jueves, 29 de diciembre de 2016

The day-after pill - myths and the truth

Some definitions about pregnancy, contraception and SRR


By Marco Paulini


When does a woman get pregnant? Do all the intercourses become creating a new being? How does emergency oral contraception work? Since August 22nd, 2016, Lima's First Constitutional Court instructed EOC to be distributed free in all health public stands, after the rule was suspended since 2009.


The problem was it actually could be sold in private drugstores, what generated unequitty in access and that is what court decision tried to balance.


But, what is all this process about? Before, I think it's necessary you understand some concepts and interpretations related to this issue in case you want to join the discussion, so you also do it under equity criteria.


Plus, I include you sources you can go deeper about this concepts (all my references are in Spanish, but you can find their equivalents in your language).


1. Reproductive cycle, ovulation and fertilization

every month, the female organism gets ready for a pregnancy. This preparation begins the first day of menstruation due to the ovaries make hormones such as estrogen and progesterone, mechanism ruled by the hypotalamus at the brain. Its objective is ova maturation, the preparation of uterus and the rest of the female sexual organs as well for a possible pregnancy.


The week after the menstruation begins, the ovaries will be the responsible for follicular maturation. As in every menstrual cycle 7 to 8 follicula start to grow, only one grows becoming mature between cycle's days 12 to 16, moment when ovulation happens. The Fallopian tube catches the mature ovum what begins its trip to the uterus, which has been preparing for a possible pregnancy swelling its endometrial layer (1). Once released, the ovum could b fertilized when joining to spermatozzoon during next 12 to 48 hours, if not it will begin to be disintegrated.


Human fertilization is intern, it happens inside the woman's body in other words, at Fallopian tubes to be exact.


Fertilization is probable if spermatozoons (male cells) are stored in the vagina by the intercourse at days 12 of 16of female menstrual cycle. Then, helped by the cervical mocus and stored in upper portion of the vagina, they start to raise to Fallopian tubes, those at the same time have gathered a mature ovum (female cell) .


For the fertilization (union of ovum and spermatozoon) to be produced, it's necessary that sexual contact (intercourse) between a man and a woman (except when artificial or assisted fertilization techniques are used) be made in a moment close to the ovulation (1).


It's actually easy to set that because this harmonious and almost timed working that female reproductive system does, the women are fertile every month during their reproductive lifetime, what begins in menarche (first menstruation) and ends in menopause. Then, her fertility or reproduction will be depend on mechanisms she and/or her partner adopts to begin or prevent pregnancies, facts those response to a biological sequence what occur cyclically in every woman, sequence that can not be unaware to take preventive measures and let them to God's fate neither.


2. Pregnancy

If spermatozzoon and owvum intercept, they will unite fusing their cores and formin one only cell, that starting in this point, will trek to the uterus, while it also begins a mitosis process, multiplying in number of cells.


3 to 4 days since the ovulation, the fertilized ovum will get the uterus, when it could last 2 to 3 days more for pinning up the endometrium, place where the new being will develop (1).


3Emergency oral contraception (EOC) and its action mechanism

The emergency oral contraception (EOC) is a method that offers an alternative to forced sexual relations or rapes, intercourses without prior contraceptive using, misusing or its failure (4). It's necessary to remark this method is effective only among 72 hours after having sex. It must not be used when this deadline is over.


It's proven the EOC works because unables the ovulation, at the same time it thickens the cervical mocus making the spermatozzoon not to go its way inside the uterus (5). So for example, Levonorgestrel emergency contraception pills prevent the pregnancy unallowing or delaying the ovulation, and avoid the fertilization due to its action on the cervical mocus, becoming it much thicky, so decreasing the spermatozzoon mobility with that, then its ability to join the ovum (4).


Thus, we support on updated scientific evidence to affirm that once the fertilization occured, the EOC doesn't interfere the process of fertilized ovam implantation and, neither it interferes the embryonic development of an already implantated ovum (4).


What it should be taken in mind is the EOC is a good method that allows preventing non-wanted pregnancies, and the protection of the woman's life in comsequence.


As I already explained, it must be paid attention to action mechanism because the EOC, as unallowing ovulation, won't display an ovum to fertilize, then there will be not a pregnancy. Also in case, that sexual relation has been happened after the ovulation, when an ovum has already been produced, this method thickens the cervical mocus as a second action mechanism, unallowing spermatozzoon and ovum encounter. So, it is proven it's not an avortive metod, bringing down the false theories which many politic authorities, influenced by their ecclesiastical colleagues, are based because here is not attempting against the life of a supposed new being, but simply conditions for the pregnancy to occur get nullified.


