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IN MID-JULY, a leaked
On its surface, this doesn't seem like anything to get up in arms about, since most states--I believe rightly--have laws on the books allowing health care providers to refuse to perform abortions if they so choose.
The controversy arises because of the draft's definition of abortion. To quote the proposal, abortion would be redefined as "any of the various procedures--including the prescription, dispensing and administration of any drug or the performance of any procedure or any other action--that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation."
Under this definition, many forms of birth control--such as IUDs, birth control pills and injectable birth control methods--could be classified as abortion, and counseling about and administration of these birth control methods could be denied to individuals seeking care in a federally funded facility.
Abortion has traditionally been considered termination and expulsion of a pregnancy, whether naturally or artificially, after implantation in the uterus. If the new proposal were to be adopted, termination of a pregnancy before implantation also would be classified as abortion.
The problem is that there is no way at present to detect a pregnancy before implantation in the uterus, making this new "definition" meaningless.
All pregnancy tests, whether urine or blood, detect a hormone called beta human chorionic gonadotropin (beta HCG), which is excreted into the bloodstream only at implantation of the pregnancy.
Because of this inability to detect pregnancy before implantation, it is not fully understood how the different forms of birth control actually work.
So, how much do we really know about the way the major birth control methods work? And how might their use be limited if this proposal became law?
HOW THE PILL WORKS
Birth control pills prevent pregnancy in several different ways. Estrogen and progesterone, the hormones found in most birth control pills, cause the mucus of the cervix (the opening to the uterus) to become thick. This makes it harder for sperm to enter the uterus and make it through the fallopian tubes to the egg.
Birth control pills also inhibit ovulation, or the releasing of an egg from the ovary. No egg, no pregnancy. And, the pill alters the uterine environment, making it inhospitable to the implantation of a fertilized egg.
The birth control patch and vaginal ring work the same way as the pill.
Injectable progestin (Depo Provera) works by altering the uterine environment and by inhibiting ovulation. The implantable progestin device Implanon alters the uterine environment but does not consistently inhibit ovulation.
The workings of the IUD (intra-uterine device) are probably the most mysterious. IUDs do not inhibit ovulation. It is believed that they alter the environment inside the uterus so that sperm are killed when they try to pass through to the egg.
WHAT IT ALL MEANS
As I said before, since there is no way to detect a pregnancy before implantation, there is no way to determine whether fertilization before implantation has occurred, or whether an IUD, a birth control pill/patch/ring/shot or implant is causing the termination of a pre-implantation pregnancy.
Until there is a reliable way to detect pregnancy before implantation, it seems that a definition such as the one proposed by HHS is scientifically useless--although an accurate interpretation of science does not appear to be the goal.
I find it hard to see this proposal as anything other than an attempt to further chip away at women's reproductive rights.
I am not arguing here whether a pro-abortion-rights or anti-abortion stance is the correct one.
However, attempting to lump contraceptives in with elective, induced abortion--and promoting measures that would potentially limit women's access to safe, reliable birth control--is heading down a very dangerous path.
Dr. Arlene Lewis welcomes reader comments and questions. She can be reached by writing to her at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at
Email: newsroom@freelancestar.com.
To read what Health and Human Services Secretary Mike Leavitt wrote recently about this issue, visit his blog at secretarysblog.hhs.gov/my_weblog. His thoughts are under the heading "Physician Conscience." Hundreds of comments about the topic also are posted on the site. |
Dr. Arlene Lewis is a gynecologist |
