Friday, October 30, 2009

Does the birth control pill cause abortions? "PART 4"

Still more evidence

Three Physicians

Dr. Paul Hayes, a pro-life Ob/Gyn in Lincoln, Nebraska, pointed me to Leon Speroff's and Philip Darney's authoritative text A Clinical Guide for Contraception (Williams & Wilkins, 1992). Dr. Hayes calls Dr. Speroff, of the Oregon Health Sciences University in Portland, "the nation's premier contraceptive expert and advocate." Speroff's text, written for physicians, says this on page 40:

Since the effect of a progestational agent will always take precedence over estrogen (unless the dose of estrogen is increased many, many fold), the endometrium, cervical mucus, and perhaps tubal function reflect progestational stimulation. The progestin in the combination pill produces an endometrium which is not receptive to ovum implantation, a decidualized bed with exhausted and atrophied glands. The cervical mucus becomes thick and impervious to sperm transport. It is possible that progestational influences on secretion and peristalsis within the Fallopian tube provide additional contraceptive effects.

As a leading scientific expert on the Pill, Dr. Speroff must be taken seriously when he states that the Pill creates "an endometrium which is not receptive to ovum implantation." This means that the Pill does in fact cause abortions.

In an e-mail to me dated February 22, 1997, Dr. Hayes pointed out a semantic aspect of Dr. Speroff's statement which I, as a nonphysician, wouldn't have noticed:

I was struck dumb when I read this, at the fact that Dr. Speroff would expect me, as a doctor, to accept the 'implantation' of an 'ovum.' Call it a fertilized ovum, or a blastocyst, or a zygote, or any one of a number of other dehumanizing names for a baby, but don't warrant to me, in a textbook for doctors, that what implants is just an ovum!

Dr. Hayes's point is that "ovum" used without a qualifier always means unfertilized ovum, and that Dr. Speroff is misusing the term consciously or unconsciously to minimize the taking of human life inherently involved in the preventing of implantation. This type of semantic manipulation is common in later stages, as demonstrated by references to "terminating a pregnancy" instead of "taking a child's life." It is further illustrated in the fact that Dr. Speroff includes as a form of "contraception" the destruction of an already conceived person.

In an interview conducted by Denny Hartford, director of Vital Signs Ministries, Pharmacist Larry Frieders, who is also Vice-president of Pharmacists for Life, said this:

Obviously, the one "back-up mechanism" [of the Pill] that we're most concerned with is the one that changes the woman's body in such a way that if there is a new life, that tiny human loses the ability to implant and then grow and be nourished by the mother. The facts are clear -- we've all known them intellectually. I learned them in school. I had to answer those questions on my state board pharmacy exam. The problem was getting that knowledge from my intellect down to where it became part of who I am. I had to accept the fact that I was participating in the sale and distribution of a product that was, in fact, causing the loss of life. ("The New Abortionists," Life Advocate, March 1994, page 26)

Later in the same interview, Hartford asked world famous fertility specialist Dr. Thomas Hilgers, "Are there any birth control pills out there that do not have this potential to abort a developing child?" Dr. Hilgers answered,

There are none! At my last count in looking at the Physicians Desk Reference . . . there were 44 different types of birth control pills. . . . and they have different concentrations of chemicals that make them work. None of these so-called birth control pills have a mechanism which is completely contraceptive. Put the other way around, all birth control pills available have a mechanism which disturbs or disintegrates the lining of the uterus to the extent that the possibility of abortion exists when break-through ovulation occurs. (Life Advocate, March 1994, page 28-29)

Three more risks of the Pill to preborn children

In My Body, My Health (Stewart, Guess, Stewart, Hatcher; Clinician's Edition, Wiley Medical Publications, 1979, page 169-70), the authors point to still another abortive potential of the Pill:

Estrogen and progestin may also alter the pattern of muscle contractions in the tubes and uterus. This may interfere with implantation by speeding up the fertilized egg's travel time so that it reaches the uterus before it is mature enough to implant.

In its 1984 publication "Facts About Oral Contraceptives," the U.S. Department of Health and Human Services stated,

Though rare, it is possible for women using combined pills (synthetic estrogen and progestogen) to ovulate. Then other mechanisms work to prevent pregnancy. Both kinds of pills make the cervical mucus thick and 'inhospitable' to sperm, discouraging any entry to the uterus. In addition, they make it difficult for a fertilized egg to implant, by causing changes in Fallopian tube contractions and in the uterine lining.

