The controversy over emergency contraception (EC) for victims of sexual assault continues to be played out in various forums, including in the literature and in legislatures. In the latter, the central issue is the inclusion of a conscience clause provision in proposed legislation that would require hospitals to provide EC to women who have been raped. The concern for Catholic hospitals is that they will be forced to provide a medication that actually does or can have an abortifacient effect. While this is not an immediate problem because levonorgestrel (or Plan B) does not seem to have such an effect, it could become a problem if other medications are used that clearly do have such an effect, such as RU486 (which is sometimes advocated in the medical literature). In some states, such as Connecticut and Wisconsin, legislation has been passed that requires hospitals, among other things, to administer EC. In other states, such as Pennsylvania and Florida, the legislation has been considered but not passed. State Catholic conferences tend to oppose such legislation, especially because of the lack of a conscience clause provision, but this is not universal.

The controversy in the literature centers primarily on the mechanism of action of EC. Here there seems to be a growing consensus that levonorgestrel most likely does not have an abortifacient effect.¹ Not all share this view, however. There are some in State Catholic conferences and elsewhere who continue to maintain that the medication is, in fact, abortifacient. In late February, in a LifeSiteNews interview, Bishop Elio Sgreccia, president of the Pontifical Academy for Life (PAL) claimed such a position. He reaffirmed the stance of the PAL's 2000 statement that the "morning-after pill" is abortifacient and that physicians and Catholic hospitals are prohibited from administering it, even in cases of sexual assault.²

Unfortunately, the statement employs the generic term "morning-after pill" which can refer to a variety of medications with different mechanisms of action and makes no reference to the scientific literature to substantiate its claim. Bishop Sgreccia's most recent comment seems not to take account of recent scientific literature on the mechanism of action of levonorgestrel, the current drug of choice for EC. Yet, by some, he is seen to be speaking "authoritatively," even though the PAL has no teaching authority. Its role is to conduct research on various issues and to advise the Holy See.

In a different vein, Fr. Nicanor Pier Giorgio Austriaco, a priest, theologian and scientist, wrote in a recent issue of The National Catholic Bioethics Quarterly:

Studies published in the past few months provide mounting evidence that levonorgestrel has little or no effect on post-fertilization events. In other words, given the limitations of scientific certitude, they suggest that Plan B, when administered once, is not an abortifacient. These human studies correlate well with earlier findings in rodents and monkeys that convincingly showed that the post-coital administration of levonorgestrel in amounts several times higher than typical doses given to women does not interfere with the post-fertilization processes required for mammalian embryo implantation. The evidence also addresses what until now has been a nagging, unanswerable question for pharmacologists: Why would levonorgestrel, a progesterone agonist that mimics the effect of progesterone, prevent implantation, when progesterone produced from the corpus luteum immediately after ovulation actually promotes implantation by converting the endometrium to deciduas? Answer: It does not.³

But what about the manufacturer's label? Much has been made about the claim made by Barr Pharmaceuticals that Plan B "May also prevent fertilization of a released egg (joining of sperm and egg) or attachment of a fertilized egg to the uterus (implantation)." Labels mean nothing without the scientific data to back up their claims.⁴

One of the most recent studies that Fr. Austriaco refers to, though probably an unethical study, provides very persuasive evidence that levonorgestrel most likely does not have an abortifacient effect.⁵ This study seems as conclusive as any can be, though it does not provide absolute certitude. Absolute certitude in this matter is not possible. What this study — together with several other studies — does provide is moral certitude. This should alleviate concerns over the provision of Plan B. It does not, however, alleviate concerns over the absence of conscience clause protection in state legislation.

NOTES

1. CHA members can view a literature review on the mechanisms of action of levonorgestrel (Plan B) at www.chausa.org/Mem/MainNav/ Ethics/Ethics+Resources/Special+Topics/ Emergency+Contraception/MechAction Levonorgestrel.htm.
2. Pontifical Academy for Life, "Statement on the So-Called 'Morning-After Pill'," October 31, 2000, www.vatican.va/roman_curia/ pontifical_academies/acdlife/documents/ rc_pa_acdlife_doc_20001031_pillola-giorno-dopo_en.html).
3. Nicor Pier Giorgio Austriaco, "Is Plan B an Abortifacient? A Critical Look at the Scientific Evidence," The National Catholic Bioethics Quarterly 7, no. 4 (Winter 2007): 707.
4. Austriaco.
5. P.G. Lalilkumar et al., "Mifepristone, but not levenorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model," Human Reproduction 22, no. 11 (November 2007): 3031-3037.

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