Daily Archives: September 12, 2011

C Rulon: Emergency Contraception

By Charles L. Rulon
Emeritus, Life & Health Sciences
Long Beach City College

Emergency contraception

Q. What is emergency contraception?

A. Since the 1970′s, rape victims have often been immedi­ately given several ordinary birth control pills to avoid pregnancy. This worked most of the time and became known as the “morning after pill”. Today, there is a specifically formu­lated “pill”, a high dose of a synthetic hormone that can be used by women within 72 hours after unpro­tected sex to pre­vent preg­nancy (www.GoToPlanB.com). EC is about 75% successful in preventing a pregnancy that would have occurred otherwise.[1]
EC was finally approved by the U.S. Food and Drug Administration (FDA) in 1999 for women 18 and over with a doctor’s prescription. In 2006 it became available without a prescription and in 2009 the age was lowered to 17. Girls under 17 can obtain a prescription.

Q. How does emergency contraception (EC) work?

A. Depending on when they are used during a wo­man’s month­ly cycle, EC works by prevent­ing the release of an egg from the ovary, or by block­­ing sperm from fertilizing the egg, or by inhibit­ing the im­plan­tation of the blastula in the en­do­met­rium or inner lining of the uterus. The blas­tula is a ball of cells smaller than a pin head that will eventually be­come the embryo.

Q. How safe is EC?

A. The World Health Organization and the U.S. Food and Drug Administration have re­viewed the scientific data on EC and found it quite safe. Although regular use is not rec­ommended, there have been no reported deaths or serious complications in over three decades of use. In addition, studies have shown no in­creased risk of birth defects or other problems with women who accidentally took high dose birth control pills after they were already pregnant.

Q. Can EC interrupt an early pregnancy and cause an abortion?

A. No. It takes about five days after fertil­iza­tion for the develop­ing blastu­la to reach the uterus and begin to implant in the endometrium. EC is ineffective once the im­plan­tation process has begun. The American Col­lege of Obstetricians and Gynecolo­gists, the World Health Organiza­tion and the Nation­al In­sti­­tutes of Health all define pregnancy as be­gin­ning with the success­ful im­plan­tation of the blas­tula in the uterus. So even as long as two decades ago, polls re­vealed that 85% of phy­si­cians in the U.S. who opposed abor­tion did support EC.[2]

Q. Should EC be avail­able to minors without a pre­scrip­tion?

A. Of course! Because of the short time factor for using EC, because so many teens are into preg­nancy denial and careless when they have sex, and because they refuse to discuss their private sex life with their par­ents, the ready availability of EC becomes critical. Remember, con­doms, foam and the sponge are already available to minors without a prescription.[3]
France made EC avail­­­able to minors with­out a pre­scription years ago. The French Gov­ern­ment says it’s just being prag­­matic. Teens have sex. They make mis­takes. Preg­nancy shouldn’t be one of them. So nurses in public high schools through­out France have been authorized to distribute EC to some 1.7 million French girls by re­quest. Free of charge.

Q. Do we really want to copy the French?

A. In this area, why not? Consider: Every year in the U.S., over three million unin­tended preg­nancies occur. Half are from contra­ceptive failure and about half of these end in abor­tions. Furthermore, over one million of these un­planned children are being born to teens at a taxpayer cost of billions of dollars a year. In addition, over two million chil­d­ren in the U.S. are physically abused each year by their mostly young par­ents. And finally, over 15 million American kids now live in poverty, with hundreds of thousands abandoned to the streets. The emotion­al, physical, social and finan­cial costs of unwanted pregnancies to all these girls and women, to their kids, to their families, and to society at large are stagger­ing. So of course EC should be widely adver­tised on TV, covered in all high school sex education classes, available without a prescrip­tion in pharmacies, and freely handed out to all girls and women during their routine family planning visits to keep for an emergency!