As noted by the previous source, these changes in Fallopian tube contractions can speed up the fertilized egg's travel time, and bring it to the endometrium when it is too immature to implant. This is another abortive possibility distinct from and in addition to the endometrium's inhospitality to the blastocyst.

But that's not all. There's yet another threat posed to a young child by the Pill. It was pointed out to me by a couple from my church who stopped using their pills after reading the package insert. I have in front of me that insert. It concerns Desogen, a combination birth control Pill produced by Organon. Near the end of the two page paper it has a heading called "Pregnancy Due to Pill Failure," under which it states:

The incidence of pill failure resulting in pregnancy is approximately one percent (i.e., one pregnancy per 100 women per year) if taken every day as directed, but more typical failure rates are about 3%. If failure does occur, the risk to the fetus is minimal.

Exactly what is this risk to the fetus? When I asked Dr. Bill Toffler of the Oregon Health Sciences University, he informed me that the hormones in the Pill, progestin and estrogen, can (though often they don't) have a harmful effect on an already implanted child. The problem is, since women do not know they are pregnant in the earliest stages, before realizing they are pregnant they will continue to take the Pill at least one more time, if not two or more (especially if cycles are irregular). This creates the risk the leaflet refers to. So not only is the pre-implanted child at risk, but so is an already implanted child who is subjected to the Pill's hormones.

The risk is called "minimal." But what does this mean? If someone was about to give your child a chemical and they assured you there was a "minimal risk," would you allow them to proceed without investigating to find out exactly what was meant by "minimal"? Wuldn't you ask whether there was some alternative treatment without this risk? Rather than be reassured by the term "minimal," a parent might respond, "I didn't know that by taking the Pill I caused any risk to a baby -- so when you tell me the risk is 'minimal' you don't reassure me, you alarm me."

So, in addition to the risk of abortion due to an atrophied endometrium, we must add the risk of the Pill causing Fallopian tube contractions that throw off the crucial timing of the blastocyst's arrival at the endometrium, as well as the chemical risk to an already implanted child.

If that isn't enough, there's still another risk, this one to children conceived after a woman stops taking the Pill:

There is some indication that there may be a prolonged effect of the oral contraceptives on both the endometrium and the cervix after a woman has ceased taking the pill. There may well be a greater likelihood of miscarriage in that period also as a result of some chromosomal abnormalities. . . . It is worth noting that the consumer advice from the manufacturers cautions that pregnancy should be avoided in the first three months after ceasing the combined oral contraceptive. (Nicholas Tonti-Rilippini, "The Pill: Aortifacient or Contraceptive? A Literature Review," Linacre Quarterly, February 1995, page 8-9)

Why should pregnancy be avoided three months after no longer using the Pill? Is it because the Pill produces effects that threaten the life and welfare of a child? If those effects are not considered no longer a risk until three months after the Pill was last taken, what does this say about the risk they pose to any child conceived when the Pill fails to stop ovulation?

The new Morning After Pill: Standard BC pills

In June, 1996 the Food and Drug Administration announced a new use for standard combination birth control pills:

Two high doses taken within two to three days of intercourse can prevent pregnancy, the FDA scientists said. Doctors think the pills probably work by preventing a fertilized egg from implanting in the lining of the uterus. ("FDA panel: Birth control pills safe as morning after drug," The Virginian-Pilot, June 29, 1996, A1, A6.)

On February 24, 1997, the FDA approved the use of high doses of combination birth-control pills as "emergency contraception" (Peter Modica, "FDA Nod to `Morning-After' Pill Is Lauded," Medical Tribune News Service, February 26, 1997). The article explains,

The morning-after pill refers to a regimen of standard birth control pills taken within 72 hours of unprotected sex to prevent an unwanted pregnancy. The pills prevent pregnancy by inhibiting a fertilized egg from implanting itself in the uterus and developing into a fetus.

