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Everything You’ve Been Told About “Plan B” Is Wrong


Chris Kahlenborn, MD - published on 02/23/15

According to the Noé paper, Plan B is almost 100% effective in stopping clinical pregnancy if given prior to ovulation and 0% effective when given on or after the day of ovulation. This means that the efficacy of Plan B depends on the composition of the particular study group. If the majority of women in the study sample are given Plan B preovulatory, efficacy will appear high; conversely, if the majority of women studied are given Plan B postovulatory, efficacy will appear low. We see evidence of this phenomenon in the Noé study: 103 women were in the preovulatory group and 45 in the postovulatory group. This corresponds almost exactly to their stated efficacy rate of 68% (i.e., 103/148 or 69.6%).

If I may summarize these findings: Plan B can prevent clinical pregnancy only if it is given to a woman before she ovulates and it does so mainly by causing an early abortion. What are the implications of these findings for emergency room physicians in their treatment of rape victims?

The Noé study has huge implications for women who have been raped and for the physicians who treat them. Department of Justice protocols recommend offering Plan B (or at least a prescription for Plan B) to all rape victims. And, according to its FDA-approved label, Plan B/Plan B One-Step is “indicated for prevention of pregnancy" and it “can be used at any time during the menstrual cycle” irrespective of whether the rape or “unprotected intercourse” occurred after ovulation and outside the fertile phase when the possibility of pregnancy is remote or nonexistent.

Patients are likely to be told that Plan B will reduce their risk of becoming pregnant. The reality is that most emergency rooms test for a prior existing pregnancy, but rarely if ever test women’s ovulatory status (by measuring levels of luteinizing hormone and progesterone). As noted earlier, top researchers who strongly advocate for Plan B have conceded that — in cases where women have begun to ovulate or have already ovulated — Plan B either has no effect or it may actually increase the risk of pregnancy. This has serious implications both ethically and medically. Emergency room physicians who continue to give Plan B without checking ovulation status, will subject many woman to a hormonal drug that may actually increase their risk of pregnancy, all the while claiming that Plan B has an efficacy rate of 85 percent!

What are the implications for Catholic hospitals that have been dispensing Plan B to rape victims on the assumption that it acts like a contraceptive when, in fact, your paper shows that when given during the fertile phase before ovulation, Plan B is more likely to prevent clinical pregnancy by an abortifacient, rather than contraceptive, mechanism of action?

In 1995, then Bishop John Myers accepted what is called today “the Peoria Protocol.” In a nutshell, the Peoria Protocol allows Plan B to be given to women who have been raped prior to ovulation only, based on the assumption that Plan B consistently stops ovulation when given in this phase. Many Bishops have accepted this protocol while others remained skeptical. We now know from several large studies by Noé et al., Croxatto et al. (Contraception, 2004) and others that Plan B does not consistently prevent ovulation. Therefore, the Peoria Protocol is based on a faulty premise.

This has immediate and serious implications for Catholic hospitals because giving Plan B prior to ovulation (following intercourse in the fertile phase) is more likely to cause an early abortion than to act as a contraceptive (by blocking ovulation or preventing fertilization). Catholic Hospitals currently using this faulty protocol are unwittingly allowing early abortions to occur in their facilities.  

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