In a religious freedom/liberty conflict among religious
employers, employees, and students, who wins?
Disagreements on how emergency
and whether it can cause an abortion.
Beliefs by religious conservatives, compared to other religious liberals, secularists, and the medical profession:
- When does a pregnancy start?
- Conservative voices: All or essentially all religious conservatives define pregnancy as starting at conception, when a pre-embryo is formed as a result of one very lucky spermatozoon fertilizing a human ovum. This pre-embryo starts out as a single cell containing a unique configuration of human DNA. An abortion happens when a pregnancy is intentionally terminated by medication or by a surgical procedure any time after conception.
- Liberal, secular, and medical voices: All or essentially all religious liberals, secularists, and medical professionals define pregnancy as starting later when a blastocyst implants itself in the lining of the womb. A blastocyst is a pre-embryo in which some cell differentiation has occurred. It reaches this stage about five days after fertilization. An abortion happens when a pregnancy is terminated by medication -- such as by the "abortion pill" RU-438, or a surgical procedure any time after implantation in the womb's lining.
- How does the emergency contraception pill (ECP) work?
- Conservative voices: As described in a previous essay, all of the Roman Catholic and conservative Protestant information sources that we have seen claim that one method by which the emergency contraception pill (ECP) can work is to induce an abortion by preventing a blastocyst from implanting in the inner lining of the womb. This would mean that ECP works sometimes as a true contraceptive by preventing ovulation or conception. However, using the conservative belief that pregnancy starts at conception, they regard ECP as being able to sometimes act as an abortifacient. Some conservative sources states that it always works as an aborifacient and thus always causes a medication-induced abortion.
- Liberal, secular, and medical voices: According to a "Statement on Contraceptive Methods by the American College of Obstetricians and Gynecologists:"
"Emergency contraceptive pills prevent pregnancy primarily, or perhaps exclusively, by delaying or inhibiting ovulation. There is no evidence to suggest that either of the FDA-approved emergency contraceptive options, levonorgestrel (LNG, such as Plan B One-Step, Next Choice One Dose, and Levonorgestrel Tablets) or ulipristal acetate (UPA, such as ella) works after an egg is fertilized."
Thus, they believe that ECP works as a true contraceptive by preventing ovulation or perhaps preventing fertilization. Some researchers have speculated that if ECP is taken after fertilization, it might actually increase the chances of the blastocyst implanting in the wall of the uterus.
Protestant denominations consider birth control a private decision for each couple. Those Protestants and Protestant groups who object to the HHS mandate sincerely believe that medication (EC) can induce an abortion.
EC medication is commonly called the "morning after pill." However, the name is confusing, because a woman need not wait until the next morning to take it. ECP should be taken as soon as possible after unprotected intercourse in order to be most effective. ECPs are still reasonably effective at preventing pregnancy if taken within 72 hours of unprotected intercourse.
Why is it important what conservatives believe about EC?
Many conservative employers believe, in spite of evidence to the contrary, that EC can or always induces an abortion. Most are pro-life and also believe that all abortions kill a human person, which is a form of murder -- equivalent to strangling a newborn baby to death.
Many pro-life groups describe religiously affiliated employers as being required to provide contraceptive medication, devices and procedures to their employees. Actually, the employers only provide access to health care plans. It is up to the interaction of the government and the insurance company to determine whether these plans include free access to contraceptive medication including EC.
It is important to realize that the ultimate decision on whether to avail themselves of these provisions of the health insurance plan is the personal decision of the employee. The employer pays a fixed rate for the plan, irrespective of whether the employee chooses to obtain birth control or not. It is the insurance company that "provides" birth control; the employer is "out of the loop."
However, many employers and educational institutions don't want to be associated in any way with facilitating a murder by making EC available free to their employees. They want the right to veto their employees' and/or students' access to EC without copays. Many have launched lawsuits to fee themselves from the HHS mandate's contraceptive requirements.
How do ECPs prevent pregnancy? Can they do it by causing an abortion?:
When the FDA originally approved the medication, there was no consensus among medical researchers about the mechanism(s) by which it worked. Some speculated that it might work by:
- Delaying ovulation if ovulation had not yet occurred, and/or by
- Inhibiting conception if ovulation had occurred, and/or by
- Inhibiting the ability of the blastocyst -- the recently-fertilized ovum -- to implant itself in the inner wall of the uterus if fertilization had occurred.
Thus, no matter how it functions, there has always been a medical consensus that EC is a contraceptive medication that prevents pregnancy, not an abortifacient that ends a pregnancy. That is because medical specialists define the start of pregancy as happening when the blastosyst is fully implanted in the uterus. If ECP could work by inhibiting implantation medical professionals would still considered it a contraceptive medication because preganncy only begins after implantation is completed.
