When the first mechanism fails, how often does the second work?
We've seen that various sources put ovulation failure at rates of 7%, 2-10%, 4-10%, 4.7%, 20% and even Dr. Ronald Chez's whopping 50%. Let's take 5-10% as a figure to work with. That would mean in an average woman's cycle, she will have two to four breakthrough ovulations every three years.
The question then becomes, how many times when ovulation occurs does the second mechanism, the thickened cervical mucus, prevent sperm from reaching the egg? It is impossible to know, but studies on animals suggest this mechanism may not be as effective as Pill manufacturers seem to assume.
Drs. MC Chang and DM Hunt did experiments on rabbits what could not be done on human beings ("Effects of various progestins and estrogen on the gamete transport and fertilization in the rabbit," Fertility and Sterility, 1970; 21, p. 683-686.) They gave the rabbits estrogen and progestin to mimic the Pill, then artificially inseminated them. They then killed the rabbits and did microscopic studies to examine how many sperm had reached the fallopian tubes.
The progestin, the hormone that thickens cervical mucus, might be expected to prevent nearly all the sperm from traveling to the tubes. However, it did not. In every rabbit that had taken the progestin, there were still thousands of sperm which reached the fallopian tubes, as many as 72% of the number in the control group. This is noteworthy evidence that the progestin-caused increased thickness of cervical mucus does not necessarily significantly inhibit sperm from reaching the egg, and therefore does not serve as an effective contraceptive.
When ovulation takes place and the thickened mucus fails to prevent conception -- which may well be the majority of the time -- the significantly altered and less hospitable endometrium caused by the Pill comes into play. Given the observably diminished capacity of the endometrium to sustain life, it seems likely that implantation may be the exception rather than the rule. For every child that does implant, many others may not. Of course, we don't know the percentage that will implant in a normal endometrium unaffected by the Pill, but it is reasonable to believe whatever that percentage is, the Pill significantly lowers it.
Approximately fourteen million American women take the Pill each year. At the 3% rate, which is firmly established statistically, in any year there will be 420,000 detected pregnancies of Pill-takers. (I say "detected" pregnancies, since pregnancies that end before implantation will never be detected but are nonetheless real.) Each one of these children has managed to implant even in a hostile endometrium.
The question is, how many children failed to implant in that hostile environment that would have implanted in a nurturing environment unhindered by the Pill? The number who die might be significantly higher than the number who survive. If it was four times as high, that would be 1,680,000 deaths; if twice as high, 840,000 deaths. If the same number of children do not survive the hostile endometrium as do survive, it would be 420,000. If only half as many died as survived, this would be 210,000 -- still a staggering number of Pill-induced abortions each year.
In his brochure "How the Pill and the IUD Work: Gambling with Life" (American Life League, P.O. Box 1350, Stafford, VA 22555), Dr. David Sterns asks:
Just how often does the pill have to rely on this abortive 'backup' mechanism? No one can tell you with certainty. Perhaps it is as seldom as 1 to 2% of the time; but perhaps it is as frequently as 50% of the time. Does it matter? The clear conclusion is that it is impossible for any woman on the pill in any given month to know exactly which mechanism is in effect. In other words, the pill always carries with it the potential to act as an abortifacient.
Though they have been unable to cite studies indicating lower figures than these, physician friends of mine tell me they believe the highest figures I've cited here are too high. I hope they are right. It concerns me, however, that they have not provided empirical evidence that refutes such figures. (If any reader has such evidence, I would greatly appreciate seeing it.)
In any case, even if the numbers are lower, they could still add up to hundreds of thousands of child casualties per year. When pro-lifers routinely state there are 1.5 million abortions per year in America (I have often said this myself), we are leaving out all chemical abortions and are therefore vastly understating the true number. Perhaps we are also immunizing ourselves to the reality that life really does begin at conception and we are morally accountable to act like it.
Let's make it more personal by bringing it down to an individual woman. If a fertile and sexually active woman took the Pill from puberty to menopause, she would have a potential of 390 suppressed ovulations. Eliminating those times when she wouldn't take the Pill because she wanted to have a child, or because she was already pregnant, she might have 330 potentially suppressed ovulations. If 95% of her ovulations were suppressed (it could be considerably less, but not much more), this would mean she would have sixteen breakthrough ovulations.
