6. Changing words to change minds

Summary: Chapter 6

Changing words to change minds

I. Introduction

In the minds of its pioneers and in the opinion of the general public, contraception was, by definition, understood to mean the prevention of conception, understood as the prevention of fertilization. In fact, this understanding endured through the middle of the twentieth century. In the terms of social morality and professional ethics at the time, the life of the newly conceived was intangible.

This concept of contraception became severely flawed when modern contraceptives (intrauterine devices and oral hormonal preparations) were introduced. Their appearance aroused the suspicion that part of their effectiveness could be due to an antinidatory effect (that is, the prevention of implantation of a fertilized ovum) that caused the loss of embryos. This revelation could carry extremely serious consequences for population policies, as well as for the efforts of their defenders.

The abortive effect was more obvious in the case of IUDs than in the case of hormonal contraceptives. Once the impact of that effect began to sink in, the promoters had to design measures to encourage their social acceptance. They chose simply to conceal the abortifacient effect in their public efforts. Hence, it was sufficient simply to refrain from investigating the mechanism of action of these contraceptives while quietly altering the vocabulary regarding pregnancy.


II. A brief antecedent of the new terminology: Velpeau and Meigs

a. An intuition of Velpeau

Alfred Velpeau, in 1829, speculated that fertilization and conception should be considered as two different phenomena. For Velpeau, “reproduction” designates the entire function, while “generation” should be reserved exclusively for gametogenesis; “fecundation” would simply express the action that brings together the sperm and the ovum; finally, “conception,” since its etymology signifies “retain,” can reasonably be used only to designate the action that causes the fertilized ovum to be “retained” within the sexual organs; thus “gestation” denotes the further development of the fertilized germ already conceived inside the animal.

b. Meigs: a more firm and radical vision

Velpeau’s ideas were introduced into the Anglo-Saxon world by Charles Meigs. They were based on what we now call the preimplantation loss of embryos. He argues that fertilization is not conception, because a woman can have a fertilized egg in her organs without having conceived it, provided that the fertilized egg is lost when blocked by blood or mucus.

c. Echoes of the Meigs concept

The obstetrics textbooks of the second half of the nineteenth century reflect widespread support of Meigs’s proposal among his colleagues. An overwhelming number of authors maintained that fertilization, impregnation and conception are synonymous and mark the beginning of pregnancy.

In the mid-twentieth century, the promoters of contraception proposed, or, better said, imposed, the notion that conception is equal to implantation.


III. Acclimatization to change: the ‘physiological control of fertility’

The acceptance of the notion that certain procedures that acted after fertilization were contraceptives, and not abortifacients, did not happen in a vacuum. It was aided by the new view of contraception that began with what scientists called “physiological control of fertility.” This approach proposed to study first the physiology of reproduction in the human species, and then draw up a strategic plan where the vulnerable points of the procreative process were identified (e.g., the production and transport of the gametes, the different phases of fertilization, the receptivity of the endometrium). Such studies would then identify the most promising, safe, and efficient procedures, resulting in the maximum ability to control while minimizing any undesirable biological effects.

But the researchers were aware that methods aimed at interfering with implantation ran the risk of not receiving broad social acceptance. That is why, in order to conceal the abortifacient effect of the new contraceptives from the general public, they created a new terminology.


IV. A new terminology for post-fertilization contraception is born

The main objective (regarding ethics, rather than biology) of the new terminology was clear: to convey the belief that contraceptives which destroyed the newly conceived embryo were “ordinary” methods of fertility control. How? The promoters of the new terminology proceeded first to propose, and then impose, a very simple idea: to declare ethically irrelevant the first fourteen days of human embryonic development that begins with fertilization.

The new definitions were first introduced in the field of medicine by the Terminology Committee of the American College of Obstetricians and Gynecologists (ACOG) through its Terminology Bulletin. They were confirmed years later with the publication of the book, Obstetric-Gynecologic Terminology, published by Hughes under the sponsorship of ACOG.


V. The terminological change is imposed authoritatively

Why were the nonscientific reasons motivating the ACOG Terminology Committee’s introduction of its new definitions in 1965 never revealed?

The answer is simple. Here is their new definition: “Conception is the implantation of the fertilized egg.” Here is the justification that the Bulletin offers us of the new definition: “This definition has been deliberately selected because the union of the sperm and the oocyte can not be detected clinically unless nesting takes place.”

What a pathetic alibi!

Despite its evident deficiencies (lack of scientific justification, conflict of moral interests, lack of logic), the new definition triumphed in a spectacular way throughout the world. In a few years, the new definitions, born in the shadow of the ACOG, were adopted by the International Federation of Gynecology and Obstetrics (FIGO) and practically all the national associations of obstetricians and gynecologists; by the World Medical Association and many national medical associations; by the American Medical Association (AMA) and the American Medical Women’s Association (AMWA). It was also assumed by the World Health Organization (WHO / WHO), the Food and Drug Administration (FDA), the National Institutes of Health (NIH) and other agencies of the Government of the United States.

The authoritative nature with which the new terminology was announced and imposed is evidenced by the responses that followers of the new terminology give to those who challenge the new definitions. They assert that the criteria they use follow what is defined by the government and the most important medical organizations in the country, and that they represent the official position of national health and medical organizations. But these are reasons justifying health policy They are clearly inappropriate for medical science.



Author: Gonzalo Herranz, University of Navarra.  Email: gherranz@unav.es

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