4. Sexual and reproductive rights (SRR) and Peruvian laws onEOC

In the other hand, each men or women has the whole right to decide on their sexuality, totally free, unattached by coercion, discrimination or violence, to decide if having kids or not, the number and spacing of them, as well as having true information with a scientific basis, and access to contraceptive methodology. In other words, to have sexual and reproductive rights (SRR), the same what were mentioned and recognized in Confference of Population and Development in Cairo, 1994, and 4th World Conference in Beijing, 1995.


Peru's Constitution doesn't mention explicitically to SRR of people, however it does recognize several rights inside or related directly to SRR of every citizen. So we find the right to dignity, free development of personality, also the right to the life, to physical and mental integrity, to fre concius, to free information, to personal intimacy for quoting someones.


Additionally on July 28th, 2005, the Family Planning technical Rule was aproved, which objective is to guarantee and standardize the attention processes on family planning inside the SRR focused from gender, setting up all person has right to enjoy the highest level of own health for allowing to enjoy own sexuality, to decide free and responsible the number and spacing of the kids, to have access with equity, without any discrimination, sexual orientation neither, to sexual health and family planning services, to the access to contraceptive methods for choosing free and volunterly, to have access to quality services of sexual and reproductive health without any type of coercion, to health institutions guard those principles to be committed.


Unfortunately, the women's SRR in Peru have not been totally recognized, as much as EOC laws have coming out behind a machismo veil, wwhich even the eecclesiastical authorities have self-allowed to give messages opposed to this contraceptive method despite Peru is a secular country, so the Church sshould not influence when ruling about issues related to sexual rights of persons.


The opposers' argument is the defense of a hypothetical being, not proven, based upon the premise of life defense.


Faith, science and machismo

despite Peruvian law fortunately begins to have a much favorable position to sexual rights, paradoxically it's still perceived there is a big number of women (not counting the men) who although recognize this contraceptive method offers a way-out before a non-wanted situation, they still see it like something attempting against the faith, prefering to accept what they had to live by God's fate, and that the woman's mission by tradition andd religion is the calling to give life despite the conditions it is given.


To us, who have a panoramic view of what happens, can affirm cathegorically this situation is just the product of the letargy and the lack of interest of Peruvian Government about recognizing and ruling on time in favor of sexual rights of people, much more women's - that the government, after paying more attention to religiosity, has come allowing laws those give to the woman a role of almost pure reproduction.


If we add disinformation to this, we have the perfect formula to continue in the chaos that non-wanted pregnancies bring themselves on. Then, we can elucidate that before such conditions, unfortunately the EOC is not an option for many of our women as a mean to protect their life, but it's not an option by own will, by pure ignorance given by the lack of information instead, because the State (almost holding hands to the Church and machismo) doesn't offer the conditions for the ownn woman to be the one who recognizes, empowers and internalizes she has sexual rights, those have not to struggle to her faith, making them to respect.


Don't lose our main focus, and this is the health of each person, translated in social health, our women's mainly, because a big amount of non-wanted pregnancies become clandestine abortion in unhealthy places those attempt against women's physical integrity, psychologic problems as well.


Let's have in mind that before rapes or any intimate relation without condom, the person exposes not only to a non-wanted pregnancy because EOC doesn't protect from sexually transmited infections nor HIV neither, due to this is not a method what avoids the contact to body secretions of the other person.


If you want to go more in-depth, I suggest go to bibliographic references I used to write this article. Remember they are in Spanish, so you can find out the equivalent in your language.

1. Saludemia. Planificación familiar. Lima: Saludemia; 2016

4. World Health Organization. Anticoncepción de Emergencia. España: Organización Mundial de la Salud; 2016.

5. Centro de la mujer peruana Flora Tristán. Anticoncepción Oral de Emergencia. Lima: Centro de la mujer peruana Flora Tristán; 2016.

8. Petrell E. Política de anticoncepción oral de emergencia: la experiencia peruana. Simposio [Serie en internet]. 2013[Citada 2016 octubre 31]; 30 (3):m [aAround 2 screens]. Available on: http://www.scielosp.org/pdf/rpmesp/v30n3/a19v30n3.pdf


No hay comentarios:

Publicar un comentario