Morning After Pills and Abortion

The Honduran Supreme Court ruled Monday that human life begins at conception.

Deciding on the legality of a decree passed just after the coup, the Court ruled that a law banning the sale of "morning after" pills as emergency contraceptives did not violate the rights of women. It further ruled that the approval of morning after pills (which took place under the Zelaya administration) was against the Honduran penal code (Article 126) which defines abortion as the death of a human being at any time during pregnancy or birth.

There is a glaring problem with this decision: it is based on false claims about how the newly rejected drugs work.

So called "morning after" or emergency contraception pills are drugs which are intended to disrupt ovulation or fertilization to prevent pregnancy. To do this higher doses of the same hormones found in oral contraceptives (estrogens, progestins, or a combination of the two) are taken within 120 hours of intercourse. A thorough review of the English language literature on the mechanism of action of emergency contraceptives carried out in 2010 by Leung, Levine, and Soon, found that

the evidence strongly supports disruption of ovulation as a mechanism of action. The data suggest that emergency contraceptives are unlikely to act by interfering with implantation, although the possibility has not been completely excluded.

A 2010 study of the mechanisms of emergency contraception drugs performed by Gemzell-Danielsson, found that in particular, the emergency contraceptive Levonorgestrel, a progestin, taken within 120 hours of intercourse

acts through an effect on follicular development to delay or inhibit ovulation but has no effect once luteinizing hormone has started to increase. Thereafter, LNG-EC cannot prevent ovulation and it does not prevent fertilization or affect the human fallopian tube. LNG-EC has no effect on endometrial development or function. In an in vitro model, it was demonstrated that LNG did not interfere with blastocyst function or implantation.

In plain language, it does not prevent fertilization or implantation once ovulation occurs.

In 2011, Noé, et al conducted a study of Levonorogesteral where the timing of administration was tied to a woman's ovulation cycle. For those that took LNG-EC in the five days before ovulation, there were no pregnancies. For those that took it on the day of ovulation, the expected number of pregnancies resulted. They concluded:

Our results confirm previous similar studies and demonstrate that LNG-EC does not prevent embryo implantation and therefore cannot be labeled as abortifacient.

These drugs don't prevent implantation; they don't prevent fertilization; they are not abortifacients. In fact, there are no recent studies into the mechanisms of these drugs that support the notion that they have any effect once ovulation takes place.

But tell that to the Honduran Supreme Court and more importantly, the Honduran College of Medicine (Colegio Médico de Honduras) which La Tribuna tells us, "carried out an objective analysis of the effects of these drugs".

Obviously this "objective analysis" didn't include a review of the literature.

The Supreme Court's reasoning went something like this. They cite the WHO definition of pregnancy as beginning at implantation, and abortion as the termination of a pregnancy. The Supreme Court wrote:

As a consequence of that, some authors who promote the use of emergency contraception conclude that there is no interruption in the pregnancy because the embryo has not implanted.

They then use that misdirection to conclude that

to have implantation, there must be a fertilized ovum, because without an embryo, there is no chance of implantation. In consequence, human life initiates at the moment of the union of the sperm and ovum, not at the moment of implantation. To negate this is to go against logic and biological principles.

Notice the deft misdirection. They take it as a given that the emergency contraceptives work by preventing implantation of the fertilized ovum, something that study after study (as we cite above) has demonstrated is not true. The overwhelming consensus of the recent medical literature on the mechanisms by which these drugs prevent pregnancy is that they only do so if the woman has not already ovulated. Once ovulation occurs, even if they take these emergency contraception drugs, the expected number of pregnancies result.

La Tribuna reports that the research paper presented to the court by the Colegio Médico de Honduras concluded counterfactually that Levonorgestrel works by blocking implantation, a statement contradicted by current research.

So Honduran women lose ground on reproductive control because of bad science on the part of the Colegio Médico de Honduras.

That should be illegal.