Analysis

Ella, approved by the FDA in 2010, consists of a single dose of ulipristal acetate and is available by prescription only. This newer MAP is more effective than levonorgestrel-only MAPs, with a reported effectiveness rate of 62% to 85%.[7] According to the Ella website, the drug can be taken up to five days (120 hours) after intercourse, though it is most effective within the first 24 hours.[8] The use of “emergency contraceptives,” like Plan B and Ella, have increased dramatically in recent years. Among women 15-44 years of age, use has increased from 2% in 2002 to 18% in 2011-2013.[9]

MAPs May End a Human Life

Although MAPs are not an abortion pill per se, like mifepristone or RU-486,[10] they nonetheless may end a human life by preventing a fertilized egg from implanting in the uterus. MAP manufacturers proudly proclaim their products are “not an abortion pill” and will not “end an existing pregnancy.”[11] However, this can only be true if they redefine pregnancy as beginning at implantation rather than fertilization.

According to embryology, the science is clear— a unique human life begins at fertilization: “Human development is a continuous process that begins when an oocyte (ovum) from a female is fertilized by a sperm (spermatozoon) from a male to form a single-celled zygote”[12] and “[t]hrough the mingling of maternal and paternal chromosomes, the zygote is a genetically unique product of chromosomal reassortment.”[13] This means that if a MAP prevents a fertilized egg from implanting in the uterus— leading to the demise of a unique human life— the MAP operated as an abortifacient drug.

Plan B’s website states the drug may work in three possible ways: 1) “[t]emporarily stops the release of an egg from the ovary;” 2) “[p]revents fertilization;” and 3) “[p]revents a fertilized egg from attaching to the uterus.”[14] The FDA notes the same three mechanisms of action: “Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization),” but more importantly, it also states, “[i]f fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation).”[15] This explains why Plan B has printed on its FDA-approved packaging: “this product . . . . may prevent . . . attachment of a fertilized egg to the uterus (implantation).”[16]

Similarly, the manufacturer of Ella, consisting of ulipristal acetate, clearly states in its brochure the drug may prevent implantation of a fertilized egg: “ella is thought to work for emergency contraception primarily by stopping or delaying the release of an egg from the ovary. It is possible that ella may also work by preventing attachment (implantation) to the uterus.” (emphasis added).[17]

Certainly, some MAP proponents cite studies suggesting levonorgestrel and ulipristal acetate do not affect implantation;[18] however, they also readily admit “it is not scientifically possible to definitely rule out that [emergency contraceptives] . . . may inhibit implantation of a fertilized egg in the endometrium.”[19]

Health and Parental Rights Concerns

Under current law, minors have unrestricted access to certain types of MAPs at their local drugstore or grocery store, raising significant health and parental rights concerns. As of 2013, levonorgestrel-only MAPs, like Plan B and its generic versions, have been available over the counter with no age restrictions. This unrestricted availability might explain the sharp rise in use of “emergency contraception” among teens aged 15-19 from 8.1% in 2002, to 13.7% in 2006-2010, and 22.9% in 2011-2015.[20] In 2006, the FDA approved over-the-counter access of Plan B, but only for women 18 years of age or older.[21] In 2013, it expanded access to women 15 years of age or older without a prescription, but in response to a court order it removed any age restriction whatsoever— making it available “for all women of child-bearing potential”[22] without obtaining a prescription or any form of parental notification or permission.

Health Concerns. The ability for girls as young as 11, 12, or 13 years of age to purchase and use Plan B without consulting a healthcare professional and with no parental involvement raises significant health concerns. Over-the-counter status is not appropriate for a medication that contains a high dose of hormones since women, and particularly minors, will not have the opportunity to consult with a healthcare professional who can review their medical history or any contraindications for the drug. Side effects of MAPs include nausea or vomiting, dizziness, fatigue, bleeding between periods or heavier menstrual bleeding, breast tenderness, headaches, changes in length of menstrual cycle, and lower abdominal pain or cramps.[23]

In addition, Plan B One-Step contains 10 to 15 times the amount of the levonorgestrel hormone found in a regular birth control pill, which does require a prescription.[24] Given the known, serious safety risks of ordinary birth control pills, including blood clots, stroke, heart attack, gallbladder disease, vision problems, and liver tumors,[25] there is concern that such extreme hormone levels in MAPs could have a significant impact on the health of women, especially minors.[26]

Parental Rights Concerns. The lack of any age restriction to purchase over-the-counter MAPs undermines parental rights and any notion of common sense. Parental consent is required for a school to give a student Tylenol, yet there is no requirement for a medication that administers a high dose of hormones to a minor girl and has the potential to end a preborn life. Denying parents the right to be involved in these types of medical decisions not only presents medical risks to their child, but also limits a parent’s ability to protect their child from unsafe sexual behaviors or even sexual abuse.