What an Abortifacient is — and What it isn’t

by Jamie L Manson on Feb. 20, 2012 Grace on the Margins

“One of the well known truisms in ethics is that good moral judgments depend in part on good facts.”

So wrote Dr. Ron Hamel, senior director of ethics for the Catholic Health Association of the United States (CHA) in the January-February 2010 issue of their journal Health Progress.

This edition of Health Progress focused on emergency contraception, particularly on the just treatment of women who check into hospital emergency rooms after suffering rape.

The ethicists and medical professionals who contributed to the journal could not have known then how valuable their articles would become two years later, when the church and country would become embroiled in a controversy over contraception.

Hamel’s words about the importance of adequate and accurate information in making moral judgments seems especially urgent now as many church leaders and commentators continue to use misleading information to argue that the HHS mandate will force employers to pay for abortion-inducing drugs.

The HHS mandate allows women free access to all FDA-approved forms of contraception. This includes the IUDs (intrauterine devices), the drug Plan B (levonorgestrel) and a new drug called Ella (ulipristal acetate), which came on the market in 2010. Church officials and others have argued that because these three contraceptives are abortifacients, the government is forcing them to participate in the distribution of devices and drugs that cause abortion.

The reality is that there is overwhelming scientific evidence that the IUD and Plan B work only as contraceptives. Since Ella is new to the market, it has not been studied as extensively. But as of now, there is no scientific proof that Ella acts as an abortifacient, either.

WHO Expert Opinion on House Bill 4643 on Abortive Substances and Devices in the Philippines

Posted on June 20, 2011 by RHAN

UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)
Department of Reproductive Health and Research
World Health Organization
Geneva, Switzerland
7 November 2006

BACKGROUND
The Committee on Revision of Laws, House of Representatives, Republic of the Philippines requested a position paper on House Bill 4643 (abortive substances and devices) from the World Health Organization (WHO) Philippines Country Office. The WHO Country Office forwarded this request to the WHO Regional Office, which in turn forwarded the request to WHO Headquarters in Geneva.

WHO Official Reply to Questions on the Mechanisms of Action of Specific Contraceptives

Posted Thu, 06/16/2011

OFFICE OF THE WHO REPRESENTATIVE IN THE PHILIPPINES
Department of Health, San Lazaro Compound, Sta. Cruz, Manila, Philippines
P.O. Box 2932, 1000 Manila, Philippines

In reply please refer to: WP/2011/0622/cd (MCN)
Prière de rappeler la référence: Honourable Edcel C. Lagman
Representative, 1st District of Albay
House of Representatives
Quezon City

6 June 2011

Dear Congressman Lagman,

This refers to your letter dated 2 June 2011 requesting this Office for expert and official opinion on three issues. Please be informed that we have forwarded your request to WHO Headquarters in Geneva, and our answers to the three (3) questions are as follows:

Question 1: While it is generally acknowledged that the two mechanisms of contraceptives consist of (a) preventing ovulation; and (2) preventing the sperm from fertilizing the egg, some say there is a third mechanism, which is to prevent the implantation of the fertilized ovum. Has this “third” mechanism been validated by clinical studies or is this a gratuitous claim by some pill and IUD manufacturers for commercial reasons?

Answer: To date, there is no scientific evidence supporting the contention that hormonal contraceptives and IUD prevent implantation of the fertilized ovum. While hormonal contraceptives directly or indirectly have effects on the endometrium that may hypothetically prevent implantation, there is already strong evidence on the primary mechanism of action of the following contraceptives:

Hormone Contraceptives Controversies and Clarifications

Authored by four Christian ProLife Obstetrician-Gynecologists
April,1999

Introduction

Recently, there has been some controversy, and serious questions have been raised by sincere individuals who are concerned that hormone contraceptives may have an abortifacient mechanism of action. This paper will help to clarify the issue based on a through review of the available medical literature regarding the mechanism of action of hormone contraceptives. It has been compiled by Board Certified practicing Ob/Gyns, in consultation with Perinatologists and Reproductive Endocrinologists, each being a physician committed to honoring the sanctity of human life from conception. We affirm that as physicians answerable to our Creator and Redeemer, we are responsible to the best of our ability to help, and not intentionally harm, our fellow human creatures. As Christian physicians, we affirm that all life is created by God and that human life is initiated at conception. Fertilization, not implantation, marks the beginning of human life. Disruption of the fertilized egg represents abortion.

