What About the Morning After Pill?

I suppose I take a different approach than many e-journalists when I comment on the decisions of priests, bishops, and cardinals. I cannot bring myself to criticize their decisions because 1) it seems backwards to mistrust a man who authoritatively speaks in the name of Christ, and 2) as a lay person, I realize that I have much to learn from them and that they are also interested in learning from lay people’s experiences. Lumen Gentium explains that if a bishop is “teaching in communion with the Roman Pontiff,” he is “to be respected as a witness to divine and Catholic truth.” The bishop speaks in the name of Christ, and in matters of faith and morals we are to accept his teaching and “adhere to it with a religious assent.”

So when I heard about the decision of the German bishops to allow Catholic hospitals to use the morning-after pill or other contraception in rape cases, I was concerned about communication, but not critical of the decision. This is an opportunity for clearer communication, not crisis-style panic, finger-pointing, and insinuating that our bishops are ignorant. We have enough of that in the misguided secular media already.

The bishops were clear that the drug is only acceptable to treat rape victims if it is used as a contraceptive and not as an abortifacient. That means it can be used before the rape victim ovulates to prevent ovulation so that the sperm of the rapist cannot fertilize her ovum. The morning-after pill cannot be used during or after ovulation because there is a possibility that fertilization will occur, an embryo will exist, and the drug would function as an abortifacient because it renders the womb inhospitable to that life that has already begun. The decision was catalyzed by the claim of a 25-year-old rape victim who was allegedly refused treatment at two Catholic hospitals in Cologne.

I don’t know why such criticism has followed from the Catholic and pro-life communities. This decision is the same decision the United States Conference of Catholic Bishops (USCCB) issued in the 2001 Ethical and Religious Directives for Catholic Health Care Services, number 36:

“Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.”

There already are guidelines for testing whether or not the woman has ovulated, and they are outlined in the Pennsylvania Catholic Conference Guidelines for Catholic Hospitals Treating Victims of Sexual Assault from 1998:

These guidelines include a sample protocol to use to determine if contraceptive intervention is clinically indicated and which protocol is designed to determine that such intervention would be truly contraceptive, and not abortifacient.

  • If the pregnancy test is positive, no antiovulant drugs may be used.
  • If the pregnancy test is negative, then needed clinical determinations would be based on the following:
  • A menstrual history provided by the victim.
  • Hormonal levels as determined by a blood test to categorize the timing of the woman’s ovulatory cycle, and
  • Results of a urine test which is a reliable guide to the prediction of ovulation.
  • If the urine test is negative, that may be an indication that the LH surge has not been initiated, and a contraceptive intervention would be appropriate.
  • If the urine test is positive, that would indicate the hormonal shift that leads to ovulation has begun. The use of a contraceptive steroid intervention could be abortifacient and is therefore not permitted, even though there might be no evidence that conception has occurred.

It seems to me that the German bishops followed the rather long-standing protocol of the United States bishops, so that there is clarity for medical professionals in Catholic hospitals faced with treating women who have suffered rape.

What are my concerns? Well, they are concerns I have as a patient who has had negative experiences in Catholic hospitals. Pills and devices have become the mainstay of obstetric and gynecological (OB/GYN) care, and when a woman seeks to speak in terms of Catholic ethics, it is rare to find a doctor able to do so. Why is this? It is because most (if not all) Catholic hospitals in the United States have doctors providing care in them that are not Catholic and may or may not be bound to Catholic ethics depending on the contractual arrangements of the hospital with the diocese. A Catholic woman is in the unfortunate position of teaching, defending, and insisting on Catholic ethics to doctors more articulate in the use of pills and devices to solve OB/GYN issues than the ethical solutions we seek. It is frustrating, discouraging, and sometimes even frightening.

Without fail, under the roofs of Catholic hospitals, I have been asked what type of contraception I use, I have been offered genetic testing so I can “chose” whether or not to abort a Down Syndrome baby, and I have even been urged to abort because I have too many children. My experiences are not unique. Many Catholic women have to deal with the same things.

So I understand the concern of fellow Catholics. It is not difficult to imagine a woman arriving at an emergency room in need of care after being raped and all this Catholic discussion of preventing ovulation, sperm capacitation, and abortifacient effects being completely ignored. It is entirely possible that handing out the morning-after pill will become the routine treatment for rape without any consideration of menstrual history. Once the woman takes the morning-after pill and leaves the hospital, there is no way to know whether she ovulated or not, whether an embryo was created or not, whether a human was killed or not. How many times has this happened already? That is the point. We will never know.

