Myth: The ‘Morning After Pill’ is an Abortifacient

"Despite some common misconceptions, emergency contraceptive methods do not terminate a pregnancy, stop the implantation of a fertilized egg, or affect a developing embryo.”

Nov 28, 2023

Outline

Introduction and Purpose

Of all methods of contraception, emergency contraception (also known as “the morning after pill”) is perhaps the most misunderstood. This is due to a prominent myth that EC causes abortion. The foundation of the myth that emergency contraception is an abortifacient is a factual inaccuracy about how emergency contraception actually works. “Despite some common misconceptions, emergency contraceptive methods… do not terminate a pregnancy, stop the implantation of a fertilized egg, or affect a developing embryo” (emphasis added).1

This newsletter addresses the origins and errors of the abortifacient myth, and provides factual information about the “morning after pill’s” mechanism of action.

Prerequisite Terminology & Concepts

In order to understand emergency contraception, one first needs basic knowledge of the following terms/concepts.

🟩 Contraception: “Contraception is the act of preventing pregnancy. This can be a device, a medication, a procedure or a behavior.”2

🟩 Contragestive: Contragestives are “agents that prevent or interrupt implantation [of a fertilized egg] in the uterus.”3 A contragestive is not an abortifacient.

🟩 Emergency contraception: “What is emergency contraception? Emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. These are recommended for use within 5 days but are more effective the sooner they are used after the act of intercourse.”4 “Using EC does not cause an abortion. An abortion ends an existing pregnancy. EC prevents pregnancy from occurring. EC must be used soon after unprotected sexual intercourse to be effective. It does not work if pregnancy has already occurred.”5

🟩 Ovulation: Ovulation is “the release of a ripe egg from a female’s ovary.”6 “Ovulation begins when the female brain releases specific hormones that spike in the bloodstream, triggering the release of an egg.”7

🟩 Fertilization: “Fertilization occurs when a female egg and male sperm meet. Though it is commonly assumed that fertilization takes place during intercourse or very shortly thereafter, it can occur up to five days later. This means that a woman can become pregnant if she ovulates and then has intercourse, or if she has intercourse and then ovulates within the next five days.”8

🟩 Implantation: “Implantation occurs when the blastocyst burrows into the endometrium and begins to transform into the placenta and embryo.”9 The process of implantation is not completed until around day 9 or 10 post-fertilization.10

🟩 Pregnancy: Pregnancy is “the state of carrying a developing embryo or fetus.”11 “According to both the scientific community and long-standing federal policy, a woman is considered pregnant only when a fertilized egg has implanted in the wall of her uterus.”12 The process of implantation is completed around day 9 or 10 post-fertilization.13

🟩 Abortion: Abortion is a medical term defined as the ending of an established pregnancy before fetal viability,141516 though "some medical dictionaries mention 20 weeks' gestation or 500 g as the limit.”17

🟩 Abortifacient: “An abortifacient is any substance that is used to terminate a pregnancy.”18 An abortifacient is not a contragestive.

Types of Emergency Contraceptive Pills (ECPs)

There are two main types of oral emergency contraception: (1) ulipristal acetate pills, (2) levonorgestrel (progestin) pills, and (3) combined (estrogen and progestin) pills. “When taken as directed, ulipristal is the most effective type of EC pill, followed by the progestin-only pill. Combined EC pills are not as effective in preventing pregnancy as the progestin-only EC pill.”19

🟩 Ulipristal acetate: “Ulipristal acetate, marketed as ella, was approved by the FDA in 2010 for sale and use in the U.S.”20 “ella is a single-dose pill that is effective in preventing pregnancy up to five days after unprotected intercourse, giving women a longer timeframe to prevent unintended pregnancy than Plan B. Its mechanism of action is similar to that of progestin-based EC.”21

🟩 Levonorgestrel: “Plan B was the first oral form of EC to be made available in the U.S. as a pre-packaged dose of pills containing the progestin, levonorgestrel. Now, there are generic alternatives available as well. Progestin-based EC pills use the same hormones found in daily oral contraceptives and are the most widely used form of EC. [These] EC pills are marketed today under the brand name Plan B One-Step and generic names.”22

🟩 Combination pills: “Certain daily oral contraceptive pills can also act as EC when taken in doses four or five times higher than the daily dose, although they are not specifically sold as emergency contraception. Oral contraceptive pills contain progestin and estrogen and are taken in two doses 12 hours apart to be effective as EC.”23

How Does Emergency Contraception Work?

