In light of the evidence, which shows only a 20% inhibition of ovulation, we must ask: Why is Plan B currently being used in Catholic institutions? Catholic moral teaching has always prohibited contraception and abortion. Blessed John Paul II referred to these entities as “fruits of the same tree.”[xii] It is clear that contraceptive pills have both contraceptive and abortifacient mechanism of action. We also realize that a contraceptive mentality can lead to the perceived need for abortion when a woman’s preferred method fails her.
Rape is a violent crime in which the sexual act does not involve the mutual love and self-donation of the spouses. Therefore it has been argued by many ethicists that a woman raped may treat the sperm as an “unjust aggressor” and the use of an Emergency Contraceptive to help prevent ovulation, which would prevent an unwanted pregnancy. According to the Ethical and Religious Directives (ERD), “If, after appropriate testing, there is no evidence that conception has occurred already, she [the woman raped] 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” (no. 36).[xiii] Since the majority of studies show that Plan B does not prevent ovulation when given in the fertile window, it is morally unacceptable to treat women who have been raped with this drug. This treatment does not comply with ERD no. 36.
All physicians who value life, and especially Catholic healthcare institutions, have a duty to re-examine the available scientific information on Plan B. We think the data shows a small anovulatory effect and suggests a significant post-fertilization or abortifacient effect. Given this information, the Peoria Protocol, and other rape-based protocols should be abandoned, as use of Plan B during the critical fertile period, would not be expected to prevent ovulations in a majority of cases, and in fact, would lead to a significant possibility of post-fertilization effect.
Moreover, as newer emergency contraceptives with better efficacies emerge, the precedent has been set for allowing agents with abortifacient mechanisms of action. Rape victims deserve compassionate care, but they also deserve the right to have accurate and complete information about the medications they are given, information currently denied them by the general scientific community.
In order to provide true informed consent, greater scrutiny of the medical literature is needed and of the conflict of interests of some of the research carried out. The conclusions of studies claiming that Plan B has no post-fertilization effect do not follow from their actual findings.[xiv]
Looking to Christ who exercised true compassion and respect for women, physicians should give treatment that does not harm them or the new life forming within them. Christ puts an end to violence by drawing good from an evil act. Violence is defeated by love.
Read part 1,and part 2 of this series. The next article in this series will feature a response from Fr. Austriaco who argues that the scientific evidence indicates that early abortions do not occur if Plan B is administered during the “fertile window.”
[i] A.J. Wilcox, C.R. Weinberg and D.D. Baird, “Timing of sexual intercourse in relation to ovulation, effects of the probability of conception, survival of the pregnancy and sex of the baby,” The New England Journal of Medicine 333 (1995): 1517-1521; D.B. Dunson, D.D. Baird, A.J. Wilcox and C.R. Weinberg, “Day specific probabilities of clinical pregnancy based on two studies with imperfect measures of ovulation,” Human Reproduction 14 (1999): 1835-1839.
[ii] G. Noé, H. B. Croxatto, et al, “Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation,” Contraception 84 (2011): 486–492.
[iii] Several earlier studies show that Plan B, when given in the fertile window, does not inhibit ovulation in the majority of patients: D. Hapangama, A.F. Glasier, and D.T. Baird, “The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle.” Contraception 63 (2001): 123-129; M. Durand et al, “On the mechanisms of action of short-term levonorgestrel administration in emergency contraception” Contraception.64 (2001):227-34; H.B. Croxatto, et al, “Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75 mg dose given on the days preceding ovulation.” Contraception 70 (2004): 442-450.
[iv] N. Novikova, et al, “Effectiveness of levonorgestrel emergency contraception given before or after ovulation – a pilot study,” Contraception 75 (2007): 112-118.
[v] K. Gemzell-Danielsson, “Mechanism of action of emergency contraception,” Contraception 82 (2010): 405-410.
[vi] Ibid.
