The reaction to the leaked draft was immediate and last month sociologist Carol Joffe, author of Doctors of Conscience, wrote about the commonsense objection of medical professionals and abortion rights advocates to the HHS move: that after eight years of Bush administration attempts to curtail abortion rights, they now propose a policy "that virtually assures there will be more abortions" by making it more difficult to obtain the contraception that will prevent unwanted pregnancies. "The proposal," Joffe wrote, "very cleverly speaks to two main policy objectives of the Religious Right: to change the cultural – as well as bureaucratic – understanding of contraception, and to further the cause of 'health worker refusals' – the growing movement of individuals who withhold access to various medications and procedures with which they have political disagreement."

In response to the public outcry from reproductive rights advocates, the official proposal was subsequently revised, though the alterations merely omitted the sections that defined birth control as abortion without substituting a more medically-recognized definition of abortion and pregnancy, meaning that individual health care entities would still be free to define birth control as abortion. HHS Secretary Mike Leavitt further denied on his blog that he intended the regulations to concern contraception or abortion but merely the issue of "the legal right medical practitioners have to practice according to their conscience and patients should be able to choose a doctor who has beliefs like his or hers." Not even his anticontraception supporters believe the turnaround, though. The Family Research Council, the political arm of James Dobson's Focus on the Family, spurred its followers to battle this week with an action alert to lobby the HHS in support of the new regulations, and in particular, to urge that the regulations apply to contraception. The FRC's pre-written form letter for the HHS specifically charges the department to cover the "reasonable beliefs" of antiabortion health care workers who think "that the destruction of that life, whether before or after implantation, constitutes an abortion." "At the very least," they write, "the regulations should specifically protect the conscience of an individual or organization which believes a given practice is an abortion because it involves the taking of human life from fertilization to birth."

These claims of equivalency between contraception and abortion have been a long time in the making among contemporary religious right activists. The recent eruption of their claims onto the public stage, helped along by an aggressively anti-choice administration, is the culmination of grassroots work begun in the early 1980s among fundamentalist and evangelical Christian activists, particularly in the homeschooling movement, who developed a pronatalist theological movement that came to be known as the Quiverfull conviction.

Homeschooling advocate Mary Pride was one of the first prominent proponents of this conviction, which argues that Christian families – particularly women – should eschew all birth control and accept every pregnancy and child as an unconditional blessing from God. "Family planning is the mother of abortion," writes Pride, in a book, The Way Home: Beyond Feminism, Back to Reality, that became a bible for the movement. "A generation had to be indoctrinated in the ideal of planning children around personal convenience," Pride writes, "before abortion could be popular."

From these explicitly ideological, antifeminist roots, a number of anticontraception groups and movements were born. Homeschoolers reading such arguments in the various publications of Pride and her fellow pronatalist advocates, including Michael Farris, Chair of the Homeschool Legal Defense Association and Chancellor of Patrick Henry College, and Bill Gothard, founder of the Institute of Biblical Principles, began having families of 8, 10, 12 and 14 children. "Paleo-conservative" think tanks such as the Howard Center began directing their energies at pronatalist national policies that would encourage larger families through the tax code and discouraging women working outside the home. And in the medical sphere, a number of evangelical and Mormon medical workers aligned themselves with prolife Catholics to expand traditionally Catholic refusal clauses on a number of different levels, broadening both the nature of the entity that could refuse to participate in "objectionable" procedures (or treat gay and lesbian patients) as well as the nature of what sorts of services could be deemed objectionable. In a dramatic shift from protecting a religious doctor who does not want to perform abortions, the new regulations would cover attendants who don't wish to handle instruments used in the procedures, nurses who don't wish to assist patients with reproductive healthcare, ambulance drivers who don't want to transport abortion patients, and pharmacists who don't want to refer women to other pharmacies to fill their birth control prescriptions. In all this could affect 584,294 separate health care entities, including schools, residency programs, labs, nursing homes, insurance carriers and grant award programs.

The overlap between such policy-oriented pronatalist professionals and the grassroots Quiverfull activists isn't just ideological. Groups ostensibly concerned with protecting medical workers' right to conscientious objection, such as Pharmacists for Life and the American Association of Pro-Life Obstetricians and Gynecologists, have paired with groups such as the Howard Center and its World Congress of Families to fight the "contraceptive mentality" – meaning the ethos of family planning and women's bodily self-determination – both by curtailing the availability of contraception and promoting "Great Families" and "Fruitful Families," where the parents are open to having as many children as they can as gifts from God. How this religiously-motivated position gets translated into public policy is surprisingly direct in these days of faith-based government. As Steve Mosher, president of the far-right Population Research Institute (an instrumental force in cutting of funding to the United Nations Population Fund for the past 7 years), told me, the United States has no business promoting family planning to developing nations women because the government, when involving itself in matters of reproduction, must always "err on the side of caution" when it comes to the beginning of life. Now that this comprehensive anti-choice position has seemingly been embraced by the HHS, medical establishments may be forced to "err" on the side of the religious far right and abandon the long-recognized definitions and standards of their own practice when it comes not just to the beginnings of life, but also to the care of their patients.