When is contraception not contraception?

June 9, 2001 3:29 PM

When is contraception not contraception? When is RU-486 a contraceptive pill and when is it a birth control pill?
posted by Steven Den Beste (20 comments total)

If a woman takes traditional birth control pills (progesterone) then the effect is to prevent ovulation. No eggs are released, so no fertilization can take place, so there's no pregnancy. But the pills have to be taken every day, and they cause changes in a woman's body. (In some women the side effects are unacceptable.) But when it works and can be used, daily progesterone is a "contraceptive pill" because it prevents conception.

Researchers in Scotland are experimenting with RU-486 for use as a birth control pill. If RU-486 is taken at a certain point in a woman's cycle, then even if she's released an egg and the egg has become fertilized, then it can't implant in her uterus and she can't become pregnant. So the researchers are trying to use things like hormone monitoring to look for the cross-over that indicates that ovulation is about to take place, so that the woman can take a single monthly dose of RU-486, thereby preventing pregnancy. By UK law, that would make it a "contraceptive pill" because, I gather, implantation rather than fertilization is the legal definition of conception, and it would prevent implantation.

On the other hand, RU-486 could be used much more reliably and simply by taking it on the first day of each month. In this case, the effect would be to spontaneously abort any pregnancy which had already begun. But while this use would be a "birth control pill", it would not be a "contraceptive pill".

I, personally, don't see any important difference between them, but I recognize that for some this is a major ethical thicket. (To say the least.) In this case, evidently the researchers are being driven by UK law which seems to distinguish between prevention of implantation and abortion after that fact. In the US right now, those events are not legally different, though politically they are obviously so. (Roe v. Wade makes abortion legal during the first six months of pregnancy.)

Still, it strikes me as a bit weird that so much scientific work is going into what amounts to trying to skirt as close to a law as possible.
posted by Steven Den Beste at 3:29 PM on June 9, 2001

it's a little know fact that doctors will prescribe multiples of conventional birthcontrol pills the morning after to women who have had unprotected sex (or so I've been told by a nurse.)

I'm deliberately being vague because birth control pills vary so much, and anyone finding themselves in this position *should* go speak to a doctor to determine the safest and most efficacious action.

rcb
posted by rebeccablood at 3:45 PM on June 9, 2001

WHAT'S THE PROBLEM???????????
posted by nonharmful at 3:54 PM on June 9, 2001

But what if, on the day RU-486 is taken, the egg has not only become fertilized but has implanted as well? Then an "abortion" has occurred, and the ill conceived ;) British law is not skirted after all.
posted by caraig at 4:02 PM on June 9, 2001

it's a little know fact that doctors will prescribe multiples of conventional birthcontrol pills the morning
after to women who have had unprotected sex

In Britain, there's a specific high dose of hormones, designed to induce a period, known as emergency contraception, aka "the morning-after pill", and it's now available over the counter, as it is in many parts of Europe.
posted by holgate at 4:07 PM on June 9, 2001

More importantly, when does it get to be a floor wax, or desert topping?
posted by dong_resin at 4:35 PM on June 9, 2001

My understanding, for years, has been that the Pill (most oral contraceptives, that is) work at 2 levels. They prevent ovulation, but if that fails, they also irritate the lining of the uterus so as to prevent implantation. I don't think there's much new here, it's just not something that's widely discussed.

Years ago, when I was growing up in a fundamentalist church, the Pastor did preach against the the Pill for this very reason. Of course, one of his kids told me that their mother used the pill... but the combination of religion and hypocrisy is not new.
posted by Medley at 5:02 PM on June 9, 2001

it's a little know fact that doctors will prescribe multiples of conventional birthcontrol pills the morning after to women who have had unprotected sex.

That’s sad since everybody should know about the morning after pill.

It’s called the morning after pill or Plan B, and Planned Parenthood and can hook you up. You have to take the doses within 3 days of having sex and that will drop the risk of pregnancy to around ~2%.

