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Apr
10
2013

Not All Morning-After Pills Are Abortifacients: The Scientific Evidence: Symposium on Plan B: Part II

Editor’s Note: The editors present this series (read part 1, part 3, part 4, part 5, part 6) on the recent furor over Plan B as an opportunity for our fellow pro-lifers to slow down, step out of activist mode, and enter into the conversation in a prayerful and thoughtful way.

The Church encourages conversation among faithful scientists and theologians as new science comes to light and as we deepen ethical reflection. Typically such conversations occur in academic settings, but since the recent furor pushed the issue into the open, causing much confusion and scandal, we felt it important to present the latest science and moral reflection in a context of faithful discussion.

We offer this series in a spirit of obedience to the Magisterium, and as an opportunity for faithful Catholics and people of good will to come to a greater understanding of the nuances of the Church’s teaching and the complexities of the science and art of medicine in the difficult situations involving the treatment of women who have been raped. There has been no (and will be no) revision in the Church’s teaching concerning direct abortion or contraceptive sexual acts between spouses. Both are morally illicit without exception.

As with all Truth and Charity Forum articles, opinions belong to the author alone and do not necessarily represent the official position of Human Life International.


 

The decision by the Catholic bishops of Germany to approve the use of morning-after pills (MAP) for victims of rape who present themselves at a Catholic hospital has generated much controversy. Critics have vehemently opposed this decision because they argue that all morning-after pills are inherently abortifacient.

Some morning-after pills are certainly abortifacients. For instance, there is scientific evidence that shows that the morning-after pill, ulipristal acetate, sold as ellaOne throughout the world, is a bona fide abortifacient.[1] Several lines of evidence suggest that it has a post-fertilization mechanism of action that leads to the death of the human embryo.

Another pill called mifepristone (RU486) is routinely used as a chemical abortifacient that can end a pregnancy if it is taken within forty-nine days of the start of a woman’s last menstrual period.[2]

Clearly, some drugs are abortifacients. However, as I have described in more detail elsewhere,[3] there are scientific studies that show that at least one morning-after pill, the drug levonorgestrel that is sold as Plan B, does not have a post-fertilization effect. In other words, it is not an abortifacient: It neither prevents the implantation of a human embryo nor undermines the life of an embryo that has already implanted himself in his mother’s womb.

Why do I think that it is unlikely that Plan B is either an interceptive or an abortifacient?[4]

There is no better summary of the scientific evidence than the statement of the International Federation of Gynecology & Obstetrics (FIGO) and the International Consortium for Emergency Contraception (ICEC) on the mechanism of action of Plan B.[5]

In their statement, these two organizations summarized the published evidence demonstrating that Plan B is neither an interceptive nor an abortifacient as follows:

  • Two studies have estimated effectiveness of LNG ECPs [levonorgestrel-only emergency contraceptive pills like Plan B] by confirming the cycle day by hormonal analysis (other studies used women’s self-reported cycle date).[6] In these studies, no pregnancies occurred in the women who took ECPs before ovulation; while pregnancies occurred only in women who took ECPs on or after the day of ovulation, providing evidence that ECPs were unable to prevent implantation.
  • A number of studies have evaluated whether ECPs produce changes in the histological and biochemical characteristics of the endometrium (the lining of the uterus where the embryo implants).[7] Most studies show that LNG ECPs have no such effect on the endometrium, indicating that they have no mechanism to prevent implantation. One of these studies found that following administration of double the standard dose of LNG, there are only minor or no alterations in endometrial receptivity.[8] One study found a single altered endometrial parameter only when LNG was administered prior to the LH surge, at a time when ECPs inhibit ovulation.[9]
  • One study showed that levonorgestrel did not prevent the attachment of human embryos to a simulated (in vitro) endometrial environment.[10]
  • Animal studies demonstrated that LNG ECPs did not prevent implantation of the fertilized egg in the endometrium.[11]
  • Two studies of women who became pregnant in cycles when they took LNG ECPs found no difference between pregnancy outcomes of women who had taken LNG ECPs and those who had not. Variables included miscarriage, birth weight, malformations, and sex ratio, indicating that LNG ECPs have no effect on an established pregnancy even at very early stages.[12]

Next page: Conclusions of FIGO and ICEC–>


Pages: 1 2

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  • http://twitter.com/margiemiguel Margie Miguel

    Mechanism of Action

    Emergency contraceptives are intended to be used after known or suspected contraceptive failure or unprotected intercourse. They are not effective if a woman is already pregnant. Plan B® (levonorgestrel) is believed to act as an emergency contraceptive principally by preventing ovulation or by inhibiting fertilization (by altering tubal transport of sperm and/or ova). IT MAY ALSO PREVENT IMPLANTATION (by altering the endometrium). It is not effective once the process of implantation has begun.
    http://www.paladinlabs.com/our_products/pdf_files/PlanB.pdf [emphasis mine]

    • Jacqui Fetsko

      Note that this info is found on page 14 of the PDF.

  • http://www.facebook.com/profile.php?id=720170053 Stef Ofhfs

    Regardless of whether certain pills have an abortifacient element or not, Father, I think a reiteration of the Catholic position — that any and all forms of contraception — are forbidden for Catholics who wish to remain faithful and in communion with the Church, would be helpful.

