Emergency Contraception: Exposing Princeton’s Institutional Involvement in Reproductive Politics

by Toni Alimi ’13 and Robert Marsland ’11

If one were to type the phrase “emergency contraception” into the Google search bar, one would expect to find among the first results Planned Parenthood, or some other “reproductive health” organization. It would come as quite a surprise, then, to learn that the very top result, ahead of all these other groups, is the website ec.princeton.edu. This Princeton-domain address is also listed along with Planned Parenthood and the FDA on the government website womenshealth.gov as a resource for “more information” about emergency contraception. When this site came to our attention, therefore, we were curious about the nature of both its content and its Princeton sponsorship.

The website is operated by the Princeton Office of Population Research (OPR), established in 1936 as the very first center for research on populations. OPR’s “public infrastructure core” consists of four branches: the Population Annual Meeting Program Application, which manages “the scientific program of the annual meeting of the Population Association of America;” Research Briefs, which “summarize the core findings of recent analyses based upon data collected for the Fragile Families and Child Wellbeing Survey,” the Future of Children journal, which is concerned with influencing policy to “better the lives of children now and in the future,” and the emergency contraception website ec.princeton.edu. This website was established in 1994 bys current director, Professor James Trussell, to educate women about Emergency Contraception and to encourage its broader use.

Prof. Trussell, a Professor of Economics and Public Affairs at the University, has been a member of the Office of Population Research since he came to Princeton as a graduate student in 1973. Serving as OPR’s director from 1992 to 1998, and again from 2002 until today, Trussell says that when he founded the website, “very few people knew about emergency contraception,” and he wanted to show women that there is a final option to prevent pregnancy after unprotected sex. In many of his articles, Trussell expresses concern over the large number of “unplanned” pregnancies in the U.S., and argues how important it is for women who accidentally have unprotected sex from time to time to know that they can still prevent pregnancy for up to 5 days after the encounter. His strong commitment to this cause has led Trussell to become one of the preeminent American authorities on emergency contraception, with at least two dozen articles published on the subject, including six out of his last seven. In addition to all of this, Trussell is on the board of directors at the National Abortion & Reproductive Rights Action League (NARAL Pro-Choice America), designating him a leader in the pro-choice movement.

The website ec.princeton.edu is a compendium of Trussell’s efforts in emergency contraception. According to the site, its mission is to increase women’s knowledge about and timely access to emergency contraception and other reproductive health choices, both in the United States and abroad. With an online database of emergency contraception providers in the United States, a database of emergency contraceptive pills around the world, and information on explaining to sexual partners how regular contraception pills can be used as a form of emergency contraception, ec.princeton.edu employs a variety of methods to further its purpose. The website includes a brand-by-brand comparison of pills by company, dosage, and hormone levels per dose. It even analyzes the effectiveness and side effects of selected pills, specifically Plan B, Plan B One-Step, and Next Choice.

While the amount of information and detail that this website holds may be considered admirable, ec.princeton.edu goes beyond merely providing “neutral” information. It forms a core part of Trussell’s avowed mission to increase the use of emergency contraception worldwide, and a very effective part at that: 130,000 people from over 50 countries view this website a total of 575,000 times per month. It is published in English, Spanish, French, and Arabic.

Among such viewers are inevitably teenage girls under 17 who have engaged in unprotected sex and are looking for answers. Even though emergency contraception pills have not yet been clinically tested on teenagers, ec.princeton.edu specifically encourages teens under 17 to use emergency contraception. To make matters worse, it pushes for girls under 17 to acquire and use emergency contraception without prior parental consent. In fact, it suggests that these teenagers “be sure to ask if the medical care [they] receive will be confidential and, if not… contact someone else to get emergency contraception.” Such an action takes a conversation that one would ordinarily expect a teenager to have with her parents, and puts it in the hands of an unknown doctor – a stranger. The website does not stop there, however. Upon acknowledging that it may be difficult for a girl who has had unprotected sex to procure the “morning-after” pill in the short time before she becomes pregnant, it encourages teenagers to keep emergency contraception pills “on hand” in a medicine cabinet to minimize the time between unprotected sex and the pregnancy prevention step.

