“EC is not the abortion pill”: a Rhetoric Fail for ellaOne

As a sex educator and counselor, I have given the emergency contraception (EC) spiel many times. There are two important points that must be made. The first is to explain that “the morning after pill,” is a misnomer because EC it works for up to 72 hours after unprotected sex. The second is to make absolutely sure that everyone understands that EC is NOT! THE! ABORTION! PILL!

Differentiating between Plan B (EC) and RU-486 (the abortion pill) was a key component of the strategy to make Plan B available without a prescription, to convince pro-life pharmacists to dispense it, and to reassure women that taking Plan B will prevent pregnancy without terminating or harming an embryo if pregnancy has already occurred. This strategy was effective, and necessary, and is often used to promote EC as the solution to “the abortion problem.”  If everyone had access to EC, women wouldn’t need to have so many abortions, and we can all agree that abortions are the least desirable outcome. Unifying as this strategy can often be, it is problematic.

A form of EC already used in 21 European countries called “ellaOne” is headed to the FDA for U.S. approval and is generating a great deal of controversy. EllaOne works differently than Plan B, and can prevent pregnancy for up to five days. FIVE DAYS.  Like Plan B, ellaOne is more effective the earlier it’s taken, but studies seem to be showing it is still more effective than Plan B.  This is a big deal.

Folks don’t realize that time can be a major barrier to obtaining Plan B, especially for those who live in rural areas, or anywhere that doesn’t have 24 hour pharmacies or Choice-friendly clinics or pharmacists.  Sometimes it can take a day or two to figure out where to get Plan B and negotiate how to get there and how to get the time off from work. The cost of Plan B (around $50) is also a barrier, and it may take a few days to scrape together the money to pay for the pill.  An extra 2 days of effective prevention could make ellaOne a real game-changer.

The problem is that ellaOne may have some chemical similarities to RU-486, the abortion pill.  According to the Washington Post, it is possible that ellaOne could induce an abortion by making the womb inhospitable to an embryo. (Much like what happens during a miscarriage.) But ellaOne (ulipristal acetate) is NOT the same as RU-486 (mifepristone). The differences are explained in this fact sheet.

Regardless, the Pro-Life lobby is well on its way to preventing ellaOne from being approved by the FDA. As Ms. Magazine reminds us, the Pro-Life lobby prevented the FDA from approving Plan B until 1998, when it had already been used in Europe since the 1970s. It took another 8 years of fighting to make Plan B available over the counter for women 18 and up. Plan B was only made available over the counter to 17 year olds in 2009. Getting ellaOne approved by the FDA will be a political battle rather than a medical one. And unfortunately, we have already sabotaged our case with our own anti-abortion rhetoric surrounding EC.

By driving home the distinction between EC and the abortion pill and stressing that EC is acceptable because of this distinction, we have set up ellaOne to fail. If ellaOne does cause “abortions” (or miscarriages, or “spontaneous abortions” just like ones that occur naturally), well, we’re screwed. We played the game of rhetoric, and now we might have to put our foot in our mouths.

I keep putting “abortions” in quotations because it’s important to acknowledge that no one is really sure if ellaOne causes abortion. The reason is not because we don’t understand what the drug does – we do – it’s that there is no consensus on when life begins, so it’s pretty hard to define what is and what isn’t an abortion when we’re talking about fertilized eggs and uterine implantation.  Does life begin with a fertilized egg? Does it begin when that egg implants on the uterine wall?  Does an egg that naturally fails to implant an abortion? A miscarriage? Or just another period? It’s confusing, but the Pro-Life lobby is happy to spin it. By claiming that ellaOne has similarities to the abortion pill, it will be viewed as an abortion pill. And by demonizing the abortion pill as the pro-EC rhetorical strategy has done, we have hurt the case for ellaOne.

In most cases, the people promoting EC are Pro-Choice and actually support RU-486.  From a Pro-Choice, pro-healthcare-access point of view, RU-486 is a good thing. It is a great option and has the potential to make abortion safer and more accessible for many women. It has even been administered via webcam to women in remote locations!

And ellaOne, even if it does sort of cause “abortions,” would be a great product to fill that in-between space – the space between Plan B and abortion. For those truly concerned with reducing the demand for abortion – real, unambiguous abortion – ellaOne is actually a good thing. A really good thing.

Let’s hope that it doesn’t take another 30 years to give American women better control over their own health, bodies, and lives.

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