The national debate over IVF, unfolding after an Alabama court decision prompted multiple clinics in the state to halt operations, prompts a question: What might be next? Could other fertility treatments and even birth control be under threat given that Roe v. Wade is no longer the law?

If the idea that birth control could be at risk in America strikes you as hard to believe, I understand. There’s no proposed legislation on the table to ban it, and it does seem unbelievable that contraception — which an overwhelming majority of US women, including religious and Republican women, have used and support — could one day disappear.

But attacks on reproductive rights have never really been about public opinion, as the overturn of Roe showed and the current national debate over IVF has further proved. While it’s not an immediate threat, anti-abortion leaders have been laying the groundwork to curtail contraception access for many decades, despite birth control being one of the most reliable ways to reduce the incidence of abortion.

Their fundamental opposition is rooted in a belief that penetrative sex is sacred and should only occur within a heterosexual marriage and in the service of having children. In their eyes, birth control has encouraged sex outside of marriage — a development they charge with weakening families, absolving men of responsibility, and steering women away from domestic duties.

These are fringe conservative views, but ones endorsed by religious institutions and groups that have long provided funding and power to the anti-abortion movement.

“I think contraception is disgusting, people using each other for pleasure,” said Joseph Scheidler, the late founder of the Pro-Life Action League, an activist group that pioneered confrontational tactics like sit-ins at abortion clinics and picketing outside doctors’ homes. The New York Times described Scheidler as the “godfather” of the movement.

Randall Terry, who founded the group Operation Rescue — known for blockading and protesting abortion clinics and patients — once laid out the logic against birth control plainly: “Any drug or device that prevents us from having children” is “anti-child,” he said. “How do we expect to defeat child-killing in the world when we cannot defeat child-rejection in our own midst?”

The political playbook for attacking birth control shares some similarities with the playbook for attacking abortion — a slow and steady chipping away of rights and access. Both efforts rely on measures like slashing funding for low-income patients, enacting parental consent laws to restrict minors’ use, and empowering ideologically supportive lawmakers and judges who push friendly legal frameworks.

But the major difference between pushing to restrict abortion access and pushing to restrict birth control is that leaders are typically much quieter about their goals for the latter, aware that open discussion will prompt fierce backlash. They typically try to paint those who suggest they’d take aim at contraception as alarmists and conspiracists.

When Democrats in Congress introduced a bill to codify access to birth control following the overturn of Roe, for example, they were met with emphatic performances of exasperation.

“This bill is completely unnecessary. In no way, shape, or form is access to contraception limited or at risk of being limited,” declared Florida Republican Rep. Kat Cammack during debate on the House floor. “The liberal majority is clearly trying to stoke fears and mislead the American people.”

Still, a growing number of Republican lawmakers — including Sens. Marsha Blackburn and Mike Braun — have recently declared that Griswold v. Connecticut, the 1965 Supreme Court decision establishing a constitutional right to birth control, was wrongly decided. Griswold relies on the same legal right to privacy that underpinned Roe, and in his concurring Dobbs v. Jackson opinion in 2022, Justice Clarence Thomas encouraged the Supreme Court to “reconsider” Griswold and other privacy-related decisions. Former Arizona Senate candidate Blake Masters went so far as to pledge to “vote only for federal judges who understand that Roe and Griswold” should be overturned.

Leaders more than occasionally reveal their underlying beliefs. Recent statements, as well as recent actions from reproductive rights opponents, have sent clear reminders about how some influential activists really think about contraception: that it’s just another form of abortion.

Activists aim to blur the line between birth control and abortion

Anti-abortion leaders tend to take advantage of one basic fact about the American people: There is great confusion about how pregnancy works, how abortion pills end it, and how birth control and emergency contraception (such as Plan B) prevent it. For example, one recent poll found that a stunning 73 percent of Americans think emergency contraception can end a pregnancy.

But among most medical experts, including those at the American College of Obstetricians and Gynecologists — there is no confusion. Birth control, including emergency contraception, prevents ovulation (when an egg is released) and fertilization (when egg and sperm meet). Pregnancy begins when a fertilized egg attaches to the lining of the uterine wall, a process called implantation. Many fertilized eggs never implant.

Yet for a highly motivated wing of the anti-abortion movement, pregnancy starts not at implantation but at conception, and human personhood begins then too, not at birth. These “fetal personhood” activists want to endow fetuses, embryos, and fertilized eggs with full rights and legal protections and thus frame any effort to prevent implantation — be it through discarding embryos from IVF or taking a daily birth control pill — as a form of killing unborn children.

It’s a stretch of scientific consensus, but certain Christian activists have long clung to this idea and have slowly been codifying it in state law through bills that claim human life begins at conception. More than a third of states currently have such laws on the books.

To blur the line between abortion and contraception, many of these activists call birth control methods “abortifacients” — agents that induce abortion. But this is misleading because there’s no pregnancy to abort. Real abortifacients are the medications that end pregnancies, namely misoprostol and mifepristone.

In rationalizing the idea that birth control can somehow abort a pregnancy before a pregnancy begins, activists make a number of claims. Human Life International, a global Catholic group, maintains that anything that prevents implantation is an abortion-inducing agent. IUDs, they insist, cause “early abortions.” Students for Life of America likewise claims all forms of hormonal birth control, including IUDs and the Pill, are abortifacients.

Georgia Republican Rep. Marjorie Taylor Greene went so far as to proclaim that Plan B emergency contraception “kills a baby in the womb once a woman is already pregnant” even though studies have shown the drug interferes with ovulation but does not inhibit implantation.

