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.

Commemorating the Coup d'Etat of June 2009: Opinions

Marking anniversaries is a basic human impulse. When the event was a positive one, we call this a celebration. When, as in the case of the coup d'Etat in Honduras, the event was violent, destructive, and disruptive, the word we use is "commemorate": to remember together.

So it is that in Honduras today, those in opposition to the coup, to the de facto regime it initiated, and to the administration of Porfirio Lobo Sosa, elected under the shadow of that regime, gathered in public, to share in marking the passage of a year since the legal order was broken in their country.

We would normally be in San Pedro Sula at this time of year, when the celebration of the founding of the city, the Feriana Juniana, takes place. In San Pedro yesterday and today the Artistas en Resistencia continued their practice of using the arts as a weapon of protest, organizing a sleepover Sunday night with cultural activities and fireworks, and promising a concert and screening of the film "Quien Dijo Miedo".

As it happens, El Tiempo, the only newspaper in Honduras that dared to print accurate stories during the coup and de facto regime (and as a result, saw its circulation increase), is published in San Pedro Sula. So it was the first place we went to see how the marking of this anniversary would be covered.

The first notable thing is that the front page includes a whole series of stories on the topic. This even includes reporting on the alternative truth commission sponsored by the Human Rights Platform.

But even more striking is the editorial stance of the paper. Of six signed editorials, four overtly condemn the coup d'Etat. There is only one that openly supports the coup. (*)

The lead (unsigned) editorial is striking: it calls attention to the connection between drug-trafficking and the coup, quoting Hugo Martinez, chancellor of El Salvador, for the punch line: "There are only two sectors that are interested in the governments in the region being weak: drug-traffickers and golpistas".

Luis Alexis Ramos writes of the "Anniversary of a betrayal" (or even, "Anniversary of an act of treason"

promoted by the oligarchic classes of the country, with the collaboration of unscrupulous and ambitious politicians and congress members, clerics and pastors that left the pulpit to meddle in politics, and with the backing of the most backward groups of the decision-makers of the Armed Forces of Honduras...The only positive thing that was obtained through this attack on the Constitution perpetrated by the Honduran oligarchy, is that the people became conscious of their role in defense of democracy, woke up from their stupor of decades; they illuminated their mind with the thoughts of liberty and rebellion in the face of injustices, and that their courage was an armor against all the affronts and the blows that the received defending their right to protest.

In "The Virus of golpismo", Eduardo David Ardon argues that due to the long history of coups in the country

we have not attained the development that the people long for, and we believe that it is only possible when a democratic process is initiated in which popular sovereignty is respected and a system of participation with justice and equity truly takes shape, because if not, if there is not justice for everyone, there will be peace for no one.

Ardon identifies golpismo as a virus in the bloodstream of some politicians because their ancestors carried out previous coups. He traces an intricate web linking many of the authors and supporters of the latest coup to relatives involved in previous disruptions of constitutional government. He continues

The golpistas of yesterday, today, and always, are the same and the people knows them already, so that it fights against them in every circumstance.

The causes of those coups and attacks on the Constitution, also are the same, since at every moment it has been the defense of their economic and political class interests, that do not compromise with the ideas of liberty and progress of the Honduran people.

Efraín Bu Figueroa labels the coup of 2009 an "Historic Rupture",

with which constitutional order was broken in Honduras. A ferocious repression was begun against the people and the independent press was silenced by bayonets. Old death squads were reactivated, that human rights institutions have denounced as dedicated to the selective elimination of the opposition, actions that persist to the present, many of them disguised as crimes by common delinquents.

The coup was fostered by powerful groups, affected in their economic interests by the diverse popular measures taken by the government of citizen power....

The political crisis of 2009 is the eruption of a political-social volcano, whose destructive energeies have been building up for many decades.... When the people began to receive timid responses to their vital needs, the controlling elite saw its special interests menaced, and its hegemonic power in danger....

One year later, Honduras is no longer the same nor will it go back to being so. The coup d'Etat, was a consequence of the distortions and weaknesses of the system, placing in evidence its failure; but at the same time opening the door, in a moment of inflection, to advance without fears, with hope and under new paradigms to a State of justice, and equity, and of confidence under new leadership and renewed ideas.

Finally, Efren D. Falcon writes in "First things First" that the answer to the question "what do Hondurans want?" is complex, beginning with what he identifies as a lack of understanding about the political-economic situation of the country on the part of the small middle class, in which he places himself. His critique of the political-economic elite is harsh:

the political leadership confuses itself and merges with a coarse business class that has not learned how to measure the consequences of its actions. It manipulates with hypocrisy and cynicism poverty and need; it makes a party of an unwanted social conscience-- that is quoted with discretion and without dignity-- but that it keeps in its Prada handbag or Armani wallet when it isn't speaking in public, citing measures of inequality that they themselves sponsor.

