Controversy over the beginning of pregnancy occurs in different contexts, particularly as it is discussed within the debate of abortion in the United States. Because an abortion is defined as ending an established pregnancy, rather than as destroying a fertilized egg, depending on when pregnancy is considered to begin, some methods of birth control as well as some methods of infertility treatment might be classified as causing abortions.
The controversy is not primarily a scientific issue, since knowledge of human reproduction and development has become very refined; the linguistic questions remain debated for other reasons. The issue poses larger social, legal, medical, religious, philosophical, and political ramifications because some people, such as Concerned Women for America, identify the beginning of a pregnancy as the beginning of an individual human being's life. [1] Many of these arguments are related to the anti-abortion movement. In this way of thinking, if the pregnancy has not yet begun, then stopping the process is not abortion and therefore can contain none of the moral issues associated with abortion, but if it is a pregnancy, then stopping it is a morally significant act.
A major complication is that ideological and religious concepts such as "ensoulment" (whether or not a human being is said to have gone from mere matter to having a spiritual entity inside) and "personhood" (whether or not a human being is said to be a distinct individual with innate human rights versus otherwise) exist outside of scientific analysis, and thus many individuals have argued that the beginning of pregnancy cannot be determined strictly through physical evidence alone. No experiment exists (or can exist) to measure the spirituality of an object or living thing in the same way that height, temperature, weight, etc. can be studied.
Generally speaking, some ideological and religious commentaries have argued that pregnancy should be stated as beginning at the first, exact moment of conception in which a human sperm makes full contact with an egg cell. In contrast, other commentaries have argued that the duration of pregnancy begins at some other point, such as when the fertilization process ends (when a new, independent cell genetically distinct from the prior egg and sperm exists) or when implantation occurs (when the new set of cells lodges itself against the uterine wall, allowing it to grow rapidly). The ambiguity's implications mean that, despite the scientific community being able to describe the physical processes in detail, the decision about what should be called "abortion" and what should be called "contraception" or pregnancy prevention are not agreed upon. [1]
Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection.[ citation needed ] This has led to some confusion about the precise length of human pregnancy, as each measuring point yields a different figure.
Event | Gestational age (from the start of the last menstrual period) | Fertilization age | Implantation age |
---|---|---|---|
Menstrual period begins | Day 1 of pregnancy | Not pregnant | Not pregnant |
Has sex and ovulates | 2 weeks pregnant | Not pregnant | Not pregnant |
Fertilization; cleavage stage begins [2] | Day 15 [2] | Day 1 [2] [3] | Not pregnant |
Implantation of blastocyst begins | Day 20 | Day 6 [2] [3] | Day 0 |
Implantation finished | Day 26 | Day 12 [2] [3] | Day 6 (or Day 0) |
Embryo stage begins; first missed period | 4 weeks | Day 15 [2] | Day 9 |
Primitive heart function can be detected | 5 weeks, 5 days [2] | Day 26 [2] | Day 20 |
Fetal stage begins | 10 weeks, 1 day [2] | 8 weeks, 1 day [2] | 7 weeks, 2 days |
First trimester ends | 13 weeks | 11 weeks | 10 weeks |
Second trimester ends | 26 weeks | 24 weeks | 23 weeks |
Childbirth | 39–40 weeks | 37–38 weeks [3] : 108 | 36–37 weeks |
At its 2004 Annual Meeting, The American Medical Association passed a resolution in favor of making "Plan B" emergency contraception available over-the-counter, and one of the claims in the resolution was that hormonal contraception that may affect implantation "cannot terminate an established pregnancy." [4] Similarly, the British Medical Association has defined an "established pregnancy" as beginning at implantation. [5] The legal definition in the United Kingdom is not clear. [6]
Other definitions exist. The American Heritage Stedman's Medical Dictionary defines "pregnancy" as "from conception until birth." [7] Definitions like this may add to a lay person's confusion, as "conception" in a scientific context may be defined as fertilization, [8] [9] in a medical context can mean either fertilization [10] [11] or implantation [12] but in lay terms may mean both. [13]
Whether conception refers to fertilization or implantation would seemingly even impact "established pregnancies" such as an ectopic pregnancy. If conception is defined as at implantation, ectopic pregnancies could not be called pregnancies. However, some medical professionals who oppose birth control, [14] such as Walter Larimore of the Focus on the Family group, have argued that the medical definition of conception should include fertilization. [15]
Finally, the standard historical method of counting the duration of pregnancy begins from the last menstruation and this remains common with doctors, hospitals, and medical companies. [16] This system is convenient because it is easy to determine when the last menstrual period was, while both fertilization and implantation occur out of sight. An interesting consequence is that the dating of pregnancy measured this way begins two weeks before ovulation.