Greene isn’t the only Republican lawmaker blurring the lines. Colorado Rep. Lauren Boebert tried to block funds for “abortifacient contraceptive drugs,” while Montana Rep. Matt Rosendale tried adding emergency contraception to a bill barring use of the federal funding for abortion. In 2022, in perhaps one of the most glaring examples, Missouri Republicans pushed unsuccessfully to restrict public funding for IUDs and emergency contraception, with one of the state senators who led it proclaiming that “life begins at conception,” and “anything that destroys that life is abortion, it’s not birth control.”

Just this past week in Iowa, House Republicans attempted to amend a bipartisan bill to legalize over-the-counter birth control by adding new language that would require pharmacists to provide misleading and inaccurate information implying contraceptives are dangerous and a form of abortion. Pulse Life Advocates, an Iowa group opposing the contraception bill, claims on its website that birth control “kills babies.”

Many of these objections will sound familiar to anyone who followed the fight around the Affordable Care Act 15 years ago. The political groundwork was laid in 2010 when the Tea Party movement came into power and fought alongside the Catholic Church against requirements that employer health insurance plans cover birth control. And in 2014, the retail chain Hobby Lobby won its case before the US Supreme Court in which it argued it shouldn’t have to provide employees with IUDs or emergency contraception since its ownership viewed such things as abortion.

Wellness influencers have joined anti-abortion activists in raising fears about birth control

While many “fetal personhood” activists have long opposed birth control for religious reasons, over the last decade they’ve found new allies among secular “wellness” influencers who propagate dubious ideas online about vaccines, nutrition, and environmental toxins.

Many of these online influencers promote the idea of “natural” products and in the last few years have added hormonal birth control to their list of substances they claim people should avoid to live a healthy life.

Seizing on general distrust of medical institutions and the fact that some users do experience adverse side effects when using birth control, these influencers have insisted that hormonal contraceptives will likely lead to weight gain, to a diminished sex drive, and to emotional disorders. These warnings often go well beyond the scientific evidence and pair neatly with the exaggerated warnings anti-abortion groups spread about contraception, like that it will cause infertility, strokes, and cancer.

Alex Clark, a popular conservative online influencer, has told her young, female audience that she’s “on a mission to get young women off this pill.” Politico reported that Clark claimed hormonal birth control “is completely altering your personality” and insisted that many forms of birth control “are actually abortifacients.”

This fusion of feminine “wellness” content and anti-abortion advocacy can also be seen in the growth of Evie Magazine, an ostensibly nonsectarian outlet targeting young women that publishes stories like “13 Reasons Why You Should Quit Hormonal Birth Control” and “Abortion Is an Anti-Woman Issue That Has Nothing to Do with Bodily Autonomy or Reproductive Freedom.” Evie also promotes a venture-backed startup that encourages controlling fertility through “natural” means.

These tactics seem to be having an effect. One poll published in June 2023 found more than half of the roughly 4,000 women surveyed expressed fears about how hormonal birth control would affect their physical and mental health. An Instagram poll by theSkimm, a media company that focuses on Gen Z and millennial women, found that a third of respondents who weren’t on birth control had stopped taking it in the past year.

Meanwhile a study published recently in Health Affairs found statistically significant evidence that barriers to birth control had increased and “reports of receiving high-quality contraceptive care” had decreased since Roe was overturned.

“Fetal personhood” activists struggle to maintain the fiction they are neutral on birth control

When asked about their intentions to restrict or protect access to birth control, Republican lawmakers and leaders of the anti-abortion movement will typically point out the fact that there’s no bill currently under consideration explicitly aimed at banning contraception.

As journalist Jessica Valenti noted in her Abortion, Every Day newsletter, the president of Ohio Right to Life mocked a state Democrat who warned of the risk to birth control by saying, “she can’t cite a piece of legislation that bans contraception … it’s fear-mongering.” Susan B. Anthony Pro-Life America’s website calls it a “MYTH” that Republicans want to stop people from getting birth control. “FACT: No state anywhere has banned birth control,” it says.

And yet taking one big swing to restrict access has never been the strategy of the anti-contraception playbook. Rather, activists either maintain neutrality on birth control or say nothing while actively working to conflate abortion with birth control and pass laws that redefine life as beginning at conception.

As journalist Christina Cauterucci pointed out at Slate, the anti-abortion group Americans United for Life claims on its website that it takes “no stance on the underlying issue of contraceptive use,” but elsewhere it insists that people who use emergency contraception “take the lives of their unborn children.” When Mother Jones reporter Kiera Butler attended the annual conference of the anti-abortion group Heartbeat International in 2022, she found restriction of birth control to be a major theme, with several sessions dedicated to the topic.

The push to redefine the start of personhood as the point of conception holds real implications for fertility treatments and the wide range of available birth control methods. Many lawmakers in states with such “fetal personhood” laws on the books have not fully grappled with the practical consequences of how enforcing those laws in the post-Roe era might work.

In the near future, most Republicans will likely continue to dismiss the idea that there’s any threat to birth control at all, and leaders of anti-abortion organizations will surely do their best to change the subject.

But pay attention to how fights over expanding access to birth control — including nonhormonal methods like condoms — play out. Pay attention to proposals to gut funding for Title X, a federal program that provides birth control to millions of low-income people in the United States. Pay attention to efforts in Congress to restrict access to contraception in foreign aid spending bills. And pay attention to how courts and lawmakers aim to expand the definition of abortion.