Plan B

So I arrive home this afternoon from new-student orientation at Dallas Seminary, and there is this message on my machine from somebody at ABC’s Nightline. My friend and bestselling author of Breaking the Da Vinci Code, Darrell Bock, gave them my name because I coauthored The Contraception Guidebook. Why today? Because today the Food and Drug Administration approved over-the-counter sales of the “morning-after” contraceptive pill to women eighteen years and older. The person at ABC wanted my take on the religious perspective.

When I returned the call, the woman with whom I spoke told me Nightline had decided not to do the story, but she wanted my info so she could call in the future on contraception-related issues.

So what do I think about “emergency contraception”?

Last Friday a friend at Christianity Today forwarded to me a Wall Street Journal piece by a Wheaton College prof in which she said, “In some cases, like Plan B—which may thin the uterine lining and prevent the implantation of a fertilized egg—contraception and abortion may appear to be the same thing.”

Whoa. I checked with my co-author, Bill Cutrer, M.D., on that one and he said this statement is actually without scientific support. The thinning of the uterine lining is possibly the method of action, but nobody has any evidence to back up that theory.

Plan B is progesterone-only. And progesterone is what I injected to sustain my pregnancies after implantation. The benefit of Plan B is that it can prevent ovulation if it’s not too late to do so. Let’s say a woman is raped early in her cycle and wants to prevent fertilization. A sonogram can identify whether she has, in fact, ovulated yet. If not, Plan B could keep the egg from releasing. Do I support the use of Plan B in such a case? You bet.

Here’s another scenario: A patient has four kids and her doctor says her heart will not take another pregnancy. She and her spouse use a barrier method that gets dislodged or torn during lovemaking. Again, her doc could do an ultrasound to determine whether she has ovulated and, if not, she would be a good candidate for Plan B. Keep the egg from releasing. No pregnancy. No embryo harmed.

According to Dr. Cutrer, the paperwork that comes with Plan B says the approach is useless if the woman has already conceived—or, as the manufacturer put it, “once implantation has begun.” So once ovulation has occurred, such a low dose of progesterone wouldn’t make much of an impact on anything by itself. Maybe it thins the uterine lining, but as Dr. Bill said, there are no studies to support its doing so, and the suggestion that the progesterone thins the lining actually contradicts the statement that Plan B is useless once implantation has begun.

All this is not to say that I am for Plan B. I oppose its over-the-counter use. Dr. David Stevens with the Christian Medical Association said, “This move by the FDA appears to be based on political expedience and ideology rather than science. It makes no medical sense to offer over-the-counter access to a powerful hormonal drug when lower doses of those hormones in contraceptives require a physician's prescription.”

So I am unhappy with the FDA’s decision. Yet as you can see, there are times when I do think “emergency contraception” may be an ethical option for those of us committed to the dignity of human life at the one-cell stage.