Do morning-after pills cause abortions?

In my previous post, I made the claim that the government will fine Hobby Lobby $1.3 million dollars per day until it complies with Obamacare’s abortion mandate. In the comments, I have received a good bit of push-back from readers claiming that the HHS mandate does not require coverage for abortifacient drugs. In particular, critics are telling me to “check my facts” and realize that morning-after pills are not abortifacient. This erroneous objection reveals that there is some confusion out there about what the “facts” really are. For this reason, I think a response is warranted.

First, pro-lifers define abortions as any measure that causes a fertilized egg or fetus to be destroyed. Pro-lifers believe that all human beings have an inalienable right to life from conception to natural death. Notice that it’s not from implantation to natural death, but from conception to natural death. When sperm unites with an egg, a new human life comes into being. In the normal course of events, that new human life travels down the fallopian tubes and into the mother’s womb where it implants into the uterine wall. Pro-choicers often say that an abortion can only occur after implantation. Pro-lifers contend that abortion can occur before or after implantation. Human life is at stake from the time of conception, and anything that destroys that life is abortifacient.

Second, Obamacare mandates coverage not only for morning-after pills, but also for intrauterine devices, also known as IUD’s. According to the FDA, IUD’s have three mechanisms of action, one of which is preventing the fertilized egg from implanting to the uterine wall. In other words, IUD’s cause the destruction of human life before implantation. Whatever your views are about morning-after pills, the abortifacient effect of IUD’s is not in dispute, and Obamacare requires coverage for these devices.

Third, despite recent controversy about morning-after pills (“Plan B” and “Ella”), recent studies contesting the abortifacient effect of morning-after pills are less than conclusive than some suggest. The FDA says that both Plan B and Ella have more than one mechanism of action. The primary mechanism is the prevention of ovulation—a truly contraceptive measure. A secondary mechanism of morning after pills prevents a fertilized egg from implanting—an abortifacient measure. This means that morning-after pills cause the destruction of human life whenever this second mechanism comes into play.

Last summer, the FDA’s labeling came into dispute after the New York Times published an article alleging that morning-after pills are not abortifacient. Citing recent scientific studies, the article claimed the FDA labels are wrong. All of this came out in the midst of a heated political campaign in which President Obama was under fire for the unpopularity of Obamacare—including the controversial contraception mandate. The Times article attempted to show that this criticism of the President’s signature healthcare law was ill-founded. There appeared to be an overt political motive behind the reporting.

In any case, evidence from within the report itself showed that the scientific evidence did not conclusively favor the thesis of the article. In fact, the studies cited only related to Plan B, not to Ella or IUD’s. Also, several of the scientists that were interviewed said that “absolute proof” was elusive. One of the scientists cited favorably in the article is Dr. James Trussell of Princeton University. Yet he produced a paper over the summer that says morning-after pills must have some other mechanism of action besides the delaying of ovulation. One possible mechanism is of course prevention of implantation. So even one of the Times‘ own experts is less than conclusive on the matter.

Fourth, after the controversial Times article was published last June, the FDA updated its Birth Control Guide (August 2012) Even after all the controversy, the updated guide continues to list the abortifacient mechanism of morning-after pills. This fact alone is telling. It calls into question the accuracy of The New York Times‘ reporting. One can’t help but wonder if some other agenda was in play with the New York Times report besides an accurate reporting of the facts.

If it were ever proven that morning-after pills have absolutely no abortifacient effect, then the pro-life moral calculus would change with respect to these devices. But no such thing has ever been proven. Here’s the bottom line. Taking into account the best scientific research and laboratory tests, the FDA still says that morning-after pills can prevent human embryos from implanting—thus causing the destruction of human life. That’s the main fact that every party to this debate needs to get straight.

36 Responses to Do morning-after pills cause abortions?

  1. Michael Beck December 29, 2012 at 2:18 pm #

    Denny, you ask “Does anyone care what happens to Hobby Lobby?” I think you answer your own question when you say that critics believe “morning-after pills are not abortifacient”. The same could be said regarding the everyday birth control pill, as Randy Alcorn and others have shown.