While I appreciate the guidance of our bishops and acknowledge that in theory they are correct, I encourage them to further consider practical implications. How will anyone know whether hospitals follow the ethical protocol? I also encourage laity to communicate upwards with bishops in the spirit of charity, because as I have also pointed out repeatedly, our dear priests, bishops, and cardinals do not frequent gynecological offices. We need to tell them what happens, and we need to respect their decisions — as if we were all on the same team.

Perhaps this current dialogue will produce clarity regarding these pills and tests for ovulation, which will in turn improve the overall care given to a woman who is truly in the midst of a life-changing crisis, a goal we all share.

 

By

Stacy Trasancos, Ph.D. is a scientist turned homemaker raising seven children with her husband in New York. She is pursuing a MA in Theology at Holy Apostles College and Seminary, and is Chief Editor at Ignitum Today and Catholic Stand. She writes about all that she is learning at her blog, Accepting Abundance.

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  • http://www.facebook.com/andrea.abate.58118 Andrea Abate

    I think most prolife Catholics were upset because they don’t really understand the teachings of the Church. It’s nuanced. I argued with people on FB about the fact that it is ok for a rape victim to use birth control. They didn’t understand that rape doesn’t fall under Humane Vitae. They were just: no birth control! no birth control!

  • http://JamesTPereira.com/ James T Pereira

    Does this mean that a wife who’s raped by husband can also use contraceptives? I didn’t know that only in loving sexual relations, are contraceptives banned.

    Does the CCC state this?

  • phantom

    My question would be is what percentage are genuine rape cases?If more young ladies
    kept thier legs crossed they would find this also is a proven method to stop pregnancy.
    Church teachings have never accepted birth control ! Pls check your source!TX

  • Sharon

    Stacy, I definitely see problems with the approval of contraception for rape victims. First, I can appreciate the list of rules given to Catholic hospitals which are intended to prevent a Catholic-hospital-induced abortion. They make sense, kind of. My first question is, what is the story with the woman who was allegedly refused treatment at two Catholic hospitals? I am guessing that by “refused treatment” she means she was not given a morning-after pill. I can’t imagine that the hospitals just refused to treat a rape victim at all. Do the bishops think that by allowing some women to take the morning after pill, but only after they basically prove that they probably were not ovulating at the time of the rape, that they will satisfy those women who want the morning-after pill whether they were ovulating or not? I don’t think that will work. Basically, the woman’s feeling most likely is, “I do NOT want to be pregnant from this rape!”, while the Catholic hospital’s position is, “If you can prove that it is unlikely that you could have gotten pregnant from the rape, we will give you a pill that will prevent ovulation. If there is a chance that you have already conceived from this rape (the purpose of the ovulation test, if I understand correctly, since a pregnancy test does not detect hormones immediately after conception), or if you already were pregnant when you were raped (the purpose of the pregnancy test), then we will not give you Plan B.” I doubt that the woman who was “refused treatment” would be satisfied with the hospital’s position. So if avoiding lawsuits is the aim, it will not work. If avoiding further upsetting the victim is the goal, I also doubt that this highly nuanced position will work.

    I also have to ask about the pregnancy test. Since I would guess that most women come for rape treatment shortly after the rape, hopefully as soon as they can get help and get to a hospital, the pregnancy test would only determine whether she had already been pregnant before the rape. I would hope that staff would make that clear to the victim – that her pregnancy was not a result of the rape. Second, I found interesting information about the effect of morning-after pills on ovulation vs. implantation. First, a woman can only get pregnant from rape if she is fertile at the time of the rape. Of the women who were fertile at the time, Plan B will work by preventing implantation anywhere from 43 – 71 percent of the time. I’m not sure I can see how this is an acceptable risk level for the unborn, or for the bishops. So, finally, if avoiding an early abortion is the goal, the bishop’s position still does not work in probably a majority of the cases.

  • CDville

    She can still get pregnant if she is fertile within a few days after the rape. That is when the emergency contraception is acceptable to suppress ovulation.

  • Stacy Trasancos

    As I understand it, in theory it is acceptable to use spermicide or to prevent ovulation (i.e. contraception) for a woman who is raped because the rape was an act of aggression and the woman can defend herself against that aggressor. Once a child exists, the child cannot be killed because the child is innocent. The “in theory” part seems straightforward. It’s the practical implications that are the subject of debate and concern. How do you know if ovulation was prevented? How do you know if an embryo was created and then killed?