If she is fertile and sexually active, a few of those ovulations might end up in a known pregnancy because the second and third mechanisms both fail. Of the other fourteen, perhaps nine would never be fertilized (some prevented by the number two mechanism, the thickened cervical mucus). And perhaps, as a result of the number three mechanism, she might have five early abortions because conception took place, but the children could not be implanted in the endometrium.
If the same woman took the Pill for only ten years, she might have one or two abortions instead of five. Again, we don't know the exact figures, and likely never will. Some would say these estimates are too high, but based on my research it appears equally probable they are too low.
There is no way to be certain, but the truth is that a Christian woman taking the Pill might over time have no Pill-induced abortions, or she might have one, three or a dozen of them.
Our beliefs should be governed by the evidence, not by wishful thinking. But since the numbers cannot be decisively determined, based on what you do know, come up with an estimate you think might be in the ballpark. Now, whatever that figure is, ask yourself this question -- is it morally right to unnecessarily risk the lives of those children?
Questions & objections
In the process of research I've had countless conversations with Christians, including physicians, pastors and many others. These are some of the questions and objections people have most often raised.
"If this is true, why haven't I heard it before?"
There are many possible answers to this question. One is that concerns about abortions, especially early ones, are not widespread among researchers, scientists and the medical community in general. Since preventing implantation isn't of concern except to those who believe God creates people at the point of conception, it isn't terribly surprising the experts haven't gotten the word out. In their minds, why should they?
While the evidence for Pill-caused abortions is substantial, it is spread out in so many obscure and technical scientific journals, dozens of them, that relatively few physicians -- much less the general public -- have ever seen the most compelling evidence at all, or if they have, only piecemeal. It has effectively fallen through the cracks and failed to get their attention.
Many well-meaning physicians, including Christians, simply are not aware of this evidence. (I know this, because that's what they've told me.) When patients hear someone suggest the Pill causes abortions, they will often come to their physician, who may be pro-life, and ak if this is true. The physician may sincerely say, "According to my understanding, the Pill just prevents conception, it doesn't cause abortions. You have nothing to be concerned about." Physicians assume that if this were really true, they would surely know it. In most cases they are not deliberately misleading their patients, but unfortunately the bottom line is that their patients are indeed misled. Based on their physician's reassurances, they don't look into the matter further, and because the dedicated physician is so busy, and confident that the Pill only prevents conception, neither does he.
An isolated reference here or there simply isn't sufficient to change or even challenge the deeply-ingrained pro-Pill consensus of medicine, society or the church. If Time magazine -- or even a major Christian periodical -- devoted a cover story to the subject, the information would reach a popular level in a way it never has before.
Even when the information leaks out, so many Christians -- including pastors and parachurch leaders -- have used and recommended the Pill, that we have a natural resistance to raising this issue or looking into it seriously when others raise it. This is likely why so few individuals or organizations have researched or drawn attention to this subject.
Ultimately, the widespread ignorance and blindness on this issue among Christians may be largely attributable to supernatural forces of evil which promote the deaths of the innocent and lie and mislead to cover those deaths. (I address this in the Conclusion.)
We also cannot escape the fact that the Pill is a multi-billion dollar worldwide industry. Its manufacturers, the drug companies, have tremendous vested interests. So too do many physicians prescribing it. (I do not mean by this that most physicians prescribe it primarily for financial gain, but simply that it is a significant part of many practices.)
Those in the best place to disseminate this information are the Pill-manufacturers. The problem, however, is that they gain customers by convincing them the Pill works, not by teaching them exactly how it works. No one takes the Pill because she knows it prevents implantation, but many might stop taking it if they knew it does.
Hence, a pharmaceutical company has nothing to gain by drawing attention to this information, and potentially a great deal to lose. There are many people in America who profess to believe life begins at conception; companies do not want these people to stop using their pills. This concern for good public relations was very evident to me in my conversations with staff at four major Pill manufacturers. It is also demonstrated in the fact that their FDA-monitored disclosures in the fine-print professional labeling, and in Physician's Desk Reference, all mention that the Pill prevents implantation, but this is stated in very few of their package inserts and none of their colorful consumer-oriented booklets.
