collaborative for Reproductive Equity (CORE) released a seven-page brief on how contraception works that can be shared with clinicians, says Swan, who is a member of CORE.
The executive summary states there is consensus in the medical community that pregnancy begins when a fertilized egg is implanted into the uterine wall and that contraception is defined as a method of preventing pregnancy by inhibiting fertilization or preventing implantation of a fertilized egg.3
“In contrast, abortion is defined as the termination of pregnancy after a fertilized egg has implanted into the uterine lining,” the authors noted.
Other organizations could provide accurate information and outreach to physicians and the public, especially now that contraception access is at risk due to abortion bans.
“We need some follow-up research to find out the impact of these beliefs, and we need to add some nuance into these beliefs,” Swan says. “Why do they believe that? Is it because of a misconception? Is it a difference in belief about when pregnancy begins?”
The survey did not allow researchers to add that nuance. This would be important for future research — especially with EC and IUDs.
“It’s especially relevant for EC and IUDs because those are the ones we’re seeing these high numbers of inaccurate beliefs about,” Swan says.
REFERENCES
- Swan LET, Cutler AS, Lands M, et al. Physician beliefs about contraceptive methods as abortifacients. Am J Obstet Gynecol 2022;S0002-9378(22)00772-4.
- Rust AM. Implications of the Dobbs decision for Wisconsin health care providers. Wisconsin Lawyer. Sept. 7, 2022.
- UW CORE. How does contraception work? Not through inducing abortion. February 2020.
New research revealed that a significant number of physicians hold erroneous beliefs about how contraceptives work. Many believe emergency contraception causes abortions, and some doctors believe IUDs and other forms of birth control also work as abortifacients, according to a study of Wisconsin physicians’ beliefs about contraception.
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