Introduction and Purpose
Of all methods of contraception, emergency contraception (also known as “the morning after pill”) is perhaps the most misunderstood. This is due to a prominent myth that EC causes abortion. The foundation of the myth that emergency contraception is an abortifacient is a factual inaccuracy about how emergency contraception actually works. This newsletter addresses the origins and errors of the abortifacient myth, and provides factual information about the “morning after pill’s” mechanism of action.
Outline
Prerequisite Terminology & Concepts
In order to understand emergency contraception, one first needs basic knowledge of the following terms/concepts.
🟩 Contraception: “Contraception is the act of preventing pregnancy. This can be a device, a medication, a procedure or a behavior.” [1]
🟩 Emergency contraception: “What is emergency contraception? Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within 5 days but are more effective the sooner they are used after the act of intercourse.” [2] “Using EC does not cause an abortion. An abortion ends an existing pregnancy. EC prevents pregnancy from occurring. EC must be used soon after unprotected sexual intercourse to be effective. It does not work if pregnancy has already occurred.” [3]
🟩 Ovulation: Ovulation is “the release of a ripe egg from a female’s ovary.” [4] “Ovulation begins when the female brain releases specific hormones that spike in the bloodstream, triggering the release of an egg.” [5]
🟩 Fertilization: “Fertilization occurs when a female egg and male sperm meet. Though it is commonly assumed that fertilization takes place during intercourse or very shortly thereafter, it can occur up to five days later. This means that a woman can become pregnant if she ovulates and then has intercourse, or if she has intercourse and then ovulates within the next five days.” [6]
🟩 Implantation: “Implantation occurs when the blastocyst burrows into the endometrium and begins to transform into the placenta and embryo.” [7] The process of implantation is not completed until around day 9 or 10 post-fertilization. [8]
🟩 Pregnancy: Pregnancy is “the state of carrying a developing embryo or fetus.” [9] “According to both the scientific community and long-standing federal policy, a woman is considered pregnant only when a fertilized egg has implanted in the wall of her uterus.” [10] The process of implantation is completed around day 9 or 10 post-fertilization. [11]
🟩 Abortion: Abortion is a medical term defined as the ending of an established pregnancy before fetal viability [12] [13] [14], though "some medical dictionaries mention 20 weeks' gestation or 500 g as the limit.” [15]
🟩 Abortifacient: “An abortifacient is any substance that is used to terminate a pregnancy.” [16]
Types of Emergency Contraception
There are two main types of oral emergency contraception: (1) ulipristal acetate pills, (2) levonorgestrel (progestin) pills, and (3) combined (estrogen and progestin) pills. “When taken as directed, ulipristal is the most effective type of EC pill, followed by the progestin-only pill. Combined EC pills are not as effective in preventing pregnancy as the progestin-only EC pill.” [17]
🟩 Ulipristal acetate: “Ulipristal acetate, marketed as ella, was approved by the FDA in 2010 for sale and use in the U.S.” [18] “ella is a single-dose pill that is effective in preventing pregnancy up to five days after unprotected intercourse, giving women a longer timeframe to prevent unintended pregnancy than Plan B. Its mechanism of action is similar to that of progestin-based EC.” [19]
🟩 Levonorgestrel: “Plan B was the first oral form of EC to be made available in the U.S. as a pre-packaged dose of pills containing the progestin, levonorgestrel. Now, there are generic alternatives available as well. Progestin-based EC pills use the same hormones found in daily oral contraceptives and are the most widely used form of EC. [These] EC pills are marketed today under the brand name Plan B One-Step and generic names.” [20]
🟩 Combination pills: “Certain daily oral contraceptive pills can also act as EC when taken in doses four or five times higher than the daily dose, although they are not specifically sold as emergency contraception. Oral contraceptive pills contain progestin and estrogen and are taken in two doses 12 hours apart to be effective as EC.” [21]
How Does Emergency Contraception Work?
The way a contraceptive works is called its mechanism of action. All EC pills share the same mechanism of action: preventing or delaying ovulation. [22] Here’s how: “Ovulation begins when the female brain releases specific hormones that spike in the bloodstream, triggering the release of an egg.” [23] Emergency contraception pills, “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.” [24]
Sperm can live inside the female body for up to five days. “This means that a woman can become pregnant if she ovulates and then has intercourse, or if she has intercourse and then ovulates within the next five days.” [25] Emergency contraception pills prevent ovulation from occurring after intercourse, when the sperm is present in the female body.— No egg is released, thus no egg is fertilized.
*If a person has already ovulated, emergency contraception will not work.
Does Emergency Contraception Inhibit Implantation?
No. Emergency contraception does not inhibit implantation of a fertilized egg into the uterine wall.