The passage of time has produced clarity. There is now a concensus in the medical community that EC works exclusively by delaying ovulation and/or preventing conception. Unfortunately, many pro-life groups continue to state as a fact that EC is an abortifacient.
The Emergency Contraception Website, is operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals. The site:
"... has no connection with any pharmaceutical company or for-profit organization,"
and its essays are
"... peer reviewed by a panel of independent experts." 1
They state that the emergency contraceptive pills work:
"... primarily, or perhaps exclusively, by delaying or inhibiting ovulation (release of your egg). It is possible that EC may affect the movement of egg or sperm (making them less likely to meet), interfere with the fertilization process, or prevent implantation of a fertilized egg. 2
They also state:
"There is no evidence to suggest that either of the FDA-approved emergency contraceptive options ... works after an egg is fertilized. 2 In two recent studies of the levonorgestrel regimen, women who presented for EC were monitored to identify their menstrual cycle day and ascertain which women took EC before ovulation, 4,5 and which took it after. Among women taking LNG before ovulation, there were no pregnancies. Among those who took it on the day of ovulation or after, there were about the number of pregnancies that would be expected with no use of EC; if LNG were effective at preventing implantation, it would most certainly be more effective when taken after ovulation. A 2010 study 7 of ulipristal acetate (Ella) found that at certain doses, it can decrease the thickness of the endometrium (by 0.6 to 2.2 mm), but it is not clear that this would in fact prevent the implantation of a fertilized egg. 2
According to a 2012-JUN report by Princeton University on emergency contraception:
"ECPs do not interrupt an established pregnancy, defined by medical authorities such as the United States Food and Drug Administration / National Institutes of Health and the American College of Obstetricians and Gynecologists as beginning with implantation." 3
Thus, no matter how it functions, there is a medical consensus that EC is a "contraceptive that prevents pregnancy, not an abortifacient that ends a pregnancy.
However, most pro-life groups refuse to accept the medical definition of the start of pregnancy. They teach that pregnancy begins at conception. Most also believe that human life -- in the form of a living single cell containing human DNA -- becomes a human person at some time during the process of fertilization. They sometimes refer to this happening at the "instant of conception.' However, conception is a process that takes many hours.
To them, if ECP could act by inhibiting implantation, then they would regard it as a possible abortifacient -- an abortion-inducing drug. Over time, many pro-life groups began to regard ECP as primarily acting as an abortifacient. More recently many refer to EC medication simply as an abortifacient. Thus we see comments like the two quotations in a previous essay.
Using an IUD in place of a pill to prevent pregnancy:
The insertion of an intrauterine device (IUD) is sometimes used as an emergency contraception method in place of ECPs. The Royal College of Obstetricians & gynaecolologists in the UK note that the copper-bearing intrauterine devide (Cu-IUD) can be inserted into the uterus:
"... up to 120 hours after unprotected sexual intercourse or within 5 days of the earliest expected date of ovulation." 6
It works by releasing copper which is highly toxic to both sperm and ova. However, its effectiveness is so much higher than ECPs at preventing pregnancy that IUDs are assumed to sometimes act by preventing implantation. Women who believe that pregnancy begins at fertilization may thus have a moral reason to not use IUDs.
How you may have arrived here:
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
- Answers to frequently asked questions about how emergency contraception works: Does emergency contraception cause an abortion," http://ec.princeton.edu/
- Answers to frequently asked questions about how emergency contraception works: How does emergency contraception prevent pregnancy?" Princeton University, 2014, at: http://ec.princeton.edu/
- James Trussell & Elizabeth G. Raymond, "Emergency Contraception," A last chance to prevent unintended pregnancy," Princeton University, 2012-JUN, at: http://ec.princeton.edu/
- N. Novikova, et al., " Effectiveness of levonorgestrel emergency contraception given before or after ovulation - a pilot study." Contraception 2007;75: Pages 112-118.
- G. Noé, et al., "Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation." Contraception 2011;84: Pages 486-492.
- "Clinical Guidance: Emergency Contraception," Royal College of Obstetricians & Gynecologists," 2012, at: http://www.fsrh.org/
- Stratton P, Levens E, Hartog B, Piquion J, Wei Q, Merino M, Nieman L. Endometrial effects of a single early luteal dose of the selective progesterone receptor modulator CDB-2915. Fertility and Sterility 2010;93:2035-2041.
Copyright © 2012 to 2014 by Ontario Consultants on Religious
Originally written: 2012-JUL-08
Latest update: 2014-JUL-15
Author: B.A. Robinson