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Emergency Contraception
- David A. Grimes, MD; and
- Elizabeth G. Raymond, MD, MPH
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IN RESPONSE:
Dr. Miller apparently disagrees with the internationally accepted definition of the beginning of pregnancy that we used in our review. Major medical organizations (1) as well as the federal government (2) concur that implantation defines the beginning of pregnancy. Fertilization is a necessary but insufficient step toward establishing pregnancy.
An in vitro fertilization example may help to clarify this point. Assume that a woman from Dr. Miller's hometown of Hickory has successful in vitro fertilization in a medical center in Charlotte, North Carolina, 64 miles distant. An egg and sperm unite in a Petri dish, leading to a unique new genetic complement. Can the woman announce to her neighbors that she is pregnant? Should her obstetrician in Hickory begin providing prenatal care? Her fertilized ovum resides in a different city. Clearly, not until the fertilized ovum successfully implants in her uterus (or elsewhere) is she pregnant. Similarly, with in vivo fertilization in the fallopian tubes, a woman is not pregnant until the ovum implants.
Contrary to Dr. Miller's claim, this is a distinction with a difference: Emergency contraception prevents a pregnancy from starting, and abortion interrupts a pregnancy already established. Whether emergency contraception acts by inhibition of ovulation or by interference with implantation, no pregnancy exists and thus no abortion can occur. Stated alternatively, regardless of its mechanism of action, emergency contraception is not abortifacient.
David A. Grimes, MD
Elizabeth G. Raymond, MD, MPH
Family Health International; Research Triangle Park, NC 27709
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
