Talk:Emergency contraception/Archive 1

Contraceptive or Abortifacient

As the article clearly and correctly states, the morning after pill is not an abortifacient, and can hardly "end" a pregnancy three days after intercourse, as implantation would not have occurred in that time. -- Someone else 02:58, 20 Sep 2003 (UTC)

You are welcome to this opinion, but some would disagree. This [1] addresses both views. -BuddhaInside

Yeah, and I'll ask my doctor her opinion about transubstantiation. -- Someone else 03:05, 20 Sep 2003 (UTC)

Ok. I have no problem with you doing that. -BuddhaInside

She says she's against it. Please don't put misinformation here. The views of both "sides" are adequately represented in this article. -- Someone else 03:12, 20 Sep 2003 (UTC)

The statement Whether emergency contraceptives are considered abortifacient hinges upon what definition of the beginning of pregnancy is subscribed to is not misinformation. While you have been repeatedly reverting the article, I have edited this statement through at least three revisions to make it as noncontroversial as possible. -BuddhaInside

Yes, and that statement was written after I characterized your prior change as misinformation. The article appropriately addresses a medical topic by considering it medically first and addressing moral concerns later. It doesn't need a discursive paragraph on religious opinions before it addresses scientifice concerns: it addresses religious concerns at the appropriate place. -- Someone else 03:24, 20 Sep 2003 (UTC)

How does an "emergency contraceptive" prevent conception, when conception may have already happened? -BuddhaInside

If it does prevent not conception but implantation it is not a contraceptive but a abortifacient. Though this pill might function both ways, "emergency contraception" is mainly just a smokescreen.

132.187.253.14 19:55, 9 May 2005 (UTC)

Read the mechanisms in the article. It should be stated that it prevents pregnancy, not conception. Removed "Because a contraceptive is literally anything which prevents conception, when taken after the moment of conception the morning after pill acts as an abortifacient." which is illogical: the first part of the sentence does not imply the latter part. You're not representing the viewpoint correctly, let alone attributing it (as it is later in the article). -- Someone else 03:36, 20 Sep 2003 (UTC) -- Someone else 03:36, 20 Sep 2003 (UTC)

I was off doing this groundwork:

Definitions of pregnancy written by those other than "religious conservatives"...

• Columbia Encylopedia - period of time between fertilization of the ovum (conception) and birth [2]
• The 'Lectric Law Library - to be the state of a female who has within her ovary or womb, a fecundated germ [3]
• WordReference - the period from conception to childbirth [4]
• American Heritage - Carrying developing offspring within the body [5] (vague, yet applies).

-BuddhaInside

The second is both quaint and bizarre, implying that eggs are fertilized in an ovary, and that an ovary and womb are synonymous. -- Someone else 03:58, 20 Sep 2003 (UTC)

Indeed. The phrase "fecundated germ" is particularly darling. -BuddhaInside

You've just reverted the article eight times without working to improve it whatsoever. It appears that your entire point is that there is only one functional definition of pregnancy, and you miss the point entirely that a contraceptive is that which prevent conception. -BuddhaInside

removing "A contraceptive is literally anything which prevents conception. When the morning after pill is taken prior to conception it indeed acts as a contraceptive, but when taken after the moment of conception it acts as an abortifacient. " is an improvement. My point is that the argument you seem so intent on pursuing is is adequately presented later in the article, in a more appropriate place, and in a more readable manner. -- Someone else 04:09, 20 Sep 2003 (UTC)

The statement "later in the article" makes it sound as though this is something that is limited to religious conservatives. Further whether the morning after pill should be considered a contraceptive or a abortifacient is debated. If the article calls it a "contraceptive" in the first paragraph, the competing viewpoint should be presented immediately. -BuddhaInside

Later in the article means that I think medical discussion should be first, and ethical discussion after. The article says it is known as emergency contraception, which is simply true, not a viewpoint. -- Someone else 04:30, 20 Sep 2003 (UTC)

Indeed. The phrasing "known as" is a key distinction. But again, once representing it as something that is called "contraceptive" by some, it is appropriate to mention that it may not be called "contraceptive" by all, and may literally be abortifacient in certain cases. It is also appropriate to create a link to abortifacient (which did not exist prior) and begin a broader definition there. -BuddhaInside

Well, so you apparently think. I myself prefer to think that people might actually like an article about the morning after pill, rather than about the ethics of the morning after pill. -- Someone else 05:35, 20 Sep 2003 (UTC)

well; you may do Someone else, but it is not everyone opinion. In my country, many schools provide courses in sexual education when kids are around 14. Some of these courses are followed by visits of national centers when kids are taught how to protect themselves from pregnancy or disease. As one can see in the article, France tried to easily provide morning pill to teenagers in school a few years ago, and the ethics of the pill is *precisely* was lead to a *major* discussion over the country, because it was argue that thought it was not "technically" ending a pregnancy, it was indeed eliminated what would become a living being. Note that some uterine device work in the same way. The catholic church considered it should not become a standard processus. Similar discussions occured over RU468 when I was a teenager. I think that no contraceptive/abortive medication/device articles should restrict themselves to practical use and consequences, but should also include some discussion over their ethical aspects. Anthère

The article DOES include discussion of ethical aspects, and it DOES distinquish between RU486 and the morning after pill. It's just not in the second paragraph. -- Someone else 07:23, 20 Sep 2003 (UTC)

Precisely. It make sense to put first (at the top) important points, and to put below less important points. Right now, the three lines sentence about the fact morning pill raise some ethical questions in paragraph number 5, while the current brand most used in the US is paragraph number 2. I object the fact the current most famous brand in the US is more important and deserve to be put at the top, more than the ethical discussion. Besides, indicating religious conservative object to its use is misrepresenting the fact that other than religious conservative could wonder over when life begins or not. Anthère

I agree with Someone else the article is fine as it is, it already presents both POV's.Also a slap on wrist for BuddhaInside. Minor edits are for typo's, fixing broken links, and changes in formatting.Adding and deleting content is not minor, and in an edit war situation you should never mark edits as minor. Theresa knott 07:35, 20 Sep 2003 (UTC)

Here is my proposition.

• Move the paragraph on most used american pill more below in the article, for a more world wide approach.
• Add pro-life in the line with "religious conservative" to make it more general and recognise the pro-life people opinion on the matter (to avoid restricting the statement to religious people). I agree that the article is probably clear enough on why some people hold that opinion
• add the link this buddha indicated above in external links for a opening toward a pro-life opinion and ethical background for discussion
• add another link toward pro-choice opinion if you feel the one above needs to be balanced

What do you think ?

Anthère

What do you think about my edits, Anthere?—Eloquence 09:07, Sep 20, 2003 (UTC)

I like them. That is more balanced. Suits me. Thanks. Anthère

The page is no more protected then ?

I made a point about the first headline though. Either this one just explains the two different types of pills in terms of chemical composition and medical risk. Or it goes further in adding brands and mentionning countries, in this case, America brands may be balanced by other countries. My preferred position would be to limit it to chemical description and medical impacts. And to move "country related" stuff below. ant

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Hmmm... we know it is available in the US, France, UK, Albania, Belgium, Denmark, Finland, Israel, Morocco, Norway, Portugal, South Africa, Australia, and Sweden. What places have made it inaccessible? -- Someone else 09:25, 20 Sep 2003 (UTC)

How about Ireland and Poland? I found a 2001 report that stated it "may be legalized" in Ireland, but I'm not sure what the current status is.—Eloquence 09:28, Sep 20, 2003 (UTC)

I'd have guessed Ireland and perhaps Italy, but it seems to be more available than unavailable. It would be nice to know though. Ireland legalized contraception in 1979 but for married couples only, with a prescription, but no mention of whether the morning after pill is available. -- Someone else 09:50, 20 Sep 2003 (UTC)

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Reading this article, I'm unclear as to whether the pill (in the emergency mode, taken soon after sex) is a contraceptive or not. Does it prevent conception (fertilization of the egg) or not? If my prior understanding of the function is correct, it acts as a form of birth control by preventing implantation of the zygote, but not as a contraceptive like condoms. — Daniel Quinlan 06:53, Sep 21, 2003 (UTC)

It can work by any of three mechanisms, depending on the stage of the menstrual cycle. It can prevent release of the ovum from the ovary (if it is not yet released); it can prevent fertilization, if the egg has been released but has not been fertilized; it can prevent implantation of a fertilized egg if it has not already been implanted. Given the time frame (within 3 days of intercourse) the former two (clearly contraceptive) mechanisms are going to be the more frequent ones. -- Someone else 07:04, 21 Sep 2003 (UTC)

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Just as an FYI, if all the factors are right and conception (fertilization) does occur as a result of intercourse, it occurs less than seven minutes after ejaculation.

See http://www.drspock.com/article/0,1510,5049,00.html for a more detailed explanation.

Pianoman123 08:53, 6 September 2006 (UTC)

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3 changes, Anthere. The first is describing the pill as acting to prevent implantation:

• [1] the more normal way would be to say it prevents pregnancy, but BI refuses to permit that.

• • Me neither. It is not clear when pregnancy begins.

• [2] on the mechanisms it's not and/or, it's just or: if you prevent the release or prevent the fertilization you can't also prevent implantion of a fertilized ovum, as there won't be one.

• • but ! precisely ! It is "you" who put "and" :-) I replaced it by "and/or" not to remove your "and". Putting "or" would just suit me perfectly :-)

• [3] Abortifacient has a clear medical meaning, and it's "an agent that results in an implanted zygote or embryo (or fetus) being expelled". The morning after pill doesn't do that: it's not classified as an abortifacient. Though those who oppose the morning after pill because it prevents implantation may use the word abortifacient to make a rhetorical point, that's their own very peculiar definition: the medical definition is the one that should be used, as it clarifies that RU-486 IS and abortifacient and the morning after pill ISN'T. -- Someone else 07:49, 21 Sep 2003 (UTC)

• • Yes, but an american medical point of view. It is just *one* point of view
  • my favorite encyclopedia (well, second after wikipedia of course), say an "agent abortif" is something that provoke/lead to abortion. Abortion is defined as being the loss of an embryo or foetus. And an embryo is an organism from the fertilization stage to 3 months. By french standard (medical ones too), a foetus is one from the fertilization moment, not the implantation (I looked for a link for you, http://www.aly-abbara.com/livre_gyn_obs/termes/emryon_foetus.html).

Anthère

That's a nice reference and the french/americans do not define embryo or fetus differently. But if you find a french (or any other countries) pharmacoepia that lists the morning after pill as an 'abortifacient' i will be VERY surprised: it just isn't one. I don't think it's a national difference. The only thing I would differ with your 2nd favorite encyclopedia is the claim that the loss of ANY embryo is abortion: I think the term more stringently defined would call only the loss of an implanted embryo an abortion; Pregnancy starts when implantation occurs: the only confusion on this matter is that it can only be spoken of retrospectively: in common speech one never has the opportunity to say "I'm pregnant" until well after implanation has already occurred. -- Someone else 08:32, 21 Sep 2003 (UTC)

Your point of view is very interesting, but I disagree with some points.

First, tough that is "private" stuff, I must respectfully disagree with the in common speech one never has the opportunity to say "I'm pregnant" until well after implanation has already occurred.

"Well after" is very much undefined. When I decided to get pregnant one year in december, we had sexual relationship on the 1rst of january, and morning sickness (morning was an understatement) started on the 4th. On the 5th of january, I went to a medical facility (in USA) for an unrelated medical pb that required medical treatment. When I indicated I was pregnant, and wanted to be sure the medication would not be a pb to the foetus, medical staff answered me I was not, I could not, and even if I was, I would not be said so before I was at least 1 week late. Followed a good bunch of discussion after which they agreed to make a test (I mean, I was a pain, right ?). The test was positive. Inside themselves, I know they admitted the fact, for they asked me to come back two days later for an echo, become of a lump that made them fear of a nidation was occurring at the wrong place (a couple days later, the lump was gone, very likely, it was the yellow corpse, which is very enlarged at 5 days of pregnancy). They then told me the medication was fine to take for a pregnant woman, but they refused to officially admit me as pregnant. I did not understand at that time :-) It is not until 3 weeks later that I was registered pregnant, even though I had already lost 6 pounds from "morning" sickness.

Something you might find interesting as well, is that the french length of pregnancy is 10 days longer than the american one. Curious eh ?

Now, to come back to the abortifacient aspect, I would not even try to check because I know it is classified in an in-between class, that we call "contraceptif d'urgence". It is of course advertised as a contraceptive. I found for you a link to the legal discussion at our assembly which occured in 2000.

http://www.assemblee-nat.fr/cri/leg11/html/20010007.asp

I will translate to you a very interesting part of it, that will show you perhaps that "medical definition" has its limits, and that we should not limit ourselves to it in our description of the issue.

Monsieur le président, mesdames les ministres, madame la rapporteuse, mes chers collègues, c'est encore à la sauvette que nous discutons d'un texte qui pose d'importants problèmes de société à l'occasion d'une niche parlementaire, un jour de moindre affluence dans l'hémicycle. Car la proposition de loi sur la contraception d'urgence n'est pas un texte anodin, à caractère technique, destiné à remédier à un simple dysfonctionnement juridique.

En proposant que la pilule du lendemain puisse être distribuée par des infirmières dans les collèges et lycées sans autorisation parentale et sans prescription médicale, ce texte pose très sérieusement plusieurs problèmes politiques et sociaux très importants. Quelle conception du rôle des parents et de leurs activités véhicule-t-il ? Comment s'insère-t-il dans les objectifs de santé publique et quelle image donne-t-il des responsabilités médicales, éducatives et politiques ? Premièrement : qu'entend-on exactement par contraception d'urgence ? Il semble qu'aujourd'hui il n'existe que deux produits susceptibles de répondre à cette appellation : le Tétragynon, à base d'oestrogènes, et le Norlevo, à base de progestérone. Seul le second serait concerné par le texte dont nous discutons, parce qu'il ne présenterait pas de dangers pour la santé. Ces pilules sont-elles réellement une méthode de contraception ? La notice du Norlevo indique : « La contraception d'urgence est une méthode de rattrapage qui vise à éviter l'ovulation ou l'implantation d'un oeuf fécondé en cas de rapport sexuel non protégé. »

En d'autres termes, soit le Norlevo a un effet nul, si le rapport a été non fécondant ou si l'ovule fécondé est en train de s'implanter, soit il a un effet contraceptif en empêchant la fécondation, soit il empêche l'implantation.

Mais l'implantation de quoi ? De l'ovule fécondé, c'est-àdire de l'embryon. La vie de l'embryon, de l'être humain, commence dès la fécondation. Il possède dès ce moment tout son patrimoine génétique, donc, quel que soit le nom qu'on lui donne, la prise de levonorgestrel peut avoir pour effet d'arrêter le développement de la vie humaine. Il n'y a en effet aucun doute scientifique sur le fait que la vie humaine commence dès la conception.

Tout le reste n'est que bavardage.

Depuis que le débat sur ce sujet a commencé, on nous affirme que la grossesse commence à la nidation de l'embryon et que c'est la raison pour laquelle la prise de Norlevo ne peut être assimilée à une interruption volontaire de grossesse. Mais il n'existe aucune définition juridique ou scientifique permettant de vérifier cette théorie.

Selon la définition de l' Encyclopaedia Universalis , l'état de grossesse commence à l'instant de la fécondation et se termine neuf mois plus tard environ. Quoi qu'il en soit, qu'on l'appelle grossesse ou pas grossesse, quand il y a eu fécondation, la vie humaine a commencé et le Norlevo interrompt bien la vie dans ce cas-là. La réalité est que le Norlevo peut être une contraception d'urgence dans certains cas, mais qu'il peut également être un abortif d'urgence. Ce n'est pas une hypothèse minime, quand on sait que, dans les vingt-quatre heures, après un rapport sexuel non protégé au moment fertile du cycle de la femme, 30 % des rapports ont déjà été fécondants. L'expression consacrée de « contraception d'urgence » est donc limitative et trompeuse. Que l'on soit pour ou contre la distribution du Norlevo dans les collèges et lycées, cette réalité mérite d'être reconnue. Les enjeux psychologiques et moraux, puis les enjeux de santé publique sont tels que nous avons le devoir de dire la vérité sur cette question à nos concitoyens. Pour cette même raison, il est indispensable de respecter l'objection de conscience du corps médical - médecins, infirmières et pharmaciens - qui ne peut être contraint à distribuer le Norlevo en raison de ses effets.

Deuxièmement, le débat sur la pilule du lendemain fait naître plusieurs questions qui relèvent du domaine de la santé publique. L'absorption d'une pilule de Norlevo équivaut à celle de vingt-cinq comprimés d'anticonceptionnel traditionnel. Ce n'est pas rien.

L'objectif affiché est de limiter les grossesses chez les jeunes filles. Or on peut se demander si le Norlevo aura un véritable impact en ce domaine. C'est au moins un sujet de débat, que Mme la ministre a du reste évoqué dans son intervention. La possibilité de prendre ce médicament ne va-t-elle pas encourager une certaine irresponsabilité chez les filles et surtout chez les garçons ?

Thanks for leaving the original French in...the translation got a few of the technical words i didn't know but i prefer to read from the source when possible :-)--Marcie 23:23, 25 Nov 2004 (UTC)

Mr. President, Mesdames the ministers, Madam the recorder, my dear colleagues, it is still hastily that we discuss a text which poses significant problems of company at the time of a parliamentary niche, one day of less multitude in the hemicycle. Because the private bill on emergency contraception is not a text pain-killer, in technical matter, intended to cure a simple legal dysfunction. By proposing that the pill of the following day can be distributed by nurses in the colleges and colleges without parental authorization and medical regulation, this text very seriously poses several political and social problems very significant.

Which design of the role of the parents and their activities does it convey? How does it form part of the objectives of public health and which image it gives medical, educational and political responsibilities?

Firstly: what does one hear exactly by emergency contraception? It seems that today there are only two products likely to answer this name: Tétragynon, based on oestrogens, and Norlevo, containing progesterone. Only the second would be concerned with the text which we discuss, because it would not present dangers to health. Are these pills really a method of contraception? The note of Norlevo indicates: "emergency contraception is a method of correction which aims at avoiding the ovulation or the establishment of an egg fertilized in the event of sexual relation not protected" In other words, is Norlevo has a null effect, if the report/ratio were not fertilizing or if the fertilized ovule is being established, either it has a contraceptive effect by preventing fecundation, or it prevents the establishment. But establishment of what? Fertilized ovule, it is -àdire embryo. The life of the embryo, human being, starts as of fecundation. It has as of this moment all its genetic inheritance, therefore, whatever the name that one gives him, the catch of levonorgestrel can cause to stop the development of the human life.

