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Emergency Contraception

Emergency contraception, otherwise known as the "Morning After Pill" is taken by the woman within 72 hours of sexual intercourse.  In New Zealand, emergency contraception is branded as Levonelle-1 or Postinor-1.  It is used in situations where the woman believes she may become pregnant after sexual intercourse.  It is also used in the case of rape, to prevent pregnancy occurring as a result of this sexual violation.  The following topics are covered here:

How does emergency contraception work?
How available is emergency contraception in New Zealand?
Does emergency contraception ever fail?
What are the side effects?
What are the contraindications?
What does the Catholic Church teach about its use?
What is Family Life International's position on the use of emergency contraception after rape?
Further reading

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How does emergency contraception work?
The active ingredient is levonorgestrel (1.5mg).  It is thought that the pill works in these ways:

The first two modes of action are contraceptive in nature, meaning they prevent the formation of new life.  The third mode of action however, can be classed as abortifacient, meaning, newly conceived life is aborted because of the drug.

The Postinor-1 data sheet updated 24 August 2011 states "The precise mode of action of POSTINOR-1 is not known.  Emergency hormonal contraception is thought to work mainly by preventing ovulation and fertilisation by altering tubal transport of sperm and/or ova."  Note the use of the term "mainly", meaning other modes of action are not ruled out.

There has been a great deal of discussion about whether or not emergency contraception / the morning after pill is in fact abortifacient.  It should be noted that a war of words has been undertaken by those who have a vested interest in working with the embryo prior to implantation.  Many now state that conception actually begins at implantation rather than when the sperm fertilizes the egg (conception).  This is a play on words to allow for experiments to be undertaken on the nascent human life as well as to add acceptability to the use of abortifacient drugs such as the morning after pill, oral contraception, implants such as Jadelle and the "injection", Depo Provera.

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How available is Emergency Contraception in New Zealand?
Emergency contraception (the Morning After Pill) is freely available in New Zealand either over the counter at many Pharmacies, or on prescription.

Palmerston North was set to approve a scheme in February 2013 where emergency contraception was available free to youth ages 12 to 25.  This despite the information published by Medsafe for both Levonelle and Postinor-1 stating that it "is not recommended in children. Very limited data are available in women under 16 years of age."

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Does emergency contraception ever fail?
Yes.  Medsafe in 2002 published an article intended to update those who prescribe the emergency contraception pill, entitled "Progestogen-Only Emergency Contraception and Ectopic Pregnancy".  In this update the efficacy of emergency contraception (levonorgestrel 0.75mg) in preventing pregnancy (determined by the interval between sexual intercourse and taking the pill) was detailed as such:

24 hours or less = 95%
25-48 hours = 85%
49-72 hours = 58%

It was noted in the Medsafe article that ectopic pregnancy might occur after using emergency contraception.

In 2011, 209 (1.3%) of all abortions in New Zealand were performed after the failure of emergency contraception.

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What are the side-effects?
Very Common
»  bleeding not related to menses
»  nausea
»  lower abdominal pain
»  fatigue

Common
»  Delay of menses more than 7 days
»  Irregular bleeding or spotting
»  Dizziness
»  Headache
»  Diarrhoea
»  Vomiting
»  Breast tenderness

Pregnancy can occur even after using emergency contraception, and there is a possibility of ectopic pregnancy.

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What are the contraindications?
According to Medsafe emergency contraception should not be used if the woman is pregnant, if there is possibility of being pregnant (for example menstruation is overdue).   It is also contraindicated if the woman is hypersensitive to any of the ingredients or if she currently has breast cancer.

Further, both Postinor-1 and Levonelle-1 is not recommended in patients with severe hepatic dysfunction.  Severe malabsorption syndromes such as Crohn's disease, might impair the efficacy of the emergency contraception.  Conditions which are considered relative contraindications include severe hypertension (BP>180+/110+), diabetes mellitus with nephropathy, retinopathy or vascular disease, ischaemic heart disease, stroke, or a past history of breast cancer.

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What does the Catholic Church teach about its use?
The Catholic Church has always opposed the use of artificial contraception because of its ability to render sterile the marriage act which should always be open to life.  Not only is it against life (contra - against, ception - conception), it allows the couple to hold back a part of themselves in what should be a full giving over to the beloved.  Artificial contraception is regarded as intrinsically evil (meaning it is wrong because of its very nature) and can never be used in a way that is good.

