EllaOne is comprised of ulipristal acetate, an antiprogesterone drug that prevents pregnancy by delaying ovulation. Though ulipristal acetate has similarities in chemical action to mifepristone—aka RU 486—it is not intended for use as contraception or as a method of terminating an ongoing pregnancy. Clinical trials of both Plan B and Ella, published recently in the Lancet, Glasie1 showed that Ella prevented twice as many unwanted pregnancies as Plan B.
Despite advances in birth control since The Pill came on the scene in the 1960’s, the fact is that 50 percent of pregnancies are still unplanned. And contraceptive failures happen even in ideal users. That means that there will always be a role for the morning-after pill. Ella does this job particularly well.
Politics, Religion, and Hypocrisy
Of course there will be the usual political jockeying before the FDA does the right thing (which is to approve this drug). Frankly, I wish the government, the church, and everyone else who would oppose the morning-after pill would simply back off and leave medical and pregnancy decisions to the only person who can really make the right decision: the woman herself, in partnership with her healthcare provider.
Let me give you an insider’s view of all this. Back in the mid-1970’s, when I was an OB/GYN resident in Boston, I worked at a Catholic hospital. We were not allowed to discuss contraception with our patients, nor do tubal ligations or anything of that nature. So we hid the diaphragms in the depths of our exam tables so the nuns wouldn’t find them. And we routinely wrote stealth prescriptions for birth control pills to “regulate periods.” Yeah, right. And every week I’d get phone calls from men who were bigwigs in the community, asking me if I could arrange an abortion for a daughter or other woman close to them. I remember one guy saying to me, “I don’t believe in abortion myself, but this would ruin my daughter’s life.” I quickly caught on to the hypocrisy of those individuals who maintained a split between their public stance and their private behavior. Publicly they imposed the moral codes popular at the time as a way to limit the choices of others, but privately they used their power and influence to bend the rules when their own personal lives were impacted.
Believe me, a lot of personal lives are impacted by fertility decisions. In the new edition of Women’s Bodies, Women’s Wisdom (Bantam 2010), I wrote, “According to Trudy M. Johnson, a licensed marriage and family therapist with 20 years of experience counseling women who are grieving what she called voluntary pregnancy (VPT) terminations, 43 percent of women under the age of 55 have had voluntary pregnancy terminations. Thirty eight percent of these are church members. That’s 55,000,000 women. (To learn more about Johnson’s work helping women grieve and process the emotional aspects of VPTs, go to www.missingpieces.org.)
“The bond between mother and child is the most intimate bond in human experience. In this most primary of human relationships, love, welcome, and receptivity should be present in abundance. Forcing a woman to bear and raise a child against her will is therefore an act of violence. It constricts and degrades the mother-child bond and sows the seeds of hatred rather than love. Can there be any worse entry into the universe than forcing a child to inhabit a body that is hostile to it? Life is too valuable to inhibit its full blossoming and potential by forcing a woman to bear it against her will. Since we know that the early lives of criminals and societal offenders are often filled with poverty and despair, it may even be dangerous to bring a being into the world who isn’t wanted. (In their best-selling book Freakonomics [William Morrow, 2005], authors Steven Levitt and Stephen Dubner hypothesize that the reduction in crime over the past few decades can be traced to the legalization of abortion!).” It’s also true that human nature is resilient. And it’s entirely possible for individuals to heal from this kind of beginning. But this should be an individual decision.
A Global Turning Point
When it comes to having babies, a woman’s ability to say when and how many (children) is one of the most significant factors that explains the greatly expanded role of women in business, education, and self-development in the last 50 years. Goldin2 The best predictor of a nation’s health and economic strength is the status of its women.
We have collectively reached a turning point in our understanding of the global impact of a woman’s state of health. It is estimated that in the 1840s half of all pregnancies ended in abortion. Smith3 Currently, as women’s power is rising, like it was in the 1840s, so is anti-choice rhetoric. Though no culture at any time in history has been a stranger to fertility control, the research of historian Carroll Smith-Rosenberg documents that reproductive freedom becomes a political issue only when there are “significant alterations in the balance of power between women and men, and of male heads of household over their traditional dependents.”Smith3 At just such a time, these changes are reflected in laws concerning women’s right to manage their own fertility.
Currently the status of women is the number one issue on the planet. And women are, in the words of Sonia Johnson, “rising like yeast all over the planet.” It’s time for all of us to assume dominion over our bodies, without fear of repercussions. As Pulitzer Prize winning journalists Nickolas Kristoff and Sheryl Wudunn have so beautifully documented in their book Half the Sky, the education and economic development of women is the key to ending global poverty and terrorism. And a woman’s education level is directly linked to her ability to assume dominion over her fertility. The approval of Ella here in the United States is a step in the right direction for women everywhere.
- Glasier, A., M.D., 2010. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non inferiority trial and meta-analysis, Lancet, Vol 375: 9714, pp: 555-562, 13 Feb
- Claudia Goldin and Lawrence Katz, “The Power of the Pill: Oral Contraceptives and Women’s Career and Marriage Decisions,” Journal of Political Economy, vol. 110, no. 4 (August 2002), pp. 730-70; available online at www.jstor.org/pss/3078534.
- Smith-Rosenberg, C., Disorderly Conduct, Oxford University Press, 1998, page 218.