There is indeed no scientific doubt on the fact that the human life starts as of the design. All the remainder is only chattering. Since the debate on this subject started, it is affirmed us that the pregnancy starts with the nidation of the embryo and that this is why the catch of Norlevo cannot be comparable with a termination of pregnancy. But there is not any legal or scientific definition making it possible to check this theory. According to the definition of Encyclopaedia Universalis, the state of pregnancy starts at the moment of fecundation and finishes nine months later approximately. At all events, that it is called pregnancy or not pregnancy, when there was fecundation, human life started and Norlevo stops well the life in this case. Reality is that Norlevo can be an emergency contraception in certain cases, but which it can also be abortive emergency. It is not a tiny assumption, when it is known that, in the twenty-four hours, after a sexual relation not protected at the fertile time from the cycle from the woman, 30 % of the reports/ratios were already fertilizing. The devoted expression of "emergency contraception" is thus restrictive and misleading. That one is for or counters the distribution of Norlevo in the colleges and colleges, this reality deserves to be recognized. Psychological and moral stakes, then the stakes of public health are such as we have the duty to say the truth on this question to our fellow-citizens. For this same reason, it is essential to respect the conscientious objection of the medical profession - doctors, nurses and pharmacists - who cannot be constrained to distribute Norlevo because of his effects.

Secondly, the debate on the pill of the following day gives birth to several questions which come under the field of the public health. The absorption of a pill of Norlevo is equivalent to that of twenty-five compressed of contraceptive traditional. It is nothing. The posted objective is to limit the pregnancies in the girls. However one can wonder whether Norlevo will have a true impact in this field. It is at least a subject of debate, which Mrs. the minister has of the remainder evoked in her intervention. Won't the possibility of taking this drug encourage a certain irresponsibility in the girls and especially among boys?

Mme Boutin was one of our 16th presidential candidate at our last elections. She is very focused on family, society, and bioethics. The dignity of the human person is at the center of her discourse.

She is a journalist, not a doctor. And not doctors only decide of the definition of words.

Anthère 11:03, 21 Sep 2003 (UTC)

Here [6] is a Catholic perspective on how pro-abortionists having been working to change the definition of words like "conception" and "abortion" in order to make pre-implant termination of the product of conception somehow not be abortion. -BuddhaInside

Medical researchers needs to have "alive" status be as late as possible, in order to use stem cells. Anthère

Whoah, whoah, whoah. This nitpicking about whether an unimplanted embryo counts as a pregnancy is completely beside the point. The primary method of operation for the morning-after pill is prevention of ovulation, with a small theoretical risk of interfering with implantation that hasn't even been shown to occur scientifically (see here for example), a risk which is also theoretically posed by the normal birth control pill. If you've already conceived when you take the morning-after pill, you'll stay pregnant. Conservatives hear about that "small theoretical risk" and jump all over it trying to make it out as the primary method of operation, but that doesn't make it so. DopefishJustin (・∀・) 21:45, Oct 24, 2004 (UTC)

Some additional Canadian data to add. The morning after pill is currently available from a pharmacist in British Columbia, Quebec and Saskatchewan. On May 19, 2004 it was announced by the health minister that there was a proposal to make the pill available in all provinices from a pharamacist. I'm not sure if this is law yet because it gets into Canadian politics. Parliament was disolved before this could have been passed, because there was a new election coming. However the suggestion seems to have come from Health Canada, perhaps (likely) with proding from politicians (or the other way around). My guess would be its likely still in the works to be available in the other provinces.

There is also complaints about the fact that the woman has to talk to the pharmacist at all about it (as well as complainst from the religious right...i'll enclose two links at the end). Apparently a pharmacist could charge $20 for the "advice" plus the cost of the pills. In practice i don't think this would happen after the pill was readily available in cities because of competition although they might be able to charge what we call "the fill fee" which is the fee they get for putting together prescriptions (the article doesn't specify--this could be the concern but fill fees are often in the $10-15 range not $20 and if you look around you can find them much cheaper.

From what i can tell there are still Estrogen versions of the morning after pill in Canada (although they are only offering plan B at the pharmacies). I pick up my birth control from a local city clinic because i'm on low income. One time i made a comment about how i wasn't going to bother using it if just the condom broke (i use a back up method) because of how sick the pill made you, because i got migraines, smoked and had a second cousin who had a major stroke at 40 (these are all very good reasons not to take high estrogen.....although it would still be a personal decision, which i was basing on the other type i used working 60% of the time over a year, not with one accident). I have taken very low dose pills once for a few months to regulate but i would never take high estrogen (in fact they don't use those pills as much as they used to because women are getting pregnant on them...miss it by half an hour one day and you may not be safe...its good for a low dose set your clock thing though). She agreed that i was a bad risk factor for the estrogen pills as a morning after option and then told me that Plan B wouldn't make me sick but that just as important in my case it had no estrogen at all.

One difficulty that might arise is that for those of limited income most prescription drugs are covered (i never thought it all that fair i paid for my birth control but you could get the pill on the coverage i have). When it becomes non-prescription it is almost always delisted these days. You can appeal and i did for an epipen and i won, but i went around bureaucratic cirlces for 6 months and i'm generally good at that kind of thing. This might mean lower access for women who are poor in the country. For those of us that live in cities that have birth control (or sexuality) centres it doesn't make a large difference---at least on a weekday, as they sell it affordably. But even with the clinic in my city many women are not aware of it, or think it below them to go when they are qualified (in fact you don't need to prove anything). I mean, who has 6 months to appeal the morning after pill or is going to think to do so in advance?

Also in this city it means that a teenager has access to the morning after pill without their parents conscent. The clinic works on a strict confidentiality basis. If you seek it out they figure you are going to make your own choices about sex (they offer counselling when you first go, although most revolves around how to find the right type of birth control for you as well as safe sex and any STD tests you might want to have as well as how to have some of them (such as HIV) done annonomously---i did go as a teen because of the price factor but i don't remember if they talked much about if i wanted to have sex as i'd already done so (with contraception) but wanted to use the clinic. They are serious about this. I know one women (15 years ago) who went to her doctor to get the pill. He refused and told her parents. She got it off the clinic and the clinic refused to even look up if she was a client or to say anything to anyone.

I do know my mom needed it about 20 years ago. And the problems she encountered (well almost did) might be more common in countries where you need a doctor to prescribe. Her gynecologist gave it to her when she got ahold of him but generally it was very hard to get at the time. Even 10 years ago in Ottawa half of the hospitals wouldn't give it out and it was difficult to get on the weekends, although the feminist centres (and the university clinic that offered it) had a list of places that it could be prescribed at as well as where not to waste your time (problems of time were arising, waiting in an emergency room for a long time [its not urgent] just to find out the hospital doesn't offer the service can cause problems if repeated).

Search engining most got discount pharmacies however these two pages had information http://www.religioustolerance.org/abo_emer04.htm and http://dawn.thot.net/cwhn.html

The religious tolerance page listed a study about teenagers use of morning after pill...are we able to cite that on here (i'm still learning exactly what can and can't be) that showed teens in didn't use it for birth control. The DAWN link has a lot of the Canadian news put on it together. DAWN stands for Disabled Women's Network and is a feminist group.

I'm going to try and edit in bits that apply to Canada. I'll check back or let me know what you think of the edit or comments here.--Marcie 23:20, 25 Nov 2004 (UTC)

Hey guys. I think the statement "The morning-after pill cannot be recommended as the main means of birth control because of its strong side effects and relatively low reliability. " is misleading. It has a 90% effectiveness give-or-take, and most women do not experience and strong side effects. See http://www.netdoctor.co.uk/sex_relationships/facts/morningafterpill.htm I hate to be the d*ck, but I would like to mark this as non-neutral until this is sorted out please. Sorry. (P.s. i'm not arguing that it should be the main means - just arguing about the reasons why) -Johnflux 08:46, 4 Mar 2005 (UTC)

I would argue that 90% is a pretty low reliability when it comes to birth control - that means it would fail to prevent (or abort if you insist) one out of every ten pregnancies. That's acceptable if you've had an "oops" and this is your only option but not for serious planning. You might tone down the language about side effects based on that article but I think one of the reasons doctors would be leery about recommending it for birth control is fear that it would bad for your system to use it on a regular basis, that's not what the drug was approved for so it probably hasn't been tested. Also, since by the time you know you're pregnant it's too late for the morning-after pill, you'd have to take it after every sexual encounter. If you're taking it that often you might as well use the real pill. DopefishJustin (・∀・) 04:29, Mar 5, 2005 (UTC)

Hi. I agree with what you say, but still uneasy about the "strong side effects". You suggest I could tone down that particular bit, but what do you suggest? How about just ".. because of its possible side effects" or something?

Johnflux 21:14, 9 Mar 2005 (UTC)

Can any of you who believe that EC is an abortifacient point to one scientific peer reviewed article that actually shows EC given after fertilization of the egg can abort it (I use the term abortion loosely to include the destruction of a fertilized egg). As far as I can tell, this idea is simply conjecture. Scientifically, it has been shown that EC administration produces no statistical reductions in the rate of pregnancy when given after ovulation. Fertilization cannot occur prior to ovulation, therefore, if EC was producing abortions after fertilization one would expect a statistical reduction in the rates of pregnancy when EC is given after ovulation. Based on this information, isn't it proper to say there is no scientific support for the idea that EC can be an abortifacient. If changes in certain hormone levels or changes in the length of the woman's luteal phase were preventing implantation of the embryo to the uterus, this would have to lead to statistically significant reduction in pregnancy rates when ECs are given after ovulation. I think it is fair and just to give the facts that have scienitific acceptance different weight than statements that are mere hypotheses. As far as I can tell, the idea that EC is an abortifacient has no science to back it up.

—Preceding unsigned comment added by 128.252.252.231 (talk • contribs) 16:40, 6 September 2006

Catholics?

The beginning of the article has "its use as a contraceptive is held to be immoral by some groups including the Catholic Church". This isn't a terribly useful statement since the Catholic Church considers all forms of contraception to be immoral (except for natural family planning). I'm sure there's no shortage of groups that oppose the pill, so is there one we can name that doesn't oppose all contraception? DopefishJustin (・∀・) 19:01, May 19, 2005 (UTC)

It could be better phrased, pointing out that Catholics oppose Plan B as something which causes abortions (it prevents implantation after conception). Catholic Crypt

214.13.4.151

I realize that the article as it stands could probably use some NPOV-ifying by an opponent of the pill, but some of the recent changes by 214.13.4.151 are not helpful to this end and it's hard for me to see how they are made in good faith. Some examples of these changes include changing occurrences of the word "woman" to "gravida" and "contraceptive" to "abortifacient".

His/her most recent edit changed the opening sentence to "The morning-after pill is a pill regimen designed primarily to interfere with the lining of the uterus to prevent implantation of a very young embryo." This is ridiculous. As a random example, see the FDA's page on the drug and the manufacturer's page, both of which describe preventing ovulation as the pill's primary (and presumably intended) effect. Unless you believe that the FDA and the manufacturer are both wrong (despite all the testing they must have done) or outright lying, interfering with implantation is not the primary or intended effect.

If there is a dispute about a statement in the article, you need to mention that it is disputed (or say "the pill's manufacturer claims that...but...") and then explain the nature of that dispute later in the article, attributing it to whatever persons or groups are making such a claim, or "opponents of the pill" if you don't have names handy. Changing the introductory paragraph to come down 100% on your side of the dispute with no explanation is not good enough for Wikipedia purely on informative grounds.

Also, to other well-meaning contributors who might come along and notice that the page seems to be inaccurate: it might be a recent change, so please check the article history to see if there is a better version that it can be reverted to rather than rewriting everything yourself. DopefishJustin (･∀･) 22:22, May 31, 2005 (UTC)

Redundant information

Much of Stevertigo's recent string of edits is redundant information that is already covered in the ==Controversy in relation to abortion== section (it was also largely POV, which I've did a little bit of NPOVing on). I propose that the redundant information be deleted, and any new information be evaluated and if it's appropriate for this article and adds to it's quality, be worked into the already existant sections like the above mentioned Controversy section. For example, some of the specific quotes can be kept but moved (though they should be re-formatted to be more encyclopedic and less like quotes in a magazine or newspaper article). Icarus 05:20, 30 July 2005 (UTC)

---

Whilst I disagree with 'pro-life' view point, I thought Stevertigo's had useful quotes on the issues as well as some interesting divergence of opinion within the 'pro-life'. I thought the article much improved for the extra information, but overall the article disorganised and need of tidy up. The sections indeed needed reorganising as some of the controversy issues came before even the description on the types emergency contraception and advise on their use.

I have reorganised the paragraphs. 'Controverses' was a 2nd level item ('==') and 'issues' & 'specific issues' sections were 3rd level ('==='), with one pointing out the opposition from 'pro-life' and one seeming more the counter-arguement, i have renamed them. Also it should be noted that the combined-pill EHCs are or have already been withdrawn due to the introduction of progesterone-only EHC. This has an impact on side-effects (eg past concern re oestrogen's effect for DVTs becomes irrelevant for progesterone-EHC).

Stevertigo's had a 3 pieces of hidden information that had asked not be deleted. They lost their 1-on-1 link to the text when I reorganised it and so I have pasted them in below. I have added some thoughts on the 3-points in what I hope will be taken as constructive.

David Ruben 17:28, 31 July 2005 (UTC)

1 Hidden section

Copyright material for notes :

Emergency Contraception is a general term for estrogen and/or progesterone type (progestin) medications used in high doses within 3 days of unprotected intercourse for the purpose of decreasing the expected pregnancy rate. There are 2 FDA approved products marketed as EC, "Preven," and "Plan B]]." The medications contain the same hormones used in standard birth control pills. However the single day’s dose is much higher that a single day’s dose of a combination birth control pill. For instance, Preven contains 10 times the daily dose of estrogen found in a low dose combined oral contraceptive (Levlite), and ten times the daily dose of progestin as well. Plan B contains only one hormone, a progestin, in a dose 15 times higher than the single day’s dose of the birth control pill Levlite. http://www.physiciansforlife.org/content/view/191/36/ Stevertigo's

• Risks tautology - to compare higher one-off dose of a drug against one that is taken for serveral weeks routinely can be considered as 1/3 (x10 / 30 days) the monthly dose, which might sound attractive for some one who only has unprotected sex x1-2 a month. Whilst not going to be dangerous (cf Paracetamol (acetomorphan) where x10 daily dose is a fatal dose), the main issues of hormones are with the long-term effects of routine contraceptive pills on cancer risk, effects on bone density, heart disease etc and where a one off high dose is not of concern.David Ruben

2 Hidden section

Following, there have likewise been some discrepancies regarding the very term "conception" (fertilization). In a statement by the American Association of Pro-Life Obstetricians & Gynecologists (AAPLOG), regarding the controversial morning-after pill, AAPLOG claims:

NOTE: This is a quote for a developing section, if you have a problem with it, hide the text (like this text is) but dont remove it, until I can rework it. Sinreg,

"[Again,] one must be careful of the terminology. Many now speak of "conception" as that moment when the human blastocyst, the early ball of approximately 100 cells, implants in the mother’s uterus (womb). The time from actual fertilization (sperm and egg unite in the Fallopian Tube) until implantation, a period of about 7-10 days, is ignored, even though no genetic change occurs in the cells during this time period. Many family planning specialists who have supported the terminology change can thus rationalize that the destruction of the human embryo between fertilization and implantation should be labeled "contraception", rather than "early abortion"." [7] Stevertigo's

3 Hidden section

Copyright material for notes:

New studies show a significant relationship between Pill use, HPV (Human Papilloma Virus which results in genital/oral warts), and cervical cancer. HPV is present in 99% of all cervical cancer cases worldwide. Use of The Pill appears to dramatically increase the risk of cervical cancer in the presence of HPV, according to recent studies.

The makers of the Plan-B MAP highlight on their website that it is "not recommended for routine use as a contraceptive." Yet there is no way to prevent misuse and abuse if readily available without a prescription.

both from http://www.physiciansforlife.org Stevertigo's

• Cause & effect are difficult to separate. People catch HPV via being sexually active. Pill use probably reduces numbers using condoms as methods of contraception and so allows more HPV infection to occur (but condoms have high failure rates and so would result in greater number of unwanted pregnancies and requested abortions than the Pill - not what anyone wants, let alone the anti-abortion pro-lifers).
• The second point on non-prescription availability and misuse as a "routine use as a contraceptive" raises some counterpoints:
  • Firstly it is not suggested anywhere that EHC will be a general sales item, it is limited via nurses or pharmacies who have protocols on its issue (time since unprotected sex, current point in the menstrual cycle, prior use).
  • Secondly , if a patient chooses to mislead (ie lie to) these heath professionals, they can equally lie to doctors at Family Planning Clinics or their Family Practitioners (GPs in UK) and go to a number of different clinics - the limitation by prescription is not going to prevent the occasional misuse. There is a cost of travel, time & inconvenience to misusers going to a number of different places to get items frequently that they should not, but this is no different from someone buying regular supplies of codeine-based cough remedies who is an addict - the protocols in place put an acceptable limitation on 'honest folk' in the history to be given and the quantities obtainable to get effective treatments conveniently (vs free-for all supply from a supermarket).
  • Finally do not be too hard on manufactureres claims, take the example of Ibuprofen which has warnings against taking for indigestion, but many ignore and suffer potentially fatal stomach ulcers as a result; one can argue to ensure manufacturers identify & communicate important information and how to make common side-effect warnings appear prominant in the labelling, but ultimately it is each users responsibility to look at the product information and heed its advice.David Ruben

FDA, NIH, ACOP are "groups"?

are the United States Food and Drug Administration, National Institutes of Health, and the American College of Obstetricians and Gynecologists usually referred to, simply as "groups" as in the article?

--Doldrums 09:23, 2 August 2005 (UTC)

Emergency Birth Control

Never heard this term used, User:85.154.20.87 can you elaborate? David Ruben 20:33, 15 August 2005 (UTC)

---

The term 'Emergency Birth Control' originated in Southern California as a term that is more accessible than 'Emergency Contraception', but which is nevertheless meaningful and accurate. Basically, the idea is that people - especially young people - will find 'Emergency Birth Control' easier to understand and remember than 'Emergency Contraception'.

"Fertilized egg" vs. "embryo"

I made a few changes in the "Controversy related to abortion" section. It used each of the terms at different times. Presumably, because the pro-life side wants to emphasize the level of development at that stage, and the pro-choice side wants to downplay it. "Fertilized egg" isn't entirely accurate, and "embryo", while technically accurate, is a bit misleading because in common usage, it usually refers to a later stage of development. So what I did was to use the most accurate term, blastocyst, the first time and add paranthetically that that's an early embryo stage. I later used "embryo" because most people don't know the word "blastocyst" and "embryo" is, after all, scientifically accurate.

