Tuesday, October 27, 2009

Does the birth control pill cause abortions? "PART 1"

by Randy Alcorn

Introduction: What's at stake?

The Pill is the popular term for more than forty different commercially available oral contraceptives. In the medical field, they are commonly referred to as BCPs (Birth Control Pills), OCs (Oral Contraceptives) and/ or OCPs (Oral Contraceptive Pills).

The Pill is used in America by about fourteen million women each year. Across the globe it is used by hundreds of millions. The question of whether it causes abortions has direct bearing on untold millions of Christians, many of them pro-life, who use it and recommend it. For those who believe that God is the creator of each person and that He is the giver and taker of human life, this is a question with the most profound moral implications. A great deal is at stake here not simply for society, but for the church of Jesus Christ.

After coming to grips with the importance of this issue, and hearing conflicting opinions for the last few years, I determined to thoroughly research this question and communicate my findings, no matter what they might be.

I wanted, and still want, the answer to this question to be "No." I came to this issue as a skeptic. Though I heard people here and there make an occasional claim that the Pill caused abortions, I learned long ago not to trust everything said by sincere Christians, who are sometimes long on zeal but short on careful research.

While I'm certainly fallible, I have taken pains to be as certain as possible that the information I am presenting here is accurate. I've examined medical journals and other scientifically oriented sources -- everything from popular medical reference books to highly technical professional periodicals. I've checked and double checked, submitted this research to physicians, and asked clarifying questions of pharmacists and other experts. Few of my citations are from pro-life advocates. Most are physicians, scientists, researchers, Pill-manufacturers and other secular sources. I am not a physician, but I am an experienced researcher. I have sought to put the most stock in sources that appear to be the most scientifically credible. (If I were conducting medical studies, obviously my not being a physician would disqualify me_but I am not doing medical studies, I am simply reading, collecting, and organizing them for this presentation.)

Because I want readers to be able to do what I did -- hunt down every original source you can and see it for yourself -- I have included full documentation and reference information directly in the text. I realize this may not feel "reader friendly" to some, but it will keep the reader from constantly having to turn to an endnotes section to see what source is being cited. (I have sometimes put in boldface type certain quoted phrases I wish to emphasize -- these are not boldfaced in the originals.)

Before going further, let me affirm a truth that is a foundational premise of all I am about to address: each human being is created by God at the point of conception. This is the clear teaching of the Bible and is confirmed by the scientific evidence. If you are not completely convinced of this, please stop now and read the first two appendices. They both answer the question, "When Does Human Life Begin?" Appendix A gives the answer of Scripture and Appendix B the answer of science. You may also wish to read the other appendices to bring a biblical perspective to the importance of the issue dealt with in this booklet.

(Because there is so much at stake, and because there is a great spiritual battle surrounding this issue, I ask the reader to pause and pray, asking God to give you his mind and heart concerning what we are about to deal with.)

Background: "Contraceptives" that aren't contraceptives

Contraceptives are chemicals or devices that prevent conception. A birth control method that kills an already conceived person is not a contraceptive, it is an abortifacient.

The problem of "contraceptives" that are really abortifacients is not a new one. Pro-life Christians have long opposed the use of Intra-Uterine Devices (IUDs), because they do not prevent conception, but keep the already conceived child from implanting in his mother's womb. (A recent study challenges this understanding, but many prior ones support it.) Likewise, we oppose RU-486, the anti-progesterone abortion pill. RU-486 is a human pesticide, causing a mother's womb to become hostile to her own child, resulting in an induced miscarriage.

Depo-Provera is an anti-progesterone injected every three months. It sometimes suppresses ovulation, but also thins the lining of the uterus, preventing implantation. Norplant is another anti-progesterone drug enclosed in five or six flexible closed capsules or rods, which are surgically implanted beneath the skin. It often suppresses ovulation, but sometimes ovulation occurs, and when it does an irritation to the uterine wall often prevents implantation.

The Emergency Contraceptive Pill (ECP) also known as the "Morning After Pill" does not prevent pregnancy, but keeps a fertilized egg from implanting in the uterus.

