A reader asks:
I have heard a great deal, even in some Catholic publications, about “emergency contraception.” Forgive my ignorance, but could you explain to me what it is about?
Answer:
Dear Madam:
The term “emergency contraception” denotes a set of practices put into action to prevent a possible unwanted pregnancy, whose mechanism of action is to counteract the development of the human embryo once fertilization has taken place. Since it cannot be ruled out that the sexual act may have occurred several days before ovulation, “emergency contraception” may at times act by blocking ovulation, but it is above all a direct action upon the embryo, and consequently an “abortifacient” practice.
The term “emergency” indicates that such practices must be employed in a period immediately following the sexual act that is presumed to be fertilizing.
Among the motives adopted by those who support such a campaign in favor of “emergency contraception” would be that of containing the effects of the “failures” of so-called “ordinary” contraception, and of reducing the percentage of women who use no contraceptive technique and who would therefore resort, occasionally or repeatedly, to surgical abortion as an instrument of birth control. An abortion that, in certain situations, is considered unsafe for the woman.
This (abortifacient) practice of birth control has been employed for several years now by some countries of Northern Europe and North America. Today there is a fierce campaign to spread it in developing countries, often taking advantage of catastrophic conditions (war, famine, mass migrations, etc.).
The forms used today in “emergency contraception” are: the repeated administration of very high doses of estrogens, or of high quantities of a combination of estrogens and progestogens, or of progestogens alone; the administration of danazol; the insertion of the coil or IUD (intrauterine device). In some countries mifepristone, better known as RU486, is also used, which acts —like danazol— by preventing the implantation of the fertilized embryo (although it also acts in more advanced periods of pregnancy)[1].
It is clear that the mechanism of action of so-called “emergency contraception” is explained, in the majority of cases, by preventing a fertilized embryo from nesting in the uterine wall and continuing its development. In other words, an abortion is brought about, that is, the death of a recently conceived human being[2].
For this reason it is a contradiction that the specialized literature claims that “emergency contraception” does not act as an abortifacient mechanism, or that thanks to “emergency contraception” the percentage of abortions is reduced.
Such an assertion has been reached by holding that pregnancy begins with the implantation of the embryo in the uterine walls (therefore not before the sixth day, as the minimum limit, and not after the fourteenth day, as the maximum limit); the embryo is called a “pre-embryo”; and abortion is considered as such only if it occurs after implantation. Consequently —it is said— “emergency contraception,” if applied before implantation, would not bring about the abortion of a pregnancy already begun: the effect would be solely that of “preventing the nesting of the embryo in the uterus.” Nevertheless, whatever may be said, the suppression of a human life in any of its phases is an abortion.
Therefore, it is necessary to restore the correct meaning to each term, so that everyone may know what reality “emergency contraception” entails. And this reality must challenge the conscience of each person, particularly of health-care workers (doctors, nurses, pharmacists, etc.) who must be prepared to raise a conscientious objection if —in the name of the dignity of the person— they do not wish to cooperate, through the prescription or administration of such products, in the killing of human individuals.
The fact that in some cases these products may have only an anovulatory effect, or that they have no effect at all when no fertilization exists, does not alter the ethical judgment on such a practice. In fact, by resorting to “emergency contraception” one voluntarily and deliberately assumes the risk of causing an abortion. In other words, should a pregnancy occur, the woman or the doctor would have opted for abortion.
Bibliography for further reading:
Bioethics Center of the Università del Sacro Cuore (Rome), Statement on the so-called “emergency contraception” (8 March 1997).
Author: Fr. Miguel Ángel Fuentes
Source: The Theologian Responds
Notes
[1] The administration of high doses of estrogen, or of combined estro-progestogens, or of progestogens during the 72 hours following sexual intercourse that is presumed to be fertilizing, produces either a luteolytic effect or a modification of the phases of endometrial development that were physiologically expected, with alterations at the cellular and/or enzymatic level. Consequently, the phase of the nesting of the eventually fertilized embryo in the uterine walls does not begin, and the pregnancy ends in abortion. To give an idea of the high doses of estrogens and progestogens administered in emergency contraception, it suffices to mention that these correspond to the quantity of hormones a woman would take over two years when using them as “ordinary” contraceptives.
Among the side effects of the intake of estrogens and estro-progestogens, the following have been found: nausea, vomiting, headache, metrorrhagia —more frequent in the case of the use of levonorgestrel alone—, but rare cases of acute pulmonary edema and an increase in the incidence of ectopic pregnancies have also been reported. Nevertheless, the long-term effects and risks of hormonal “emergency contraception” are still not known, above all in the case in which it is used more than once in the course of a woman’s fertile life.
[2] Studies carried out on women to whom combined estrogens and progestogens were administered at the imminence of ovulation have also demonstrated the inhibition of the release of the oocyte: this effect, more properly “contraceptive,” not foreseeable in the usual modalities of administration of the product, is present in only 20% of cases.
