Mommy, Where Do Political Debates Come From?
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 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.
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.
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).
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?
- Morning-After Pills Don’t Block Implantation, Science Suggests (nytimes.com)
- Editorial: How Morning-After Pills Really Work (nytimes.com)
- Debate on Morning-After Pill — NYTimes.com (stannecenter.wordpress.com)
- Morning-After Pill Akin to Abortion? The Science Says No (healthland.time.com)
- Controversy over morning-after pills may be unfounded (mercurynews.com)
- What Happens to Your Period When You Stop Taking the Pill? (everydayhealth.com)
- Drug’s Nickname May Have Aided Politicization (nytimes.com)
- New look at morning-after pills suggests debate is off target (seattletimes.nwsource.com)