“The fact that women take emergency contraception after intercourse helps enable the perception that emergency contraception works by preventing implantation of a fertilized egg. However, because fertilization can take place up to five days after intercourse, emergency contraception functions only on eggs that have not yet been released and fertilized.” [26]
Emergency contraception has no effect on the uterine lining, and numerous studies have “found no difference in endometrial receptivity to implantation after exposure to Levonorgestrel EC compared to controls.” [27] “Levonorgestrel EC taken after ovulation does not affect implantation.” [28]
Emergency contraception merely “disrupt[s] the feedback system between the brain and ovaries, thus inhibiting the release of an egg.” [29] “Emergency contraception functions only on eggs that have not yet been released and fertilized.” [29] The “weight of the evidence shows that Plan B and its cousin, Ella,... stop ovulation” [29] by “disrupt[ing] the feedback system between the brain and ovaries, thus inhibiting the release of an egg.” [30]
“No egg is released, no egg is fertilized, and no fertilized egg is destroyed.” [31]
Is Emergency Contraception an Abortifacient?
No, emergency contraception is not an abortifacient.
“An abortifacient is any substance that is used to terminate a pregnancy.” [32] Abortifacients end a pregnancy. Emergency contraception does not. “The morning after pill only works by preventing ovulation, it can not cause an abortion and it will not have any effect in a case where an egg has already been fertilized.” [33]
Many prominent anti-abortion groups are also opposed to contraception in general. For decades now, these groups have been “working to stigmatize contraception by blurring the lines between contraception and abortion.” [34] Claiming that some forms of contraception (including emergency contraception) are abortifacients furthers their goal. But it is a complete misnomer to label emergency contraception as an “abortifacient.” [35] Emergency contraception is not an abortifacient.
“Emergency contraception is effective only in the first few days following intercourse before the ovum is released from the ovary and before the sperm fertilizes the ovum. Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo, thus cannot cause abortion.” [36] “If someone takes EC pills while they are pregnant, research shows that the pregnancy will not be affected. Emergency contraception will not cause a miscarriage or an abortion, and it doesn’t affect fetal development.” [37]
To reiterate, emergency contraception pills merely “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.” [38] No egg is released, no egg is fertilized, no fertilized egg is destroyed, no implantation is inhibited, and no pregnancy is ended. [39]
How Did the Abortifacient Myth Begin?
The confusion surrounding emergency contraception pills began when Plan B went from a prescription-only medication to being available over-the-counter in 2006. [40] “When the drug company that owned Plan B at the time, Barr Pharmaceuticals, sought FDA permission to sell it over-the-counter, the effort faced opposition from anti-abortion forces, according to historical accounts, as well as interviews with people involved. Those forces included a member of the scientific advisory panel reviewing the application,” Dr. Joseph Stanford. [41]
Standard “was a Catholic-influenced Mormon physician who believed human life (and personhood) begins at fertilization.” [42] He “argued that a remote possibility existed that Plan B could prevent implantation of a fertilized egg.” [43] “Despite having no scientific evidence to support that claim, the company agreed to list the post-fertilization mechanism on the packaging as a way of getting the application approved.” [44]
“That seemingly innocuous capitulation has paid dividends for abortion opponents, codifying in official government documents a mechanism of action that would be used to blur the line between contraception and abortion.” [45]
Anti-abortion groups had long been working to non-medically redefine pregnancy as beginning with fertilization. [46] [47] Against contraception in general, prominent anti-abortion groups were able to point to the politically, not medically, formulated labeling for Plan B (as inhibiting implantation) as “proof” that emergency contraception “causes early abortions.”
But “there's one thing [fertilization] definitely does not begin. Medically, at least, fertilization does not mark the beginning of pregnancy.” [48] As Daniel Grossman, an obstetrician/gynecologist at the University of California, San Francisco, explained, “The medical community has really been quite clear about when pregnancy begins, and that definition is that pregnancy begins once implantation occurs." [49] Fertilization “isn't a clean indicator of anything,” because “there’s an incredibly high rate of fertilized eggs that don’t implant.” [50] In fact, 50-80% of fertilized eggs will never implant into the uterine wall [51] [52] [53], because they “never begin dividing” and are thus incapable of implantation. [54]
Furthermore, as we have already discussed above, emergency contraception does not inhibit implantation of a fertilized egg. Emergency contraception pills merely “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.” [55] No egg is released, no egg is fertilized, no fertilized egg is destroyed, no implantation is inhibited, and no pregnancy is ended. [56]
Yet, “despite the clear and long-standing medical consensus that pregnancy is not established until implantation,” [57] and despite “the weight of the evidence clearly show[ing] that emergency contraceptives… are not abortifacients,” [58] and despite the fact that the Plan B labeling was politically-driven, [59] anti-abortion groups continued to push the “abortifacient” myth, with great success. The result has been the widespread, disinformation-fueled confusion about emergency contraception's mechanism of action and its status as a contraceptive.
