Personal Essays

Credit: Brian Kusler

Plan B

Determining that precise instant when life starts is a big subject in American politics, but it’s rarely discussed with much nuance.

There are few situations that make you feel as cheap as asking a pharmacist for emergency contraception. Taken within 72 hours of unprotected sex, two white tablets resting in blister packs—levonorgestrel, 750 micrograms of synthetic hormone—lower the risk of pregnancy by 89 percent. But the effectiveness of the dose decreases exponentially with time, and when you are 18, newly moved from London to New York, with grand plans that you are desperate not to derail, it is impossible to walk to the pharmacy slowly.

So you move at a stilted run, or so I found myself doing, November 1st, 2003, honing in on the Columbus Circle Duane Reade. The drama of a pregnancy scare is a contained, potential calamity in the mind that no one else sees. But the undignified speed, the frantic catches in my practiced speech for the pharmacist, and particularly the pumpkin orange wig in my bag and flecks of green glitter in my eyelashes—this was the morning after Halloween, of course it was—added to a feeling of 99-cent store cheapness. I told myself the broken condom was at fault, that taking the pill was the responsible thing to do, but asking the pharmacist for it out loud sounded shockingly like saying “I have irresponsible sex dressed like a pumpkin and I don’t think about the consequences till morning.”

And so being denied at the counter felt like being punished for that perceived slovenliness; denied twice more at other pharmacies intensified the rebuke. In Europe, emergency contraception has been available on request and consultation with a pharmacist since 1999. But although the morning-after pill was approved by the Food and Drug Administration for use in February 1997, it wasn’t until August 2006 that it was approved for over-the-counter sale. Charm, beg, reason or blubber, all of which I did a little that morning in 2003, Plan B was only available by prescription. For a pharmacist to supply it without a doctor’s written consent was a federal crime.

The biological process of getting pregnant is vastly more complicated, and takes a lot longer to complete, than the physical fun of the opening act. For a start, the first wave of sperm released during sex is unable to fertilize an egg, since the spermatozoa haven’t undergone the process of capacitation. This is the removal of plasma proteins, the reorganization of membrane lipids and pH levels: the equivalent of a sperm at home in boxer shorts changing into a sports coat and tie for the party, as an artist’s impression in the University of Colorado’s guide, “Pathophysiology of the Reproductive System,” charmingly illustrates it. And as capacitation takes several hours, there’s an opportunity to avoid pregnancy that may be entirely scientifically, and ethically, viable.

Should a capacitated sperm successfully activate and fertilize an egg, however, the ethics become more complicated. Biologically, it’s the Big Bang beginning of life. But legally, it’s not.

Criticizing the morning-after pill felt like a concession to the pro-life/anti-choice lobby, groups who would deny women the hard-won right to a safe and legal abortion.

The fertilization of an egg is one of the final steps towards a pregnancy, but it is not the last one. Pregnancy will not occur unless the egg implants itself on the uterine lining, and the likelihood of this successfully taking place depends on the particular day of the woman’s ovulation cycle. The odds are low—ask any couple who’ve undergone fertility treatment. It doesn’t happen immediately, either; the implantation phase typically begins five to seven days after fertilization, and it’s only at the point of successful implantation that the FDA and the American College of Obstetricians and Gynecologists define the start of conception.

But I didn’t know any of this. All I knew was that the shadowy threat of a baby was getting more solid by the minute and that by asking for the pill I’d invited it into existence. Leaving the last pharmacy and loitering on the sidewalk, I’d followed the scenario through too far to just go to brunch and forget about it.

As doctors Frank Davidoff and James Trussell point out in their American Medical Association Journal article “Plan B and the Politics of Doubt, “ there is no method for reliably detecting fertilization of an egg prior to implantation. This means it is impossible to prove with certainty how the hormones in the emergency contraceptive pill inhibit pregnancy. They may act overtly like contraceptives—logical since levonorgestrel is the hormone found in standard birth control pills—inhibiting pregnancy by preventing or delaying ovulation and interfering with the process of fertilizing the egg. Or they may inhibit the egg’s implantation, an effect that starts to sound a lot closer to abortion.

The point, artificial as it may sound, is that suddenly there was a window in which I could decide for myself whether I was pregnant because for up to seven days, science, with all its certainty, was unable to tell me otherwise. And so it’s within this limbo that debate about the nature and validity of emergency contraception ricochets endlessly, where politics, science, and ethics get entangled.

