Beginning of pregnancy controversy
Controversy over the beginning of pregnancy occurs in different contexts, particularly as it is discussed within the debate of
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
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
Definitions of pregnancy beginning
Traditionally, doctors have measured
Event | Gestational age
(from the start of the |
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 |
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) |
missed period
|
4 weeks | Day 15[2] | Day 9 |
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
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
Although many
Legal implications
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]
History
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."
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 – mechanism of action
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]
Possibly affected methods
- Hormonal contraception, including emergency contraception, are known to be effective at preventing ovulation. Some scientists believe hormonal methods may have a secondary effect of interfering with implantation of embryos.[citation needed]
- Intrauterine devices (IUDs) have been proven to have strong spermicidal and ovicidal effects;[37][38] the current medical consensus is that this is the only way in which they work.[39] Still, a few physicians have suggested they may have a secondary effect of interfering with the development of pre-implanted embryos;[35] this secondary effect is considered more plausible when the IUD is used as emergency contraception.[40]
- The luteal phase defect (LPD). LPD is believed to interfere with the implantation of embryos.[41]
- Natural Family Planning (NFP) methods are intended to prevent fertilization through avoiding intercourse during fertile periods. Luc Bovens argues that, under an assumption that the age of gametes has an effect on embryo viability, errors in NFP method result in the occurrence of lower-viability embryos. This is intended to be an ethical thought experiment; Bovens states that his assumption "is not backed up by empirical evidence, but does have a certain plausibility."[42] His argument is controversial.[43] The age of gametes at the time of fertilization has been shown to have no effect on miscarriage rates in most cases, but is a significant risk factor where there is history of miscarriage.[44] Age of gametes at the time of fertilization has been shown to have no effect on low birth weight or preterm delivery.[45]
Viability and established pregnancy
A related issue that comes up in this debate is how often fertilization leads to an established,
Ethics of preventing implantation
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
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
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]
Detectable pregnancy
A protein called
Philosophical issues
The distinction in
See also
Notes
- ^ a b c "The Implications of Defining When a Woman Is Pregnant". The Guttmacher Report on Public Policy. May 2005, Volume 8, Number 2.
- ^ ISBN 978-1-107-06434-8.
- ^ ISBN 978-93-88696-53-1.
- ^ FDA Rejection of Over-The-Counter Status for Emergency Contraception Pills American Medical Association House of Delegates Resolution:443. Retrieved April 30, 2007
- ^ BMA (May 2005). "Abortion time limits: A briefing paper from the British Medical Association". Archived from the original on 2006-08-27. Retrieved 2006-07-31. "The term 'abortion' is used throughout this paper to refer to the induced termination of an established pregnancy (i.e. after implantation)."
- ^ Hope, T. & Savulsecu, J. "Handout 3: Outline of Legal Positions in England and Wales". Medical Ethics and Law Teaching Materials: Termination of Pregnancy. The Oxford Centre for Ethics and Communication in Health Care Practice, Oxford University. pp. Appendix 3: Some key points in the law on abortion and fetal damage. Archived from the original on 2006-03-23. – "It is generally assumed that when the Act states that 'pregnancy has not exceeded its 24th week' it means 24 weeks since the first day of the woman's last period. But this is not clear – particularly if there is evidence that conception had taken place on a day after this....The Attorney General said, in 1983 (see Brazier 1992 page 293-4) that there is no pregnancy until implantation. This is persuasive but not binding precedence." "Termination of Pregnancy Handout (pdf)" (PDF).
- ^ The American Heritage Stedman's Medical Dictionary, 2002
- ISBN 9780547470924. Archived from the originalon 2013-06-22. Retrieved 2013-10-06.
- ISBN 978-0199561469.
- ISBN 978-0323085410.
- ISBN 978-1416062578.
- ^ "Sex Selection" (PDF). ACOG. February 2007. Archived from the original (PDF) on June 10, 2015.
- ^ "Conception". Merriam-Webster. 5 February 2024.
- ^ Larimore, Walter. "Ethical Issues Regarding Hormonal Contraceptives". The Truth About Birth Control. Retrieved 14 March 2011.
- ^ Larimore, Walter L; et al. (2004). "Response: Does Pregnancy Begin at Fertilization?" (PDF). Family Medicine.
- ^ Doctor:George P. Pettit, M.D. (2002). "Due Date Calculator".
Hospital:Northwestern Memorial Hospital (2006). "What is a trimester?". Archived from the original on 2005-11-04.
Medical company:The Merck Manuals Online Medical Library (2003). "Stages of Development: Pregnancy". - ISBN 9780919225008.
- ^ Stein, Rob (2008-07-31). "Workers' Religious Freedom vs. Patients' Rights". Washington Post. pp. A01. Retrieved 2008-08-05.
- ^ Shapiro, Joseph (2008-08-22). "HHS Backs Protections For Anti-Abortion Doctors". Washington Post. Retrieved 2008-08-24.
