Society and Emergency Contraception

Andy had an interesting post on sex, emergency contraception, and society that raised a lot of questions for me (these aren't questions I have the answers to, nor are they directed to Andy, to whose arguments they're really only tangential). In his post, Andy refers to some bloggers whose contraception failed and they were subsequently denied access to emergency contraception. He's primarily concerned with how society weighs the rights of doctors or pharmacists who think emergency contraception and birth control pills (ECs are big doses of regular oral contraceptives and prevent pregnancy in the same ways as the pill) are "uncomfortably close to abortion" against the rights and responsibilities of couples who largely consider sex to be non-procreative. The angle I want to approach this issue from is less about sex and its consequences and more through the lens of when life begins and when it should be protected.

Some time ago I read an essay in the Washington Post (I think) about a woman who experienced the exact situation Andy describes. She and her husband had a couple kids and didn't want more so they used contraception. Somehow the contraception failed and the woman searched in vain to obtain emergency contraception. She was denied access until after the window of EC's effectiveness had closed, became pregnant, and then had an abortion. This woman was outraged because she felt that when one morally acceptable (to her) avenue of preventing pregnancy was cut off, the only way she could prevent having another baby was by a morally troubling option: abortion. Although the doctors and/or pharmacists who denied her ECs thought that a fertilized egg was the moral equivalent of a 12-week fetus, this woman clearly thought there was a big difference.

So how should society balance the incompatible desires of people who believe personhood begins at conception and those who believe it begins sometime after that? Personhood and the rights that go with it are impossible to pin down objectively - there's no scientific proof or theological consensus - instead, it comes down to what people feel about when life is valuable and should be protected (and I don't mean to trivialize people's beliefs by pointing this out; strong feelings on all sides are still worthy of respect). If we lived in an ideal world, there wouldn't be contraception that fails, accidental pregnancies, unwanted children, or pharmacies and hospitals without policies to protect their employees' consciences while simultaneously meeting the medical needs of their female patients, and this wouldn't be an issue. But in a less than ideal world where we are sometimes forced to choose between preventing pregnancy (even if it possibly means that a potentially fertilized egg won't be implanted in the uterine wall) and possibly preventing an abortion, where should society's interest's lie?* Does society have a stake in distinguishing between a fertilized egg and a fetus with a heartbeat and fingernails, or should society consider them equal as well? Can we use objective criteria (rather than moral beliefs) to consider when weighing the rights of one against the rights of another, or does it all come down to affirming one set of values at the expense of another? How should a pluralistic society best account for diversity of belief when making policy?


*Of course, we're dealing in so many hypotheticals here. Hormonal contraception works primarily to prevent or delay ovulation and there's no evidence that it inhibits implantation of a fertilized egg. Yet there is enough doubt that many people do feel morally conflicted about that possibility. Likewise, we don't know which unintended pregnancies will end in abortion, although the trend is that half of these unwanted babies will be aborted. One could argue that society's interest lies in children being born but, as I've covered in this blog many, many, many times in the past, claiming that a nation that accepts 17.8% of its children living in poverty and 8.3 million children living without health insurance could possibly care about children is laughable. (Unless those children stand to inherit multi-million dollar estates; then their welfare is in society's interest.)