Pro-Life Drugstores and the Meaning of 'Abortion'

Some pharmacies are spreading misinformation about the pill and other contraceptives.

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Corrected on 6/18/08: An earlier version of this post incorrectly stated that antiabortion pharmacies refuse to fill prescriptions for the abortion pill combo, Mifeprex, when in fact, doctors must administer these drugs in their offices.

I was dismayed to read a front-page article in today's Washington Post that "pro-life pharmacies" are coming into fashion in this country, including one set to open this summer in Chantilly, Va. The Post reports that many, including the new one in Chantilly, won't stock Plan B emergency contraception (which prevents pregnancy within the first 48 hours of unprotected sex) or any kind of birth control; that means no access to condoms, spermicide, or the pill.

Pharmacists who work in these places have religious objections to contraception, but as the article points out, they have no trouble filling Viagra prescriptions. They also generally don't have signs in the pharmacy window labeling themselves as "pro life" establishments, so unknowing women who wander in may be forced into an embarrassing situation when they try to purchase Plan B or get their pill prescription filled. (I'm waiting to see whether women's rights advocates will be picketing these pharmacies much the way pro-life activists picket all those unmarked abortion clinics.)

What concerns me is the potential impact these pharmacies will have on women's access to birth control—especially if they become widespread in small rural towns with few pharmacies. But I'm even more worried about the misinformation campaign that's spreading about the pill. "The Pill Kills" logo is displayed prominently on the website of Pharmacists for Life International, a group that promotes pharmacists' rights to refuse to fill objectionable prescriptions. If you click on a link below the logo, you'll get details on a June 6 "pro life" protest against oral contraceptives. Pro-lifers claim that the pill sometimes leads to fertilized eggs being aborted. Although hormonal contraceptives were designed to suppress ovulation, it's theoretically possible—though rare—for a pill user to ovulate. If she does, the pill makes the uterine lining too thin for a fertilized egg to implant. What's important to understand, though, is that most major medical organizations, including the American College of Obstetricians and Gynecologists, define conception as beginning at the moment of implantation. Without a viable pregnancy, there can be no abortion.

ACOG faced this issue head-on two years ago when it lobbied for Plan B to go over the counter, arguing that emergency contraception simply prevents pregnancy and cannot cause an abortion. As Oklahoma gynecologist Dana Stone points out in a blog post on

We now face fringe movements trying to turn a woman's egg into a baby, birth control pills into a form of abortion, and all forms of contraception into murder. Call it nostalgia for the good old days, when men were men, sex was unspeakable, and women lived in fear of unintended pregnancies. Let's get the medical facts straight. Birth control pills use two different mechanisms to prevent the release of an egg each month. Other effects of the pill can either reduce sperm motility or thin the uterine lining—all simply to keep a fertilized egg from implanting if ovulation does occur.

The Pharmacists for Life site also reported, in chilling terms, the news of a British girl dying last week from the abortion pill regimen, which is a combination of the medications mifepristone and misoprostol. What the site didn't point out is that the risk of death is extremely small: Just a handful of women have died worldwide from the regimen, and half a million women have used it in the United States alone. What's more, a University of Michigan study released today shows that the risk of death is increased only when the misoprostolpills are administered inappropriately, inserted vaginally instead of taken orally. Vaginal insertion reduces side effects like nausea and vomiting but can suppress key immune responses that keep dangerous bacteria in check, the study finds.