Science and politics

by Eszter Hargittai on February 14, 2004

Those interested in reproductive health and rights probably already know that back in December an advisory panel of the Food and Drug Administration recommended that the “morning after” pill[1] be sold over the counter (OTC). The easy availability of such emergency contraception (EC) could reduce unwanted pregnancies significantly. Unfortunately, the issue is now running up against political hurdles.

Opponents suggest that easy access to “Plan B” would lead to an increase in sexually transmitted diseases because people would take protection less seriously. However, studies have shown that easier access to contraceptives of this sort does not necessarily lead to change in the level of sexual activity or protections used against STDs.[2]

For those concerned about abortion issues, please note that EC does not cause abortion, rather, it prevents pregnancy in the first place. So for those who are against abortion, supporting EC should be an obvious choice since by preventing unwanted pregnancies it is likely to reduce the number of abortions as well.

Since the efficacy of this pill is closely tied to its prompt use, requiring women to see a physician in order to get it is a big barrier to its use and utility. Evidence shows all the ways in which this switch to OTC availability would be beneficial. EC is already available without a prescription in thirty countries and in Israel, Norway and Sweden it is sold OTC. A decision about its US availability is expected next week unless the FDA asks for an extension in which case we may have to wait another few months.

fn1. Calling this pill the “morning after” pill is problematic. One does not need to wait until the morning after to use it, nor is it too late to use it later. The pill can be used safely and effectively in the 72 hours following the act (granted, the earlier the better).

fn2. Jackson RA, Schwarz EB, Freedman L, Darney P. Advance supply of emergency contraception : effect on use and usual contraception―a randomized trial. Obstet Gynecol 2003;102:8-16.

Glasier A, Baird D. The effects of self-administering emergency contraception. N Engl J Med 1998;339:1-4.

Raine T, Harper C, Leon K, Darney P. Emergency contraception: advance provision in a young, high-risk clinic population. Obstet Gynecol 2000;96:1-7.

Results from other related studies are forthcoming.



sean 02.14.04 at 1:12 am

not to start a fight here, but it’s pretty naive to think any abortion opponents would be swayed by your “EC does not cause an abortion” claim. most pro-lifers with strong views on the subject believe life (and claims to rights) begins at conception. while i’m sure you can create a moral argument for why a fetus would have different rights pre and post implantation, i would say that the medical definition of “pregnancy” isn’t the defining moral moment for most who hold such views.


eszter 02.14.04 at 1:32 am

I had provided a link to a page about this, but I just noticed the link was broken. I don’t know if you saw this on that page: “Medical authorities such as the United States Food and Drug Administration/National Institutes of Health and the American College of Obstetricians and Gynecologists define the beginning of pregnancy as the implantation of a fertilized egg in the lining of a woman’s uterus. [my emphasis] Implantation begins five to seven days after fertilization (and is completed several days later). Emergency contraceptives work before implantation and not after a woman is already pregnant.”

I realize you may be saying that some people may disagree with this as well. It may be, although I would like to know whether they actually understand the physiological differences between the various steps in the process.

I guess one question is whether by “conception” one means fertilization or implantation.


sean 02.14.04 at 1:48 am

i did acknowledge in my post (though clearly not carefully enough), that i understand the medical definition of pregnancy has everything to do with implantation. but my point was that for pro-lifers (at least the ones i know), it is the fertilization that is important. i was trying to make the distinction between beginning of “life” and of “pregnancy”. i didn’t want to start any arguments about “life” of course, but just wanted to point out that “life” is what matters to the “pro-lifers”. implantation is a more relevant time point from the standpoint of the mother, while fertilization is a more relevant point from the standpoint of the fetus.


sean 02.14.04 at 1:54 am

again, i think using implantation as the relevant time of “life” could help pro-lifers get around lots of inconsistencies re: in vitro, stem cells, etc., but that’s an argument that has to be fully made, and i don’t think many pro-lifers are yet of that view, which is why they mostly object to EMC, even knowing the physiology of it.


maurinsky 02.14.04 at 4:31 am

I think most pro-lifers are really opposed to people having sex for any reason other than to make babies within the confines of marriage, so I don’t think they care about any difference between fertilization and implantation. Many pro-lifers are opposed to masturbation because it’s against God’s plan (“Every sperm is sacred”).


rdb 02.14.04 at 4:38 am

Note that US Attorney General John Ashcroft has previous introduced laws asserting legal status begins at fertilization, which would make use of IUDs and the contraceptive pill abortion.


