When does life really begin?
Opponents of the reproductive health (RH) bill argue that many types of contraceptives are abortifacients, meaning they terminate life inside the mother’s womb, a position flatly rejected by its proponents.
While advocates of the bill assert that life does not begin at fertilization which means no life is ended by the anti-implantation effect of contraceptives, medical experts from UST – Dr. Edilberto Gonzaga and embryology professor Josephine Lumitao – are clear: Life begins at fertilization.
Fertilization marks the union of the egg and the sperm cells, Lumitao said.
Gonzaga said the fertilized egg, scientifically called a “zygote”, immediately becomes a living individual during the process.
“The moment this happens, a new individual is formed. [That individual is considered] human because he or she already has 46 genetic complement, a unique genetic identity,” said Lumitao, adding that the life of a zygote is no different from that of an adult.
“Both the zygote and the adult are still actualizing or in the process of developing their potential. The adult, of course, has probably developed most of his potential while the zygote is just beginning to develop his,” she said.
But proponents of the RH bill insist that life does not begin at fertilization but at implantation. The argument is crucial because it maintains that there is nothing to abort until the fertilized egg is actually implanted. A number of contraceptives work within this so-called “window.”
“Fertilization is conception,” said Lumitao, adding that implantation is a separate event that occurs five to seven days after fertilization.
Once an egg is fertilized in the fallopian tube, it immediately undergoes cell division until it becomes a solid ball of cells. The inner group of cells will become the embryo while the outer group will become the placenta (the covering that protects and provides nutrients to the embryo).
As the cells divide, the zygote moves out of the tube and floats toward the uterus before it implants itself, she said.
According to Lumitao, the blastocyst or developing zygote exchanges signals with the maternal endometrium (inner linings of the uterus) in order to implant.
During implantation, the outer group of cells (future placenta) attaches itself to the uterus for nutritional supplement. If it fails to do so, the zygote will eventually die and be flushed out of the mother’s womb as if a regular menstruation occurred.
Lumitao compares this phenomenon to a satellite (zygote) that needs to dock at the mother ship (uterus) in order to survive. They communicate with each other to help the satellite find its way. If interference occurs, it will fail to dock and die from lack of food and oxygen.
‘Contraceptives’
Oral contraceptives or pills are the meat of all debates regarding abortifacients.
Lumitao said pills have three mechanisms of action: prevention of ovulation, thickening of the cervical mucus to make it impenetrable by the sperm, and last, the most controversial of all, is damaging of the endometrium (linings in the uterus) to make it unwelcoming to the fertilized egg – a mechanism that inhibits implantation and thus makes pills potentially abortifacients.
“The first two mechanisms are mostly contraceptives, but if escape ovulation (caused by a low dose of oral contraceptives pills) occurs and the egg is fertilized, the blastocyst cannot implant [itself] because the contraceptives produce a thin endometrium not receptive to implantation,” she said.
During the 1960s, hormonal pills were developed to address the same “population problem.” Lumitao said that the pills at that time contained almost pure synthetic estrogen, which is the bioidentical hormone based on the structural and chemical design of human hormones. Estrogen is the female’s natural sex hormones that help regulate menstrual cycle.
“Pills with high dose of synthetic estrogen are completely anti-ovulatory,” she said.
Though safe from inducing abortions, pure synthetic estrogen brought many side effects such as blood clots and stroke. This paved way to the manufacturing of pills with combined estrogen and progestin (synthetic progesterone).
Progesterone is also a natural female sex hormone. The high progestin level of the pill damages the lining of the uterus which prevents implantation, Lumitao said.
Although less side effects may occur, this made the combined oral pills more dangerous due to higher incidence of anti-implantation.
Mini-pill (pure progestin pills) and morning-after pill (emergency pills) are similar to the combined oral contraceptives. Intrauterine devices or IUD’s, on the other hand, intervene with the implantation by causing irritation to the female’s uterine lining.
Lumitao said that IUD’s are foreign bodies so white blood cells react to prevent it. Moreover, she said they are “unsanitary and may cause urinary tract infection (UTI).”
The anti-implantation effect of contraceptives is caused by the inaccuracy of these pills to prevent ovulation.
According to Lumitao, 25 percent of health women regularly taking oral contraceptives may experience break-through ovulation.
20 percent of these cases experience fertilization.
She said that if we take the average of these two studies, approximately 5 “pill induced abortions” occur for every 100 women using oral contraceptives for one year.
‘Essential medicines’
Though potentially abortifacients, pills, IUD’s, and the like, are categorized in the RH bill as essential medicines to be made available in all hospitals and government units nationwide.
Lumitao said contraceptives should not be considered essential medicines because they are agents that may cause side effects or even death.
“Early or prolonged use of contraceptives have higher predisposition to breast cancer or liver cancer,” she said. “Women, being complacent of not getting pregnant, tend to be more sexually active and thus have higher incidence of acquiring sexually transmitted infections or cervical cancer.”
Moreover, she said that no matter how contraceptives and other family planning devices are classified, “they are still not medicines.” Jan Eva Mari P. De Vera and Fidel Elino Miguel P. Flores
