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FDA says emergency contraception not abortifacient; bioethicist questions evidence

Plan B One Step on shelf

John Nacion | NurPhoto via AFP

John Burger - published on 12/27/22

Catholic bioethicist says there is still enough concern about Plan B to advise ovulation testing.

The Food and Drug Administration just before the Christmas weekend revised consumer information, now saying that some forms of “emergency contraception” cannot cause abortions.

Plan B One Step works before the release of an egg from a woman’s ovary, preventing ovulation, the FDA stated, saying it will not work after fertilization.

But there is still doubt about that determination, according to a Catholic bioethicist, and the new FDA position might be used to suppress any attempts to make sure women using the pills are not unwittingly snuffing out the life of newly conceived human beings.

According to a December 23 New York Times report on the decision, the FDA “didn’t look at any new evidence but considered evidence contained in an application from some consumer group in 2018 to alter the label,” noted John Brehany, Executive Vice President and Director of Institutional Relations for the National Catholic Bioethics Center (NCBC). “Could taking Plan B still allow conception or fertilization to take place? The short answer is yes.”

The medication is often taken by women who have had sex and realized that there were no contraceptives used and fear getting pregnant. It is also used by women who are victims of rape. But some Catholic hospitals, before administering emergency contraception, have traditionally tried to determine whether ovulation has taken place or not, out of concern that if it has, there is a chance that the drug will have an abortifacient effect.

Brehany said that some states are tightening up laws in that regard, forbidding hospitals from doing any testing for ovulation. 

The NCBC’s position on the use of Plan B has been that someone using Plan B in the context of a sexual assault “should have moral certitude that giving Plan B will successfully prevent ovulation, but it should not be given at a time when it would not prevent ovulation but it may impact implantation,” Brehany said. “I think there’s still some questions out there that make that good advice.”

He is afraid that the new FDA determination will be used to undercut any efforts to make sure there is “moral certainty” that ovulation has not taken place.

The NCBC doesn’t agree with legislation that bars healthcare professionals and institutions from any discretion in dispensing Plan B. “We think it’s imprudent,” Brehany said. “Responsible testing may indicate that it’s fine to give Plan B but people should be permitted and in fact they should be” trying to determine whether ovulation has taken place.

“What I see is efforts in more states to create such legislation” to mandate dispensing of emergency contraception with no questions asked. “The State of Louisiana passed a law last July in which the goal was to increase access to Plan B so women didn’t have to go out of state to get abortion. But there was no provision for any testing for ovulation or anything else, such that essentially there is a demand to dispense Plan B.” 

Similar legislation may be on the horizon in Texas.

“My concern is that the FDA’s changed position will be used to undercut efforts to allow any form of testing before providing Plan B and if anything will be used to justify what I would call a dispense-on-demand legal framework,” Brehany said. “I would say that once Plan B is available on demand they’ll probably up the ante further by making something like Ella available on demand.”

Ella is another form of emergency contraception, but is more akin in its chemical composition to the abortion drug RU-486. 

“It’s much more likely to alter the endometrium where a human embryo would seek to implant and make it harder for the embryo to implant and survive,” he said.

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