The research team behind the Contragestive Time project explore how alternative forms of fertility control can reshape how we think about contraception and abortion.
‘Contragestive Time’ is a five-year multi-stranded research project, funded by a Wellcome Trust Discovery Award. The project seeks to expand the ways we understand reproductive timing and to lay the groundwork for a new approach for those looking to control their fertility. Despite decades of development, contraception has not fulfilled its promise – many struggle to find methods that are accessible, acceptable and effective, and increasingly those wishing to control their fertility in the UK are turning away from hormonal options. Innovation is urgently needed.
‘Contragestives’ are alternative forms of fertility control that, unlike contraceptives, act in the invisible interval between possible fertilisation and the earliest point at which abortion becomes possible. This interval is invisible because, prior to either the resumption of bleeding or a positive pregnancy test, very few – if any – markers indicating pregnancy or its absence can be seen or felt. In the absence of signs that a pregnancy had or had not occurred, contragestives therefore have the potential to ensure that there is no pregnancy. Because of this uncertainty about what may or may not have occurred, contragestives blur the traditional boundaries between contraception and abortion: this ambiguity is both their promise and their risk.
The question of ‘time’ is the fundamental theoretical context of conversations about the difference between abortion and contraception, about what pregnancy is and is not, about who gets to decide and how this changes for different people in different contexts. Thinking about temporality and contragestive time thus helps us to think about fertility control differently. ‘Contragestive Time’ carefully and collaboratively explores how to intervene in this overlooked temporal window. Moving beyond entrenched debates about when ‘life’ begins and the ethics of contraception and abortion, the project examines the historical, cultural, philosophical, and temporal concepts that sustain the distinctions between contraception and abortion, and the ‘clock time’ through which reproduction is usually measured. By creating new ways of understanding reproductive time, it tests legal and regulatory frameworks, generates new clinical knowledge, and considers the implications for policy, rights, and care.
Contragestive uncertainties: a group discussion
There is no one definition of ‘contragestion’ within our project. Instead, one of our main aims is to develop different ways of understanding the concept. The ‘Contragestive Time’ research team come from an array of different disciplines and backgrounds – philosophy, sociology, law, psychoanalysis, anthropology, as well as advocacy and clinical medicine and research. Thinking through the concept of ‘contragestion’ and ‘contragestive time’ across (trans–) and between (inter-) these different disciplines is a central part of the project. We hope that through this process new ways of thinking will emerge. This piece is the first of what will likely be many attempts to think with contragestion.
Over the course of a month, through writing and in conversation, we circled around the question: ‘What is contragestion?’ While this began as an attempt to develop a shared definition, it soon gave way to an acceptance that one fixed definition was not only impossible, but also undesirable. Instead, as we wrote and discussed, the conversation shifted away from an attempt to come up with a shared concrete definition, and towards what it means to be working on an uncertain concept. As it became clear that there was no one definition of contragestion we responded to a new prompt: ‘contragestive uncertainties’. Over a number of discussions – online, in person, and in writing – the conversation grappled with the difficulty of dealing with an undefined object of study, foregrounding this ambiguity. As we did so, different threads of thinking about contragestion emerged.
Contragestion as a historical object
The concept of ‘contragestion’ was first proposed in research in endocrinology and reproductive medicine. While it predates this usage, the term came to prominence in the work of the French biochemist and endocrinologist Étienne-Émile Baulieu in the 1980s. A group of chemists at the French pharmaceutical company Roussell Uclaf synthesised the anti-progesterone RU486 (now commonly known as mifepristone), a compound that Baulieu would later define in many ways, including as ‘an unpregnancy pill’.’ In his work, ‘contragestion’ refers to methods of fertility control that are neither contraception nor abortion. This includes:
all aspects of fertility control interfering with the establishment or continuation of an early pregnancy. It applies as soon as sperm and egg have fused, and it pertains to effects on tubal transport of fertilized ova, blastocyst formation, preparation for nidation [implantation], or disruption of the nidation process itself (Baulieu 1985).
However, in the scientific literature, the meaning of ‘contragestion’ is far from settled (Baulieu 1994; Choucroun 2024; Sheldon and Caruso, n.d.). For example, definitions diverge as to whether contragestion is best understood as overlapping with the categories of contraception and/or abortion or as a distinct category that sits between – and is defined in opposition to – them. Different definitions identify different windows of time – more or less narrow, more or less broad – within which contragestives operate as contragestives. Does the contragestive window end with established implantation? Does it begin pre- or post-ovulation? Are IUDs, which potentially work in this contragestive window, contragestives rather than contraceptives? Does this distinction even make any sense? Despite these uncertainties there is a renewed interest within clinical research into contragestion as a method of fertility control (Cameron et al. 2023). In ‘Contragestive Time’, our exploration stretches to include not only the clinical but also the psycho-social, legal, ethical and philosophical dimensions that shape the meanings of contragestion.