Dr. James Walker, in his paper "Oral Contraception: A Different Perspective" (Pharmacists for Life, PO Box 1281, Powell, OH, 43065), points out the Pill's potential to cause abortion. He then says,
A large percentage of consumers would undoubtedly refuse to use this form of birth control if they were aware that oral contraceptives worked in this way. Also, a large number of physicians would refrain from using this method of contraception if they were aware of the abortifacient mechanism of oral contraceptives . . . why is the medical (or prescribing) and consumer population so poorly informed? It could be that the pharmaceutical industry is interested in making large profits without regard for the sanctity of human life. Or it could be that the medical community has become so conditioned to supply means for instant gratification, that our eyes have been blinded to the eternal consequences of our daily action.
"If we don't know how often abortions happen, why shouldn't we take the Pill?"
We can be certain that the Pill causes some abortions. But since we are uncertain about the actual numbers of abortions, how should we act on our uncertainty?
If a hunter is uncertain whether a movement in the brush is caused by a deer or a person, should his uncertainty lead him to shoot or not to shoot?
If you're driving at night and you think the dark figure ahead on the road may be a child, but it may just be the shadow of a tree, do you drive into it or do you put on the brakes?
Shouldn't we give the benefit of the doubt to life? Let's say that you are skeptical of all this research, all these studies, and all the Pill manufacturers' claims that the Pill sometimes results in the death of a child. (You might ask yourself if the reason is because of your bias and vested interests, but for the moment let's just say you're genuinely uncertain.) Is it a Christlike attitude to say "Because taking the Pill may or may not kill a child, I will therefore take it"? If we are uncertain, shouldn't that compel us not to take it?
My research has convinced me the evidence is not uncertain, but compelling, in the single most important sense -- the Pill does result in abortions. Only the numbers are uncertain. Can we really say in good conscience, "Because I'm uncertain exactly how many children are killed by the Pill, therefore I will take it"? (How many dead children would it take to be too many?)
It seems to me more Christlike to say, "Because I know there is a widespread understanding of the most informed scientific and medical people (including the research departments of those manufacturing it) that the Pill does sometimes cause abortions, I will therefore not take the Pill and I will encourage others not to."
"But spontaneous abortions happen frequently anyway"
One physician pointed out there are many spontaneous abortions and miscarriages. Because of this, he felt we should not be troubled by pre-implantational abortions caused by the Pill. I've heard the same logic used to defend fertility research and in vitro fertilization in which embryos are conceived outside the womb. Three to six of these may be implanted in a uterus in the hopes one may live, but the majority die, and some are frozen or discarded. (In the best case scenario, two to five die in the attempt to implant one, and often all of them die.)
When, even under optimal conditions, physicians attempt to implant an embryo conceived in-vitro, it is true that there is a low success rate. According to Dr. Leon Speroff, the success rate in any given cycle is 13.5% and since typically three to six embryos may be used to attempt implantation, the actual survival rate is just over 3%. This means that 29 out of 30 embryos die in the attempt to implant a child (Clinical Gynecologic Endocrinology and Infertility; Williams and Wilkins, fifth edition, 1994, page 937-39). This confirms that in the natural process of a woman's cycle there are likely many early miscarriages, perhaps considerably more than there are live births.
Since this is true, however, does it therefore follow, "Because God or nature causes millions of early abortions a year, it's okay if we cause some?"
The proper response to this is that there is a big difference, a cosmic difference, between God and us! What God is free to do and what we are free to do are not the same. God is the giver and taker of life. God is the potter, we are the clay (Isaiah 45:9-11). He has the right to take human life, we do not. Nature is under the curse of sin and as a result there is widespread death in this world, both inside and outside the womb (Romans 8:19-22). God is the Superintendent of nature and can overrule it when he so chooses. But none of this permits us to say "because God lets so many people die, I'll go ahead and kill some of them myself!"
