The first seven days.

Wednesday’s New York Times car­ried an arti­cle by Pam Bel­luck, “Abor­tion Qualms on Morning-​​After Pill May Be Unfounded”. The arti­cle details the ongo­ing debate over the use of so-​​called “morn­ing after” pills, mar­keted in the United States under the brand names Plan B and ella, and how that debate may be pred­i­cated on bad or incom­plete science.

The debate over these drugs has strayed from the realm of health and med­i­cine into the region of politics.

There are three drugs in the debate, each of which has a dif­fer­ent mech­a­nism of action.

The first of these drugs to come on the mar­ket, and the most con­tro­ver­sial, is mifepre­stone, for­merly called RU-​​486 and sold as “Mifeprex” or “The Early Option Pill”.

Lev­onorgestrel is mar­keted as “Plan B One-​​Step”, “Next Choice” and “Lev­onorgestrel Tablets”.

The newest of these drugs is ulipristal acetate, which is being sold as “ella”.

First, let’s look at how babies are made, then we can dis­cuss how these drugs work.

Con­cep­tion

In an ideal world, a woman of child­bear­ing age expe­ri­ences a burst of hor­mones from the pitu­itary gland, a pea-​​sized gland under the brain at the roof of the mouth, about 14 days after the begin­ning of the last men­strual period. Luteiniz­ing hor­mone (LH) is named because it stim­u­lates release of an egg (ovu­la­tion) and what’s left behind in the ovary turns into a struc­ture called the cor­pus luteum (“yel­low body” in Latin). The cor­pus luteum, in turn, begins secret­ing hor­mones like prog­es­terone (“in favor of preg­nancy” in Latin) which plump up the uter­ine lin­ing and pre­pare it for the arrival of the fer­til­ized egg. Once it arrives, the fer­til­ized egg bur­rows into the uter­ine lin­ing where it remains for the next 39 weeks.

Implan­ta­tion: Day 6 after sperm meets egg.

This process both occurs faster and slower than one might expect. Stud­ies have shown that after inter­course, the first sperm reach the uter­ine tube (Fal­lop­ian tube), where fer­til­iza­tion usu­ally occurs, in about 20 to 30 min­utes. That these tiny swim­mers can make their way so far so fast is a tes­ti­mony to the tenac­ity of con­cep­tion and the con­tin­u­a­tion of life. The sperm can live for two to three days. If just one of the 300 mil­lion sperm reach the egg, then fer­til­iza­tion can occur. Yet, after fer­til­iza­tion occurs, the zygote’s jour­ney to the uter­ine lin­ing takes about six days, dur­ing which time it’s divid­ing into a ball of cells which can implant in the uter­ine lining.

There are sev­eral ways of stop­ping this process.

Bar­rier meth­ods such as a con­dom or diaphragm phys­i­cally stop the sperm from trav­el­ing to the uter­ine tubes. A diaphragm works even bet­ter if a sper­mi­ci­dal (“sperm killing”) jelly is used to seal the con­tact between the diaphragm and the cervix (the lower open­ing of the uterus).

Grounded, in reality.

Hormone-​​based meth­ods block the LH sig­nal and keep ovu­la­tion from occur­ring. This is illus­trated, in a fash­ion that’s a lit­tle twee for my tastes, in a car­toon on the ella web­site. The con­ven­tional forms of birth con­trol pills also work in this way but must be used con­tin­u­ously and are inef­fec­tive if started after inter­course occurs. Plan B and ella work even after inter­course, so they obvi­ously are more use­ful for pre­vent­ing unwanted pregnancies.

Meth­ods that trig­ger inflam­ma­tion in the uterus either block the fer­til­ized egg from implant­ing or stim­u­late the uter­ine lin­ing to reject the embryo after it has already implanted. Sci­en­tists esti­mate that this process actu­ally occurs nat­u­rally in about half of all preg­nan­cies; because the implan­ta­tion takes place about a week before the next men­strual period begins, women would be unaware that implan­ta­tion had occurred and failed.

Each per­son who has an opin­ion in the abor­tion debate has a posi­tion on each of these. For exam­ple, if one believes that life begins at con­cep­tion, then bar­rier and hormone-​​based meth­ods are accept­able because they pre­vent sperm and egg from meet­ing (see car­toon at right). Inflammation-​​based meth­ods are unac­cept­able because they pre­vent implan­ta­tion of a “per­son” (if the pro­posed “per­son­hood” amend­ments are successful).

The Catholic Church, on the other hand, has taken the posi­tion that any inter­fer­ence with the process of con­cep­tion is unac­cept­able. Recently, Pope Bene­dict changed the Church’s posi­tion on the use of bar­rier meth­ods. What used to be a blan­ket ban now has an exemp­tion if the con­dom (for exam­ple) is used to pre­vent the spread of dis­ease. How­ever, the Church is still opposed to the use of bar­rier meth­ods for con­tra­cep­tion. Since the use of all forms of birth con­trol is unac­cept­able to the Catholic Church, it has trig­gered a debate on government-​​mandated insur­ance for con­tra­cep­tives that DC and I have writ­ten about previously.

Belluck’s New York Times arti­cle details how incor­rect infor­ma­tion was added to both the drug infor­ma­tion insert required by the Food and Drug Admin­is­tra­tion (FDA) and the National Insti­tute of Health’s web­site entries on lev­onorgestrel (Plan B) and ulipristal (ella).

An open ques­tion is how this infor­ma­tion came to be added to the FDA-​​mandated infor­ma­tion sheet. Bel­luck reports exten­sively on this issue, and it appears that evi­dence of a polit­i­cal debate within the FDA, if any, has been lost. It is clear that the drug com­pa­nies which pro­duce and mar­ket these drugs asked repeat­edly for the infor­ma­tion to be removed, to no avail.

We might never know how the wrong sci­en­tific infor­ma­tion made its way onto the label. Clearly, in the face of over­whelm­ing sci­en­tific data which fails to sup­port an effect of Plan B or ella on implan­ta­tion, it’s time to remove the incor­rect infor­ma­tion, but now even that rea­son­able step is fraught with polit­i­cal meaning.

Where do you stand on the ques­tion of when life begins? Is it con­sis­tent with your views on these drugs?

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