Politics & Policy

“Plan B”: Politics vs. Science?

One half of this fight is missing.

There’s no disputing that politics has crept into the debate. What’s missing from the discussion is science. Aside from pie-in-the-sky predictions about how many abortions will be averted, supporters of Plan B are not coming to grips with the findings of science and social science.

Here’s what science tells us:

‐ First, studies — many conducted by proponents of emergency contraception (EC) — show that widespread access to EC does not reduce rates of unintended pregnancy or abortion.

‐ Second, repeated use of Plan B is not as safe as advertised.

‐ Third, Plan B has at least four different modes of action, two of which are post-fertilization effects (acting on the newly created embryo). Depending on when in a woman’s fertility cycle sexual activity occurs and Plan B is taken, ECs can end the life of a developing human being.

Plan B Doesn’t Reduce Abortion Rates

Anna Glasier, a leading EC researcher, gave 5 packets each of ECs to almost 18,000 sexually active young women in one health district of Scotland. The women shared these with almost 5,000 friends; the drug thus reached 27 percent of all 16- to 29-year-old sexually active women in the district. Glasier expected a significant reduction in abortion rates. But after 16 months she concluded, in a report for the journal Contraception: “No impact on abortion rates was measurable.” Birth and abortion rates were roughly the same in all health districts.

Tina Raine randomly assigned 2,117 California women aged 15-24 to one of three groups. The first received three packets of EC to take home. The second received instructions on how to obtain EC free without a prescription at local pharmacies. The third (the control group) had to return to the clinic for EC. In the six-month study period, there was no significant reduction in pregnancy rates among the three groups — an this in spite of the fact that the first group was nearly twice as likely to use EC. The pregnancy rate was 8 percent among those with EC packets at home, 7.1 percent among those with pharmacy access, and 8.7 percent in the control group. And all but 18 percent of the women were also using another method of contraception.

Jacqueline Gardner summarizes the inconclusive results of the Washington State Pilot Project, which allowed pharmacists to dispense EC without a prescription from February 1998 to June 1999. Abortions in Washington dropped 5 percent between 1997 and 1998 (before increasing again in 1999). However, as she concedes, “national abortion rates also were declining during this period, reaching their lowest levels since 1978.” The Alan Guttmacher Institute reports that the national abortion rate dropped 5 percent between 1996 and 2000, but only 3 percent in Washington.

Sourafel Girma and David Paton, after examining the impact of free, over-the-counter EC on teenage pregnancy rates, concluded: “We find little evidence that pharmacy [EC] schemes have led to lower under-18 pregnancy rates in England.”

The title of T. Tyden’s 2002 article in the medical journal Lakartidningen on Sweden’s experience with EC is clear enough: “No reduced number of abortions despite easily available emergency contraceptive pills.”

Anne Williams found that greatly increased access to contraceptives and a more than three-fold increase in the use of EC in Scotland since 1990 (where they are available free over-the-counter to teens) has had almost no effect on the number of teenage pregnancies. (He findings are in the Scottish Council on Human Bioethics Report The Morning-After Pill (click on “Publications,” then “By Type,” then “Reports”).

Safety of Plan B

Plan B and other methods of EC are the equivalent of taking 4, 8, 10, or 40 times the daily dose of various oral contraceptive pills in a 12-hour period.

EC proponent David Grimes, MD, explains (reg. req.): “Repeated use of EC wreaks havoc on a woman’s cycle, so the resulting menstrual chaos acts as a powerful deterrent to using this method too often.”

An FDA Postmarketing Safety Review yielded 116 adverse events, including convulsions and 28 cases of ectopic pregnancy. The United Kingdom’s regulatory authorities report a threefold greater risk of potentially fatal ectopic pregnancy with EC use. New Zealand and China have also reported an increased risk.

Washington, Scotland (see the Williams report above), England, and Sweden (see also the Tyden report above) have reported a dramatic rise in sexually transmitted infections, notably Chlamydia, since increasing access to EC.

Dual Contraceptive and Abortifacient Actions of Plan B

The American Pharmaceutical Association’s Continuing Education Program Special Report “Emergency Contraception: The Pharmacist’s Role” reads in part:

Like oral contraceptives that are taken on a daily basis, emergency contraceptives might prevent pregnancy by inhibiting any of the events necessary for pregnancy to become established …:

1. Ovulation …;

2. Fertilization …;

3. Transport of the fertilized egg to the uterus; or

4. Implantation of the blastocyst in the endometrium (by creating changes in the endometrium unreceptive to implantation).

Science textbooks on embryology tell us that “fertilized egg” and “blastocyst” are technical names for a newly conceived and developing human being. He or she will die in the first week of life if prevented from implanting in the mother’s womb. This is true regardless of the oddity that some have redefined “pregnancy” and “conception” as occurring at implantation (so they can call such drugs anti-pregnancy or “contraceptive” measures).

As Anna Glasier et al. conclude in their report cited above:

[It] is possible that EC may be less effective than we belief [sic]. Estimates of efficacy are unsubstantiated by randomized trials. Efficacy is based on rather unreliable data and a great many assumptions and have been questioned both in the past and more recently. … While advanced provision of EC probably prevents some pregnancies for some women some of the time, the strategy did not produce the public health breakthrough hoped for.

So why do some want to put women at risk by making EC available without medical assessment? Maybe it has something to do with politics.

Susan E. Wills, a lawyer, is associate director for education at the pro-life office of the United States Conference of Catholic Bishops.

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