It is one thing for God to take a human life. It is an entirely different thing for us to do so. His prerogatives are unique to Him. He is the Creator, we are the creatures. (See Appendix D: God is Creator and Owner of all people.) The same principle applies when someone says that since a baby will probably die within a few days or weeks of his birth, we may as well abort him now. The difference is between losing a child to death (by God's sovereign choice) and choosing to kill that child. This is a fundamental and radical difference. (See Appendix E: God has exclusive prerogatives over human life and death.)
To justify using a chemical that takes some lives by saying it really causes fewer abortions though preventing conception again puts us in the place of God. The logic seems to be that God is letting many children die, so when we will kill some ourselves we can take consolation in knowing that the chemical that kills some children prevents many children from ever being conceived and therefore from ever dying.
But God has never delegated the right to us to unnecessarily risk the lives of our children. Furthermore, if there are fewer miscarriages because of the Pill it is not because the Pill brings any benefit to a preborn child, but only because it results in less children. This is all an illusion -- it is not that lives are truly being preserved, but simply that there are fewer lives to preserve! There is less death only because there is less life.
Using this logic, the most pro-life thing we could do would be to eliminate all pregnancy and thereby all children. We could congratulate ourselves that we eliminated abortion by eliminating children. (The number of people with cancer could also be lowered by reducing the number of people in society, but we would hardly think of that as a cure -- especially if the means we used to have less people meant killing some of them!)
We may indeed lose through early spontaneous miscarriages several children we don't even know of. But that in no way justifies our choosing to take something into our bodies that puts the lives of other children in danger.
"But Pill-takers aren't intending to have abortions"
I've been told several times that because most people's intention in taking the Pill is to prevent conception, not to have an abortion, it's therefore ethical for them to continue taking the Pill.
I certainly agree that most women taking the Pill don't intend to get abortions. In fact, I'm convinced 99% of them are unaware this is even possible. But the fact remains that while the intentions of those taking the Pill may be harmless, the results can be fatal.
A nurse giving your child an injection could sincerely intend no harm to your child, but if she unknowingly injects him with a fatal poison, her good intentions will not lessen the tragedy of the results. Whether the nurse has the heart of a murderer or a saint, your child is equally dead. The best intentions do nothing to reverse the most disastrous results.
In this sense, taking the Pill is analogous to playing Russian roulette, but with more chambers and therefore less risk per episode. In Russian roulette, participants usually don't intend to shoot themselves. Their intention is irrelevant, however, because if they play the game long enough they just can't beat the odds, and they die.
The Russian roulette of the Pill is done with someone else's life, a new and unique creation of God. Each time someone taking the Pill engages in sex, she runs the risk of aborting a child. (Instead of a one in six chance, maybe it's a one in thirty or one in a hundred or one in five hundred chance, I'm not sure, but it's certainly a real risk -- the scientific evidence tells us the chemical "gun" is loaded.) The fact that she will not know when a child has been aborted in no way changes whether or not a child is aborted. Every month she continues to take the Pill increases her chances of having her first -- or next -- silent abortion. She could have one, two, a half dozen or a dozen of these without ever having a clue.
A word that continuously surfaced in my research and my dialogue with the birth control pill manufacturers was the word "primary" as opposed to "secondary." A pro-life physician told me he felt comfortable still using the Pill because "It's primarily contraceptive and only secondarily abortive."
But how would you respond to someone who says "here, eat this hamburger -- the meat we use sometimes causes fatal food poisoning, but its primary effect isn't to poison you, so don't worry about it." Or more to the point, what would you think if a doctor said to you, "This chemical I'm about to inject in your child has the primary effect of curing his allergies; it also may kill him, but that would only be a secondary effect."
Saturday, October 31, 2009
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.)
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.)
Thursday, October 29, 2009
Does the birth control pill cause abortions? "PART 3"
What do the Pill manufacturers say?
Searle
I asked an excellent pro-life physician, and a good friend, to call a birth control manufacturer concerning the statements in their inserts. He contacted Searle, whose package insert for their pill Demulen, says "alterations in the . . . endometrium (which may reduce the likelihood of implantation) may also contribute to the contraceptive effectiveness." (Note that Searle twice uses the term "may," in contrast to Ortho and Wyeth, which in their information in The PDR state the same effect as a fact rather than a possibility.)