End note: The FDA finally changed Plan B's label and updated its information on the medication in 2022, clarifying that “Plan B One-Step does not prevent a fertilized egg from implanting in the womb and does not cause an abortion.” [60]
Citations
[1] Bansode OM, Sarao MS, Cooper DB. Contraception. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536949/
[2] World Health Organization. (2021, November 9). Emergency contraception. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/emergency-contraception#:~:text=What%20is%20emergency%20contraception%3F,after%20the%20act%20of%20intercourse
[3] American College of Obstetricians and Gynecologists. (2019). Emergency contraception. ACOG. https://www.acog.org/womens-health/faqs/emergency-contraception
[4] Dictionary of Unfamiliar Words: ovulation. (n.d.) Dictionary of Unfamiliar Words by Diagram Group. (2008). Retrieved November 18 2023 from https://www.thefreedictionary.com/ovulation.
[5] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 214. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[6] Ibid. 5, pp. 214-15
[7] Ibid. 5, p. 215
[8] Artal-Mittelmark, Raul. “Stages of Development of the Fetus - Women’s Health Issues.” Merck Manuals Consumer Version, Merck Manuals, 30 Aug. 2023, www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus.
[9] “Medical Definition of Pregnancy.” RxList, RxList, 29 Mar. 2021, www.rxlist.com/pregnancy/definition.htm.
[10] Gold, Rachel Benson, and Guttmacher Institute. “The Implications of Defining When a Woman Is Pregnant.” Guttmacher Institute, 30 Aug. 2022, www.guttmacher.org/gpr/2005/05/implications-defining-when-woman-pregnant.
[11] Artal-Mittelmark, Raul. “Stages of Development of the Fetus - Women’s Health Issues.” Merck Manuals Consumer Version, Merck Manuals, 30 Aug. 2023, www.merckmanuals.com/home/women-s-health-issues/normal-pregnancy/stages-of-development-of-the-fetus.
[12] “Chapter 11: First- and Second-Trimester Pregnancy Loss.” AccessMedicine, https://accessmedicine.mhmedical.com/content.aspx?sectionid=263815963&bookid=2977#263816185.
[13] “Abortion: Taber's Medical Dictionary.” Abortion | Taber's Medical Dictionary, https://www.tabers.com/tabersonline/view/Tabers-Dictionary/766365/all/abortion.
[14] Grimes, David A., and Gretchen Stuart. “Abortion Jabberwocky: The Need for Better Terminology.” Contraception, Elsevier, 21 Oct. 2009, https://www.contraceptionjournal.org/article/S0010-7824%2809%2900415-6/fulltext.
[15] Ibid. 14
[16] Abortifacient. Abortifacient - an overview | ScienceDirect Topics. (n.d.). https://www.sciencedirect.com/topics/medicine-and-dentistry/abortifacient#:~:text=An%20abortifacient%20is%20any%20substance,commonly%20used%20to%20induce%20abortion
[17] American College of Obstetricians and Gynecologists. (2019). Emergency contraception. ACOG. https://www.acog.org/womens-health/faqs/emergency-contraception
[18] Published: Aug 04, 2022. (2022, August 4). Emergency contraception. KFF. https://www.kff.org/womens-health-policy/fact-sheet/emergency-contraception/
[19] Ibid. 18
[20] Ibid. 18
[21] Ibid. 18
[22] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 215. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[23] Ibid. 22
[24] Ibid. 22
[25] Ibid. 22, pp. 214-15
[26] Ibid. 22
[27] Endler, M., Danielson, K. G., & Li, R. (2022, January 23). Effect of levonorgestrel emergency contraception on implantation and ... Contraception. https://www.contraceptionjournal.org/article/S0010-7824(22)00006-3/fulltext
[28] Ibid. 27
[29] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 212. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[30] Ibid. 29, p. 215
[31] Ibid. 29
[32] Abortifacient. Abortifacient - an overview | ScienceDirect Topics. (n.d.). https://www.sciencedirect.com/topics/medicine-and-dentistry/abortifacient#:~:text=An%20abortifacient%20is%20any%20substance,commonly%20used%20to%20induce%20abortion
[33] The ella® pill: All you need to know about ella®: Ella®. ellaone USA. (2020, July 20). https://www.ella-now.com/all-you-need-to-know-about-taking-ella/#:~:text=By%20taking%20ella%C2%AE%20as,egg%20has%20already%20been%20fertilised
[34] Dreweke, J., & Guttmacher Institute. (2023, August 15). Contraception is not abortion: The strategic campaign of antiabortion groups to persuade the public otherwise. Guttmacher Institute. https://www.guttmacher.org/gpr/2014/12/contraception-not-abortion-strategic-campaign-antiabortion-groups-persuade-public
[35] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 212. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[36] Mittal, S. (2014, November). Emergency contraception - potential for women’s health. The Indian journal of medical research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345752/#:~:text=Emergency%20contraception%20is%20effective%20only,embryo%2C%20thus%20cannot%20cause%20abortion
