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Emergency Contraception: Yes? No? When?

It's not a straightforward "thou shalt" or "thou shalt not." But the "emergency contraception" debate can't get off the ground without clarifying some crucial terms.

Recently, a spokesman for the bishops of Louisiana suggested that the use of so-called “emergency contraception” is compatible with Catholic teaching in cases of rape. The news article reporting this connected it with the explicit exception made for “emergency contraception” in the restriction of abortion by new Louisiana abortion laws, made possible by the Supreme Court’s overturning of Roe v. Wade. There are, however, a tangle of issues here that I will try to separate.

The Catholic Church teaches that human life is worthy of protection from the moment of conception—the moment when the genetic material of an ovum and of a sperm are united to form a new human (see the Catechism of the Catholic Church 2270 and following). The Church, further, demands that this life be protected by law (2273).

There is dispute—to which I shall return—about the mechanism by which the pills used as “emergency contraception,” such as “Plan B,” work: do they simply impede ovulation, or do they also prevent the implantation of a fertilized ovum in the wall of the uterus? The latter would cause that newly formed human being’s death.

Governor John Bel Edwards, who signed the legislation, describes the law as stipulating that “pregnancy and the life of an unborn child begin at implantation, rather than fertilization,” and therefore allowing an end run around prohibiting abortions even in the case of rape. This suggests that he sees “emergency contraception” as at least potentially not contraceptive at all, but abortifacient: as causing an abortion.

This makes the Louisiana law less than ideal, even if, as a ban on abortion in a wide range of circumstances, it is a welcome improvement on what went before it.

The bishops of Louisiana’s apparent approval of the wording of the legislation, however, is not motivated by the view of Governor Edwards: that a sufficiently early abortion is licit. To understand the argument made by some Catholic ethicists here, we have to take into account two principles.

First, the Catholic tradition has always allowed victims of rape to attempt to impede conception. This is clearly and correctly set out in the United States Bishops’ Conference’s Ethical and Religious Directives for Catholic Health Care Services (36). The reason this is not ruled out by the Church’s general prohibition of contraception is that it does not involve the “double intention” both to have sex and to frustrate sex’s procreative potential. The victim of a rape, obviously, does not intend the sexual act. Similarly, it is permissible to intend not to conceive and to implement that intention by abstaining. What is wrong is to intend to engage in a sexual act and to intend the frustration of that act’s procreative potential, be it before, during, or after the act.

This is the basis of the claim that nuns who fear being raped can take the contraceptive pill—the “nuns in the Congo” case. But applying it to the taking of particular pills raises the question of what exactly the pills are doing.

This brings in the second of the two ideas: that “emergency contraception” is or at least can be contraceptive in the strict sense: that it can prevent conception by suppressing ovulation.

Supposing there was a pill that did nothing but suppress ovulation, this would indeed be a contraceptive in the strict sense, whether used before or after sexual intercourse. It would be wrong for a woman to take these pills with a view to preventing conception from acts she intended to engage in, but it would not be wrong, on the above argument, if she did not intend to engage in any.

But do such pills actually exist? Dr. Bruno Mozzanega of the University of Padua has done some of the key work in this area. Speaking of one of the chemicals used in such pills, he writes, noting that the pills are up to 80% effective:

Besides, we wonder how [ulipristal acetate], if taken after ovulation, could delay a follicular rupture that may have already occurred up to four days earlier. This suggests that [its] effectiveness . . . relies on other mechanisms, particularly on its endometrial effects.

In other words, by preventing implantation.

What of the other chemical used, levonorgestrel? In another paper, Mozzanega casts serious doubt on the evidence for the claim that it does not prevent implantation, concluding that “at present, literature data do not seem to fully support that [levonorgestrel-based pills] avoid pregnancies by inhibition of ovulation.”

Such considerations have led the Catholic Medical Association to condemn the use of Plan B, which uses levonorgestrel, for victims of rape. The CMA points out that Plan B’s own website admitted in 2015 that “it is possible that Plan B One-Step may also work by . . . preventing attachment (implantation) to the uterus (womb).” (This admission has since been removed.) The CMA statement concludes, “Further research is needed to find a drug that can be used after sexual assault to prevent conception without taking a human life.”

Despite this, the argument is sometimes made, including by some people advising bishops, that this amounts to a mere risk of causing an abortionand this is perhaps a reasonable risk for rape victims to take.

One way I have seen this argument developed is in terms of the timing of ovulation. If a rape victim is about to ovulate, and the pill prevents ovulation, it would seem legitimate for her to take it. If the victim has just ovulated, then if the pill works, it will work by preventing implantation. The exact time of ovulation, however, is not always easy to establish, and the idea that a rape crisis center or hospital would make Plan B available conditionally, on the basis of some calculation along these lines, seems completely impractical. It certainly isn’t what is envisaged in the demand by Louisiana’s Law 513: that all licensed hospitals in the state stand ready to make “emergency contraception” available. What the law is saying is that the pills should be given for the asking. What happens next is, at best, a matter of chance.

It should be noted that to hide the mechanism of the pill from the user would be a grave violation of her moral autonomy, and to deceive those giving her medical care would be grossly unprofessional. Everyone needs to be clear-sighted about what he is doing.

Can the decision to take the pill, knowing what it can do but not knowing whether ovulation has taken place, be presented as a merely risking the death of a new human life? And if so, would this be licit?

The Church teaches us to respect and protect the life of the unborn from the moment of conception, in the way we would respect and protect human life at later stages. This does not exclude all risk-taking: the study of ethics is full of hard cases in which risks to different people must be balanced. For example, Catholic teaching allows pregnant women who need medical treatment, such as for cancer, to receive such treatment even if it is likely to kill the unborn child. The document of the USCCB already cited notes:

Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child (47).

The cases of rape and “life of the mother” are not parallel, however. First, the intention of taking the pill generally would seem to be best described as an intention to prevent a developing pregnancy, either by suppressing ovulation or by preventing implantation. If this is indeed the intention, then it is wrong: a conditional intention to cause an abortion (“if ovulation is not suppressed, then I intend that implantation be prevented”) is still an intention to cause an abortion. As the Church teaches, no hoped-for good result of this plan of action can justify it.

Second, if it is genuinely not the intention (“I want to suppress ovulation and am prepared to risk other consequences if this fails”), but the user knows that there is a serious risk of ending a developing human life, then we are in the realm of risk-taking. The mother’s life is not at stake in the rape case, so there’s no question of balancing risks between two lives. Accordingly, it would be a case of a wrongful recklessness, because the risk is not proportional to the good intended.

The debate about abortion in the case of rape comes back in at this point. Our compassion for victims of rape is exactly what prevents us, as people who acknowledge the moral status of the unborn, from sending rape victims down the pathway of abortion. It may seem, to bystanders, that killing an unborn child conceived in rape makes the problem go away. But in terms of the rape victim’s trauma, physically, morally, and spiritually, it does nothing but compound the harm done—even at the earliest stages of that innocent child’s life, and no matter how “easy” and inconsequential taking a pill might seem when compared with a complicated and more obviously gruesome late-term surgical abortion.

The pro-life movement and the Church have much work to do in offering alternatives to abortion, and in offering forgiveness, healing, and acceptance for all those affected by our modern culture of violence and death. This work does not involve obscuring the Church’s moral clarity on “emergency contraception.”

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