Q. But if EC becomes too easy to obtain, won’t teens use it instead of contra­ceptives?

A. Some might, but at least they would be using something! Besides, EC can have unpleasant side-effects including nau­sea, vomiting, head­aches and cramping. It’s also less effective in preventing pregnancy (75% effective) than are most contra­ceptives. And, of course, EC provides no protection against AIDS and the other two dozen or so sexually trans­mit­ted diseases. This is the main reason why condom usage is so important with casual sex.

Q. Won’t giving teens EC encourage even more sex and more unwanted preg­­nancies?

A. Numerous studies have al­ready shown that in-depth sex education classes and the easy availability of contra­ceptives do not result in more sex. But they do result in more responsible contraceptive usage. Also, most contra­ceptives are not fool-proof. The condom has a 15%/year failure rate with typical use. Even the pill has an 8% failure rate with typical use. Teens are careless and make mistakes. So with EC as a backup, unwanted pregnan­cies can be greatly reduced.
In most Wes­t­­ern European coun­tries, teens are just as sexual as here. But be­cause of widespread availa­bility of sex edu­ca­tion, con­traception and EC, plus less sexual guilt, the teen preg­nancy rate is one-half to one-tenth of ours! Also, the spread of sex­­u­ally transmitted diseases is viewed as a serious pub­lic health problem, not a sign of dirtiness and immor­al­ity.

Q. Still, isn’t abstinence preferable for teens?

A. Arguably, certainly for young teens. But in the U.S. only 7% of males and 20% of females are currently holding out for their honey­moon. So for those teens who’ve chosen to be sex­ual, shouldn’t our society do everything possible to avoid unwanted pregnancies?

The importance of EC

Q. Could EC re­ally make that big a difference worldwide?

A. Absolutely! Globally, literally millions of families are devastated year after year as women with small children die from illegal botched abor­tions, or from pregnancy complications, or suf­fer chronic debilitating pain from massive infections, perforated uteruses and punctured intestines from botched abortions.
Furthermore, there are now one bil­lion teenagers worldwide who are (or soon will be) having sex. Most lack any sex education, or any access to family plan­ning services. In addition, tens of millions of aban­don­ed children now wander­ the streets of its major cities and over ten million children continue to die every year from preventable causes.
But with EC the number of un­intended pregnan­cies could potentially be cut in half. In HALF! Thus, the wide­spread easy availability of EC could consti­tute one of the most important advances in birth control in the last 30 years. The ability of women to have re­productive control over their own bod­ies has long been an essential goal in the never-ending bat­tle for global fe­male equality and stronger families, plus re­duced poverty and disease.
In addition are sobering environmental realities. Our planet continues to pile up over 75 mil­lion additional humans every year, roughly half of whom were never planned in the first place. Because of human activity, invaluable for­ests and topsoil are disap­pearing at alarming rates. Water tables are seriously dropping in many ar­eas. Deserts and waste­lands are rapid­ly ex­panding. Species extinc­tion is accelerating. Massive, de­stabi­lizing ecological migrations to al­ready over­crowded cities continue to occur­ and global warm­ing has now become a major concern. If this environmental deterioration is al­lowed to continue, famines, riots and even social disintegration can’t be far behind.

Opposition to EC

Q. Why haven’t I heard more about EC?

A. Because of strong religious opposition from funda­men­ta­list Pro­tes­­tants and, in particular, from the Roman Catholic Church.[4] God has “told” them that once fertiliza­tion has oc­curred, a sacred, precious, innocent, new human life has come into existence, a life to be protected above all else. So “EC pills are abor­tifa­cients that murder innocent pre-born babies!” reads the anti-abor­tion lit­era­ture. Thus, to vig­­or­ously oppose EC is to do “God’s Will.”
Also, anti-abortion activists are claiming that EC encourages promiscuity, which leads to more unwanted pregnancies, which leads to more abortions! These religious beliefs, coupled with patriarchal power motives and moral zealotry have largely fueled the anti-abor­tion, anti-EC, anti-con­­­tra­­cep­tion and anti-sex edu­ca­tion efforts in the United States.
As a result, few family doctors until recently have been informing their patients and few health education instructors have been teaching their stu­dents about EC. In addition, drug manufacturers were slow to mar­ket EC fearing law­suits, boycotts and major finan­cial back­lashes from religiously conserva­tive mut­ual funds. Also, dozens of states have introduced bills that allow pharm­acists to re­fuse to fill prescrip­tions for EC.

