When exactly does life begin? It seems to be a vague, philosophical question, but the impetus to solidify an answer has become increasingly vital in political debates concerning the legality of abortion. The lack of a completely accepted definition has this time fronted a movement, spearheaded by Virginia Del. Robert Marshall, R-Prince William, to limit the accessibility of emergency contraception on the campuses of Virginia's public colleges and universities.
"I don't think the state should be supporting this," Marshall said in a tone of determination.
Two state universities, James Madison University and George Mason University, have stopped distributing emergency contraceptives after Marshall pressured them to do so, though both student health centers can still prescribe the pill, to be gotten elsewhere.
The emergency contraception pill, known as ECP, or more commonly as the "morning-after pill," has been available since the FDA approved the first marketed version, Preven, in 1998. FDA approval, however, has not put an end to the controversy surrounding the drug. ECPs can be taken up to 72 hours after the sexual act to diminish the chance of an unwanted pregnancy. It consists of two doses of oral contraception, one taken as soon as possible, up to 72 hours after intercourse, and the second administered 12 hours later. The ECP then can work in one of three ways: Preventing ovulation, prohibiting the meeting of the sperm and the egg, or in the case of an already fertilized egg, precluding implantation of the egg by altering the lining of the uterus.
The vast majority of the time ECPs function through the first method, but it is the last method, in which the egg has already fertilized, which has caused the recent commotion.
To Marshall, a Catholic, pregnancy and life commence at conception. Therefore, preventing a fertilized egg from attaching to the uterus, in his view, is an abortion.
The FDA Web site clearly states that ECPs are not an abortive measure and are ineffective if the woman is already pregnant.
"The FDA decided in 1997 that pregnancy begins at implantation, but you won't graduate from the U.Va. Medical School thinking that," Marshall said.
Marshall's opinion clashes with current medical opinion, which maintains that pregnancy begins not at conception but at implantation.
Del. Mitchell Van Yahres, D-Albemarle, disagreed sharply with Marshall, speaking with a tinge of frustration on the subject.
"I think Robert Marshall is trying to attach a religious intent to something in the scientific realm," Van Yahres said. "He's using his religion to determine what an abortion is."
Marshall's crusade commenced this past spring when he sent a letter addressing the dispensing of ECPs to several Virginia public universities, the University being among the recipients.
"I asked are they distributing the drug and under what circumstances," Marshall said.
In the letter to James Madison University, Marshall called ECPs a method of abortion and voiced his distress at discovering the school made it available to students through its health center.
"I see no reason why an institution that is there to cultivate the minds of the students has to get involved in this," Marshall said.
He added that he finds the term "emergency contraception" a misleading appellation.
"This is a finesse, another term for a lie, because women would have a moral objection to an abortion, but not to contraception," he said.
Marshall also said he believes ECPs haven't been sufficiently tested: "There were no long range studies that were done saying that this is safe. They are making women into guinea pigs and that shouldn't be done."
In the letters he went on to cite Virginia's informed consent law, which mandates the "voluntary written consent to abortion by a pregnant woman" before she terminates her pregnancy.
Although ECPs are not currently included under Virginia's informed-consent law, the JMU Board of Visitors still voted on April 18 to discontinue the selling of ECPs on campus. After a firestorm from students, resulting in a petition of nearly 3,000 signatures, the JMU Board neither discussed nor rescinded its decision at its June meeting.
The University of Virginia has distributed ECPs to students at the Elson Student Health Center since 1998, according to Student Health Director James Turner. The health center prescribed the drug to 260 students in the last academic year.
"The attorney general has ruled this is not abortion, it's contraception," Turner said.
At the University, a woman interested in the pill has to make a gynecology appointment before she can obtain a prescription. The appointment is usually free, although the ECP costs $15 at the Student Health pharmacy.
"We prescribe it in our pharmacy because it is a standard practice which is established in Virginia ... We are not breaking the law or committing malpractice. We want to provide the best, most up-to-date contemporary care available to science, and ECPs are one of those tools," Turner said.
The ECP the University currently offers is Plan B, which was approved by the FDA in 1999. Plan B contains only progestin, while Preven, the other main ECP, is a combined contraceptive which contains progestin and estrogen. The main side effect of ECPs are nausea and vomiting, although Plan B greatly lessens the likelihood of such adverse effects.
If the University decides to ban the selling of ECPs on Grounds, the health center would still be able to prescribe the pill to students, and the students could get it filled at local pharmacies. CVS pharmacies in Charlottesville sell Plan B at a cost of $28.99 and Preven at $24.19.
Banning the drug from the University pharmacy "will present some logistical problems in getting to the pharmacy," Turner said. "Especially for firstyears who don't have cars."
Rising fourth-year College student Eileen Conaway said was appalled by the Board's decision at JMU.
"I think that it's incredibly presumptuous that a politician with absolutely no medical background can declare a drug abortive, which is contrary to what the FDA says it is, and to impose his morals on a population of students and institutions across Virginia," she said.
Although Conaway said she herself would never take the drug because of her own beliefs about when life begins, she staunchly defended the right of other students to have access to ECPs.
"I think that students should have the option if they choose to use it," she said.
University students who support the distribution of the pill don't have to worry yet.
"Our intent is to keep providing this," Turner said. He added that two decades ago the health center would see approximately 200 unwanted pregnancies every year, most of which terminated in abortion, but now that number has dropped to 20 to 25 unwanted pregnancies every year.
"We are convinced that ECPs prevent abortions," Turner said.
The pending success of Marshall's campaign, however, could have additional consequences in regard to contraception. Since the emergency contraception pill is similar to a birth control pill, limitations on ECPs could also affect birth control. ECPs and birth control often share the same main ingredient, progestin, and usually function in the same way by preventing ovulation.
Before ECPs were officially packaged as Preven and Plan B, doctors would tell apprehensive patients to take multiple doses of their usual monthly cycle of birth control pills, which basically would act how an ECP acts. Although Marshall said that ECPs are different since they are such a strong dose at one time, Van Yahres said that if Marshall is against ECPs then he is effectively against birth control, and that very well could be the next thing to go.
As far as the response Marshall is getting in the Virginia legislature, Van Yahres commented, "I think it is being taken very seriously, because none of the Republicans are repudiating him."
Marshall also believes he is being taken seriously: "It's not just Bob Marshall that is asking these questions now"
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