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Emergency Life Prevention

      To the Editor:
      The recent article on emergency contraception
      • Batur P.
      • Kransdorf L.N.
      • Casey P.M.
      Emergency contraception.
      and another procontraception article published earlier in the Proceedings
      • Marnach M.L.
      • Long M.E.
      • Casey P.M.
      Current issues in contraception.
      justify contraception because of the incidence of “unintended” pregnancies, and both cite the same article in support.
      • Finer L.B.
      • Zolna M.R.
      Unintended pregnancy in the United States: incidence and disparities, 2006.
      However, the authors do not mention that the article by Finer and Zolna
      • Finer L.B.
      • Zolna M.R.
      Unintended pregnancy in the United States: incidence and disparities, 2006.
      clearly documents that the rate of unintended pregnancies actually increased between the years 2001 and 2006 despite years of massive and well-orchestrated promotion of contraception and an 89% user rate.
      • Finer L.B.
      • Zolna M.R.
      Unintended pregnancy in the United States: incidence and disparities, 2006.
      This increase should cause any reflecting person to pause and question the premise that the widespread promotion of pills and devices that facilitate a casual and recreational approach to an act inherently procreative will simultaneously reduce the natural end of that act. Yet, predictably, there is the same old tired call for even more access to and dispensation of contraceptives. This is comparable to asserting that cancer is an “unintended” consequence of smoking, so the answer is better filters, not smoking cessation, or that automobile accidents are an “unintended” consequence of speeding, so the answer is more and better seatbelts, not obeying the speed limit. Like smoking leading to cancer, the procreative act does not always lead to pregnancy, ie, natural contraception is built into a woman's cycle of fertility. Unlike smoking and cancer, procreation is the natural and normal purpose of the procreative act, a fact obscured by the ubiquity of the word “sex” for what used to be called “the marital act.” Both smoking and the procreative act are volitional behaviors, not biological necessities, as is the case with respiration and digestion.
      The Finer and Zolna article,
      • Finer L.B.
      • Zolna M.R.
      Unintended pregnancy in the United States: incidence and disparities, 2006.
      which is the only article cited by the authors of the procontraception articles to justify contraception,
      • Batur P.
      • Kransdorf L.N.
      • Casey P.M.
      Emergency contraception.
      • Marnach M.L.
      • Long M.E.
      • Casey P.M.
      Current issues in contraception.
      also says that the stigmatization of abortion may be one factor contributing to reducing the incidence of abortion, along with the decreased stigmatization of nonmarital childbearing. If stigmatization has such efficacy, as it has with smoking, why not stigmatize nonprocreative sexual acts to reduce the rate of unintended pregnancy? If physicians can increase “responsible” sexual behavior via contraceptives, why can't physicians increase abstinence rates or decrease nonprocreative sexual behavior, ie, pursue “responsible” primary prevention? Why the almost exclusive focus on technological solutions (which involve big industry) and not primary behavioral change? If the goal is abstinence for irresponsible drinking and smoking behavior, why not promote abstinence for irresponsible use of the procreative act? Primary prevention was remarkably effective in reducing the incidence of AIDS in Uganda in the 1990s.
      • Hanley M.
      • de Irala J.
      Affirming Love, Avoiding AIDS: What Africa Can Teach the West.
      The answer may lie in some physicians' highly selective recognition of certain unhealthy vices reflecting our fallen nature. Gluttony still engages physicians and anger still engages psychiatrists, but one historic unhealthy vice has become not only passé but actually relabeled as conducive to a healthy lifestyle: lust. The curious message advanced by our modern contraceptive specialists is that the procreative act is entirely natural, but not its end. Why does an act so naturally health promoting and conducive to quality of life and well-being need to be rendered “safe” by physicians? Medicine is not immune from ideology, despite its veneer of dispassionate science, and ideology can become so entrenched that alternatives either are not pursued or are actively disparaged.
      Unintended pregnancies from rape constitute a special case in which primary prevention is challenging. The rapist changes the procreative act into an act of violence, so preventing conception is reasonable, assuming that it can be accurately determined that it has not already occurred.

      Hilliard MT. Dignitas Personae on caring for victims of sexual assault: a commentary on Dignitas Personae, Part Two, n. 23. National Catholic Bioethics Center website. http://www.ncbcenter.org/resources/information-topic/dignitas-personae/new-forms-interception-and-contragestation/. Accessed September 14, 2016.