Q. How about advertising EC on TV?

A. Good luck! Even mod­ern effective contraceptives (repre­senting some of the most important scientific advances in the history of civilization) are still not being widely adver­tised on American television. In 1986, 50 years after it became le­gal to adver­­tise contra­ceptives in the U.S., the first con­dom commercials ap­peared on tele­vi­sion—but not be­cause we had the high­est teen preg­nancy rate of all developed na­t­ions. Instead, it was a long overdue response to the deadly AIDS epi­demic. Yet, even then the up­roar, politi­cal pressure and threatened boy­cotts from the Christian Right squash­ed most ads. Con­tra­ceptive education and advertise­ments, they believed, encour­ages non-mar­i­­tal sex. Even the mention of respon­si­ble con­tra­ceptive use in most net­work pro­gram­ming has been censored for decades.

Q. Wouldn’t the Catholic Church be op­posed to EC regardless of the abortion issue?

A. Yes, since the Church is already strongly op­posed to all forms of “arti­fi­cial” con­tra­ception. Until 2011, the pope was even opposed to condoms for married couples in which one par­tner was HIV positive. U.S. bishops also have been vocal and consistent oppo­nents of EC (plus opposed to all domestic and interna­tional fam­ily planning programs). At the United Nations, Vatican officials have aggres­sively used their Church’s of­ficial governmental status (which no other reli­gion has) to block pro­grams and poli­cies that would make contra­cep­tion and EC more accessible in the poor­er parts of the world.

Q. Hasn’t there also been a problem with Catholic hospi­tals in the U.S. when it comes to EC?

A. Absolutely. One in six hospital admit­tances are to Catholic hospitals. That’s 50 million patients a year. About 80% of these hos­pitals don’t offer EC to rape victims brought in. Nor do they re­fer rape victims to hospitals that do supply EC.[5] To make matters worse, in recent years an in­creas­ing number of non-sectarian hospitals and HMOs have been taken over by Catholic health or­gani­za­tions.

The American public and EC

Q. Do most Americans agree with those opposed to EC?

A. No. Few really consider fertilized eggs and microscopic blas­tu­las to be so valuable or sacred that women should be forced to stay preg­nant against their will. Remember, even the majority of anti-abortion phy­si­cians in the U.S. support EC. The Religious Coalition for Repro­ductive Choice repre­sents several dozen reli­gious groups in this country. It argues that since major Christian faiths strongly dis­a­gree as to God’s position on contraception, EC and abortion, this entire is­sue is not (and never has been) a strug­gle between the God-fear­ing and the God­less, as the Christian Right has character­ized it.[6]

Q. Where do Catholics stand on these issues?

A. The majority of American and Euro­pean Catho­lics are us­ing mod­ern means of con­tra­­cep­tion in about the same mea­sure as are Protes­tant and Jewish couples. And by the late 1980s, Cath­o­­lic women in the U.S. were actually having abor­tions at a slightly higher rate than were Pro­tes­tants.

[1]The Office of Population Research at Princeton University operates the EC Web site, http://opr.princeton.edu/ec/.
[2]Trussell, J., Stewart, F., Hatcher, R., 1992, “Emer­gency con­tra­ceptive pills: A simple proposal to reduce unin­ten­ded pregnancies,” Family Planning Perspec­tives, 24: 269-273.
[3]Ellertson, C. et. al., 1998, “Should emergency contracep­tive pills be avail­able without prescription?’ Journal of the American Medical Women’s Association 53 Continue reading

C Rulon: Medical Abortions (A potential revolution in women’s reproductive health)

By Charles L. Rulon
Emeritus, Life & Health Sciences
Long Beach City College

Introduction

In 2000, 12 years after RU-486 (a.k.a. Mifepristone or the abortion pill) became available in France, the U.S Food and Drug Administration finally approved it (with several restrictions) for the early medical termi­nation of preg­nancies. By 2008 medical abortions accounted for about one-fourth of all abortions nation­wide.

