The Morning-After Myth

Science, technology, and life.
Dec. 4 2008 7:49 AM

The Morning-After Myth

David Savage, one of my favorite legal writers, has a good story in the L.A. Times about President Bush's plan to protect medical employees from punishment when they refuse to violate their consciences. The idea sounds good till you read the details : The rule bars "any entity" that gets federal money (e.g., private companies that happen to be funded in part by a grant) from disciplining any employee, including one "whose task it is to clean the instruments." Savage reports :

Proponents, including the Christian Medical Assn. and the U.S. Conference of Catholic Bishops, say the rule is not limited to abortion. It will protect doctors who do not wish to prescribe birth control or to provide artificial insemination, said Dr. David Stevens, president of CMA. "The real battle line is the morning-after pill," he said. "This prevents the embryo from implanting. This involves moral complicity. Doctors should not be required to dispense a medication they have a moral objection to."

William Saletan William Saletan

Will Saletan writes about politics, science, technology, and other stuff for Slate. He’s the author of Bearing Right.

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Hey, I'm all for respecting moral objections. Doctors are entitled to their own ethical judgments, regardless of what the medical establishment says. But they're not entitled to such defiance when the judgments in question are scientific. And what Dr. Stevens says about the morning-after pill—that it "prevents the embryo from implanting"—is such a gross misrepresentation that it's amazing he's in charge of any medical association.

Let's get clear on two important points. First, "morning-after" does not mean "after-fertilization." To repeat what I wrote about this two years ago :

An egg loses its fertility within 12 to 24 hours . It takes sperm about 10 hours to reach the egg, and sperm can survive in the female reproductive tract for up to five days . If you want to get pregnant, you'd better send in the sperm before the egg shows up. But if you don't want to get pregnant, and the sperm are on their way or already there, you still have time to stop the egg.

Second, of all the ways in which a morning-after pill might block pregnancy, preventing implantation is the least plausible. Chemically, a morning-after pill is a form of oral contraception. Here are the facts :

The risk that oral contraception will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small , since the primary effect of oral contraception is to prevent ovulation , and the secondary effect is to prevent fertilization . To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation.

So what Stevens says is, at a minimum, a gross distortion. And it's a particularly evil distortion because it steers women away, not from abortion, but from the measure that is at that moment most likely to prevent them from later resorting to an abortion. If I ran a medical facility and found out one of my doctors was feeding patients that kind of propaganda, I'd fire him. And the government, particularly a government that calls itself conservative, has no business standing in my way.

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