<p>@ Gobluu-</p>
<p>First, a point of semantics, technically oral contraceptives are NOT abortifacients, as by definition, the term applies to the termination of a pregnancy, which can only occur after said pregnancy has begun, i.e. after implantation of the embryo in the endometrial lining. </p>
<p>However, there is some debate in the medical community as to what role exactly post-fertilization effects play in the function of oral contraceptives. As a medical student, I have studied this both in class and on my own by looking into the literature for some additional detail and clarification. I have also discussed this at length with my friend who is in pharmacy school since she has obviously had more pharmacology than I have. Basically what I’ve found is this:</p>
<p>OCPs are super effective at preventing ovulation, and, barring that, also play a role in preventing fertilization if ovulation does occur. But, if these fail, the effects of the pill on the endometrial lining may reduce the likelihood that a zygote will implant (via decreased endometrial thickness and changes in expressed integrins), leading to the general consensus that this may sometimes play a role in the mechanism of action of these drugs (your point). Many women also do not take the medication correctly and skip days or take the pill at different times (also in your video), which in theory would raise this percentage. However, in that case, it is not really fair to blame the medication itself for user error. Also, the quality of the data on how often post-fertilization non-implantation occurs in women taking oral contraceptives (as prescribed or non-compliantly) is not the best, partly because the pills are typically very effective at preventing fertilization from occurring (therefore the study must be very large) and also because it is difficult to detect the presence of a zygote before it has implanted. Also, a good study would have to compare the rate of post-fertilization non-implantation in women taking hormonal contraceptives to that of women who are not on them. Based on data we do have, this rate may be anywhere from 33-80%. As an aside, to me, this is an astounding number if you work from the assumption that life begins at the moment of fertilization. Especially considering it does not include the percentage of pregnancies that result in a miscarriage or stillbirth. Working from these numbers (or any others I have found), well over half of the people to have ever lived have died before they were born.</p>
<p>This all certainly makes me question a few things, but the current data on birth control pills and the research on the physiology of pregnancy initiation has yet to convince me that OCPs are causing any more death than natural processes in the real world even if it is theoretically possible that they are. We don’t actually know for sure. And if they are, this number may be small enough that it may be offset by the number of lives saved by OCPs in the form of reduced rates of death from ovarian cancer or prevention of maternal complications. Does this mean we’re playing God? Sort of. But we do that every day when we administer drugs that help the vast majority of people but may cause death or complications from side effects in a minority. Or when we offer a heart transplant to one patient and turn down another. In analyzing a treatment, researchers come up with as much information as they can and come up with statistics like “number needed to treat” or “number needed to harm” to determine the costs/benefits of administering the treatment at a population level. In all of these cases, the intention and expectation is that you will help the patient not harm them or anyone else, though unintended and undesired side effects often occur. It gets into complicated ethical and philosophical territory. Very few things in medicine or life are black and white and we often don’t have all the information.</p>
<p>All anyone can do is do the best they can with all the information they have access to. Many people may come to different conclusions based on the very same information or have other reasons to oppose birth control. That’s why I believe any institution, company, or medical practitioner should be able to refuse to provide any non medically necessary medical intervention if they oppose it on medical or moral grounds.</p>
<p>I apologize for the tangent, but I am studying for my boards and you hit a nerve.</p>