The issues of mechanism of action of commonly used hormone contraceptives has threatened to split the pro-life physician community. Review of information currently being disseminated reveals some powerful and well written rhetoric. However, the issue of mechanism of action of hormone contraceptives is not one which will be illuminated by rhetoric. The mechanism of action of any medicine will not change based on how we feel about it, or on who developed it, or on how eloquently it is defended or opposed. How a medication works is a scientific question.

The hormone contraceptives include four basic types: combination oral contraceptives (COCs), injectables (Depoprovera), progestin only pills (minipill, or POPs), and implants (Norplant). In this paper, they will, where convenient, be collectively referred to as the “pill.” Most hormone contraceptives are noted to work by 3 methods of action:

1)Primarily, they inhibit ovulation by suppression of the pituitary/ovarian axis, mediated through suppression of gonadotrophin releasing hormone from the hypothalamus.

2)Secondarily, they inhibit transport of sperm through the cervix by thickening the cervical mucous.

3)They cause changes in the uterine lining (endometrium) which have historically been assumed to decrease the possibility of implantation, should fertilization occur. This presumption is commonly known as the “hostile endometrium” theory.

Hormonal Contraceptives: Are They Abortifacients?

A Physicians’ Report

Hormonal Contraceptive Report
January 1998

Currently the claim that hormonal contraceptives [birth control pills, implants (Norplant), injectables (depoprovera)] include an abortifacient mechanism of action is being widely disseminated in the prolife community. This theory is emerging with the assumed status of “scientific fact,” and is causing significant confusion among both lay and medical prolife people. With this confusion in the ranks comes a significant weakening of both our credibility with the general public and our effectiveness against the tide of elective abortion.

This paper is meant to provide some clarifying information on the issue based on current knowledge and experience regarding the mechanism of action of hormonal contraceptives. It has been compiled in consultation with, and by cooperative effort of, several practicing obstetrician-gynecologists, perinatologists, and reproductive endocrinologists (all among the undersigned), each being a physician committed to the sanctity of human life from conception.

We begin with the recognition that within the Christian community there is a point of view which holds that artificial birth control per se is wrong. We would consider this a personal matter of conscience and belief, and this paper is not intended to argue for or against this issue.

In this discussion we accept the time honored definition that conception occurs when a sperm penetrates an egg. Disruption of the fertilized egg after this point represents abortion. We consider fertilization, not implantation, to be the beginning of human life.

Most literature dealing with hormonal contraception ascribes a three-fold action to these agents. 1) inhibition of ovulation, 2) inhibition of sperm transport, and 3) production of a “hostile endometrium,” which presumably prevents or disrupts implantation of the developing baby if the first two mechanisms fail. The first two mechanisms are true contraception. The third proposed mechanism, IF it in fact occurs, would be abortifacient. (Note: the developing baby at the time of implantation is called a “blastocyst,” and will be referred to as such in this paper. “Endometrium” is the lining of the uterus into which the blastocyst implants.)

The entire “abortifacient” presumption, therefore, depends on “hostile endometrium” actually being hostile to the blastocyst, resulting in the loss of blastocysts that would otherwise prosper and grow. Since there are no scientific studies demonstrating the validity of this presumption, abortifacient proponents appeal to the writings of scientists and clinicians involved in the production or study of these contraceptive products. Nearly all of these sources freely use the term “hostile endometrium” to describe the changes which occur in the uterine lining when these medications are used. And most make the presumption that these changes contribute to birth control effectiveness. On the surface, this would seem to be nearly incontrovertible evidence that the “pill” is, at least occasionally, an abortifacient. However, we again emphasize that there are no scientific studies that we are aware of which substantiate this presumption.