Contraception or Deception?     8/22/2002
By Elizabeth Bossom

Updated March 8, 2006

While many American women have never heard of the morning-after pill, those who are familiar with it are often vocal and passionate—whether they are advocates or critics.

Several female politicians, including Sen. Hillary Clinton (D-New York), want to use your tax money to promote this little-known but highly controversial pill. On the other hand, some nurses and pharmacists would rather lose their jobs than be forced to provide women and teenagers with the morning-after pill.

What is it about this tiny pill that causes such turmoil? The morning-after pill, also referred to as emergency contraception or postcoital contraception, is usually prescribed after sex with failed or no contraception. When taken within 72 hours of sexual intercourse, the morning-after pill is 75–85 percent effective in preventing conception or possibly ending an early pregnancy.

According to the American College of Obstetricians and Gynecologists (ACOG), “Use of emergency contraception could prevent as many as 1.5 million of the approximately 3 million unintended pregnancies that occur each year in the United States.”¹ However, many concerned medical professionals argue that this controversial product does not necessarily prevent pregnancy. They believe that, at least in some cases, it kills a developing embryo. And that would make it an abortifacient, a way to kill an unborn child.

Two products approved by the Food and Drug Administration are dedicated for use as morning-after pills, namely Preven and Plan B. Other methods of “emergency contraception” involve massive doses of regular birth control pills or insertion of an intrauterine device.²

PREVEN
Preven consists of 0.25 mg of levonorgestrel (synthetic progesterone) and 0.05 mg of ethinyl estradiol (synthetic estrogen). It is taken within 72 hours of intercourse. Then 12 hours later, the woman takes a second dose of the pills. Gynetics, the company that markets Preven, describes its product in the following manner:

Preven prevents pregnancy in the same way birth control pills prevent pregnancy because Preven is a special dose of birth control pills. Preven can stop or delay ovulation (the release of an egg), it can stop sperm from fertilizing an egg if it was already released, and it can stop a fertilized egg from attaching to the wall of the uterus. Because so much goes on in your body after sex and before you become pregnant, Preven has many opportunities to prevent pregnancy. You probably remember the cycle of events from health class in school. It takes quite a bit of time—anywhere from 8 to 10 days³—for pregnancy to occur after intercourse. Although an egg lives only 24 hours if it isn’t fertilized, sperm live longer and can fertilize eggs that are released several days after unprotected sex. The fertilized egg travels down the fallopian tube and enters the uterus. And, finally, the fertilized egg must attach itself to the wall of the uterus before pregnancy occurs. If you can stop any one of these things from happening, you can prevent pregnancy. That’s where Preven comes in.⁴ [emphasis added]

PLAN B
Plan B, the other FDA-approved dedicated morning-after pill, simply contains levonorgestrel. The woman takes one tablet within 72 hours of intercourse and another tablet 12 hours later.⁵ According to the product’s developer, Women’s Capital Corporation:

The exact mechanism of action of Plan B is unknown. Levonorgestrel is believed to act as an emergency contraceptive principally by preventing ovulation or interfering with fertilization (by altering the tubal transport of sperm and/or ova). In addition, it may inhibit implantation by altering the endometrium. Plan B is not effective once implantation has begun. Once pregnancy is established, Plan B cannot interrupt the pregnancy or cause an abortion.⁶

DEFINING PREGNANCY
While both companies are quick to say that the morning-after pill will not end a pregnancy, it is helpful to understand what they define as “pregnancy.”

ACOG defines pregnancy as “the successful implantation of a fertilized egg,” and requires that several events occur to classify a pregnancy:

“For a woman to become pregnant, a series of events must happen over a period of about a week and a half, including: 1) she must ovulate 2) her egg must be fertilized by male sperm, and 3) the fertilized egg must implant itself into the lining of her uterus.”⁷

However, that third requirement, implantation in the uterus, is more a political construct than a scientific qualification. Embryologists have long believed that a pregnancy begins at fertilization, rather than implantation in the uterus. After fertilization, the tiny human being has all his or her genetic information. To address the myth that the “product of fertilization” is not a real human being, philosopher and biologist Dianne Irving wrote:

Scientifically, there is absolutely no question whatsoever that the immediate product of fertilization is a newly existing human being. A human zygote is a human being. It is not a “potential” or a “possible” human being. It’s an actual human being—with the potential to grow bigger and develop its capacities.⁸

Long before implantation, there is a real human being living inside the mother’s body.