[vii] In vivo and in vitro studies show that Plan B has no effects on cervical mucus, sperm function or capacitance: J.A. Do Nascimento, et al, “In vivo assessment of the human sperm acrosome reaction and the expression of glycodelin-A in human endometrium after levonorestrel-emergency contraceptive pill administration,” Human Reproduction 22 (2007) 8: 2190-95; Yeung, et al, “Roles of glycodelin in modulating sperm function,” Molecular and Cellular Endocrinology 250 (2006): 149-156; A. Hermanny, et al, “In vitro assessment of some sperm function following exposure to levonorgestrel in human fallopian tubes,” Reproductive Biology and Endocrinology 10 (2012):8; L. Bahamondes, et al, “The in vitro effect of levonorgestrel on the acrosome reaction of human spermatozoa from fertile men,” Contraception 68 (2003): 5-59; M.L. Uhler, et al, “Direct effects of progesterone and antiprogesterone on human sperm hyperactivated motility and acrosome reaction,” Fertility and Sterility 58 (1992)6:1191-1198.
[viii] J.B. Trussell ed., “The Politics of Doubt,”Journal of the American Medical Association 296 (2006) 14: 1775-1778.
[ix] The following studies confirm sperm reach fallopian tubes in minutes to hours: G. Kunz, D. Beil, H. Deininger, L. Wildt and G. Leyendecker, “The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hystero-salpingoscintigraphy,” Human Reproduction 11 (1996): 627-32; D.S.F. Settlage, M. Motoshima and D.R. Tredway, “Sperm transport from the external cervical os to the Fallopian tubes in women: a time and quantitation study.” Fertility and Sterility 24(1973):655-661; M. Ahlgren, “Sperm Transport to and Survival in the Human Fallopian Tube,” Gynecologic Investigation 6(1975):206-214.
[x] Studies by Meng and Lakitumar did not administer Plan B at all to women in their fertile period and Palomino gave it on the day of LH surge, not before. C.X. Meng et al, “Effect of levonorgestrel and mifepristone on endometrial receptivity markers in a three-dimensional human endometrial cell culture model,” Fertility and Sterility 91 (2009)1:256-264; P.G.L. Lalitkumar et al, “Mifepristone, but not levonorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model.” Human Reproduction 22 (2007)11: 3031-3037; W.A. Palomino, P. Kohen and L. Devoto, “A single midcycle dose of levonorgestrel similar to emergency contraceptive does not alter the expression of the L-selectin ligand or molecular markers of endometrial receptivity,” Fertility and Sterility 94 (2010): 1589-1594.
[xi] I.C. Bagchi et al, “Progesterone receptor-regulated gene networks in implantation,” Frontiers in Bioscience 8 (2003): s 852-861.
[xii] Pope John Paul II, The Gospel of Life: Evangelium Vitae (Boston: Pauline Books & Media, 1995), no. 13.
[xiii] (italics ours) http://www.usccb.org/about/doctrine/ethical-and-religious-directives/
[xiv] Novikova et al, 115-118; Durand et al, 227-234.
Rebecca Peck, M.D. is a board-certified family physician who practices family medicine with her husband, Dr. Benjamin Peck, M.D. at Pecks Family Practice in Ormond Beach, Florida. They have over 5,000 patients in their pro-life, NFP-only medical practice. Dr. Rebecca Peck teaches the Marquette NFP method (http://nfp.marquette.edu) and is active in her Church, Prince of Peace Catholic Church, and the Orlando Diocese. Ben and Rebecca are members of the Catholic Medical Association and have written and spoken on a variety of pro-life topics. They are blessed to have six beautiful children.
- Plan B’s Main Mechanism of Action: The Case for a Post-Fertilization Effect
- Over the Counter Oral Contraceptives are BAD for Women’s Health
Fr. Juan R. Vélez, M.D., is a Catholic priest of the Prelature of Opus Dei, presently working in San Francisco and Berkeley. He holds a doctorate in dogmatic theology from the University of Navarre. Fr. Juan has a medical degree, also from the University of Navarre, and was previously board certified in internal medicine. He is author of Passion for Truth, the Life of John Henry Newman (TAN, 2012) and co-author of Take Five, Meditations with John Henry Newman (Our Sunday Visitor, 2010). He has also published a number of journal articles on theology and on medical ethics. He posts short reflections on Cardinal Newman’s writings at: www.cardinaljohnhenrynewman.com.
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