    The simple answer is most Christians do not want to believe that these “medications” could really cause abortions. This whole issue really revolves around Christians’ beliefs about birth control/contraceptive, which is an issue very few people want to touch. I’ve heard many sermons given on (surgical) abortions, but I’ve never once heard anyone mention these pills in one of those sermons. What is birth control? What is a contraceptive? What does it actually do? Is it right for Christians to use them?

    Usually the logic goes like this. Christian X thinks contraceptives are never sinful. Plan B morning after pill (pictured above) says it’s a “contraceptive” on the box, therefore Plan B is fine for a Christian to use and Hobby Lobby should be fine paying for it.

    • Lissa Hailey December 29, 2012 at 7:28 pm #

      I have no problem with birth control (setting aside for the moment the issue of whether or not Morning After pills are abortifacient) and have used various methods over my adult lifetime. My husband had a vasectomy and I had a medical procedure that effectively made me sterile. (TMI? Sorry … ) We have, between us, 9 children and 7 grandchildren – some planned, some not, all very much wanted and loved.

      However, I understand the objection of the Catholic Church to any method, drug, or treatment that would prevent conception. While I do not agree with that objection, I fully, completely and whole-heartedly support the right of the Church and Catholic-owned businesses to not be forced to provide contraception, abortion or sterilization whether directly by performing or prescribing, or indirectly, by paying for it through insurance provided to employees.

      It behooves us all – pro-life or pro-choice, for or against birth control, religious or not – to support businesses like Hobby Lobby and their efforts to not be forced to act against their beliefs. If their 1st Amendment rights can be violated, then so can ours.

      • Robert Nolin December 30, 2012 at 11:39 am #

        ^ Well said.

  2. Robert Stankey December 29, 2012 at 3:14 pm #

    “One of the scientists cited favorably in the article is Dr. James Trussell of Princeton University. Yet he produced a paper over the summer that says morning-after pills must have some other mechanism of action besides the delaying of ovulation. One possible mechanism is of course prevention of implantation.”

    Later in the linked article by Dr. James Trussell, he explores the possibility of emergency contraception pills affecting implantation:

    “The reduced efficacy with a delay in treatment, even when use is adjusted for cycle day of unprotected intercourse, suggests that interference with implantation is likely not an inevitable effect of ECPs. If ECPs did prevent all implantations, then delays in use should not reduce their efficacy as long as they are used before implantation.”

    • Michael Beck December 29, 2012 at 7:06 pm #

      When it comes to taking a human life, I don’t find much confidence in statements that use terms of “likely not an inevitable effect” and “as long as they are used before implantation.” No one knows the moment of implantation. Also, notice that the last sentence is condition, “If ECPs did prevent all implantations…” We are not discussing whether it prevents “all” implantations, but even one is murder.

    • Denny Burk December 31, 2012 at 2:23 am #

      Dear Robert,

      Here is a paragraph from page 7 of Dr. Trussell’s paper. I leave it to readers to decide whether or not I have represented him fairly. Please note the portions I have underlined:

      To make an informed choice, women must know that ECPs—like all regular hormonal contraceptives such as the birth control pill, the implant Implanon, the vaginal ring NuvaRing, the Evra patch, and the injectable Depo?Provera, and even breastfeeding—prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in the endometrium. At the same time, however, all women should be informed that the best available evidence is that the ability of levonorgestrel and ulipristal acetate ECPs to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with post?fertilization events.

      Its very high effectiveness implies that emergency insertion of a copper IUD must be able to prevent pregnancy after fertilization.

      It’s obvious that Trussell favors the idea that Plan B and Ella are contraceptive only, but he cannot say so in so many words because the research he cites is divided. As I said in my post, this is less than definitive.

      In any case, the point of citing his paper was not to say that his evidence was definitive one way or the other. I think he has appropriate qualifications throughout. The point of citing him was to show that his conclusions seem much more qualified than the thesis of the New York Times article.

      Thanks,
      Denny

      • Roy Fuller December 31, 2012 at 10:24 am #

        In light of your comments above, a follow-up question: do you believe that standard birth control pills are abortifacient?

        • Denny Burk December 31, 2012 at 4:02 pm #

          It’s a little less clear with birth control pills because the doses are so much lower–even though it’s the same drugs. I think Randy Alcorn presents a strong case. I think that folks on the other side do as well. Because the evidence is inconclusive, I choose to err on the side of life, which means avoiding the pill.

