Pregnancy Prevention or Abortion? New Emergency Contraception Pill Walks the Line

Feb. 1, 2010— -- More than a "morning after pill", a new emergency contraceptive pill, ellaOne, can prevent pregnancy for up to five days after unprotected intercourse.

While it is not yet available in the United States, the new pill may one day offer American women yet another option for preventing pregnancy. But critics of the drug say that it is not so much emergency contraception as emergency abortion.

"This is a thinly-veiled attempt to get an abortion drug over-the-counter," said Dr. Donna Harrison, president of the American Association of Pro-Life Obstetricians and Gynecologists.

Because fertilization of egg and sperm can only be prevented within 24 hours of intercourse if the woman has just ovulated, Harrison says, any emergency contraceptive that is effective five days after sex most likely works by preventing the fertilized egg from implanting in the uterus. And if one believes pregnancy begins with fertilization, that action would be considered abortion.

"To label this as emergency contraception when it's clearly an abortive action is dishonest," said Harrison.

But according to Dr. Lauren Streicher, clinical instructor in Obstetrics and Gynecology at Northwestern Medical School, thinking that emergency contraception is equivalent to an abortion "is a big misconception."

It takes five to seven days for the fertilized egg to implant in the uterus and begin to grow, she says. She argues that if one interrupts the process before this implantation takes place, pregnancy never begins.

"There are many people who are reluctant to take emergency contraception because they think it's abortive, but it's apples and oranges," she said. "With emergency contraception, it's really to stop a pregnancy of occurring."

Not surprisingly, these differing opinions hinge on the same definitional controversy that has plagued the abortion debates for decades: at what point does pregnancy begin -- when the egg is fertilized, or when it implants in the uterus?

Because these two events can occur up to a week apart, emergency contraceptives, especially ellaOne, with its five-day window for use, walk the line in this controversy.

New Drug Revives Old Debates

Available by prescription in Europe since September, ellaOne is 50 percent more effective -- and effective for 48 hours longer -- than the "morning-after pill" or Plan B, according to new research published Friday in the Lancet.

In the study of nearly 1,700 women aged 16 to 36 who sought emergency contraception, women who took a morning-after pill had a 2.6 percent chance of becoming pregnant, while women who took ellaOne had only a 1.8 percent chance, and five-day window of opportunity to take the pill.

Researchers noted that all forms of emergency contraception are more effective the sooner after intercourse they are taken, but ellaOne was found to be even more effective -- two thirds more -- than Plan B if taken within 24 hours of intercourse.

For those who support the use of emergency contraceptives, ellaOne is an important and vital innovation that will provide more reliable pregnancy prevention.

"This is great news [because] the need for emergency contraception is so great," Streicher said, pointing out that 50 percent of pregnancies are unplanned. Among those, she said, half involve couples using contraceptives that either malfunctioned -- like a condom breaking -- or were insufficient, like a diaphragm without spermicidal foam.

"People often think unplanned pregnancies are [the consequence of] people being irresponsible, but that's not [usually] the case. It's often from a failed attempt at contraception -- that's why it's so important that we have emergency contraception."

Streicher says the longer window for taking ellaOne fills a much-needed gap in reproductive health because those who most often have unwanted pregnancies -- teenagers, those without access to adequate gynelogical care -- cannot always get to a doctor for treatment within a day or two.

"In a perfect world you want anyone to use emergency contraception within 24 hours, but the reality is that having this five-day option is going to decrease the number of undesired pregnancies," she said.

Emergency Contraception -- A False Sense of Reproductive Security?

But this more powerful form of emergency contraception raises several concerns for pro-life advocates.

Harrison says that unlike Plan B, ellaOne acts is chemically similar to the common abortion pill RU-486, which is taken to abort a fetus as late as two months into pregnancy.

She feels that ellaOne is likely to carry the same risks as RU-486, such as excessive bleeding and infection, and says her biggest concern is risks this new drug could pose to the women who take it.

Harrison cites one Plan B study, in which more than half the women who participated didn't know how to use the pill correctly. It is currently available over-the-counter.

Given that ellaOne would also be available over the counter if it was brought to the U.S. as an emergency contraceptive, Harrison fears the chance for misuse and adverse side effects.

"That's the purpose, to slip an abortive agent into the country as an over-the-counter drug. It's deceitful."

In the recent Lancet study, however, the only serious adverse event researchers found with ellaOne was dizziness, and this only occurred in one subject.

Another concern among critics of the drug is the fear that it will give women a sense of false security, leading them to be more lax about using contraception or practicing abstinence.

"Habits follow technology. Contraception was supposed to prevent an abortion, but it has led to an increase in abortion when people got used to it being around and of course the increased effectiveness of technology [like this] means people will relax that much more on their inhibitions," said Stephen Phelan, communications manager for Human Life International, an anti-abortion missionary organization.

But Streicher countered that in her twenty years of experience, and in the literature on the topic, this fear is unfounded.

"Emergency contraception does not increase the chance that someone is going to not use contraception or that someone is going to start sexual activity at an earlier age. On the contrary, it is necessary option for women who have that rare contraception failure or...even more importantly, for those who are raped."

According to HRA Pharma, the company that produces the drug, elleOne was made in the hope of providing "the potential to enable women to take greater control of their own health." The statement came from Dr. Erin Gainer, CEO of HRA Pharma, in a company press release.