  • Stacy Trasancos

    Sharon,

    You are right, the woman was refuse the MAP. I think your assessment is right, and I agree about the ovulation and pregnancy test. Good points. As for the MAP, that is where the debate centers, it seems. Does it prevent ovulation only? Or does it sometimes prevent ovulation and other times inhibit implantation (a chemically induced abortion)? The answer from the studies I’ve read is the latter, which makes me think that any use of this drug is a bad idea in Catholic hospitals. *I think* (disclaimer) that the issue with the German bishops/US bishops is that they believe there is no risk for chemically induced abortion. They assume that it can reliably be used only to prevent ovulation. Again — in theory it makes sense, but the more I read about MAP I don’t see how in practice it can work.

  • Stacy Trasancos

    The President of the Pontifical Academy for Life answered that, James. http://vaticaninsider.lastampa.it/en/inquiries-and-interviews/detail/articolo/pillola-chiesa-church-iglesia-carrasco-22574/

    “Why is contraceptive medication acceptable in rape cases but not in other circumstances?

    The criteria the Church follows in its rejection of contraceptives can be found in the Humanae Vitae and even before that, in the Casti Connubii. It refers to marital intercourse which consolidates a couple’s bond, has a pro-creational purpose and so on. Rape, on the other hand, is a sexual act whose meaning has been destroyed by violence. Therefore, in this case, the moral implications of contraception are lost. A violent act cannot be considered a demonstration of openness to life.”

    I also note that the answer given about the MAP causing abortions seems lacking. Again, in theory it makes sense, but in practice I’m not sure how anyone will ever know whether the MAP caused an abortion or not.

  • Diane

    We are in the process of updating our brochure on MAPs at One More Soul (www.omsoul.com, 800-307-7685). If I remember correctly, a study showed that 80% of the time, ovulation is not prevented by MAPs. But 100% of the pregnancies were. So it seems the abortifacient properties of MAPs are more reliable than the anovulatory properties. Even with all the pre-ovulatory testing, these pills may not be as effective as we are led to believe in preventing ovulation. Therefore, we may inadvertantly be promoting more early abortions in using the MAP rape protocol described above.

  • Stacy Trasancos

    Diane, excellent website. Thank you. I’m sharing it with all the young adults at Ignitum Today. I’ve been reading some MAP papers. Astonishingly, even in the pro-MAP papers that argue that the pills ONLY prevent ovulation, the studies they cite actually show they do both, stop ovulation and alter the endometrium.

  • Sharon

    CDville, you are right. But… I am trying to figure out how this works. LH surge is detected about 1.5 days before ovulation. Basically, having studied NFP at least at the user level, it is my understanding that prior to ovulation, the woman’s reproductive tract is inhospitable to sperm. It is at the time of that surge that sperm are able to live long enough to cause conception. An egg can be fertilized up to 24 hours after ovulation. So that basically leaves a window of maybe three days when a rape could cause a pregnancy. The standard given above says that if the LH surge has not occurred, then they give the MAP. I am really not seeing the point. If the LH surge has not occurred, then the sperm will die before ovulation and pregnancy will not occur. If the LH surge has occurred, then they will not give the MAP and the woman could still become/already be pregnant from the rape. Someone correct if I’m off on the real number of days that a woman could become pregant – not the number of days to avoid to be sure to avoid pregnancy if that is the couple’s intent from NFP, but the number of real days, based on the ovulation tests, that the woman could become pregnant.

    If I were a woman who wanted to be absolutely certain that I did not get pregnant from a rape, and the Catholic hospital I went to said they would only give me a morning after pill if I could prove that conception was essentially already unlikely, then I would sue the hospital as the woman in Germany did. And I would get a lot of sympathy from the media and from people who already are in favor of exceptions for abortion in the case of rape. I just don’t see how the bishops in the US and Germany have not made a mistake. Endorsement of the MAP for rape seems to me only to cause confusion, scandal, and according to this website, possible abortion.

    http://www.morningafterpill.org/how-does-it-work.html

    Where is the “win” in this situation? And while I am not in favor of criticizing bishops, I am in favor of asking them to rethink a decision if it really doesn’t seem to be right.

  • Stacy Trasancos

    “And while I am not in favor of criticizing bishops, I am in favor of asking them to rethink a decision if it really doesn’t seem to be right.” Amen.

  • Sharon

    A woman wouldn’t go to a hospital and claim she was raped, and go through all of the procedures involved in treating a rape victim, if all she was really looking for was a morning after pill.