It’s “Jane’s Lucky Day…” announced a 2002 radio spot in San Francisco, “because she still has 72 hours after unprotected sex to prevent pregnancy with Plan B emergency contraception.” The ads were a part of a marketing scheme to position emergency contraception as exactly that—a last-resort contraceptive. By implication, Jane was lucky because the new Plan B meant there was no need to consider the old one—now, presumably, Plan C—abortion.

By breaking conception into different components, the function of the morning-after pill can comfortably be separated from that of a straight abortificant, such as RU-486, which induces a termination of pregnancy if taken within 49 days of gestation. In contrast, Plan B is ineffectual once an egg has implanted—it can’t reverse a completed conception. And if life doesn’t officially begin until implantation, if it’s impossible to know when implantation takes place, then it’s possible to view the drug as a contraceptive lasso that shoots out and ropes the fertilized egg before it gets away and, let’s say, does any damage.

This is the reassuring view of Dr. Kathleen Hill-Besinque, associate professor and director of experiential programs at the University of Southern California, who worked with Barr Pharmaceuticals, the company who bought the rights to Plan B. “There’s no evidence that emergency contraception stops the fertilized egg from implanting, and there’s a lot that happens between a fertilized egg and pregnancy,” she explained over the phone during a conversation this summer. Furthermore, levonorgstrel “prevents pregnancy…Abortion is not preventing pregnancy—it’s terminating it.”

The more I learned about the issues involved in emergency contraception, the more shameful I felt. It’s different from pumpkin-hussy shame—that mix of prudish embarrassment at even admitting to a stranger I’d had sex, and fear at what might come next if I really was pregnant. Because my Plan C, which I didn’t stop to think about, but which was with me all morning, was the same as Jane’s. If I’d gotten pregnant at 18 I’m almost sure I would have had an abortion.

No, this new shame was that five years ago, considering myself responsible for seeking out the pill, and flush from my A+ grade in high school biology, I hadn’t taken this debate into account at all. The ticking timer on the search for the morning-after pill pushed everything else out of my mind. I admit, I didn’t care what the pill would do to my body, or how, as long as it did what it said on the box. And so to hear Besinque’s science five years later was reassuring, given that I had no desire to entertain thoughts of a retrospective abortion. I was convinced that was what I’d avoided. Furthermore, I didn’t want to admit doubt about a crucial victory for women’s reproductive rights; criticizing the morning-after pill felt like a concession to the pro-life/anti-choice lobby, groups who would deny women the hard-won right to a safe and legal abortion.

But it’s not that easy, and it shouldn’t be. After Dr. Besinque I called Dr. Janice Crouse, director of the Beverly LaHaye institute, the think tank for the conservative, evangelical public policy body Concerned Women for America. Crouse withheld her blessing over the morning-after pill for the same reasons as Besinque gave hers. Scientific uncertainty compelled these two women to occupy the same territory, even as they turned it to completely different ends.

I imagine what could have happened if I hadn’t sent out a last-ditch lasso, if I’d taken that chance and chance got me pregnant.

“We view the pill as a form of abortion,” Crouse explained. “It’s basically a pill to keep a woman from being pregnant.”

“But isn’t that what contraception does?” I asked, part journalist, part devil’s advocate. Concerned Women for America takes a tight-lipped, neutral position on birth control, although it is quick to point out potential health risks of taking it.

“Yes,” she said, but swiftly followed up. “Here you actually have the potentiality for a pregnancy. In some instances [an egg] would be implanted, in others not. You don’t know with the morning-after pill if you are using birth control or in effect aborting. And you can’t take that chance.”

Her argument is logical and not easily dismissed, and it doesn’t look good for me and Jane. How do I justify taking that chance, and so imperiously deciding if a child would be good for me? I picture myself one day in the hazy future, sitting on the couch watching something junky on TV and instinctively, repeatedly, following the ballooning curve of my stomach, and getting breathless at the miracle of a person growing inside. I find the image incredibly natural, comforting, and, crucially, distant. Even having entertained this limbo of potential pregnancy, I am still glad that I ended up at Mount Sinai hospital, kicking my feet on the linoleum for two hours before seeing a nurse, and explaining, numbly, what I needed. A doctor ran in, signed the prescription, I left, took the pills, and went to bed.

I do acknowledge the massive selfishness of this decision; the fact that I only took myself into consideration, and not the ghostly life, is a shocking one to confront five years later. But then I imagine what could have happened if I hadn’t sent out a last-ditch lasso, if I’d taken that chance and chance got me pregnant. Whether I prevented or ended life is unknown to me, and that I never really chose between the two but shut my eyes and opted for the easy way out, is a painful thing to confront. But the relief I feel at not being pregnant is enough to throw the selfishness into a balance, and makes it bearable.