Beginning of pregnancy controversy
Encyclopedia
Controversy over the beginning of pregnancy usually occurs in the context of the abortion
debate. Depending on where pregnancy is considered to begin, some methods of birth control
or infertility treatment might be considered abortifacient
. The controversy is not primarily a scientific issue since knowledge of human reproduction and development has become very refined, but rather is primarily a linguistic and definitional question. The issue may also have social, medical, political and legal ramifications, but only if one equates the "beginning of pregnancy" with the "beginning of an individual human being's life".
from a number of convenient points, including the day of last menstruation
, ovulation, fertilization
, implantation and chemical detection. This has led to some confusion about the precise length of human pregnancy, as each measuring point yields a different figure.
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."
Similarly, the British Medical Association
has defined an "established pregnancy" as beginning at implantation. The legal definition in the United Kingdom is not clear. Other definitions exist. The American Heritage Stedman's Medical Dictionary
defines "pregnancy" as "from conception until birth." Definitions like this may add to a lay person's confusion, as "conception" in a medical context is defined as implantation but in lay terms may mean either fertilization or implantation. However, some medical professionals who oppose birth control, including prominent member of Focus on the Family
Walter Larimore, have argued that the medical definition of conception should include fertilization.
Finally, the standard historical method of counting the duration of pregnancy
begins from the last menstruation and this remains common with doctors, hospitals, and medical companies. This system is convenient because it is easy to determine when the last menstrual period was, while both fertilization and implantation occur out of sight. An interesting consequence is that the dating of pregnancy measured this way begins two weeks before ovulation.
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.
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." It was only in 1875 that Oskar Hertwig
discovered that fertilization includes the penetration of a spermatozoon into an ovum. Thus, the term "conception" was in use long before the details of fertilization were discovered. By 1966, a more precise meaning of the word "conception" could be found in common-use dictionaries: the formation of a viable zygote
.
In 1959, Dr. Bent Boving suggested that the word "conception" should be associated with the process of implantation instead of fertilization. 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."
The 1965 ACOG definition was imprecise because, by the time it implants, the zygote is called a blastocyst
, so it was clarified in 1972 to "Conception is the implantation of the blastocyst." Some dictionaries continue to use the definition of conception as the formation of a viable zygote.
Birth control methods usually prevent fertilization. This cannot be seen as abortifacient
because, by any of the above definitions, pregnancy has not started. However, some methods might have a secondary effect of preventing implantation, thus allowing the zygote
to die. Those who define pregnancy from fertilization subsequently may conclude that the agents should be considered abortifacient
s.
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 and a study of the combined oral contraceptive pill has been proposed.
(after the woman's Last Menstrual Period), and an additional 7% miscarry or are stillborn. As a result, even without the use of birth control
, between 50% and 70% of zygotes never result in established pregnancies, much less birth.
groups. Hormonal contraceptives have a possible effect of preventing implantation of a blastocyst, as discussed previously. Use of these drugs with the intention of preventing pregnancy is seen by some pro-life groups as immoral. This is because of the possibility of causing the end of a new human life.
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 pro-life groups do not consider the practice to be immoral, citing the bioethical principle of double effect
. Likewise, when a hormonal contraceptive is used with the intention of preventing fertilisation, the intended reduction in implantation failures, miscarriages and deaths from childbearing may outweigh the possibility that the method might cause some implantation failures.
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. 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.
(EPF) is detectable in a woman's blood within 48 hours of ovulation if fertilization has occurred. However, testing for EPF is time consuming and expensive; most early pregnancy tests detect human chorionic gonadotropin
(hCG), a hormone that is not secreted until after implantation. Defining pregnancy as beginning at implantation thus makes pregnancy a condition that can be easily tested for.
between existing persons and potential future persons has been questioned. Subsequently, it has been argued that contraception and even the decision not to procreate at all could be regarded as immoral on a similar basis as abortion
. In this sense, beginning of pregnancy may not necessarily be equated with where it is ethically right or wrong to assist or intervene. In a consequentialistic
point of view, an assisting or intervening action may be regarded as basically equivalent whether it is performed before, during or after the creation of a human being, because the end result would basically be the same, that is, the existence or non-existence of that human being.
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
debate. Depending on where pregnancy is considered to begin, some methods of birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
or infertility treatment might be considered abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....
. The controversy is not primarily a scientific issue since knowledge of human reproduction and development has become very refined, but rather is primarily a linguistic and definitional question. The issue may also have social, medical, political and legal ramifications, but only if one equates the "beginning of pregnancy" with the "beginning of an individual human being's life".