[37] Watkins, R. (2023, January 30). What’s the difference between emergency contraception and abortion pills? Power to Decide. https://powertodecide.org/news/whats-difference-between-emergency-contraception-and-abortion-pills
[38] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 215. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[39] Ibid. 38, p. 212
[40] Varney, S. (2023, July 20). Misinformation clouds America’s most popular emergency contraception. KFF Health News. https://kffhealthnews.org/news/article/emergency-contraception-plan-b-private-equity-abortion-debate/
[41] Ibid. 40
[42] ChoGlueck, C. (1970, January 1). Broadening the scope of our understanding of mechanisms: Lessons from the history of the morning-after pill. PhilSci Archive. http://philsci-archive.pitt.edu/15867/1/Sythese%20Broadening%20Scope%20Mechanism%20MAP%20final.pdf
[43] Varney, S. (2023, July 20). Misinformation clouds America’s most popular emergency contraception. KFF Health News. https://kffhealthnews.org/news/article/emergency-contraception-plan-b-private-equity-abortion-debate/
[44] Ibid. 43
[45] Ibid. 43
[46] Rovner, J. (2011, June 1). Abortion foes push to redefine personhood. NPR. https://www.npr.org/2011/06/01/136850622/abortion-foes-push-to-redefine-personhood
[47] Gold, R. B., & Guttmacher Institute. (2022, August 30). The implications of defining when a woman is pregnant. Guttmacher Institute. https://www.guttmacher.org/gpr/2005/05/implications-defining-when-woman-pregnant
[48] Rovner, J. (2011, June 1). Abortion foes push to redefine personhood. NPR. https://www.npr.org/2011/06/01/136850622/abortion-foes-push-to-redefine-personhood
[49] Ibid. 48
[50] Zhang, S. (2015, October 2). Why science can’t say when a baby’s Life begins. Wired. https://www.wired.com/2015/10/science-cant-say-babys-life-begins/
[51] Ibid. 50
[52] Mehta, Dr. J. (2023, September 18). These symptoms confirm, failed implantation of fertilized egg. Signs of Unsuccessful Egg Implantation| Key Insights. https://www.shreeivfclinic.com/blogs/symptoms-of-failed-implantation-of-fertilized-egg/#:~:text=Failed%20implantation%20is%20relatively%20common,even%20realizes%20she%20is%20pregnant
[53] Rovner, J. (2011, June 1). Abortion foes push to redefine personhood. NPR. https://www.npr.org/2011/06/01/136850622/abortion-foes-push-to-redefine-personhood
[54] Ibid. 53
[55] Frank, Rachel. “Miss-Conceptions: Abortifacients, Regulatory Failure, and Political Opportunity.” Yale Law Journal, vol. 129, no. 1, Oct. 2019, pp. 215. 2019-2020, https://www.yalelawjournal.org/pdf/FrankNote_nsp64s9w.pdf.
[56] Ibid. 55, p. 212
[57] Gold, R. B., & Guttmacher Institute. (2022a, August 30). The implications of defining when a woman is pregnant. Guttmacher Institute. https://www.guttmacher.org/gpr/2005/05/implications-defining-when-woman-pregnant
[58] Dreweke, J., & Guttmacher Institute. (2023, August 15). Contraception is not abortion: The strategic campaign of antiabortion groups to persuade the public otherwise. Guttmacher Institute. https://www.guttmacher.org/gpr/2014/12/contraception-not-abortion-strategic-campaign-antiabortion-groups-persuade-public
[59] Varney, S. (2023, July 20). Misinformation clouds America’s most popular emergency contraception. KFF Health News. https://kffhealthnews.org/news/article/emergency-contraception-plan-b-private-equity-abortion-debate/
[60] Goodman, B. (2022, December 23). FDA specifies plan B emergency contraceptive does not cause abortions. CNN. https://www.cnn.com/2022/12/23/health/fda-plan-b-label-abortion/index.html
What most folks don’t realize is that at least two processes must occur before there is even a zygote. First the egg must complete meiosis II. Second the nuclei from both cells must merge together to form a single cell with a diploid nucleus. This is the definition of a human zygote. The zygote must undergo a number of cell divisions by a process called mitosis. Not to be confused with meiosis, mitosis causes the cell number to double with each division. If the zygote does not develop properly then it may very well not implant into the endometrial lining of the uterus. Any error that occurs along the developmental process could result in a blastocyst not implanting therefore there is no pregnancy.
You can’t redefine pregnancy nor can you redefine birth such that the PL crowd does. They want the definitions to fit with the 14th amendment narrative but that isn’t how the constitution reads. They are deceptively trying to change the rules.