All of these birth control methods either sometimes or often alter the mother's womb in a way that causes it to reject the human life which God designed it to nourish and sustain. Christians properly reject these methods because they know that human life begins at conception, six days before implantation begins. Therefore, anything that interferes with implantation kills a person created in the image of God.

These birth control methods are often referred to as "contraceptives," but they are not exclusively contraceptives. That is, they do not always prevent conception, but sometimes or often result in the death of already conceived human beings.

(The term "fertilized egg" is itself unfortunate and dehumanizing -- the truth is that both egg and sperm are in no sense human beings, but simply products of two human beings. At the point of fertilization someone brand new comes into existence, with twenty-three chromosomes from the egg and twenty-three from the sperm combining into a never-before-existing and unique human being. As the sperm no longer exists, neither in essence does the egg, for it is replaced by a new creation with a unique DNA, rapidly growing and dividing on its own. This new human being is no more a mere "fertilized egg" than it is a "modified sperm." He or she is a newly created person, with not only gender but the equivalent of hundreds of volumes of distinct genetic programming.)

The Mini (progestin-only) Pill

Progestin-only pills (which have no estrogen) are often called "minipills." (Many people confuse them with the more popular combination estrogen-progestin pills, which are the true "Birth Control Pill."

Drug Facts & Comparisons is a standard reference book for physicians. In the 1996 edition (page 419), it says this under "Oral Contraceptives":

Oral contraceptives (OCs) include estrogen-progestin combos and progestin-only products. Progestin-only [pills] . . . alter the cervical mucus, exert a progestational effect on the endometrium, apparently producing cellular changes that render the endometrium hostile to implantation by a fertilized ovum (egg) and, in some patients, suppress ovulation.

Note that progestin-only pills have as a primary effect to make the uterine lining (endometrium) "hostile to implantation by a fertilized ovum." In other words, they cause an abortion of a human being roughly a week after his or her conception.

I have been told that many users of the minipill erroneously think their ovulations are being suppressed. In his book Gynecology: Principles & Practices (YearBook Medical Publishers, 3rd edition, 1979, page 735), R.W. Kistner says, "Certainly the majority of women using the progestin-only pill continue to ovulate."

In his book Hormonal Contraception: Pills, Injections & Implants, Dr. Joseph W. Goldzieher, states, "Endometrial resistance to implantation is an important mechanism of the minipill." (Essential Medical Information Systems, PO Box 811247, Dallas, Texas, page 35).

A 1981 Searle leaflet, packaged with their progestin-only pill, says that product "makes the womb less receptive to any fertilized egg that reaches it."

The Physician's Desk Reference, 1996 edition (page 1872) describes "Progesten-Only Oral contraceptives" by saying they "are known to alter the cervical mucus and exert a progestational effect on the endometrium, interfering with implantation."

Clearly the progestin-only pill, by its effects on the endometrium, causes abortions and must be added to the list of abortive birth control methods. Like all the aforementioned products, the changes the mini-pill creates in the mother's endometrium make the womb hostile to the newly conceived child, rather than hospitable to him, as God designed the mother's womb to be.

But what about the far more widely-used Birth Control Pill, with combined estrogen and progestin? Is it exclusively a contraceptive? That is, does it always prevent conception? Or does it, like these other products, sometimes result in abortions? That is the central question of this booklet.

The birth control pill: My own vested interests

To make the issue more personal, I'll share my own experience. In 1991, while researching my book Pro-life Answers to ProChoice Arguments, I heard someone suggest that birth control pills can cause abortions. This was brand new to me -- in all my years as a pastor and a pro-lifer, I had never heard it before.

My vested interests were strong in that Nanci and I used the Pill in the early years of our marriage, as did many of our pro-life friends. Why not? We believed it simply prevented conception. We never suspected it had any potential for abortion. No one told us this was even a possibility. I confess I never read the fine print of the Pill's package insert, nor am I sure I would have understood it even if I had.