Of course, the pills do not "prevent pregnancy" since pregnancy begins at conception, not implantation. (Acting as if pregnancy begins at implantation takes the emphasis off the baby's objective existence and puts it on the mother's endometrium's role in sustaining the child that has already been created within her.) As World magazine (March 8, 1997, page 9) points out, "In reality the pill regimen -- designed to block a fertilized egg from implanting into the uterus -- aborts a pregnancy that's already begun."

It is significant that this "morning after pill" is in fact nothing but a combination of several standard birth control pills taken in high dosages. When the announcement was made, the uninformed public probably assumed that the high dosage makes birth control pills do something they were otherwise incapable of doing. But the truth is it simply increases the chances of doing what it already sometimes does -- cause an abortion.

In a April 29, 1997 USA Today cover story (page 1A), "Docs spread word: Pill works on morning after," Marilyn Elias wrote,

U.S. gynecologists are launching a major nationwide campaign to make sure women know about the best-kept morning-after contraceptive secret: common birth control pills. . . . Some oral contraceptives may be taken after intercourse -- two in the first dose up to 72 hours after sex, then two more 12 hours later -- and will prevent 75% of pregnancies . . . Critics call the morning-after method de facto abortion, but Zinberg says the pills work before an embryo implants in the uterus so there's no abortion.

Again, the truth is these pregnancies aren't prevented, they are terminated. It's semantic gymnastics to redefine abortion in such a way that killing the fertilized egg doesn't qualify. Life does not begin at implantation, it begins at conception. To suggest that a fertilized egg is not a living person just because she has not yet settled into her home (the endometrium), and therefore it's fine to make her home hostile to her life, is as fallacious as suggesting the homeless are not really people since they aren't living in a house, and it's therefore all right to burn down homes they might otherwise have inhabited and leave them out in the cold to die.

After all is said and done, the Pill appears to be different only in degree, but not in kind from every other birth control chemical, including RU-486, Depo-Provera, Norplant, the mini-pill and the morning after pill. It may not cause as many abortions as these, but like all of them, it does in fact cause abortions.

Evidence to the contrary?

Is there any evidence refuting the abortive potential of the Pill? I have not only searched far and wide to find such evidence myself, I have also asked a number of physicians to provide me with any they have or know of. Beyond the letter from Dr. Struthers at Searle, dealt with previously, I have seen very little of such evidence.

One source is "Advances in Oral Contraception" in The Journal of Reproductive Medicine (January 1983, page 100 ff.). The article is a question and answer session with eight physicians. The pro-life physician who gave this to her pastor underlined several statements that in her mind do not support the evidence that the Pill causes abortions. This is one of them:

Do the OCs with 30 micrograms of estrogen act primarily by preventing implantation rather than suppressing ovulation?

Dr. Christie: "Our studies in Europe and Canada showed that the 150/30 pill's main mode of action is inhibition of ovulation." (page 101)

This statement is not in conflict with the evidence I've presented. No one disputes whether the inhibition of ovulation is the Pill's main mode of action, only whether preventing implantation is a secondary or tertiary mode. A more significant segment of the same article is this one:

Are factors besides anovulation affected by the contraceptive action of the Pill?

Dr. Christie: Yes -- cervical mucus, maybe nidation, the endometrium, so it's not in the appropriate condition for receiving a fertilized ovum. The authorities agree that with the LH and FSH changes, no ovulation occurs; the egg isn't there to be fertilized.

Dr. Goldzieher: Some time ago Pincus found, when studying Enovid 5 and 10, that conceptions occurred with these pills. To me his evidence indicates that there must not be much of an antiimplantation effect on the endometrium if a woman can skip a very-high-dose OC for a few days and become pregnant. If there is an antiimplantation effect, it certainly is absent in some cases.

These statements are significant, but do they only qualify the mountain of other evidence, they do not refute it. Dr. Christie acknowledges the anti-implantational effect of the Pill, but says that with the proper chemical changes no ovulation occurs. He is surely not claiming that these chemical changes always happen in the intended way, nor is he denying that ovulations occur among Pill-takers. He is well aware that pregnancies occur (as Dr. Goldzieher confirms in the very next sentence), and for every measurable pregnancy there are obviously a number of breakthrough ovulations.