I also removed "fertilization" from "there have likewise been some discrepancies regarding the very term "conception" (fertilization)." The very discrepancy is over whether or not the two are indeed synonyms, so it's POV to push that they are. --Icarus 02:18, 25 September 2005 (UTC)

In reference to the second paragraph, a zygote almost immediately goes into cellular division so it is no longer a zygote when it is denied implantation. In addition the implantation of a zygote is impossible. Zygotes can't exchange chemicals, attach, or begin development of the ambilical cord. Only an embryo can attach to the uterus. Blastocyst is even less accurate. Changing zygote to embryo in the second paragraph would be more accurate.

http://en.wikipedia.org/wiki/Embryos

--Shok 20:14, 15 February 2006 (UTC)

Remove clean up tag?

What needs to be done in order for everyone to be satisfied in removing the clean up tag?

The article looks good to me. I'll remove the tag after 24 hours. --Uthbrian (talk) 05:56, 14 January 2006 (UTC)

Zygote/Blastocyst/Embryo?

This page uses many terms for the baby. At what stage (how many cells) is the baby in when it implants into the Uterus? Can't we just call it what it is: a BABY? 202.142.214.182 14:48, 16 January 2006 (UTC)

• No. See WP:NPOV.--Fenice 14:50, 16 January 2006 (UTC)
• No. Indeed very POV, too simplistic a term and factually incorrect (not all of a fertilised egg goes on to form the delivered baby):
  • Firstly following fertilisation, the 1-cell entity is clearly different from an 8-cell entity, in turn different from the structural organisation found in a blastocyte. None of these is the 'baby', as a sizable part will form the placenta & amniotic sac and no one would suggest these have 'rights'.
  • From a developmental point of view, there are clear further developmantal stages after implantation. Using a bland label of 'baby' is as unhelpful as 'human' (eg distinguish from a foetus, delivered neonate, infant, child, adult).
  • The term 'baby' as applied prior to delivery is seen by pro-choice as POV (by the pro-life viewpoint), being an emotive term suggesting the foetus has the ability to exist independantly with soul & full rights which has of course legal-moral-religious-ethical aspects etc.
  • The pro-choice viewpoint would be that a distinction is needed between the various developmental stages in discussing viability, ethical/moral considerations and the resulting legal framework.
  • Use of the separate terms is required in the descriptive explaination of what EC is, how it works and at at which stage of intercourse -> delivery it applies to (i.e. medically and and thus legally EC is pre-implantation, abortion is post-implantation).
• I recognise pro-life disputes the definition of a human individual being at delivery, to the time of implantation or of fertilisation (aside from EC, these distinctions are also important when considering the status of fertilised eggs from IVF) - the article already discusses this at some length to give the overall NPOV required in WP. David Ruben ^Talk 18:10, 16 January 2006 (UTC)

Issues against, redundancy, inaccuracy

I am moving the following paragraph out of the main page to the talk page in order to discuss its possible permanent deletion:

Because such drugs are generally considered to be abortifacients by pro-life groups, it has been the object of controversy within the wider abortion debate. Other controversial aspects are the effect of such pills on a later-term fetus and the possible ability of ECPs to cause birth defects.

The first sentence above is almost identical to the first sentence of the following paragraph Pro-Life groups ... claim that such pills are "abortion pills", rather than "contraceptive pills." If people prefer the top sentence better than the second one, or want to integrate the two together, so be it, but I do not think they both belong because they convey the exact same bit of information: the fact that pro-life groups think EC causes abortions.

The second sentence above in regards to birth defects is completely baseless. If people want it included, it needs to be mentioned that the FDA has removed 'birth defects' from the list of side effects for the medication, and that studies involving women who continue to take birth control pills (same chemicals in EC) while pregnant suffered no birth defects in relation to the drug use. source If anyone wants the second sentence included, I'd like a citation of a Pro-lifer who makes this claim, and I'd like to see it presented in language the clearly illustrates the facts behind this claim (namely, that EC does not harm a fetus). For the time being, I have moved this paragraph to the talk page until these issue can be resolved.--Andrew c 03:58, 18 February 2006 (UTC)

Chooserr, why not discuss this on the talk page? You have accused me of wanting to censor a fancy word. I clearly state above that "If people prefer the top sentence better than the second one, or want to integrate the two together, so be it". My motivation had nothing to do with the wording or content, just the fact that the exact same concept is conveyed in two different sentences. Seems redundent to me. Next, are you going to cite your source in regards to birth defects? Are we going to discuss how we are going to integrate that information along side the work I cited above?--Andrew c 05:50, 18 February 2006 (UTC)

Andrew C, I'm sorry that I accused you. I don't mean to be rude or anything I'm just - Passionate. Sorry. While it might not technically be an Abortifacient it would stop the embryo which already has been fertilised from attaching to the wall of the uterus, right? If so this is seen as an abortion by most pro-life people. I believe this should be stated somewhere.

Also I would like to request that we delete the quote by the former member of the FDA, or atleast add a foot note to the bottom of that section, because it seems very biased to say that by killing the young embryo you are stopping abortions. Chooserr 02:50, 19 February 2006 (UTC)

• Might I observe I think you are both partially right - yes the two paragraphs somewhat duplicate themselves, but also have additonal information. A greater problem is that the first sentance of both paragraphs repeat the explanation as to why EC is seen as abortifants (viewpoint that pregnancy starts at fertilisation vs implantation) already made 3 paragraphs previously ("The morning-after pill may, however...").
• I also think in the second paragraph mentioning "gestational age" is confusing - what is meant in this context is the arguement as to when pregnancy starts (fertilisation vs implantation), yet as a doctor I think of gestational age as starting from the last menstrual cycle (so at fertilisation in mid-cycle I would count as at 2/40, by implantation (say 7 days later) at 3/40, and at the 1st missed period 4/40) - so whenever one defines the start of pregnancy, as a doctor this does not alter my reference point of "gestation age" as starting weeks beforehand at the last period.
• Mention of embryonic stem cell research is perhaps inappropriate in this article, as EC is never used for such egg collection (stem cell research comes from spare embryos from IVF, or performing a surgical abortion and taking tissues from what is "havested"). Of course such collection and use of eggs is strongly objected to by some pro-lifers and I sure is mentioned in relevant articles.
• Duplication of the term 'controversy' in the phrase "controversy over gestational age boundaries have been controversial" is tautology and needs rewriting.
• I take the point though about whether hormonal pills affect a pregnancy that continues (whether a failled attempt at EC or in cases of contraception failure in women taking the normal monthly pills), and this being of vital concern for pro-lifers who care for the future of the "unborn baby" (for want better/agreed terminology). After all the warnings existed in the original EC and monthly contraceptive-pill drug datasheets. Of course such warnings were a result of animal trials using very much higher doses and as a sensible precaution (it intuitively seems reasonable to suppose that hormones might have an effect). However over time the number of women continuing to take their normal monthly-pills for some months into gestation before realising that they were pregnant, or indeed failling ever to realise that they were pregnant (so called 'missed pregnancies') have mounted. From such cases, I am unaware that the (reasonable) initial concerns for fetal harm have been realised/demonstrated. Do the data sheets still list the pills as hazardous during pregnancy (vs lacking an indication and not being warrented if pregnancy has already become established) ?

From the Plan B datasheet

Many studies have found no effects on fetal development associated with long-term use of contraceptive doses of oral progestins (POPs). The few studies of infant growth and development that have been conducted with POPs have not demonstrated significant adverse effects. source

From the Levora datasheet:

Extensive epidemiological studies have revealed no increased risk of birth defects in women who have used oral contraceptives prior to pregnancy.60–62 Studies also do not suggest a teratogenic effect, particularly insofar as cardiac anomalies and limb reduction defects are concerned, when taken inadvertently during early pregnancy.60, 61, 63, 64

...

It is recommended that for any patient who has missed 2 consecutive periods, pregnancy should be ruled out before continuing oral contraceptive use. If the patient has not adhered to the prescribed schedule, the possibility of pregnancy should be considered at the first missed period. Oral contraceptive use should be discontinued if pregnancy is confirmed. source

It seems that most of the sheets mention no clinical correlation between the drug use and birth defects, but still recommend that pregnant women not take the pills. This page says The FDA removed warnings about adverse effects of oral contraceptives on the fetus from the package insert several years ago. All that said, I like your proposed changes. and give it my thumbs up.--Andrew c 17:43, 19 February 2006 (UTC)

• So how about this as a rewrite, to explicitly explain rational of anti-viewpoint:

EC have been the object of controversy within the wider abortion debate. Pro-Life groups —dominantly Christian, consider the onset of pregnancy as being from the moment of fertilsation (rather than later at implantation) and so consider the interference of a fertilised ovum's implantation as being an abortion. This leads pro-life groups to generally considered EC drugs as being "abortion pills" (abortifacients), rather than "contraceptive pills.". The controversy over EC measures is complicated by each side's different definitions of the relevant terms.

Another concern is whether such pills may have a possible effect on a later-term fetus and so risk birth defects, although there is a lack of scientific evidence to support the cautions originally present on the drugs' datasheets.

Can I suggest an amendment to my own proposal. One can't test for a negative (there is nothing to test for), but only look out for a postitive event. Therefore is "although there is a lack of scientific evidence to support..." POV, or at least somewhat clumsy English ? Would a neater, and more technically correct phrase be "although post-marketing surveillance data has not supported..." ? David Ruben ^Talk 00:29, 20 February 2006 (UTC)

I agree that that wording is more accurate, but I'm concerned that it will not be entirely clear that the 'birth defect' concerns have been removed from the datasheets. I would propose adding an additional clause to the last sentence along the lines of ..., and has sense been removed. only that is extremely wordy and ackward. It's not that big of a deal, I'm still entirely for your proposed changes.--Andrew c 00:49, 20 February 2006 (UTC)

• PS Chooserr, may I ask 2 questions to help my understanding :
  • The current paragraphs refer to "pills" or "abortion pills", and I quite understand the pro-life viewpoint on these (although not personally subscribing to this viewpoint). However what is the pro-life viewpoint on IUDs used as "emergency contracption" (I accept this is much less frequently used than the hormonal approach and is somewhat undermentioned in the article)? I ask this because my understanding is that the evidence suggests IUD cause (via foreign-body effect and low levels of copper) the presence of macrophages to attack sperm and make local enironment (mucus) unfavorable to sperm, thus preventing fertilisation. If this mechanism of action is disputed, then I would understand that pro-lifers might also feel that implantation rather than fertilisation may be being prevented, and so by their viewpoint be causing an abortion.
  • If it could be confirmed that hormonal-pill-EC only acted via preventing sperm survival or passage to an ovum such that fertilisation never occured, would this in principle (in your understanding) remove the objection by some pro-lifers that these are abortifants ? Alternatively would the disruption to the "outcome of the natural union of man and women" (for want of a better phrase) also be seen as an objection to hormonal-pill-EC ? David Ruben ^Talk 05:20, 19 February 2006 (UTC)

David,

To tell you the truth I'm not up on the "pro-life" issues. I don't subscribe to any magazines, or such. A general rule of thumb for me though is that any device that kills an embryo, even before it attaches its self, is wrong, along with all forms of contraceptives excluding natural family planning. The reasons for not liking abortifants, and not liking contraceptives are different, because many non-religious pro-life organisations would argue that if it just prevents the sperm and egg from conjoining it is alright - it isn't killing something "with the potential to become human", while religious pro-life organisations would say it is wrong. Not because it is killing the embryo, but because the contraceptive device is immoral in their religion - just as murder would be immoral. And the last wasn't a fanciful analogy, because most of society's morals stemmed from the Church.

As for your first question though I can't really give a seperate answer - I've never even heard of IUDs prior to your comment, and the wikipedia article was less than useless in telling me how they work. 21:22, 22 February 2006 (UTC)

I'm not sure why Chooserr is avoiding the talk page, but Chooserr has presented an alternative wording for these paragraphs in question:

Because such drugs are generally considered to be abortifacients by pro-life groups, it has been the object of controversy within the wider abortion debate. Also while there have been no conclusive studies as to whether or not ECs can harm a fetus it is believed by many pro-life groups that it can cause birth defects. Planned Parenthood states that while this is unlikely it is recommended that ECs shouldn't be taken if a women knows she is pregnant [9].

Pro-Life groups —dominantly Christian opposers of abortion in all cases (including embryonic stem cells) —claim that such pills are "abortion pills", rather than "contraceptive pills." As knowing the actual age of a pregnancy can be difficult, controversy over gestational age boundaries have been controversial, and both sides have claimed different definitions of the relevant terms.

In my opinion, this wording does not clear up the redundency issue that was part of my initial concern. Saying "there have been no conclusive studies" implies that the results are 'inconclusive' or a 'toss up' when in actuality, there has been NO causal relationship between the drugs and birth defects to the point where these warning have been removed from the drug information sheets. I clearly like David Ruben's wording better, but if Chooserr wants to work on combining the two or otherwise make their opinion known on this matter, maybe we can work on reaching a concensus instead of having 5 different people making big changes to that section all at the same time.--Andrew c 00:59, 20 February 2006 (UTC)

Hippocrite

Hippocrite has recently deleted the whole first paragraph in the section on pro-life views. And Colle deleted the last sentence on the difficulties of determining whether someone is pregnant or not - the former may have been an over sight. Chooserr 00:53, 20 February 2006 (UTC)

No, it was not. You are inserting OR into this article by attempting to insinuate that a PP page that you unearthed reccomends pregnant women not take EC because it will harm their fetus. Hipocrite - «Talk» 00:56, 20 February 2006 (UTC)

The material I remoeved was baseless pov meandering. There should be real issues in the "issues against" section --not fabricated ones.--Colle||Talk-- 00:58, 20 February 2006 (UTC)

The last sentence you remove, Colle, wasn't baseless, and I thought the fact the pregnant and non-pregant is more than a little blurry was NPOV.

Hipocrite, I wasn't implying that Planned Parenthood said it would harm their fetuses, and I gave a link so the person can determine FOR THEMSELVES. Chooserr 01:04, 20 February 2006 (UTC)

The section still outlines exactly how the destruction of the embryo is considered by some to be abortion. However, the reality is that abortion is the termination of a fetus. It is appropriate to outline the view of embryonic abortion, but it shouldn't be presented as fact.--Colle||Talk-- 01:08, 20 February 2006 (UTC)

If abortion is the destruction of a fetus where does the term Chemical abortion come in? Is that a myth...you can try a google search to find out. Chooserr 01:10, 20 February 2006 (UTC)

Chemical abortion is the termination of a fetus.--Colle||Talk-- 01:15, 20 February 2006 (UTC)

Apparently not - [8] Chooserr 01:26, 20 February 2006 (UTC)

• Hey calm down everyone please :-) What needs to be present in the article is not any single idea of the "absolute truth", as this is strongly contested by both sides. Instead the encyclopaedic entry should be a fair and NPOV description of each side of the debate. As Chooserr correctly indicates, part of the problem in discussing the issues is that some of the terms are differently defined by pro-choice/pro-life. Wikipedia, and this article, is not the place to discuss whether the term 'pregnancy' correctly applies to fertilisation or implantation (both options are claimed), nor whether the term 'abortion' is the removal of any fertilsed egg or at the later stage following implantion (again both options are claimed). If pro-life defines pregnancy as from fertilisation and abortion as being anything done after this, then this is factually their position and it is no use pro-choicers insisting that this is not 'abortion' as it is before implantation. Likewise if pro-choice defines contraception as from fertilsation to before implantation, and abortion as only after implantation, we are talking at cross-purposes to pro-lifers as to whether we are referring to fertilised egg/embryo/fetus/pregnancy prevention/pregnancy cessation. The two viewpoints are both internally consistant, just mutually exclusive :-)
  • So pro-choicers - please stop attacking Chooserr and wholesale removing paragraphs - the viewpoint of pro-life does factually exist and is internally self-consistant, even if we disagree with how they define the terms. It is (at least) a significant minority and thus must be included within wikipedia, as required by NPOV policy. Or to put it another way: to understand a viewpoint is being NPOV and required by wikipedia, but is separate from whether one personally subscribes to the viewpoint.
  • Likewise Chooserr, whilst I support the inclusion of the pro-life points (but personally do not subscribe to them), I do feel there is some duplication of information across the paragraphs that might be better resequenced.
    • In particular I think the pro-life viewpoint section should first define its definition of the various terms, prior to showing how this leads (internally self-consistant) to the viewpoint that EC are arbortifants.
    • Otherwise, as we see occuring with this edit-war, pro-choicers fail to 'understand' the viewpoint and merely argue as to the "correct" definition of various terms.
  • I hoped my suggested alternative (above) would both explain (for the benefit of both sides) in smaller logical steps, and more clearly, the pro-life viewpoint. I hoped this would allow pro-choicers to leave the section alone, as being a fair NPOV description of a viewpoint they now understand but do not personally subscribing to.
• So to resuggest as a further alternative (I've further reworked it: defining terms in smaller steps): David Ruben ^Talk 03:21, 20 February 2006 (UTC)

EC have been the object of controversy within the wider abortion debate. Pro-Life groups —dominantly Christian, consider the onset of pregnancy as being from the moment of fertilsation (vs. at later implantation) and define any interference after this as constituting an objectionable abortion. Pro-life objection therefore includes measures in the interval between fertilisation and implantation as consituting an abortion, rather than the pro-choice term of contraception. This leads pro-life groups to generally considered EC drugs as being "abortion pills" (abortifacients), rather than "contraceptive pills.". The controversy over EC measures is complicated by each side's different definitions of the relevant terms.

(physiciansforlife quote goes here rather than after the second paragraph)

Another concern is whether such pills may have a possible effect on a later-term fetus and so risk birth defects, although post-marketing surveillance has not identified such problems and newer drug datasheets have downgraded these concerns.

• • First of all, I have not stated if I support abortion rights. Anyways, the last line of your suggestion is baseless POV, there is no reason to subject readers to uneccesary fear. I don't have a problem with the rest of the content of your suggestion, but I do find it to be excessivly wordy. The article currently states essentially the same thing --The disagreement on whether destoying an embryo is the same as aborting a fetus.--Colle||Talk-- 04:07, 20 February 2006 (UTC)

• • • Yes I agree quite wordy and I agree with your summary of the nub of the disagreements. My own point of view would also to be dismissive of the last line, its just that I suspect its removal will be seen by pro-lifers as also being POV. Also I agree that points duplicated and split between paragraphs, but I did not feel pro-lifers would accept a restructuring of the section, if this also included a drastic abbreviation. So in the interests of NPOV, I was trying to follow a middle ground and get some sort of consensus that we can all agree to somewhat dislike :-) David Ruben ^Talk 04:25, 20 February 2006 (UTC)

• • • • I don't necessarily believe that the last bit is POV or baseless, it just hasn't properly been researched, but there must have been reason to worry or it wouldn't have been added in the first place. Maybe the user who originally added the content saw a news article - we might want to research through the history and find out who was the first to add it.

