William Saletan completely misses the boat on emergency contraception.
Emergency contraception, also known as the “morning-after pill” and marketed in this country as “Plan B,” is a drug that a woman can take after sex but before an embryo attaches to her womb. If you don’t know much about this murky week in the reproductive process, it’s time to learn. Lawmakers in many states are deciding right now whether EC will be easy or hard to get. Some say it causes abortions. Some say it only prevents them. And the dirty little secret is, nobody really knows.
And… wrong. We actually do know how ECPs work, because they contains the exact same hormones as birth control pills, and we have a pretty good idea as to how those operate. They thicken cervical mucus so that it’s tougher for sperm to get through, and they inhibit ovulation. Those are their primary functions.
A small clarification needs to be made here, too. “Emergency contraception” is a broad term, and is usually used in reference to emergency contraception pills, or ECPs. But another form of emergency contraception is the insertion of an IUD soon after unprotected sex. That often gets forgotten or overlooked (and indeed, Saletan doesn’t mention it).
Some have speculated that birth control pills and Plan B can prevent a fertilized egg from implanting in the uterus. That’s what Saletan means when he says that “nobody really knows.” He’s right, we don’t know for sure whether or not BC and ECPs prevent implantation — but the most recent, comprehensive studies suggest that they don’t.
Many people think EC can’t be birth control, since it’s taken after intercourse. This is—forgive me—a misconception. Sex-education classes often give the impression that the egg waits for sperm to show up. It’s usually the other way around. An egg loses its fertility within 12 to 24 hours. It takes sperm about 10 hours to reach the egg, and sperm can survive in the female reproductive tract for up to five days. If you want to get pregnant, you’d better send in the sperm before the egg shows up. But if you don’t want to get pregnant, and the sperm are on their way or already there, you still have time to stop the egg.
So far, so good. (Interesting piece of trivia: In one study, sperm survived in a woman’s body for 12 days after intercourse. That, obviously, is exceptionally rare).
That’s the idea behind Plan B. “It prevents pregnancy mainly by stopping the release of an egg,” says the manufacturer, Barr Pharmaceuticals Inc. However, Barr adds, the drug “may also prevent the fertilization of an egg” or prevent a fertilized egg “from attaching to the uterus.”
There’s the rub. If you think a fertilized egg is a human being, as anti-abortion activists do, then preventing it from attaching to the uterus is abortion. Some anti-abortion groups—Americans United for Life, the American Life League and Concerned Women for America—assert flatly that Plan B does this. The National Right to Life Committee, however, isn’t sure. It’s taking no position until Plan B’s effects are clarified. The South Dakota legislature, which banned abortions a month ago, exempted any “contraceptive measure, drug or chemical, if it is administered prior to the time when a pregnancy could be determined through conventional medical testing”—i.e., Plan B.
Now, wait a minute: Here’s the problem with adopting anti-choice terms and their skewed view of reality. Abortion by definition ends an established pregnancy. Pregnancy by definition occurs when a fertilized egg attaches to the uterus. How can an “abortion” occur if there was never a pregnancy to begin with?
But nevermind that. The anti-choice world view may be a little like looking down the rabbit hole, but Saletan is perfectly happy to swallow it up.
Let’s look at this again: “If you think a fertilized egg is a human being, as anti-abortion activists do, then preventing it from attaching to the uterus is abortion. ” Now how seriously would we take this statement if I said, “If you think that the human capacity for love is kept in the heart, as I do, then a heart transplant effectively transfers one person’s capacity for love to another”? Sure, I might believe it, but does that make it true or valid or even worth discussing? There are medical truths, and there are ideological agendas, and there are religious beliefs. Sometimes they overlap, and sometimes they don’t. But accepting this anti-choice argument at face value and repeating it as if the anti-choice idea that pregnancy begins at conception and you can abort a pregnancy that never existed is just as valid as the actual medical definitions of pregnancy and abortion is plain irresponsible. And it’s bad journalism.
Even the Catholic Church is uncertain. The U.S. Conference of Catholic Bishops authorizes doctors to offer a rape survivor a drug that blocks ovulation or fertilization “if, after appropriate testing, there is no evidence that conception has occurred already.” According to the Catholic Health Association, most Catholic hospitals interpret this directive liberally, since conception is hard to verify and there’s “no direct scientific evidence” that EC blocks implantation.
“Conception is hard to verify”? Try… nearly impossible. Pregnancy tests detect pregnancies, not fertilized eggs. Which he might have known had he, say, read his own article:
as the Catholic Health Association explains, “There is no current method for ascertaining that an ovum has been fertilized until implantation.” It takes a week and a half for hormones to register in pregnancy tests. To verify fertilization before then, you’d have to open the woman up. And that would kill the embryo.
And about half of fertilized eggs naturally don’t implant anyway, shedding serious doubt on the contention that fertilization should be the point at which we consider “life” and “pregnancy” to begin.
If the two camps were to stop spinning and listen for a moment, they might learn something from each other. Proponents of EC, who talk so much about choice and information, might realize that their denials of any abortion risk from Plan B, through semantics or stretching of the evidence, deprive women of informed consent. The right to choose a pill that’s probably birth control but possibly abortion includes the right to know that’s what you’re choosing.
I agree that women have a right to know that both ECPs and birth control pills may prevent a fertilized egg from implanting. But that doesn’t make it an abortion, not by any stretch. And putting Plan B in a completely different category that birth control pills is innaccurate, and furthers the confusion about what it actually does.
Saletan has done us all a major disservice with this misleading and factually inaccurate article.