Sunday, October 23, 2011

ACOG Patient Information

Last post, I linked some of ACOG's literature for providers. Now, I'll examine some of their literature for patients. I received five patient-information pamphlets when I became a member (yes, I am a member, but I also joined AAPLOG). ACOG sells these pamphlets to OB/GYNs in private practice. From their list of literature, I chose these five to receive:
  1. Birth Control Pills
  2. Emergency Contraception
  3. Human Papillomavirus Infection
  4. HIV and Women
  5. How to Prevent Sexually Transmitted Diseases
(I purposefully chose the hot-button issues because I expect that when "reproductive rights" are not involved, ACOG's recommendations are medically sound.) Let's just look at Emergency Contraception (EC).

Look at these two quotes:
Depending on where a woman is in her menstrual cycle and when the pills are given, these pills may:
  • Prevent or delay ovulation
  • Block fertilization
  • Keep a fertilized egg from implanting in the uterus
(The last bullet notes the abortafacient property of emergency contraception and all birth control pills.)
...there is still a chance you could become pregnant. If you take a pregnancy test and the result is positive, talk to your doctor. Emergency contraception does not harm a pregnancy or the health of the baby.
For ACOG, fertilized egg ≠ baby, when the opposite is the case. But pro-choice advocates rarely respond to zygote/baby/product-of-conception vocabulary debates. In reality, one doesn't need to mention the conceptus—the argument swings on women and choice.

A quick syllogism:
  1. An abortafacient is a drug or device that induces abortion. 
  2. An abortion is a termination of a pregnancy. 
  3. An abortafacient terminates a pregnancy.
This first-order syllogism depends on the definitions of "abortafacient" and "pregnancy." Because the definition of "abortafacient" is purely nominal, this argument stands or falls depending on the definition of "pregnancy."

A common definition of a pregnant woman is one carrying an embryo or fetus. (According to my embryology class, "embryo" and "fetus" are the same thing on either side of 8 weeks after fertilization.) I would say that a woman becomes "pregnant" when she carries a zygote (a white paper by Maureen Condic demonstrates that "zygote" and "embryo" are the same thing on either side of implantation). Thus, a woman could be pregnant, EC could act as an abortafacient, and she would have undergone a chemical abortion. But ACOG says otherwise: they say that she becomes pregnant only if EC does not work at all.

Perhaps they define pregnancy some other way, such as: a woman is pregnant when her hCG test is positive (assuming it's not a false positive). What does this definition say? Follow me as I unpack this "definition."
  1. A woman is pregnant when her hCG test is positive (assuming it's not a false positive).
  2. A woman is pregnant when her blood contains human chorionic gonadotropin.
  3. A woman is pregnant when there is something in her body is producing human chorionic gonadotropin.
  4. A woman is pregnant when there are syncytiotrophoblast cells in her body are producing human chorionic gonadotropin.
  5. A woman is pregnant when there are living, working cells (that belong to an embryo) in her body
  6. A woman is pregnant when there is an embryo in her body
We have arrived at the common (underlined) definition above. With an embryology textbook and a some recent research, I can see that pregnancy is the carriage of a zygote (or later stage of unborn human offspring). Can't ACOG?

One of my college friends described the moment her sister realized the implications of the abortafacient property of OCPs. She sat shocked and sad. She couldn't believe that the weighty choice of to abort was never given to her to make. ACOG, do not rob women of their decision-making power! Do not hide the state of their bodies from them. Do you think they can't decide for themselves? How paternalistic!

ACOG, admit that women are pregnant if the first two methods of EC (and OCPs) don't work. Dignify women with an informed choice.


  1. Your last point correlates providentially with the homily I heard yesterday. The priest's brother had, 20 years ago, impregnated his girlfriend. He felt he had no choice but to help her get an abortion. This has been a heavy weight on his heart all these years. Even now he's afraid his teenage daughter might be forced into the same "choice," and so wants to put her on birth control.

    If abortions/ECs/contraceptives are pro-choice, why do so many people feel forced into them?

  2. Thanks for your comment; I'd never heard that kind of story from the man's perspective. Your last sentence is so right; so sad.