• • • • I do want to say though that it should be mentioned in the most neutral tone of voice that planned parenthood advises people not to take the pill if they are pregnant. Chooserr 04:11, 23 February 2006 (UTC)

Recent Edits

I've decided that I will attempt to retain from edit warring, and try to explain my edits clearly on the talk pages, or in the summaries if I answer any questions posed to me after words. I'm not sure if this strategy will work, particularly because I doubt all other users will refrain from making reversions even if I do discuss with them, none the less I will attempt to rationalise it out.

My reason for reverting Alienus was that my addition (a rewording of content previously in the article) works towards explaining how it is hard to define pregnancy, and states briefly that pro-life and pro-choice people have varying definitions of pregnancy. I think this shouldn't be deleted, but maybe expanded a little more, and given a link to a site that explains these difference clearly. What do you think? Chooserr 04:04, 23 February 2006 (UTC)

It is not hard to define pregnancy, which is defined medically from implantation. If you would like to say that the pro-life groups believe that pregnancy begins at conception rather than implantation, please do so, but do not do so without citing a reliable source for such a statement, and please be aware that if you do so, someone will likley note that the medical community defines pregnancy differently. Hipocrite - «Talk» 14:16, 23 February 2006 (UTC)

It sort of says that in the quote making it redundant any way. Chooserr 00:18, 24 February 2006 (UTC)

My most recent edit, the adding of infertility to the risks, is from information I gathered from ALL.org, which while pro-life does site sources. You can view a list of their sources the bottom of this page. Chooserr 00:37, 24 February 2006 (UTC)

re Side-Effects. Chooserr whilst your recent addition of some numbers to side effects incidence (eg headache 50% & nausea 20%) indeed make the previous "rarely" seem inappropriate, to which type of ECP are these figures for: combined oestrogren-Progesterone (Yupze) or emergency progesterone-only contraceptive pill (EPOC) ? If the older combined Yuzpe then yes I think I would agree (nausea figure seems about right - I'm surprised by, but wont dispute, the high incidence of headache). However Yuzpe been withdrawn in UK (?likewise elsewhere) for about 2 years. The incidence on EPOC of headache is, I believe, far less and particularly the rates of vomiting far lower & any nausea less intense than with the older regime. Indeed patients previously regularly reported vomiting on combined PC4 and needed additional doses if vomiting was too close to the time of dosage, but I have not (yet) encountered vomiting on EPOC Levonelle. Certainly both types have lowered incidence of side effects if taken with food rather than an empty stomach (?a source of discrepency between how high side effects can be and how high they need be in practice?). Of course causing side effects of nausea & vomiting is somewhat irrelevant when compared to the far higher rates of these symptoms if a pregnancy occurs and continues (not of course that this should have any bearing on a decission to use EC). David Ruben ^Talk 01:09, 24 February 2006 (UTC)

Well David, I'm not sure what it is for each different type of emergency contraceptive, but the precentages came from a pro-choice website so I decided to add them without searching much more into it. I thought that most would agree on that. Chooserr 01:14, 24 February 2006 (UTC)

I just did a brief check on your 'facts'. I went to the Plan B datasheet, which only applies to that particular brand of EC. However, they had nausea (23%), abdominal pain (18%), fatigue (17%), headache (17%), and menstrual changes listed, which is different from your statistics. First, you need to explain exactly what your information is in reference to, and then you need to cite the source for your statistics. However, because there are many different froms of EC, all with different side effects, I think quoting exact percentages is not helpful (unless there has been a scholarly stasticial analysis of a random sampling of different brands of EC). --Andrew c 01:28, 24 February 2006 (UTC)

I was just going to say I could hunt down the stats if you want, and provide the website, but I would like to comment on the last part of your post which I forgot to comment on before. I don't believe it is irrelivant, because even if you would vomit due to pregnancy it still might concern people about these minor risks (I do wonder not being in the medical proffesion if you could actually throw up the pill before it takes effect) Chooserr 01:19, 24 February 2006 (UTC)

(sorry computer crashed out, so delay in relying) The combined pill after a short while could be partially absorbed sufficiently to cause nausea & vomiting, but before enough had been absorbed to be effective at preventing pregnancy. David Ruben ^Talk 03:02, 24 February 2006 (UTC)

I got the information from aafp.org, but I found out that I got it wrong. It lists nausea at 50 percent, and vomiting at 20 percent. Chooserr 01:33, 24 February 2006 (UTC)

You said to consult the talk page, for details, but you haven't added any new information. I'm not strictly against your version, but I do believe that we should out line the more serious risks. Chooserr 01:44, 24 February 2006 (UTC)

I edited it to be more general. I had a couple problems with Chooserr's last edits. I do not think it is appropriate to list %s. Because there are so many different forms of EC, and because I am not aware of any scholarly stastical analysis of all the different brands, it is misleading to quote a number found only on Plan B's datasheet. Also, a couple of the side effects I have not found listed anywhere. Finally, the sentence about heart attack and stroke does not really apply to side effects. There are lists of people who may not want to take EC, such as pregnant women, people with certain types of cancer, history of heart attack/stroke, etc... but thats different from 'side effects'. --Andrew c 01:45, 24 February 2006 (UTC)

I assumed by side effect you meant any result (most likely detrimental) other than the desired result, and I believe that the increased risk to people who have had a heart attack or stroke of severe abdominal pain and blood clotes a side effect. Chooserr 01:49, 24 February 2006 (UTC)

You are playing word games. Compare Side effects and Contraindication. Maybe look at the Oral contraceptive page or an actual drug datasheet for more info. There is already a section on Contraindiction right above side effects. Maybe you can expand that to include some of the stuff listed under the Your Health header here or another source.--Andrew c 02:02, 24 February 2006 (UTC)

I had assumed that the emergency progesterone only contraception trialed by and recommended by the WHO was Levonorgestrel 1500mcg total dose, available under a variety of brand names around the world. So in this respect isn't EPOC a standardised product unlike Yuzpe regimen which could be achieved with either a variety of standard combined contraceptive pills (but many low-dose tablets taken at once) or specific high-dose products ? Are other progesterones used outside of UK ? if not, then one could specify data about EPOC/Levonorgestrel 1500mcg. David Ruben ^Talk 03:02, 24 February 2006 (UTC)

That is a good point (and you obviously know more about this than me). In the US, there is only one dedicated EC product (progesterone only): Plan B. However, the FDA has approved 20 different oral contraceptive (combined estrogen and progesterone) pills for EC use. Personally, I am content with keeping things general, but I wouldn't totally mind if someone else wants to write up the statistical analysis of side effects and specify what product they are referencing. But general is also fine with me.--Andrew c 03:40, 24 February 2006 (UTC)

Most recent edits

My most recent edit - a reversion to Andrew C's version - was because David's is lacking in certain ways. Nothing extrordinarily big, but it does miss the last section on the OTC bills, and a reference to the Catholic document which it is forced contradiction with. Chooserr 00:07, 26 February 2006 (UTC)

Except your version is not verifiable (IOW - false), and is also OR. Perhaps you should go back on your "no edit warring" promise. Hipocrite - «Talk» 15:06, 26 February 2006 (UTC)

Controversy

Chooserr, after recently looking at the Parental Notification article, I wonder if you could add some info to your recent addition to Emergency Contraception: There is also controversy over the Over the Counter bills considered by some states which would make it possible for a women to receive Emergency contraceptives without a prescription, or reporting a rape (if one has occurred).

• Are these bills only seeking to allow just adults to obtain EC without the need for a prescription?
• Do they seek that a Chemist has to provide a sale when clinically appropriate (ie intervals since intercourse, time within menstrual cycle) ?
  • If the Chemist is allowed to personally conscientiously object, are they required to advice the woman where such a service is available from ? (this is the situation in the UK although, as I gather, this is a professional standards issue for Doctors & Pharmacists, rather than subject to specific legislation)
• Do the acts make any mention of OTC supply to minors, or is this a separate issue that allows for doctors being able to prescribe to minors? (I'm unqualified to comment on UK Pharmacy regulations in this but I gather it is similar to Doctors who need consider the minor’s maturity to make informed decision for any medical issue if seen alone, should suggest advising parents, but in principle need to respect confidentiality and be able to justify breach of confidentiality if they feel minor unable of making informed decision)

Somewhat separately, given a previous section title is "Controversy in relation to abortion", would it be better to retitle this section as "Controversies over provision of EC" (or "Controversies over legal provision") with subheadings of "Provision for rape victims" (for the previous paragraph) and "Provision as OTC sales" (for this latest paragraph) or some such similar titles? David Ruben ^Talk 09:25, 28 February 2006 (UTC)

David,

I personally am not sure of all the specifics. There may be an minimum age - for now. This law also wouldn't allow provisions for the pharmacist to object on moral grounds. You can find more information here. Chooserr 06:45, 1 March 2006 (UTC)

Church quote

Copied from my talk page to keep discussion in one place:

I'm currently checking (google) to make sure that is an exact quote from the Church, but in the mean time I've re-added it for even though it may be slightly repetitive I believe that an exact quote wouldn't hurt, and it would be more verifiable than Wikipedia just coming out and vaguely point in the pro-life direction saying, "this is what they believe". Chooserr 00:08, 4 March 2006 (UTC)

• I agree the quote is informative, just that I thought it both repeated the explanation already given about opposition to EC in general and specifically to why this also applies in cases following rape. To reduce duplication, perhaps reduce the lead-in explanation of "Catholic church teaching is opposed to the provision of emergency contraceptives to rape victims since the contraceptives may prevent the implantation of the fertilized ovum, and thus are a form of chemical abortion." to: "The Catholic Church explains its opposition to EC in cases of rape thus:"
• Also given its quite lengthy quote, perhaps enclose in the mark up <small> ... </small> but not sure how legible this appears in other people's browsers. David Ruben ^Talk 00:22, 4 March 2006 (UTC)

That might be alright...the only thing is I can't seem to find it online so it maybe that there is a slight error in the text or that the user who added it had the document in hand and it isn't published elsewhere. I'm not sure. Chooserr 00:26, 4 March 2006 (UTC)

I'm generally a fan of quoting people in sufficient length to let them explain themselves, but this is overboard. It's just too big a quote for an article in which Catholicism is, to be frank, a minor footnote. If this were "Catholicism and emergency contraception", then such a large quote might be appropriate. Alienus 00:29, 4 March 2006 (UTC)

The quote seems correct - its from the same document as the current reference No 13 you kindly provided (its the vatican website): http://www.vatican.va/roman_curia/pontifical_councils/migrants/documents/rc_pc_migrants_doc_2003072_salud%20reproductiva_en.html - see the 3rd paragraph of section III. David Ruben ^Talk 00:39, 4 March 2006 (UTC)

Well than I have no problem re-adding it. Chooserr 00:46, 4 March 2006 (UTC)

I do have a problem withy ou re-adding it, and I may well express my problem by reverting such an add. I never doubted the accuracy of the quote, just the relevance of so large a block of text for what ought to be an incidental subject. Perhaps you could quote relevant portions of it in place of your summary. Alienus 03:54, 4 March 2006 (UTC)

I agree that this quote should not be included. It is long, and repeats information that is presented elsewhere in the article, and in that very section. The purpose of the quote is a long explanation why Catholics think EC is actually a type of abortion. Because this position is presented elsewhere in the article, I think the current version is sufficent enough to convey that the law is forcing Catholic hospitals to do something that they morally oppose. If I am missing something important about the quote, please tell me. --Andrew c 02:27, 6 March 2006 (UTC)

Controversy 2

I found a reliable source that basically echoes that the over the counter laws can be controversial [9]. Chooserr 03:49, 5 March 2006 (UTC)

It seems like you want to add one sentance that says "There is controversy over making EC an over-the-counter medication". Maybe you could work to tell us WHY it is controversial, and give more information about OtC availability. What you have now seems incomplete and fragmentary. I went to your source, but I cannot find the full text of the editorial, so I cannot comment on that. I hope you don't mind me removing that section until you have more time to flesh it out.--Andrew c 02:14, 6 March 2006 (UTC)

Ok Chooserr, I found this and read through it. I'll summarize the 'controversies' listed.

1. Education. There is prevalent confusion in US teenagers about timing, proper use, dosage, etc in regards to EC. A doctor’s visit (say, for a prescription) is one way to get this information out to teenagers. This argument assumes that over the counter EC users would not read the instructions or would otherwise misuse the drug.
2. STD screening. Requiring teenagers to go to a doctor in order to obtain EC could allow the doctor to test for STDs. This is an issue because a significant number of teens resort to EC after unprotected sex. Over the counter EC may prolong identifying and treating STDs in a small, yet significant number of teens.
3. Possible replacement of traditional methods of birth control. It has been suggested that over the counter access to EC may cause some teens to not consider more effective measures of BC (or may encourage teens to be MORE sexually active). Studies in Finland suggest that this is not a concern. Additionally, that Finnish study suggested that easier access to EC does not increase sexual activity either. Multiple other studies in India and US suggest that easy access to EC promotes its use, but does not affect other methods of birth control while reducing the number of unplanned pregnancies.

The biggest issue here is that it is difficult for someone who needs EC to obtain it within 72 hours. Finding a physician and obtaining an appointment on such short notice is especially difficult for teenagers. So, how 'controversial' is this? I found another study here about EC without a prescription in Canada. No real controversy. Is this content relevent enough to include in the article? I think this issue particularly is very US centric. On top of that, the OtC issue in the US is already covered under the heading International availability. So what exactly do you want to add again? Maybe I'll move some of the OtC content already in the article down to the controversies section... --Andrew c 04:23, 6 March 2006 (UTC)

Andrew C,

I reverted your edit because it isn't necessary so long as the quote is in place and to me it seems your only goal is to remove this comment. I don't know why, but I still believe that it makes more sense for them to say what they want rather than us subquoting them. If your argument remains that we are focusing too much on just the Catholics then I'd be glad to add a section on any other religions who are forced to provide ECs.

As for your above comment. I don't know why it is controversial. I just stated that it IS controvesial. If you'd like to expound further on that section be my guest. Chooserr 05:16, 6 March 2006 (UTC)

I asked specifically what was SO important about the quote that a) wasn't already covered in the Controversy in relation to abortion and b) wasn't covered by This law is controversial because it requires Catholic Hospitals to provide medicine that some Catholics morally oppose... [because] the contraceptives may prevent the implantation of the fertilized ovum, and thus are a form of chemical abortion. You quote has NOTHING to do with the Mass. law, and all about presenting the POV that EC is an abortificiant, which not only is already in the article elsewhere, but it has its own section. The controversial part about the law is that Catholic churchers are being forced to do something that they morally oppose. Seriously, what is the relevence of your quote? Could you try to justify it better before readding it, because I honestly do not see its purpose outside of taking up space with your POV.

Next, what exactly is covered in your ONE sentence about OtC that isn't covered in the International availability section? There is already a place in the article for OtC discussion. If you want to move that text to the 'contriversies' section do that, or if you want to add your text to the already existing OtC section, do that... but having the same information in two different places does not make sense. I'm not trying to war with you, but please consider these things. I'll refrain from reverting for the time being, but know that I object to your changes for the above reasons.--Andrew c 05:50, 6 March 2006 (UTC)

It has nothing to do with the Mass. law as you stated - except that this is the reason why it would interfere with the Church's right of freedom of religion. It also explains exactly why they are opposed to it. I really don't see why you can't just leave it alone. Chooserr 05:52, 6 March 2006 (UTC)

Oh yeah and I'm not trying to "use up space" with my POV. If I wanted to us up space for my POV I'd most likely place the information near the top of the page not the bottom. Chooserr 05:54, 6 March 2006 (UTC)

I think you missed my point. I asked what your quote said that a basic summary and the other sections of the article doesn't already convey. I clearly think there is a more concise way to present the fact that Catholics oppose the law because they think EC is a type of abortion. There, I just did it. I am not opposed to linking and otherwise referencing the text. But is there any way we can make things more concise?--Andrew c 06:07, 6 March 2006 (UTC)

[reset margins]I have reworked the section some, including quotes material from the bigger quote, a link to the quoted document, a link to another Catholic document, etc. I still have a problem with this version because I feel it is too wordy/redundent, but perhaps it is a comprimise we can all agree on. Personally, I would cut it down to two or three sentances max. For example:

A Massachusetts law that went into effect on 14 December, 2005, requires all hospitals in the state to provide emergency contraception to any "female rape victim of childbearing age." This is controversial because it would force Catholic Hospitals to provide a medication that morally oppose (link to document).

And then move the Catholic's position up to the Emergency contraception in relation to abortion->Issues Against section.--Andrew c 16:59, 6 March 2006 (UTC)

There's controversies and there's controversies

I don't understand why "Controversy in relation to abortion" and "Controversy" are two different sections, with those names. They should either be merged, or named in a way that distinguishes them better. -GTBacchus^(talk) 05:57, 6 March 2006 (UTC)

I believed that they should be seperate because one would discuss the pill its self giving information as to why everyone isn't using it and the other would talk about how different states are either trying to ban it or force hospitals and pharmacies to provide it. I'm tempted to add the two states (one of which I think is Missouri) that take the choice of the store/pharmacy to decide what they carry and sell away from them by forcing them to buy and stock ECs. Chooserr 06:02, 6 March 2006 (UTC)

Well, perhaps they could be subsumed under one header, with more descriptive subheaders? Having two controversy sections back to back, one with a totally generic name, isn't very helpful for readers. -GTBacchus^(talk) 06:06, 6 March 2006 (UTC)

I agree. The second more generic section seems more to deal with US legal issues than actual 'controversies' surrounding the drug itself.--Andrew c 06:09, 6 March 2006 (UTC)

Well, I guess that making it a subsection wouldn't harm anything it is just that I'm afraid it would confuse the reader more. Anyway I'll fix it. Chooserr 06:12, 6 March 2006 (UTC)

Chooserr and 'lost section restoration'

First of all, your attempt at a revert was sloppy. You kept in my edits, but readded the older version, thus creating two copies of nearly every sentence in that section (but maybe that was a mistake). Next, you are ignoring the rational I have put forth for my edits. Your sentence about OtC is completely vague and meaningless, and ignores the fact that there is already a section about OtC controversy under the heading International availability. If you want to reorganize that section and add a header, do that. But adding that one unacceptable sentence under a different header does not help the article. Secondly, I made a case for why your long quote not be included. I then tried to cut things down, being concise while still keeping part of the quote and linking to the two sites. I asked you twice above, and I will ask you again. What exactly is being said in the quote that isn't included in my consise version, or other parts of the article? Remember this section is about the Mass. law, not the Church's position on EC, or the argument for EC being an abortificiant (which already has it's own section). So, I can't stop you from editing (nor would I want to), but could you please try to address these concerns and make a stronger case for your edits before readding them. --Andrew c 14:28, 10 March 2006 (UTC)

Bias against Pro-life position

Hey I am pro-choice for the first trimester but CLEARLY this whole article is slanted toward the pro-abortion lobby. I think these folks are entitled to their viewpoints even if I don't agree with it 100%.