Definitions of pregnancy beginning
Traditionally, doctors have measured pregnancyPregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
from a number of convenient points, including the day of last menstruation
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
, ovulation, fertilization
Fertilisation
Fertilisation is the fusion of gametes to produce a new organism. In animals, the process involves the fusion of an ovum with a sperm, which eventually leads to the development of an embryo...
, implantation and chemical detection. This has led to some confusion about the precise length of human pregnancy, as each measuring point yields a different figure.
At its 2004 Annual Meeting, The American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
passed a resolution in favor of making "Plan B" emergency contraception
Emergency contraception
Emergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...
available over-the-counter, and one of the claims in the resolution was that hormonal contraception
Hormonal contraception
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
that may affect implantation "cannot terminate an established pregnancy."
Similarly, the British Medical Association
British Medical Association
The British Medical Association is the professional association and registered trade union for doctors in the United Kingdom. The association does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The association’s headquarters are located in BMA House,...
has defined an "established pregnancy" as beginning at implantation. The legal definition in the United Kingdom is not clear. Other definitions exist. The American Heritage Stedman's Medical Dictionary
Medical dictionary
A medical dictionary is a lexicon for words used in medicine. The three major English language medical dictionaries are Stedman's, Taber's, and Dorland's Pocket Medical Dictionary. Other significant medical dictionaries are distributed by Elsevier, the world's largest publisher of medical and...
defines "pregnancy" as "from conception until birth." Definitions like this may add to a lay person's confusion, as "conception" in a medical context is defined as implantation but in lay terms may mean either fertilization or implantation. However, some medical professionals who oppose birth control, including prominent member of Focus on the Family
Focus on the Family
Focus on the Family is an American evangelical Christian tax-exempt non-profit organization founded in 1977 by psychologist James Dobson, and is based in Colorado Springs, Colorado. Focus on the Family is one of a number of evangelical parachurch organizations that rose to prominence in the 1980s...
Walter Larimore, have argued that the medical definition of conception should include fertilization.
Finally, the standard historical method of counting the duration of pregnancy
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
begins from the last menstruation and this remains common with doctors, hospitals, and medical companies. This system is convenient because it is easy to determine when the last menstrual period was, while both fertilization and implantation occur out of sight. An interesting consequence is that the dating of pregnancy measured this way begins two weeks before ovulation.
Legal implications
In August 2008 the U.S. Department of Health and Human ServicesUnited States Department of Health and Human Services
The United States Department of Health and Human Services is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America"...
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.
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. 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." It was only in 1875 that Oskar Hertwig
Oskar Hertwig
Oscar Hertwig was a German zoologist and professor, who also wrote about the theory of evolution circa 1916, over 55 years after Charles Darwin's book The Origin of Species...
discovered that fertilization includes the penetration of a spermatozoon into an ovum. Thus, the term "conception" was in use long before the details of fertilization were discovered. By 1966, a more precise meaning of the word "conception" could be found in common-use dictionaries: the formation of a viable zygote
Zygote
A zygote , or zygocyte, is the initial cell formed when two gamete cells are joined by means of sexual reproduction. In multicellular organisms, it is the earliest developmental stage of the embryo...
.
In 1959, Dr. Bent Boving suggested that the word "conception" should be associated with the process of implantation instead of fertilization. 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."
The 1965 ACOG definition was imprecise because, by the time it implants, the zygote is called a blastocyst
Blastocyst
The blastocyst is a structure formed in the early embryogenesis of mammals, after the formation of the morula. It is a specifically mammalian example of a blastula. It possesses an inner cell mass , or embryoblast, which subsequently forms the embryo, and an outer layer of cells, or trophoblast,...
, so it was clarified in 1972 to "Conception is the implantation of the blastocyst." Some dictionaries continue to use the definition of conception as the formation of a viable zygote.
Birth control – mechanism of action
- See also COCP: Mechanism of Action
Birth control methods usually prevent fertilization. This cannot be seen as abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....
because, by any of the above definitions, pregnancy has not started. However, some methods might have a secondary effect of preventing implantation, thus allowing the zygote
Zygote
A zygote , or zygocyte, is the initial cell formed when two gamete cells are joined by means of sexual reproduction. In multicellular organisms, it is the earliest developmental stage of the embryo...
to die. Those who define pregnancy from fertilization subsequently may conclude that the agents should be considered abortifacient
Abortifacient
An abortifacient is a substance that induces abortion. Abortifacients for animals that have mated undesirably are known as mismating shots....
s.
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 and a study of the combined oral contraceptive pill has been proposed.
Possibly affected methods
- Hormonal contraceptionHormonal contraceptionHormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
, including emergency contraceptionEmergency contraceptionEmergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...
