Vol. 9, No. 7 September 1998
Emergency Contraceptive Pills (ECPs)
The truth, the whole truth, and nothing but the truth
The times, they are semantically-challenging. No Wonderland this, but the Mad Hatter would feel right at home in a place where sundry meanings are ascribed to simple words. For decades abortion supporters have so honed the art of equivocation that one needs specialized training (preferably legal, but at least grammatical) to decode the hidden meanings in everyday terms.
Sometimes the sleight-of-tongue is as simple as substituting product of conception for preborn child, or employing choice instead of abortion. A word like abortion is, after all, a wellspring of negative connotations, and it takes a certain genius to neutralize such unpleasantness. Choice served brilliantly in the public debate until publicity surrounding partial-birth abortion connected the dots for many Americans, and choice began to look disturbingly like killing a real baby.
Recently, another euphemism for abortion has proved remarkably versatile: pregnancy termination. Like choice, "termination of pregnancy" deflects attention away from the target of abortion and toward the mother's will or condition, urging us to "Pay no attention to that baby behind the placenta!" Forget the new, unique, miraculous human being who might grow up to find a cure for cancer or break home run records or write achingly beautiful poetry—or just be a joyful child who loves his parents beyond all merit. No, let's just think about the pregnancy — having to endure moodiness, weight gain, and nausea while playing host to a rapidly growing parasite. Thus considered, abortion—as a way to terminate a pregnancy — is not such a frightful thing. After all, "terminating a pregnancy" is what a live birth does, too!
Taking it a step further, if one could say that a woman "conceives" only when a "fertilized ovum" implants in her uterine wall, then destruction of the embryo between fertilization and implantation logically could be labeled "contra-ceptive"—at least in a world where semantics trumps reality. And so, obligingly, the leadership of the American College of Obstetricians and Gynecologists (ACOG) redefined conception in 1965. This word play has allowed some to argue that the abortifacient actions of drugs and intrauterine devices (IUDs) before implantation do not cause abortions.
Does ACOG really believe that implantation of a "fertilized egg" is the start of pregnancy? Of course not. We can cite, for example, this statement by Dr. David Grimes (a long-time advocate of post-coital "contraception") in a proposed revision of an ACOG Technical Bulletin: "These therapies should prevent a fertilized egg from implanting in a woman's uterus, the time at which pregnancy begins."
When Hanna Klaus, M.D., FACOG, objected in writing to his equating implantation with the start of pregnancy, ACOG capitulated. The exchange of letters is instructive. Dr. Klaus wrote:
Even if one chooses to define pregnancy only when the maternal organism begins to react to the conceptus, implantation is too late. Several markers of the blastocyst have been recognized. At least early pregnancy factor (EPF) has been documented in IUD wearers whose blastocysts were aborted in the presence of the IUD. [Smart et al., Fertility and Sterility, 37:201-204 (1982)] To define pregnancy as beginning only at implantation ... diminishes the vast majority of women who value the entire process of procreation. (Letter to Dr. Sebastian Faro, Chair, Committee on Technical Bulletins/GYN, ACOG, dated April 5, 1994)
ACOG's official response, dated June 17, 1994, reads in part:
Your letter ... was reviewed by the Committee on Technical Bulletins-Gynecology at its past meeting. ... The Committee felt that your points were well taken. In deference to your views, the committee has removed this statement from the document. (Letter to Dr. Hanna Klaus from Rebecca Rinehart, Associate Director, Publications, ACOG)
This modest reality check did not deter ECP enthusiasts, like Dr. Grimes and Princeton professor James Trussel, from their campaign to reinvent conception, pregnancy, and abortion. And with the news that the Food and Drug Administration (FDA) has approved "Preven," an ECP kit produced by the New Jersey firm Gynétics, the media are uncritically repeating the claim that ECPs do not cause abortion. Those ubiquitous Planned Parenthood postcards ("You have 72 hours to erase last night") already are being reinforced with articles and advertisements in women's magazines eager to publicize the wonders of ECPs. With no awareness of irony, a woman can publicly declare that: "It was a lifesaver for me" because she wouldn't "have to go through [an abortion] again" (The Washington Post, Sept. 22, 1998, Health Section, p. 12). It emphatically was not a "lifesaver" for any child conceived that night who then would have been aborted.