Here is part of a letter dated February 13, 1997, written by Barbara Struthers, Searle's Director of Healthcare Information Services, to my pro-life physician friend:
Thank you for your recent request for information regarding whether oral contraceptives are abortifacients . . . . One of the possible mechanisms listed in the labeling is "changes in the endometrium which may reduce the likelihood of implantation." This is a theoretical mechanism only and is not based upon experimental evidence, but upon the histologic appearance of the endometrium. However, as noted by Goldzieher, the altered endometrium is still capable of sustaining nidation, as shown by pregnancies occurring in cycles with only a few or no tablet omissions.
Dr. Struthers (PhD) makes a valid point that the Pill's effects on the endometrium do not always make implantation impossible. But in my research I never found anyone who claimed they always do. The issue is whether they sometimes do. To be an abortifacient does not require that something always cause an abortion, only that it sometimes does. In fact, whether it's RU-486, Norplant, the mini-pill or the Pill, there is no chemical that always causes an abortion. There are only those that do so never, sometimes, often and usually. Thus, the point that the Pill doesn't always prevent implantation is true, but has no bearing on the question of whether it sometimes prevents implantation, which Searle's own literature indicates. (Children who play on the freeway, climb on the roof or are left alone by swimming pools don't always get killed, but this hardly proves these practices are safe and do not result in fatalities.)
Dr. Struthers goes on to say, "It is unlikely that OCs would decrease the likelihood of endometrial implantation, particularly when one appreciates that the blastocyst is perfectly capable of implanting in various 'hostile' sites, e.g. the Fallopian tube, the ovary, the peritoneum."
Her point is that the child sometimes implants in the wrong place. True enough -- but, again, no one is saying this doesn't happen. The question is whether the Pill sometimes hinders the child's ability to implant in the right place. (Whether the child implants in the wrong place or fails to implant in the right one, the result is the same -- death. But while in the first case the death is not caused by a human agent, in the second case -- by taking the Pill -- it can be.)
Dr. Struthers then says, "Used as directed, the hormone level in modern OCs is simply too low to cause interception, that is, failure of the blastocyst to implant."
If this is true, then why does the company's own literature -- produced by their researchers and submitted to the FDA, the medical community, and the public -- suggest the contrary? And why do dozens and dozens of scientific and medical sources I am drawing from in this article definitively state the contrary? If Dr. Struthers is right, not just some but all of these other sources have to be wrong.
Dr. Struthers further states, "Until the blastocyst implants . . . there would be no loss of an embryo and, therefore, no abortion. Thus, the theoretical mechanism of reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition."
Now we cut to the heart of her presuppositions. Having said implantation won't be pevented, she then says even if it is (why add this if it never happens?), the result isn't really an abortion. This statement is profound both in its breadth and its inaccuracy. It's a classic logic-class-illustration of faulty reasoning. It's like saying "Sudden Infant Death Syndrome does not affect toddlers; therefore, it does not involve the deaths of human beings." Such a statement assumes facts not in evidence -- that infants are not people because they are pre-toddlers. In exactly the same way Dr. Struthers begs the question by assuming -- without bothering to provide any evidence (there is none) for this assumption -- that pre-embryo human beings are not really human beings.
But if human life does begin at conception, which is the overwhelming biological (not to mention biblical) consensus, then causing the death of a "blastocyst" is just as much an abortion as causing the death (or she puts it, "loss") of an "embryo." The days-old individual is a smaller and younger person than the embryo, but he or she is no less a person in the sight of God who created him. (People do not get more human as they get older and bigger -- if they did, toddlers would be more human than infants, adolescents more human than toddlers, adults more human than adolescents and professional basketball players more human than anyone.)
Dr. Struthers says the "reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition." This statement is unscientific in the extreme. The biological definition she ignores is not just some obscure definition of life, but the precise definition which the vast majority of scientists, including biologists, actually hold to -- that life begins at conception. (See Appendix B: When Does Human Life Begin? The Answer of Science. An early abortion is still an abortion, and no semantics change this reality. (Though for some they do manage to obscure it.)