Why the 12 year delay? Because since the late 1970s there has been a “civil war” of sorts in the U.S. over abortion. There have been bombings, shoot­ings, death threats, clinic destruction and physicians murdered. Anti-choice literature continues to claim that it’s no coinci­dence that RU-486 was produced by the same German com­pa­ny that made the poison gas for the death camps in Nazi Germany.

Yet, comparing the U.S. to Nazi Ger­many pre­sents a window to the extre­m­ist world-view of anti-choice activists. The many pro-choice religious, social and medical groups that endorse a woman’s right to choose would never have done so if they had believed for one second that abortion was equiva­lent to mur­der­ing babies.[1]

The Republicans in Congress and in state legisla­tures continue to be strongly anti-abor­tion. In just the first seven months of 2011, some 472 anti-choice state bills had already been introduced. Today, 87% of all counties in the U.S. no longer even do early abortions.

But Mifepristone could potentially diffuse much of America’s (and many developing nations) current abortion “civil war”. It could do this:

a) By moving abortions out of the easily picketed (and bombed) public cli­n­ics into the pri­vacy of a doctor’s office and the privacy of one’s own home;

b) By encour­ag­ing very early abor­tions (safer, cheaper, less upset­ting, more politi­cally tenable than later ones);

c) By causing a miscarriage that is indistinguishable from a natural one (especially important for women in countries where they risk arrest if they seek help in a hospital after a botched abortion); and

d) By greatly in­creas­­ing the number of physicians willing to do abortions. Over one-third of doctors inter­viewed in the U.S. have said they would be wil­ling to dis­pense Mifepristone in the pri­vacy of their offices.

In addition, 5 out of 6 abortions take place in developing countries where abortion is frequently illegal and/or where poor sterilization and training makes surgical abortions quite dangerous. 70,000 women die every year from botched abortions and millions more need hospital care due to hemorrhaging and life-threatening infections. As a result, having a private medical abortion rather than a public or clandestine surgical one potentially represents a major revolution in women’s reproductive health.

“As word spreads among women worldwide about what a few pills can do, it’s hard to see,”

writes Kristof in the N.Y. Times (8/1/10),

“how politicians can stop this gynecological revolution.”

Basic information

Q. How does Mifepristone work?
[2]

A. Mifepristone [Mifeprex™] blocks the action of pro­ges­terone. Progesterone is a “pro-gestation” hormone neces­sary for the uter­ine lining to support a devel­op­ing embryo. With­­­­out pro­ges­terone the uterine lining breaks down and is expelled along with the em­bryo. When used with the drug, misoprostol a day or two later (which brings about uterine contractions), Mifepristone is over 95% effective if taken within 9 weeks of gestation.

Q. How safe is Mifepristone?

A. All drugs carry some risk. But Mife­pristone has proved to be much safer than car­rying to term and giving birth. In the 1990′s over 600,000 women in Europe and millions more in China used Mifepristone to terminate an un­wanted pregnancy.[3] No deaths were reported. In contrast, dozens of men have already died from using Viagra, a drug with far fewer restrictions. According to the FDA there are no known long term risks associated with using mifepristone and misoprostol.

Therefore, women may pursue another pregnancy whenever they feel the time is right after having a medical abortion.

Q. What are the side effects and cost of a medical abortion?

A. There’s cramping and bleeding similar to an early natural miscarriage. There can also be nausea and diarrhea. It costs about the same in the U.S. as an early surgical abor­­tion (vacuum aspiration). In India, a medical abortion pill kit is sold online for about $5.

