The morning-after pill’s been framed, it seems. Federally approved labels on all morning-after pills, such as Plan B One-Step, Ella, NextChoice and other generic versions of emergency contraception, say the medications may work by preventing fertilized eggs from implanting in a woman’s uterus. But the science suggests that’s not true.
It’s the implantation claim that has anti-abortion activists and religious groups riled up about emergency contraception and about the Obama administration’s health care law, which requires insurers, including those that cover employees of Catholic institutions, to pay for the morning-after pill (along with other birth control). If you believe that a fertilized egg is a person, then it follows that a pill that prevents the implantation of the egg would be akin to abortion.
But in a revealing article published on Wednesday in the New York Times, reporter Pam Belluck lays out what the science really shows about how emergency contraception works and explains the history of how the notion that it blocks implantation ended up on drug labels and stuck.
In short, how the pills work: by delaying ovulation — the release of eggs from the ovaries, which occurs before fertilization — to keep sperm from reaching the egg. Depending on the pill, emergecny contraception may also work by thickening cervical mucus so sperm have trouble getting around. So, the pills block fertilization from happening in the first place.
The story of how the implantation myth got started is more complicated: apparently, the Food and Drug Administration (FDA) felt obliged to mention the possibility that emergency contraception could thwart implantation of a fertilized egg — even though there was no scientific evidence of that fact — on the label, back in 1999 when the first morning-after pill, Plan B, was approved. What was the agency’s hunch based on? According to Belluck, it was partly “wishful thinking” and partly the fact that daily birth control pills, some of which contain progesterone, Plan B’s active ingredient, may alter the lining of the uterus, which is where a fertilized egg would implant. Never mind that such alterations haven’t been proven to prevent implantation or that morning-after pills don’t actually trigger such changes anyway.
Over the years, as evidence mounted that the morning-after pill didn’t interfere with implantation, the makers of Plan B, which is now sold as Plan B One-Step, repeatedly asked the FDA to delete that language from the label. The FDA repeatedly declined. Citing confidentiality, FDA officials wouldn’t tell Belluck why.
Recent studies cited by the Times show that when women are given Plan B before ovulation, they don’t get pregnant. When they take the drug after ovulating, they become pregnant at the same rate as they would not taking the drug. Another study found that adding Plan B in a dish with fertilized eggs didn’t prevent the eggs from attaching to uterine lining cells. The data on Ella are thinner because Ella is a lot newer — approved in 2010 — but they fall right in line with the findings on Plan B.
Tellingly, as Belluck reports:
European medical authorities have not mentioned an effect on implantation on Ella’s label, and after months of scrutiny, Ella was approved for sale in overwhelmingly Catholic Italy, where laws would have barred it if it could be considered to induce abortion, said Erin Gainer, chief executive of Ella’s manufacturer, Paris-based HRA Pharma.
But despite the evidence, the abortion opponents interviewed by the Times remained unconvinced, showing once again that when it comes to politics, dogma and truth just don’t mix.
Read the full New York Times story here.