THE MECHANISM
The morning-after pill affects a woman’s body in several ways. If taken before ovulation, it can sometimes prevent ovulation, so that the egg’s release is at least delayed and therefore not fertilized. According to the FDA, “Emergency contraceptive pills are thought to work primarily by delaying or prohibiting ovulation.”⁹

However, in cases where the egg has been fertilized before or despite the pill’s effect, many believe that the morning-after pill could work as an abortifacient (a drug that causes an abortion). Hormonal contraceptives thin the lining of the uterus. If the embryo fails to attach itself in the uterus and gain sustenance from the lining, then it will die. Some medical professionals believe that the morning-after pill can indeed make the lining inhospitable to the embryo, thus leading to the death of a newly conceived life.

The Alan Guttmacher Institute’s Family Planning Perspectives made this observation in 1995: “Emergency contraceptive pills, also known as morning-after pills, are a postcoital hormonal treatment that appears to inhibit implantation of the fertilized ovum.”¹⁰

Christian Medical and Dental Association Executive Director David Stevens, M.D., wrote:

If the woman has already ovulated before or at the time of intercourse, the pill prevents implantation. If the woman hasn’t ovulated, the pill can prevent ovulation from shortly after it is taken until there is no sperm present. Since the sperm is motile for less than 72 hours, if the “morning-after” pill is lowering the pregnancy rate from 72-120 hours, it is doing this by preventing implantation.

People are being deceived when they are told the pill is not an abortifacient. These pills do prevent a living human embryo from implanting. The deception is possible because pregnancy has been redefined as implantation of the embryo in the lining of the uterus. The “morning-after” pill propaganda turns the concept of informed consent on its head.¹¹

State Director Judy Smith of Concerned Women for America of Kansas, who is also a registered pharmacist, suggested that “often they [morning-after pills] cause abortions by creating a hostile environment within the uterus, preventing implantation, with the result that the embryo cannot obtain nutrients and dies.”¹²

Definitively proving that fertilized eggs cannot implant is extremely difficult. To do so, it must be scientifically determined that a number of variables have transpired: a woman has ovulated, the egg has been fertilized by sperm, but it was unable to implant because of the morning-after pill.

In fact, some doctors do not believe that hormonal contraceptives turn the endometrium lining into a “hostile environment” for the growing embryo. Several pro-life obstetricians and gynecologists, who believe that “fertilization, not implantation, marks the beginning of human life” and who also agree that “disruption of the fertilized egg represents abortion,” wrote about a problem they see with the “hostile endometrium” theory.

Doctors agree that the uterine lining is generally thinner in women who have taken hormonal contraceptives than in women who have not. However, these physicians argue that the measurements from those who take hormonal contraceptives often come from the uterine linings of women who have not ovulated. When a woman does ovulate, her body produces “10 to 20 times the level of both estrogen and progesterone.” Furthermore, “these high levels act on the lining ... to prepare it for implantation and support of the arriving (via the fallopian tube) living embryo.”¹³ During the days between ovulation and implantation, the body is preparing itself for implantation:

It is highly probable that the so-called “hostile to implantation” endometrium—heralded (without proof) from the beginning by the “pill”-producing companies, echoed (without investigation) by two generations of scientific writers, and now adopted (as a scientific fact) by some sincere prolife advocates—simply does not exist six days after ovulation in a pill cycle.¹⁴

These doctors suggest further research and add, “If scientific study should validate that a hormonal contraceptive agent is partly abortifacient in its action, we would oppose that agent just as we oppose elective medical and surgical abortions.”¹⁵

Two other doctors, who researched the postfertilization effects of hormonal contraceptives and published the findings in the American Medical Association’s Archives of Family Medicine, determined that the evidence suggested that there are postfertilization effects at least some of the time. However, both doctors observed that very few patients were aware of the possibility.¹⁶ They firmly believe that women should be given enough information to make an informed decision about whether they wish to use the morning-after pill.

