Compelling arguments for developing new post-fertilisation methods of birth control

11/07/2015 § Leave a comment

A 2013 article by Elizabeth Raymond et al[1] makes a compelling case for encouraging reproductive health researchers to develop new post-fertilisation methods of birth control. As she points out, post-fertilisation can cover the time periods both before and after implantation, which in every woman will not happen in the exact same number of minutes, hours or days. But as they argue, and Sally Sheldon[2] also discusses, the greater difficulty is not the scientific challenge but the political one.

Developing new and improved methods of contraception, emergency contraception and abortion has been one of the priorities of the UN’s Human Reproduction Programme (HRP),[3] based at the World Health Organization, for over 40 years now. HRP’s public sector research has had a huge influence on pharmaceutical companies’ research, production, sale and distribution of birth control and abortifacient methods.[4] Without their research and collaboration with the French company that developed mifepristone, for example, it is unlikely that medical abortion with mifepristone+misoprostol would exist, nor that work would have been done on effective regimens for using misoprostol alone for inducing an abortion.

While HRP are not researching post-fertilisation methods of fertility control, they are, according to their website,[5] working on a just completed “proof of concept” study on the use of a levonorgestrel pill that can be taken 24 hours before or after intercourse up to six times a month.[6] All praise to them for this ‒ a pericoital method that can be used more than once a month ‒ what a great idea!

HRP’s current research projects also include a study of three possible pain control approaches for medical abortion, and another on the burden and severity of complications related to unsafe abortion.[7] Might it be possible to get them to engage in new research on a post-fertilisation method or even a very early abortion method? After all, mifepristone and misoprostol have been around for 25 years now, and if we think about how much pre-fertilisation contraceptive methods have changed during that 25 years, perhaps the motivation to get back to the bench would increase.

Women are definitely interested. A recent survey of more than 1,000 women in Britain by Bpas found that 48% of women would consider a once-a-month pill to stop development of early pregnancy by detaching any fertilised egg from the lining of the womb. Only a quarter (26%) said they would not, with the remainder (26%) unsure.[8] Why take a pill every day if you could take one once a month ‒ and perhaps only if your period is late.

Meanwhile, the rest of us need to get to work on the political difficulties new methods like this might raise. As Sally Sheldon discusses, the legal difficulty is that such methods would not be considered contraception but would fall within current legal definitions of abortion, potentially limiting their approval by governments. Thus, in countries like Great Britain that define pregnancy as beginning at implantation, approving them would require a change in the law.

Which is only one of many good reasons why abortion should be treated like every other form of medical care, subject to approval, availability and use based on its public health benefits, safety and efficacy.

References

[1] Raymond EG, et al. Embracing post-fertilisation methods of family planning: a call to action. Journal of Family Planning & Reproductive Health Care 2013; 39(4):244-246.

[2] Sheldon S. The regulatory cliff edge between contraception and abortion: the legal and moral significance of implantation. Journal of Medical Ethics http://jme.bmj.com/content/early/2015/06/17/medethics-2015-102712.full

[3] UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

[4] http://www.who.int/reproductivehealth/projects/en/

[5] http://www.who.int/reproductivehealth/projects/contraception/en/

[6] http://www.who.int/reproductivehealth/projects/HRX3_Pericoital-levonorgestrel.pdf?ua=1

[7] http://www.who.int/reproductivehealth/projects/pua/en/

[8] http://www.reproductivereview.org/index.php/rr/article/1711/ .

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