So You Think You Know How the Morning After Pill Works?

So did I. Stay with me to the end, I argue that we reject any use or further testing of the morning after pill (MAP) completely.

Here is what I thought I knew.

The Luteinizing hormone (LH) in the female menstrual cycle precedes ovulation by about a day. It is the pink line with a spike in the graph shown here. If the MAP is taken too soon before the LH surge, it has no effect. If the MAP is taken just before that, it can stop the LH surge and thereby prevent ovulation. If it is taken during or after the surge, it probably will not stop ovulation but it may or may not interfere with implantation of an embryo should the ovum become fertilized by sperm. If it is taken after implantation, it has no effect.

Thus, the MAP is morally illicit for married couples because it is contraception. It is considered by some to be morally licit only 1) in the case of rape, and 2) if it is taken just before the LH surge to prevent ovulation. It is illicit to give it to a rape victim during or after the LH surge because there is a risk that the pill will cause the death of an embryo by inhibiting implantation, which is a chemically-induced abortion. Is that what you thought too?

This understanding is consistent with the guidelines outlined in the Pennsylvania Catholic Conference Guidelines for Catholic Hospitals Treating Victims of Sexual Assault from 1998.It is consistent with the United States Conference of Catholic Bishops (USCCB) position issued in the 2001 Ethical and Religious Directives for Catholic Health Care Services, number 36. It seems to be consistent with the recent decision of the German Bishops Conference to allow the MAP which was praised by the President of the Pontifical Academy for Life.

But it does not seem consistent with what the scientists and doctors are saying.

Some Catholic medical professionals warn that there is no MAP that will not affect implantation and that in about half the cases chemically-induced abortions result. Other Catholic professionals explain that it is possible to know whether the MAP will cause an early chemical abortion by determining if a woman is ovulating, and they describe tests to do this. But who is correct? There are still questions unanswered.

What happens if the pill is taken at the right time, but ovulation occurs anyway? If the MAP only prevents ovulation 50-60% of the time, does the pill then interfere with implantation if fertilization occurs? This would also be a chemically-induced abortion, right?

Or what happens if the pill is given during the LH surge accidentally? Hormone fluctuations vary for a woman, and vary even more from one woman to the next. What happens if the MAP is taken slightly after the LH surge? Will the MAP interfere with implantation in that case?

There have been studies to answer these questions, but the results vary. This is a good point to make note of something important but rarely discussed: The only way to definitively get these answers is to intentionally test on human subjects knowing that the test may kill them. That is immoral.

The pro-MAP medical professionals who have already done testing do not add any clarity to the questions either. The opinion that seems to be the longest held is that MAPs probably reduce the incidence of fertilized eggs that do not implant. Some say there is no proof that implantation is inhibited, but they concede that in theory it could be. Established forms of emergency contraception, such as the Yuzpe regimen which uses large doses of both estrogen and progestin and the copper-releasing intrauterine devices (IUDs) are long known to inhibit implantation. Less is known about other forms, such as Plan B (progestogen only) and Ella (ulipristal acetate, a chemical cousin of mifepristone). The Plan B manufacturer claims that it shouldn\’t affect or terminate an existing pregnancy. The Ella manufacturer claims that it may also work by preventing attachment to the uterus. Who would give a child medicine with a label that said it \”shouldn\’t\” or \”may\” terminate him?

Most recently some researchers even go so far as to claim boldly (and without any new testing) that Plan B and Ella do not ever interfere with implantation even though Plan B contains 50 times (30 micrograms every day vs. 1,500 micrograms in two doses) the synthetic hormone that the progestogen-only mini-pill contains which is known to thin the lining of the uterus and stop implantation, and Ella uses a chemical that behaves as the known abortifacient mifepristone. One researcher even said that both pills \”have absolutely no effect after ovulation\” but there is no new data to support such certainty. If they are right, the debate would be over. Or do they just want it to be over?

In March 2012 the International Federation of Gynecology & Obstetrics (FIGO) released a definitive statement on the mechanism of the Plan B pill. They likewise said that it does \”not prevent implantation\” but cited the same studies others have cited when they said that in theory it could and probably does. One is only left to conclude that the talking points changed even though the science did not. In addition, the United States Food and Drug Administration, the National Institutes of Health, and the American College of Obstetricians and Gynecologists have all redefined pregnancy as beginning with implantation which allows drug companies to declare that no drug that prevents implantation is abortifacient – circumventing the real question about human life. Why did they do this?

Studies have been conducted for decades now and it is still not scientifically clear how to even determine whether the MAP caused an embryo to die or not. It is not that they cannot analyze the tests; it is that they do not even have a test available. So, to add to the point made before, those who want that answer about implantation must not only demand testing on the lives of human subjects knowing some may die, and they also demand testing that will not give a definitive answer. That is not only immoral; it is nonsense.

So does anyone know how the MAP works? It seems not. That the pro-MAP professionals changed talking points about its mechanism and about pregnancy, thereby circumventing the real question, seems to suggest that they do strongly suspect that the pills interfere with implantation, but will not admit it. In fuzzy language, the manufacturers conclude that prevention of implantation is not proven as a mechanism, but they cannot prove that it is not a mechanism even though other MAPs and uses of these drugs in different dosages are known to work by preventing implantation. They seem to think it is unreasonable to have to prove the negative, but that is a standard required of any other medication if the lives in question are valued by society.

Remember, professionals who promote the MAP have are not concerned with protecting embryonic human life; their motivation lies elsewhere. Should those of us who are motivated to ensure that human life is not directly ended continue to demand more tests then? We already know that lives have been lost in the development of these drugs. Asking for more proof implicates us in the act, even if remotely. I conclude that not only do we not know how the MAP works, we do not need to know because it would require senseless testing on embryonic human lives from an industry not motivated to protect them. There is enough confusion in Catholic hospitals already. We ought to reject the MAP completely and focus on other ways to help victims of rape.

© 2013. Stacy Trasancos. All Rights Reserved.