  3. Amber December 29, 2012 at 4:01 pm #

    If you have the time to read this very long and technical article, I think you will see that hormonal contraceptives (including the morning after pill) do not prevent implantation: http://www.aaplog.org/position-and-papers/oral-contraceptive-controversy/hormone-contraceptives-controversies-and-clarifications/

    • Denny Burk December 29, 2012 at 5:32 pm #

      Read my post explaining the abortifacient mechanism of morning-after pills: “Do morning-after pills cause abortions?.”

      • Amber December 29, 2012 at 6:10 pm #

        Yes, I did read your post. In the article I linked in my previous comment the pro-life doctors explain that if a woman ovulates the hormonal changes in her body cause the lining of her uterus to thicken at that point. So if a woman’s birth control fails and she does ovulate, the lining of the uterus will no longer be thin and the fertilized egg will have no problem implanting. You do not address this point in your post.

        Morning after pills work in the same way that regular birth control pills do: they prevent ovulation. If a woman has already ovulated or if she’s already pregnant, taking the morning after pill won’t do anything for her. The only reason morning after pills ever work is because you don’t get pregnant immediately after sex. Sperm can live in a woman’s body for I think about 3 days or so (correct me if I’m wrong). So if she hasn’t ovulated yet and she takes the morning after pill, it may prevent her from ovulating and then the sperm won’t have anything to fertilize.

    • Michael Beck December 29, 2012 at 7:02 pm #

      Amber, the article does not conclude that. The best it can say is:

      “Thus, the question of whether OCPs produce a “hostile endometrium” with breakthrough ovulations and in such instances are functionally chemical abortifacients remains an unanswered question…”

      The FDA, PDR, and the pill makers all admit that a secondary mechanism is prevention of implantation.

      • Adam Omelianchuk December 31, 2012 at 10:24 pm #

        Right, but the secondary mechanism is hormonally linked to the first, and their point is that if the first fails (prevention of ovulation), then the third will fail (prevention of implantation). The FDA and the Pill manufacture include the third effect, because if one were to artificially inseminate oneself, one would be frustrated by the third effect of the pill.

  4. Robert Stankey December 29, 2012 at 6:13 pm #

    Here is another quote from the article by Dr. James Trussell:

    “[T]he best available evidence is that the ability of [emergency contraception pills] to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with post?fertilization events.”

  5. John Klink, Jr. December 29, 2012 at 6:37 pm #

    Those who attempt to excuse the HHS mandate on the basis of the specific functional mechanics of the drug are missing the point. There are two issues at stake in the many legal challenges by groups such as Hobby Lobby.

    Issue 1:
    Reguardless of the mechanism, no company (or person) should be forced to pay for (or offer via insurance plans) something they find morally reprehensible on religious grounds. To be forced otherwise is a violation of the right to freely exercise one’s religion. The Catholic Church finds contraception of any kind to be a distortion of God’s design and therefore morally wrong. Eitherway, the HHS mandate is designed to force people (who opporate companies) to violate the moral teaching of their faith.

    Issue 2:
    I agree with Denny’s assesment of the facts related to the function of these drugs/devices covered by the HHS mandate. The FACT that such drugs/devices can cause abortions and are therefore abortiofacient in function only takes it beyond the violation of religious free exercise to a violation of the Sanctity of Human Life. In plain language, it causes the death of a living person.

    Even if Issue 2 is someday scientifically proven to be built on a faulty premise (it hasn’t yet as Denny has repeatedly shown.), Issue 1 is still something that our American forefathers believed was worth dying for.

    • John Sandeman December 29, 2012 at 10:24 pm #

      So should a Jehovah Witness owned company be able to gain an exemption from covering blood transfusions. how far should religious exemptions go?
      John Sandeman

      • Stephen Beck December 29, 2012 at 11:08 pm #

        Should every company be required to provide health insurance at all?

      • Johnny Mason December 29, 2012 at 11:50 pm #

        A JW company should not be forced to pay for anything it finds morally reprehensible or against their religious beliefs. So if they were to offer health insurance that covered everything but transfusions, then that should be their right, since they are providing that benefit.