Dr. Goldzieher, whose own work, cited elsewhere in this booklet, acknowledges the antiimplantation effect, is affirming that "it certainly is absent in some cases." He bases this on the fact that pregnancies do occur. This is akin to Dr. Struthers' point that the blastocyst sometimes implants in 'hostile' sites such as the Fallopian tubes and the ovaries, and also in the Pill-affected endometrium. The point, a valid one, is that the conceived child sometimes implants in more hostile environments. But this is no way undermines the obvious fact that he will more often implant in a more favorable environment.

Once again, no one is claiming that the Pill's diminishing of the endometrium always makes implantation impossible. Obviously it doesn't. The issue is whether it sometimes does. That plants can and do grow through cracks in driveways does not negate the fact that they will more likely grow in the tilled fertile soil of the garden. The Pill's changing the endometrium from fertile to inhospitable does not always result in an abortion, but sometimes it does. (And "sometimes" is all it takes to be an abortifacient.)

I have before me an article, a four page letter from a pro-life physician, assuring the recipient that the Pill, Norplant and Depo-Provera are not abortifacients, while RU486, the "morning after pill" and the "minipill" are. She is not certain about the IUD. The letter is well written, but it is missing a crucial element -- it does not cite a single study or produce any evidence whatsoever to back up any of its claims. (The sole reference is to a textbook that may somewhere within it -- no page numbers indicated -- offer evidence that the IUD does not really cause abortions.) In the absence of any such evidence, I am forced to conclude that this letter is simply a sincere expression of the physician's personal beliefs about birth control methods. Unfortunately, beliefs do not constitute evidence.

I was also sent a photocopied page from an article, but unfortunately the name and date of the publication isn't included and I have no way to trace it. The article is an excerpt from a speech by a pro-life physician named Dr. Mastroianni:

"It's also important," Dr. Mastroianni added, "when talking about oral contraception, to dispel any idea that the pill acts as an abortifacient. Propaganda has led some people to believe that somehow the pill works after fertilization, and that's further from the truth than anything I can think of. The pill works by inhibiting ovulation, as well as by thickening the cervical mucus and therefore inhibiting sperm migration."

This confident claim is made wihtout the offer of any evidence to support it. (Leveling the accusation of "propaganda" is not the same as presenting evidence, or refuting it.)

When the scientific and medical sources, including not just reference books but original studies reported in medical journals over decades, consistently affirm there is a third effect of the Pill that does in fact work after fertilization, how can a physician state this to be "further from the truth than anything I can think of"? When these sources consistently and repeatedly conclude there are at least three ways the Pill works (one of which is clearly abortive), how can someone definitively say there are really only two?

I do not consider this quotation from a well-meaning pro-life physician as evidence of anything but the human tendency (which I confess to as well) to deny something we do not wish to believe. (If a reader knows Dr. Mastroianni, and he does have evidence for his beliefs not cited in his presentation or this article, I would very much like to see it.)
When I submitted to him a half dozen of the sources I've cited in this booklet, a pro-life physician I very much respect wrote this to me:

It is known fact that 6% of women on bcps will become pregnant while on the pill, meaning that cervical mucous failed, ovulation occurred, and implantation was successful. This implies that when bcps don't work, it is because they totally fail, and that when mechanisms 1 and 2 don't work, implantation is not prevented by the bcps causing an early abortion. If I believed bcps worked by causing abortion, I wouldn't recommend them. I firmly believe that when they work, they work by preventing ovulation and by creation of thick cervical mucous.

I do not question this physician's sincerity, but I do question the logic. We do not know how often mechanism number one, two or three actually work, we only know that sometimes all three fail. But because number one and two sometimes fail, no one therefore concludes that they always fail. So why conclude that because number three sometimes fails, therefore it always fails?

How can we look at a known pregnancy, which proves the failure of all three mechanisms, then conclude that number one and number two normally work, but that number three must never work? The logic escapes me. If number three were not abortifacient in nature, I don't think anyone would deny that it happens. The denial is not prompted by the evidence but by the desire that what the evidence indicates not be true.

How often does the Pill cause abortions?

Though it is clear that the Pill does in fact cause abortions, it is difficult to determine the numbers of times it does this. This depends on how often the Pill fails to prevent ovulation, and how often when ovulation succeeds and pregnancy occurs, the third mechanism prevents a fertilized egg from implantation.