It is time, then, to revisit some of the undisputed truths regarding human development and the actions of hormonal contraceptives so we can challenge the misinformation that is quickly achieving the status of "conventional wisdom."
When Does Life Begin ... and End with ECPs
Almost any current or former high school student can explain when life begins, although the recall of terminology may be imprecise. No credible scientist disagrees with the chronology found in standard biology textbooks. To understand the process, it's helpful to review fertility in women.
The monthly cycle:
Women, on average, have a 28-day cycle, though individual variations may be great. The cycle begins on the first day of menstruation. Soon afterward, the pituitary gland secretes follicle-stimulating hormone (FSH) which stimulates development and growth of an ovarian follicle and its ovum (also known as egg or oocyte). The follicle secretes increasingly high levels of estrogen, a hormone which stimulates the cervix to produce mucus which assists fertility. About one day before ovulation, estrogen levels peak and the pituitary gland then produces an increase in luteinizing hormone (LH). LH stimulates the follicle to release the ovum (ovulation).
Once released, the ovum will live no longer than about 24 hours, unless fertilized. After ovulation, the follicle (now called the corpus luteum) begins to secrete progesterone for 11 to 16 days ("luteal phase"). This hormone prevents further ovulation in that cycle, maintains the lining of the uterus, causes the cervical mucus to thicken or disappear, and closes the cervix. Estrogen levels fall rapidly after ovulation for 24 hours, then rise again, but are overshadowed by the much larger quantity of progesterone. Both hormones fall 2-3 days before the end of the luteal phase and then menstruation ensues.
Fertility is very low the first several days of the cycle. This period is followed by a fertile phase of 5 days of changing mucus, which culminates in the peak symptom and an additional three days, ending one or two days after ovulation. Maximum fertility is usually found from 2-3 days before the peak symptom to the day after it. The likelihood of pregnancy at peak and on the day of ovulation, is 30%; fertility ceases within three days after peak.
Why does the fertile period last 5-7 days when the egg's lifespan without fertilization is 24 hours? Because sperm can survive in cervical crypts for about five days, ready to fertilize an egg when it is released.
Once an egg is released from the ovary, it enters the oviduct or Fallopian tube, the conduit between the ovaries and the uterus. Sperm travel into the oviduct seeking an egg.
"Fertilization is a sequence of events that begins with the contact of a sperm (spermatozoon) with a secondary oocyte (ovum) and ends with the fusion of their pronuclei ... and the mingling of their chromosomes to form a new cell. This fertilized ovum, known as a zygote, is a large diploid cell that is the beginning ... of a human being." (Moore, Keith L., Essentials of Human Embryology. Toronto: B.C. Decker, Inc., 1988, p.2.) "Although human life is a continuous process, fertilization is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is thereby formed. ... The combination of 23 chromosomes present in each pronucleus results in 46 chromosomes in the zygote. Thus the diploid number is restored and the embryonic genome is formed. The embryo now exists as a genetic unity." (O'Rahilly, Ronan and Müller, Fabiola. Human Embryology and Teratology, 2nd edition. New York: Wiley-Liss, 1996, pp. 8, 29). "Almost all higher animals start their lives from a single cell, the fertilized ovum (zygote). ... The time of fertilization represents the starting point in the life history, or ontogeny, of the individual." (Carlson, Bruce M., Patten's Foundations of Embryology, 6th edition. New York: McGraw-Hill, 1996, p.3.) "Embryo: An organism in the earliest stage of development; in a man, from the time of conception to the end of the second month in the uterus." (Dox, Ida G. et al. The Harper Collins Illustrated Medical Dictionary. New York: Harper Perennial, 1993, p. 146.) "The fertilized egg, now properly called an embryo, must make its way to the uterus." (Carlson, Bruce M., Human Embryology and Developmental Biology. St. Louis: Mosby, 1994, p.3). (See also www.nccbuscc.org/ prolife/issues/bioethic/fact298.shtml for numerous quotations from medical texts.)
