Most of us have known for a while that emergency contraception (EC) is not an abortifacient: it’s a contraceptive. This is an important distinction in a world where abortion is a politically-charged issue, and now, science is seriously backing us.
Studies over the last several years (about which more in a moment) have confirmed that these pills work by interfering with ovulation and preventing egg and sperm from meeting, but the one thing they don’t appear to do very well, if at all? Block implantation of fertilized eggs.
This seems like splitting hairs to those of us who support the right of individuals to choose what they do with their own bodies, up to and including decisions about terminating pregnancies. But it’s a whole different ball game to the anti-choice movement and its fervent belief that a fertilized egg is morally equivalent to a full-fledged human being. Under their metric, abortion is “homicide,” and numerous anti-choice organizations have attempted to characterize EC as an abortion or “murder” pill.
And it’s not just about beliefs, of course: even as extremists are coming for birth control, these groups are also lobbying to get EC exempted from requirements that health plans cover birth control. That’s why EC’s medical status has been such a hot potato lately. If it’s an abortifacient, that means conservative companies can exempt it from health care requirements and people would be required to buy it on their own. If it’s birth control, though, those selfsame conservatives are just going to have to swallow that particular bitter pill and pony up for employees covered under a health care plan who need EC.
Personally, I happen to believe abortion should be covered like any other health care need, but unfortunately, people like me aren't the ones who make the policy.
The science behind precisely how EC worked was a bit nebulous for a while, with several theories as to how it might function. In addition to interfering with ovulation and making it harder for sperm to get to eggs, some researchers theorized that it might prevent implantation by changing the lining of the uterine wall. That would mean that if an egg was fertilized, it wouldn’t have anywhere to go.
Which still wouldn’t have made EC an abortifacient, since it wouldn’t have “interrupt[ed] an established pregnancy.” Instead, it would have assured that a pregnancy never happened in the first place, which would place it in the category of a contraceptive. But for anti-choice fanatics, every fertilized egg is a person, and thus, a drug that prevented implantation would cause an abortion.
Even though fertilized eggs routinely don’t implant naturally, using medication to accomplish that goal is viewed negatively by conservatives, who are apparently convinced that every single fertilized egg has the potential to progress to a full-term pregnancy.
50% of fertilized eggs manage to hang on long enough to implant.
So it’s good news that there’s some definitive science on this subject.
A 2010 study in “Contraception” looked at the use of EC before and after ovulation. The conclusion? “We conclude that LNG [levonorgestrel]-EC prevents pregnancy only when taken before fertilization of the ovum has occurred.” A similar study in 2007 offered comparable results. So did another study in 2001.
In other words, science has been pretty convinced for quite a while that levonorgestrel EC (like that used in Plan B) doesn’t act on fertilized eggs. Labeling and discussions in the larger medical community have lagged behind, which is frustrating and needs to change, because patients need to understand what they are taking, and what it does (and doesn't) do.
What about Ella, which uses ulipristal acetate as the primary ingredient? It's been singled out because it is a relation of mifepristone, the drug used in RU-486. That’s led some anti-choicers to insist the medication is an abortifacient.
While there’s a chance ulipristal acetate may interfere with a fertilized egg, its primary mechanism of action appears to be in delaying ovulation, explaining why it can be effective for up to five days. It’s provided in such a low dose in comparison with its cousin mifepristone that it’s unlikely to abort a pregnancy -- especially since it wouldn’t be provided with a paired prostaglandin to induce abortion, as is done with RU-486.
And, notably, studies indicate that it also works primarily by inhibiting ovulation. A study that ran in “Reproductive Science” last year indicated that ulipristal acetate needed to be used within “a critical time window” to be effective, suggesting that ovulation, not implantation, played a key role in the efficacy of this drug.
In other words: Nope, it's not an abortifacient.
Conservatives will no doubt keep fighting on this as part of their larger war on women and contraception in general, but it’s time to blow the myth that these drugs cause abortions to smithereens. Even if you take an extremist and medically incorrect definition of abortion that includes a failure to implant (in which case tons of people are spontaneously aborting all the time and they don’t even know it), that’s still not what these drugs do.
Instead, they act precisely as intended: to prevent pregnancy.
Sorry, anti-choicers, but you’re gonna have to pony up for EC for those that want and need it.