What I wanted to know is what happens if the woman IS already pregnant and takes the pill. She may be already pregnant, and not know it, from a previous encounter. Will the baby be harmed?

There is so much verbage trying to justify this drug, which some consider unsafe by the way, that needed info is left out or lost in a sea of words.

Oh, and one more thing I found odd. In a article 3,174 words long, the word baby does not appear one single time. Doesn't even unwanted or unplanned pregnacies involves babies??

Lets tighten this up people.

Less opinion, more facts.

--149.152.34.18 22:59, 17 April 2006 (UTC)

• Well, no, unwanted and unplanned pregnancies, at least at the point where emergency contraception is useful, do not involve "babies"; they don't even involve fetuses; they don't even involve embryos. The entire point of a morning-after pill is to prevent implantation; no implantation, no blastocyst; no blastocyst, no embryo. Regarding being already pregnant, everything I've read indicates the morning after pill has no effect at all if the woman is already pregnant. At worst, it's useless. --jpgordon∇∆∇∆ 23:33, 17 April 2006 (UTC)

Anon: You must have missed this part of the article Unlike forms of chemical abortion such as Mifepristone, emergency contraception does not end pregnancies and will not harm a developing embryo. Also, this article is about a form of contraception, not abortion. The condom article also does not use the word baby once. If you have information on why this drug is so 'unsafe' feel free to add it, or post a link to that info here. But otherwise, it is made clear in its own section the Contraindications and side effects, which are the same as for normal oral contraceptives because they are basically the exact same thing. If you have a specific example of where the article is pushing a POV, feel free to list it here, or remove that POV yourself. Thanks for your concern, but I'm not exactly sure we see eye to eye on this yet.--Andrew c 01:11, 18 April 2006 (UTC)

I think he or she had a valid question that is not answered in the article. The article does not say one way or the other whether or not the drug is harmful to the child. I think that’s a valid concern. The article reads as if any user of this drug would always get an abortion if she were already pregnant. There is no mention whatever what would happens to the development of the child, or children in the event of a multiple birth, if the drug is taken while the mother is already unknowningly pregnant and the mother latter chooses life. The lack of information is not proof the drug is safe. The advertisements I have seen for this drug do not boost among its talking points that the drug is safe for an existing child. --69.37.90.237 12:21, 22 April 2006 (UTC)

• The article says quite clearly, Unlike forms of chemical abortion such as Mifepristone, emergency contraception does not end pregnancies and will not harm a developing embryo. What part of "will not harm" is unclear? --jpgordon∇∆∇∆ 14:59, 22 April 2006 (UTC)

There is some evidence that artificial estrogens and progestins, including phthalates, parabens, and oral contraceptives, can cause feminization of male fetuses (i.e. slightly smaller ano-genital distance, more risk of undescended testicles, etc.) These studies were done on women who were exposed to these chemicals every day of their pregnancy (most people in industrialized countries have high concentrations of phthalates and parabens in their blood). While EC would carry the same type of risks, because is it just two days of exposure, taking EC carries a much smaller risk of birth defects than, for example, regular eating of microwave popcorn (which has high levels of phthalates from the coating on the paper). Because the research on all these effects is kind of sketchy, I don't think it should be included in the article. Lyrl 14:52, 22 April 2006 (UTC)

• If there is no adverse effect, then there will tend not be anything to report this with, but here goes:
  1. An article in 1989 describing the safer use of routine combined hormonal contraceptives with an oestrogen dosage below the initially introduced 50mcg notes "There is only 1 report of increased incidence of congenital heart disease in infants whose mothers took pills during pregnancy." Derman R (1989). "Oral contraceptives: a reassessment". Obstet Gynecol Surv. 44 (9): 662–8. PMID 2671844.. Subsequently most combined pills now use 20-30mcg oestrogen, and the current US & UK emergency contraceptive contains none at all, being progesterone-only.
  2. "No cases of congenital abnormality have been reported in babies born to women taking the minipill at conception" Graham S, Fraser IS (1982). "The progestogen-only mini-pill". Contraception. 26 (4): 373–88. PMID 6759029.
  3. Looking at the NZ data sheet (they have open web access) for Levonelle (=levonorgestrel, the progesterone-only ECP) "In the case of failure of emergency contraception, epidemiological studies indicate no adverse effects of progestogens on the fetus." Furthermore, bearing in mind that Levonelle is only licensed for use within 72hours of intercourse, it goes on to note that "It is generally considered that known teratogens will not produce malformations before organogenesis starts, which is later than 72 hours after fertilisation.", so this would suggest adverse events would not occur even if there was an unrecognised risk with administration later in pregnancy.
• Most drugs fail to have an adverse effect on either other specific diseases or on birth defect rates. Drugs go through a safety checking process before licensing, which the licensing bodies then decide upon. No later researcher will go looking for an adverse effect if none has been previously reported or have been suggested by anecdotal cases.
• As for whether to include any of this in the article: Normally an article on a drug will not list all the things a drug does not treat, fail to have an adverse effect with or lack of teratogenic effects. So medically, there seems no need to so include in the article. However this topic has a wider debate around it than just the medical, so do other editors feel this does need to be included as a counter-argument to the claims of some in the pro-life viewpoint, or would this be better in the "higher-level" articles on birth control/contraception ? David Ruben ^Talk 15:27, 22 April 2006 (UTC)

Well I don't know about that. All kinds of drugs have been approved that make people sick or cause birth defects. Many hair treatments pills say right on the package that any woman of child bearing age whether she is pregnant or not must not even touch the pills. Another pain killer made my father very fat which lead to his getting diabetis. Then there is fin fyn or whatever. Latter these harmful drugs are pulled but not before the damage is done. Of course when you are talking about anything to do with abortion, the abortion cheerleaders last concern of all is the health of a fetus. That is of no concern whatever. --149.152.34.43 22:33, 23 April 2006 (UTC)

149.152.34.43 - All the drugs you reference either have known effects - with warnings on the package - or are very new. The hormone (or hormones) in EC pills have been used by millions and millions of women for forty years. As pills do have a failure rate, especially when not taken correctly, there have been hundreds of thousands of babies born to women on the pill during conception. If there were any major adverse fetal effects from these hormones, they would be known by now.Lyrl 22:53, 23 April 2006 (UTC)

Anon: I understand your concerns, but to include something in Wikipedia, it must be verifiable. If you have any data or sources that prove EC is harmful to fetus, please cite them. Pointing to the adverse health effects of other drugs, or mentioning personal anecdotes about your family, is not encyclopedic. I believe other editors have cited sources that explain how EC is not harmful to fetuses. As lyrl points out, oral contraception has been around for 40 years. Women may become pregnant without knowing it and continue to take the pill for a few months into their pregnancy. Case studies of these instances have shown no birth defects. Please read the section "II. Birth Defects" here, and check out their cited sources for even more information. --Andrew c 15:31, 24 April 2006 (UTC)

Proof is needed the drug is safe. —The preceding unsigned comment was added by 69.37.254.159 (talk • contribs) .

Could you explain a little more? What exactly are you looking for? Could you point to another article that you feel adequately covers drug safety in a manner that you'd like to see done here?--Andrew c 02:38, 3 May 2006 (UTC)

Citation permission

We had cited a paper without permission. I have since received persmission to cite it for wikipedia. I was also referred to a forthcoming updated version of the paper. For more information about this, see Wikipedia:Successful requests for permission#Emergency Contraception.--Andrew c 20:27, 2 May 2006 (UTC)

I don't understand, why would a citation require permission? You're not copying his article, so there are no copyright issues. Obviously, there are no patent or trademark issues either. A citation is just an identification of an existing document; one does not require permission from an author to cite his work. eaolson 23:39, 10 May 2006 (UTC)

Click on the link to the PDF in question. Read what it says at the top of the page. I, personally, have never heard of anything like this before, but I wanted to obey the author's wishes.--Andrew c 00:06, 11 May 2006 (UTC)

---

Yeah, I'm super pro choice, and i can tell the bias in the article. Not neccesarily with what is said, but there is a pro choice tone. And the choice of facts. I'm sure all the facts are prettty accurate, but unfortunately overwhelming facts that seem to support one side could be considered biased. If there is overwhelming evidence that the nazis killed millions of people, and i placed that on an article, does it make me biased against nazis? probably, but it doesn't make me wrong.

---

EC and Mini pill

don't they both prevent implantation.

You can not say one is a contraception and the other is an abortion just because of the time you take them.

whats the IUD classed as when its used as an EC —Preceding unsigned comment added by Blonde2max (talk • contribs) 16:02, 5 May 2006

Controversy over beginning of pregnancy

This section has been expanded a couple of times but reverted as off-topic to EC. To me, it's an interesting topic. I'm not sure if this is covered in any existing articles, but if not would anyone support making this its own article? Any name suggestions?Lyrl 22:06, 15 May 2006 (UTC)

It seems to me that the best place to discuss the definition of pregnancy (or when it begins) is in the... umm... pregnancy article. And then in a sentence or two in other relevent articles, mention that some people hold the POV that pregnancy beings at fertilization and other implantation.--Andrew c 22:38, 15 May 2006 (UTC)

True, but I'm not sure that would be the appropriate place to address the ethical issues of actions that prevent implantation (hormonal contraception, breastfeeding, and, as recently alleged by Prof. Bovens in the Journal of Medical Ethics, the rhythm method). The argument that hormonal contraception is immoral, but breastfeeding is OK due to the principle of double effect, etc. Lyrl 17:38, 27 May 2006 (UTC)

I found an article with a "fertilization vs. implantation debate" section: Abortifacient.Lyrl 00:50, 30 May 2006 (UTC)

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"highly contested" vs "medically incorrect"

Al, I looked into this carefully and I easily find medical sources using "pregnancy" to refer to from conception. See The American Heritage® Stedman's Medical Dictionary (dictionary.com) and Langman's Medical Embryology p. 117 as examples. I do understand that it may seem clear-cut to some people, but the term varies in medical use, while "contested" is verifiable. I also suspect there is more at play than just politics and morality in the lack of uniformity. Darrowby 12:01, 2 June 2006 (UTC)

"Highly contested" sounds a bit weasly to me... makes it sound as if the contestation is not entirely valid. According to the American Medical Association, implantation is what starts a pregnancy, not fertilization, and although they are not the one difinitive source, I would think that most of the medical community would agree. I would say more that the medical community's assertion that pregnancy begins at implantation is what is contested, not the other way around, as it's primarily laypeople contesting what medical experts are saying, in this case. I would support reworking this sentence completely, but I disagree with the change of "medically incorrect" to "highly contested". romarin[talk to her ] 13:43, 2 June 2006 (UTC)

This is an old topic on the abortion articles. It turns out that the start of pregnancy used to be ambiguous, since was clarified in response to in vitro fertilization. Fertilizing an egg in a petri dish does not make anyone pregnant. Rather, when that egg implants, the woman becomes pregnant. Therefore, pregnancy starts with implantation. There are some outdated usages out there, but the term is defined with great clarity WITHIN THE MEDICAL COMMUNITY. Al 14:57, 2 June 2006 (UTC)

Excellent point Al; I hadn't really even thought about in vitro fertilization, and how that could clarify the position so much. It's true, no one is pregnant when an egg is fertilized in a petri dish, which, biologically, is no different than fertilization occuring anywhere else. It's pretty clear that any assertion otherwise would be "medically incorrect". romarin[talk to her ] 17:47, 2 June 2006 (UTC)

Unless you want to claim the petri dish is pregnant. :-)

The other detail to mention is that pregnancy tests actually detect the hormonal changes caused by implantation. Until IVF, there was no practical way to detect a fertilization before that point. In this way, pregnancy tests really do test for pregnancy, not merely fertilization. Al 17:53, 2 June 2006 (UTC)

Wow, I see a whole new controversy on the horizon: is it moral and/or ethical to dispose of a petri dish that has been pregnant? As it has been the vessel of the creation of new life, does this mean that the petri dish is now a living being itself? Oh, what to do with unwanted petri dishes? ;) romarin[talk to her ] 18:04, 2 June 2006 (UTC)

The argument I'd expect is that the fertilized egg in the petri dish has a moral right to be implanted in an appropriate uterus. This argument, however, would not carry much weight with me, particularly since IVF is normally paired with fertility drugs that cause multiple ovulation, and only the most viable eggs are kept for implantation after the waiting period. Frankly, it makes about as much sense to say that male masturbation is immoral because each sacred sperm has a moral right to enter the pregnancy sweepstakes in an appropriate vagina. Al 23:26, 2 June 2006 (UTC)

Well yes, of course, didn't you know that Every Sperm is Sacred? romarin[talk to her ] 04:36, 3 June 2006 (UTC)

So I've been told, musically. Al 05:12, 3 June 2006 (UTC)

The medical world wasn't in ignorance of the basic facts of development before IVF; that did have an influence on terminology, but none of those basic facts changed, and actual (observed) medical usage of the term doesn't seem to be consistent in the way you suggest. But despite those clear (and very recent) examples, and even though I'm not the one making the new assertion, seemingly it makes no difference and it's put right back in. That makes no sense. Outdated? 2002 and 2004 were the dates of those publications.

This is POV and I've already shown that phrase inaccurate, so why is it still here? It doesn't belong. Darrowby 06:36, 3 June 2006 (UTC)

BTW, Romarin said 'I disagree with the change of "medically incorrect" to "highly contested".'

It's the reverse. I believe "highly contested" was just changed to "medically incorrect." Darrowby 07:17, 3 June 2006 (UTC)

Well excuse me then, but I wasn't aware of the whole history of this article. I was referencing the point at which "medically incorrect" was changed to "highly contested," which did happen yesterday. So to clarify my position, I support the change that Alienus made to that sentence in the first place, changing "highly contested" to "medically incorrect".

As for the inaccuracy, if the medical community holds a certain truth at large, then to claim the opposite would be "medically incorrect," no? No one is saying that it is universally incorrect or anything, whatever that would mean, just that it is not something that the medical world views as correct. How is this not a valid assertion? And how is it POV to state what a certain group of people, who are authorities on the topic, hold to be true? romarin[talk to her ] 14:05, 3 June 2006 (UTC)

Well, that's a good question. The "medical community/world" itself (we're not talking about anyone else) does not use these terms consistently. So, it isn't possible to say "medically incorrect." It's POV because it's an assertion that favors one side but turns out not to be verifiable. Darrowby 20:52, 3 June 2006 (UTC)

Darrowby, I can't say I agree with your most recent edit regarding this paragraph. It now reads as though both options (fertilization and implantation) are given equal validity, which is simply not the case. Even if there is discrepancy within the medical community, which I'm sure there is, doctors, other health care workers, and scientists overwhelmingly support the notion of pregnancy beginning with implantation. This paragraph needs to reflect that. Although I appreciate your attempt at avoiding POV, you have given equal voice to two things that are not equal, and have ended up exhibiting a strong POV. romarin[talk to her ] 22:39, 4 June 2006 (UTC)

I'm aiming for two things, accuracy and lack of bias. The article originally used a statement that was accurate, this was changed to one that was not. (As was demonstrated.) Removing inaccuracy and POV does not create POV! :) I understand how you feel, but the 'medically incorrect' version just doesn't hold up.

To give you some background, I'm pro-life but I myself had always assumed that preg. started with implantation, so I wasn't starting out to back up my own viewpoint here. But anything that looks possibly biased in any direction always stands out to me, and I decided to double-check on that 'medically incorrect' assertion. I was surprised to find current medical usage from conception, and right away too--not after hard searching. And looking around I also started to understand (or at least suspect) why the definition may be more than just political/relgious and bigger than pre/post IVF too. So, the situation is not as clear-cut as POV sources would have us believe, or for that matter as I originally assumed myself. We have to uphold accuracy. Darrowby 23:16, 4 June 2006 (UTC)

Ok, I think it's a lot better now; I liked Al's changes a lot, and I accept most of the changes you made to his revision. However, that first paragraph... I really don't think "disputed" cuts it. I'm wracking my brain trying to think of a compromise, but nothing is coming yet. "Disputed" in this context gives me the same weasly feeling that "highly contested" did, particularly as it does nothing to address the majority opinion, at least among experts. Saying "this is based on the belief that pregnancy begins at fertilisation, which is disputed" makes it sound like it's disputed by some fringe group of people, do you know what I mean here?

I appreciate your explanation, and agree that the situation is probably not as clear-cut as we all may have thought. But what we should look at is who is saying what, who is using fertilization and who is using implantation as the starting point. All I know off the top of my head is that the American Medical Association's official statement is that pregnancy begins at implantation. If there are a majority of medical associations across the globe who concurr, then that is pretty important evidence. If a few doctors who happen to be very vocal disagree, then sure, we've got a few doctors saying the opposite, but is that significant enough to warrant equal validity to both sides? I agree that we have to uphold accuracy, and I'd really like to find some kind of compromise that will do just that to the fullest extent. Maybe simply finding more detailed information about actual usage of the two terms is what we need. romarin[talk to her ] 00:12, 5 June 2006 (UTC)

P.S. Regarding your first statement, I understand your frustration at the original state of the article, but I can't really speak to that directly, as I only recently started paying attention here. I was also away from my computer for a few days when this most recent wave of edits started taking place, so I'm kind of jumping in here in the middle of all of it. Sorry if the things I say exhibit my ignorance at what was going on a week ago. romarin[talk to her ] 00:21, 5 June 2006 (UTC)

I would be fine with mentioning the AMA's position, how about just doing so and letting that stand on its own merit? Darrowby 00:18, 5 June 2006 (UTC)

I think that may be a good interim addition, but I also think we should look into what other medical associations go by. romarin[talk to her ] 00:23, 5 June 2006 (UTC)

(reset indentation) In the UK abortion is legally accepted (as opprosed to what any one person or group might otherwise wish) as the termination of a pregnancy following implantation and requires 2 doctors to consent prior to the proceedure and sign a legal document (Certificate A) and then a further certificate is signed on the day of the proceedure. Anything prior to implantation is considered contraception and outside the scope of the Abortion Act 1967 and the Offences Against the Persons Act 1861. So in UK, taking medication within the 3 days following intercourse or insertion of an IUCD within 5 days, will be before fertilistion/implantation is complete and thus counts as a contraception measure. None of this directly addresses ethical/moral/religious opinions as to what some might wish to have considered the start of pregnancy, but the de facto legal situation in the UK is currently of implantation. A few historical legal and current Medical advice links as references to this:

• The Oxford Centre for Ethics and Communication in Health Care Practice, Oxford University. Medical Ethics and Law Teaching Materials: Termination of Pregnancy - Handout 3: Outline of Legal Positions in England and Wales (From Hope, T. and Savulsecu, J. Medical Ethics and Law: the Core Curriculum.) Appendix 3: Some key points in the law on abortion and fetal damage. See the section 'Inter-uterine contraceptive devices (IUCDs) and “morning after” pills'.
• BMA (2005). "Abortion time limits: A briefing paper from the British Medical Association". {{cite web}}: Unknown parameter |month= ignored (help)
• "There has, in the past, been some uncertainty about whether certain types of contraceptives, such as hormonal emergency contraception and intra uterine devices should be classed as abortifacients which could be issued only under the terms of the Abortion Act. This question was resolved by a Parliamentary answer in May 1983 in which it was clarified that the prevention of implantation does not constitute the "procuring of a miscarriage" within the terms of the Offences Against the Persons Act 1861. This interpretation was tested and confirmed in the case of R v HS Dhingra in 1991." British Medical Association (1999). "The law and ethics of abortion: Conscientious objection clause". {{cite web}}: Unknown parameter |month= ignored (help)

David Ruben ^Talk 02:43, 5 June 2006 (UTC)

Thanks for providing this research. Let's see if we can integrate it. Al 06:59, 5 June 2006 (UTC)

Rates fertilised embryos implanting

"Fertilised embryos naturally fail to implant some 40 to 60 percent of the time."

does not directly relate to:

"The claim that pregnancy begins with fertilisation and not implantation is highly contested."