This is not an abortion pill. Women are not having anything remotely like abortion when they take this, contrary to some pro-life propoganda. The pill simply blocks an egg from implanting in the uterus. You know, it stops ovulation. I guess since some religous folks are against any contraceptives at all (like the Pope), that won’t placate them.

In many states you can get it over the counter. Call any Planned Parenthood service or hospital, they should be able to give you details. It is available over-the-counter in lots of states and some places in Europe.

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posted by capt.crackpipe at 5:18 PM on June 9, 2001

Ahem. I meant dessert topping.
posted by dong_resin at 5:58 PM on June 9, 2001

Um, blocking implantation and preventing ovulation are not the same.

multiples of conventional birthcontrol pills the morning after

That's what the morning after pill is, at least in many places in the US.

But, yes, one would hope that more people knew about the availability of such services and used PP.
posted by noether at 6:07 PM on June 9, 2001

Um, blocking implantation and preventing ovulation are not the same.

I stand by my complete misunderstanding of female anatomy.
posted by capt.crackpipe at 8:00 PM on June 9, 2001

Some people believe that conception occurs at fertilization, and therefore preventing implantation would still be abortion in this view. The law seems to say that conception does not occur until implantation. What is the medical definition? This would clear up any misunderstanding as to what is happening. Is it an abortion pill? Then let's call it that.
posted by jmcnally at 8:12 PM on June 9, 2001

>capt.crackpipe: I stand by my complete misunderstanding of female anatomy.<

the ovary releases an egg. it floats down the fallopian tubes to the uterus. during this float, it may become fertilized by a sperm. if it does, it will implant itself in the uterus (hopefully - if it implants in the fallopian tube, very soon, the fallopian tube will rupture, and without intervention the mother will die.)

so, to prevent a pregnancy, you can
1) prevent the woman from ovulating (the Pill)

2) prevent the sperm from reaching an ovum (any barrier method)

3) prevent a fertilized egg from implanting in the wall of the uterus (IUD)

rcb
posted by rebeccablood at 8:19 PM on June 9, 2001

Fertilization must take place in the Fallopian tube, by the way, because the cell must divide a large number of times and form a primitive structure called a "blastula" before it reaches the uterus. If it has not done so, it isn't capable of embedding in the wall. A fair number of them don't anyway. As such things go, humans are actually not very fertile.

I don't believe that there's any formal precise medical definition of "conceive" (but I Am Not A Doctor -- where's Jason when we need him?). Doctors will speak more precisely of ovulation, fertilization and implantation, which are readily identifiable events. "Conception" is fundamentally a moral and legal issue, not a medical one. But I believe that Rebecca is correct that a woman is not technically considered to be pregnant until implantation occurs.
posted by Steven Den Beste at 8:38 PM on June 9, 2001

Someone needs to invent a pill for men that turns dutifully ordinary Caspar Milquetoast sperm into little homocidal polliwogs that seek out and destroy fertilized eggs. That's the kind of birth control guys could get into.
posted by pracowity at 4:27 AM on June 10, 2001

When does life begin? When you start paying taxes.
posted by Postroad at 8:13 AM on June 10, 2001

By "begin" you mean "suck".
posted by dong_resin at 9:23 AM on June 10, 2001

If a "woman is not technically considered to be pregnant until implantation occurs", then something's got to be done about the term "ectopic pregnancy". Seeing as how apparently conception=implantation in the UK, do the Brits have a different term for when the embryo grows outside the womb?
posted by isomorphisms at 10:42 AM on June 10, 2001

An ectopic pregnancy is no more a pregnancy that a false pregnancy is a pregnancy.
posted by rodii at 11:08 AM on June 10, 2001

Doctors use terms in ways which don't make sense to laymen. For instance, we normal human beings use "tumor" to mean cancer.

To a doctor, a "tumor" is any growth. It turns out that pregnancy is considered a "tumor". (True!)

So don't read too much into the phrase "ectopic pregnancy".
posted by Steven Den Beste at 11:58 AM on June 10, 2001