The way a contraceptive works is called its mechanism of action. All EC pills share the same mechanism of action: preventing or delaying ovulation.24 Here’s how: EC pills prevent pregnancy by acting upon the hypothalamic-pituitary-ovarian axis (HPO axis). “Ovulation begins when the female brain releases specific hormones that spike in the bloodstream, triggering the release of an egg.”25 Emergency contraception pills, “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.”26

Sperm can live inside the female body for up to five days. “This means that a woman can become pregnant if she ovulates and then has intercourse, or if she has intercourse and then ovulates within the next five days.”27 Emergency contraception pills prevent ovulation from occurring after intercourse, when the sperm is present in the female body.— No egg is released, thus no egg is fertilized.

*If a person has already ovulated, emergency contraception will not work. This is because ECPs are neither contragestives nor abortifacients. ECPs do not contain any mechanism to inhibiting and or to ending an established pregnancy.

Does Emergency Contraception Inhibit Implantation?

No, ECPs are not contragestives, “agents that prevent or interrupt implantation [of a fertilized egg] in the uterus.”28

Emergency contraception does not inhibit implantation of a fertilized egg into the uterine wall. “ECPs (emergency contraceptive pills) prevent pregnancy without any post fertilization effects” (emphasis added).29

“The fact that women take emergency contraception after intercourse helps enable the perception that emergency contraception works by preventing implantation of a fertilized egg. However, because fertilization can take place up to five days after intercourse, emergency contraception functions only on eggs that have not yet been released and fertilized.”30

Emergency contraception has no effect on the uterine lining, and numerous studies have “found no difference in endometrial receptivity to implantation after exposure to Levonorgestrel EC compared to controls.”31 “Levonorgestrel EC taken after ovulation does not affect implantation.”32

Emergency contraception merely “disrupt[s] the feedback system between the brain and ovaries, thus inhibiting the release of an egg.”33 “Emergency contraception functions only on eggs that have not yet been released and fertilized.”34 The “weight of the evidence shows that Plan B and its cousin, Ella,... stop ovulation”35 by “disrupt[ing] the feedback system between the brain and ovaries, thus inhibiting the release of an egg.”36

“No egg is released, no egg is fertilized, and no fertilized egg is destroyed.”37

*If a person has already ovulated, emergency contraception will not work. This is because ECPs are neither contragestives nor abortifacients. ECPs do not contain any mechanism to inhibiting and or to ending an established pregnancy.

Is Emergency Contraception an Abortifacient?

No, ECPs are not abortifacients. “An abortifacient is any substance that is used to terminate a pregnancy.”

“ECPs prevent pregnancy without any post fertilization effects” (emphasis added).38

“An abortifacient is any substance that is used to terminate a pregnancy.”39 Abortifacients end a pregnancy. Emergency contraception does not. “The morning after pill only works by preventing ovulation, it can not cause an abortion and it will not have any effect in a case where an egg has already been fertilized.”40

“Emergency contraception is effective only in the first few days following intercourse before the ovum is released from the ovary and before the sperm fertilizes the ovum. Emergency contraceptive pills cannot interrupt an established pregnancy or harm a developing embryo, thus cannot cause abortion.”41 “If someone takes EC pills while they are pregnant, research shows that the pregnancy will not be affected. Emergency contraception will not cause a miscarriage or an abortion, and it doesn’t affect fetal development.”42

To reiterate, emergency contraception pills merely “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.”43 No egg is released, no egg is fertilized, no fertilized egg is destroyed, no implantation is inhibited, and no pregnancy is ended.44

[*Of note: Many prominent anti-abortion groups are also opposed to contraception in general. For decades now, these groups have been “working to stigmatize contraception by blurring the lines between contraception and abortion.”45 Claiming that some forms of contraception (including emergency contraception) are abortifacients furthers their goal: to restrict and even prohibit contraception. However, it is a complete misnomer to label emergency contraception as an “abortifacient.”46 Emergency contraception is not an abortifacient.]