THE MARKET
Aside from the morning-after pills’ abortifacient potential, the strategy used to market it is of great concern. In the United States, teenagers are able to get a prescription for the morning-after pill without parental knowledge or consent at Planned Parenthood or other “family planning” clinics.

Is it morally justifiable to market the morning-after pill to minors?

The marketers of Plan B developed ads to be placed in college newspapers and hung on dorm room walls. One ad featured a shirtless male model and the following text:

Of all the things you’d love to hear him whisper in your ear, “Oops—the rubber broke” isn’t one of them. Condoms, like men, aren’t perfect. Unfortunately a condom’s imperfections aren’t cute or lovable. … Find out how morning-after contraception, taken within 72 hours after intercourse, can be your back-up plan in preventing pregnancy. ACCIDENTS HAPPEN. That’s why there’s morning-after contraception.¹⁷

Abortion promoters realize that if they can attract a young woman, they may have a client for life. National Abortion and Reproductive Rights Action League (NARAL), the self-proclaimed “political arm of the pro-choice movement,” described it this way:

The need for emergency contraception can bring women, and young women in particular, into the family planning centers, where they can receive other health care services and counseling. For those who remain sexually active, emergency contraception provides a bridge to ongoing contraception and disease prevention.¹⁸

What disease prevention? Promotions of the morning-after pill acknowledge the faults of condoms, the only tool “family planning” agencies tout for disease prevention. The morning-after pill provides no protection from any of the 25 (at least) known sexually transmitted diseases, including HIV, human papillomavirus, chlamydia, herpes, gonorrhea, genital warts, syphilis and hepatitis B.

Reviews of 16 recent print advertisements for “emergency contraceptives” show zero references to the lack of protection from sexually transmitted diseases.¹⁹

Teenagers, the target audience of many “emergency contraception” advertisements, are notoriously worried about pregnancy but may have very little knowledge about diseases contracted by sexual activity. “Family planning” groups need to do more to convey the seriousness and prevalence of STDs. To prey upon or perpetuate that ignorance does America’s children a grave disservice.

In England, where use of the morning-after pill is more widespread than in the United States, 40 percent of users are under the age of 20.²⁰ It is not far-fetched to believe that, in future years, the youth of the United States could follow a similar pattern if the morning-after pill is more widely marketed. Even the American Civil Liberties Union of Hawaii acknowledges that teenagers are prime targets for the morning-after pill, saying, “Research shows that this (minors) is the very population who may use contraception sporadically or incorrectly and thus may need emergency contraception even more than older women.”²¹

Meanwhile, in the United States, sexually active teenagers face what the Centers for Disease Control and Prevention calls an “epidemic of STDs.”²² The majority of new infections each year occur among young men and women in their teens.

RIGHTS OF CONSCIENCE
Five California nurses quit their jobs in a county health clinic in the summer of 1999 when they were asked to sign a pledge to dispense the morning-after pill to clients.²³ A sixth nurse, Michelle Diaz, did not want personally to dispense the morning-after pill, and she expected to be reassigned.²⁴ Diaz spoke to the press about her position and was fired shortly thereafter. In May of 2002, a U.S. District Court jury found that the county was liable for violating Diaz’ right to free speech and her right to freedom of religion. The jury said that the county also failed to reasonably accommodate Diaz’s religious beliefs.²⁵

Although Diaz won her case almost three years after being fired, there are hospitals, clinics and pharmacies across the country that fail to respect the conscientious objections of employees. Many health care professionals are ethically opposed to prescribing and dispensing the morning-after pill. Should a nurse who has devoted herself to helping patients be forced to dispense a drug she believes is harmful?

About half the states have laws that provide some form of protection for health care professionals who conscientiously object to providing the morning-after pill.²⁶ Several other states are considering legislation that would protect health care workers who do not want to offer the morning-after pill. Planned Parenthood and other pro-abortion organizations notoriously oppose these conscience exceptions, saying women in rural areas would be denied service if local health-care providers objected to the morning-after pill.