- ^ Stein, Rob (2008-08-22). "Protections Set for Antiabortion Health Workers". Washington Post. pp. A01. Retrieved 2008-08-24.
- ^ a b Webster’s Revised Unabridged Dictionary Archived 2012-07-10 at archive.today (1913 and 1828) via the ARTFL Project. See definitions of "pregnant" and "pregnancy".
- ^ Webster’s Third New International Dictionary (1966), defining conception as the "act of becoming pregnant (formation of a viable zygote); state of being conceived; that which is conceived (embryo, fetus)..." quoted in Mallett Shelley, Conceiving Cultures Archived 2006-08-30 at the Wayback Machine, p. 284 (U. Mich. 2003).
- ^ Boving, B.G., "Implantation Mechanisms", in Mechanics Concerned With Conception. Hartman, C.G., ed. (Pergamon Press 1963), page 386.
- ^ American College of Obstetricians and Gynecologists Terminology Bulletin. Terms Used in Reference to the Fetus. No. 1. Philadelphia: Davis, September, 1965.
- ^ Biggers, J., "Ambiguity of the Word Conception: Implications if S. 158 is Enacted", The Human Life Bill Appendix, Hearings Before the Subcommittee on Separation of Powers of the Committee on the Judiciary, United States Senate, p. 281-288 (1982).
- ^ Hughes, E.C. "Gametogenesis and Fertilization", in Obstretric-Gynecologic Terminology. Philadelphia: Davis, 1972: 299–304.
- ^ Dictionary.com.
- ^ "Birth Control Options". my.clevelandclinic.org. Cleveland Clinic. Retrieved 14 July 2023.
- PMID 9321535.
Any device or drug that acts after implantation is conventionally regarded as an abortifacient rather than a contraceptive.
- ^ Attia (May 12, 2023). "Do I Need Emergency Contraception or the Abortion Pill?". plannedparenthood.org. Retrieved 14 July 2023.
- S2CID 36847373.
- S2CID 6431709.
- PMID 27833181.
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.
- ^ DeSanctis, Alexandra (November 4, 2016). "Yes, Some Contraceptives Are Abortifacients". nationalreview.com. National Review.
- ^ PMID 12501086., which cites:
- Smart Y, Fraser I, Clancy R, Roberts T, Cripps A (1982). "Early pregnancy factor as a monitor for fertilization in women wearing intrauterine devices". Fertil Steril. 37 (2): 201–4. PMID 6174375.
- Smart Y, Fraser I, Clancy R, Roberts T, Cripps A (1982). "Early pregnancy factor as a monitor for fertilization in women wearing intrauterine devices". Fertil Steril. 37 (2): 201–4.
- ^ Lloyd J DuPlantis, Jr (2001). "Early Pregnancy Factor". Pharmacists for Life, Intl. Retrieved 2007-01-01.
{{cite journal}}
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(help) - ^ "Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs)". Family Health International. 2006. Archived from the original on 17 June 2006. Retrieved 2006-07-05.
- ^ Keller, Sarah (Winter 1996). "IUDs Block Fertilization". Network. Family Health International. Archived from the original on 23 June 2006. Retrieved 2006-07-05.
- ISBN 978-0-9664902-0-6.
- ^ Trussell, James; Elizabeth G. Raymond (September 2010). "Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy" (PDF). The Office of Population Research at Princeton University and the Association of Reproductive Health Professionals. Archived (PDF) from the original on 23 September 2010. Retrieved 2010-10-27.
{{cite journal}}
: Cite journal requires|journal=
(help) - ^ PMID 1521642.
- PMID 16731736.
- PMID 16731736. Retrieved 10 July 2013.
- PMID 7755073.
- S2CID 24939823.
- ^ Kennedy, T.G. Physiology of implantation. 10th World Congress on in vitro fertilization and assisted reproduction. Vancouver, Canada, 24–28 May 1997.
- PMID 6196101.
- PMID 10362823.
- ^ Finn, J.T. (2005-04-23). ""Birth Control" Pills cause early Abortions". Pro-Life America — Facts on Abortion. prolife.com. Archived from the original on 19 August 2006. Retrieved 2006-08-25.
- ^ Doesn't breastfeeding do the same thing as the Pill? Archived 2006-10-15 at the Wayback Machine Eternal Perspective Ministries, 2006. Accessed May 2006.
- ^ "Emergency Contraception & Conscience: Christian Right Attacks on Contraceptives". About.com Religion & Spirituality Agnosticism / Atheism. Archived from the original on 28 June 2006. Retrieved 2006-06-22.
- ^ Shorto, Russell (2006-05-07). "Contra-Contraception". New York Times Magazine. pp. 4 of 9-page online article.
- ^ Page 212 and 213 in: Abortion and the Golden Rule By R. M. Hare. Philosophy and Public Affairs. Vol. 4, No. 3 (Spring, 1975), pp. 201-222 [1]
- ^ Do Potential People Have Moral Rights? By Mary Anne Warren. Canadian Journal of Philosophy. Vol. 7, No. 2 (Jun., 1977), pp. 275-289 [2]