How Did the Abortifacient Myth Begin?

Early Opposition to Emergency Contraception

In 2003, the manufacturer of Plan B applied for over-the-counter status. “The hope many people had for the drug was tied to an ugly number: 21. That is the number of abortions in the U.S. per year per 1,000 women of reproductive age, which put[] the country at or near the top among developed nations. Put another way, according to a study released [in 2006] by the Guttmacher Institute, there [were] 6.4 million pregnancies a year in the U.S., 3.1 million of which [were] unintended and 1.3 million of which ended[] in abortion… If women had quick, easy access to a backup contraceptive, the thinking of Plan B proponents went, those rates — and thus the abortion rate — would drop.”47

"I saw it as a win-win situation, something that everyone on both sides of the abortion issue could support," said Dr. Susan F. Wood, the director of the Office of Women's Health at the F.D.A. at that time.48

Reproductive and women's health professionals in the United States expected the over-the-counter application for Plan B to be quickly approved. “Experts overwhelmingly considered it safe: in December 2003 the F.D.A.'s own joint advisory panel voted 28-0 that it was ‘safe for use in the nonprescription setting’ and then voted 23 to 4 in favor of granting Plan B over-the-counter status.”49 “After the agency's advisory committees voted in favor of over-the-counter status for Plan B at the end of 2003, and after it was further approved at every level of the agency's professional staff, standard procedure would have been for the Center for Drug Evaluation and Research arm of the F.D.A. to approve the application.”50

However, “one member of the F.D.A.'s Reproductive Health Drugs Advisory Committee had reservations: Dr. W. David Hager, a Christian conservative whom President Bush appointed to lead the panel in 2002… Dr. Hager said he feared that if Plan B were freely available, it would increase sexual promiscuity among teenagers. F.D.A. staff members presented research showing that these fears were ungrounded: large-scale studies showed no increase in sexual activity when Plan B was available to them, and both the American Academy of Pediatrics and the Society for Adolescent Medicine endorsed the switch to over-the-counter status.”51

Meanwhile, as a government report later revealed, Dr. Janet Woodcock, then the deputy commissioner for operations at the F.D.A., had expressed a truly ludicrous fear that making Plan B available over the counter would lead Plan B to “take[] on an 'urban legend' status that would lead adolescents to form sex-based cults centered around the use of Plan B."52

Note: Subsequent studies have shown that access to emergency contraception over-the-counter does not increase teens’ sexual activity.

Furthermore, “[a]s evidenced by court testimonies, political interference in the decision not to approve Plan B for unrestricted OTC access reached the level of White House intervention. Dr. Woodcock, then-FDA Acting Deputy Commissioner, and Galson informed Dr. Jenkins and Dr. Sandra Kweder, Deputy Director of the Office of New Drugs at the FDA, that Plan B was not going to be approved and that the decision was going to be made at a higher-than-normal level within the FDA. Woodcock told Kweder that former FDA Commissioner McClellan had made his decision with White House involvement and that ‘there were a lot of constituents who would be very unhappy with….an over-the-counter Plan B.’ Woodcock informed another FDA staff member that the OTC switch denial was the only way to ‘appease the [Bush] administration’s constituents.’ In a January 2004 letter to former President Bush, 49 conservative members of Congress urged the President to deny the application for OTC use, mainly because they were concerned about teenage use of the drug.”53

In May 2004— with crazed fears about teenage sex cults and female promiscuity swirling, and after Bush administration and Congressional interference— the FDA rejected the finding of its scientific committees and denied the Plan B manufacturer’s application for over-the-counter status.54

