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Introduction: Birth control pills, Depo-provera injections, and Norplant implants achieve their anti-fertility effects primarily by causing temporary sterilization, secondarily by causing abortion by preventing the implantation of the approximately week old human from successfully attaching or "implanting" into the wall of the mother's womb, and thirdly by acting as a contraceptive barrier to sperm by thickening the cervical mucous. That some drugs promoted as contraceptives may really cause abortion has not been clear to many Americans for whom abortion presents serious moral questions.

 Background of the Pill: Gregory Pincus, co-developer of the Pill, credits a visit from Planned Parenthood's founder Margaret Sanger who promised research money for the development of the Pill! ¹ Sanger, who supported abortion, was concerned about developing a Pill as a means of curbing the "population explosion." ² Like Sanger, Pill supporters who shared Sanger's demographic concerns, such as Dr. Robert Kistner of Harvard, were less concerned about means than ends: "Our efforts to control population growth should not lead to mass guilt about methodology. It would be tragic if an effective postcoital pill or long-term progestational agent were declared illegal because of its abortifacient effect." ³

 Conflict of Values: Guilt would be a problem for some. In 1962 Dr. Mary Calderone, then Medical Director of Planned Parenthood, said that: "if it turns out that these intrauterine devices operate as abortifacients, not only the Catholic Church will be against them, but Protestant churches as well." ⁴ Legal problems existed because the language of pre-Roe anti-abortion laws was such that the "broad language of statutes and cases would suggest that to use pre-implantation means on a pregnant woman would be unlawful... manufacturers, distributors or sellers of the pre-implantation means might be prosecuted under statutes prohibiting the manufacture, distribution, or sale of abortifacients." ⁵

 Technology Meets Biology: Planned Parenthood's Dr. Abraham Stone noted in 1952 that any mechanical, chemical or "biologic method[s] that would prevent ovulation or fertilization merely prevent life from beginning.... Measures designed to prevent implantation fall into a different category. Here there is a question of destroying a life already begun." ⁶ The federal Department of Health, Education and Welfare also acknowledged this in a survey of birth control research: "All of the measures which impair the viability of the zygote at any time between the instant of fertilization and the completion of labor constitute, in the strict sense, procedures for inducing abortion . Administration of compounds whose mechanism of action is of this character to man either as an investigative procedure or as a practical birth control technique poses legal questions that have as yet not been resolved." ⁷ The problem was that most of the promising research included anti-implantation or abortion causing actions. ⁸

 Facts vs. Semantics: With biology such a stubborn thing, Pill promoters turned to semantics for a solution. Swedish researcher Bent Boving, at a 1959 Planned Parenthood-Population Council symposium noted that: "Whether eventual control of implantation can be reserved the social advantage of being considered to prevent conception rather than to destroy an established pregnancy could depend upon something so simple as a prudent habit of speech." ⁹ The advice was not isolated. At the 1964 Population Council symposium Dr. Samuel Wishik pointed out that acceptance or rejection of birth control would depend on whether it caused an early abortion. Dr. Tietze, of Planned Parenthood and the Population Council, suggested, as a public relations ploy, "not to disturb those people for whom this is a question of major importance." Tietze added that theologians and jurists have always taken the prevailing biological and medical consensus of their times as factual, and that "if a medical consensus develops and is maintained that pregnancy, and therefore life, begins at implantation, eventually our brethren from the other faculties will listen." ¹⁰

 In 1965 the American College of Obstetrics and Gynecology (ACOG) responded with its own semantic answer: CONCEPTION is the implantation of the fertilized ovum." ¹¹ Not everyone accepted these manipulations. Dr. Richard Sosnowski said he was troubled "that, with no scientific evidence to validate the change, the definition of conception as the successful spermatic penetration of an ovum was redefined as the implantation of a fertilized ovum. It appears to me that the only reason for this was the dilemma produced by the possibility that the intrauterine contraceptive device might function as an abortifacient. ¹²

 The Pill and Abortion: The federal Food and Drug Administration approved the Pill for Limited use in 1960. First generation Pills allowed ovulation in 6.8% of menstrual cycles. ¹³ (Because of health problems, the Pill's high levels of estrogen were reduced, but less estrogen allows greater breakthrough ovulation.) After much study a 1969 FDA Advisory Committee said the Pill's "high degree of contraceptive effectiveness [was] brought about through interference with several phases of the reproductive process. an influence on the hypothalamus... is probably responsible for the... inhibition of ovulation.... The second major effect is on the endometrium. The progestin acts as an antiestrogen causing alteration in endometrial glands and as a progestin, causing pseudodeci-dual reactions. Both of these alter the ability of the endometrium to participate in the process of implantation." (Emphasis added.) Longtime Planned Parenthood associate Dr. Lewis Hellman chaired the advisory committee, and Dr. Christopher Tietze of Planned Parenthood and the Population Council was a committee member along with other Planned Parenthood members. ¹⁴ And former Planned Parenthood President Dr. Alan Guttmacher is also on record as recognizing the triple mode of action for the Pill. ¹⁵

 Pill Labeling: In December, 1976 the federal FDA proposed mandatory patient package inserts accompany all Pill prescriptions: "The Food and Drug Administration will regard as misbranded and subject to regulatory action any oral contraceptive that is shipped in interstate commerce... after April 6, 1977 without labeling that is substantially the same as set forth in this notice." Thus the FDA required Pill manufacturers to tell physicians that the Pill included a mode of action that every physician would understand from his medical training to be an early abortion: "Combination oral contraceptives.... Although the primary mechanism of action is inhibition of ovulation, alterations... in the endo-metrium (which reduce the likelihood of implantation) may also contribute to contraceptive effectiveness... progestin oral contraceptives are known to... exert a progestational effect on the endometrium, interfering with implantation, and, in some patients suppress ovulation." ¹⁶

 Physician package inserts for the Pill are still required in 1998, and they still use language that indicates the Pill, Depo provera and Norplant inhibit implantation. These chemicals "harden" lining of the womb (uterus) creating a hostile environment and thus make it harder for the tiny multi-celled human being to implant in the wall of the womb. This constitutes abortion at approximately on week of life. There is no definitive medical agreement as to in what percent of the monthly cycles this occurs.