Not surprisingly, Preven provides a ready-made letter on its Web site for readers to send to congressmen. The letter says:

I am writing to urge you to reject legislation allowing exemption clauses, often termed ‘conscience clauses.’ … These exemption clauses allow these professionals to refuse to provide medically needed treatments, such as contraception, abortion services or sterilization, because they conflict with the provider’s religious beliefs.²⁷

However, this argument is deceptive because abortion services are rarely if ever “medically needed treatments.” It is extremely rare for a woman to have an abortion for physical health reasons. Pregnancy is not a disease that needs “treatment,” and morning-after pills do not provide any health benefits.

MAKING THE MORNING-AFTER PILL ACCESSIBLE
Currently, ACOG urges doctors to prescribe the morning-after pill ahead of time, so that women have a “just-in-case” dose of the pills readily available in their medicine closets.

Abortion providers would like even fewer restrictions on the availability of “emergency contraception.” In most states, the prescription, as with all birth control pills, must come from a doctor. In 2001, a group of organizations, including NARAL and the American Medical Association, requested that the FDA drop this safety requirement.²⁸

“The American Medical Association is now pushing to make emergency contraception an over-the-counter product, like Tylenol or Sudafed,” wrote Janelle Brown in a feature for Salon.com magazine.²⁹

Not everyone is comfortable with the thought of women getting the pills without seeing a doctor. Dr. John Diggs, spokesman for the Consortium of State Physician Resource Councils, says:

Other medical issues are ignored. If the cocktail is over-the-counter (available without a prescription), then there [is] no limit on how often the pills can be used. Consequently, some women will essentially be taking high-dose hormones regularly, which may increase the frequency of catastrophic side effects of these drugs—stroke, life-threatening blood clots.³⁰

However, the drug’s supporters didn’t give up. Women’s Capital Corporation, which created Plan B, and Plan B’s current owner, Barr Labs, petitioned the FDA to make the drug available without a prescription. In May of 2004, the FDA rejected the request because of inadequate information about the drug’s effects on adolescents.

In 2005, Barr Labs again approached the FDA, this time with a proposal to make Plan B available over-the-counter to only those over the age of 16. Younger teens would still require a prescription. The unprecedented request to make a drug available over-the-counter with an age restriction raised significant issues for the FDA: Did the agency have this authority and how could such a plan be enforced?

The FDA asked for comments from citizens on the issue. In the meantime, the FDA’s ruling making the pill available only with a prescription still stands, and pressure from abortion advocates continues.

TRAGEDY IN BRITAIN
In Great Britain, the morning-after pill is available without a prescription. In fact, in an effort to lower the teen birthrate, Britain has gone so far as to use public funds to enable women under 20 to walk into local pharmacies and pick up free doses of the morning-after pill.³¹ Meanwhile, The London Times reported an epidemic of sexually transmitted diseases among British teenagers, with skyrocketing diagnoses of the diseases among teens over a five-year period.³²

Throwing the morning-after pill at teenagers will never solve this problem. It is far less dangerous and more effective to share with teenagers the concept that sex is a wonderful experience for couples to share with each other when they have the security of matching wedding bands. How misguided that the British government should choose to fund a morally controversial program that fails to reduce adolescent sexual activity and sexually transmitted diseases.

In fact, more widespread marketing of “emergency contraception” could parallel an increase in sexually transmitted disease. One Plan B advertisement markets itself as the emergency contraception that “can keep accidents from complicating your life.”³³ Will adolescent girls take that to mean that emergency contraception provides widespread protection from any negative effects of sexual activity? If teens continue or increase sexual activity with the false hope that the morning-after pill is the perfect protection, it is only reasonable to expect that already high rates of sexually transmitted diseases will climb even higher. If a doctor’s prescription becomes no longer necessary, his or her opportunity to clear up misconceptions about the morning-after pill would simply be removed from the process.

MAKING IT POLITICAL
Here in America, pro-abortion organizations have launched several campaigns and created numerous television ads, magazine spreads, and posters to promote the morning-after pill. In the spring of 2002, a huge network of “reproductive rights” organizations banded together for a nationwide Back Up Your Birth Control campaign. Leading up to the campaign, the FDA lengthened the shelf lives of Preven and Plan B. A chief campaign goal was to encourage more women to keep handy doses of the morning-after pill in their medicine closets.