Although many anti-abortion advocates have argued that both pregnancy and status of a separate human life beginning happen at fertilization, several examples also exist of people within those movements taking alternate views. For example, doctor and social activist Bernard Nathanson wrote in his 1979 work Aborting America that a confirmed moment of implantation should be considered the point at which a distinct human being exists. He specifically stated (note that 'alpha' is his shorthand for an organized group of cells), "Biochemically, this is when alpha announces its presence as part of the human community by means of its hormonal messages, which we now have the technology to receive... know[ing] biochemically that it is an independent organism distinct from the mother." [17]
In August 2008, the U.S. Department of Health and Human Services proposed a regulation to protect certain actions of health workers: refusal to provide patient services that the health workers believe to be abortifacient. The ban on discrimination against these employees would apply to all organizations that receive grant money from HHS. A draft version leaked in July proposed that the U.S. federal government define abortion as including "termination of [human] life... before... implantation." The official proposal dropped the definition of abortion, instead leaving it to the objecting individual to define abortion for him- or herself. Groups on both sides of the controversy believe the ban is intended to allow health workers to refuse to dispense IUDs and hormonal contraceptives, including emergency contraception. It has drawn widespread criticism from major medical and health groups. [18] [19] [20]
In the past, pregnancy has been defined in terms of conception. For example, Webster's Dictionary defined "pregnant" (or "pregnancy") as "having conceived" (or "the state of a female who has conceived"), in its 1828 and 1913 editions. [21] However, in the absence of an accurate understanding of human development, early notions about the timing and process of conception were often vague.
Both the 1828 and 1913 editions of Webster's Dictionary said that to "conceive" meant "to receive into the womb and ... begin the formation of the embryo." [21] However most references say that it was only in 1875 that Oskar Hertwig discovered that fertilization includes the penetration of a spermatozoon into an ovum. Thus, the term "conception" was in use long before the details of fertilization were discovered. By 1966, a more precise meaning of the word "conception" could be found in common-use dictionaries: the formation of a viable zygote. [22]
In 1959, Dr. Bent Boving suggested that the word "conception" should be associated with the process of implantation instead of fertilization. [23] Some thought was given to possible societal consequences, as evidenced by Boving's statement that "the social advantage of being considered to prevent conception rather than to destroy an established pregnancy could depend on something so simple as a prudent habit of speech." In 1965, the American College of Obstetricians and Gynecologists (ACOG) adopted Boving's definition: "conception is the implantation of a fertilized ovum." [24]
The 1965 ACOG definition was imprecise because, by the time it implants, the embryo is called a blastocyst, [25] so it was clarified in 1972 to "Conception is the implantation of the blastocyst." [26] Some dictionaries continue to use the definition of conception as the formation of a viable zygote. [27]
Birth control methods usually prevent fertilization. [28] This cannot be seen as abortifacient [29] because, by any of the above definitions, pregnancy has not started. [30] However, emergency contraception might have a secondary effect of preventing implantation, thus allowing the embryo to die. [31] [32] [33] Those who define pregnancy from fertilization subsequently may conclude that the agents should be considered abortifacients. [34]
Speculation about post-fertilization mechanisms is widespread, even appearing on patient information inserts for hormonal contraception, but there is no clinical support. One small study, using fourteen women, might be considered as providing evidence of such an effect for IUDs [35] and a study of the combined oral contraceptive pill has been proposed. [36]
A related issue that comes up in this debate is how often fertilization leads to an established, viable pregnancy.[ citation needed ] Research in in-vitro fertilization patients suggests that fertilized embryos fail to implant some 30% to 70% of the time, although it is unknown whether this rate corresponds to inherently low human implantation rates (in natural conception) or to an altered physiological state. [46] [47] Of those that do implant, about 25% suffer early pregnancy loss by the sixth week LMP (after the woman's Last Menstrual Period), and an additional 7% miscarry or are stillborn. [48] As a result, even without the use of birth control, between 50% and 70% of zygotes never result in established pregnancies, much less birth.