In the year 2000, the Pontifical Academy for Life published a "Statement on the so-called morning after pill" in which it was made very clear that its use was never morally licit.  It was also made very clear that those who directly co-operate in administering emergency contraception were also morally responsible: 

"Consequently, from the ethical standpoint the same absolute unlawfulness of abortifacient procedures also applies to distributing, prescribing and taking the morning-after pill. All who, whether sharing the intention or not, directly co-operate with this procedure are also morally responsible for it. "

Most recently in the document Dignitas Personae, which affirms the dignity of every human person from conception through to natural death the seriousness of intercepting the implantation of newly conceived embryo was reiterated:

"It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived, and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. … Therefore the use of means of interception…fall within the sin of abortion and are gravely immoral." (23)

Recently there has been controversy around the use of emergency contraception in the case of rape.  The German Bishops have recently released a decision to allow the use of the emergency contraception (the Morning After Pill) in the case of rape when it does not have an abortifacient effect.  Part of their statement read:

“The plenary meeting affirmed that at Catholic hospitals, women who are victims of rape receive human, medical, psychological and pastoral help as a matter of course. This can include administration of a "morning after pill" to the extent that it has a preventative and not an abortifacient effect. Medical-pharmacological methods that cause the death of an embryo still may not be used. The German bishops trust that in Catholic institutions, practical treatment decisions will be made on the basis of these moral theological precepts. In any event, the decision of the woman concerned is to be respected.”

The statement has caused confusion amongst Catholics and a number of groups who actively promote the pro-life position, have had to go into damage-control mode.

New Zealand's John Kleinsman of the Nathaniel Centre has also suggested that it would be morally licit for victims of rape to use emergency contraception.  However, he has based his information on a recent report by the International Federation of Gynecology and Obstetrics (FIGO), which apparently shows that the drug does not have an abortifacient effect.  FIGO is a known abortion advocacy group with strong ties to pro-abortion groups such as the International Planned Parenthood Federation,  Bill and Melinda Gates Foundation, United Nations Population Fund and others.

In February of this year Dr James Trussell, a lead researcher on emergency contraception and also deeply involved in abortion advocacy said that the morning after pill works to "prevent pregnancy primarily by delaying or inhibiting ovulation and inhibiting fertilization, but may at times inhibit implantation of a fertilized egg in in the endometrium.While there is some discussion in the scientific/medical community as to how levonorgestrel works to prevent pregnancy, there is no conclusive evidence that it does not work as an abortifacient.  Therefore it would be wise to reserve judgement, err on the side of caution and consider emergency contraception illicit in all cases.

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What is Family Life International NZ's position on the use of emergency contraception after rape?
Family Life International NZ acknowledges that rape is a violent violation of the human person.  A violation that is evil.  We acknowledge that the woman who is raped must receive all the emotional, physical and spiritual care possible.  However, causing the death of nascent human life conceived through this act cannot be tolerated under any circumstances.  The child is made in the image and likeness of his Creator, and any attempt to end the child's life is an attack on God.

We agree with Human Life International's position paper which is reprinted in part below.  Note that in the US emergency contraception containing levonorgestrel is marketed as "Plan B".  The Paper below has been abridged in places.

HLI Position Paper on Administration of "Plan B" Contraceptives to Victims of Rape
Having researched the question and completed the series, HLI makes the following conclusions:

1.  Recent large and robust studies indicate that Levonorgestrel-only contraceptives such as Plan B rarely block ovulation, and most likely do result in the death of the embryo if administered during the first 4-5 days of the fertile window.*

2.  A Luteinizing Hormone (LH) protocol - a test whose outcome has been understood to determine whether a drug can be administered based on where the victim is in her cycle - cannot in fact detect that a woman is in these first days of her fertile window.  Therefore a negative LH test may well encourage administration of Plan B precisely when it is most likely to cause an early direct abortion.**

3.    Because recent scientific studies have provided very strong data that indicates Plan B rarely has any contraceptive effects and is likely to have embryocidal effects, a medical practitioner cannot attain moral certainty that administration will not lead to early abortion.

4.  Since one cannot attain moral certainty that abortion will be avoided, protocols and policies that currently permit Catholic health care providers to administer Plan B need to be reconsidered by the appropriate diocesan authorities and hospital administrators.  Nations in which abortion is illegal should be aware of this potential abortion-inducing effect and should prohibit the administration of these drugs.