Participating organizations promoted the morning-after pill to the general public. For instance, Planned Parenthood treated Time magazine and Newsweek subscribers in Minnesota to ads that featured a woman’s tongue with a little pill nestled on it, and the headline, “The morning after, the morning after that, and the morning after that pill.”³⁴

In correlation with the campaign, Sen. Patty Murray (D-Washington) and Rep. Louise Slaughter (D-New York) introduced identical bills in the U.S. Congress in March 2002 that would grant up to $50 million in federal funds over a five-year period to promote the morning-after pill.³⁵ If the “Emergency Contraception Education Act” were to pass, the Secretary of Health and Human Services would be authorized to make unprecedented arrangements with nonprofit organizations like Planned Parenthood to educate the public about “emergency contraception.” Since Planned Parenthood sells the pills, they would basically be getting free advertising for their product. It would be just one more way for public funds to fill Planned Parenthood coffers.

RESPECT FOR YOUNG LIVES
Even though “reproductive rights” groups are hyping the morning-after pill, it still is not widely used by American women. Only 6 percent of American women in a 2003 Kaiser Family Foundation survey said that they had ever used “emergency contraceptive pills,” up from 2 percent in 2000. ”³⁶ But as marketers launch advertising campaigns that omit important information, more and more uninformed American women may make decisions they will regret when they learn the facts.

In cases where fertilization has already occurred, the morning-after pill could likely kill a developing embryo. When this is the case, serious ethical concerns arise. Sincere, upstanding citizens and health care providers who morally object to use of the morning-after pill should be free to abide by their convictions without threat of losing their livelihood.

Women have a right to know the controversy surrounding the morning-after pill so that they may make informed decisions. Concerned Women for America urges women to consider the facts and to make decisions that respect the lives of human beings, even in their earliest stages.