      • David Thomas December 30, 2012 at 2:37 am #

        John, about 20 years ago I had a seminary classmate (as coincidence would have it, at Southern Baptist Seminary where years later I met Denny) who had been a Jehovah’s Witness. His case was remarkable in that his young child had a severe illness that required a blood transfusion for her to survive. The courts got involved, and the transfusion was mandated. It was the venomous reaction of this man’s fellow JWs (they wanted to kidnap the child from the hospital, and when he wouldn’t they wished death upon her) that became the straw that broke the camel’s back for him. He finally left that movement and became a Baptist minister.

        The point of the story is to illustrate how absolutely incongruous it is to appeal mindlessly to the “principle” idea on these matters without considering where parallels break down. People should obviously have freedom of religion, even up to and including convictions about medical practices, /provided these practices don’t cost powerless individuals who cannot speak for themselves (or wish to opine otherwise) their very lives/. Blood transfusions are often a life or death issue, and that is why it is unreasonable to yield this ground to JWs (which is clearly your intention in bringing that medical procedure into the discussion).

        However, if someone’s very life depends on stopping a microscopic fertilized egg from developing into a pregnancy then I would suggest the person is playing Russian Roulette by engaging in the sexual act that leads to such a dangerous condition. (I’m being facetious: there is no such medical condition that makes pregnancy life or death at that stage of embryonic development–excepting the life of the child, of course).On the contrary, pregnancy is a healthy, normal function of human existence (the both of us being prime examples thereto!).

        A closer parallel between mandating JW blood transfusion belief and the requirement of paying for abortifacient drugs would be to insist upon an insurance policy that somehow requires JWs to /give/ blood in violation of their belief–in other words, an aspect of the procedure that isn’t an immediate life or death matter for the participant in question. I’m sure you would agree that no individual should be required to give blood–or pay for others to give blood–against their convictions. In other words, demanding that the Greens pay for abortifacient drugs is demanding that they pay for a procedure that 1) they believe–along with millions of other Christians across history–to be murder, and 2) is a drug of convenience for someone who simply failed to be responsible with cheaper, safer forms of preventative contraception. On the other hand, the JWs’ stand on transfusions has to do with Old Testament dietary injunctions against “eating” blood as something ceremonially unclean–not immediate matters of life or death, and 2) addresses a procedure that for generations has saved many, many lives and for which there is no substitute.

        In other words, the “principle” doesn’t apply. I believe many former classmate would take /major/ issue with the attempt to parallel the extreme and marginal understanding of Old Testament texts that was nearly used to justify letting his little girl die, and the use of drugs that kill unborn children.

        • Johnny Mason December 30, 2012 at 11:33 am #

          In no way am I saying that blood transfusions should be disallowed, but that the JW should not have to pay for it in the benefits they offer. In this case, if an employee is need of a BT, then they would have to pay for it themselves. There are other options as well. The employee can get supplemental insurance to cover BT, which would be a minimal cost, or the employee could choose not to work there. By mandating that an employer MUST provide coverage for a whole array of things is just another form of plunder.

          An employer should be able to offer a whole assortment of insurance options; from comprehensive coverage, to coverage that may only cover major issues, like cancer, heart disease, or the like. If I am a young single, male then why should I pay for coverage that covers pregnancy, or mental health services, or addiction programs, or a whole slew of things that have no relevance to my current station in life.

          We could solve all the problems by decoupling insurance from employment and have everyone buy their own insurance. That way there are no conflicts of interest.

          • David Thomas December 31, 2012 at 3:07 am #

            Johnny, I was responding to John Sandeman.

            You and I have no argument.

            • Johnny Mason December 31, 2012 at 9:15 am #

              oops, my bad.

        • John Sandeman December 31, 2012 at 1:20 pm #

          “Blood transfusions are often a life or death issue, and that is why it is unreasonable to yield this ground to JWs (which is clearly your intention in bringing that medical procedure into the discussion).”

          No my intention was not to yield ground to JWs, but to see how people on this forum would apply the principle of religious freedom and the mandate for a different example. So, perhaps I could ask the question another way: are there any other instances where religious exemptions might be sought other than contraception or abortion?

          As someone from another country I find the linking of Health Insurance to employment to be rather curious in any case.