These are our conclusions pending any developments in scientific research.  Further, it appears that no contraceptive exists that is known to meet the reasonable criteria expressed by the Church above.

...Here we have considered the use of a contraceptive following the unjust act of rape. We must, however, also reaffirm the Church’s unchanged and unchangeable doctrine on both abortion and the contraception of the marital act – both remain morally illicit without exception. As Pope Paul VI wrote in Humanae vitae, “it is necessary that each and every marriage act remain ordered per se to the procreation of human life.” (11)

We hope that Catholic bishops and those who advise them in these issues will see the urgency of revisiting the approval of Plan B for treatment of women who have been raped. These women deserve the absolute best life-affirming care possible, and this care should not include drugs that only compound the violence already suffered by causing abortions.

Further, we ask those concerned both for women who suffer rape and for nascent human life to approach bishops on these questions with respect, and pray for our shepherds that these and all answers to questions about human life and dignity may express, in the words of Dignitas personae, “a great ‘yes’ to human life.”

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* There is a distinction in the scientific community between an abortifacient effect, which disrupts a pregnancy after implantation, and an embryocidal effect, which is “interceptive” or prevents implantation. Plan B appears to have the latter, embryocidal, effect. Since a human life is destroyed in either case, the distinction is not moral but technical, so we have stayed with the common language term and note here the difference.

** Previous scientific statements on Plan B’s mechanism of action declared Plan B to work mainly by preventing ovulation. Recent scientific evidence suggests, however, that Plan B does not work by preventing ovulation. Moreover, recent scientific evidence also shows that Plan B has no effect on cervical mucus or sperm function. Finally, as suggested in Point 1, recent evidence suggests that due to shortening of the luteal phase and other indicators, Plan B may likely prevent the new embryo from implanting into the uterine wall, resulting in an embryocidal effect.

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Further Reading:

Pre-Implantation and Emergency Contraception
by John Wilks
The terms "pre-implantation contraception" [PIC] and "emergency contraception" [EC] as well as ‘post-coital contraception' [PCC] are synonymous expressions inaccurately used to describe the administration of a drug or use of a device post intercourse, with the explicit intention of stopping implantation of a newly created human embryo. These three terms are also collectively referred to, in both the lay and medical literature, as the ‘morning-after' pill. [MAP]  Read more...

Statement on the So-Called "Morning After Pill"
by the Pontifical Academy for Life
As is commonly known, the so-called morning-after pill recently went on sale in Italian pharmacies.  It is a well-known chemical product (of the hormonal type) which has frequently - even in the past week - been presented by many in the field and by the mass media as a mere contraceptive or, more precisely, as an "emergency contraceptive", which can be used within a short time after a presumably fertile act of sexual intercourse, should one wish to prevent the continuation of an unwanted pregnancy.  The inevitable critical reactions of those who have raised serious doubts about how this product works, namely, that its action is not merely "contraceptive" but "abortifacient", have received the very hasty reply that such concerns appear unfounded, since the morning-after pill has an "anti-implantation" effect, thus implicitly suggesting a clear distinction between abortion and interception (preventing the implantation of the fertilized ovum, i.e., the embryo, in the uterine wall).  Read more...

Instruction Dignitas Personae on Certain Bioethical Questions
by the Congregation for the Doctrine of the Faith
The dignity of a person must be recognized in every human being from conception to natural death.  This fundamental principle expresses a great "yes" to human life and must be at the center of ethical reflection on biomedical research, which has an ever greater importance in today's world.  The Church's Magisterium has frequently intervened to clarify and resolve moral questions in this area.  The instruction Donum vitae was particularly significant.  And now, twenty years after its publication, it is appropriate to bring it up to date.  Read more...

Levonelle-1 Data Sheet
by Medsafe
The precise mode of action of LEVONELLE-1 is not known.  At the recommended regimen, levonorgestrel is thought to work mainly by preventing ovulation and fertilisation if intercourse has taken place in the preovulatory phase, when the likelihood of fertilisation is the highest.  It may also cause endometrial changes that discourage implantation.  Read more...

Postinor-1 Data Sheet
by Mesafe
The precise mode of action of POSTINOR-1 is not known.  Emergency hormonal contraception is thought to work mainly by preventing ovulation and fertilisation by altering tubal transport of sperm and/or ova.  Read more...

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Last updated 26 November 2013