The controversy around emergency contraception is one part just plain confusion and one part Catholic Church law, which says that life begins at the moment that the sperm fertilizes the ova.
The email received by Gambit Weekly had originated with Courtenay Mendell at the Blanco for Governor campaign, who had sent a message five days before the election to her mother. “I hate to make one candidate more pro-life than the other,” it read, “but he (Jindal) is poising [sic] himself as a solidly pro-life candidate, which he clearly is not. Love, Court.”
Before forwarding it on to a number of people, her mother had added this note: “Dear pro-lifers, breaking news. Check out this website for a Gambit magazine article from 11-4-03 where Bobby Jindal says he is 100% pro-life but he approves of the “morning-after pill” — RU486 — in certain cases … this makes him NOT 100% pro-life.”
Mendell says she approves of her mother’s addition. “That is accurate,” she says.
Mendell’s note referred to Gambit Weekly‘s Nov. 4 endorsement of Bobby Jindal, which noted that Jindal supports making what this paper called “emergency room contraception” available to rape victims. These events illustrate the general confusion surrounding emergency contraception. First of all, it’s not emergencyroom contraception — it’s emergency contraception (EC), also known as the morning-after pill, and it can prevent pregnancy if it’s taken within 72 hours of unprotected intercourse. In most non-religious hospitals, emergency-room staff treating sexual-assault victims will generally offer EC. Some states now require all emergency rooms to do so. If taken within 72 hours, the pills reduce the likelihood of pregnancy by 75 to 99 percent.
Emergency contraception is not, however, the same as RU486.
RU486, commonly known as the “abortion pill,” is prescribed by a gynecologist for a woman who has taken a test confirming her pregnancy and who chooses to abort the fetus. “RU486 works to end an established pregnancy,” says Kristen Moore, president of the Washington, D.C.-based Reproductive Health Technologies Project. By blocking certain hormonal receptors, RU486 causes the birth sac to detach from the uterine wall, she explains.
That’s much different from emergency contraception, which received FDA approval in the late 1990s and will next month be considered for over-the-counter use. Basically, EC uses high doses of the hormones found in birth control pills. “It works like birth control,” says Moore, “by delaying ovulation, inhibiting fertilization, demobilizing sperm, and thickening (uterine) mucus to prevent implantation.”
Courtenay Mendell was not aware of any difference between emergency contraception and RU486. In the final gubernatorial debate between the two Catholic candidates, Mendell’s candidate, Kathleen Blanco, herself furthered the confusion. “Bobby,” she said in the debate televised live on WWL-TV during the week before the election, “Gambit magazine said that you supported the morning-after pill. Now what am I to assume, because … you say that you’re completely against abortion?” Jindal did not respond directly to the question.
Yet according to the Catholic health code, Jindal can be considered pro-life and still support emergency contraception for rape victims. Use of emergency contraception for rape victims falls within church policy with a couple of caveats, says Fr. Robert Guste from Our Lady of Perpetual Help Catholic Church in Kenner, who was one of the recipients of Mendell’s mother’s email. “If so-called emergency contraception is given at a time in a woman’s cycle that it could be determined that it would act to prevent conception, but not result in an abortion, then it would be acceptable,” Guste says.
The group Catholics for a Free Choice formed in 1973, soon after the U.S. Supreme Court made abortion legal in its landmark decision Roe v. Wade.
“The organization was founded to give voice to the majority of Catholics in the country who believe that abortion should be legal,” says Catholics for a Free Choice president Frances Kissling. “The majority of Catholics also support and use contraception,” she says, and so EC should not be considered differently.
Most Catholic groups only support the use of EC within a narrow window, says Cathy Cleaver Ruse, spokesperson for the Secretariat for Pro-Life Activities, part of the United States Conference of Catholic Bishops. Ruse confirms that Directive 36 of the Ethical and Religious Directives for Catholic Health Care Services specifies that women who have been raped can receive emergency contraception if testing shows that there’s no evidence that conception has already occurred.
Brenda Desormeaux at the Women’s Center, an anti-abortion group in Lafayette, says that she also follows that policy. However, she says, she is personally not in favor of the pills because “rape victims very seldom, less than one-tenth of one percent of one percent, get pregnant from a rape.”
The National Right to Life Committee, when asked about emergency contraception, emailed a three-paragraph statement that said nothing about contraceptives except to note that RU486 is not one. “That comment is all I can give you,” says spokesperson Kristi Hayes. The statement does explain that the committee “believes life begins when an egg containing a full compliment [sic] of chromosomes becomes a diploid cell.”