  • rakeys

    Stacy, If a woman has already ovulated, it only takes 15 min to an hour for the sperm to reach the egg, IF conception is going to occur, it has already happened by the time she reaches the hospital !! The MAP then has only one action left to take, STOP the fertilized egg from implanting! Why does the MAP thin the lining of the uterus if that was not its purpose?
    No hospital is going to take all the steps necessary to insure that the rape victim has not yet ovulated,by asking her questions about her last period, and about her mucus, etc. They, with the bishop’s blessing, will just give them the MAP . She goes home, does not have a baby. Everyone is happy, except the new life already created which has just been killed when it could not implant but no human know that , Only God. The bishop will have to answer for his decision. I believe the evidence about the MAP just stopping ovulation is lacking
    A woman is only fertile approximately 7 days our of the month, and in 75% of the cases the MAP is totally useless, since the woman can not get pregnant anyway. Unfortunately, The Map is abortifacient at least 50 % of the time.

    Sperm can live only 3 to 5 days max in the womb in the days just prior to ovulation. The MAP is only effective as a contraceptive only if taken within the 5 days prior to ovulation, assuming it acts instantaneously.
    I know this will upset many people, and Todd Akin took a lot of grief when he said that a woman’s body might shut down the whole process, but any woman who has used NFP know that stress and anxiety can change the ovulation.cycle. A rape victim’s hormones may change. under the extreme stress she is under, and stop or delay ovulation, but that only happens if she has not already ovulated.

  • Stacy Trasancos

    Sharon,

    To your first paragraph, I doubt all the details of the situation with the woman are known, but, yes, she was refused the MAP at two hospitals. I don’t think the bishops’ goal it is to avoid lawsuits, but to define ethical guidelines consistent with the teaching of the Church. They say a drug that only prevents ovulation, only for a rape victim is moral. A drug that causes a chemically induced abortion is not.

    What I cannot get my head around is the science. Plan B is synthetic progesterone only, a high dose. At first the drug company indicated on the label that it worked by preventing ovulation and by interfering with implantation. The latter makes it abortifacient.

    Then they said, only recently, that the FDA made them put the latter mechanism on the label, but that it really did not happen. They did tests on rats and monkeys, and a few more on women (have to be small test groups) and concluded that Plan B only prevents ovulation, never interferes with implantation.

    But think about it. The progesterone only BC pill (the minipill) works by both mechanisms, it is abortifacient because it thins the lining of the uterus. But they want us to believe that a much higher dosage will have no effect? It is true that BC is taken daily, and MAP is taken once, but it doesn’t make any sense that one would affect the uterus, and the other, in a higher dose, would not at all.

    The bottom line — like you said, too risky. That’s why many are upset by the bishops even approving MAP *if* they only prevent ovulation. They believe that no such pill exists. The bishops have said that it is for them to define the moral guidelines, and it is for scientists and doctors to define the science. Yet, the more I think about it, the more I suspect we cannot trust some scientists and doctors who are not so much searching for truth as they are flattery and $$$.

  • Stacy Trasancos

    Sharon,

    “The standard given above says that if the LH surge has not occurred, then they give the MAP.”

    Yes, they give the drug and it is supposed to stop or delay the LH surge so that the sperm die before ovulation. Sperm could live. For some women there is more fluid than others, and there is a fluid build up leading up to ovulation, and the window for those women would be wider.

    Also, it is difficult to know what an LH surge looks like from one woman to the next, and thus, even harder to know whether one woman using one test is right before the surge, in the surge, or after it.

    I’m like you, I just don’t see the “win” either. I put these questions to myself (I try, I can’t image rape) and no – there is no way I’d risk any of those pills. I am not one little bit convinced that there is no risk for abortion. There has to NO risk. All the scientists and doctors can say right now is that “best evidence” indicates it is an ovulation stopper only, but that best evidence is extremely weak, a few studies on ~30 women, and some rats and monkeys. Plus, I hate to say it, but I’m not even sure we can trust that the studies were done with absolute rigor for honesty and truth.

  • Stacy Trasancos

    rakeys,

    “They, with the bishop’s blessing, will just give them the MAP . She goes home, does not have a baby.”

    I agree. It makes sick the more I think about it. The scientists will also have to answer for their decisions if they are being untruthful.

    “Why does the MAP thin the lining of the uterus if that was not its purpose?”

    The latest studies say it does not, but I don’t see how that can be the truth. If the scientists would be truthful and we could trust them (honestly, I do not on this topic), then the matter would be settled. No MAP, ever. Period. End of story. I have tried, as have others, to figure out what they did exactly and how they figured out with such astonishing confidence that MAP never, ever are abortifacient, and their confidence is unfounded in my opinion.