 We, the undersigned physicians, do therefore declare that the pill and similar birth control products act, part of the time, by design, to prevent implantation of an already created human being. These products clearly cause an early abortion and are-despite the semantic gymnastics of their ardent apologists-abortifacient.

 We further declare that the so-called emergency contraceptive products being promulgated on the American people work in the same fashion and are also abortifacient.

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FOOTNOTES

1) Gregory Pincus, The Control of Fertility, Academic Press, New York, 1965, p. 6; Planned Parenthood Federation of America, Research Facilities, Activities and Accomplishments, memo, 1/20/53, Margaret Sanger Collection, Library of Congress.
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2) Margaret Sanger, Family Limitation, 1st ed., 1914, 15-16, Margaret Sanger collection, Library of Congress (MSCLC); Sanger Speech, Washington DC, (MSCLC) speech was first given in 1916 and delivered 119 times; letter from Sanger to Hanna Stone, 3/10/32 copy to Marjorie Provost (Sanger's handwriting) Sophia Smith Collection, Smith College.
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3) Robert W. Kistner, M.D., The Pill, Delacourt Press, 1969, p. 248.
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4) Dr. Mary Calderone, discussion, :Mechanisms of Contraceptive Action," in Intrauterine Contraceptive Devises: Proceedings of the Conference, held April 30-May 1, 1962, New York City, ed. C. Tietze and S. Lewitt, published by Excerpta Medica Foundation, 110.
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5) Sybil Meloy, "Pre-Implantation Fertility Control and the Abortion Law," Chicago-Kent Law Review, vol. 41 (1964): 183, 205-06. Planned Parenthood recognized in its amicus brief for Roe v. Wade that criminal abortion laws could be applied to the IUD because of its potential to prevent implantation. PPFA's physician group (APPP) Amicus brief on page 44 cited Cybil Meloy, and also said that prosecutors had not used state anti-abortion laws to outlaw the use of IUD's.
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6) Abraham Stone, M.D., "Research in Contraception: A Review and Preview," presented at the Third International Conference of Planned Parenthood, Bombay, India Report of Proceedings, November 24-29, 1952, no copyright, Family Planning Association of India, 101.
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7) A Survey of Research on Reproduction Related to Birth and Population Control (as of January 1, 1963) US Department of Health, Education, and Welfare, Public Health Service, p. 27.
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8) Memo to Dr. Drill from Dr. Saunders, re: "Effects of Drugs on Mating in Rats," 12/9/54, Gregory Pincus Papers, Manuscript Division, Library of Congress; Abraham Stone, The Control of Fertility, Scientific American, April, 1954, vol. 190, no. 4, 31-33.
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9) Bent Boving, "Implantation Mechanisms," in Mechanisms Concerned with Conception, ed. C.G. Hartman (New York: Pergamon Press, 1963), p. 386. Boving acknowledged (p. 321): "...the greatest pregnancy wastage, in fact, by far the highest death rate of the entire human life span, is during the week before and including the beginning of implantation, and the next greatest is in the week immediately following."
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10) Proceedings of the Second International Conference, Intra-Uterine Contraception, held October 2-3, 1964, New York City, ed. Sheldon Segal, et al., International Series, Excerpta Medica Foundation, No. 1, September 1965.
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11) ACOG Terminology Bulletin, Terms Used in Reference to the Fetus, Chicago, American College of Obstetrics and Gynecology, No. 1, September 1965.
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12) Dr. Richard Sosnowski, head of the Southern Association of Obstetricians and Gynecologists "The Pursuit of Excellence: Have We Apprehended and Comprehended It?" American Journal of Obstetrics and Gynecology, vol. 150. No. 2 (September 15, 1984) 117.
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13) Joseph Rovinsky, M.D., "Clinical Effectiveness of a Low Dose Progestin-Estrogen Combination," Obstetrics and Gynecology, vol. 23, no. 6, June, 1964, p. 845, citing Goldzieher et al., JAMA, 180:359, 1962. "In 6.8 percent of menstrual cycles they have studied on patients on norethindrone medication, urinary pregnanediol excretion reached levels ordinarily found only in the postovulatory phase of a normal menstrual cycle."
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14) Advisory Committee on Obstetrics and Gynecology, Food and Drug Administration, 1969, Second Report on the Oral Contraceptives, 8/1/69, "Report of the Task Force on Biologic Effects," Philip Corfman, NIH, Chairman, app. 4, p. 69.
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15) Alan F. Guttmacher, M.D., "Prevention of Conception Through Contraception and Sterilization," Gynecology and Obstetrics, vol. 1, ch. 22n, December, 1966, p.8.
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16) Federal Register Vol. 41, No. 236, Tuesday, December 7, 1976, 53634.
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