Beginning about 6 days after fertilization, if conditions are ideal, the embryo will implant in the uterine lining (a process taking several days). The authors of Contraceptive Technology estimate that "approximately 50% of embryos do not survive" beyond two weeks even if no direct actions are taken to end their lives. This vulnerability has been posited as a justification for considering implantation the beginning of pregnancy, even the beginning of life. By this reasoning even lethal experiments could be performed on pre-implantation human embryos (or on newborn children in a region with high infant mortality!). Yet this fragile creature is indisputably human. His or her vulnerability should rather be a call for greater care than for annihilation.
What are hormonal ECPs?
The regimen approved by the FDA for post-coital "contraception" identifies six brands of ordinary birth control pills (OCs)—containing estrogen and progestin—and requires that a high dose of such pills be taken within 72 hours of "unprotected intercourse," followed by a second high dose 12 hours later. Preven, newly marketed by Gynétics and approved by the FDA in September 1998, is simply a kit containing the two high doses of OCs, plus a pregnancy test kit to rule out existing pregnancy from an earlier episode of intercourse.
How do hormonal ECPs work?
According to the FDA, "EC 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)." (FDA, Federal Register Notice, Vol. 62, No. 37, Feb. 25, 1997). These properties of OCs have long been acknowledged, but it is impossible to determine which mode of action is responsible in any given cycle for a woman's failure to conceive or maintain pregnancy after "unprotected" intercourse. It is important to note that "ovulation is not always stopped, ... cervical mucus is not always made impenetrable, ... the lining of the womb is not always rendered unreceptive to a fertilized ovum every cycle, ... and Fallopian tube activity does not always inhibit sperm and ovum unification. ..." (Wilks, J., A Consumer's Guide to the Pill and Other Drugs, 2d edition. Stafford, VA: ALL, Inc., 1997. Numerous citations omitted.) Breakthrough ovulation and pregnancy occur even with "perfect" use of OCs. (Ibid., pp. 3-10).
Depending on where a woman is in her monthly cycle when intercourse occurs, and depending on the timing of the doses of ECPs, one might expect different modes of action to predominate. For example, for as many as 21 days of the average 28-day cycle a woman is normally infertile. Intercourse is not likely to produce a child, because there is no egg or imminent egg available to be fertilized. All modes of action may be present, including disruption of the next ovulatory cycle, but none is necessary to prevent conception, fertilization or implantation.
Once the fertile phase has begun, however, "taking a high level of estrogen via ECPs within 72 hours of intercourse ... may, in fact, precipitate ovulation. This would make it more likely, rather than less, that fertilization will occur," according to Dr. Klaus. In such a case, the risk of a potentially fatal ectopic pregnancy has also been shown to increase. (Morris, J.M. and G. Van Wagenen, "Interception: the use of postovulatory estrogens to prevent implantation," Am. J. Obstet. Gynecol., 115:101-6 (1973); Diana Rabone, M.D., "Postcoital contraception—coping with the Morning After," Current Therapeutics, p.46 (1990), cited in Wilks, op.cit., p.156)
Beginning four days before ovulation, the average likelihood of conception from intercourse jumps from 0% to 11%. It rises to 30% on the day preceding, and day of, ovulation, before dropping to 9%, 5% and 0% on the three subsequent days. ECPs taken promptly could fail to prevent fertilization and thus result in the death of an embryo who is unable to implant successfully due to ECP-induced changes in the endometrium.
If an ovum is in the Fallopian tube, the process of fertilization may begin within 15 to 30 minutes after intercourse. The "morning after" is already too late for any contraceptive effect to intervene. Thus some researchers conclude that "post-coital drugs act principally to terminate a viable pregnancy by interfering with the endometrium: ... 'this mode of action could explain the majority of cases where pregnancies are prevented by the morning-after pill.'" (Wilks, op. cit., p. 154, citing Grou, F. and I. Rodriges. "The morning-after pill; How long after?" Am. J. Obstet. Gynecol. 171:1529-34 (1994).)