    I understand what you are saying about stress and delayed ovulation, and appreciated this from Dr. Dominic Pedulla. http://catholiclane.com/a-doctors-commentary-akin-is-right/

  • Catherine Anne

    Wow! I can’t believe the bishops would approve the MAP! I have trouble with this decision on a number of levels.
    First of all, let me say that I use ovulation predictor kits to try to get pregnant. I also use NFP at the same time–charting, temperatures, mucus observation. Two days ago, on Saturday, I had my LH surge in the morning. I still had an LH surge in the afternoon that day on digital ovulation test. Supposedly, this means that you will ovulate in the next 12-36 hours from the time you first get the LH surge. Well, yesterday (Sunday), on digital Clearblue test for LH surge, it said there was NO LH SURGE! I suppose could be because I already had my LH surge the day before and it had worn off. Remember that the LH surge tells you that you ARE GOING TO OVULATE, NOT THAT YOU ARE OVULATING OR HAVE OVULATED!!! There is no way to tell for certain the exact moment that you ovulate. I am sure that yesterday I was fertile and probably able to conceive because the egg was already there (the egg usually lives about 24 hours), The egg had probably either been released the day before (Saturday) and was still “hanging around” or it was being released that day (Sunday), EVEN THOUGH THERE WAS NO LH SURGE SEEN ON DIGITAL OVULATION TEST (which I guess the digital is supposed to be more sensitive and easy to read than the two lines).

    Therefore, a woman could get a reading at the hospital that there is no LH surge, when in fact she has ovulated the day before or is ovulating at the moment. Then, the MAP pill could definitely be causing an abortion because there would be no way to suppress ovulation. I also doubt that the woman would have been using LH surge predictor kits the two days before this so that she would know that she just had her LH surge.
    Also, even if the MAP is used days before ovulation, how certain are they that it would stop ovulation? With the BCP, it is used for many days leading up to the fertile time to keep hormone levels more consistent, I would think. How do they know there would be enough time in the couple of days leading up to ovulation, if the body is already in motion to ovulate. Checking LH surge? Maybe, but I am not entirely convinced that it might be too late or that the body might ovulate anyway.
    I suspect, although I have no evidence, that the MAP may be more effective at causing abortions (making the lining thinner) than in suppressing ovulation.
    On a moral note, I did not know that artificial birth control was forbidden and a sin only in a loving marriage. I thought that even with premarital sex or with sex that is not given freely or lovingly in marriage, that birth control was still a sin. I thought that artificial contraception went against nature and natural law (and God’s law) and that trying to artificially “control” ovulation on my own, intstead of leaving this into the hands of God, was sinful. I was never told this was not the case in all of my years of Catholic learning. Is this an actual teaching from the Catechism and the Pope or is it just an interpretation of some bishops? I do not mean to demean the bishops. It is just puzzling to me.
    Thank you for bringing this issue to our attention! I had no idea!

  • Jenn

    The practical result of this decision–the practical result, mind you–is that the same sorts of Catholic hospitals that pressured you to abort will now have a stock of the MAP on hand and administer it indiscriminately. If challenged by the bishops (as they almost certainly won’t be), the hospital administrators will likely claim they understood the bishops’ decision to permit liberal use of the MAP or challenge (or even ignore) the bishops’ teaching authority, as did St. Joseph’s Hospital with Bishop Olmstead in Phoenix. In practical terms, the bishops have become enablers of abortion with this decision.

  • http://www.facebook.com/pegon.zellschmidt Pegon Zellschmidt

    Lumen Gentium explains that ‘IF’ a bishop is “teaching in communion with the Roman Pontiff,… “. Benedict himself said that what happened in the wake of Vatican II .. the misrepresentations of the council were so dominant that they “created so many calamities, so many problems, so much suffering: seminaries closed, convents closed, banal liturgy ..”. That seems to be the issue.

  • Stacy Trasancos

    Catherine, thank you for showing how impossible it would be to know if a woman has ovulated yet in a single visit to the emergency room. I’m still digging and will do a follow up, but I promise you this. I have never (never!) read so many scientific papers that refuse to answer the question. What I’m reading is appalling. I don’t know how to say it any other way — the scientists are lying. Flat out lying, and playing word games. They say “We cannot prove that the MAP works by inhibiting implantation.” But the question we have is “Does it ever end human life?” So they say “Pregnancy begins at implantation; therefore, it does not end pregnancy.” It’s ridiculous. Thank you again for your comment!

  • Cathy

    I guess if the woman takes it knowing that she does not want the pregnancy is where the sin lies because she is making a conscious effort of creating an “inhabitable” place for the embryo to plant if fertilization did occur. So, in some sense, it is considered an unwanted pregnancy. You are just controlling the environment and getting rid of the problem before it becomes detectable to a birth control test. Same concept with birth-control. A woman is playing God because she is controlling the nature of how her body conceives and when she can conceive. I think that is where the major problem is.

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