1. “A Closer Look at Emergency Contraception,” American College of Obstetricians and Gynecologists Fact Sheet, as found at www.acog.org/from_home/departments/dept_notice.cfm?recno=11&bulletin=1571.
2. This paper will focus on the two dedicated oral prescriptions, Preven and Plan B. However another method involves insertion by a doctor of a copper-T intrauterine device (IUD) after sex with failed or no contraception. According to the American Pharmaceutical Association, “Postcoital insertion of a copper-releasing intrauterine contraceptive device (IUD) is a highly effective but far less convenient method of emergency contraception. IUDs are available only through health care providers and must be inserted by a health care provider.” (Emergency Contraception: The Pharmacist’s Role, American Pharmaceutical Association Special Report, 2000, p.1.)
3. While implantation in the uterus may occur as early as 6 days after ovulation, most implantation occurs between 8 to 10 days after ovulation.
4. Frequently Asked Questions about Preven, as found at www.preven.com/prodinfo/faq_preven.asp#2.
5. “Product Information,” as found at www.go2planb.com/tools_for_pharmacists.
6. Manual for Health Care Providers, as found at www.go2planb.com.
7. “A Closer Look at Emergency Contraception.”
8. Dianne Irving, M.A., Ph.D., “When do Human Beings Begin? ‘Scientific’ Myths and Scientific Facts,” International Journal of Sociology and Social Policy 1999, 19:3/4:22-36, as found at www.physiciansforlife.ca/whendoes.html.
9. “FDA OKs Emergency Contraception for Use After Unprotected Sex,” FDA Consumer, Volume 32, Number 6,(November-December 1998).
10. C. Harper and C. Ellertson, “Knowledge and Perceptions of Emergency Contraceptive Pills Among a College-Age Population: A Qualitative Approach,” Family Planning Perspectives, Vol. 27, No. 149, (July-August 1995).
11. “Pharmacists Dispense ‘Morning-After’ Pills,” News and Views, Vol. 1, No. 16, as found at www.cmdahome.org/index.cgi?cat=208&art=1057&BISKIT=2685894789&CONTEXT=art#PILLS.
12. Judy Smith, R.Ph., “Emergency Contraception Education Act,” Kansas Legislative Update, as found at www.states.cwfa.org/kansas/update/lu2002-04-01_c.shtml.
13. Susan Crockett, M.D., Donna Harrison, M.D., Joe DeCook, M.D., and Camilla Hersh, M.D., “Hormone Contraceptives Controversies and Clarifications,” April 1999, as found at www.aaplog.org/decook.htm.
14. Ibid.
15. Ibid.
16. Walter Larimore, M.D., Joseph Stanford, M.D., “Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent,” Archives of Family Medicine, Vol. 9, No. 2, (February 2000).
17. “Love, Ernesto” poster, as found at www.sea.ddb.com/ia_portfolio_item.asp?id=185.
18. “Emergency Contraception: An Important and Underutilized Contraceptive Option,” (NARAL Foundation Fact Sheet, December 18, 2001), 1-2, as found at www.naral.org/mediaresources/fact/emergency.html.
19. Print ads from “Back Up Your Birth Control,” Planned Parenthood, Women’s Capital Corporation and Reproductive Health Technologies Project, as found at www.backupyourbirthcontrol.org/toolkit/pdf/Back-Up_Poster.pdf, www.plannedparenthood.org/ec/joan.html, www.plannedparenthood.org/action/postcard, www.sea.ddb.com/pop_file.asp?filename=LiveFiles/5/185/planb_ia_poster_lrg.jpg, and www.ecprinceton.edu/news/media/phone.jpg
20. Fiona Dawe and Howard Meltzer, “Contraception and Sexual Health, 1999,” (Office for National Statistics, London, 2001), 6.
21. Stephanie Healea, “Morning-After Pill Bill passed by State House,” Honolulu Starbulletin.com, March 14, 2002, as found at http://starbulletin.com/2002/03/14/news/story2.html.
22. “Tracking the Hidden Epidemics: Trends in STDs in the United States,” (Centers for Disease Control and Prevention, Biennial Report, 2000), as found at www.cdc.gov/nchstp/dstd/Stats_Trends/Trends2000.pdf.
23. “The Emergency Contraceptive Newsletter,” American Society for Emergency Contraception and Consortium for Emergency Contraception, Vol.4, No. 2, (Fall 1999).
24. “Five Nurses Quit Rather Than Agree to Dispense ‘Morning-After’ Pill,” Sacramento Bee, June 21, 1999, as found at www.morningafterpill.org/nurses.htm.
25. “ACLJ Wins Religious Discrimination Case Against California Health Agency Over ‘Morning-After Pill,” May 28, 2002, as found at www.aclj.org/news/pressreleases/020528_morning_after.asp.
26. NARAL Fact Sheet, 3, www.naral.org/mediaresources/fact/emergency.html.
27. Form letter, as found at www.preven.com/resources/campaign.asp.
28. NARAL Fact Sheet, 5, www.naral.org/mediaresources/fact/emergency.html.
29. Janelle Brown, “High-Noon for the Morning-After Pill,” Salon.com, June 20, 2001, as found at www.salon.com/mwt/feature/2001/06/20/pill/.
30. John R. Diggs, Jr., M.D., “Morning-After Pill Passed out like Antacids,” as found at www.prolife-mcfl.org/MorningAfterPillpassed.html.
31. Beth Gardiner, “Morning-After Pill Free to British Teens,” Associated Press, March 20, 2002.
32. Carol Midgley, “The Price of Casual Sex,” The London Times, January 29, 2002.
33. “So Many Men. So Many Reasons to Have Back-up Contraception” poster, as found at www.sea.ddb.com/ia_portfolio_item.asp?id=185.
34. “Emergency Contraception Campaign Aims To Reduce Unintended Pregnancies,” Planned Parenthood of MN/SD Press Release, St. Paul, Minnesota, March 19, 2002 as found at www.ppmsd.org/news/news.asp#ec.
35. H.R. 3887, in the 107^th Congress, as introduced on March 6, 2002, by Rep. Louise Slaughter, as found at www.thomas.loc.gov.
36. "Women's Health Care Providers' Experiences With Emergency Contraception," Survey Snapshot, June 2003, Kaiser Family Foundation, as found at http://www.kff.org/womenshealth/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=14300.

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