It could be used in another way but it doesn't work there. Darrowby 13:29, 2 June 2006 (UTC)

Well, some extra text and citation has been added, but these statements still share no logical relationship. The one does not support the other. Interesting, maybe, but unrelated. Darrowby 06:36, 3 June 2006 (UTC)

Or considering the new changes, I guess I should consider these statements separate now, and say instead that the content about natural failures to implant does not relate in any meaningful way to the topic of controversy over the beginning of pregnancy. Probably misplaced and originally intended in another part of the article. Darrowby 07:17, 3 June 2006 (UTC)

I had added the text "It is argued that the high loss rate of early embryos is reason to avoid defining pregnancy at conception" to try to draw the paragraphs together, but that was deleted by Al. Although actually the fertilization vs. implantation debate is likely off topic for this article - expansions to that section have been reverted twice before. I recently expanded that section in the abortifacient article, where it seems more on-topic, and have been trying to think of an appropriate way to link there. Lyrl 02:17, 4 June 2006 (UTC)

Pro-life vs anti-abortion and pro-choice vs abortion-rights?

There's been some reverting between "anti-abortion" and "pro-life," with Andrew c pointing me towards WP:NCI. Trouble is, the naming conventions article is entirely about demographic groups (ethnicities, sexual orientations etc), and does not touch on whether or not these naming conventions (in particular, deference to self-identification) should apply to political movements. Most of the convention's examples are favored because they are the most inoffensive -- e.g., "gay" and "homosexual" are equally descriptive, but "gay" is favored because it is inoffensive to more gay people. "Pro-choice" and "pro-life" aren't npov by any stretch of the imagination (as there is no consensus around when life begins and the abortion-rights movement doesn't exist to protect choice in general), and the available substitutes -- "anti-abortion" and "abortion-rights" -- are accurate and inoffensive, even if the movements themselves don't favor these terms.

Does wikipedia have an established standard around the naming of political movements? If not, I'd say we should opt for the most politically neutral language available. --Rocketfairy 13:40, 18 May 2006 (UTC)

Reading through the other pages on WP:NC, I thought it was clear that a) use terms that the public would most likely search for b) use terms with which groups self-identify c) NPOV is not the same thing is no-point of view. If we say "pro-life" and "pro-choice", we are still being neutral by presenting both sides. Our goal is just to be neutral, not to erase POV completely (a la non-point of view). --Andrew c 14:02, 18 May 2006 (UTC)

"Pro-life", however, encompasses a number of things other than abortion that aren't relevant to this topic. For example, euthanasia. As such, I would suggest "anti-abortion" is a more precise term. But it's a fine distinction. eaolson 23:41, 18 May 2006 (UTC)

Eaolson, I personally don't like the term anti-abortion because it makes the pro-life movement seem reactionary, and single issued. I believe that we should just stick with pro-life and "pro-choice". Chooserr 01:19, 19 May 2006 (UTC)

Chooserr, many of us don't like the term pro-life because it presupposes that embryos are alive. Wikipedia shouldn't name things in whichever way seems favorable to some; rather, we should use names that are accurate and neutral. "Anti-abortion" is accurate: The controversy is around abortion, and the opposition to EC comes from groups that oppose abortion and that aim to restrict it. The opposition is driven by a single issue, as it comes from groups that oppose abortion but share no consensus around other questions of life (e.g., the capital punishment, the appropriate use of military force, vegetarianism). As such, the more narrow, less biased characterization "anti-abortion" is more appropriate. By the same token, "pro-choice" may well be inappropriate.

I remain unconvinced of Andrew c's claim that WP:NCI applies, as it refers to "identities" -- people may identify themselves as pro-life or pro-choice, but those labels refer to contentious political movements, not demographic groups, and neither politeness nor balance requires that we defer to a political movement's claims in naming it. --Rocketfairy 02:08, 19 May 2006 (UTC)

Rocketfairy, I'm sure many people don't like the term "pro-choice" because it doesn't give a choice to the fetus/embryo are you condoning the entire wikipedia removal of that term? If so I'd be glad to facilitate its removal for you.

Besides that I still feel anti-abortion is inaccurate because it is not a "single issue". Most pro-life websites also disagree with euthanasia, which is quite different from abortion. A Google search for pro-life along with a brief search of their website will confirm this, along with many other similarities. 02:18, 19 May 2006 (UTC)

Also Rocketfairy there is no debate over the fact that embryos are alive. The fact that they are persons is what is disputed. Chooserr 02:20, 19 May 2006 (UTC)

(Reset indent) I'm not talking about the use of the term in general; if I was, I'd be doing it on Pro life, not here. As I said, the question here is about a single issue. You recommend I google pro-life and look at "their website"; I went ahead and did so. Among the first 10 links are the US Conference of Catholic Bishops (opposes euthanasia, capital punishment and the invasion of Iraq, considers these positions integral to a culture of life) and National Right to Life ("Other congressional issues" doesn't have any reference to capital punishment or war). What unites these groups? What unites the groups opposing EC?

iirc the term pro-choice appears once in the article; if we can agree on an acceptable substitute, I'd be happy to change it. "Abortion rights" isn't a good fit here, as the pro-ec lobby tends to reject the idea that EC is abortifacient. But I'd definately be open to alternatives. (For the record, I don't tend to call myself pro-choice; I consider the term arrogant and not particularly precise.)

And, yes there is debate over whether or not embryos are alive. --Rocketfairy 02:36, 19 May 2006 (UTC)

Rocketfairy, is there really a controversy about embryos being alive? I thought everyone could atleast conceed that point - just as everyone recognizes single-celled organisms are alive, even a persons cells as living.

As for what unites the groups I typed it Pro-life (not in quotes) and recieved 10 results on the first page. Of these discounting abortionisprolife.com (pro-choice), prolifeblogs.com (a blog site not an organisation), and prolife.org (unable to load) every site except one (http://www.prolifeaction.org/) talked at least briefly about Euthanasia. Chooserr 03:00, 19 May 2006 (UTC)

failure to implant

There are references all over the internet to "studies that show pregnancy will occur in 60% of natural cycles in fertile couples." The presumption being that the other 40% of the time embryos could have been created and yet failed to implant. None reference their sources, though.

I wasn't able to find that particular study (if it exists). I did find here a pregnancy rate of 66.7% in cycles where intercourse occured on Peak Day of cervical mucus. And this study found a pregnancy rate of 71.4% (in women with prior pregnancy) to 80.9% (in nulligravidas) in the first cycle for women trained in a mucus-only fertility awareness method. So the lowest figure for failure to implant (assuming all cycles resulted in embryos being conceived) would be 19.9%.

For a high figure, I searched for IVF studies. This site claims a 40% pregnancy rate for transfer of one embryo (so a 60% failure to implant). This study claims a 23.9 to 36.4% implantation rate for IVF (so a 63.6-76.1% failure to implant).

"Fertilised embryos naturally fail to implant some 40 to 60 percent of the time" is the current statement in this article. I'm not sure what to change it to, but hope the studies I've found will give someone else ideas. Lyrl 14:52, 20 May 2006 (UTC)

As an aside re the quote above re pregnancies occuring in 60& of natural cycles. Firstly the remaining 40% is not the rate of failure to implant - some may be, but there will also be occassions when no fertalisation ever had occured. Secondly I doubt these values for the following reason: the medical definition of sub-fertility is the failure to conceive despite regular intercourse over the course of one year. As such, approx 75-85% of couples will conceive over the course of a year. Given success at conceiving within one year is therefore the definition of normal fertility and there are 12 months in a year, the conception rate can not be 60% a month. Of course acheiving pregnancy is not normally distributed (the smooth bell-shape curve with equal percentages above and below a mean level - one can't conceive in a negative number of months) and the majority will conceive quickly, with some couples having a relatively lower success rate and thus taking on average longer than other couples. Quick back-of-envelope calculation (assuming all "normal" couples have equal fertility rates - which is false as couples do vary) shows that a conception rate of about 15% a month will acheive a cumulative success of 85% over one year. For more information on success rates see:

Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G (2005). "Definition and prevalence of subfertility and infertility". Hum Reprod. 20 (5): 1144–7. PMID 15802321.{{cite journal}}: CS1 maint: multiple names: authors list (link)

David Ruben ^Talk 00:13, 28 May 2006 (UTC)

Couples of normal fertility having intercourse at random times of the cycle have a 24% per-cycle pregnancy rate (see the next-to-last sentence in this abstract). Couples using fertility awareness methods to time intercourse have the higher pregnancy rates I cited above in the first cycle of trying - if you look at the studies, you will see that pregnancy rates in the second and later cycles are much lower. If a couple is using a fertility awareness method to time intercourse, a diagnosis of subfertility can be made after six months rather than one year.

The rate of non-pregnancy in a cycle is the maximum theoretical rate of failure to implant. It is likely that some or even most of the non-pregnancies were due to conception not occuring, but there is currently no way to tell for sure which explanation is the correct one. Lyrl 03:06, 28 May 2006 (UTC)

I think we have to be careful about using implantation success percentages from IVF. In IVF, the fertilized egg is observed for a while, and only then implanted. This weeds out some of the eggs that, if inseminated, could not implant. Further confusing things, many eggs do implant but quickly self-abort. These show up as so-called "chemical pregnancies", if at all. As a result, the majority of fertilizations do not lead to a (detectable) pregnancy. Al 17:56, 2 June 2006 (UTC)

IVF is only done on infertile couples. Failure to implant in that population is significantly higher than in couples of normal fertily. I would only support the use of IVF implantation rates as an absolute maximum.

In couples of normal fertility, studies have detected pregnancy in up to 80% of women after one cycle of trying conceive (see references above). The statement "the majority of fertilizations do not lead to a (detectable) pregnancy" is blatantly false.

Chemical pregnancies are detected chemically, with a home pregnancy test or a blood beta test. The very sensitive tests available now can detect virtually all implantations, even if miscarriage occurs after just a couple of days. Just because a pregnancy does not develop enough to be confirmed visually on an ultrasound (approx. 6th week of pregnancy, 4th week after conception, 3rd week after implantation) does not mean the pregnancy is "not detectable." Lyrl 23:07, 2 June 2006 (UTC)

I'm all for getting some more accurate numbers for what percentage of conventionally fertilized eggs fail to implant. I suspect it's pretty high because, in the days between fertilization and implantation, there is plenty of opportunity for a nonviable egg to self-destruct, leaving it in a state where it will not implant. Of course, some of these manage to implant but quickly self-abort.

Note that, in these cases, the egg never had a chance of being carried to term in the first place, and whether it qualifies as an implantation failure or an early self-abortion is of only incidental concern; either way, it was never going to be an infant. I should mention that it's quite possible for a healthy egg to fail to implant or to abort early on, but this is a substantially less common case.

Yes, if the woman happens to take a pregnancy test at just the right moment (after implantation but before hormone levels return to normal due to the self-abortion), she'll detect that she had been pregnant. Under normal circumstances, though, she'll never know. Typically, such chemical pregnancies don't last long enouigh to manifest symptoms such as morning sickness or tender breasts, so the only indication is a heavy period.

The issue at hand, though, is what percentage of covential fertilizations implant and remain implanted long enough to be noticed as a missed period. Everything I've seen puts the figure at well under 50%. If you have better sources, please share them. Al 23:23, 2 June 2006 (UTC)

Here is a pregnancy rate of 66.7% in cycles where intercourse occured on Peak Day of cervical mucus. And this study found a pregnancy rate of 71.4% (in women with prior pregnancy) to 80.9% (in nulligravidas) in the first cycle for women trained in a mucus-only fertility awareness method. So the lowest figure for failure to implant (assuming all cycles resulted in embryos being conceived) would be 19.9%. Much less than 50%. Lyrl 23:51, 2 June 2006 (UTC)

That link was interesting, but its focus was primarily on success of NFP. It didn't really offer much in the way of hard numbers for either implantation failures or early self-abortions. Got anything more specific? Al 23:57, 2 June 2006 (UTC)

If 66.7% of couples acheived a detectable pregnancy in a single cycle of intercourse near ovulation, then at most 33.3% of embryos failed to implant. The topic at hand is implantation failure, not early miscarriage, so the subsequent miscarriage rate is not relevant. But the implantation failure rate (assuming all cycles resulted in conception - which there is no way to verify) of 33.3% is. Lyrl 00:14, 3 June 2006 (UTC)

Correction: I clicked on the first link twice and therefore dismissed it as more of the same. The actual second link does give that 71% figure, but it's not all that helpful. First of all, since these are women who are very actively trying to get pregnant, we can expect that they'll be using a pregnancy test. This means that we're getting rate of pregnancy, not rate of viable pregnancy. In other words, how many of those 71% are just chemical pregnancies? The other confounding factor is that this study involves women who are using ideal timing. It's unclear whether timing is a relevant factor in implantation and self-abortion rates. For example, sperm that are old by the time they reach the egg may well create fewer viable blastocysts. Likewise, the lining of the uterus decays rapidly, so a healthy late-fetilized egg might implant just as its being shed. Al 00:03, 3 June 2006 (UTC)

The discussion at hand is failure to implant, not early miscarriage. While emotionally the same for many people, there is a distint difference in the biology of what happened to both the embryo and the woman. It is not possible to determine if timing is a relevant factor in implantation, as poor timing is also going to reduce the number of conceptions occuring. However, studies have been done on timing of intercourse and early miscarriage [10] showing overall no effect (although a subset of women do see an effect, they are a small enough percentage of the population to not effect the overall numbers).

Also, implantation occurs 6-12 days after ovulation. Short luteal phases of less than 12 days can be a cause for RPL - but that has to do with the woman, and not with the embryo or when intercourse occured relative to ovulation. Because of the very short life of human ova (typically 6-12 hours), timing of intercourse has very little effect on timing of conception. Sperm can live in the female reproductive tract for up to five days. Lyrl 00:14, 3 June 2006 (UTC)

Lyrl, I've researched this before and have consistently seen higher numbers for both. A quick google turns up a figure of 50% [11] failing to implant. Another confounding factor is the idea that "In countries where abortion is illegal, doctors see a whole lot of patients for "incomplete spontaneous abortion" requiring D&C." [12]. Al 01:09, 3 June 2006 (UTC)

More on 'medically incorrect'

I'm not happy with the latest round of changes, but I do admin that the "before" has problems, too. Therefore, I'm going to give this some though and see if I can improve on it. Al 22:35, 4 June 2006 (UTC)

Al, the background is good and I like it, but then there is the same problem of asserting the defition is now from implantation and other usage is untrained or old fogies. (Heh, heh, heh.) That will need adjustment for the original reasons, because it has the original problem. BTW, I'd say this controversy over beginning of preg. could be its own article, do you agree? Also BTW, note my other recent comment above in the original discussion section on 'medically incorrect.' Darrowby 23:30, 4 June 2006 (UTC)

Al, I hope the latest will work for you. (Which would probably mark our first major agreement!) I have no desire to bias in direction of any POV, just want neutral and above all, accurate. Darrowby 23:48, 4 June 2006 (UTC)

I made a few changes, largely to the area that Romarin had some issues with. I'd still like to insert a sentence explaining precisely why the high failure rate of fertilized eggs is seen as relevant.

I can explain the argument, of course, but I want to find an outside source to cite, so as to avoid original research. The basic gist is that, since most fertilized eggs never turn into much of anything, we shouldn't treat them as anywhere near as important as, say, a late-term fetus. Whereas a late-term fetus is very likely to turn into a baby if given a few months, a fertilized egg would most likely never become a baby.

Moreover, this is already how we act. It's not as if anyone holds funerals for "late, heavy periods", which is the most a woman's going to notice unless she's actively testing for pregnancy.

Again, I do not want to insert these words; I want someone else to say this sort of thing, more or less. You can help by finding me a solid sitation, as per WP:RS. Al 06:40, 5 June 2006 (UTC)

Another thought to consider: someday there will be the advent of artificial womb, and that will raise the question, is the artificial womb 'pregnant'?

The word origin means 'before birth.' With an artificial womb, will there be a 'birth'? Darrowby 23:59, 4 June 2006 (UTC)

I believe Aldous Huxley suggested "decanting", but I doubt that would ever catch on.  :-)

A petri dish does not provide nutrition the way a the uterus does, but an artificial womb would have a nidation point that fulfills this role, so I expect that a blastocyst that implants itself into an artificial uterus will be considered a pregnancy.

