Emergency contraception (a.k.a. EC, ECP, "Morning After" Pill)

Does emergency contraception (EC)
reduce or increase the abortion rate?

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The debate:

Some public health organizations are publicizing the use of emergency contraception (EC). Among those sex-ed classes which do not follow the abstinence-only format, many mention EC it as an option in the case of unprotected sex, rape or contraceptive failure. Many health clinics at high schools, colleges, and universities are now publicizing and distributing EC to female students.

"The American College of Obstetricians and Gynecologists has urged its members to offer prescriptions for emergency contraception [in advance of need] during patients' regular checkups." ₁

As is usual in matters relating to abortion, opinions are hopelessly divided on whether EC increases or decreases the number of abortions. Pro-life and conservative Christian groups have conclusions which are totally opposite from those reached by pro-choice groups, religiously liberal groups, and medical organizations.

The conflict will never be resolved until both sides agree on their belief of when pregnancy begins, and whether EC interferes with implantation of the fertilized ovum -- a blastocyst -- in the wall of the uterus. This is very unlikely in the foreseeable future:

	The medical definition of the start of pregnancy has been in place for decades and is not likely to be changed.
	Pro-choice groups find the medical definition very useful because it might increase the acceptablility of IUDs as a form of emergency contraception among the general public. Also, if the public accepts the medical definition, then even if EC is eventually found to occasionally interfere with the implantation of the blastocyst, the public's acceptability of EC would not decrease much.
	Pro-life groups find their own definition very helpful to their cause because it if eventually shown that EC can interfere with implantation, it results in the apparent increase in the number of abortions through the use of EC. This, in turn, raises public opposition to EC.
	Medical research has determined that it is almost certain that EC cannot interfere with implantation. In fact, it may be impossible.
	Pro-life groups generally reject this finding. Many believe that EC can interfere with implantantation; some believe that this is the main or only mechanism by which it operates.

Pro-life view: EC increases abortions:

Family Research Council (FRC) is one of the leading fundamentalist Christian organizations. They frequently describe themselves as being "pro-family." They promote pre-marital abstinence, restrictions on abortion access, prevention of same-sex marriage, and reduced civil rights for gays and lesbians.  Back in 2002, in one of their Washington Update reports called "Truth in Labeling," and in their article titled "Little Pills: Targeting Youth with New Abortion Drugs," the FRC describes, correctly, how EC can prevent ovulation, or prevent conception. However, they also state that EC can prevent implantation of the blastocyst -- an fertilized ovum -- in the uterine wall. _2,3 Medical researchers later concluded that this third effect is extremely unlikely or impossible.

The FRC indicates that "two percent of women said they used the morning after pill." It is not clear to what group of women they are referring. If we assume that a random sampling of all of the approximately 70 million American women in their of fertile years were involved, then this survey concluded that about 1.4 million women admitted to have taken EC by the time of the survey. Such a poll involves very personal questioning. In all probability, the actual number of users of EC is much higher -- say three million, because many women would be reluctant to discuss such a matter with an anonymous stranger. The chance of a pregnancy resulting from unprotected sex ranges from about 1% to 8%, depending upon when in the menstrual cycle the intercourse took place. A commonly accepted average is one chance in 50 or 2%. Thus, about 60,000 pregnancies were probably impacted by the use of EC. The medication is believed to be about 85% effective if taken within a day or two after unprotected intercourse. That is, 85% of the pregnancies that would have occurred without the use of Emergency Contraceptive Pills would not have occurred. Thus, EC has prevented about 50,000 pregnancies from proceeding prior to the survey. This number appears to have increased rapidly as more women become aware of the existence of EC.

Conception can happen a few days after unprotected intercourse. This would give the woman time to take EC and either prevent ovulation or conception. But, in rare instances, conception can occur within a few hours of unprotected intercourse. Thus, it is quite feasible for conception to have already taken place before the woman had an opportunity to take emergency contraception. In this latter case, research has since shown that there is a very small or even zero possibility if any that EC might interfere with implantation. However, most pro-life groups reject this finding.

Since FRC and most other pro-life groups define pregnancy as beginning at conception, and they believe that the use of EC can interrupt pregnancy by preventing the implantation in the wall of the uterus, then they believe that in a certain percentage of cases, conception will begin, the EC will prevent implantation by acting as an abortifacient. Thus a certain percentage of the 50,000 uses of EC would actually induce an abortion. Thus, the true abortion count, would have been increased by some fraction of 50,000.

This calculation is only valid if one accepts the pro-life belief that EC is capable of preventing implantation. However, as noted above, it appears that there is little or no chance that EC can interfere with implantation. If you accept this finding, then EC becomes a form of birth control and not an abortifacient. The true abortion count would not increase.

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The pro-choice and medical view: EC reduces abortions:

Information sources provided by pro-choice, religious liberal and medical organizations state that EC prevents unwanted pregnancies and thus avoids the need for many abortions. The EC web site at  Princeton University states that the:

"...use of emergency contraception does not cause an abortion. In fact, emergency contraception prevents pregnancy and thereby reduces the need for induced abortion. Medical science defines the beginning of pregnancy as the implantation of a fertilized egg in the lining of a woman's uterus. Implantation begins five to seven days after fertilization (and is completed several days later). Emergency contraceptives work before implantation and not after a woman is already pregnant. When a woman is already pregnant, emergency contraception does not work. Emergency contraception is also harmless to the fetus and the mother." ₅

Subsequent medical research shows that it is nearly certain or impossible for EC to interfere with implantation.

The Alan Guttmacher Institute estimates that there are about 6.3 million unintended pregnancies each year in the U.S. ₆ The FDA predicted that if doctors and women adopt EC, then up to 2.3 million of these pregnancies could be prevented. Since about 40% of unwanted pregnancies are terminated by abortion, the use of EC would eliminate the need for almost one million abortions per year. This would reduce the level of abortions to a small fraction of their present levels. A conference in India indicated that ECP could make a major impact at reducing that country's 11 million legal and illegal abortions each year. ₇

References:

1. Lawrence Morahan, " 'Morning-After' Pill Available at Some DoD Clinics," CNSNews.com, 2002-JUN-3, at: http://www.cnsnews.com/ViewPentagon
2. "Truth in Labeling," Family Research Council, Washington Update, 2002-DEC-18.
3. "Little Pills: Targeting Youth with New Abortion Drugs," Family Research Council. Online at: http://www.frc.org/
4. "Sexuality Education: Counseling and Health Questions and Answers," at: http://www.princeton.edu/
5. "Emergency contraception website," Princeton University, at: http://ec.princeton.edu/
6. Julie Severens Lyons, "Law makes morning-after pill available without prescription: Pharmacies will be able to dispense emergency contraceptives," The Mercury News, 2001-OCT-16, was at: http://www0.mercurycenter.com/
7. Report of a national meeting on emergency contraception held in Lucknow, India in 1996-DEC, was at: http://www.path.org/

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Copyright © 2002 to 2013 by Ontario Consultants on Religious Tolerance
Originally written: 2002-DEC-19
Latest update: 2013-MAY-12
Author: B.A. Robinson

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