The intention of a woman to prevent pregnancy is an important factor in whether or not the act of contraception is seen as abortive by some anti-abortion groups. Hormonal contraceptives have a possible effect of preventing implantation of a blastocyst, as discussed previously. Use of these drugs with the intention of preventing pregnancy is seen by some anti-abortion groups as immoral. This is because of the possibility of causing the end of a new human life. [49]
However, hormonal contraception can also be used as a treatment for various medical conditions. When implantation prevention is unintentionally caused as a side effect of medical treatment, such anti-abortion groups do not consider the practice to be immoral, citing the bioethical principle of double effect. [50] Likewise, when a hormonal contraceptive is used with the intention of preventing fertilisation, the intended reduction in implantation failures, miscarriages and deaths from childbearing may outweigh the possibility that the method might cause some implantation failures.[ citation needed ]
A related application of the principle of double effect is breastfeeding. Breastfeeding greatly suppresses ovulation, but eventually an ovum is released. Luteal phase defect, caused by breastfeeding, makes the uterine lining hostile to implantation and as such may prevent implantation after fertilization. [41] Some pro-choice groups have expressed concern that the movement to recognize hormonal contraceptives as abortifacient will also cause breastfeeding to be considered an abortion method. [51] [52]
A protein called early pregnancy factor (EPF) is detectable in a woman's blood within 48 hours of ovulation if fertilization has occurred. However, testing for EPF is time-consuming and expensive; most early pregnancy tests detect human chorionic gonadotropin (hCG), a hormone that is not secreted until after implantation. Defining pregnancy as beginning at implantation thus makes pregnancy a condition that can be easily tested.[ citation needed ]
The distinction in ethical value between existing persons and potential future persons has been questioned. [53] Subsequently, it has been argued that contraception and even the decision not to procreate at all could be regarded as immoral on a similar basis as abortion. [54] In this sense, beginning of pregnancy may not necessarily be equated with where it is ethically right or wrong to assist or intervene.[ citation needed ] In a consequentialistic point of view, an assisting or intervening action may be regarded as basically equivalent whether it is performed before, during or after the creation of a human being, because the result would basically be the same, that is, the existence or non-existence of that human being.[ citation needed ]
Any device or drug that acts after implantation is conventionally regarded as an abortifacient rather than a contraceptive.
Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA)... data suggest that when administered pre-ovulation, it may have a post-fertilization MOA.
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(help)A copper intrauterine device (IUD), also known as an intrauterine coil or copper coil or non-hormonal IUD, is a type of intrauterine device which contains copper. It is used for birth control and emergency contraception within five days of unprotected sex. It is one of the most effective forms of birth control with a one-year failure rate around 0.7%. The device is placed in the uterus and lasts up to twelve years. It may be used by women of all ages regardless of whether or not they have had children. Following removal, fertility quickly returns.
Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy.
The combined oral contraceptive pill (COCP), often referred to as the birth control pill or colloquially as "the pill", is a type of birth control that is designed to be taken orally by women. It is the oral form of combined hormonal contraception. The pill contains two important hormones: a progestin and estrogen. When taken correctly, it alters the menstrual cycle to eliminate ovulation and prevent pregnancy.
Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilized by sperm. In addition, the uterine lining (endometrium) is thickened to be able to receive a fertilized egg. If no conception occurs, the uterine lining as well as the egg will be shed during menstruation.
Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.
Levonorgestrel is a hormonal medication which is used in a number of birth control methods. It is combined with an estrogen to make combination birth control pills. As an emergency birth control, sold under the brand names Plan B One-Step and Julie, among others, it is useful within 72 hours of unprotected sex. The more time that has passed since sex, the less effective the medication becomes, and it does not work after pregnancy (implantation) has occurred. Levonorgestrel works by preventing ovulation or fertilization from occurring. It decreases the chances of pregnancy by 57–93%. In an intrauterine device (IUD), such as Mirena among others, it is effective for the long-term prevention of pregnancy. A levonorgestrel-releasing implant is also available in some countries.
A hormonal intrauterine device (IUD), also known as an intrauterine system (IUS) with progestogen and sold under the brand name Mirena among others, is an intrauterine device that releases a progestogenic hormonal agent such as levonorgestrel into the uterus. It is used for birth control, heavy menstrual periods, and to prevent excessive build of the lining of the uterus in those on estrogen replacement therapy. It is one of the most effective forms of birth control with a one-year failure rate around 0.2%. The device is placed in the uterus and lasts three to eight years. Fertility often returns quickly following removal.