How Effective are ECPs at Preventing or Interrupting Pregnancy?
The oft-cited 74% effectiveness rate for ECPs comes from a 1996 meta-analysis of ten clinical trials by Trussel et al. This percentage is the average of a range of effectiveness from 55.3% to 94.2%. A recent project in Washington State tracked demand, but did not report effectiveness. There, pharmacists collaborated in an Emergency Contraceptive Project sponsored by Program for Appropriate Technology in Health (PATH) and others. Under the project, trained pharmacists could write and fill prescriptions for ECPs. A reported 52% of women and girls seeking ECPs did so due to "contraceptive failure."
Another alarming aspect of the program is the demand generated by publicity. During their study, calls to the ECP Hotline increased ten-fold to 1,160 per month. More than 2,700 prescriptions were filled in the first four months alone. (HUMAN LIFE News, Sept.1998, p. 11, newsletter of Human Life of Washington.)
In an effort to determine whether women would use ECPs too often if they were allowed to keep them in their medicine cabinet, Anna Glasier, M.D. and David Baird, D.Sc. studied two groups of women in Edinburgh, Scotland. A total of 1,083 women were recruited who had previously used ECPs or had a surgical abortion. These women are "not exactly" a representative group, according to Margaret Pfeifer, M.D., an ob/gyn at the Mayo Clinic in Rochester, Minnesota. Because of their history of abortion or ECP use, they were more likely than other women to use ECPs. They also had a fairly high educational level and were given detailed written and oral instructions concerning use. Data was available for analysis on 1,071 women (549 with ECPs at home and 522 in a control group who would first need to obtain a doctor's prescription for ECPs). Among the treatment group, 47% used ECPs at least once in the two-year period of study, compared to 27% use among the controls. Ten percent of each group used ECPs more than once. One woman was dropped from the study after she used ECPs more than four times in four months. There were 28 pregnancies (5%) in the treatment group and 33 pregnancies (6%) in the control group. Eight women in the treatment group and four in the control group appear to have become pregnant during a cycle in which emergency contraception was used. The children who survived the ECPs were subsequently aborted. (Glasier and Baird, "The Effects of Self-Administering Emergency Contraception," N. Engl. J. Med., 339:1-4 (1998).)
What are the Side Effects of ECP Use?
About 50% of women experience nausea and 20% vomit. A far more serious side effect is the increased risk of ectopic pregnancy. The Princeton University website promoting ECPs also warns: "It is possible ... that a woman using ECPs could have one of the dangerous or even fatal complications that have been reported in very rare cases with normal, prolonged use of birth control pills. These include: thrombophlebitis (blood clots in the legs), lung clots, heart attack, stroke, liver damage, liver tumor, gallbladder disease, and high blood pressure" (www.princeton.edu/ec/ecpnyou.html).
What are the Risk Factors for ECP Use?
Women who smoke cigarettes and those who have experienced any of the following conditions are advised not to take ECPs: blood clots in the legs or lungs, cancer of the breast or reproductive organs, stroke, heart attack, and "any serious medical disorder such as diabetes, liver disease, heart disease, kidney disease, sever migraine headaches, or high blood pressure" (http://opr.princeton. edu/ec/ecpnyou.html and www.fwhc.org/ecinfo_n.htm).
"Is it progress if a cannibal uses knife and fork?"
The marketing machine is now working nonstop. Pro-abortion groups hail the leap of progress for "women's rights." Professor Trussel, who manages an ECP website and hotline, explains he "want[s] to make emergency contraception the same household name that McDonald's hamburgers is." Print and radio ads, even free public service announcements abound. Commuters in Los Angeles are visually assaulted by billboards featuring a 40-foot high photo of a used, broken condom. We can't begin to compete with their resources. So it's up to every pro-life citizen, armed with the truth about ECPs' abortifacient potential, to present that truth in every appropriate forum, beginning with letters to the editor and articles or small ads in college newspapers. Otherwise the over-hyped and misleading marketing of ECPs will greatly increase their use, and cause a corresponding increase in lives lost to its abortifacient potential.
