The use of Plan B is increasing in the United States. A new report from the National Center of Health Statistics tells us that between 2006-2010 11% of sexual experienced women reported using emergency contraception versus 4.2% in 2002. About half used the morning after pill because they had a contraception failure, like a broken condom, and about half because they failed to use contraception. Increased use of the morning after pill in these exact scenarios is excellent, because this is the intended use. Preventing an unplanned pregnancy through the use of contraception is a good thing.

Except apparently for the pro-life movement. WIthin minutes of tweeting about Plan B, I received tweets with the #prolife hashtag decrying this as promoting abortion.

This misinformation and these lies have to stop.

Plan B, which is the progestin levonorgestrel, does not, and in fact can not, cause abortion. Not by any definition (i.e. not even an egg that has been fertilized one second previously). Plan B works by preventing ovulation.


Levonorgestrel is a progestin, meaning it’s a synthetic (not found in nature) hormone that is very similar to the natural hormone progesterone. Progesterone is so named because it is pro-gestational. When ovulation occurs the corpus luteum (basically, the empty egg sac left behind in the ovary) starts to produce progesterone. Lots of it. This is to support the pregnancy and promote implantation. While the progestin in the morning after pill is synthetic and not exactly identical to progesterone (see the two images of the chemical structure), it is very similar biologically and no evidence


even suggests that progestin negatively affect an embryo, either pre or post implantation. In fact, there is a wealth of evidence to say that synthetic progesterones have no negative impact on fertilization or implantation because birth control pills contain progestins. If progestins caused abortion by the “implantation definition” birth control pills would be 100% effective.

FIGO, the International Federation of Gynecology and Obstetrics has even issued a statement that levonorgestrel emergency contraceptives do not inhibit implantation.

Now Ella, the newer morning after pill could theoretically have an effect on a implantation as it is a progesterone receptor modulator, however, this theory is not supported in the literature and is a weak theory at best. If Ella were an abortifacient it would be 100% successful regardless of when it was taken during the month, and that’s not the case. Regardless, Ella wasn’t approved by the FDA until August of 2010 and didn’t become available until December 1, 2010 so the chance that any women in the study actually took Ella is slim to none. It may have been on the selves by December 2010, but it is far more expensive, requires a prescription, and even now represents only a fraction of the morning after pill market. In addition, Ella isn’t Plan B.

While it’s worthy to argue that more use of the morning after pill could represent a failure to make Plan A universally available to American women, meaning more contraceptive options, easier access, and long-acting reversible options (like IUDs) with no co-payment that is clearly not the argument of the “pro-life” movement.

So how does Plan B, a medication that can’t possibly cause abortion, get co-opted by the “pro-life” movement? And it’s not just the trolls on twitter, the American Society of Pro-Life OB/GYNs refuses to believe the science on Plan B as well. In falsely calling Plan B an abortifacient the “pro-life” movement is blatantly disregarding facts to promoting an agenda of reproductive control, because anyone who truly wanted to lower the rate of abortion would be handing out Plan B on every street corner.

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  1. A major hurdle is that the manufacturer of Plan B describes in the product labeling the drug’s action which reads in part – “In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun.”

    This statement from the manufacturer suggests that the use of this agent could cause and early chemical abortion by making the endometrium hostile to the embryo. A significant number of people do believe that human life begins at conception (while pregnancy begins medically at implantation). So it is not completely unfounded that persons of good will, reading the plain language of the package insert in an attempt to be good consumer & patients, conclude that this agent is abortafacient at least in part. The same link above suggests that the use of this (and similar agents) raise the ectopic pregnancy rate from an expected 2% to 10%. This is also a serious concern apart from the issue at hand.
    The jury is still out as to if EC actually drops the pregnancy rate (and by extension the abortion rate). A study from China suggested that increased use of ECs may not reduce abortion rates. But in Utah a 300% increase in Plan B dispensing did drop the abortion rate 6%. A separate review of the literature concluded that “Increased access to emergency contraceptive pills enhances use but has not been shown to reduce unintended pregnancy rates.” Finally, a well done paper out of Columbia University completed in 2012 concluded “We find that expanded access to EC has had no statistically significant effect on birth or abortion rates.” This same study (Section 2.4) suggests that it also decreased the incidence of sexual assault reporting.

    The confusion in the literature suggests that this agent is not well understood and seemingly problematic on many levels – the mode of action is not well stated and the promise of decreased pregnancies and by extension, a presumed decreased abortions is not convincingly illustrated in the literature. Since contraception is a public policy issue now (since the public in some manner funds all or most of it) it is less between a “woman and her physician” since the public minimally has an interest in assuring that what is publicly funded is at least (1) understood (2) effective and (3) does not make the things worse (which would be the increase in ectopic pregnancy & a decrease in sexual assault reporting would be).

    Such an understanding does not in any way impede the doctor-patient relationship. Indeed, many pharmaceutical agents are added and removed from formularies (or reimbursement plans) that are shown to be misunderstood, ineffective or with medical, social or cultural side effects worse than what the agent treats. With respect to this agent, little seems to be understood although a lot seems to be shouted.

    Pregnancy is rarely the intended end of every heterosexual encounter, but it certainly needs to be an expected one. Giving agents that prevent pregnancy may be good but only if they actually do what they promise to do without significant medical, social and cultural side effects. This to me, is not a moral issue.

    What is pretty certain is that Plan B fails to deliver on the promises of the past. Does anyone think that EC will reduce a woman’s risk of pregnancy 74% today?

    This agent is far from well understood and its use is a legitimate disputed point worthy of debate.

  2. Ugh, there’s a Society of Pro-Life OB/GYNs? Why would anyone even go into the field if they didn’t believe in providing all women’s health services? It just doesn’t make sense!

  3. Misinformation gets what they want much more effectively than admitting that they are against non-reproductive sex, period.

    1. I think you hit the nail on the head with that comment, Loren. I sometimes have trouble figuring out what these “pro-lifers” are all about, but in that context, it makes perfect sense.

      1. If you examine “pro-life” actions from the standpoint of assuming they’re actually trying to make non-reproductive sex dangerous and scary they almost always make sense. Since this results in far fewer contradictions than their stated position I think it’s much more likely to be what’s actually going on.

        There is also the fact that given enough discussion I have a nearly 100% track record of getting pro-life people to admit punishment of sex they don’t approve of is part of it.

        The only ones that come to mind as never saying anything about punishment were non-religious pro-lifers–they honestly considered the fetus to be a person and were sorry for the woman saddled with an unwanted pregnancy. These are a tiny minority.

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