To be or not to be. The U.S. Food and Drug Administration (FDA) has just reaffirmed in an update that the Plan B emergency contraceptive is not to be considered an abortion drug. This news shouldn’t be too surprising to medical experts who have been emphasizing all along that Plan B is not an abortion drug. Plan B is also known as the “morning after pill,” which once again is not an abortion drug. It’s a single pill that may be taken the morning after, the morning after sex, that is, and not the morning after you’ve found out that you are pregnant.
Plan B, which, by the way, is not an abortion drug, is considered to be an emergency contraceptive because it is designed to be taken soon after you’ve had an uh-oh moment during sexual intercourse. This can be an “uh-oh, the condom broke” or an “uh-oh, forgot to take the pill” moment. It can also be an “uh-oh, I thought you said ‘use taste deception’ instead of ‘use contraception’ during sex” or an “uh-oh, what is contraception” or an “uh-oh, you mean a sandwich bag is not the same as a condom” moment. In this case, “soon after” doesn’t mean several months or several years after the “uh-oh” moment. It means “as soon as possible within 72 hours after unprotected sex or contraceptive failure,” according to the FDA’s “Plan B One-Step (1.5 mg levonorgestrel) Information” website.
The FDA also updated this website on December 23 to emphasize the fact that Plan B is not an abortion dug, added a new section that asks itself, “Is Plan B One-Step an abortifacient (causing abortion)?” To which, the website provides the following pretty clear answer: “No.” That’s because Plan B is, if you haven’t figured out yet, not an abortion drug. As the section says, “Plan B One-Step will not work if a person is already pregnant, meaning it will not affect an existing pregnancy.” And since it should not affect an existing pregnancy, Plan B, which is marketed by Foundation Consumer Healthcare, isn’t considered an abortion drug because abortion is defined as terminating an existing pregnancy.
The section goes to say that “Plan B One-Step prevents pregnancy by acting on ovulation, which occurs well before implantation. Evidence does not support that the drug affects implantation or maintenance of a pregnancy after implantation, therefore it does not terminate a pregnancy.” Since it does not terminate a pregnancy, plan B is, guess what, not an abortion drug.
The FDA probably deemed it necessary to provide these updates because, surprise, surprise, there’s a lot of misinformation and disinformation about Plan B out there. If you haven’t heard, earlier this year in June, the Supreme Court reversed the Roe v. Wade ruling nearly 50 years after it was made in 1973, thereby eliminating federal protections for abortion. Once that happened, around half the states in the U.S. rushed to implement limits on abortion.
Now, this ruling shouldn’t have affected emergency contraception. After all, the American College of Obstetricians and Gynecologists (ACOG) had already emphasized in 2010 (and reaffirmed in 2022) that “hormonal emergency contraception confers no risk to an established pregnancy or harm to a developing embryo.” In other words, emergency contraception like Plan B is not an abortion drug. Yet, some politicians seemed to seize on the FDA’s somewhat vague wording about Plan B to push forward restrictions on emergency contraception as well. As of December 1, 2022, according to the Guttmacher Institute, “nine states have adopted restrictions on emergency contraception.” This has included the following:
- “1 state excludes emergency contraception from the services to be covered in the state’s family planning program.
- 2 states exclude emergency contraception from their contraceptive coverage mandate.
- 6 states explicitly allow pharmacists to refuse to dispense contraceptives, including emergency contraception.
- 3 states allow pharmacies to refuse to dispense emergency contraception.”
This was interesting because emergency contraception does not equal abortion drug.
Then there was what U.S. Rep. Marjorie Taylor Greene (R-Georgia) said when she was was arguing against a bill that would require Department of Veterans Affairs (VA) facilities to include B when covering costs for contraception. Taylor Green claimed that “The Plan B pill kills a baby in the womb once a woman is already pregnant. The VA should not be paying for abortion.” Yeah, that would be kind of wrong, wrong as a space-lasers-caused-the-California-wildfires song.
This is what happens when you have politicians making science and medicine-related policies when they have little scientific and medical background or at least little inclination to follow scientific and medical evidence.
Let’s look at the actual science behind Plan B. Plan B’s active ingredient is 1.5 mg of levonorgestrel, which is a type of progesterone. If you are worried about giving someone who is pregnant a type of progesterone, keep in mind that those who are pregnant already make progesterone.
As described on the FDA website, levonorgestrel acts by inhibiting ovulation. Ovulation is when one of your ovaries releases a mature egg into the adjoining fallopian tube. The FDA website also has a section that states, “Plan B One-Step works before release of an egg from the ovary. As a result, Plan B One-Step usually stops or delays the release of an egg from the ovary. It is one tablet that contains a higher dose of levonorgestrel than birth control pills and works in a similar way to prevent pregnancy.”
After ovulation occurs, the released egg then travels down the fallopian tube, remaining there for about 12 to 24 hours. It is there that the egg can be fertilized by any sperm that may be present. Fertilization is when conception occurs. The fertilized egg subsequently moves to the uterus, implanting itself into the uterine wall. Doctors consider this implantation to be when pregnancy begins. Therefore, levonorgestrel or Plan B is supposed to act well before fertilization has even happened.
That’s why the effectiveness of Plan B depends on how quickly you take it after you’ve had either unprotected sex or contraceptive failure. That’s also the reason for the 72 hour threshold for taking the pill. After this time period, the pill likely will have no effect since ovulation may have already occurred and the pill shouldn’t affect any of the subsequent steps. For example, a study published in a 2001 issue of the journal Contraception showed that getting two doses of levonorgestrel over a 24 hour period had no noticeable effects on the uterine linings of 45 women.
So ultimately, the FDA simply confirmed what was known already: that Plan B is not an abortion drug. It doesn’t act by terminating a pregnancy. Rather, it acts by inhibiting a step that can eventually lead to pregnancy. That’s why you don’t consider a condom to be an abortion device no matter how long you keep wearing the condom after sex. Similarly, that’s why your don’t consider Plan B to be an abortion drug.