1998-99 Respect Life Program
Proclaiming the Gospel of Life with Honesty and Love
Now available from the National Conference of Catholic Bishops, the 1998-99 Respect Life Program packet offers a wealth of materials of interest both to Catholics and to the broad pro-life community. The informative packet is a key component of the Church's annual program—in its 27th year—to promote respect for human life and dignity.
In addition to materials on innovative pro-life programs and resources, prayers, a full-color poster and flier, and clip art/quotes, six articles explore contemporary threats to human life and relate them to Catholic teaching. More than 1.5 million fliers, as well as upwards of a million copies of the program articles, are expected to be distributed in parishes during the month of October.
Denver's Archbishop Charles J. Chaput, OFM Cap. reflects on the rhetoric used to market abortion and euthanasia, and the "hidden costs" we continue to pay for accepting abortion in America. In "Choose Life: Toward a Culture of Life in the New Millennium," Archbishop Chaput reminds us that "the Nazi euthanasia campaign began on the merciful-sounding pretext of relieving people of unbearable pain. It ended with killing the mentally and physically disabled, the infirm, the insane, the anti-social, the merely troublesome, and, of course, 6 million Jews."
It is all too easy for a society to become indifferent when they are confronted, not with the truth of what abortion and euthanasia are, but with marketing rhetoric. As killing becomes more acceptable and more widespread, the harm caused to society is incalculable.
Abortion has a corrosive effect on our attitude toward life. Abortion "has touched the lives of millions. No one in our society has escaped unscathed; everyone is affected by the hardening of heart which comes when a culture tolerates killing. ... It undermines the very concept of human rights."
With truth as our weapon of choice, he urges us to persevere in defending the child's inviolable right to life. We must be insistent and untiring in proclaiming the value and dignity of every human life if we hope to reverse the cultural trend in America and build a culture of life in the next millennium.
Population Research Institute's president Steven Mosher, Ph.D.—an internationally recognized expert on China, human rights, demography, and population control—will shock generations of Americans schooled on the population bomb menace. Mosher details the imminent population implosion—a real and greater threat to economic and political stability than population growth. In tracking U.S. support of international population control efforts, he exposes the abuse of human rights inherent in the "successful" programs, and demonstrates how the coercive abortion and sterilization programs undermine basic health care in the third world.
Richard Doerflinger of the NCCB Pro-Life Secretariat and Carlos Gomez, M.D., Ph.D., medical director of the palliative care program at the University of Virginia Health System, collaborate on an article debunking "terminal sedation," aptly titled "Killing the Pain, Not the Patient." Euthanasia advocates are attempting to blur the distinction between intentionally killing a patient—by a "one shot" (as it were) lethal injection or overdose—and possibly hastening a patient's death by using narcotics for pain control. They argue that it is more humane and less hypocritical to "relieve suffering" by causing death in one fatal dose than gradually. Indeed, many doctors fear that giving "high doses of painkillers such as morphine will suppress the breathing reflex and cause death." This plausible, but erroneous, fear now promoted by euthanasia enthusiasts is based on false assumptions about the effect of pain-control medications on patients experiencing intractable pain and the generally inadequate training doctors receive in pain management techniques. When administered for pain, drugs such as morphine are taken up first by the patient's pain receptors. Patients quickly develop a resistance to side effects like respiratory suppression. "As long as a patient is awake and in pain, the risk of hastening death by increasing the dose of narcotics is virtually zero." For sound medical as well as philosophical reasons (see a lucid discussion of the principle of "double effect"), the two approaches to care for the dying—killing vs. aggressive pain management—differ fundamentally.