    • Arland Nichols

      Father Austriaco is faithful priest and scientist who believes what the Church teaches in Humanae vitae. He has written about this teaching elsewhere most notably in chapter 3 in his excellent bioethics textbook. The Church teaches that a woman may take a drug that prevents ovulation following the crime of rape. See the full quote from the US Bishops above. This is Part 2 in the series and many of these good questions and concerns will be addressed in forthcoming articles. God bless.

  • Juan Velez

    Fr. Austriaco explains that he will address the concern of some critics in a subsequent article, still I would like to point out now that the assertion of the heavily biased FIGO and International Consortium for Contraception (ICEC) flies in the face of the evidence. Their biased and mistaken statement, was however prior to important data from G. Noé and H. Croxatto (2011), as is the review on which Fr. Austriaco bases his statements (a 2010 review article). In their 2011 article Noé and Croxatto write: “Eighty-two of the 103 women treated before ovulation completed the 5 days of follow-up, and in 63 (80%) of them, FR was detected” where Follicular Rupture (FR) indicates ovulation. LNG only prevents ovulation in a small percentage of women, and when taken in the fertile period.

    • Dale Noble

      Fr. Juan…it’s good to have a pro-life doctor’s opinion regarding this. Thank you for your comments. I don’t understand why a Catholic organization is even buying into this, and promoting it in seminar.

  • Mariam

    I concur with Stef Ofhfs, I think it’s irrelevant if they are proved at this point to not be abortifacients. They continue to be contraception, which is contrary to the Truth of our Catholic faith. I do not understand the point to make a different, or to even promote the difference.

    • Jonathan

      The point becomes relevant in cases of rape, where the the Church teaches that it is permissible to prevent conception.

      • http://www.facebook.com/rosalinda.lozano Rosalinda Lozano

        Please provide a church resource that says that it is permissible to prevent conception in cases of rape.

  • Ana

    I agree with Mariam and Stef below. Use of contraceptives are still contrary to natural law and our Church’s teachings. Besides, Fr Velez has pointed out that studies cited by Fr Austriaco is not up-to-date. It is unfortunate that confusion is again being sowed by articles such as this. I would be very careful and discriminate in the “facts” presented by any study or article that deals with contraceptives or reproductive drugs, whether they are abortifacients or not.

  • Arland Nichols

    “Compassionate and understanding care
    should be given to a person who is the victim of sexual assault. Health care
    providers should cooperate with law enforcement officials and offer the person
    psychological and spiritual support as well as accurate medical information. A
    female who has been raped should be able to defend herself against a potential
    conception from the sexual assault. If, after appropriate testing, there is no
    evidence that conception has occurred already, she may be treated
    with medications that would prevent ovulation, sperm
    capacitation, or fertilization. It is not permissible, however, to
    initiate or to recommend treatments that have as their purpose or direct
    effect the removal, destruction, or interference with the implantation of a
    fertilized ovum.” (USCCB, Ethical and Religious Directive n 36.)

    • http://www.facebook.com/rosalinda.lozano Rosalinda Lozano

      The USCCB is a lay organization and does not speak directly for the Church. Do you have a Catholic document that speaks to a woman who has been raped?

      • The Gadfly

        The USCCB is the UNITED STATES CONFERENCE of CATHOLIC BISHOPS, hence it is not a lay organiztion.

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  • Chris Kahlenborn

    I think the main point by Father Velez and Dr. Peck is well taken. If Plan B allows ovulation, then you really have to explain why one does not see evidence of clinical pregnancy especially since sperm can be found in the fallopian tubes for days after intercourse. To date no one has explained to me how you can have ovulation and sperm in the fallopian tubes and yet fail to see evidence of a clinical pregnancy. The only explanation that I have heard, is that women who do ovulate while taking Plan B, have abnormal or “dysfunctional ovulation.” But the evidence for this is very weak, especially when one notes that the women who did ovulate in Noe and Croxatto’s paper had progesterone levels over 12, which is consistent with successful ovulation. If one cannot adequately explain this, then I think to be fair, abortion has to be assumed to be the mechanism of action by default, until proven otherwise.

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  • http://www.facebook.com/erika.vandiver Erika M Vandiver

    This article fails to address the 5-7 days between conception and implantation. According to the “updated” medical definition implantation is the start of pregnancy, not conception. Yet, as Catholics we firmly believe life begins at conception. In addition, conception can take place in a rather large window (depending on the timing of ovulation and/or intercourse). The effective window for Plan B is about 72 hours — about the same as conception relative to ovulation & intercourse. Once conception occurs, we, as Catholics, believe a new defenseless human is created. It is unknown, since medical science doesn’t consider the step between conception & implantation as pregnancy, whether Plan B disrupts the newly conceived, but non implanted life or not. Until this can be answered, Plan B should only be used with supreme caution if at all. Jesus said how we treat the least of His people is how He will treat us… I’d say a newly conceived human is just about the least of God’s people. He also warned us agains leading others astray or to their downfall…

  • http://twitter.com/Tweet4_Life K.G. Smith

    The conclusion is from sources that “admittedly” — are not pro-life. If they’re okay with killing they’ll lie about the killing especially to protect their profession’s reputation and pocketbook– emergency contraception is also big business so don’t expect Big Pharma to tell the truth. Any pro-abortion doctor or scientist in the chain of evidence and research is a weak link that calls the whole into question. Why are we so eager and naive enough to trust our opponents?

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