, are known to be effective at preventing ovulation. Some scientists believe hormonal methods may have a secondary effect of interfering with implantation of embryos. - Intrauterine deviceIntrauterine deviceA copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...
s (IUDs) have been proven to have strong spermicidal and ovicidal effects; the current medical consensus is that this is the only way in which they work. Still, a few physicians have suggested they may have a secondary effect of interfering with the development of pre-implanted embryos; this secondary effect is considered more plausible when the IUD is used as emergency contraceptionEmergency contraceptionEmergency contraception , or emergency postcoital contraception, refers to birth control measures that, if taken after sexual intercourse, may prevent pregnancy.Forms of EC include:...
. - The lactational amenorrhea methodLactational Amenorrhea MethodThe lactational amenorrhea method is a method of avoiding pregnancies which is based on the natural postnatal infertility that occurs when a woman is amenorrheic and fully breastfeeding...
works primarily by preventing ovulation, but is also known to cause luteal phase defect (LPD). LPD is believed to interfere with the implantation of embryos. - Fertility awarenessFertility awarenessFertility awareness refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health....
methods are known to work by preventing fertilization. It has been speculated they have a secondary effect of creating embryos incapable of implanting (due to aged gametes at the time of fertilization), although this is disputed . 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. Age of gametes at the time of fertilization has been shown to have no effect on low birth weight or preterm delivery.
Viability and established pregnancy
A related issue that comes up in this debate is how often fertilization leads to an established, viable pregnancy. Current research suggests that fertilized embryos naturally fail to implant some 30% to 60% of the time. Of those that do implant, about 25% suffer early pregnancy loss by the sixth week LMPGestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation age....
(after the woman's Last Menstrual Period), and an additional 7% miscarry or are stillborn. As a result, even without the use of birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
, between 50% and 70% of zygotes never result in established pregnancies, much less birth.
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 pro-lifePro-life
Opposition to the legalization of abortion is centered around the pro-life, or anti-abortion, movement, a social and political movement opposing elective abortion on moral grounds and supporting its legal prohibition or restriction...
groups. Hormonal contraceptives have a possible effect of preventing implantation of a blastocyst, as discussed previously. Use of these drugs with the intention of preventing pregnancy is seen by some pro-life groups as immoral. This is because of the possibility of causing the end of a new human life.
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 pro-life groups do not consider the practice to be immoral, citing the bioethical principle of double effect
Principle of double effect
The principle of double effect; also known as the rule of double effect; the doctrine of double effect, often abbreviated as DDE or PDE; double-effect reasoning; or simply double effect, is a set of ethical criteria for evaluating the permissibility of acting when one's otherwise legitimate act...
. Likewise, when a hormonal contraceptive is used with the intention of preventing fertilisation, the intended reduction in implantation failures, miscarriages and deaths from childbearing may outweigh the possibility that the method might cause some implantation failures.
A related application of the principle of double effect is breastfeeding
Breastfeeding
Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...
. 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. Some pro-choice groups have expressed concern that the movement to recognize hormonal contraceptives
Hormonal contraception
Hormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
as abortifacient will also cause breastfeeding to be considered an abortion method.
Detectable pregnancy
A protein called early pregnancy factorEarly pregnancy factor
Early pregnancy factor or early conception factor is a protein associated with mammalian embryos shortly after fertilization. It may be composed of more than one molecule. It was first described in 1976.-Detection:...
(EPF) is detectable in a woman's blood within 48 hours of ovulation if fertilization has occurred. However, testing for EPF is time consuming and expensive; most early pregnancy tests detect human chorionic gonadotropin
Human chorionic gonadotropin
Human chorionic gonadotropin or human chorionic gonadotrophin is a glycoprotein hormone produced during pregnancy that is made by the developing embryo after conception and later by the syncytiotrophoblast .. Some tumors make this hormone; measured elevated levels when the patient is not...
(hCG), a hormone that is not secreted until after implantation. Defining pregnancy as beginning at implantation thus makes pregnancy a condition that can be easily tested for.
Philosophical issues
The distinction in ethical valueValue (ethics)
In ethics, value is a property of objects, including physical objects as well as abstract objects , representing their degree of importance....
between existing persons and potential future persons has been questioned. Subsequently, it has been argued that contraception and even the decision not to procreate at all could be regarded as immoral on a similar basis as abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
. In this sense, beginning of pregnancy may not necessarily be equated with where it is ethically right or wrong to assist or intervene. In a consequentialistic
Consequentialism
Consequentialism is the class of normative ethical theories holding that the consequences of one's conduct are the ultimate basis for any judgment about the rightness of that conduct...
point of view, an assisting or intervening action may be regarded as basically equivalent whether it is performed before, during or after the creation of a human being, because the end result would basically be the same, that is, the existence or non-existence of that human being.