Contragestion as a boundary problem
The need for categorisation comes from cultural and legal boundaries. At times in our project, it may be helpful to use a working notion of contragestion as a method which works up to the moment when a person is eligible for abortion. At present, in UK law, there is an upper gestational limit for legal abortion but no lower one, with access to services turning on a combination of clinical, legal and institutional factors. This idea of ‘eligibility’ for abortion as the end point of contragestive time is likely to turn in part on the question of when a pregnancy begins, and what ‘counts’ as a pregnancy. ‘Contragestive time’, then, might also be understood as the period of time before it is possible to ‘know’ whether or not there is a pregnancy – when a potential pregnancy is not yet measurable, visible, apparent or experienceable and a non-pregnancy is not yet confirmed.
The word ‘gestation’ comes from the Latin, gestatio, meaning ‘a bearing or carrying’, and is related to gerere, to carry or bring forth. The decision to stop carrying (contra-gestion) what you may not be carrying could be thought of as a way of taking care of situations that are undecided, refusing the need to know. But even this throws up many questions. Pregnancy tests can now detect Human Chorionic Gonadotropin (hCG) levels at earlier and earlier points in time, sometimes several days before a missed period. A single positive pregnancy test at this early stage is no guarantee that the pregnancy will progress beyond the very earliest stages of implantation. Crucially, this puts a lot of ethical and legal weight on the detection of a hormone whose rise signals that a biological process (embryo development and implantation) is underway but not that it will necessarily continue. This reveals the dangers of relying on a single pregnancy test, as if it draws a definitive line in what is actually a continuous and uncertain biological process.
Attending to contragestion in this way prompts close investigation of how a specific set of practices, mediated by technologies, operate within particular legal, medical, social and political settings. It also prompts us to consider how questions of governance and control require careful attention to the potential risks of a definition of contragestion that might become rooted in ways that we cannot control. In undoing the distinction between contraception and abortion, what social and political gains in fertility control do we risk losing? Emergency contraception (EC) provides one example. Its legality has depended on establishing it as contraception rather than abortion: oral EC acts before pregnancy is established, principally by preventing or delaying ovulation, and does not terminate an established pregnancy, a distinction that is particularly important in contexts where abortion is politically contested and legally restricted. By establishing that current or future pharmaceutical interventions are effective across multiple reproductive windows after sex, contragestion deliberately unsettles this boundary, raising the possibility that hard-won distinctions protecting access to EC could also be destabilised (Grossman 2025).
Contragestion as a critical or disruptive concept
In our research, the lack of any settled definition of contragestion, far from being a limitation, presents us with an opportunity. For it is not just the definition but the thing itself that cannot be easily pinned down. It is an awkward concept for an awkward thing. Of course, to some extent, all biological processes are uncertain in that the definitions of when they start and finish are unclear (consider birth and death, for example). But it seems to us that contragestion’s uncertainty is particularly consequential because of the way that this uncertainty might be wielded. This means that, beyond its biological definition, contragestion can also be understood as a critical or disruptive concept, as a tool for thinking, not only a thing to be interrogated but a means for interrogating things.
As a means of interrogation then, it is necessary to use the term in different and varied ways across the project, in different contexts, at times narrowing its definition for strategic reasons to define a medical intervention, for instance; at other times expanding it into a more capacious term, able to capture something broader. This could include understanding contragestion as an embodied historical and cultural practice, an assemblage, a material object, an intra-action, a discourse, and so on. At points across the project, there will be moments when these narrow and capacious definitions confront one another. For example, in a feasibility trial for a contragestive intervention that the project has instigated, what happens when a necessarily narrow and measurable definition of contragestion that is necessary for the trial to proceed comes up against our expansive understanding elsewhere in the project? Holding such a contradiction is part of the challenge of ‘Contragestive Time’.
Contragestion is also a temporally critical and disruptive concept. Contragestive time is neither the continuous ‘anticipatory time’ of hormonal contraception, nor the ‘emergency time’ of emergency contraception or abortion. Instead, contragestive time is the deliberate opening of a time of not-knowing and deciding not to know.
