Emergency contraception is designed to prevent or stop pregnancy after sex has occurred. There are two basic methods, the Emergency Contraceptive Pill (ECP) and the copper-based IUD. An abortifacient is medication taken after a fertilized egg has implanted on the uterine wall to cause a chemically-induced abortion.
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Reliability rates are difficult to pin down because of sample sizes, the fact that using a placebo would be unethical, varying fertility rates, and the fact that data is highly dependent on self-reporting from the subjects (rates are largely extrapolated from animal experiments). In general, 8% of women who have unprotected sex during the fertile part of their cycle will become pregnant. A "99% effectiveness rate," then, means that one woman became pregnant where researchers would have expected eight to become pregnant without emergency contraception. But if a medication is listed as reducing the rate of pregnancy by 75%, that means 75% of the eight women did not become pregnant — or 2 out of 100 did.
Emergency Contraception Methods
Emergency Contraceptive Pill
ECPs consist of one or two pills designed to prevent pregnancy for the cycle in which they are taken.
- Progestin-only: Most medications marketed as the "morning-after pill" rely solely on the progestin levonorgestrel. It is available over the counter in the US. Effectiveness is approximately 99% (out of 100 women, 1 would get pregnant instead of 8). Potential side effects include nausea, diarrhea, dizziness, fatigue, headache, and breast tenderness, along with standard allergic possibilities. Effectiveness decreases if used later than 24 hours after sex or if ovulation already occurred in the days before the pill was taken. Effectiveness also decreases for women over 165 pounds, dropping to 0% for women over 176 pounds.
Method: The levonorgestrel in progestin-only ECPs attempts to prevent pregnancy in three ways: It can prevent or delay the release of an egg if the user has not already ovulated. It thickens the mucus in the cervix to keep the sperm from reaching the egg. And it interferes with the development of the uterine lining to discourage a fertilized egg from implanting.
- Estrogen and progestin: Estrogen/progestin ECPs are not specifically available, but the concept is the same when normal estrogen/progestin birth control pills are used at a specific dose to prevent pregnancy. The dosage depends on the particular birth control pill used, as they have different amounts of estrogen and progestin. Effectiveness is about 98% (out of 100 women, 2 would get pregnant instead of 8). Side effects are similar to progestin only, but generally worse. The advantage is convenience in that more women would have birth control pills on hand and wouldn't have to go to the pharmacy to buy them.
Method: Estrogen/progestin ECPs act in much the same way as progestin-only ECPs. It is possible that they have less of an effect on the lining of the uterus, but they may inhibit the transport of the fertilized egg to the uterus.
- Mifepristone: Mifepristone (RU-486) is not technically an emergency birth control method — it is an abortifacient. Its purpose is to chemically induce the abortion of a fetus that is attached to the uterine wall. RU-486 is designed to be used within the first nine weeks of pregnancy. Side effects are usually similar to those during a spontaneous miscarriage, although a handful of deaths have been attributed to the drug. Effectiveness is 92-95%; if the drug fails in completing an abortion, a surgical abortion is required.
Method: Mifepristone is an antiprogestin which attaches to the cell receptors in the place of the natural progesterone, hi-jacking the fertility process that progesterone regulates. The first tablet, mifepristone, releases the placenta from the womb wall, softens the cervix, and increases the contractions to come. The second, taken between 6 and 48 hours later, initiates contractions to expel the fetus.
- Ulipristal acetate: Known by the brand name "ella," ulipristal acetate is also an antiprogestin — a lower-dosage version of mifepristone. It is available through prescription only. It is more effective on days 4 and 5 and more effective closer to time of ovulation than progestin-only or estrogen/progestin pills. It is possibly still effective for overweight and obese women. Marketed as Esmya, ulipristal acetate is also used for uterine fibroids. It has possibly fewer side effects if used as an ECP (headache, abdominal pain, nausea, dysmenorrhea, dizziness and fatigue are the most commonly reported), but progressively worse side effects if used for an extended amount of time for fibroids. Although spontaneous abortion and birth defect rates are unknown at this low dosage, and it is not marketed as an abortifacient, the medicine is the same as that found in RU-486 and is known to be harmful to fetuses; pregnancy tests are sometimes required. Like other forms of ECPs, it may lead to an ectopic pregnancy.
