IUD use attracts new opposition from anti-abortion groups

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(Reuters) -- A rapid increase in the number of U.S. women turning to intra-uterine devices to prevent pregnancy has prompted escalating attacks on the birth control method from groups that oppose abortion.

The next battle will be at the U.S. Supreme Court, which has agreed to consider a new religious challenge to contraceptives coverage under President Barack Obama's healthcare law. Although the case deals broadly with whether religiously affiliated groups should be exempt from providing birth control coverage to their employees, some parties in the case have focused specifically on IUDs.

IUDs work primarily by preventing sperm from reaching an egg. But they have come under fire from anti-abortion groups because, in rare instances, they can prevent a fertilized egg from implanting in the uterus. Those who believe that life begins at conception consider blocking implantation to be terminating a pregnancy rather than preventing pregnancy.

"IUDs are a life-ending device," said Mailee Smith, staff counsel for the Americans United for Life, which filed an amicus brief in support of the challenge before the high court. "The focus of these cases is that requiring any life-ending drug is in violation of the Religious Freedom Act."

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IUD use attracts new opposition from anti-abortion groups
WASHINGTON, DC - JANUARY 22: Activists participate in the 2016 March for Life January 22, 2016 in Washington, DC. The annual event marked the anniversary of the Supreme Court Roe v. Wade ruling in 1973. (Photo by Alex Wong/Getty Images)
Pro-abortion activists gather in front of the US Supreme Court in Washington, DC, 0n January 22, 2016 as the country marks the 43rd anniversary of the Roe v Wasde Supreme Court decision which legalized abortion. / AFP / Nicholas Kamm (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)
A young anti-abortion activist chants slogans during a march to the US Supreme Court in Washington, DC, 0n January 22, 2016 as the country marks the 43rd anniversary of the Roe v Wade Supreme Court decision which legalized abortion. / AFP / Nicholas Kamm (Photo credit should read NICHOLAS KAMM/AFP/Getty Images)
Anti-abortion demonstrators take part in a rally, Tuesday, Jan. 19, 2016, at the Capitol in Olympia, Wash. (AP Photo/Ted S. Warren)
An anti-abortion demonstrator holds a sign and a flower while cheering during a rally, Tuesday, Jan. 19, 2016, at the Capitol in Olympia, Wash. (AP Photo/Ted S. Warren)
WASHINGTON, DC - SEPTEMBER 21: Right to Life advocates pray during a sit-in in front of a proposed Planned Parenthood location while demonstrating the group's opposition to congressional funding of Planned Parenthood on September 21, 2015 in Washington, DC. The Right to Life groups who took part in the protest are also calling on Pope Francis to 'address the pro-life issue and the defunding of Planned Parenthood' when he addresses Congress on September 24. (Photo by Win McNamee/Getty Images)
MANHATTAN, NEW YORK CITY, UNITED STATES - 2015/08/22: Assembly of some 150 anti-abortion protesters behind barricade in front of Planned Parenthood. A coalition of anti-abortion protesters protested on Mott Street in Manhattan in front of Planned Parenthood. (Photo by Andy Katz/Pacific Press/LightRocket via Getty Images)
WASHINGTON, DC - JANUARY 22: U.S. Capitol Police stand guard after pro-choice activists blocked the street and temporarily stopped the annual March for Life in front of the U.S. Supreme Court January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - JANUARY 22: A pro-life activist holds a sign as he participates in the annual March for Life January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - JANUARY 22: Pro-choice activists shout slogans before the annual March for Life passes by the U.S. Supreme Court January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - JANUARY 22: Pro-life activists participate in the annual March for Life as they pass in front of the U.S. Capitol January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - JANUARY 22: Pro-life activists try to block pro-choice activists as the annual March for Life passes by in front of the U.S. Supreme Court January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - JANUARY 22: Pro-choice activists block the street and temporarily stop the annual March for Life in front of the U.S. Supreme Court January 22, 2015 in Washington, DC. Pro-life activists gathered in the nation's capital to mark the 1973 Supreme Court Roe v. Wade decision that legalized abortion. (Photo by Alex Wong/Getty Images)
A pro-choice activists holds a placard in front of the US Supreme Court in Washington, DC, January 22, 2015, as she and others await the pro-choice activists with the March For Life. Tens of thousands of Americans who oppose abortion are in Washington for the annual March for Life, marking the 42nd anniversary of the Supreme Court's Roe v. Wade decision. AFP PHOTO/JIM WATSON (Photo credit should read JIM WATSON/AFP/Getty Images)
Pro-choice activists block the road against US Capitol Police, who are escorting the March For Life's path, in front of the US Supreme Court in Washington, DC, January 22, 2015. Tens of thousands of Americans who oppose abortion are in Washington for the annual March for Life, marking the 42nd anniversary of the Supreme Court's Roe v. Wade decision. AFP PHOTO/JIM WATSON (Photo credit should read JIM WATSON/AFP/Getty Images)
A pro-choice activist is arrested and carried away by US Capitol police after blocking the road against the March For Life's path in front of the US Supreme Court in Washington, DC, January 22, 2015. Tens of thousands of Americans who oppose abortion are in Washington for the annual March for Life, marking the 42nd anniversary of the Supreme Court's Roe v. Wade decision. AFP PHOTO/JIM WATSON (Photo credit should read JIM WATSON/AFP/Getty Images)
WASHINGTON, DC - JANUARY 21: Anti-abortion advocates stage a 'die-in' protest at Lafayette Square near the White House January 21, 2015 in Washington, DC. In a written statement on Tuesday, the Obama administration denounced a GOP-backed bill that would ban abortions after 20 weeks and suggested the President would veto H. R. 36 - Pain-Capable Unborn Child Protection Act if the bill reached his desk. (Photo by Drew Angerer/Getty Images)
Anti-abortion activists take part in the annual 'March for Life' rally on January 22, 2015 in Washington DC. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
WASHINGTON, DC - JUNE 30: Anti-abortion advocates cheer in front of the Supreme Court after the decision in Burwell v. Hobby Lobby Stores was announced June 30, 2014 in Washington, DC. The high court ruled 5-4 that requiring family-owned corporations to pay for insurance coverage for contraception under the Affordable Care Act violated a federal law protecting religious freedom. (Photo by Chip Somodevilla/Getty Images)
WASHINGTON, DC - JUNE 26: Pro-life activists gather outside the U.S. Supreme Court June 26, 2014 in Washington, DC. The court overturned today a Massachusetts law barring protests within 35 feet of abortion clinics. (Photo by Win McNamee/Getty Images)
WASHINGTON, DC - JUNE 26: Pro-life activists gather outside the U.S. Supreme Court June 26, 2014 in Washington, DC. The court overturned today a Massachusetts law barring protests within 35 feet of abortion clinics. (Photo by Win McNamee/Getty Images)
Supporters of Women's Rights and LGBT groups protest across from the Beverly Hills Hotel, owned by the Sultan of Brunei, demanding he rescind a Taliban-like Brunei penal code which included the stoning to death of gay men and lesbians and the public flogging of women who have abortions, on May 5 2014 in Beverly Hills, California, before the arrival of Jay Leno who spoke in support of the groups. The southeast Asian nation of Brunei, a would-be member of the Obama administrations Trans Pacific Partnership (TPP) agreement, is under fire from Hollywood and human rights activists for adopting a brutal penal code based on Sharia law with punishments including flogging, dismemberment and death by stoning for crimes such as adultery and sodomy. AFP PHOTO / Frederic J. BROWN (Photo credit should read FREDERIC J. BROWN/AFP/Getty Images)
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IUD use among U.S. women using contraceptives grew to 10.3 percent in 2012 from 2 percent in 2002, according to the Guttmacher Institute, making them the fastest growing birth control method. Their popularity has grown as women recognized that newer versions of the device don't carry the same safety risks as a 1970s-era IUD known as the Dalkon Shield.