In fourteen years as a pastor, doing considerable premarital counseling, I always warned couples against the IUD because it causes abortions. I typically recommended young couples use the Pill because of its relative ease and effectiveness.

At the time I was researching Pro-life Answers, I found only one person who could point me toward any documentation that connected the Pill and abortion. She indicated just one primary source that supported this belief and I only came up with one other. Still, these two sources were sufficient to compel me to include this warning in my book:

Some forms of contraception, specifically the intrauterine device (IUD), Norplant, and certain low-dose oral contraceptives, often do not prevent conception but prevent implantation of an already fertilized ovum. The result is an early abortion, the killing of an already conceived individual. Tragically, many women are not told this by their physicians, and therefore do not make an informed choice about which contraceptive to use. . . . Among pro-lifers there is honest debate about contraceptive use and the degree to which people should strive to control the size of their families. But on the matter of controlling family size by killing a family member, we all ought to agree. Solutions based on killing people are not viable. (Pro-life Answers to ProChoice Arguments, Multnomah Press, 1992, 1994, page 118).
In reference to the abortive potential of low-dose oral contraceptives, in my book I footnoted two articles, one "Investigational Contraceptives," in the May 1987 Drug Newsletter, page 34; the other the January 1990 "Contraceptive Technology Update," page 5.

At the time, however, I incorrectly believed that "low dose" birth control pills were the exception, not the rule, and that most people who took the Pill were in no danger of having abortions. What I've found in my recent research is that since 1988 virtually all oral contraceptives used in America are low-dose, that is, they contain much lower levels of estrogen than the earlier birth control pills. Danforth's Obstetrics and Gynecology (Philadelphia: J.B. Lippincott Co., 1994, 7th edition, page 626) says this:

The use of estrogen-containing formulations with less than 50 micrograms of estrogen steadily increased to 75% of all prescriptions in the United States in 1987. In the same year, only 3% of the prescriptions were for formulations that contained more than 50 micrograms of estrogen. Because these higher-dose estrogen formulations have a greater incidence of adverse effects without greater efficacy, they are no longer marketed in the United States.

After the Pill had been on the market fifteen years, many serious negative side effects of estrogen had been clearly proven (Nine Van der Vange, "Ovarian activity during low dose oral contraceptives," published in Contemporary Obstetrics and Gynecology, edited by G. Chamberlain; London: Butterworths, 1988, page 315-16). These included blurred vision, nausea, cramping, irregular menstrual bleeding, headaches and increased incidence of breast cancer, strokes and heart attacks, some of which led to fatalities.

Beginning in the mid-seventies, manufacturers of the Pill steadily decreased the content of estrogen and progestin in their products. The average dosage of estrogen in the Pill declined from 150 micrograms in 1960 to 35 micrograms in 1988. These facts are directly stated in an advertisement by the Association of Reproductive Health Professionals and Ortho Pharmaceutical Corporation in Hippocrates magazine, May/June 1988, page 35.

Likewise, Pharmacists for Life confirms:

As of October 1988, the newer lower dosage birth control pills are the only type available in the U.S., by mutual agreement of the Food and Drug Administration and the three major Pill manufacturers: Ortho, Searle and Syntex. (Oral Contraceptives and IUDs: Birth Control or Abortifacients?, November 1989, page 1.)

What is now considered a "high dose" of estrogen is 50 micrograms, which is in fact a very low dose in comparison to the 150 micrograms once standard for the Pill. The "low dose" pills of today are mostly 20-35 micrograms. As far as I can tell (from looking them up individually in medical reference books), there are no birth control pills available today that have more than 50 micrograms of estrogen. If there are any, they are certainly rare.

Not only was I wrong in thinking low dose contraceptives were the exception rather than the rule, I didn't realize there was considerable documented medical information linking birth control pills and abortion. Still more has surfaced in the years since.

I say all this to emphasize I came to this research with no prejudice against the Pill. In fact, I came with a prejudice toward it. I certainly don't want to believe I may have jeopardized the lives of my own newly conceived children, nor that I was wrong in recommending it to all those couples I counseled as a pastor. It would take compelling evidence for me to change my position, but I resolved to pursue this research with an open mind, sincerely seeking the truth and hoping to find out the Pill does not really cause abortions. As we will now directly examine the evidence, I urge you to ask the Lord to give you an a truth-seeking mind and an open heart.