I posed the question to Dr. Harry Kraus, a physician and writer of popular novels with medical themes. This was his response in a December 23, 1996 e-mail:

You have asked a very good question, but one which is impossible to answer in concrete statistics: How often do birth control pills prevent pregnancy by causing the lining of the uterus to be inhospitable to implantation? You will not see an answer to that question anywhere, with our present state of the science. The reason is that we can only detect early pregnancy by a hormone, beta-hcg (Human chorionic gonadotropin) which is produced by the embryo after implantation. After fertilization, implantation does not take place for approximately six days. After implantation, it takes another six days before the embryo (trophoblast) has invaded the maternal venous system so that a hormone (beta-hcg) made by the embryo can reach and be measured in the mom's blood. Therefore, the statistic you seek is not available.

Keeping in mind that definitive numbers cannot be determined, there are nonetheless certain medical evidences that provide rationales for some physicians and pharmacists to estimate the numbers of Pill-induced abortions.

Determining the rate of breakthrough ovulation in Pill-takers is one key to coming up with informed estimates.

In his Abortifacient Contraception: The Pharmaceutical Holocaust (Human Life International, 1993, page 7), Dr. Rudolph Ehmann says,

As early as 1967, at a medical conference, the representatives of a major hormone producer admitted that with OCs [oral contraceptives], ovulation with a possibility of fertilization took place in up to seven percent of cases, and that subsequent implantation of the fertilized egg would usually be prevented.

Bogomir M. Kuhar, Doctor of Pharmacy, is the president of Pharmacists for Life. In his booklet Infant Homicides Through Contraceptives (page 26), he cites studies suggesting oral contraceptives have a breakthrough ovulation rate of 2 to 10%. Fertility specialist Dr. Thomas Hilgers estimates the rate at 4 to 10%, adding that minipills allow ovulation 50-60% of the time ("The New Abortionists," Life Advocate, March 1994, page 29).

Dr. Nine van der Vange, at the Society for the Advancement of Contraception's November 26-30, 1984 conference in Jakarta, stated that her studies indicated an ovulation rate of 4.7% for women taking the Pill.

How do these percentages translate into real numbers? The Ortho Corporation's 1991 annual report estimated 13.9 million U.S. women using oral contraceptives. Multiplying this by the low 2% ovulation figure, and factoring in studies showing a 25% overall conception rate for normally fertile couples of average sexual activity, Dr. Kuhar arrives at a figure of 834,000 birth-control-pill-induced abortions per year. Multiplying by the high 10%, the figure is 4,170,000 per year. The low figure is over 50% the number of surgical abortions (1.5 million), the high is 250% that number. (Using other studies, also based on total estimated number of ovulations and U.S. users, Dr. Kuhar attributes 3,825,000 annual abortions to IUDs; 1,200,000 to Depo-Provera; 2,925,000 to Norplant.)

J.C. Espinoza, M.D., says,

Today it is clear that in at least 5% of the cycles of women on the combined Pill "escape ovulation" occurs. This fact means that conception is possible during those cycles, but implantation will be prevented and the "conceptus" (child) will die. That rate is statistically equivalent to one abortion every other year for all women on the Pill. (Birth Control: Why Are They Lying to Women?, page 28.)

In a segment from his Abortion Question and Answers, published online by Ohio Right to Life, Dr. Jack Willke states:

The newer low-estrogen pills allow "breakthrough" ovulation in up to 20% or more of the months used. Such a released ovum is fertilized perhaps 10% of the time. These tiny new lives which result, at our present "guesstimations," in 1% to 2% of the pill months, do not survive. The reason is that at one week of life this tiny new boy or girl cannot implant in the womb lining and dies.

There are factors that can increase the rate of breakthrough ovulation and thereby increase the likelihood of the Pill causing an abortion. Dr. Bogomir Kuhar says,

The abortifacient potential of OCs is further magnified in OC users who concomitantly take certain antibiotics and anticonvulsants which decrease ovulation suppression effectiveness. It should be noted that antibiotic use among OC users is not uncommon, such women being more susceptible to bacterial, yeast and fungal infections secondary to OC use. (Contraceptives can Kill Babies, American Life League, 1994, page 1.)

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