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive pill—was first marketed as a contraceptive in 1960. In the ensuing decades many other delivery methods have been developed, although the oral and injectable methods are by far the most popular. Hormonal contraception is highly effective: when taken on the prescribed schedule, users of steroid hormone methods experience pregnancy rates of less than 1% per year. Perfect-use pregnancy rates for most hormonal contraceptives are usually around the 0.3% rate or less. Currently available methods can only be used by women; the development of a male hormonal contraceptive is an active research area.
Etonogestrel is a medication which is used as a means of birth control for women. It is available as an implant placed under the skin of the upper arm under the brand names Nexplanon and Implanon. It is a progestin that is also used in combination with ethinylestradiol, an estrogen, as a vaginal ring under the brand names NuvaRing and Circlet. Etonogestrel is effective as a means of birth control and lasts at least three or four years with some data showing effectiveness for five years. Following removal, fertility quickly returns.
There are many methods of birth control that vary in requirements, side effects, and effectiveness. As the technology, education, and awareness about contraception has evolved, new contraception methods have been theorized and put in application. Although no method of birth control is ideal for every user, some methods remain more effective, affordable or intrusive than others. Outlined here are the different types of barrier methods, hormonal methods, various methods including spermicides, emergency contraceptives, and surgical methods and a comparison between them.
Antiprogestogens, or antiprogestins, also known as progesterone antagonists or progesterone blockers, are a class of drugs which prevent progestogens like progesterone from mediating their biological effects in the body. These drugs competitively inhibit progestin at progesterone receptors. They act by blocking the progesterone receptor (PR)and/or inhibiting or suppressing progestogen production. Antiprogestogens are one of three types of sex hormone antagonists, the others being antiestrogens and antiandrogens.
Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs), and subdermal contraceptive implants. They are the most effective reversible methods of contraception because their efficacy is not reliant on patient compliance. The typical use failure rates of IUDs and implants, less than 1% per year, are about the same as perfect use failure rates.
A contraceptive implant is an implantable medical device used for the purpose of birth control. The implant may depend on the timed release of hormones to hinder ovulation or sperm development, the ability of copper to act as a natural spermicide within the uterus, or it may work using a non-hormonal, physical blocking mechanism. As with other contraceptives, a contraceptive implant is designed to prevent pregnancy, but it does not protect against sexually transmitted infections.
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.
Sex after pregnancy is often delayed for several weeks or months, and may be difficult and painful for women. Painful intercourse is the most common sexual activity-related complication after childbirth. Since there are no guidelines on resuming sexual intercourse after childbirth, the postpartum patients are generally advised to resume sex when they feel comfortable to do so. Injury to the perineum or surgical cuts (episiotomy) to the vagina during childbirth can cause sexual dysfunction. Sexual activity in the postpartum period other than sexual intercourse is possible sooner, but some women experience a prolonged loss of sexual desire after giving birth, which may be associated with postnatal depression. Common issues that may last more than a year after birth are greater desire by the man than the woman, and a worsening of the woman's body image.
Protestant views on contraception are markedly more pluralistic than the doctrine expressed by the Magisterium of the Roman Catholic Church, due to historical divergences of theological thought that began during the Protestant Reformation, including the rejection of an infallible doctrinal authority other than Scripture. The doctrine of various forms of Protestantism as a whole from the Reformation until 1930 strongly condemned contraception as the Catholic Church does, but such opposition has since almost totally been dropped. Since the 1940 Seventh Lambeth Conference of the Anglican Communion, major mainline Protestant denominations shifted their doctrine to accepting contraception. In general, most liberal Protestants, such as the United Church of Christ, hold relatively settled views that accept the use of contraception, while conservative evangelicals denominations mostly also accept the use of contraception; however, some evangelicals are divided on the issue, with a small minority of denominations seeing natural family planning as the only permissible method. Other traditions such as Laestadian Lutheran Churches, do not permit the use of birth control and may teach Quiverfull doctrine, which holds that Christians should have large families.
An intrauterine device (IUD), also known as intrauterine contraceptive device or coil, is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%). Among birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.
Reproductive coercion is a collection of behaviors that interfere with decision-making related to reproductive health. These behaviors are meant to maintain power and control related to reproductive health by a current, former, or hopeful intimate or romantic partner, but they can also be perpetrated by parents or in-laws. Coercive behaviors infringe on individuals' reproductive rights and reduce their reproductive autonomy.
Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.
There are many types of contraceptive methods available in France. All contraceptives are obtained by medical prescription after a visit to a family planning specialist, a gynecologist or a midwife. An exception to this is emergency contraception, which does not require a prescription and can be obtained directly in a pharmacy.