Malta Medical Journal is unequivocal: emergency contraceptive pill is not abortifacient

Existing medical knowledge has never demonstrated that the morning after pill prevents the implantation of a fertilised ovum, which means that in no way can the emergency contraceptive pill be considered as an abortifacient.

The unequivocal statement was made in the editorial of the journal of the University of Malta Medical School, written by paediatric cardiologis Professor Victor Grech.

“The scientific truth of the matter is that extant medical knowledge, up to the time of writing, has never demonstrated that levonorgestrel [LNG] emergency contraception [ECP] prevents the implantation of a fertilised ovum. ECP therefore cannot, in any way, be considered abortifacient,” the editorial reads.

A debate on whether medicines suppliers should be allowed to import emergency contraceptives Levonelle 1500mcg tablet and ellaOne has been raging on ever since the Women’s Rights Foundation filed a judicial protest calling on the authorities to allow their importation.

Access to the emergency contraception pills is set to be discussed for one last time this evening during a join parliamentary committee meeting.

In his editorial, the professor, who argues that the whole debate was a storm in a teacup, explains that the primary mechanism of the morning after pill is to prevent fertilisation by impeding ovulation.

“The most recent scientific evidence shows that LNG ECP delays ovulation and does not prevent implantation nor does ECP cause the loss implanted embryos.”

To push his argument further, Grech - a consultant paediatrician with a special interest in paediatric cardiology - points out that even Catholic bishops in Germany have acknowledged that ECP does not prevent implantation – even though the Church only approves its use for rape.

The professor goes on to call out the hypocrisy of those who came out against the morning after pill, arguing that most have ignored the existence of “local equivalents that can and are being used as emergency contraception and that ECP can be delivered by fast courier to our doors.”

A new women’s pro-life organisation was quickly set up to oppose the importation of the ECP, claiming that it could encourage rape and abusive behaviour by men, and that it is linked with increased sexual promiscuity.

Archbishop Charles Scicluna and Gozo Bishop Mario Grech also joined the fray, claiming that it formed part of “a throwaway culture in which humans are discarded as waste.”

A number of members of parliament, including those who are general practitioners by profession, came out against the pill, prompting the Prime Minister to call for a joint committee in parliamentary to discuss the issue.

In its editorial, the Malta Medical Journal argues that “wild accusations” are not enough to sway anyone, but any decision should be based on scientific evidence.

“Blind statements that ECP can or possibly might cause implantation failure must be backed by evidence-based scientific literature – which (up to the time of writing) is non-existent.”

Although the World Health Organisation states that the ECP is “effective only in the first few days following intercourse, before the ovum is released from the ovary and before the sperm fertilizes the ovum” and, even though ellaOne is covered by a Europe-wide permit, Malta had never granted importers permission.

Turns out, that the reason why goes back to 2006, after the bioethics committee - a consultative committee of scientists, priests and other political appointees – blocked the importation of Levonelle despite the go-ahead of pharmaceutical regulator, the Medicines Authority.

The journal’s editorial also delves into the product labels of the ECP, some of which continue to state that one of the modes of action “may be” the prevention of implantation – even though there is no such scientific evidence.

“Clearly, citing a package insert which contains a myriad of biases that date back from 2006 and are thus based on data prior to 2005 is ludicrous given the plurality of robust studies published in peer reviewed journals since,” Grech writes.

“This appears to be the stance blindly taken by several individuals and organisations in this country, who repeatedly cite an inaccurate package insert while ignoring abundant and unbiased scientific research, along with recommendations by reliable bodies such as WHO and FIGO.”

Bringing the three-page editorial to an end, Grech concludes that the availability of the morning-after pill is “a non-issue.”

“This media furore has once again highlighted the local penchant for generating storms in teacups, wasting time, effort and resources on a non-issue. Reservations dependent on science should be settled by scientific evidence.

“This particular topic has needlessly vexed individuals and groups into dogmatic postures that are entirely without basis in fact – they are fighting a lost battle.”