Emergency contraception receives its fair share of controversy since it is considered to be possibly abortificient if used after the woman has ovulated

Apart from the fact that there are tests for ovulation, many women know, or can learn, how to recognise body biological markers to know when they are ovulating, thus helping them either to conceive or to avoid pregnancy in a natural way.

Emergency contraception (EC) has also been accepted by the British Episcopal conference if used in instances of rape and if used before ovulation. Recently, Catholic theologians and bioethicists, most notably Dr Daniel Sulmacy, who is a renown physician and ethicist working in the (Catholic) Kennedy Institute of Ethics at Georgetown University (a Jesuit University), and who happens also to be a Franciscan Friar, has written an intriguing article saying that when one considers the implications of false positives and false negatives that any medical test can have, the test for ovulation cannot predict a pregnancy and that when all the maths is done (which he duly carried out), it is better to do a pregnancy test.

On the other hand, EC is used in cases other than rape on a daily basis. So the question is whether one should still be careful if EC is used after ovulation. The short answer is ‘yes’ – one should still recognise the possibility of pregnancy and be cautious – at least until the federal food and drug administration (the FDA) decides it is safe.

But the evidence is accumulating against EC’s abortificient effect. Dr Petra Casey of the Mayo clinic asserts that “these medications are there to prevent or delay ovulation; they don’t act after fertilisation”. Mayo clinic is too much of a frontline medical facility to allow one of its consultants to issue statements based on opinion or without scientific backing, especially in the United States, where the issue of EC is now up for discussion in the coming elections.

The FDA has declined to discuss its past decision even though it is acknowledged that the agreement to list its ‘possible’ abortificient effects was made without scientific backing but using the inference that once one is changing the lining of the uterus and tubes, then a fertilised egg will find it difficult to implant and will be aborted. But Erica Jefferson, a spokeswoman for the FDA, acknowledges that the emerging data suggests that emergency contraception does not inhibit implantation. So things seem bound to change in the (near?) future.

Would a change brought about by the FDA bring about a change in morality and legislation locally? Certainly, our parliament would be forced to make a decision. Already doctors have to resort to what is called off-label use of normal contraceptive pills if they use (following Church guidelines for rape) EC following rape. Conversely, since normal contraception is not illegal, if evidence shows (and the FDA approves) EC as not preventing implantation of any fertilised eggs, then based on past statements by ministers of health who appealed for evidence, it would be embarrassing not to legislate in its favour.

On the other hand, contraception is always a moral issue; as is sexual activity outside marriage. Sexual activity has always come with moral baggage. Although many now accept that young people are having sex, it does not mean they agree wholeheartedly that it should be so. Once in a committed relationship, adultery is still in our dictionaries. Many young people still believe that this human activity should be reserved to loving relationships which culminate in a marriage, even not for religious reasons.

Of course contraception and understanding of cycles have removed the fear of pregnancy and gave scope to an increase in sexual activity – which is why many resisted sexual education.

The reality is that we use contraception; and many of us doctors prescribe it when necessary (even though there is a right to objection of conscience) and it would seem that if this is the case then EC would be amongst the tools we now can use without fear of causing abortion. But we also know that something which has been ingrained in us will take more than an FDA approval to bring about a change in moral scope – that of making it equivalent to normal contraception.

Pierre Mallia is Associate Professor in Family Medicine, Patients’ Rights and Bioethics at the University of Malta;

he is also Ethics Adviser to the

Medical Council of Malta.

He is also former president of the

Malta College of Family Doctors