The Abortion-After Pill
Why "Emergency Contraceptives" Are Misnamed
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NEW YORK, FEB. 9, 2002 (Zenit.org).- The Church has a long history of helping refugees, including active cooperation with the United Nations in this field. But in recent years the two have clashed over U.N. use of the morning-after pill.
The United Nations argues that this pill is not abortive, while the Church and many medical authorities insist that it can be.
Newly published evidence supports the position that so-called emergency contraceptives do, in fact, have an abortive effect. One example is an article in the March issue of The Annals of Pharmacotherapy, entitled "Postfertilization Effect of Hormonal Emergency Contraception" and written by Chris Kahlenborn, MD; Joseph B. Stanford, MD, MSPH; and Walter L. Larimore, MD.
In the article, the authors note that defenders of emergency contraception claim that this method is morally acceptable because, unlike the abortion-inducing drug mifepristone (RU-486), it prevents pregnancy rather than aborting an existing life.
In fact, the article provides evidence that "morning-after pill drug regimens may cause the death of a living embryo by blocking its attempts to attach inside the uterus."
The report notes that it has been widely assumed that the ingredients in morning-after pills work mainly by preventing ovulation. But the authors describe how the drugs sometimes fail to prevent ovulation and rely instead on an after-fertilization effect, causing abortion of the newly formed embryonic life.
Examining one of the methods, the Yuzpe regimen, the study observes that even under "highly optimistic" assumptions, the abortive effect of the pill could account for "13-38% of the estimated effectiveness."
The article points out that regardless of the personal beliefs of the physician or drug provider, it is important that patients have information relevant to their own beliefs and value systems. Hence, failure to mention to a woman that a drug could induce the death of an embryonic life within her, would amount to a lack of informed consent.
In February 2000, the Archives of Family Medicine published another article by Dr. Larimore, entitled "Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent." Larimore examined the abortive effects of contraceptives in general and found that the morning-after pill does not differ radically from daily contraceptives: Its main difference is that it involves a single, larger dose of the same substances.
The article notes: "The primary mechanism of oral contraceptives is to inhibit ovulation, but this mechanism is not always operative." Given that ovulation does sometimes occur, contraceptives are designed to have secondary effects that take place after fertilization of the ovum -- notably, the prevention of implantation in the uterus. "Good evidence exists to support the hypothesis that the effectiveness of oral contraceptives depends to some degree on postfertilization effects," Larimore writes.
This finding was echoed, in effect, by Dr. Felicia Stewart, co-director of the Center for Reproductive Health Research and Policy at the University of California-San Francisco.
When California last year approved the sale of the morning-after pill without a doctor´s prescription, Stewart announced that in some cases these pills "may also prevent pregnancy by keeping a newly fertilized egg from implanting in a woman´s uterus," the San Jose Mercury News reported Oct. 16.
The United Nations readily admits this too. A 1998 publication of the U.N. Population Fund, "Reproductive Health Services in Crisis Situations," contains a report written by two doctors of the British Faculty of Family Planning and Reproductive Health Care of the Royal College of Obstetricians and Gynecologists.
In "Recommendations for Clinical Practice: Emergency Contraception," the physicians, Ali Kubba and Chris Wilkinson, describe how the pills work and how they affect the uterus. The emergency pill produces changes in "the endometrium, making it unsuitable for a fertilized ovum to implant," they write.
The article also observes that the intrauterine device has the same effect on the endometrium. IUDs form part of the reproductive health kit distributed to refugees by the United Nations.
Death of an embryo
U.N. officials deny that the emergency contraceptives are abortive, saying that preventing implantation of a fertilized ovum is not abortion. However, as the Annals of Pharmacotherapy clearly points out, preventing implantation causes the death of a living embryo. Such an action is undeniably abortive, however it is labeled.
The U.S. Conference of Catholic Bishops issued a declaration last May 2 concerning the morning-after pill. "American women are being misled: This drug will act as an abortifacient, after fertilization has already occurred," said Cathleen Cleaver, spokeswoman for the bishops´ pro-life activities office.
An October 1998 document of the bishops´ conference, "Emergency ´Contraception´ and Early Abortion," notes how the U.S. Food and Drug Administration admits that morning-after pills "act by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation)."
The bishops´ document also quotes Brown University associate professor of medicine Ralph Miech. "This type of pill causes an abortion," he wrote in the Providence Journal newspaper on Aug. 3, 1998. "From a pharmacologic perspective, this type of pill should be called an ´abortion-after pill.´"
This position is supported in a statement made by Canadian Physicians for Life. The group notes that the description of the morning-after pill as emergency contraception "fails to accurately describe its abortifacient action and is misleading the public. The confusion is aggravated by the current attempt to redefine pregnancy as occurring after implantation. It is a basic fact of human embryology that life begins at conception."
The Church and the U.N.
Last Sept. 14, three pontifical councils (for health care workers; migrants and travelers; and the family) published a note to guide the bishops´ conferences, "The Reproductive Health of Refugees." The document notes that, among the organizations the Holy See cooperates with to help refugees, "the United Nations occupies a special place of importance."
But the declaration expressed profound concern about the U.N. "Inter-Agency Field Manual on Reproductive Health in Refugee Situations." The manual "contains negative values that offend the dignity of the poorest and most vulnerable populations, with proposals to restrict the birthrate, an irresponsible concept of sexual relations, and even abortion," declared the pontifical councils.
The note observes that, in the U.N. manual, "No attention is paid to the culture and the religion of the refugees." Moreover, "The Manual is guided by what we can define as a utilitarian or neo-Malthusian approach."
Regarding the morning-after pill, the document describes how the World Health Organization has tried to deny the human status of the embryo during its first days of life by terming it a "pre-embryo." The pontifical councils dismiss this as "a sophism because such a label does not correspond to the precise biological reality."
The note also criticizes the manual for treating lightly the matter of sterilization, describing it as simply "contraception," when it is, in fact, a radical measure that eliminates all possibility of future procreation. While the United Nations does immensely good work for refugees, its promotion of contraception, abortion and sterilization all too often offends the dignity of the very people it aims to serve.