Catholic Medical Quarterly

The Journal of the Catholic Medical Association (UK)

Building knowledge. Building faith. Protecting the vulnerable.

• Home
• CMA (UK) Website
• Contact us
• About Us

Catholic Medical Quarterly Volume 73(2) May 2023

“Emergency Contraception” and Rape

Joseph Shaw

So-called “Emergency Contraception”, often called “the Morning After Pill” (MAP) in the UK, perhaps a less misleading name, is the source of enduring controversy in Catholic ethics. Matters are particularly complicated in the case of rape. This article will attempt to untangle some of the threads involved in this debate. [1]

The Catholic Church teaches that human life is worthy of protection from the moment of conception—the moment when the genetic material of an ovum and of a sperm are united to form a new human.[2] The Church, further, demands that this life be protected by law.[3]

There is dispute—to which I shall return—about the mechanism by which the active ingredients of the MAP work: do they simply impede ovulation, or also prevent the implantation of a fertilized ovum in the wall of the uterus? The latter would cause that newly formed human being’s death.

It is sometimes argued by Catholic ethicists that even if the latter is a possible outcome, there are circumstances in which it would be permissible for a rape victim to use the MAP. To understand the argument, we have to keep in mind two principles.

The first is that the Catholic tradition allows the victims of rape to attempt to impede conception. This position is set out clearly in the United State Bishops’ Conference guidance for Catholic health services:

A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.[4]

This is not ruled out by the Church’s general prohibition of contraception because such treatments do not involve the “double intention” both to engage in the sexual act and to frustrate that act’s procreative potential. In the case of rape there is obviously no intention on the part of the victim to engage in the sexual act.

By parallel, it is permissible to intend not to conceive, and to implement that intention by abstaining from sexual intercourse. What is wrong is to intend to engage in a sexual act and to intend the frustration of that act’s procreative potential, be it before, during, or after the act.[5]

This is the basis of the view that nuns who fear being raped can take the contraceptive pill—the “nuns in the Congo” case, which has passed into legend after being discussed in a theological journal in 1961.[6]

However, applying this principle to the taking of particular pills raises the question of what exactly the pills are doing. This brings in the second principle: that the MAP is or at least can be contraceptive in the strict sense, namely that it can prevent conception by suppressing ovulation.

Supposing there was a pill that did nothing but suppress ovulation, this would indeed be a true contraceptive, whether used before or after sexual intercourse. On Catholic principles, it would be wrong for a woman to take these pills with a view to preventing conception from acts she intended to engage in, but it would not be wrong, on the above argument, if she did not intend to engage in any.

The question is whether such pills actually exist,  particularly, for present purposes, for use after intercourse. Dr Bruno Mozzanega of the University of Padua has done some of the key work in this area. Speaking of one of the chemicals used in such pills, he writes, noting that the pills are up to 80% effective:

Besides, we wonder how [ulipristal acetate], if taken after ovulation, could delay a follicular rupture that may have already occurred up to 4 days earlier.This suggests that [its] effectiveness ... relies on other mechanisms, particularly on its endometrial effects.[7]

In other words, it could only achieve its very high success rate by preventing implantation, alongside,
perhaps, other causal mechanisms.  What of the other chemical used in such pills, levonorgestrel? In another paper, Dr Mozzanega casts serious doubt on the evidence for the claim that it does not prevent implantation, concluding “at present literature data do not seem to fully support that [levonorgestrel-based pills] avoid pregnancies by inhibition of ovulation.”[8]

It is such considerations which have led the (American) Catholic Medical Association to condemn the use of one popular pill, “Plan B”, which uses levonorgestrel, for victims of rape.[9] They point out that Plan B’s own website admitted in 2015 that “it is possible that Plan B One-Step may also work by...preventing attachment (implantation) to the uterus (womb).” (This embarrassing admission has since been removed from their website.)[10] The Catholic Medical Association statement concludes:

Further research is needed to find a drug that can be used after sexual assault to prevent conception without taking a human life.

Despite this, the argument could be made that taking the MAP amounts to a mere risk of causing an abortion—and that this is perhaps a reasonable risk for rape victims to take.

One way I have seen this argument developed is in terms of the timing of ovulation. If a rape victim is about to ovulate, and the pill prevents ovulation, it would seem legitimate for her to take it. If the victim has just ovulated, then if the pill still works, it will clearly work by preventing implantation.

The exact time of ovulation, however, is not always easy to establish, and the idea that a rape crisis center or Catholic hospital would make the MAP available conditionally, on the basis of some calculation along these lines, seems impractical.

It should be noted that to hide the mechanism of the pill from the user would be a grave violation of her moral autonomy; to deceive those giving her medical care would be grossly unprofessional. Everyone needs to be clear-sighted about what they are doing in prescribing or taking the MAP.

Can the decision to take the pill, knowing what it can do, but not knowing whether ovulation has taken place, be presented as a merely risking the death of a new human life? If so, would this be licit?

The Church teaches us to respect and protect the life of the unborn from the moment of conception, in the way we would respect and protect human life at later stages. This does not exclude all risk-taking: the study of ethics is full of hard cases in which risks to different people must be balanced. Catholic teaching, again, allows pregnant women who need medical treatment, such as for cancer, to receive such treatment even if it is likely to kill the unborn child. The document of the US Bishops’ Conference already cited notes (§47)

Operations, treatments, and medications that have as their direct purpose the cure of a pro­portionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

Such cases, and the case of the rape victim and the MAP, are not parallel, however. First, the intention of taking the pill would seem to be best described as an intention to prevent a developing pregnancy, either by suppressing ovulation or by preventing implantation. If this is indeed the intention, then it is wrong: a conditional intention to cause an abortion (“if it ovulation is not suppressed, then I intend that implantation be prevented”) is still an intention to cause an abortion. Since abortion is an intrinsically evil act, as the Church teaches, no hoped-for good result of this plan of action can justify intending it.

Possibly, the intention could be different. The agent might think: “I want to suppress ovulation, and am prepared to risk other consequences if this fails.” If this is the intention, the agent knows that there is a serious risk of ending a developing human life, and we are in the realm of risk-taking. However, the mother’s life is not at stake in the rape case, unlike the cases envisaged in the passage from the US Bishops’ document just quoted, so there is no question of balancing risks between two lives. Accordingly, it would be a case of a wrongful recklessness, because the risk is not proportional to the good intended.

The debate about abortion in the case of rape comes back in at this point. Our compassion for victims of rape is exactly what prevents us, as people who acknowledge the moral status of the unborn, from sending rape victims down the pathway of abortion. It may seem, to bystanders, that killing an unborn child conceived in rape makes the problem go away, but in terms of the rape victim’s trauma, physically, morally, and spiritually, it does nothing but compound the harm done—even at the earliest stages of that innocent child’s life, and no matter how easy and inconsequential taking a pill might seem.

The pro-life movement and the Church have much work to do in offering alternatives to abortion, and in offering forgiveness, healing, and acceptance for all those affected by our modern culture of violence and death. This work does not involve obscuring the Church’s moral clarity on the MAP.

Dr Joseph Shaw, MA, DPhil Oxf is a public philosopher, freelance writer, and recovering academic.
From 2005 until the 30th September 2022 I was a Senior Research Fellow at St Benet's Hall, a Permanent Private Hall of Oxford University, and a member of the Philosophy Faculty of Oxford.