Charles V 02.14.04 at 4:52 am

Birth is the defining moral moment when rights are conferred upon an individual. Until that point, the rights of the mother should override any “rights” given to a fetus. This doesn’t mean that the fetus doesn’t deserve special consideration, just that it’s each mother’s right to decide which arbitrary biological or emotional milestone marks the beginning of her child’s life. In my humble opinion.

So-called pro-lifers seek to impose their own arbitrary definition of life’s beginning onto all women, and not coincidentally, this earliest possible beginning of life allows the greatest amount of control over other women’s bodies.


Chris 02.14.04 at 6:10 am

I have no idea what the medical reasons for defining pregnancy as beginning at implantation are, but I’m quite confident that they’re medical reasons and not moral reasons. I can’t think of any justification for holding that an unimplanted but fertilized egg is not a person, but an implanted egg is. The claim that “emergency contraception” cannot cause abortion is very close to intellectually dishonest, in my opinion, because it disguises a serious moral issue behind a medical term of art.


Maureen 02.14.04 at 8:16 am

“I can’t think of any justification for holding that an unimplanted but fertilized egg is not a person, but an implanted egg is.”

Actually, there’s a pretty big difference–the unimplanted, fertilized egg is a clump of undifferentiated cells. The zygote can split into a multitude of individual zygotes–Brave New World, anyone?–and each of the zygotes can develop into its own person, each with its own soul. Now, since a zygote can split until it’s implanted in the womb and uterine hormones cause the zygote’s cells to begin to differentiate, and therefore the zygote has the potential for more than one life, I don’t see how a soul, or whatever it is that gives us human dignity, could come into play before implantation. What if a zygote received a soul before implantation, but it suddenly split? We don’t believe that genetically identical twins share a soul; therefore who gets the original soul? Surely it would be easier for the soul to enter the flesh when the individuality of that flesh is assured.


Mark Byron 02.14.04 at 10:42 am

Charles-“Birth is the defining moral moment when rights are conferred upon an individual.”

Using the word “moral” implies that God (or something like it) is in the mix. What teachings do you use to define that point rather than sometime before or after birth?


raj 02.14.04 at 12:48 pm

What is the science issue here? The only issue is a political one: whether the substance should be available over the counter.

I hate to tell you, but the fact is that there are no science issues regarding whether ANY substance should be available over the counter. The only issues regarding that are political ones.


Gemma 02.14.04 at 5:42 pm

Actually, Plan B (the so-called morning-after pill) works primarily by preventing ovulation, not by preventing implantation. It’s nothing more than a double dose of the ordinary birth-control pill Progestin.

There’s a very tiny risk of preventing implantation by using progestin, but no more so than by using other common medications, such as anti-inflammatory agents (ibuprofen, naprosyn).


John 02.16.04 at 2:08 am

A year ago the Nat’l. Institute of Health defined pregnancy as “from conception”. In the past year they have changed the definition under pressure from political activists determined to bypass parental notification requirements for prescription abortificients.


Ken 02.16.04 at 4:38 pm

Here’s an even better question.

Why not allow regular birth control pills to be sold over the counter?


WSM 02.16.04 at 4:47 pm

This doesn’t seem more political than David Kessler’s work. I realize that academic lefties don’t approve of breast implants or smoking, whereas they do approve of sex, but that is a political judgment, not a scientific one.


Amanda Butler 02.16.04 at 7:54 pm

“Why not allow regular birth control pills to be sold over the counter?”

Doctors do want to monitor patients on birth control pills to a certain extent. The Pill does sometimes raise blood pressure, and they’re particularly worried about this in smokers. “Do you smoke?” is one of the questions asked when women go in for a prescription (I’ve had friends lie and get away with it).

I think it would be reasonable to sell birth control pills over the counter at places where the pharmacists were trained in taking blood pressure. Only if your blood pressure were above normal/healthy would you be required to see a doctor. They also might not be able to give you the ten months’ prescriptions like doctors can; perhaps only three months at a time so the blood pressure could be monitored more often.

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