  6. Lissa Hailey December 29, 2012 at 7:27 pm #

    My comments keep disappearing and I get a internal server error.

  7. David Thomas December 29, 2012 at 8:12 pm #

    Congrats on the shout out on Fox, Denny…

    http://radio.foxnews.com/toddstarnes/top-stories/hobby-lobby-to-defy-obamacare-mandate.html

    I wish it had been under other circumstances…

  8. Mel Jacobs December 30, 2012 at 4:28 am #

    I arrived via a friend’s FB post. I’m upset that you are putting this kind of misinformation out there. You seem to be unfamiliar with common conventions of scientific writing, and this is causing you to be suspicious that the pill really does cause abortions, despite lack of supporting evidence. You are saying, “lack of conclusive proof to rule out effect, therefore, the effect is there.” Absolute proof is always elusive in science; it is not surprising that a researcher would acknowledge this, and good researchers say such things about well-supported hypotheses. It is also difficult to provide evidence for a null hypothesis (e.g., that an effect is NOT present). That is one reason why scientists couch their language in words like “may” and “suggests.” The effect may be small and hard to detect. Using careful language is part of being a good scientist and not going beyond the evidence. This careful language should not be taken as evidence that ECPs interfere with implantation, when numerous studies fail to support this.

    By the way, you misrepresent the FDA guide. It says they “may” interfere with implantation, and they are wise to say so because there is the possibility that studies with greater resolution may find this to be the case. But the best extant evidence we have is that the morning after pill does not cause abortions. Public policy makers cannot make laws based on the possibility that some minute effect may be present; they have to make laws based on the best available evidence. This evidence comes entirely from science, not religious ideology, suspicion, or captilizing off of the careful language scientists use to mislead scores of blog readers.

    It appears that you read Trussel’s paper merely to quote-mine it. If you understood it, you are intentionally misrepresenting it. Trussel acknowledges that the effectiveness of ECPs in one particular study was very high, and suggested that this would indicate another mechanism of action– so that part you reported correctly. However, Trussel then opts for the more empirically probable interpretation that this study overestimated the effectiveness of ECPs (i.e., there is no other mechanism of action; see page 5, last paragraph).

    By stating, “If it were ever proven that morning-after pills have absolutely no abortifacient effect….” you are setting an infinitely high bar. Science can never do that, even for the things about which we are nearly 100% confident. Scientists do not “absolutely” do anything, nor do they “prove” things, unless they are doing so mathematically.

    • David Thomas December 31, 2012 at 3:06 am #

      Mel, I will not attempt to answer for Denny, but will only make a brief observation, punctuated by an illustrative question.

      It seems you go to great length to demonstrate Denny’s “misunderstanding” of scientific and medical language–all the while completely misunderstanding /Denny’s/ language, which is the language of informed conviction. Instead expounding about /how/ I feel you are misunderstanding him, I will simply put a question to you:

      Given the Trussel/FDA statements about the procedures Denny and others here object to, would you freely ingest them yourself (for whatever reason) if /your/ life depended upon them NOT being abortifacient in the way we are convinced they /are/?

      Put another way, would these drugs have been approved if they posed the same possibility of ending the life of the woman who takes them as they do of ending the life of that which was/may-have-been conceived in her?

      • Mel Jacobs January 9, 2013 at 6:39 pm #

        The “language of informed conviction” sounds like a euphemism for bias. In any case, conviction is a poor excuse for making false statements or misrepresenting data. Consider how you would evaluate someone who disagreed with you who made false statements. Would you give them the benefit of the doubt simply because they were “convicted?” I do not think I “completely misunderstood” Denny; if you think I did, please provide a specific instance in which I did so.

        There is evidence that caffeine, aspirin, and other commonly used substances can cause harm to a fetus (actually, the evidence is stronger than it is for the morning after pill). Would you be willing to “freely ingest them yourself (for whatever reason) if /your/ life depended upon them NOT being briain? I say this to demonstrate how poor the reasoning behind your question is. There is a possibility that many commonly ingested agents may cause harm to a fetus. But it would be silly to advocate that these substances should be made illegal or, if they were pharmacological substances, not funded by health care plans. By the way, I could also ask your question in reverse: would you be willing to stake your life on the claim that the pill prevents implantation? This illustrates that it is poor reasoning to require a proposition to be 100% certain in order to acknowledge that it is reasonable according to the best evidence we have.

