Selling the Pill
If you asked a birth control pill user or a medical professional how the "pill" works, the most common answer would be that it prevents ovulation. That answer is only partially correct. But to those who sell the "pill" or other hormonal contraceptives, it is important that this impression is maintained. This is done through artful use of the word "contraceptive".
When a woman ovulates, an ovum (egg) containing 23 chromosomes passes from the ovary into the fallopian tube. If she has had sexual intercourse within the past few days there is a good chance that the male sperm containing its 23 chromosomes will meet up with the ovum and fertilization will take place. The resultant zygote contains the full human complement of 46 chromosomes and begins to divide repeatedly. During its 3 day journey down the fallopian tube to the uterus, the zygote has formed a ball of cells called the morula. By the fourth day, the cells have rearranged themselves into a blastocyst, and some of them send out processes in preparation for implantation into the endometrial tissue on wall of the uterus. Implantation begins on the 6th or 7th day after ovulation, and is complete by day 12.
In common usage, conception is equated with fertilization, or the formation of the zygote, which occurs in the fallopian tube. This same usage is found in many medical textbooks and dictionaries. [e.g., 1,2,3] The word "contraception" can be found by the lay person in Webster's New World Dictionary to mean the intentional prevention of fertilization of the human ovum. [4] The definition of pregnancy is much more nebulous, referring often to the carrying of young within the uterus. This definition obviously predates the time in which the process of fertilization was understood.
The American College of Obstetricians and Gynecologists has decreed that pregnancy begins with implantation. [5] It is confusing to read the current literature in this field, because many of the authors also utilize the word conception synonymously with implantation. Abortion, to this group, is the interruption of pregnancy (after implantation). Quite a number of newer medical dictionaries, bowing to this usage, now allow two definitions of conception: 1] the formation of a viable zygote, and 2] the onset of pregnancy marked by implantation of the blastocyst. The word contraceptive is therefore applied to any drug or device that prevents pregnancy- all the way up to the time of implantation. The Ob-Gyn Association's understanding of the term differs from that of the general public.
It is important to realize that a very large segment of the American population believes that the use of hormonal contraceptives will prevent the need for abortion, a procedure that they would prefer to avoid. And most of these people are operating with the idea that conception is the formation of the zygote, and that this correctly marks the beginning of life. This difficult contradiction is due to the fact that the early hormonal contraceptives contained large amounts of estrogen, and efficiently prevented ovulation. Newer agents contain much less estrogen and occasionally allow breakthrough ovulation. Their efficiency in preventing pregnancy is partly due to inhibition of implantation of the blastocyst. The endometrium in the uterus is rendered unreceptive to the implantation process and the blastocyst perishes. The hormonal birth control agents have other, possible, minor mechanisms of action, the importance of which is difficult to quantify.
The morning after pill regimen also works by prevention or delay of ovulation, and by prevention of implantation. Which mechanism is dominant depends on the time in a woman's monthly cycle that the regimen is used.[6]
Some birth control classifications that are based on biological considerations follow:
Contraceptive - prevents fertilization (conception), the joining of the sperm and egg.
Interceptive - prevents implantation of the zygote in the uterus. (This term is borrowed from Dr. Ralf Rahwan, professor of pharmacology and toxicology at Ohio State).[7] Interception is a mini-abortion.
Abortive, or abortifacient - causes the death of the fetus at any time after implantation and before birth.
For convenience and clarity, those who regard the formation of the zygote as the beginning of human life can lump the last two classifications together.
Those who are "selling" hormonal birth control claim that ignorance has limited the popularity of the morning after pill regimen, and that people believe that it is abortifacient merely because it is used after intercourse. They very clearly claim that prevention of pregnancy before implantation is not abortion, even in the face of the biological fact that human development is under way for at least five days prior to implantation. [8] According to Dr. David A. Grimes of San Francisco General Hospital, "Fertilization is a necessary but insufficient step toward pregnancy". In order to illustrate this idea, he explains:
"For example, a couple from Oakland, California, might go to a clinic offering in vitro fertilization in San Francisco. If the procedure was successful, the sperm and egg would unite in a petri dish. Could the woman then announce to her Oakland neighbors that she was pregnant? Her fertilized egg would reside across the bay in a different ZIP code. Not until the preembryo was successfully implanted in her body would she become pregnant. The same holds true for the fertilized egg traversing the fallopian tube." [9]
In drawing up this artificial analogy, the doctor is ignoring the biological potential and intrinsic value of the human zygote, and the fact that it interacts chemically with the mother even prior to implantation.
In conclusion, it is important to bear in mind that all hormonal birth control agents that are currently available have at least some interceptive (abortifacient) potential. Also, some medical professionals define the words conception, contraception , and abortion in very different ways than the general public, and the confusion this produces serves to enhance the marketability of hormonal birth control. Unfortunately, this means that countless women are receiving this type of medical treatment without the benefit of informed consent.
REFERENCES
1] Schibley Hyde, Janet; Understanding Human Sexuality, McGraw-Hill Book Company, New York. 1986.
2] Moore, Keith L., and Persaud, T. V. N. The Developing Human- Clinically Oriented Embryology, W. B. Saunders Company, Philadelphia. 1998.
3] Thomas, Clayton L., Ed.. }{\b\fs28 Taber's Cyclopedic Medical Dictionary, 15th ed. F. A. Davis Company, Philadelphia, 1985.
4] Guralnik, David B., Ed. Webster's New World Dictionary of the American Language, 2nd College Edition. William Collins + World Publishing Co., Inc., Cleveland, 1976.
5] Hughes, E. C., Ed, Committee on Terminology, The American College of Obstetricians and Gynecologists, Obstetric-Gynecologic Terminology. F. A. Davis Company, Philadelphia, 1972.
6] Food and Drug Administration. Prescription Drug Products; Certain Combined Oral Contraceptives for Use as Postcoital Emergency Contraception. Federal Register 1997; 62 (37): 8610-12.
7] Rahwan, Ralf G.. Pharmacological Approaches to Birth Control: Contraceptives, Interceptives, Abortifacients. U. S. Pharmacist, 1997; 10: 31-42.
8] Glasier, Anna. Emergency Postcoital Contraception. N Engl J Med, 1997. 337: 1058-1064.
9] Grimes, David A. Emergency Contraception - Expanding Opportunities for Primary Prevention. N Engl J Med, 1997; 337: 1078-1079.
Author: Karen L. Brauer M.S., R.Ph.