Now more than 10 percent of U.S. women using contraceptives use IUDs. Other forms of birth control, such as daily pills, are on the decline.

Obama's Affordable Care Act has also boosted the use of intrauterine devices. The law requires insurers to fully cover birth control, including the entire $800 to $1000 cost for insertion of an IUD.

Should the high court agree with the plaintiffs and rule that they are exempt from the coverage, IUDs could become much more costly for women who work at such organizations, some legal experts say. As many as 3.5 million people worked at public charities with religious affiliations, according to 2013 data from the National Center for Charitable Statistics at The Urban Institute.

Planned Parenthood, long a target from religious groups for providing access to abortions, has also become a significant source of the devices, with IUD use by its patients up 57 percent between 2009 and 2013.

ACCOMMODATION OR EXEMPTION

The Obama administration created an exemption for houses of worship and some related organizations that object to funding birth control for employees, but now other types of religiously affiliated groups want similar waivers.

In 2014, the Supreme Court accepted the position of Hobby Lobby, a chain of craft stores owned by religious Christians, ruling that private companies that are closely-controlled could opt out of contraception coverage based on the owners' beliefs.

Hobby Lobby, among other things, objected to birth control that could prevent "an embryo from implanting in the womb," including two types of IUDs, according to court documents.

The current high court case consolidates seven lawsuits filed by nonprofit groups with religious affiliations, such as a colleges and retirement homes run by nuns. The ruling could be applied to more than 100 similar lawsuits, potentially affecting hundreds of thousands of women, according to lawyers on both sides of the issue. Little Sisters of the Poor, one of the plaintiffs, for example has more than 2,000 employees.

The Obama administration has already allowed such nonprofit groups an exemption from providing birth control coverage, but created an accommodation that would still guarantee benefits to their employees.

Under the accommodation, nonprofits are required to notify their insurers, plan administrators or the federal Department of Health and Human Services that they object to the coverage. The insurance plan then directly offers employees separate contraceptive coverage. Organizations that fail to give notice face fines.

The groups that filed the cases now before the Supreme Court, including Geneva College and Priests for Life, contend that the notification requirements violate the Religious Freedom Restoration Act of 1993, which says the government can't burden religious groups without a compelling reason.

Some of the organizations are challenging coverage for all forms of birth control while others focus only on methods that potentially interfere with fertilized eggs, including the so-called "morning-after pill" and IUDs.

Mark Rienzi, a lawyer with the Becket Fund for Religious Liberty, which represents the Little Sisters of the Poor, said that his clients feel that completing the paperwork would make them complicit in providing birth control. Filing for the accommodation would still trigger an offer of birth control coverage from an insurer, he said.

Houses of worship, he pointed out, do not need to complete paperwork or provide the coverage. "No one takes over their health plan and uses it to distribute the abortion-inducing drugs and contraceptives," he said.

No matter what happens next year at the Supreme Court, the battle over the IUD is likely to continue.

"The stakes are very high," said Aram Schvey, senior policy counsel at the Center for Reproductive Rights. "We know this kind of plan is effective. When people aren't burdened by cost, they choose more expensive, more dependable, longer-lasting contraceptives, like IUDs."

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