Emergency Contraception (EC)
Part 2: Can EC and regular hormonal
pills prevent implantation
in the uterine wall? In other words,
is it contraceptive or abortifacient?
Can EC prevent implantation of a blastocyst?
The answer is a definite yes and no, depending upon whose expertise one draws.
YES: William Cardinal Levanda, Prefect of the Congregation for the Doctrine of the Faith, issued "Instruction Dignitas Personae on certain bioethical questions" on 2008-DEC-08.
Section 23 of the document covers "New forms of interception and contragestation." The document identifies in its footnote 43 that "... the IUD (intrauterine device) and the so-called 'morning-after pills' are the best known interceptive methods." Levanda states as a fact that one of the ways in which emergency contraceptive "certainly" works is as an interception agent that prevents implantation. Since the Church teaches that pregnancy and a human person both begin at the time of conception, preventing implantation kills a human being. The document condemned EC as a type of abortion and thus "gravely immoral."
The document states:
"Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall.¬ Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted."
"In order to promote wider use of interceptive methods, it is sometimes stated that the way in which they function is not sufficiently understood.¬ It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used, also because conception does not occur after every act of sexual intercourse.¬ It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. ..."
"As is known, abortion is 'the deliberate and direct killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth.' Therefore, the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral.¬ Furthermore, when there is certainty that an abortion has resulted, there are serious penalties in canon law."
Unfortunately, Levanda does not give any research findings that support his assertion that "the effect of inhibiting implantation is certainly present."
In the vast majority of cases, it seems obvious that women who take EC are hoping and expecting that it will prevent ovulation or prevent conception. They do not expect to induce an abortion.
NO: William Saletan who writes for Slate.com analyzed Cardinal Levanda's document. 1 Saletan wrote in 2009:
Saletan commented on whether women who seek to prevent the implantation of an embryo generally intends to have an abortion. Saletan suggests that it would be irrational for her to seek that because there is no evidence that suggests that it could happen. There is a much higher probability that a woman would be seeking to avoid ovulation or prevent conception.
"Is the effect of inhibiting implantation 'certainly present'? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this 'interceptive' is chemically identical to the best-known contraceptive: the pill. And the risk that this drug will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation."
"So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. 2 The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:"
'Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation'." 2
'Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation'."
"So, in summary:
'[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events'." 1
"The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience." 1
In another article, 3 he refers to an paper written by physicians at the Catholic Pontifical University of Chile -- of all places. 4 It shows how breast feeding an infant protects women from becoming quickly pregnant again soon after having given birth in the same way as EC does. He wonders whether the Church will want to stamp out breast feeding as well.
Recently, medical researchers have concluded that the medication prevents pregnancy only by preventing ovulation or conception. For example, the Emergency Contraception Website, at Princeton University and the Association of Reproductive Health Professionals state:
"There is no evidence to suggest that either of the FDA-approved emergency contraceptive options ... works after an egg is fertilized." 5
Signs of changes in belief:
2012-MAR: The International Federation of Gynecology and Obstetrics declared that Plan B does not inhibit implantation. Rather, it blocks fertilization. 6
2012-JUN: Pam Belluck, writing for the New York Times, said:
"Based on the belief that a fertilized egg is a person, some religious groups and conservative politicians say disrupting a fertilized egg‚s ability to attach to the uterus is abortion, 'the moral equivalent of homicide,' as Dr. Donna Harrison, who directs research for the American Association of Pro-life Obstetricians and Gynecologists, put it. Mitt Romney recently called emergency contraceptives 'abortive pills.' And two former Republican presidential candidates, Newt Gingrich and Rick Santorum, have made similar statements.
But an examination by The New York Times has found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.
It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents‚ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos." 7
2013-FEB: The Catholic bishops in Germany cited research into the mechanisms by which EC works, and decided to drop their opposition to the use of the morning-after pills in Catholic hospitals for victims of rape. 6
Who is right?
Catholic women who follow the teachings of their church are in a lose-lose situation with regard to the use of EC. If it acts only as a contraceptive, as all available evidence seems to indicate, then the church forbids them to use it. If it can sometimes act to discourage implantation, then the woman is regarded as having committed an even more serious sin, equivalent to having an abortion which the church considers a form of murder.
It would appear that there is essentially no chance that EC actually inhibits implantation. There is some suggestion, as noted above, that it may enhance implantation. So, it would seem that women who believe that regular birth control is ethically acceptable might be able to accept emergency contraception as ethical with a clear conscience.
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
William Saletan, "Coitus Interceptus," Slate magazine, 2009-JAN-05, at: http://www.slate.com
Frank Davidoff, James Trussell, "Plan B and the politics of doubt," Journal of the American Medical Association," 2006-AUG-24, at: http://jama.ama-assn.org/
William Saletan, "Where the rubber meets Roe," Slate, 2006-SEP-30, at: http://www.slate.com/
S. Diax, et al., "Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women," Pub Med, 1992-SEP, at: http://www.ncbi.nlm.nih.gov/
"How emergency contraception works: How does emergency contraception prevent pregnancy?," Princeton University, at: http://ec.princeton.edu/
- Ruth Moon, "Murky Plan b: The morning after pill may not cause abortion." Christianity Today, 2013-MAY, Page 15.
Pam Belluck, "Abortion Qualms on Morning-After Pill May Be Unfounded," New York Times, 2012-JUN-05, at: http://www.nytimes.com/
Copyright © 2010 to 2014, by Ontario Consultants on
Originally published on 2010-JUN-19
Latest update: 2014-JUL-01
Author: B.A. Robinson