To this, he contrasts

the growth of a social movement whose extension has no equal in national history. We call this phenomenon the Resistance: resistance to the coup d'Etat, and against an infinity of irregularities that today are perfectly unmasked. What is moving through the country today is a resistance against the present social and political-economic order, ever stronger winds of change.

These editorial opinions contrast vividly with the failure in much of the English language press to understand that the coup of 2009 was a response by a threatened political-economic elite to the possibility of broader effective participation on the part of the Honduran people, to relatively small steps toward economic equity and participation in governance by that people.

The repeated recognition that there is no going back, and that the resistance movement mobilized by the coup may well be the real lasting legacy of that attempt to hold back change, is and should be the story, one year after what history will look back on as the grossest miscalculation by a group in power thinking they could hold back change by force and will.


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*The sixth signed editorial in Tiempo, by Nicaraguan writer Sergio Ramirez, is ambiguous. It presents an argument against people who rely on "one book". If we take this as a call for tolerance of pluralism, mark it in the category of opposed to the coup. Ramirez, a former revolutionary during the anti-Somoza fight in Nicaragua, wrote in negative terms about the coup in Honduras last year, calling the international press to task for not identifying it clearly as a military coup, calling attention to the dangerous political involvement of the military, to cite just two examples.

But he also is engaged in fighting against what he sees as the danger of continuismo in Nicaragua. So the framework for his editorial is not that of the Honduran editorialists, and he makes no mention of the anniversary. Yet it is interesting to read in the context of that anniversary. He asks explicitly whether we should hold against Marx "the socialism of the 21st century". References to 21st century socialism in Honduras usually come from those who see danger in the kinds of participatory democracy promoted under Manuel Zelaya. We would not be surprised if this editorial is read by those people as support for their position, regardless of Ramirez' own intentions.

Alternative truth, official truth, or honest disagreement?

An article published by IPS today, written by Thelma Mejía, attests to the widespread skepticism about the newly formed Honduran Truth Commission.

Composed of former Guatemalan vice president Eduardo Stein; Michael Kergin, a Canadian diplomat; María Amadilia, former Peruvian minister of justice; and Honduran members Julieta Castellanos and Jorge Omar Casco, assisted by Sergio Membreño as technical secretary, the Commission will begin its work on May 4.

As Mejía points out, conservative forces in Honduras-- notably the Unión Cívica Democrática (UCD)-- are opposed to including Julieta Castellanos. In addition, Mejía points out, "human rights groups criticised the inclusion of Casco, whom they link with the most radical fringe of the political right". Meanwhile, the Human Rights Platform notes that the Truth Commission has been established without following international norms.

The selection of the international members of the commission appears to have been constrained by the need to avoid participants from countries that have been critical of the coup. Since few governments in the world refrained from expressing outrage about the de facto regime, and many governments have not yet recognized the Lobo Sosa administration, the range of candidates was restricted from the outset. While Mejía cites Minister of Foreign Relations Mario Canahuati as saying the selection was made from a group of 15 competitive candidates, she quotes Reina Rivera of the Human Rights Platform as saying that

We believe that the selection of the international members was made more on the basis of their nationalities than their competence and abilities. The representatives from Canada and Peru are not well looked upon in some sectors, which is why some reject the Commission, while others view it with reservations.

Among those skeptical others: pro-coup businessman and ANDI president Adolfo Facussé, who reportedly said

this Truth Commission is a demand of the international community and we already know what its findings will be.... [These] will be geared to what the world wants to hear, and not to what really happened in Honduras. I don't have very high expectations regarding this question. It won't contribution to reconciliation; on the contrary, it will create greater division.

Finally, something on which both sides can agree! But surely even if it doesn't heal the wounds, finding out the truth will help? well, not so fast:

As we previously pointed out, the fact that the commission will seal records for ten years suggests the search for truth in Honduras is premature, if the committee thinks the country cannot handle hearing what it expects to discover. The report that Stein suggests will be complete in eight months is hard to imagine, if it has to avoid sensitive topics.

On the positive side, Mejía reports plans for an "Alternative Truth Commission", reportedly with the backing of Amnesty International and other human rights organizations, to "monitor the process and the conduct of those who make up the Truth Commission".

So, while we may share the skepticism of the left, right, and pro-business sectors in Honduras about the official Truth Commission, there is a chance that opposition to the proposed whitewash will keep a focus on the actual events of the coup and its aftermath and give human rights groups a chance to call attention to ongoing repression.