Q. How do women who’ve had a medical abortion feel about it?

A. In one study of 1,049 women who had already had an earlier surgical abor­tion such as vacuum aspir­ation three-fourths said they pre­ferred the medical abortion.[4] But some women maintain that because of the side effects of a medical abortion they would have preferred a safe, quick abortion via vac­uum aspiration . . . . except for the “domestic terrorist” ac­tivities of the picketing anti-abortionists at clinics where vacuum aspirations are performed.

Q. Could Mifepristone be used as a “morning-after pill”?

A. Yes! In fact, Mifepris­tone appears to be better than any of our currently avail­able emer­gen­cy con­tra­cep­tive pills. Its success rate is much higher (99% vs. 75%) and there appears to be signi­fi­cantly less nausea, vomiting and head­aches.

Q. Are there other uses for Mifepristone?

A. The American Medi­cal Associ­a­tion has en­dor­sed testing Mifepristone as a possible treatment for breast and prostate can­cer, glaucoma, certain brain tumors, infertility and en­do­metri­osis.

Q. Would the easy availability of Mifepristone result in more abortions?

A. It didn’t in France or Sweden. But there abortion is viewed as a public health issue instead of a sinful/criminal one. The U.S. is a dif­fer­ent story. If all it took were a few pills taken in the privacy of one’s home to end an un­wanted preg­nancy in its very early stages, then who knows? Some have esti­ma­ted that the abortion rate for early abortions could rise consider­ably. But pro-choice supporters see such a possible increase as another giant step forward in the ageless quest for women to gain re­pro­ductive con­trol over their own bodies and for couples to give birth only to truly wanted children. Besides, if the U.S. and state governments were really inter­ested in significantly lowering the abortion rate, we’d have widespread in-depth sex education and excel­lent inexpensive contracep­tion, plus emergency contraception readily available for all, including teens. This has been done for decades throughout Western Europe where the teen pregnancy rate varies from one-half to one-tenth of ours.

Q. I’ve read that Mifepristone can cause wide-spread infant de­form­ities. Is this true?

A. No. You’ve been reading dishonest propaganda cranked out by the anti-choice activists. After over 600,000 medical abor­­tions in Europe, Mifepristone has yet to be im­pli­cated in any fetal ab­nor­mali­ties.

Q. Didn’t France initially have trouble marketing RU-486?

A. Yes. RU-486 (Mifepristone) was initially developed in France in 1988. But it was only on the market for a month before being pulled from distri­bution by Roussel–Uclaf, the drug manufacturer, because of intense pressure from mostly American-inspired anti-abortionists. How­ever within one week the French Minister of Health order­ed the drug to once again be dis­tributed, stating that RU-486 was “the moral property of women, not just the property of the drug com­pany.” This is in glaring con­trast to how the U.S. has acted.

Q. How has our government responded to Mifepris­tone?

A. Over three decades ago the Republican Party joined forces with the Religious Right and has fought against the right of women to terminate unwanted pregnancies ever since. As a result, under Republican Party leader­ship Mifepris­tone studies were banned in the United States up to 1993 when Bill Clinton became President. Clinton immediately issued an exec­u­­tive order lifting the ban and began to exert pressure on Roussel–Uclaf to make this drug avail­able in the United States.
In 1994 Roussel–Uclaf removed itself from this heated controversy by donating the U.S. rights to man­ufacture RU-486 to the Population Council, a New York-based nonprofit organization that pro­motes repro­ductive health.

By 1996, Mifepristone’s safety and effectiveness had been confirmed by the U.S. Food and Drug Admin­istration. Now all that was needed was a manu­fac­turer. And that’s where the whole process bogged down. The anti-abortionists threatened mas­sive boy­cotts and liability lawsuits against any company seek­ing to obtain F.D.A. approval to manu­facture Mife­pris­tone. They also threatened to target anyone who helped to manu­facture, market, sell, or finance its produc­tion. As a result, virtually all of the major pharma­ceuti­cal companies declined to ei­ther produce or distribute Mife­pris­tone.[5]

Also, a num­ber of state legisla­tures intro­duced laws out­lawing the use of Mife­pristone if it ever became available. In 1998 the House of Representa­tives voted to bar the FDA from using funds for the testing, development, or man­u­facture of any drug that could be used for an early medi­cal abortion.