Therein lies the entire argument, says Kissling. “In the minds of most people, a two-celled fertilized ova is not a person,” she says. “But for the church, a pregnancy exists at the moment of fertilization, before the fertilized ovum travels down the Fallopian tube into the uterus.” That differs from the medical establishment, which declares pregnancy just a bit later. “For medical science,” says Kissling, “a pregnancy exists when a fertilized egg implants itself in a woman’s uterus.”
This difference may seem small, but it’s important in a couple of circumstances. For in vitro procedures, medical science waits until the ovum implants in the woman’s uterus before declaring a pregnancy. According to church definition, if a few different eggs and a sperm are united in petri dishes, each of them is technically a human person. As a result, most anti-abortion groups also oppose in vitro fertilization.
This difference in definition also plays a role in the church’s view of EC. “What the church says about emergency contraception is that sometimes it causes an abortion and sometimes it doesn’t,” says Kissling. Either way, EC is forbidden because both contraceptives and abortion are forbidden. But rape victims are allowed to use it. “The church makes a narrow exception when a woman has been raped,” says Kissling. “The theory is, if you’ve been raped, you have the right to reject the violator of that rape, a right in that instance to prevent that sperm from creating a pregnancy.”
There’s a catch, however. Fertilization takes about a day. And so if the woman has waited a day, Catholic hospitals will not dispense EC because any ovum is likely to be fertilized. “So for sure, within the first 24 hours after a rape, fertilization has not occurred,” says Kissling. “After that, it’s a question mark.”
Cleaver Ruse explains that, according to the Catholic health directives, if no conception has occurred, the woman “may be treated with medications that do three things, prevent ovulation, sperm capacitation, or fertilization.” If there was a more accurate test for fertilization, the directive might change to reflect that new precision, she says. Kissling agrees — as science develops, theology also changes, she says.
For a woman who is not concerned with Catholic Church policy, EC pills are still effective up to 72 hours, possibly even longer, because EC’s hormones cause the uterine lining to thicken and reject a fertilized egg. In the eyes of the Catholic Church, the loss of that fertilized egg is an abortion.
Kissling and her group often explain this policy to Catholic hospitals. But that doesn’t mean she agrees with it. “There is absolutely no reason that the laws of any state or country should be based upon a bishop’s understanding of biological science,” she says.
Confusion about emergency contraception is not just limited to Catholics. According to a recent survey by the Henry J. Kaiser Family Foundation, two-thirds of women aged 18 to 44 “are aware that there is something a woman can do to prevent pregnancy in the few days following sexual intercourse.” That means that one-third of women are not aware of EC. Even fewer have access to it.
Which may be why Kaiser found that, nationwide, only 6 percent of women aged 18 to 44 have ever used EC.
“Most doctors still are not initiating conversations about EC with their patients,” says Kirsten Moore, whose organization, Reproductive Health Technologies Project, is sponsoring a campaign titled “Back Up Your Birth Control with EC.” Posters for the campaign feature an illustration of Rosie the Riveter flexing her bicep with the phrase “Be Prepared” underneath it.
The ideal is for every woman to have a dose of EC in her medicine cabinet, says Moore. “Your doctor knows you’re trying to prevent pregnancy,” she says, “but they forget to talk about a backup plan.”
Barriers exist even after a prescription is issued. Some pharmacists do not stock EC, either because there is little or no demand for it or because they oppose the use of it. Since 1998, some states — including Washington, Alaska, California, Hawaii and New Mexico — have begun to allow pharmacists to dispense EC directly — and promptly — to women without an individual doctor’s prescription.
Some research has suggested that using EC prevents abortions. Researchers charting abortion trends for the year 2000, when only 2 percent of women reported using EC, estimate that 51,000 abortions were prevented by EC use that year. They suggest that increased use of EC may account for nearly half of the decline in abortion rates between 1994 and 2000.
It may be too early to make those sorts of projections because the number of women using EC is still so small, says R. Catherine Cohen, medical director for Planned Parenthood of Louisiana and the Mississippi Delta, which routinely dispenses EC through its clinics. “I think the fact of the matter is, women are just not using EC enough,” Cohen says.
That may change after next month, when the FDA will consider changing the status of EC from prescription-only to over-the-counter. But before women can use it, they have to know about it, Cohen emphasizes. Some of the primary messengers will be doctors like her, many of whom don’t currently raise the topic.
“I don’t always talk to my patients about it,” Cohen admits. “But even having this conversation reminds me that I should.”
This article first appeared in the 1 December 2003 edition of Gambit Weekly.