John Haas, Ph.D., S.T.L., president of the National Catholic Bioethics Center, authors an article on the science and ethics of reproductive technology entitled "Begotten not Made." Infertility is a growing problem in the United States and it is understandable that many couples would wish to resort to in vitro fertilization (IVF) to overcome their inability to conceive children. The Catholic Church has, in fact, found certain medical interventions to overcome infertility morally acceptable, but not IVF.
Given recent debates on cloning, Dr. Haas believes it is time to revisit a 1987 Vatican document entitled Donum Vitae ("The Gift of Life") which addresses the morality of many modern fertility procedures. The test is rather simple: "If a given medical intervention helps or assists the marriage act to achieve pregnancy, it may be considered moral; if the intervention replaces the marriage act in order to engender life, it is not moral." In IVF, lab technicians create an embryonic human in a petri dish with raw material provided by biologic parents, thus eliminating the marriage act.
Why should even non-Catholics be concerned about IVF? "Over 90% of the embryos created [in IVF procedures] perish at some point in the process." In other words, nine unborn children have their lives sacrificed so that one of their siblings may be born. Public controversy has swirled around several mid-pregnancy "selective reductions" of "excess" fetuses in the past year. But few people realize that every day of the week, a far greater number of younger embryos are quietly lost, discarded, frozen or consigned to use in scientific experimentation.
Thomas Lickona, Ph.D., director of the Center for the 4th & 5th Rs (Respect and Responsibility), S.U.N.Y. at Cortland professor and Christopher-award winning author of Educating for Character, contributed "Sex, Love and Character: A Message to Young People." A psychologist specializing in character development, Dr. Lickona tackles the tough questions about premarital sex most often posed by young people and answers them with a strong and compelling case for chastity.
Deacon George Brooks, director of advocacy and jail chaplain for Kolbe House, the Archdiocese of Chicago's prison and jail ministry, draws on his experiences in prison ministry to shed light on the subhuman conditions under which incarcerated individuals are often forced to endure their term of punishment. He also suggests ways in which parishes and individuals can get involved in bringing the love of Christ into the lives of those in prison.
A full-color flier explores how we may move from this century's rejection of fundamental Christian values into a "great springtime for Christianity" in the new millennium.
The Respect Life Program packet can be purchased through the NCCB Secretariat for Pro-Life Activities (see box for address and phone). Texts of the materials will appear on the Secretariat's website (www.nccbuscc.org/ prolife) in October.
In an October 2, 1998 Ad Limina Address to the bishops of California, Nevada and Hawaii, John Paul II stated:
We are coming to the end of a century which began with confidence in humanity's prospects of almost unlimited progress, but which is now ending in widespread fear and moral confusion. If we want a springtime of the human spirit, we must rediscover the foundations of hope. ... Above all, society must learn to embrace once more the great gift of life ... and defend it against the culture of death, itself an expression of the great fear that stalks our times....
6. An essential feature of support for the inalienable right to life ... is the effort to provide legal protection for the unborn, the handicapped, the elderly, and those suffering from terminal illness. As bishops, you must continue to draw attention to the relationship of the moral law to constitutional and positive law in your society: "Laws which legitimize the direct killing of innocent human beings ... are in complete opposition to the inviolable right to life proper to every individual; they thus deny the quality of everyone before the law."... What is at stake here is nothing less than the indivisible truth about the human person on which the Founding Fathers staked your nation's claim to independence. The life of the country is much more than its material development and its power in the world. A nation needs a "soul." It needs wisdom and courage to overcome the moral ills and spiritual temptations inherent in its march through history. ... Catholics, and especially Catholic legislators, must continue to make their voices heard in the formulation of cultural, economic, political and legislative projects which "with respect for all and in keeping with democratic principles, will contribute to the building of a society in which the dignity of each person is recognized and the lives of all are defended and enhanced." ... Democracy stands or falls with the values which it embodies and promotes. ... In defending life, you are defending an original and vital part of the vision on which your country was built. America must become, again, a hospitable society, in which every unborn child and every handicapped or terminally ill person is cherished and enjoys the protection of law.
is a publication of the NCCB Secretariat for Pro-Life Activities
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