Campaign shrouded in misinformation
Janice Mawhinney reported in the Toronto Star February 4, 1997, that the Toronto Public Health Department has established birth control clinics in five Toronto high schools and that these clinics provide what she called ECP (Emergency Contraceptive Prevention). Children from the age of 14 upwards are accepted at these clinics. The Department of Health is contemplating the opening of further such clinics in other high schools. This is their response to an increasing teen pregnancy rate in Toronto, which has currently reached the level of 4,000 per year. About 65 per cent of these resulted in abortion.
Jackie Smith of the Toronto Public Health Department stated that many of these pregnancies and abortions could have been prevented if these young women knew the facts about emergency contraception and how to get it quickly. Since ECP in fact almost always aborts, it therefore is not true to state that either pregnancy or abortion could have been prevented by its use.
Grou, F. and Rodrigues, J. in ‘The morning-after pill; How long after? (171: 1529-34) 1994, in the American Journal of Obstetrics and Gynecology conclude that the post-coital drugs (ECP) act principally to terminate a viable pregnancy by interfering with the mucosal lining of the uterus – the endometrium. This inhibits the implantation of the fertilized ovum in the wall of the uterus. Prof. Rahwan, ‘Chemical contraceptives, interceptives and abortifacients,’ (p.7) concludes that this method of birth regulation should be renamed drug-induced abortion. As Prof. Rahwan has said, “Contraception involves the prevention of conception by interference with any step prior to fertilization of the ovum. Contraceptive mechanisms would include,… interference with sperm mobility… inhibition of ovulation, or interference with the encounter between sperm and ovum by physical barriers. Interception involves interference with the implantation (nidation) of the already fertilized ovum, and, from a biological standpoint, must therefore be considered an early abortifacient approach.” This kind of abortion has been called ‘interception’ and is distinguished from contraception.
With the perceived threat to the availability of abortion under U.S. President Ronald Reagan, the American medical profession immediately pointed out what they had not formerly ever admitted, that the drugs they had described as contraceptive before were in fact, frequently abortifacient. They feared that any legislation which limited abortion would also limit contraception. This kind of abortion has been called ‘interception’, as distinguished from ‘contraception’.
Sue Johanson (Toronto Star, February 4, 1997) stated that ECP was achieved by preventing implantation of the fertilized egg. Yet she, and the medical profession nonetheless call this ‘contraception,’ despite the biological fact that conception of a new life, a new human being, is recognized by all scientists as beginning at the time of the fertilization of an egg by sperm, and the formation of a one-celled organism called the zygote. There is no debate over this scientific fact; what is really up for discussion is the value of that life.
The pill most widely used in Canada is called ovral. The dose is two tablets as soon as possible following intercourse and a further two tablets taken 12 hours later. The tablets each contain 250 mcg, of d-norgentrel (as 500 mcg. Of the di-racemate) and 50 mcg. of ethnyl estradiol. These are taken within 72 hours of ‘unprotected’ intercourse. The four tablets required add up to 200 mcg. of ethinyl estrodiol plus 2 mg. of norgestrel.
As of 1995, the use of oral contraceptives for ECp was ‘off-label.’ There were no medications in Canada approved specifically for post-coital ‘contraceptive’ use. The company which manufactures Ovral, Wyeth-Ayerst, Canada Inc. stated on June 6, 1995 “Ovral tablets are not indicated for postcoital interception, even though the formulation has been advocated in clinical publications.” They also stated that their position on the use of Ovral had not changed; they stated that “we clearly do not recommend it for this indication,.”
Why did the drug company make this statement? The reason is that they are aware of the danger of side effects. What are the possible side effects?
1) Ectopic pregnancy (Rabone D. Postcoital contraception. Coping with the Morning After Current Therapeutics 1990, p. 46)
2) As well, the medical literature notes an increased possibility of blood clot formation because of the higher dose administered to the woman. (USP DI 12th ed., 1992, op.cit. p. 1355)
Wyeth-Ayerst does not want to be held legally liable for these complications. This leads to the question… why would physicians want to be legally liable by prescribing outside of the approved guidelines of a drug’s therapeutic use profile? Why does the magazine Sex Talk (Vol 3, No. 1) which is produced by the Toronto Department of Public Health, state categorically that ECP is safe? Dr. Miriam Kafman of the Hospital for Sick Children calls it “very safe; safer to take this on a one-time basis than to be on the birth control pill for a length of time… It would only be if someone had breast cancer or ovarian cancer or had blood clots that you probably shouldn’t use ECP.” The pharmaceutical company, which stands to lose much more if sued by a consumer of Ovral, used for ECP, disagrees with her.
In the U.S., Wyeth-Ayerst is currently facing many costly court cases as a result of marketing Norplant (Levo Norgesteral) a ‘birth control’ implant. Norplant, though advertised as a contraceptive, acts as an abortifacient.,
The falsehood that ECP is contraception misleads many people. A worker at the Crossways Birth Control Clinic was quoted in Sex Talk as saying that ECP “saves people having to make the decision on whether to have an abortion.” Another person, who had attended the Bay Centre of Birth Control, and who had received ECP said, “I felt relieved that I didn’t have to have an abortion.” This misunderstanding is based on misinformation coming from our government and our medical profession, due to an incorrect understanding of when human life begins.
Dr. Marion Powell, on the CBC Health Show, aired Feb. 3, 1996, stated that she would prefer to see these pills (ECP available over-the-counter, rather than by prescription. Clinics were recommended because family factors often ask ‘tough’ questions, she said. It must be remembered however, that prescription drugs are so classified by law, because they require that the patient be assessed and counselled.
The need to know
Physicians ask ‘tough’ questions when they enquire about conditions which might make ECP hazardous to a woman. For example:
1) History of/or actual clotting disorders – which may cause death;
2) History of/or actual disease of blood vessels to the brain – may cause stroke or death;
3) History of/or actual disease of the coronary arteries – may cause myocardial infarction or death;
4) Active liver disease, or benign or malignant lives tumours;
5) History of jaundice;
6) Known or suspected cancer of the breast. There is particular concern for a young woman with a family history of breast cancer or of cancer of the reproductive organs where elevated estrogen levels are connected to an increase in such cancers;
7) Undiagnosed vaginal bleeding;
8) Blood vessel disease of the eyes – may cause blindness;
9) Cigarette smoking – this increases the risk of disease of the coronary arteries. Note that the numbers of young women who smoke is rapidly increasing.
There are some of the reasons that the drug companies have so far resisted pressure to list ‘morning after pills’ as a legitimate use of these hormones. These are also the reason why family doctors ask ‘tough’ questions. Doctors, apart from their natural and professional concern for the welfare of women, also fear liability and resulting law suits. Because of these numerous hazards, the pharmaceutical companies may eventually cease manufacturing these drugs.
The morning after pill is being pushed as a contraceptives medication, whereas, in fact, it is an ‘interceptive’, which an early abortifacient. Young women are being misinformed about the mechanism of action and of the hazards of these drugs.
(Dr. Shea is the former chief of the Department of Radiology at the Centenary Hospital, Scarborough, Ontario).