The Physician's Desk Reference

The Physician's Desk Reference is the most frequently used reference book by physicians in America. The PDR, as it's often called, lists and explains the effects, benefits and risks of every medical product that can be legally prescribed. The Food and Drug Administration requires that each manufacturer provide accurate information on its products, based on scientific research and laboratory tests. This information is included in The PDR.

As you read the following information, keep in mind that implantation, by definition, always involves an already conceived human being, and therefore any agent which serves to prevent implantation thereby functions as an abortifacient.

This is the PDR's product information as listed by Ortho, one of the two largest manufacturers of the Pill, under Ortho-Cept:

Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus, which increase the difficulty of sperm entry into the uterus, and changes in the endometrium which reduce the likelihood of implantation. (The PDR, 1995, page 1775).

The FDA-required research information on the birth control pills Ortho-Cyclen and Ortho Tri-Cyclen also state that they cause "changes in . . . the endometrium (which reduce the likelihood of implantation)." (The PDR, 1995, page 1782).

Notice that these changes in the endometrium, and their reduction in the likelihood of implantation, are not stated by the manufacturer as speculative or theoretical effects, but as actual ones. (The importance of this distinction will surface later.)

Similarly, Syntex, another major Pill manufacturer, says this in Physician's Desk Reference (1995, page 2461) under the "Clinical Pharmacology" of the six pills it produces (two types of Brevicon and four of Norinyl):

Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus), and the endometrium (which may reduce the likelihood of implantation).

Wyeth, on page 2685 of The PDR, 1995, says something very similar of its combination Pills, including Lo/Ovral and Ovral: "other alterations include changes in the cervical mucus . . . and changes in the endometrium which reduce the likelihood of implantation." Wyeth makes virtually identical statements about its birth control pills Nordette (The PDR, 1995, page 2693) and Triphasil (page 2743).

A young couple showed me their pill, Desogen, a product of Organon. I looked it up in The PDR (1995, page 1744). It states one effect of the pill is to create "changes in the endometrium which reduce the likelihood of implantation."

The inserts packaged with birth control pills are condensed versions of longer research papers detailing the Pill's effects, mechanisms and risks. Near the end, the insert typically says something like the following, which I am quoting directly from the Desogen pill insert:

If you want more information about birth control pills, ask your doctor, clinic or pharmacist. They have a more technical leaflet called the Professional Labeling, which you may wish to read. The Professional Labeling is also published in a book entitled Physician's Desk Reference, available in many bookstores and public libraries.

Of the half dozen birth control pill package inserts I've read, only one included the information about the Pill's abortive mechanism (a package insert dated July 12, 1994, found in the oral contraceptive Demulen, manufactured by Searle). Yet this abortive mechanism was referred to in all cases in the manufacturer's Professional Labeling, as documented in The Physician's Desk Reference. (Again, the full disclosure in the Professional Labeling is required by the FDA.)

If all this is repetitive, it establishes that according to multiple references throughout Physician's Desk Reference, which articulate the research findings of a variety of birth control pill manufacturers, there are not one but three mechanisms of birth control pills: 1) inhibiting ovulation (the primary mechanism), 2) thickening the cervical mucus, thereby making it more difficult for sperm to travel to the egg, and 3) thinning and shriveling the lining (endometrium) of the uterus to the point that it is unable to facilitate the implantation of the newly fertilized egg. While the first two mechanisms are contraceptive, the third is abortive.

When a woman taking the Pill discovers she is pregnant (according to The Physician's Desk References efficacy rate tables, listed under every contraceptive, this is 3% of pill-takers each year), it means that all three of these mechanisms have failed. Clearly then, this third mechanism sometimes fails in its role as backup, just as the first and second mechanisms sometimes fail. Each and every time the third mechanism succeeds, however, it causes an abortion.

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