Contragestive futures?
For all these reasons contragestion is an idea with the power to disrupt and redefine how we think about fertility control. As a clinical intervention it could offer new options to people who are trying to prevent pregnancy as part of a wider strategy to place control and decisions about reproduction with those most affected by it. This raises the important question of who is seen as having the power, knowledge or experience to legitimately propose a meaning for contragestion and based on what information.
This piece has been written on the basis of the thinking of the Contragestive Time research team, but as we move into the second year of the project we will increasingly learn from different publics, especially those with lived experience of fertility control or its failure. We will solicit a constellation of views, to discover how contragestive time might be conceptualised among people for whom it matters in different ways, depending on how ‘contragestion’ intersects with people’s sociocultural histories and present-day environments and lives. Our approach to contragestion will be shaped by what we learn in this process. Thinking through the meaning of contragestion helps us to ask: what are the ethics of intervention in the gendered body, in reproduction, for people with different histories and positionalities within, against and alongside reproductive governance and control?
About the authors
The Contragestive Time project is a collaboration between Birkbeck, the University of Bristol, University of Sussex, Manchester Metropolitan University, King’s College London, London School of Hygiene & Tropical Medicine, King’s College Hospital NHS Foundation Trust, and the British Pregnancy Advisory Service (BPAS). Wellcome Discovery Award number: 319338/Z/24/Z
We would like to thank Rebecca Jopling and Aoife Knight for their support of the project.
Lisa Baraitser is Professor of Psychosocial Theory at Birkbeck University and the principal investigator of Contragestive Time.
Paula Baraitser is an academic and NHS consultant in sexual health at Kings College Hospital, with specialist training in public health and sexual and reproductive health, she is a co-investigator on Contragestive Time.
Elena Caruso is Senior Research Associate in Law at the University of Bristol and a postdoctoral researcher on Contragestive Time.
Holly Isard is the Engaged Research Fellow for Contragestive Time, based in the department of Psychosocial Studies at Birkbeck University.
Patricia Lohr is Director of Research and Innovation at the British Pregnancy Advisory Service (BPAS) and a co-investigator on Contragestive Time.
Rhiana Mills is a Research Assistant and PhD student in Social and Medical Anthropology at University of Sussex, her PhD is an ethnography of the development of a contragestive technology as part of Contragestive Time.
Sarah Milton is a Senior Research Fellow in the Department of Global Health & Social Medicine, Kings College London and a co-investigator on Contragestive Time.
Clare Murphy is a Senior Research Fellow at Birkbeck and a co-investigator on Contragestive Time.
Stella Sandford is Professor of Philosophy at Manchester Metropolitan University and a co-investigator on Contragestive Time.
Sally Sheldon is Professor of Law at the University of Bristol and a co-investigator on Contragestive Time.
Maya Unnithan is Professor of Social and Medical Anthropology, School of Global Studies at the University of Sussex and a co-investigator on Contragestive Time.
Edited by: Holly Isard and Stella Sandford
References
Baulieu, Etienne-Emile. 1994. ‘RU486: A Compound That Gets Itself Talked About’. Human Reproduction (Oxford, England) 9 Suppl 1 (June): 1–6. https://doi.org/10.1093/humrep/9.suppl_1.1.
Baulieu, Etienne-Emile. 1985. ‘RU 486: An Antiprogestin Steroid with Contragestive Activity in Women’. In The Antiprogestin Steroid RU 486 and Human Fertility Control, edited by Etienne-Emile Baulieu and Sheldon J. Segal. Springer US.https://doi.org/10.1007/978-1-4684-1242-0_1.
Cameron, Sharon, Hang Wun Raymond Li, and Kristina Gemzell-Danielsson. 2023. ‘Is Contragestion the Future?’ BMJ Sexual & Reproductive Health 49 (3): 145–47. https://doi.org/10.1136/bmjsrh-2022-201758.
Choucroun, Danielle. 2024. ‘Contragestion: Build Back Better’. EGO European Gynecology and Obstetrics, 045–047. https://doi.org/10.53260/EGO.2460111.
Grossman, Daniel. 2025. ‘New Data on Ulipristal Acetate and Misoprostol for Medication Abortion — A Step Forward?’ NEJM Evidence 4 (2). https://doi.org/10.1056/EVIDe2400460.
Sheldon, Sally, and Elena Caruso. n.d. ‘Minding the Gap: Contragestive Futures and Regulatory Barriers’. Unpublished Manuscript.