The letter from Dr. Struthers certainly contains some valid information along with the invalid. But how seriously can we take its bottom-line conclusions that the Pill is not an abortifacient? One physician I showed it to said a "healthcare information services director" is a public relations position with a primary job of minimizing controversy, denying blame, putting out fires, and avoiding any bad publicity for products with both with physicians and the general public. Perhaps this assessment was unfair -- I don't know. But on reading her letter I determined to personally call the research or medical information departments of all the major birth control manufacturers and hear for myself what each of them had to say.
When I called Syntex, they informed me that all their "feminine products," including the Pill, have recently been purchased by Searle. So I called Searle's customer service line, identified myself by name, and was asked to explain my question. When I said that it related to the Pill's mechanism of preventing implantation, the person helping me (who didn't identify herself) became discernibly uneasy. She asked me who I was (I gave her my name again) and then asked me to wait while she conferred with her colleagues. After several minutes she got back on the line and said "Dr. Struthers will have to talk to you about this, and she's not in."
Since Dr. Struthers was unavailable, I asked the woman if she could offer me any guidance. She said, uneasiness very evident, "By any chance are you asking about this for religious reasons?" I said, "Yes, that's part of it." She said, "Well, I can tell you that our pills are not abortifacients." I asked "then why does your professional labeling talk about the Pill reducing the likelihood of implantation?" She said, "I can't answer that question. You'll have to talk to Dr. Struthers." I left my number, but Dr. Struthers didn't call me back. Since I already had her position, as stated in her fax to my physician friend, I didn't call her back either.
Organon
Next I called Organon, the maker of the birth control pill Desogen. After explaining my question about their literature that says the Pill sometimes prevents implantation, I was handed over to Erin in medical services. She informed me "the primary mechanism is preventing ovulation." After my follow-up question, she said, "The other mechanisms also happen, but they're secondary." When I asked how often the primary mechanism fails and the secondary mechanisms kick in, she said "there's no way to determine the number of times which happens and doesn't happen."
Reading between the lines, Erin said, "If you're asking if it's an abortifacient . . . [pause]" I interjected, "Yes, I am." She continued, ". . . that's difficult to ever say that." She added, "What happens is, if ovulation occurs, the Pill will thicken the mucus and thin the endometrium so that it doesn't allow that pregnancy." She quickly added, "but it's not like the IUD." (Meaning, I took it, that preventing implantation is the primary function of the IUD, whereas it is only a secondary function of the Pill.)
Wyeth-Ayerst
Wyeth-Ayerst Labs is the maker of six combination Pills. I called and spoke with a medical information coordinator named Adrianne. I read to her the professional labeling of their Pills that says "other alterations include changes . . . in the endometrium (which reduce the likelihood of implantation)." I asked if she knew how often the Pill prevents implantation.
Once again it became obvious that I was pro-life, presumably because no one but a pro-lifer would care about this issue. Adrianne read to me a printed statement that said "these mechanisms are not abortifacient in nature." She carefully explained that inhibiting ovulation and thickening the cervical mucus were contraceptive, not abortive. Of course, I agreed 100%. She then said, reading from the statement in front of her, "while it is true that progestins do alter the uterine lining, this is not considered a contraceptive action of these methods. The fact that these methods are not 100% effective and successful pregnancies have occurred clearly demonstrate that successful implantations can occur."
Over the following ten minutes, Adrianne kept talking about the first two mechanisms. I kept asking about the third. Finally she said, "That occurs, but it doesn't prevent a pregnancy." I thought, that's true, it doesn't prevent a pregnancy, it actually ends a pregnancy, but I knew that wasn't what she meant. I then referred her back to Wyeth's professional labeling and pointed out once more the third mechanism. She followed along with her copy and said, "That third effect happens, but it's not considered a contraceptive action, because sometimes it fails to prevent pregnancy."
(Of course, she had already acknowledged that sometimes the Pill fails to prevent ovulation and sometimes the thickened cervical mucus fails to prevent the sperm from impregnating the egg. In the same way a visible pregnancy proves the third mechanism has failed, it proves the other two mechanisms have also failed. Yet they are still considered to be real mechanisms of the Pill, despite the fact they sometimes fail. Why shouldn't the third effect be treated the same way?)