We're not quite at the point of creating an artificial uterus, but I do know for a fact that there is serious research going on in that direction, with some initial results (on animals) that are intriguing. Al 06:40, 5 June 2006 (UTC)

The use of "pregnancy" to mean from conception (or LMP) is not just still around here or there, it's widespread, practically everywhere. In medical use with (naturally) pregnant women, I think LMP or conception is probably much more commonly used for counting than implantation, at least in U.S. Use in books is common. There is some debate by doctors. Legal definitions vary and may conflict--many U.S. states use conception or fertilization. There are some pro-life physician orgs that either define preg. from conception, or define the killing of a fertilized egg as abortion. Given all this (way more than I originally expected, as I originally assumed the implantation def. would be near-universal until I searched and found otherwise) I have to say that this article should not try to adopt or promote one view in a situation where there are multiple prominent views. (This is covered in the NPOV policy.) The reader is supposed to decide, according to the policy, we don't have to hold the reader's hand and force them to accept a position. If the facts are there, no spin is needed. I went ahead and added examples of the other def's in current use. Darrowby 13:17, 5 June 2006 (UTC)

Use of LMP is side issue as it defines a separate concept of "dates of pregnancy", not the state of "pregnant" itself. LMP as a basis for "dating the pregnancy" (ie the 40 weeks) is a totally abstract invented concept (counting system could be from fertilisation or date of the missed period or even negative numbers counting up to zero-day of delivery). Given that in the past women could not necessarily know & report their ovulation date, nor know the precise date their period was missed (given most women have cycles that vary by at least 1-2 days), it is easiest to estimate by calculation from the known last menstrual known period (LMP). However use of LMPs to calculate the Estimated Date of Delivery (EDD) and "pregnancy duration" must be adjusted if the woman has regular but atypical length cycles (from the assumed average of 28 days). So the LMP is defined as the zero count-point (i.e. pregnancy duration 0/40), the ovulation that usually (in a 28 day cycle) occurs around day 14 is at 2/40, the missed period is at 4/40. No one though would retrospectively look back on a pregnancy and talk about a women at 1/40 as actually being pregnanct - as this is 1 week prior to ovulation ! Indeed if a woman typically has 21 day menstrual cycles, then the corrected EDD calculation works by assuming a zero-point 1 week prior to the last known period, in such case the counted day of +6 is a day before that woman had a period - so definitly no period, nor any ovum yet developed from immature oocytes.

Yet Darrowby is quite correct, as a doctor, I only ever document the "duration of pregnancy" when seeing antenatal cases and this is largely based on the LMP (although ultrasound dates are used if there is more than 7 days discrepency with the LMP-EDD). The number of days of gestation (ie from date of fertilisation) is not used, as clinically this is rarely precisely known (except perhaps in cases of IVF).—The preceding unsigned comment was added by Davidruben (talk • contribs) 14:11, 5 June 2006.

David, thanks again for chiming in to clarify these matters. Al 03:50, 6 June 2006 (UTC)

Thanks David, I'm okay with nixing LMP (since it doesn't affect the issue anyway) but two of those three sources you cut were definining, not just counting, and from fertilization/conception, not from LMP. Those are quite relevant and shouldn't be summarily cut--we've been using simple URL links but they'll be made into proper citations. So I'll put them back minus the LMP. Darrowby 05:37, 6 June 2006 (UTC)

Oh, sorry, I see they were moved to another pararagraph; looking at diff I thought they had been removed altogether. My mistake. Yes, either way is fine. BTW, that web citation format is nice, I'll use it. Darrowby 06:01, 6 June 2006 (UTC)

Detected pregnancies

There is no source for "early spontaneous abortions are generally not detected as pregnancies." In the U.S., half of pregnancies are unplanned. Meaning half are planned - and those women hoping to be pregnant are likely to be doing pregnancy testing, even before their period is due (some boxes of HPTs advertise "can be used 5 days before your period is due"). And a significant fraction of the unplanned pregnancy women know that they are at risk of pregnancy that cycle, and again are likely to be using pregnancy tests. Modern home pregnancy tests are capable of detecting a pregnancy just 1-2 days after implantation (3-4 days for the cheapie tests). Therefore, I am suspicious of the quoted statement. Lyrl 22:45, 7 June 2006 (UTC)

Also, what definition of pregnancy is this article going by? "Of those that do implant, about 25% are miscarried in the first month of pregnancy" references a study about 6 weeks LMP. Saying "the first month of pregnancy" implies that pregnancy should be calculated from conception. Lyrl 22:49, 7 June 2006 (UTC)

In the first month after implantation, 25% are miscarried. Al 22:56, 7 June 2006 (UTC)

Really ? 25% seems a little high for first 6 (or is that 7) weeks from LMP. I understood (and advise patients) that of established pregnancies (meaning missing the next due period - ie 4/40 from LMP), approx 20-25% will miscarry in the subsequent 8 weeks (i.e. to 12/40 weeks from LMP). This would imply that the miscarriage rate by week 6 (? 7) from LMP should be less than 20-25%. David Ruben ^Talk 23:11, 7 June 2006 (UTC)

I hear you but that's what the citation says. If you have another, perhaps we could include it, too.

Consider that an implantation that aborts quickly won't even cause a missed period, so it doesn't count as an established pregnancy. Al 04:46, 8 June 2006 (UTC)

True. David Ruben ^Talk 16:59, 8 June 2006 (UTC)

Pregnancy or implantation

The fact of the matter is, the primary mode of action of EC is ovulation prevention. Therefore no egg is ever fertilized, therefore, saying EC works by preventing implantation is extremely misleading. How can it prevent the implantation of something that was never created in the first place? The implantation mechanism of EC is only hypothetical, it still remains unproven scientifically, so once again, it is extremely misleading to say EC works by doing something that isn't even proven. While I understand your concern that IF you use a specific definition of pregnancy favorable to a POV, and IF you err on the side of caution and assume EC is doing something that has only been suggested hypothetically (and has not been demonstrated to actually be occuring) then there is a chance the perhaps a women becomes "pregnant" but that pregnancy is ended before implantation can occur. However, because this situation is so conditional and precarious, it would seem folly to define EC by it. That said, I personally believe this POV can be covered in another section (which I believe it already is). In fact, even the opening section has a sentence about this POV. If this isn't sufficient, then maybe there is another way to word the opening line that is a compromise, but as it stands the current version is much more accurate than the "implantation" version.--Andrew c 13:26, 10 June 2006 (UTC)

Saying that EC always works to prevent implantation is false. It has been proven to work by delaying ovulation, and thus preventing conception.

A few small studies have shown that EC continues to be effective up to five days after intercourse[13]. Because average sperm life is three days, I would not expect the effectiveness rates to continue to be high at five days, if the only effect was to delay ovulation.

There has been a study showing that, if taken during the LH surge (12-36 hours before ovulation), EC causes luteal phase defect (LPD) instead of delaying ovulation. LPD is called "insufficient corpus luteum function" on this site and this one. LPD could indicate that the egg released was defective and incapable of being fertilized, thus being another contraceptive mechanism. But LPD is considered by many to release good eggs, but simply prevent them from implanting - thus why women with diagnosed LPD are prescribed progesterone supplements to help them maintain pregnancy [14].

While interference with implantation is known to NOT be the primary mechanism, and has not been directly proven, it is certainly plausible as a back-up mechanism of EC based on what we know of the human reproductive system and EC's effects on it. Lyrl 15:26, 10 June 2006 (UTC)

Sperm live for up to five days, though they average only three. See? Al 00:00, 11 June 2006 (UTC)

Right, so I would expect to see some effectiveness at five days, but lower effectiveness than at three. But the site I linked to claims the effectiveness is the same at five days as at three. Does that make sense? Lyrl 01:48, 11 June 2006 (UTC)

But PMID 9708750 Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception concludes "With either regimen, the earlier the treatment is given, the more effective it seems to be". David Ruben ^Talk 02:26, 11 June 2006 (UTC)

That study only addresses effectiveness up to 3 days (72 hours). What I'm concerned about is the difference in effectiveness between 72 hours and 120 hours, which there is currently only a small amount of data on. If the small studies showing the same effectiveness at 120 hours as at 70 hours hold up, that would be a big argument for some effect besides delaying of ovulation. Or am I missing something? Lyrl 17:14, 11 June 2006 (UTC)

Well I'm not the most informed person here as s some may have guessed, but I'll read over the comments here in order to get better informed on the subject. My only concern is that I don't feel that "pregnancy" is the right word (not that implantation is either now that I think of it), especially when it has been admitted that if pregnancy is defined as from fertilisation there is a possiblity that it may cause an abortion of sorts. Chooserr 05:20, 12 June 2006 (UTC)

Thank you Lyrl, I think I had slightly misread/misinterpreted your point. Indeed the BMJ editorial states "Pregnancy rates were slightly higher among women who started treatment more than 72 hours after unprotected intercourse", which is what I had read, but then it goes on ", but the difference was not significant. The dramatic upward trend in failure rates with time elapsed before starting treatment shown in the first WHO study was not confirmed.". The point at which my statistcal knowledge reaches its limit is with this response to that editotorial (available only with the on line version) that points out that there were some real differences and that the confidence intervals of the two sets of data were different:

"In the von Hertzen trial, the estimated fraction of prevented pregnancies in the women who took single dose and two dose levonorgestrel within 3 days was 84% and 79% respectively, compared with 63% and 60% in those who took these regimens 4 or 5 days after unprotecetd intercourse. Although efficacy was reduced, it didn't seem to have been reduced by much.

However, it is important to look at the 95% confidence intervals around these figures. From the data available in the trial, there is a 95% chance that a single dose regimen of levonorgestrel taken 4 or 5 days after unprotected intercourse only prevents as few as 1.5% of pregnancies (and a 1 in 20 chance that it prevents even fewer). A delayed two-dose regime might not work at all (the confidence interval quoted is actually negative, but the implication of this, ie an increase in pregnancies, is counter-intuitive). This contrasts with the lower confidence limits for single or two-dose levonorgestrel taken withn 3 days of intercourse (73% and 66%).

The authors noted a trend towards lower efficacy with time from unprotected intercourse, and this is in accordance with the original pivotal WHO study of (two-dose) levonorgestrel (Lancet 1998; 352: 428)

So yes it seems it is more effective the sooner it is taken, but you are also correct that there remains a considerable effectiveness at 5 days that is not so disimilar to the 3 day values.

Given following that the usual combined or progesteron-only contraceptives can failure (i.e. implantation not prevented in those cases) and that some women continue on their regular contracptives for 1 or more months unaware of their pregnancy and without obvious effect (i.e. no abortion caused), I wonder if this has some bearing on our discussions here: are we so certain as to the time limits for normal fertilised-egg implantation, does this issue make it less likely that ECP can act to prevent implantation, or is the issue just the much higher dosages of hormones used in ECP (but noting that far higher progesterone levels subsequently occur normally during pregnancy than is reached with normal POP contraception; I'm unaware of progesterone-only ECP blood levels) ? David Ruben ^Talk 10:59, 12 June 2006 (UTC)

Proposed Infobox for individual birth control method articles

Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article. I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:27, 14 June 2006 (UTC)

last revert re: external links

Can someone explain this? I thought the edit was helpful, but having the title of the page part of the hyperlink, and the descriptive commentary not part of the hyperlink (as with a number of other EL entries). So why was it reverted?--Andrew c 18:08, 19 June 2006 (UTC)

I thought it was helpful, too. If you put it back, I'll support you. MamaGeek (Talk/Contrib) 18:36, 19 June 2006 (UTC)

Quote referencing?

There are a few quotes in Controversy over post-fertilization effects of EC that aren't cited, and I, sadly, don't have time this week to look them up. Could anyone else do that for me?

I also just changed references to "fertilized egg" to the more scientifically accurate "zygote". --BCSWowbagger 05:10, 11 July 2006 (UTC)

Mifepristone in EC role?

This article states that "ECPs are not to be confused with chemical abortion drugs like Mifepristone (formerly RU-486) that act after implantation has occurred."

However, articles such as this one (note the NEJM excerpt near the bottom) indicate that while a large dose (~600mg) of mifepristone can be used to induce abortion, it can also be used in a lower dose (~10mg) as an emergency contraceptive in much the same way as Plan B, acting primarily by preventing ovulation. (See also this AAFP article. Seems to me that this article should acknowledge that, but I'd rather somebody more conversant with the science did that if possible. --Calair 04:33, 21 July 2006 (UTC)

Okay, added it myself. With much trepidation, since I suspect the fact that mifepristone can be used as an abortifacient is going to cause confusion, but I've tried to make it clear that the different dose means a different mechanism. --Calair 11:35, 23 July 2006 (UTC)

Yes, but the point in the article was not that mifepristone cannot be used as EC, but that EC cannot induce an abortion. Even if it could prevent implantation (though there is no scientific evidence of this, ever.), a pregnancy is not legal until implantation occurs. The sentence should be reworded, but the general aim (that EC is not an abortion method or abortifacient based on every scientific test it has ever gone through) was correct.

United States section edits (refusal clauses)

I've made a partial revert of the recent edits in this section:

"organizations don't like the fact" sounds very unprofessional and reminds me of a childs taunt. I've changed it back to "organizations have expressed concern" because I think it's better writing for an encyclopedia article.

I changed "some parts of the country" back to "many parts of the country" as refusals to provide EC has been documented all over the U.S. (see the reference I added).

I changed "might" to "may" because it's better grammer, and re-added "reasonable" to clarify that these organizations want EC to be readily available, not just technically available for women willing to jump through legal hoops. I left the syntax changes to that sentence, though, as it does seem a little easier to read now.

I removed the quotation marks around women's right to medically appropriate, effective, and legal reproductive health services. If we disagree on the wording, let's come up with an alternative. But just putting quotes to imply that women don't actually have a right to health care - is not something I'm going to agree with.

I reworded the last sentece somewhat: "regardless" sounds more professional to me than "in spite of," and having both beliefs and convictions listed looked redundent so I deleted one. And added the ref to the Planned Parenthood article at the end. Lyrl ^Talk _Contribs 17:53, 23 July 2006 (UTC)

Okay, I'd like to start by saying that I'm glad that you didn't just revert me out of hand, but that I feel some parts of your partial revert aren't appropriate. I don't care about the re-adding of convictions (though for some reason beliefs and convictions sounds better to me) and I care less about re-adding might (again my mistake), but I really am upset about the "organizations have expressed concern". I mean, even if my wording has the ring of a childish taunt it contains more truth than the other version. It seems to gloss it all over - they really are upset, and are only concerned about how many of the pills they can sell. Sorry, but that is it.

As for also I like "inspite of", because "regardless" is again trying to gloss over the fact that pharmacist is being held hostage, being forced to violate deeply held beliefs.

And "resonable" is also irksome, but I don't know any alternative yet.

Chooserr 18:06, 23 July 2006 (UTC)

News with FDA

Someone should probably add the info that FDA plans to make emergency contraception over-the-counter for women 18 and over. Remember 17:28, 31 July 2006 (UTC)

Is there a press release to this effect, or is this from someone in the media speculating ? I doubt latter would be notable, or count as encyclopaedic.David Ruben ^Talk 19:08, 31 July 2006 (UTC)

This is what I was talking about [15]

Dec. 16, 2003 Advisory Committee meeting votes

In Section 3.2, International availability--United States, the first paragraph should:

1. Give the final 23 to 4 vote of the committee.
2. Give the only two unanimous (28 to 0) votes of the committee (Plan B was safe as an OTC drug, Plan B was not found to substitute for regular use of other contraception.
3. Cite the offical FDA meeting documents.

References:

December 16, 2003 FDA Advisory Committee for Reproductive Health Drugs Joint meeting with Nonprescription Drugs Advisory Committee

December 16, 2003 Final questions (PDF)

Question No. 3: Based on the AUS (Actual Use Study) and literature review, is there evidence that non-Rx availability of Plan B leads to substitution of emergency contraception (EC) for the regular use of other methods of contraception?

Question No. 4: Do the data demonstrate that Plan B is safe for use in the non-prescription setting?

Question No. 6: Do you recommend Plan B be switched from Rx to non-Rx status?

December 16, 2003 Transcript (PDF)

Question No. 3 vote: Yes: 0, No: 28, page 359, line 15

Question No. 4 vote: Yes: 28, No: 0, page 364, line 14

Question No. 6 vote: Yes: 23, No: 4, page 412, line 6

69.208.222.59 18:42, 1 August 2006 (UTC)

Contraindications should be method-specific

In Section 1.3, ECPs-Contraindications & Interactions:

1. The contraindications should be method-specific and accurate, not generalized and inaccurate.
2. The contraindication to using emergency contraception pills (combination estrogen-progestin or progestin-only) during pregnancy should say why they are contraindicated (they are not effective in women who are already pregnant) so as not to implicitly and incorrectly suggest that they have been shown to cause fetal or maternal harm.
3. The contraindications to using emergency contraception pills in women with a history of heart attack, stroke, or blood clots, or patients with severe liver disease or the very rare condition of porphyria is due to the estrogen component of combination estrogen-progestin contraceptives, and does not apply to progestin-only contraceptives.

Reference:

American Academy of Pediatrics Committee on Adolescence (2005). Emergency contraception. Pediatrics. Oct; 116(4):1026-35. PMID 16147972

"Safety and Contraindications of Emergency Contraception", page 1030:

1. "There are few absolute contraindications to the use of combination-hormone emergency contraception. There are no contraindications to progestin-only emergency contraception."
2. "The World Health Organization has stated that the only contraindication to the combination estrogen/progestin emergency-contraception method or the progestin-only emergency-contraception method is a known pregnancy, primarily because the treatment will not work if the patient is already pregnant."
3. "For chronic health conditions in which estrogen-containing OCs are contraindicated, combination emergency-contraception regimens may still be offered because the duration of use is extremely short. However, many providers prefer to prescribe progestin-only regimens for teens with known hypercoagulable states, such as a history of blood clots or hereditary hypercoagulopathies or thrombophilias. Because pregnancy may increase the risk of adverse outcomes in these health conditions, the contraceptive benefit and availability of combination emergency contraception may outweigh the risk of treatment."

69.208.222.59 18:44, 1 August 2006 (UTC)

Should the article imply EC probably does not prevent implantation?

The study reports I have actually read have been ambiguous. While the researchers always conclude with statements sounding like the study disproved any anti-implantation effect, if you actually read the study, other things jump out at me. The two main points:

• EC causes luteal phase defect. Embryos do not try to implant in the uterus until 6-12 days after fertilization (90% by 10 days) - luteal phase defect means that menstruation starts before that 10-12 day window is up, possibly washing away a viable embryo.

• The only study I've seen to explore EC's effectiveness beyond 3 days found that it had the same effectiveness taken 5 days after intercourse as when taken 3 days after intercourse. If there was no anti-implantation effect, I would expect effectiveness at 5 days to be lower than that at 3 days. The sample size at 5 days was actually too small to be statistically significant, so no firm conclusions can be drawn from this - but it is suggestive.

Also consider that some studies have tested for anti-implantation effects by testing for hCG, a hormone that is not detectable until after implantation. And then say that because they did not detect this chemical in animals given EC, EC must not interfere with implantation. The logic here escapes me.

