Monday morning, PST: time for some science with a side of controversy, Danio-style
There’s a Department of Health and Human Services document circulating that’s got the pro-choice lobby up in arms. Afarensis and The Questionable Authority weighed in on the sociopolitical impact of such a policy last week, but in addition to the significant threat to reproductive rights that it presents, this proposal is yet another example of the complete lack of scientific expertise informing decisions about public health.
At issue is the determination of a time point that marks the beginning of pregnancy. The consensus of the medical community is that an established pregnancy occurs at the point when the blastocyst successfully implants into the uterine wall. This time point makes a lot of sense in considering early events in the reproductive process. Pre-implantation embryos have a vast distance to travel, complex chemical cues to navigate, and a ticking biological clock to contend with within the bounds of the female reproductive cycle. Roughly 40% of all embryos don’t survive the ordeal. These odds are one good reason to hold off on crying ‘pregnant’ until a successful implantation is achieved; another is that implantation signifies the beginning of the physiological impact of a pregnancy on a woman’s body. Developmental events prior to implantation have essentially no impact on maternal tissues, which are just marking time until the beginning of the next menstrual cycle. The massive signaling between embryonic and uterine tissues that occur during implantation, the establishment of maternal and embryonic connections and boundaries, delineating the difference between ‘self’ and ‘not self’, are all medically relevant occurrences in terms of the physiology of the female patient, hence the general accord within the medical community in marking this time point, and none before it, as the point at which a pregnancy is established.
Naturally, the ‘life begins at conception’ crowd takes issue with this definition. The DHHS document echoes the concerns of the religious right in a proposal that seeks to give citizens the power to decide for themselves when a pregnancy begins, and act accordingly in exercising their religious freedom. The document details numerous preexisting ‘conscience provisions’ designed to protect the rights, and the federal funding, of institutions or individual health care workers who decline to perform any service they deem morally objectionable or contrary to their particular belief system. These are the grounds upon which it has been acceptable for ambulance drivers to refuse to transport women to clinics where abortions will be performed, for emergency room staff to fail to offer or administer emergency contraception after a rape, and for pharmacists to refuse to fill prescriptions for oral contraceptives. Pro-choice advocates and proponents of church-state separation alike have been outraged by these faith-driven attacks on reproductive choice, but the authors of the document in question bemoan the ‘intolerance’ conveyed in any expression of these sentiments. They contend that such conscientious objectors are well within their rights to refuse such treatment if it conflicts with their religious views, and use this concern as a platform to expand the degree to which they may do so.
Federal endorsement of the opinion that life begins at ‘conception’ (in reality, as we know, the matter is not so easily settled) is a grim development, not only because of what it could mean for abortion rights, but because of how some forms of contraception are reputed to function. Although the indisputable primary effect of oral contraceptives, including EC, is to inhibit ovulation, it has been widely accepted that a secondary mechanism by which these treatments prevent pregnancy is through changes to the uterine lining that decrease the likelihood of successful implantation. Further, interference with the implantation process has long been thought to be the principle mechanism by which IUDs prevent pregnancy. It is thus not surprising that those who believe a pre-implantation embryo is a fully-vested human life consider the above mechanisms forms of abortion, and health-care workers holding this view would, under this new policy, be acting within their rights to freely hold and express their religious beliefs when denying these treatments to patients. The kicker, though, is that there are precious few studies investigating the hypothesized implantation-blocking properties of either oral contraceptives or IUDs, and the few published data that are available do not support these claims.
Previous studies of Levonorgestrel have concluded that, while ovulation is effectively suppressed if administered in a timely manner , it appears to have a negligible effect on post-ovulatory events. A 2007 review of multiple studies investigating the presence of viable gametes and pre-implantation embroys in IUD users concluded that the inflammatory response resulting from the presence of an IUD, as well as the actions of synthetic hormones released from the device, have significant effects on the reproductive process prior to fertilization.
Interestingly, many of the studies investigating these contraceptive mechanisms have taken place in Chile, a conservative country where all abortions–even therapeutic ones–are illegal. It is troubling to think that increasing restrictions on reproductive rights could necessitate similar studies by researchers in the US. It is more troubling still to realize that, given the diminishing currency of science in this country, even the most conclusive and rigorous studies may not affect policy changes if they do not align with popular opinion.