The website also provides a manual, EC at the Grassroots, a self-described “Manual for Developing an Emergency Contraception Access Campaign in Your Community.” This twenty-two-page grassroots organzation guide is published by the National Network of Abortion Funds (NNAF). And, as one might well expect, the NNAF was created specifically to raise funds to help women pay for abortions. While this manual does not directly endorse abortion, it presents abortion in a very positive light, and clearly demonstrates the seamless ideological connection between Trussell’s efforts and the pro-choice movement at large. At one point, the manual states that, “In many rural areas, women in need of information and timely access to EC must contend with barriers ranging from their remote location to a conservative climate that limits and distorts public awareness of the issue.” This statement summarizes the ideological one-sidedness that underlies the entire website: its authors are so convinced of their position’s unassailability that they refuse to acknowledge the controversy that continues to surround the issue of emergency contraception, and dismiss their opponents as either misguided or malicious distorters of reality. With more than 50% of Americans today currently identifying themselves as pro-life, it is hard to see any truth behind the pretensions to neutrality of a website that openly allies itself with pro-choice activists, and ignores the clear and present controversy.

In statements on the problems caused by “conservative climates”, the authors of this manual are actually criticizing the legitimacy of the ongoing pro-choice/pro-life debate. Despite the abundant assertions throughout the manual and the website that it is impossible for emergency contraception to cause an abortion, this debate has not yet been definitively settled. In the FAQ section, ec.princeton.edu details the three ways in which emergency contraception can prevent pregnancy. If taken before the sperm and egg meet, emergency contraception pills can prevent or delay ovulation and fertilization. If taken after the sperm fertilizes the egg, the website admits the possibility that the drug prevents the implantation of the new embryo, causing it to die from lack of nutrition. Trussell and other emergency contraception advocates avoid the conclusion that killing the embryo is effectively an abortion by some sophistic wordplay: since “pregnancy” is defined by the National Institutes of Health and the American Association of Obstetricians and Gynecologists as beginning at implantation, and since “abortion” refers to the “termination of a pregnancy,” killing an embryo before implantation is not an abortion. Trussell himself seems to recognize this blatant sophistry, and so goes to great lengths to show that the cases of implantation being prevented by emergency contraception are rare or non-existent. His demonstration is by no means conclusive, however, and he himself admits throughout the website that this third method is a possibility.

The firm pro-choice position that leads Trussell to dismiss concerns about emergency contraception’s abortifacient potential is present throughout the site, especially in its external links to sites such as www.prochoice.org, a website that unabashedly advertises the virtue of abortion over other options such as adoption or parenthood. This website too presents itself as an “informational” site, but it is even more clearly ideological than the emergency contraception site. For example, the site refers to the unborn child as a “pregnancy” in an attempt to hide the harsh realities of abortion, e.g., “[In a surgical abortion] suction is used to remove the pregnancy from the cervix.” In addition, the main source given for “safe and accurate information” on the option of parenthood is the well-known abortion supporter and provider Planned Parenthood; the only other link for information about parenthood is broken. Other links provided by Trussel’s site include: the Guttmacher Institute, the National Organization for Women, the Feminist Majority Institute, NARAL Pro-Choice America, and Condomania, just to name a few. To be fair, there is one link (out of about 50) to a site that advocates natural family planning. Numerous other instances throughout the Princeton site reveal the intensity of the ideology behind it, which views the unborn child as a “medical condition,” and adults as radically autonomous individuals whose decisions should be dictated by subjective feelings. While Trussell claims that his site and organization are not activist and are not advocating abortion, it is easy to see his pro-choice, NARAL advocacy seeping into his purportedly unbiased and informative opinions on the use of emergency contraception.

To complicate matters further, the National Institute of Health currently funds the Office of Population Research, and, with it, its overtly pro-choice agenda. OPR had received previous funding from a host of foundations, including the Compton Foundation, the Educational Foundation for America, and the John Merck Fund. According to Trussell, however, OPR turned to the NIH in 2009 when funding dried up as the preceding organization, the William and Flora Hewitt Foundation, cut funding due to a change in priorities. Today, the NIH grants OPR $11 million per year. Each branch of the public infrastructure core receives some part of the grant, but Professor Trussell was reluctant to disclose exactly how much of the grant is spent on Emergency Contraception, specifying only the payment of a part-time Webmaster. Nevertheless, regardless of how the money is spent, the simple fact that OPR receives federal funding lends credence to the idea that it should be purposefully maintaining political neutrality.

The Office of Population Research was created first and foremost as a research organization at Princeton University. Yet although research may still be its primary occupation, it sponsors an activist agenda by encouraging women all around the world to use emergency contraception while withholding or obfuscating crucial information about the continuing controversy over the safety of the drugs and their abortifacient potential. Perhaps as despicable, it encourages the use of drugs on a clinically untested segment of the population – underage teenage girls. Although the office denies it, OPR is taking political and social stands on controversial issues, while at the same time receiving federal funding. One wonders: if OPR opposed abortion or advocated sexual abstinence, or if its director were an ardent supporter of the Anscombe Society or the National Right to Life Committee, would the student body and University administration so passively accept its ideological posturing?

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