Thursday, October 02, 2008

Plan B: Prevention or Termination?

Katie Couric recently asked Sarah Palin about her position on Plan B, the controversial pill often referred to as the “Morning-After Pill,” or in some circles, an “Abortion Pill.” Palin’s answer, though shrouded in her trademark non-specifity, indicated that she does not condone the pill because of her pro-life position - though she is supportive of contraception.

I was curious about the actual effects of this pill, so I did some research.  Emergency Contraception is branded as a form of pregnancy prevention that can be taken up to 5 days AFTER intercourse.  For many non-biology majors, that doesn’t really compute unless it implies that the pill terminates a pregnancy that has already had the opportunity to begin.

Here is what I found…

Plan B prevents ovulation. So, if you have any lingering ... um ... “gentlemen callers” in your system after the fact, taking the pill will prevent a new egg from coming out to meet them, thereby preventing fertilization.

Plan B does NOT dislodge a fertilized egg from the uterus - so unlike RU-486, it does NOT cause an abortion in this way.  So if you’re already pregnant when you take it, it won’t help you.  It basically won’t have any effect.

ECPs do not interrupt an established pregnancy, defined by medical authorities such as the United States Food and Drug Administration/National Institutes of Health and the American College of Obstetricians and Gynecologists as beginning with implantation.*

But there’s a missing link in the chain. Eggs that have not been released won’t be.  Eggs that have been released, fertilized and have made their way into the uterus to attach to the lining are not at risk from the pill.  But what about an egg that has already been released, gets fertilized, and is still on its way toward the uterus (a process that takes about a week) when the pill takes effect?

The jury is still out on whether the pill prevents implantation of a fertilized egg.  Many scientists don’t think it affects implantation, but admit they don’t know for sure.

The reduced efficacy with a delay in treatment, even when use is adjusted for cycle day of unprotected intercourse, suggests that interference with implantation is likely not an inevitable effect of ECPs. If ECPs did prevent all implantations, then delays in use should not reduce their efficacy as long as they are used before implantation.*

Clinical associate professor in the University of Washington’s Department of Pharmacy, Don Downing, promotes the theory that Plan B does not interfere with implantation.  When he is questioned on the assurance of his data, his response is typically, “Do you have 100 percent proof there’s a God?  Or that the lunch you ate yesterday or the Tylenol you took this morning didn’t interfere with implantation?”

I know.  Not the most convincing answer.

At any rate, the clinical definition of pregnancy begins with implantation, so in scientific terms Plan B never causes an “abortion” even if it does interfere with implantation.  Incidentally, implantation is also the medical definition of “conception.”

So the real question for any anti-abortionist forming a position on Plan B, is when you believe life actually begins.  Many conservative pro-lifers believe life begins at conception, and that true definition of “conception” is fertilization.  This has been the traditional viewpoint since science first shed light on the egg-sperm process.  If a fertilized egg is a human life, then anything that interrupts the implantation of that egg effectively terminates that life.

However, it is somewhat difficult to assert the significance of a fertilized egg as a human life, when the human body naturally discards up to half of all fertilized eggs.  Most of these implant-failures go completely unnoticed.

It may seem like splitting hairs to debate the exact moment that human life begins, but the issue is critical to the millions of Americans who see a sacred value in that life.  At some point, you have to be able to say, “This counts, but this doesn’t.”

So what do you think?

*”Emergency Contraception” by James Trussell, PhD and Elizabeth G. Raymond, MD, MPH, September 2008