While it is obvious EC prevents pregnancy primarily by delaying ovulation, and the article currently seems rather balanced in presenting the possibility of a secondary anti-implantation effect, many editors seem convinced that such a secondary effect has been disproved. So I'm just trying to put some information out there to keep in mind during future edits. Lyrl ^Talk _Contribs 23:32, 21 August 2006 (UTC)

Stats on abortion and unintended preg.

I just reverted to restore some statistics related to the abortion rate and number of unintended pregnancies. I tend to think these are relevant to the article, since preventing unintended pregnancies is preciely the purpose behind contraception. Abortion rates speak to the number of unintended pregnancies. I can envision a student researching this topic and finding those stats to be useful... So I would keep them in. Thoughts? --TeaDrinker 00:27, 23 August 2006 (UTC)

[edit conflict, ha ha almost identical posts] Here is the place to discuss removing the longstanding content. As I said, these numbers are relevent because there is a dominant POV that EC reduces future abortions. Maybe this needs to be qualified in some manner, or presented in a more NPOV manner, but I clearly do not think removing the numbers is the answer. What do others think?--Andrew c 00:28, 23 August 2006 (UTC)

(This was written before the other posts)

Okay, people want to discuss the stats (or claim they do because I think it is very telling for someone to suggest that we all sit down and talk about it as they have their way reverting the article. If you want to discuss then innitiate the discussion DO NOT just revert an edit to the version you like and then feign to be all reasonable saying "let us take this to the talk page"!) that is fine with me. The reason that I feel that the stats should be removed is that it is drawing a conclusion that lack of availablity to ECs (something I'm a bit confused about. What lack is there? Or is that just a way of pointing fingers at Hospitals who because of their morals cannot provide ECs, but don't want to close their doors because of all the other good they do) leads to higher abortion rates which either doesn't exist, or hasn't been explored properly. There are a whole product range of birth control accessible aside from ECs, why then should a million abortions be attributed to their not supposed lack of availability? So now what is the other side? Chooserr 00:34, 23 August 2006 (UTC)

I don't think there is anything wrong with reverting to the version that you, the editor, thinks is appropriate, as long as the WP:3RR rule is respected. I think the major difference between EC and abortion, compared against other forms of birth control, is the lack of planning needed. EC and abortion both work post-coitus, whereas other forms almost exclusively must be planned ahead of time (some unusual ones, like an IUD immediately inserted, can be used, but rarely are). --TeaDrinker 00:46, 23 August 2006 (UTC)

You forget though that you are an editor too, and to revert whilst maintaining that one should go to the talk page with it isn't exactly leading by example, is it? Anyways yes it doesn't require too much forethought, however to make an analogy between millions of abortions and the supposed lack of ECs is ludicrous. I'm sure many people don't use any form of contraception, and then somewhere down the road when they discover they are pregnant (long after ECs would work) they feel that the only option is abortion, and go to get one. This probably happens much more than accountable under the lack of ECs theory. Chooserr 00:59, 23 August 2006 (UTC)

Rape is specifically mentioned in the stats. The controversy over whether hospital emergency rooms should offer EC to rape victims is certainly relevent to this article, and statistics on how many rapes result in pregnancy, and how many of those pregnancies could be prevented by offering EC, are certainly relevent. Arguing over the applicability of the stats (i.e. not all rape victims go to hospital emergency rooms) is one thing, completely removing them is another.

If someone uses no form of contraception, they often realize the next day that was a bad idea, and at that point can seek emergency contraception. If a condom breaks, the woman may seek emergency contraception. What percentage of women will seek such treatment varies depending on how accessible EC is. Again, I can see debate over the exact numbers, but complete deletion of the material is not something I agree with.

This material has been in this article for a long time. It is the responsibility of the person making the changes to justify them on the talk page (if they are disputed), and is customary on wikipedia to leave articles in their original format while debates are carried out. Lyrl ^Talk _Contribs 01:09, 23 August 2006 (UTC)

Well I don't have the time to debate this right now (I actually have to go out) however maybe it should be noted that less than 1% of abortions are because of rape [16] - you know just to shed some light on the matter. Chooserr 01:14, 23 August 2006 (UTC)

Regardless of how people feel about these stats, can we get some sort of citation for them. I think they are very informative but when I can't find out where stats come from they usually become suspect to me. Remember 02:25, 23 August 2006 (UTC)

Is "take it to the talk page" is code for move it out of the way so no one can here it whimper as it slowly dies??? If not I'm shocked at the little discussion that has taken place here. Chooserr 02:03, 24 August 2006 (UTC)

I found citations so that should ease Remembers concerns. I also phrased a few things with qualifiers to make it a bit more NPOV. So I think most concerns have been covered. Only 2 editors wanted to outright remove it: an anon who hasn't commented here on talk, and Chooserr. If the discussion has been lacking , perhaps it is because the "other side" of the debate has been offline. So maybe we can start the discussion now. --Andrew c 02:06, 24 August 2006 (UTC)

My concern isn't primarily the data, but the way the article seemed to be blaming 1 million abortions on lack of ECs and not just lack of morality. Chooserr 02:17, 24 August 2006 (UTC)

Failure

I just have a quick questions on the failure stats of ECs presented in the box in the right hand corner. Why is it comparing the perfect use of IUDs to the typical use of ECs? Aren't they different? How can there be a "typical" use for ECs? All you have to do is take the pill right? Shouldn't that be perfect use for ECs then? Any help answering these questions would be appreciated. Chooserr 02:22, 24 August 2006 (UTC)

If you read the article, it states that IUDs can be used as a method of EC, in addition to "Plan B" in the states or "Levonelle" in UK. However, it is confusing that they split up the two different methods for typical vs. perfect. Also, ECPs are often 2 pills taken 12 hours apart.--Andrew c 02:28, 24 August 2006 (UTC)

Advocacy Groups?

I saw today's revert of Othnielj, and got to thinking. Obviously, his edit was out of line and NPOV (to say the least), but why aren't there any anti-EC advocacy groups listed in the external links? I mean, there are more than a few blatantly biased pro-EC advocates on there, so should we maybe find some balance here? --BCSWowbagger 00:43, 25 August 2006 (UTC)

Articles such as this are about something, by which I do not mean "promotion" or "advocacy" but rather I use "about" to indicate a "description". We do not populate articles about Jewish or Islamic topics with external links for evangelical missionary Christian groups hoping to convert “unbelievers” to salvation, nor do we populate every article on transplantation or subsequent anti-rejection medication with links to Jehovah's Witnesses who object to the required blood or tissue transfer. Similarly topics on geology or palaeontology are not all full of external links to creationist viewpoint sites (the main subject pages may have a link, but not every sub-topic article).

Wikipedia is a work as a whole, and no one article has to cover all opposite or tangential issues. An article on a particular Dinosaur and its example fossil record, does not need to go into explanation of what a fossil is, nor to extinction theories nor therefore to creationists alternative viewpoint to fossil records and radioisotope dating - the overall collection of the separate articles gives wikipedia the coverage of all these aspects.

There is the issue of the selection of sources - a drug formulary or official Family Planning agency site have notability, where as "anti-EC advocacy groups" are by their very nature un-official and so harder to verify in wikipedia as being notable - Catholic Church positional statement or a country’s main pro-life group would count, but smaller groups are hard to show notable under WP:Reliable sources and Wikipedia:External links.

What is a strong argument is that NPOV requires only neutral mentioning of alternative minority viewpoints, not the granting of equal article space.

I suppose in conclusion needs be a "good" (and how do we define that) source. PS Chooser and particularly Lyrl both I believe personally hold strong pro-life views, yet edit in exemplary NPOV style with meticulous sourcing - I'd be interest in their take on where the "opposing" view points should be covered in either just the main topic of Birth control or within each individual components/methodology articles (COCP, POP, Depo-provera, IUD, Condom etc). David Ruben ^Talk 01:30, 25 August 2006 (UTC)

Oh, I agree very much about the difficulty of determining which articles should have opposing external links and which ones should not. I was involved in a brief but verbose edit war at pro-choice over the same basic issue--where I supported removing all pro-life links in the pro-choice article since, after all, pro-life has its own article. But, given that the entire EC debate is contained pretty much in this article (arguably in beginning of pregnancy controversy, too), it seems to me that there should be some sort of balance in the external links. I do not agree that the current set of links is purely informational; The Morning-After Pill Conspiracy, the American Society for Emergency Contraception, and of course Planned Parenthood, among others, are clearly advocacy groups and require balance or should be removed to maintain NPOV. At least, this is my understanding of NPOV. *hides behind New Wikipedian sticker which is quickly reaching obsolescence*

I also more than recognize the difficulty of finding respectable, reliable sites that advocate for the other side. Outside of the Catholic Church, anything resembling organized EC opposition is pretty hard to find. I will do what I can to root up some decent links, if the consensus agrees with my position. --BCSWowbagger 05:42, 25 August 2006 (UTC)

I for one encourage you to find such links... In topics like this it's probably best to come clean on one's own bias, yet action in line with the stated bias won't always ensue. Me, I'm pro-choice in a strict legalistic sense-- but more than that I'm pro-truth and it is very obvious to me that Plan B and similar hormone pills as well as IUDs are patently abortifacient (or, if you prefer, they act to prevent implantation). It's hard to believe that Planned Parenthood and other orgs have so thoroughly induced researchers to play possum on these mechanisms of action, but at first glance this seems to be the case since, as you and others above state, it's very difficult to find website material by upstanding individuals and/or orgs that honestly discuss these matters... I'll be looking too. JDG 11:13, 26 August 2006 (UTC)

There is, in my mind, two aspects of this article. The first is providing good information which is not encyclopedic--where to go to find EC, specifics on how to take it, etc.--that information should be judged on its accuracy rather than the political leanings of the source. If all the page says is how to get EC, then the politics of the link are to a large extent irrelevant. The second aspect of the article is normative: should people use EC, what are the ethical issues around it. There I think it is reasonable to identify notable groups opposing EC and link to their arguments (as well as pro-EC groups). We might want to consider seperate subsections for these two purposes. --TeaDrinker 18:22, 27 August 2006 (UTC)

Same old POV in a new form

To Andrew c.: On the Emergency contraception page, I'm afraid we can't leave the sentence you restored today as is ("ECPs are not to be confused with chemical abortion methods that act after implantation has occurred."). I understand that you retained (with heavy qualification) the "some consider ECPs abortifacient" statement a few paragraphs down, but that's not good enough. To leave intact, with no qualifier at all, a sentence that states "EC is not abortion" (which this sentence, in effect, does) is POV in the extreme. I'll wait a bit for you to tone down its "absoluteness" before doing so again myself. Thanks. Cross-posting this to your Talk. JDG 19:39, 25 August 2006 (UTC)

See the comments above about advocacy groups vs. description. I think this is a matter of undue weight. The question is, how prevelent is the alternative definition of pregnancy/abortion? How much scientific is there to support the pre-implantation claims concerning ECPs? We mention the alternative views already in that section. Mentioning the exact same thing twice is not only redundent, but, IMO, giving undue weight. Maybe, as a compromise, we could add a footnote to the first claim, asking the reader to learn more in the controversy section. Please check out my changes.--Andrew c 21:31, 25 August 2006 (UTC)

Wording, repetition in United States Availabilty section

I was just reading the article and the sentence "The FDA had more pledged to rule on the application by September 1, 2005" caught my eye as it doesn't really make sense to me. The second part of the sentence isn't much better either - the present tense is used to describe something that seemed to occur last year (according to my interpretation of what the sentence is trying to say). Overall it just seems to jump from September 2005 to August 2006 without mentioning what happened in the intervening period (no pun intended).

Also I noticed the events of August 24, 2006 seem to be mentioned twice - the first time just a few sentences after the above mentioned section, and secondly at the end of the section. I don't what to touch the article myself as it seems to be a 'hot' topic so perhaps someone more familiar with this article could tidy the above and clarify what happened for the benefit of the reader. Ninja-lewis 00:39, 26 August 2006 (UTC)

Good points! I also noticed 3 different people adding the same information about the OTC status. I believed I reverted one of those edits. Please feel free to take a stab at editing the article. We always welcome new users and fresh perspectives, plus, we aren't supposed to bite the newcomers.--Andrew c 01:31, 26 August 2006 (UTC)

Dispute of studies claiming EC works only by preventing ovulation

The article currently says "the first two mechanisms (preventing ovulation and fertilization, respectively) fully account for all successful uses of emergency contraception." The following are quotes from the studies that supposedly support this assertation:

[EC taken on day 10 of the cycle]... the remaining (three participants) presented significant shortness of the luteal phase with notably lower luteal P4 serum concentrations... Participants in Group D [EC taken in late follicular phase] had normal cycle length but significantly lower luteal P4 serum concentrations. [17]

Ovulatory dysfunction, characterized by follicular rupture associated with absent, blunted or mistimed gonadotropin surge, occurred in 35%, 36% and 5% of standard, single dose or placebo cycles, respectively. [18] I'm reading that ovulation happened, but the hormones needed to maintain a pregnancy did not. This sounds like a possible fertilization-but-not-implantation situation to me.

This review describes studies in rats and monkeys that show no difference in pregnancy rates when taken shortly after ovulation - but does not address the luteal phase length and hormonal effects shown in humans when ECPs are taken before ovulation, but ovulation is not prevented. It also describes the study in the previous paragraph, but completely ignores the "ovulatory disfunction" found by that study.

I seriously question that these studies "prove" or "indicate" or otherwise provide strong evidence against postfertilization effects of EC. Lyrl ^Talk _Contribs 14:49, 26 August 2006 (UTC)

Well, this is now over my head. I will say that, in writing the paragraph in question (from an anonymous IP; cursed login cookies), I focused primarily on the conclusions of the various articles, becuase words like corpus luteum tend to recall 9th grade health class and I'd rather avoid that, thank you very much. I will also state that my paragraph article actually says that recent studies indicate that prevention of ovulation and fertilization fully account... etc. I fully agree--as does Science as a whole--that there is no proof either way, and still a significant debate over this issue. --BCSWowbagger 23:30, 26 August 2006 (UTC)

The authors of the studies themselves seem to completely ignore their own findings and state things in interviews like "this study indicated that EC only works by preventing ovulation". I really question their bias.

I believe I have read somewhere (unfortunately, do not remember where) that it has been theorized that the "ovulatory disfunction" actually changed the ovum in some way so that it physically could not be fertilized, even in the presence of sperm. But unless that theory has been specifically tested (I imagine one would have to use monkeys and flush their uterine cavities to look for embryos in females that ovulated despite taking EC) - we shouldn't say in this article that there is any evidence either way, which I recently realized (don't think I'd paid attention to that section before) this article currently does. Lyrl ^Talk _Contribs 14:47, 27 August 2006 (UTC)

EC does not change transport of sperm

After intercourse, sperm move through the cervix and arrive in the fallopian tubes beginning 1.5 minutes after ejaculation. All sperm that are going to do so have arrived in the fallopian tubes within 45 minutes after ejaculation. Sperm stick to the walls of the fallopian tubes, and are released in waves over a period of several days as they wait for the arrival of an egg. (See explanations by sperm physiologist Dr. Joanna Ellington: [19] [20])

Because sperm are already waiting in the fallopian tubes, taking EC hours after intercourse is not going to affect sperm transport. Taking bcp pills on a regular basis changes cervical mucus in a way that prevents sperm from ever getting into the uterus or fallopian tubes. Again, this does not apply to post-coital use of EC, because the sperm are already in the fallopian tubes - any changes it causes in cervical mucus is closing the barn door after the horse got out, so to speak.

The theory about EC changing the tubal transport of ova/embryos would actually be a postfertilization effect - embryos don't try to implant in the uterus until 6-12 days after fertilization. By increasing the speed at which embryos travel through the tubes, hormonal contraceptives might cause them to arrive in the uterus too soon, when they aren't ready to implant, and they just fall out of the woman. Lyrl ^Talk _Contribs 14:47, 27 August 2006 (UTC)

Wait a second. I thought that the article already said that it is impossible for ECs to affect an already fertilised egg and, from a certain prespective, cause an abortion. I think it even went so far as to say that the only reason why there is still any doubt is because it is impossible to prove a negative(?). If hormonal contraceptive, and ECs which you say are just that except in a stronger dose, can cause an embryo to just "fall out" of a women, then shouldn't that be mentioned somewhere? Chooserr 17:08, 27 August 2006 (UTC)

I've changed the wording to remove the implication that "not an abortifacient" had been practically proven. The particular theory on tubal transport I thought was too obscure to include in the article. I just commented on it on the talk page because an edit had (inaccurately) made it appear that changes in tubal transport might have an anti-fertilization effect. Lyrl ^Talk _Contribs 20:32, 27 August 2006 (UTC)

Since the U.S. government is considered a very reliable source, I will post this link to the FDA's Q&A. It is unclear on the mechanism, but it is very clear on what EC does: inhibits ovulation, and inhibits fertilization. Unless there are a whole bunch of darned good studies that have a contrary conclusion, the article must retain the statement of this mechanism. It seems to me, Lyrl, that you are on the verge of violating WP:OR in the way in which you are ignoring conclusions and drawing new ones yourself, although I hear your complaint about article bias and am sympathetic. I will re-add the reference to the fertilization-prevention mechanism (without further details about cervical mucus, etc., since I have been unable to substantiate that) at my next opportunity and await further comment. --BCSWowbagger 23:16, 27 August 2006 (UTC)

I agree with the OR part. Even if you are a scientist in the field of research medicine and you know for a fact that the study proves one thing, but the conclusions and media about the study are wrong and biased, we cannot mention that in the article. We must have a source to back up all claims. If we have a reliable counter study, or media report discussing the faults of the study's conclusion, then we can mention it, but until then, publishing personal interpretations (even if they are correct) violates WP:V and WP:OR. That said, Lyrl brings up some very valid points, and we shouldn't take sides in the debate (and the debate does exist). We should keep in mind NPOV, and make it clear who is saying what. "Group A holds belief B, study C found D" etc. We need to avoid unqualified statements that do not point out where the views come from.--Andrew c 14:27, 28 August 2006 (UTC)

references technical issues

I think something is messed up with the references. There are only 43 unique references, but when the page is rendered on my screen, it lists 84, and most of them are repeats. Some references are cited multiple times (they have superscript letters preceding them), yet most of the intrapage links are broken. I tried to fix this problem, but something is still wrong. Things look fine in the preview, so I am thinking it may be a coding or rendering problem that I can't fix. Is anyone else experiencing strange numbering things (such as the very first footnote being numbered 43?) --Andrew c 20:21, 28 August 2006 (UTC)

Wikipedia talk:Footnotes discusses same thing occuring on multiple pages - its therefore a metawiki programming problem, so relax whilst someone at wiki central fixes it for us.... David Ruben ^Talk 22:39, 28 August 2006 (UTC)