Emergency Contraception and the Pregnancy Debate

The Food and Drug Administration has until the end of this month to decide whether to allow emergency contraception — the so-called morning-after pill — to be sold without a prescription. Critics of the medication say it causes very early abortions; the FDA classifies it as a contraceptive that prevents pregnancy.

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LINDA WERTHEIMER, host:

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The Food and Drug Administration has until the end of this month to decide whether to allow emergency contraception--the so-called morning-after pill--to be sold without a prescription. Critics say the medication causes very early abortions. The Food and Drug Administration classifies it as a contraceptive that prevents pregnancy. Who's right depends upon the answer to the question `When does pregnancy start?' NPR's Julie Rovner reports.

JULIE ROVNER reporting:

Luke Vander Bleek of Morrison, Illinois, is a pharmacist who fills prescriptions for monthly birth control pills but not for emergency contraception, even though it consists of higher doses of some of those same birth control pills. He told a US House committee last week that his problem is not one of chemical makeup, but of intent.

(Soundbite of House committee hearing)

Mr. LUKE VANDER BLEEK (Pharmacist): Emergency contraception has only one FDA indication, to be taken after unprotected sex or contraceptive failure.

ROVNER: Van der Bleek says his understanding of emergency contraception is that it can stop an egg from being fertilized, which he doesn't object to, or it can stop an already fertilized egg from implanting itself in the woman's uterus, to which he does object.

(Soundbite of House committee hearing)

Mr. VANDER BLEEK: I have regard for the third person in the relationship. There's me, there's the expectant mother that comes in and there is the live child that I have to recognize has a possibility of existing and that my involvement in dispensing this prescription is involvement in the extinguishing of that life.

ROVNER: But most doctors say that fertilized egg alone does not constitute the beginning of a pregnancy. Tina Raine is an obstetrician-gynecologist at the University of California-San Francisco.

Dr. TINA RAINE (University of California-San Francisco): We consider or define a pregnancy as beginning when a fertilized egg has implanted or established itself in the uterus.

ROVNER: Raine says what really renders a woman pregnant from a medical point of view is a positive pregnancy test.

Dr. RAINE: And the pregnancy test detects the hormone that begins secreting once the pregnancy has established itself in the uterus.

ROVNER: Exactly when pregnancy begins is more than a medical question, says Rachel Benson Gold of the Alan Guttmacher Institute, a reproductive health research group.

Ms. RACHEL BENSON GOLD (Alan Guttmacher Institute): It's a critical distinction because how you define when a pregnancy begins is how you distinguish between what is preventing a pregnancy and what is terminating a pregnancy.

ROVNER: In other words, what's a contraceptive and what's an abortion. State laws on the subject vary, but the federal government has long agreed with the American College of Obstetricians and Gynecologists that pregnancy begins at implantation. For example, language known as the Hite Amendment forbids federal funding for most abortions under the Medicaid program, yet despite that restriction, Gold says, coverage is available for, quote...

Ms. GOLD: ..."drugs or devices to prevent implantation of the fertilized ovum." In other words, if the purpose of the drug is to prevent implantation, it is not considered an abortion for purposes of the Hite Amendment.

ROVNER: An even stronger statement, she says, comes as part of federal regulations establishing safeguards for research on pregnant women.

Ms. GOLD: In that context, they've defined, you know, what constitutes pregnant, that pregnancy encompasses the period of time from implantation until delivery.

ROVNER: But abortion opponents say asking when pregnancy begins is the wrong question. Joseph DeCook is a retired obstetrician-gynecologist from Holland, Michigan, and vice chair of the American Association of Pro Life Obstetricians and Gynecologists.

Dr. JOSEPH DeCOOK (American Association of Pro Life Obstetricians and Gynecologists): It's not that important when, quote, "pregnancy" starts. If you're looking at it from the sanctity of life standpoint, an individual human being starts at fertilization. Nobody questions that, nobody. I mean, a fertilized human egg doesn't--never becomes a pig or a bird. It always becomes a human being.

ROVNER: DeCook did prescribe birth controls when he practiced, which not all members of his organization do. He didn't prescribe emergency contraception but not because he thought it could cause an abortion, rather, he says, because he wasn't sure how it worked.

Dr. DeCOOK: So I didn't practice the kind of medicine where I gave stuff to pregnant women and didn't know how it worked.

ROVNER: A further complication is the ongoing confusion between emergency contraception and mifepristone, also known as RU-486, which does cause an abortion. OB-GYN Raine says the two are completely different.

Dr. RAINE: Emergency contraception does not have an effect on an established pregnancy and the abortion pill, or RU-486, that is designed to actually interrupt an established pregnancy.

ROVNER: In fact, says Raine, progesterone, the main chemical in emergency contraception, is often used to support a pregnancy once it's been established. Still, the fight over emergency contraception is already giving elected officials fits. In just the past two weeks, two Republican governors with pro-choice records and 2008 presidential aspirations--Massachusetts' Mitt Romney and New York's George Pataki--both vetoed bills that would make emergency contraception more easily available.

Julie Rovner, NPR News, Washington.

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