Method: Like mifepristone, ulipristal acetate is an antiprogestin which prevents progesterone from binding to receptors to facilitate the normal fertility process. The primary way ulipristal acetate prevents pregnancy is by delaying the release of an egg during ovulation, but it can also thin the lining of the uterus to prevent implantation of a fertilized egg.
With an effectiveness rate of about 99.9%, the most effective form of emergency contraception is the copper intrauterine device. IUDs are traditionally used for long-term pregnancy control, but when inserted shortly after sex, they have the same result. Possible side effects include anemia, backache, inflammation, bleeding between periods and heavy bleeding during periods, and cramping; a small percentage of users will get pelvic inflammatory disease. It is designed to be implanted and removed by a doctor, although some women will spontaneously expel the device. Copper IUDs are more expensive than other types of emergency contraceptives but once inserted can be used as traditional contraception for up to ten years.
Method: Unlike hormonal medication, IUDs do not affect ovulation. The copper in an IUD incites the uterus and fallopian tubes to produce chemicals toxic to sperm, which prevents fertilization. If the timing of ovulation was such that fertilization had already taken place, the copper IUD also thins the walls of the uterus, discouraging implantation of a fertilized egg.
Emergency Contraception and Abortion
Do emergency contraception methods cause abortion? RU-486 obviously does, but what about the others? First know that much of the methods of the different emergency contraceptives are based on what "should" happen when specific chemicals are introduced into a human; very little empirical evidence has been observed. Pro-choice proponents insist emergency contraceptives do not cause abortions, but this is based more on the definition of "pregnancy" than the method of birth control. Both the medical community and the federal government (including the American College of Obstetricians and Gynecologists and the Department of Health and Human Services) generally agree that "pregnancy" starts when a fertilized egg is implanted on the wall of the uterus. Conception, however, is the moment the egg is fertilized. Morning-after pills and IUDs are said to not affect an established pregnancy — a fertilized egg does not constitute a pregnancy, therefore it doesn't matter if it implants or not.
Upon fertilization of an egg, two half-cells, each with half the needed genetic material, combine to form one cell — the zygote. Changes in the mother's hormone levels can indicate the fertilization of an egg in as few as 24 hours. By the time the embryo implants on the uterine wall, about 6—9 days later, the blastocyst consists of several hundred cells, including embryoblasts, which will further develop into a fetus, and the trophoblasts, which will go on to form the placenta.
For years, the belief of many academicians was that life begins at fertilization. If this is true, then a pre-implanted, fertilized egg is a human life — to include fertilized eggs left in fertility clinics.
The question is important: Does life begin at fertilization, or does it begin at implantation — or later? Because if life begins at implantation, progestin and estrogen/progestin emergency contraceptives are not abortifacients. If life begins at fertilization, they have the potential to be since they can prevent implantation thus causing the zygote to be non-viable.
Medically and logically, stating that life doesn't begin until implantation doesn't make sense. It is at fertilization that the zygote has all the DNA he or she will ever have. Before implantation, the blastocyst has already started splitting into cells. Implantation ensures the embryo will have access to resources he or she needs to grow. To say an embryo at the zygote or blastocyst stage is not alive before implantation is like saying an infant is not born until he or she starts nursing.
Scripture also supports the idea that life begins at fertilization. Psalm 139:13-16 is the most popular passage used when speaking of conception and abortion issues. In it, David praises the God who formed him; particularly of interest is verse 16:
Your eyes saw my unformed substance; in your book were written, every one of them, the days that were formed for me, when as yet there was none of them."Unformed substance," here, is the Hebrew word golem (from which the Jewish legend of the clay monsters is taken). It means a mass, held together but without form or organization — much like the mass of cells that is a blastocyst. God no less "formed" the growing blastocyst than He did the implanted embryo. There is no logical or theological difference between the two.
Why is this even an issue? Emergency contraception is used if a woman had careless sex without protection, if the protection malfunctioned, or if she was raped. It is used to prevent pregnancy so that a conventional abortion is not necessary. For the pro-life Christian, it is tempting to think one or two pills will take care of the problem, no guilt needed. It's not that simple. They are not 100% effective. They can have some strong side effects. And although all but RU-486 are designed to prevent ovulation and/or limit the mobility of the sperm, every medication makes the uterine wall less friendly for implantation. That would be like delivering the baby, and then refusing to give her food.
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