      The contraceptive prescriber also changes the procreative act, this time into an act of pleasure seeking or recreation. The next step is a medical “bait and switch” in which responsibility (“safe sex”) is preached for acts the physician has rendered irresponsible with regard to their natural teleology. Why not “safe” bulimia? Are not calories an “unintended” consequence of the pleasure of eating?
      Abortion is actually the “unintended” consequence of trying to reduce unwanted pregnancies through contraception since abortion is simply backup for failed contraception. But perhaps this is not unintended. Contraceptive physicians who breathlessly assure us that contraception—emergency or otherwise—is not abortifacient demand as an ethical obligation that all physicians counsel and/or refer patients not only for contraceptive options but also for sterilization and abortion, even if it violates their conscience.
      • Marnach M.L.
      • Long M.E.
      • Casey P.M.
      In reply—contra contraception.
      It is not a coincidence that those who take life away from the life-giving act do not just get more health, freedom, and pleasure but more death—over 58 million surgical abortions performed just in the United States since 1973 and countless more from contraceptives acting as abortifacients.

      Ertelt S. 58,586,256 Abortions in America since Roe v. Wade in 1973. LifeNews.com website. http://www.lifenews.com/2016/01/14/58586256-abortions-in-america-since-roe-v-wade-in-1973/. Published January 14, 2016. Accessed September 14, 2016.

      Is preventing new lives and promoting death really an emergency for what used to be an exclusively healing profession?

      References

        • Batur P.
        • Kransdorf L.N.
        • Casey P.M.
        Emergency contraception.
        Mayo Clin Proc. 2016; 91: 802-807
        • Marnach M.L.
        • Long M.E.
        • Casey P.M.
        Current issues in contraception.
        Mayo Clin Proc. 2013; 88: 295-299
        • Finer L.B.
        • Zolna M.R.
        Unintended pregnancy in the United States: incidence and disparities, 2006.
        Contraception. 2011; 84: 478-485
        • Hanley M.
        • de Irala J.
        Affirming Love, Avoiding AIDS: What Africa Can Teach the West.
        National Catholic Bioethics Center, Phildelphia, PA2009: 30
      1. Hilliard MT. Dignitas Personae on caring for victims of sexual assault: a commentary on Dignitas Personae, Part Two, n. 23. National Catholic Bioethics Center website. http://www.ncbcenter.org/resources/information-topic/dignitas-personae/new-forms-interception-and-contragestation/. Accessed September 14, 2016.

        • Marnach M.L.
        • Long M.E.
        • Casey P.M.
        In reply—contra contraception.
        Mayo Clin Proc. 2013; 88 ([letter]): 901-902
      2. Ertelt S. 58,586,256 Abortions in America since Roe v. Wade in 1973. LifeNews.com website. http://www.lifenews.com/2016/01/14/58586256-abortions-in-america-since-roe-v-wade-in-1973/. Published January 14, 2016. Accessed September 14, 2016.

      Linked Article

      • Emergency Contraception
        Mayo Clinic ProceedingsVol. 91Issue 6
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          Emergency contraception (EC) may help prevent pregnancy in various circumstances, such as contraceptive method failure, unprotected sexual intercourse, or sexual assault, yet it remains underused. There are 4 approved EC options in the United States. Although ulipristal acetate requires a provider's prescription, oral levonorgestrel (LNG) is available over the counter for women of all ages. The most effective method of EC is the copper intrauterine device, which can be left in place for up to 10 years for efficacious, cost-effective, hormone-free, and convenient long-term primary contraception.
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      • Current Issues in Contraception
        Mayo Clinic ProceedingsVol. 88Issue 3
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          Contraceptive management in women should take into account patient lifestyle and coexisting medical issues as well as method safety, efficacy, and noncontraceptive benefits. This review focuses on common and timely issues related to contraception encountered in clinical practice, including migraine headaches and associated risk of ischemic stroke, the use of combined hormonal contraception along with citalopram and escitalopram, contraceptive efficacy and safety in the setting of obesity, contraceptives for treatment of menorrhagia, the association of intrauterine contraception and decreased risk of cervical cancer, and the association of venous thromboembolism and combined hormonal contraception.
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      • In Reply—Emergency Life Prevention
        Mayo Clinic ProceedingsVol. 91Issue 12
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          We thank Dr Nelson for his interest in our article “Emergency Contraception,”1 published in the June 2016 issue of Mayo Clinic Proceedings, and for sharing his point of view. We recognize that the topic of contraception is a sensitive one for some.
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