  9. Dawn Curtis December 30, 2012 at 6:41 am #

    Lissa, I believe you missed Michael’s point completely, which was not saying that we should be against all methods of sterilization, but that birth-control pills are also abortifacient; i.e., they have two methods of action, one which prevents ovulation and one which prevents implantation in case of “break-through” ovulation. Anyone who is against the morning-after pill and IUD’s should, if they are consistent, also be against other abortifacient birth-control methods regardless of their popularity. I am not Catholic, by the way.

  10. jamesandlindseymorgan December 30, 2012 at 11:05 pm #

    Thank you Denny for posting such a clear explanation! Few Christian doctors actually know this or are willing to tell their patients. May this bring to light the reality of every decision that we make needs to be with eternity in mind!
    (ps I am a family practice physician)

  11. Larry Geiger December 31, 2012 at 3:33 pm #

    I don’t think that we should be paying for any of this stuff. If people want it, then they should pay for it just like cosmetic surgery. You guys are arguing around in circles and it should be as clear as no one pays for anything they don’t want to pay for. We are so balled up in this country with everyone being forced to pay for a bunch of stuff that NO ONE should be forced to pay for (union dues, insurance, elective surgery, “women’s health care”, dental checkups and on and on and on.) It’s just a bunch of Americans’ trying to get something for nothing. Maybe we should be taking a stand for people to get up off their lazy behinds and earning and paying for the benefits they want for themselves.

  12. Karen White January 1, 2013 at 11:08 am #

    Just a gentle reminder. It is a well-known fact in academic medicine circles that science cannot “prove” negatives. It just isn’t intended to work that way. It is unreasonable to say that pro-lifers would legitimately be okay with birth control if it could be shown to not cause abortions. The structure of experimentation precludes this possibility. (for the same reason, evolutionists cannot prove that creation didn’t take place – side note)

    I know there is a lot of disagreement and speculation on this issue and my goal isn’t to persuade people they should or shouldn’t prescribe or use birth control. Just wanted to point this out.

    Furthermore, let’s assume for a moment that the issue is obvious – not just birth control but something like having to provide insurance coverage for actual abortions – is it truly legitimate to invoke civil disobedience in something like this? When Christ told the disciples to pay taxes, do we have reason to believe all the taxes were used for pure and righteous causes? I’m sure some of the tax money was used for very anti-God, anti-biblical purposes, and yet Christ commanded us to pay. I would think this means we must pay for these insurance policies according to the law, while lobbying to have them changed.

    Just some thoughts from a very pro-life physician.

    • Becky G. Miller January 2, 2013 at 3:29 am #

      I’m afraid this may not post because it’s time for me to re-up, so it will be short. Remember Daniel’s dilema, the lion’s den & the outcome (Daniel: 6). And Shadrach, Meshach, and Abed-Nego in Daniel:3.
      Also, when the Pharisees (Matthew 22:15-22)(?) tried to entangle Jesus “in His talk” by asking Him if it was “lawful to pay taxes to Caesar or not”, He responded with “Render therefore to Caesar the things that are Caesar’s, and to God the things that are God’s.” He changed the verb they used from “pay” to render, which literally means “to pay back.” Christians have a responsibility to obey the law of the land unless it is sinful to do so (Rom. 13:1-7, l Pet. 2:13-17). When they are in conflict, believers are to follow God (Acts 4:18-20, 5:29). God’s laws, will…His everything should always come first. My story (rather HIStory) & I’m sticking to it! Love to all & Happy New Year!

  13. James Rednour January 1, 2013 at 12:14 pm #

    I don’t like paying for the military industrial complex. As a pacifist, it is against my deepest held beliefs. Does that mean I can argue that I should not be taxed to support an institution that I find morally reprehensible? Whatever happened to “Render unto Caesar…”?

  14. Paul Reed January 1, 2013 at 4:58 pm #

    Another question is “do birth control pills cause abortions?” Many Christians want to remain deliberately ignorant, because if they knew the truth, they’d have to do something. You’ll occasionally hear a sermon about surgical abortion being wrong, but rarely one on chemical abortions.

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