“The drug's manufacturer reapplied two months later, this time for permission to sell it over the counter to women ages 16 and up, seemingly dealing with the issue of youth.”55 Then, in August 2005, FDA Commissioner Lester M. Crawford “announced[] that the F.D.A. would delay its decision, a delay that could be indefinite. The announcement made headlines across the country. Dr. Wood, the F.D.A.'s women's health official, resigned in protest.”56

The Abortifacient Myth Begins

The confusion surrounding emergency contraception pills began when Plan B finally went from a prescription-only medication to being available over-the-counter in 2006.57

“When the drug company that owned Plan B at the time, Barr Pharmaceuticals, sought FDA permission to sell it over-the-counter, the effort faced opposition from anti-abortion forces, according to historical accounts, as well as interviews with people involved. Those forces included a member of the scientific advisory panel reviewing the application,” Dr. Joseph Stanford.58 Stanford “was a Catholic-influenced Mormon physician who believed human life (and personhood) begins at fertilization.”59 He “argued that a remote possibility existed that Plan B could prevent implantation of a fertilized egg.”60 “Despite having no scientific evidence to support that claim, the company agreed to list the post-fertilization mechanism on the packaging as a way of getting the application approved.”61

“That seemingly innocuous capitulation has paid dividends for abortion opponents, codifying in official government documents a mechanism of action that would be used to blur the line between contraception and abortion.”62 The FDA finally changed Plan B's label and updated its information on the medication in 2022, clarifying that “Plan B One-Step does not prevent a fertilized egg from implanting in the womb and does not cause an abortion.”63

Redefining Pregnancy

Anti-abortion groups had long been working to non-medically redefine pregnancy as beginning with fertilization.6465 Against contraception in general, prominent anti-abortion groups were able to point to the politically, not medically, formulated labeling for Plan B (as inhibiting implantation) as “proof” that emergency contraception “causes early abortions.”

But “there's one thing [fertilization] definitely does not begin. Medically, at least, fertilization does not mark the beginning of pregnancy.”66 As Daniel Grossman, an obstetrician/gynecologist at the University of California, San Francisco, explained, “The medical community has really been quite clear about when pregnancy begins, and that definition is that pregnancy begins once implantation occurs."67 Fertilization “isn't a clean indicator of anything,” because “there’s an incredibly high rate of fertilized eggs that don’t implant.”68 In fact, 50-80% of fertilized eggs will never implant into the uterine wall697071, because they “never begin dividing” and are thus incapable of implantation.72

Furthermore, as we have already discussed above, emergency contraception does not inhibit implantation of a fertilized egg. Emergency contraception pills merely “disrupt the feedback system between the brain and ovaries, thus inhibiting the release of an egg.”73 No egg is released, no egg is fertilized, no fertilized egg is destroyed, no implantation is inhibited, and no pregnancy is ended.74

Yet, “despite the clear and long-standing medical consensus that pregnancy is not established until implantation,”75 and despite “the weight of the evidence clearly show[ing] that emergency contraceptives… are not abortifacients,”76 and despite the fact that the Plan B labeling was politically-driven,77 anti-abortion groups continued to push the “abortifacient” myth, with great success. The result has been the widespread, disinformation-fueled confusion about emergency contraception's mechanism of action and its status as a contraceptive.

End note: The FDA finally changed Plan B's label and updated its information on the medication in 2022, clarifying that “Plan B One-Step does not prevent a fertilized egg from implanting in the womb and does not cause an abortion.”78

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Michelle Jordan

What most folks don’t realize is that at least two processes must occur before there is even a zygote. First the egg must complete meiosis II. Second the nuclei from both cells must merge together to form a single cell with a diploid nucleus. This is the definition of a human zygote. The zygote must undergo a number of cell divisions by a process called mitosis. Not to be confused with meiosis, mitosis causes the cell number to double with each division. If the zygote does not develop properly then it may very well not implant into the endometrial lining of the uterus. Any error that occurs along the developmental process could result in a blastocyst not implanting therefore there is no pregnancy.

You can’t redefine pregnancy nor can you redefine birth such that the PL crowd does. They want the definitions to fit with the 14th amendment narrative but that isn’t how the constitution reads. They are deceptively trying to change the rules.

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