I remember sitting in a dimly lit lecture hall, just over a decade ago, listening to my professor expound on the benefits of oral contraception. The day’s lesson was emergency contraception (EC), specifically, Plan B® (levonorgestrel), known commonly as “the morning after pill.” She addressed this lecture hall full of future pharmacists and taught us how to counsel patients about the drug, about its benefits, dose timing, and mechanism of action (MOA). This was at a Catholic school, mind you.
What piqued my interest that particular day, however, was the mechanism of action, that is, how a drug actually works, at the cellular, and even molecular level. She explained that levonorgestrel (LNG) inhibits ovulation, which most of our class already knew; but she went on to explain that LNG may also prevent a fertilized egg from implanting. She meant this to be a positive thing. I whispered to my friend, “That sounds like an abortion, right?” “Sure does,” came his reply.
Colloquially known as the “morning after pill,” this agent has been the source of fierce debate since its originally approval in 1999, and that debate has only intensified in the wake of Dobbs. December 23, 2022, saw a decisional memorandum from the FDA updating the MOA for Plan B One-Step®, arguing against any post-ovulatory mechanistic effects in the packaging—specifically, prevention of implantation of a human embryo. Why does this change to the product packaging matter?
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Plan B One-Step® is marketed as an emergency contraceptive, meaning that the drug prevents pregnancy if taken after intercourse. The mechanism, as updated, now reads “Plan B One-Step® works before release of an egg from the ovary. As a result, Plan B One-Step® usually stops or delays the release of an egg from the ovary. Plan B One-Step® is one tablet that contains a higher dose of levonorgestrel than birth control pills and works in a similar way to prevent pregnancy” (emphasis added).
If the language update is true, then the drug is simply a contraceptive, and that’s the end of the matter. If the change is the product of political mischief, then the drug might prevent implantation after all and is thus an abortifacient. Though contraception and abortion are both grave, the difference between the two is immense. We must unpack these data ourselves to find the truth; the most vulnerable human lives depend on it.
When Plan-B® was first approved by the Food and Drug Administration (FDA) for non-prescription use in 2006, the company was asked by the FDA to include information relevant to the MOA in the package labeling, including prevention of attachment of a fertilized egg to the uterus. At the time of approval, data were available demonstrating a decrease in the number and diameter of endometrial glands following LNG administration. These data were enough to conclude that LNG could theoretically impact implantation, and the product’s own package labeling has cited these effects on implantation for over a decade.
Fast forward to 2022, and we find the drug manufacturer requesting a change to LNG-EC package labeling because “some consumers are hesitant to use a product that might affect postovulatory events, in particular implantation of the blastocyst.” Users of the drug are concerned that LNG-EC acts as an abortifacient, as implantation is necessary for the survival and growth of the human embryo. The drug manufacturer cites new data available since the approval, asserting that “updates to the labeling are needed to make the labeling more accurate, to reduce consumer confusion, and potentially to reduce barriers to use of the legally marketed approved product.”
We should ask why this push is coming now; hardly any of these cited data were introduced in the past year, and most have been available for some time. This past summer saw the overturning of Roe v. Wade, thus returning governance of abortion laws back to individual states. I suspect that this event alone has more than a little to do with this drug mechanism update, as well as the recent push to dispense mifepristone from retail pharmacies. If a state bans abortion, and LNG-EC may reasonably be classified as an abortifacient, then the drug can be pulled from the market. This is a nightmare scenario for the manufacturer and pro-choice groups—and a hopeful possibility for the pro-life movement.
None of these data from the FDA memorandum, on either side of the debate, are particularly good or recent, and there remains reason to be concerned that the drug can affect implantation, as the manufacturer itself stated outright in previous product labeling. All of the studies cited are plagued by many of the same problems, and all have significant limitations.
For their part, the FDA, in an astonishingly biased document, makes both critical omissions and faulty assumptions in what is ostensibly an implicitly coordinated effort with the manufacturer to keep Plan B One-Step® widely available. In addition, and rather predictably, an important study published by the Catholic Medical Association in 2016 outlining some of these mechanistic data was itself ignored in the memorandum.
The takeaway is that LNG-EC can, despite what the updated labeling claims, impair the implantation of a human embryo in a number of ways. If a human life is at stake, we must assume that the threat against implantation is always present and that, as a mechanism of abortion, it must always be avoided. Think of it in terms of Pascal’s Wager. We must “bet” on protecting life.
In his encyclical Evangelium Vitae, St. Pope John Paul II tells us:
The close connection which exists, in mentality, between the practice of contraception and that of abortion is becoming increasingly obvious. It is being demonstrated in an alarming way by the development of chemical products, intrauterine devices and vaccines which, distributed with the same ease as contraceptives, really act as abortifacients in the very early stages of the development of the life of the new human being.
St. John Paul II was clear here that “contraception and abortion are often closely connected, as fruits of the same tree.” To be sure, as John Paul II tells us, contraception and abortion are different in nature and moral gravity, but they cannot be separated. Just as conception and birth are joined together in service of love and life, contraception and abortion are two sides of the same ghoulish coin.
Abortion is the natural end of a contraceptive mentality, and Plan B serves as an icon of the relationship between contraception and abortion. It either prevents the conception of a life, or it takes that very life, with no distinction between the two.
For those who have utilized LNG-EC in the past, our focus must be education and mercy. Many people who have utilized or encouraged the use of the drug understand that they are employing a form of contraception but not necessarily an abortifacient. To many, this revelation will come as a shock. Others, however, will be totally indifferent, or may even dispute it. A merciful response insists on commitment to the truth, helping others along the path to salvation through Jesus Christ and spiritual healing. We are called to bring them all to a healing encounter with Christ, even if only through our prayers.
Our nation festers with support for the right to kill an unborn baby. As Catholic moral teaching asserts, unequivocally, human life begins at the moment of conception, and thus the early human embryo is a person, complete with body and soul, and made in the image and likeness of God. It is within this framework that we must look to ensure that every human life is treated with the dignity and respect of a child of God.
What applies to a full-term child so too must apply to a newly conceived child. If we truly believe that an unborn baby is a human being, then we must endure the laughter and jeering of contemporary society, and, orienting our entire being toward the sanctity of human life, disavow any form of “emergency contraception,” while empowering others with accurate scientific information in order to do the same.
[Image Credit: AFP via Getty Images]