­Finally, in September 2000, 12 years after it became avail­able in France, the U.S Food and Drug Admin­istration approved Mifepristone for early termina­tion of pregnancy.

Misoprostol

Misoprostol causes uterine contractions. It is used with Mifepristone in medical abortions. Yet, 5 out of 6 abortions take place in developing countries where abortions are frequently illegal. But misoprostol is not illegal. It has long been widely available for treating gastric ulcers and for saving lives of women with postpartum hemorrhages. Also, it is cheap, stable at room temperatures, easy to transport, easy to administer, and does not require refrigeration, even in hot climates. It can be found on Internet sites all over the world.

So what? So researchers have discovered that misoprostol all by itself can be 75-85% effective in terminating an early pregnancy. This makes misoprostol potentially much better and safer than the horrible alternatives available to the tens of millions of women who seek out illegal abortions each year. Active research on the optimal dosing and administration strategy of misoprostol is ongoing throughout Latin America and East Asia.[6] In the roughly 15%-25% of cases where misoprostol administration does not lead to a complete abortion, additional intervention is required.

Some closing thoughts

History has clearly documented that it’s the num­­ber of mater­nal deaths and injuries, not the number of abor­tions, that are most affected by laws attempting to block elective abortions. In poor coun­­tries, the risk of death from an illeg­al abor­­tion is from 25-100 times greater than it would be from having a legal one.

Also, pregnancies in poorer coun­tries can be very dan­ger­ous. Over 600,000 women die yearly from pregnancy-related com­plica­tions. Since half of these preg­nancies were never wanted in the first place, the availability of excellent contra­cep­tion, plus emergency contraception, plus medical abortions and vac­uum aspira­tion as backups, could prove invaluable. Those who oppose such availability are assisting in the reproductive enslavement of women, the disintegra­tion of millions of families, the spread of poverty, and the increase in the number of illegal abortions.

Yet conservative Christians continue to claim they’re doing God’s will by opposing essentially all abortions. But, since the Bible is silent regarding elective abortions, where is it written that God wants us to force women to stay pregnant against their will—to be unwilling embryo incubators? Where is it written that God wants women to be either celibate or obligatory breed­ing machines? Furthermore, in spite of biblical interpretations, where is the religious wisdom and social justice today in placing women in a permanently subor­dinate position to men and essen­tially in reproductive bondage to the state?
————————————————

[1]The Religious Coalition for Repro­duc­tive Choice, repre­sents over 40 dif­ferent denominations and faith groups in this coun­try and can be reached at www.rcrc.org. Also Phy­sicians for Repro­ductive Choice and Health, which now has thous­ands of physician members and speaks for over 130,000 physicians in getting RU-486 released. See www.PRCH.org.

[2]www.medicationabortion.com – a multi-language website provides accurate information about medication abortion to health service providers including physicians, nurse practitioners, physician assistants, counselors, and office staff as well as educational information for women considering the option of medication abortion. For additional updates on Mifepristone, check www.earlyoption-pill.com, www.popcouncil.org, www.now.org, www.feminist­.org, www.PRCH.org.

[3]As of 2000, Mifepristone was legal in Austria, Belgium, China, Denmark, Finland, France, Germany, Greece, Israel, the Netherlands, Russia, Spain, Sweden, Switzerland and the United Kingdom.

[4]Winikoff, B. et al, 1998, “Acceptability and feasibility of early pregnancy termination by mifepristone-miso­pro­stol: Results of a large multi-center trial in the United States,” Archives of Family Medicine, 7: 360-366.

[5]New York Times Magazine, July 14, 1999.; Feminist Majority Newsletter, Sept. 1999.

[6]Gynuity – http://www.gynuity.org/ – Instructions for Use of Misoprostol for Women’s Health in several languages.