Seton Healthcare, a large Catholic hospital network in Texas, has reversed policy and decided to provide the controversial Plan B emergency contraceptive to sexual assault victims. Plan B is considered to be an abortifacient — a drug or method that causes an abortion of a fertilized ovum — by some in the medical and theological community. Seton is part of the Ascension Health network, the largest non-profit healthcare system in the United States.
In an email to supporters, director of NARAL Pro-Choice Texas Sara Cleveland expressed satisfaction that Seton, which operates more than 50 Catholic hospitals and clinics in Texas, “has now implemented a policy to ensure that sexual assault survivors will be offered emergency contraception (EC) as a standard course of treatment — regardless of whether they choose to undergo an exam or file a police report.” Cleveland received a call from Seton on August 9 confirming the policy change and told supporters by email that she was “happy to announce that there is now a stronger process in place to help protect sexual assault survivors in Central Texas from unintended pregnancy.”
Cleveland claimed that the change at Seton was the result of research, advocacy, communication, and perseverance, and to exchanges with a “vice-presidential level contact at Seton.”
Seton spokeswoman Adrienne Lallo confirmed that Seton now provides the controversial drug Levonorgestrel — known as Plan B or Plan B One Step — as an emergency contraceptive to women claiming sexual assault who are not pregnant and within 72 hours of having presented themselves to the hospital. Lallo would not identify NARAL’s contact at Seton but said that the person is no longer employed at Seton. Lallo said Seton is in compliance with Directive 36 of the Ethical and Religious Health Care Directives for Catholic Care Services issued by the US Conference of Catholic Bishops in 2009 to Catholic hospitals, and with Ascension Healthcare guidelines.
The Catholic Church teaches that contraception is illicit for Catholics, but Directive 36 explains that women who are victims of sexual assault may use methods to prevent the fertilization of an ovum following rape. However, Directive 45 in the same document says that a drug that creates an environment in the uterus, which fertilized ova cannot attach and are thus expelled, would be considered an abortifacient and thereby illicit.
Lallo said that in the past when rape victims were brought to a Seton emergency room but did not want to transfer to another facility for a forensic exam, they were not given emergency contraception. Now, under the current policy according to Lallo, “emergency contraception can be administered to female patients who have been sexually assaulted, refused transfer for a [forensic exam] at a neighboring hospital, requested emergency contraception within 72 hours of the assault and are not pregnant, as confirmed by a pregnancy test.” This new policy squares with the bishops’ directives, Lallo said.
Is Levonorgestrel an abortifacient?
Product information for Levonorgestrel claims that it stops the release of an ovum from the ovary and may prevent fertilization or attachment of an ovum to the uterus, which happens if the ovum is fertilized. The inhibition of fertilized ova to be implanted would thus appear to violate Catholic principles about abortion.
Whether Levonorgestrel is abortive, or merely contraceptive, is still debated in Catholic circles. For example, John Brehany PhD of the Catholic Medical Association explained to Spero News that he did not have enough information about Levonorgestrel to be able to say whether Catholic healthcare institutions can use it.
The use of Plan B has been a source of contention between secular authorities and Catholic bishops in the past: In 2007, after legislation was passed in Connecticut mandating that Plan B be made available to rape victims, the Connecticut’s Catholic bishops and hospital administrators declared that “this law is seriously flawed, but not sufficiently to bar compliance with it at the present time.” However, the bishops cautioned that if it’s discovered that Plan B leads to a chemical abortion, then the “matter would have to be reopened.”
The USCCB office on pro-life activities directed Spero News to the Catholic Health Association, which then offered an article written in 2010 by Sandra E. Reznik MD PhD to answer questions about Levonorgestrel and the Catholic stance on its use.
Writing in “Plan B: How it Works,” Dr. Reznik disagrees with Levonorgestrel’s own claims that it can interfere with the implantation of fertilized ova. Reznik wrote that scientific evidence showing that Plan B treatment is completely ineffective after five days is overwhelming: It works only by preventing fertilization, not by preventing implantation, she wrote.
To the contrary, Thomas W. Hilgers MD of the Pope Paul VI Institute for the Study of Human Reproduction, told Spero News that Levonorgestrel indeed has “the potential to be abortive,” and that pregnancy cannot be determined within 72 hours of conception.
Pregnant, or not?
Spero News was told by a Seton staff member in Austin, Texas that administering Levonorgestrel would follow “pregnancy tests,” but that this is a decision to be made “by the woman and her physician.”
Ellen Decareau of Seton’s Communications group spoke to Spero News and specified that whether or not a urinalysis or serum (ovulation) test is used “depends on the situation.” As to whether or not an ovulation test is required, Decareau answered “no.” However, she said if a pregnancy test is performed, Levonorgestrel is offered if the test is negative.
John Bruchalski MD, a Maryland obstetrician/gynaecologist, told Spero News that the dispute over the use of Levonorgestrel is largely one of semantics. Dr. Bruchalski confirmed that Levonorgestrel can be abortive depending on the point during menstruation or ovulation at which the treatment is provided.
Speaking to Spero News, ethicist John Haas PhD STL of the National Catholic Bioethics Center, said that there is abundant evidence that Levonorgestrel does indeed prevent implantation of fertilized ova.
Haas said that it is an anovulant (prevents ovulation) and it is not necessary to get into an argument as to whether the drug is abortifacient. What is at issue, he claims, is whether the woman involved has ovulated. If she has, then giving Levonorgestrel is not necessary. An ordinary pregnancy test is not sufficient to assess a woman’s pregnancy status who is requesting emergency contraception, making necessary an additional ovulation test in order to prevent terminating the life of fertilized ova. Giving Levonorgestrel when it is not necessary amounts to “bad medicine,” said Haas. It is only if Levonorgestrel is given before ovulation that it is an anovulant and thus serve as a permissible emergency contraceptive in the Catholic understanding. Haas said “If Levonorgestrel is given in a Catholic hospital prior to ovulation then it is a morally licit ‘emergency contraception’ following a rape.”
But pro-life organizations around the country also have not reached a consensus whether Levenorgestrel causes an abortion of a fertilized ovum. Spokesperson Pam Sherstad of Right to Life of Michigan told Spero News that her organization and National Right to Life have no position on contraception in general or on the use of Levonorgestrel. Her group’s research concluded that there is no scientific consensus as to whether or not Levonorgestrel induces abortion.
Research assistance for this article was provided by Bai Macfarlane of Mary’s Advocates.
Levonorgestrel (side effects)
Ethical and Religious Directives for Catholic Health Care Services (US Conference of Catholic Bishops)
Ascension Health summary of emergency contraception for rape victims
National Catholic Bioethics Center
Morning-after Pill (The Anscombe Bioethics Centre)