I said, "According to your professional labeling, sometimes your Pills do prevent a fertilized egg from implanting -- is that correct or incorrect?" She paused for a very long time and I heard papers shuffling. Finally she said, "Yes, that's correct, but not always . . . that's why we can't say contraceptives are 100% effective."
I said, "Okay, let me try to summarize, and please correct me if I'm wrong. There are three different ways the Pill operates. #1 usually works. When #1 fails, #2 may work. When #1 and #2 fail, #3 may work. And sometimes all three fail."
She said "Yes, that's correct." She offered to send me information by mail and I gladly accepted the offer. (I had asked Searle and Ortho to do this but they said they didn't have anything they could send me.) She warmly invited me to call back if I needed any more information.
When I received the information in the mail, it contained three things. The first was a cover letter written by Robin Boyle, , R.Ph., Wyeth's Manager of Drug Information. It was clearly a form letter designed for those expressing concerns about abortion, and contained the precise contents that Adrianne quoted to me. Also enclosed was a colorful booklet entitled Birth Control with the Pill, which is designed "to be distributed only with Triphasil sample." In the section "How the Pill Works," it states "The pill mainly prevents pregnancy in two ways." It then speaks of only the first two mechanisms and makes no reference whatsoever to the third, which prevents implantation. (This booklet does not fall under the same FDA requirements of full disclosure that the professional labeling does.)
The detailed, fine print "professional labeling" was also enclosed, and, as reflected in The PDR, it does in fact speak about "alterations include changes in . . the endometrium (which reduce the likelihood of implantation)." It struck me as obvious that virtually everyone receiving this information would read the large print, attractive, colorful, easy-to-understand booklet (which makes no mention of the abortive mechanism), and almost no one would read the extremely small print, black and white, technically worded, and completely unattractive sheet -- the one that acknowledges in the fine print that the Pill sometimes causes abortions by preventing implantation.
It is safe to say that virtually none of Wyeth's consumers will read the highly technical study printed in a 1988 International Journal of Fertility article, by none other than Wyeth's own Regional Director of Clinical Research, who stated one way oral contraceptives work is "by causing endometrial changes that will not support implantation." (Dr. G. Virginia Upton, "The Phasic Approach to Oral Contraception," The International Journal of Fertility, volume 28, 1988, page 129.)
Ortho
On March 24, 1997, I had a lengthy and enlightening talk with Richard Hill, a pharmacist who works for Ortho-McNeil's product information department. (Ortho-McNeil and Searle are the largest birth control pill manufacturers.) I took detailed notes. Hill was not guarded, was most helpful, and never asked me about my religious views or my beliefs about abortion. He informed me "I can't give you solid numbers, because there's no way to tell which of these three functions is actually preventing the pregnancy; but I can tell you the great majority of the time it's the first one [preventing ovulation]."
I asked him, "Does the Pill sometimes fail to prevent ovulation?" He said "yes." I asked, "What happens then?" He said, "The cervical mucus slows down the sperm. And if that doesn't work, if you end up with a fertilized egg, it won't implant and grow because of the less hospitable endometrium."
I asked him how many of the contraceptives available on the market are low dose. He said, "I don't have statistics, but I also work in a pharmacy and I can tell you the vast majority of the time people get low dose pills." He confirmed that there are some "higher dose" pills available, with 50 micrograms of estrogen instead of 20-35 micrograms, but said these were not commonly used. (Remember, even 50 micrograms is only 1/3 of the average estrogen dosage in pills of the 1960's, and is still low dose by those standards.)
I then asked Hill if he was certain the Pill made implantation less likely. "Oh, yes," he replied. I said, "So you don't think this is just a theoretical effect of the Pill?" He said the following, as I took detailed notes:
Oh, no, it's not theoretical. It's observable. We know what an endometrium looks like when it's richest and most receptive to the fertilized egg. When a woman is taking the Pill you can clearly see the difference, based both on gross appearance -- as seen with the naked eye -- and under a microscope. At the time when the endometrium would normally accept a fertilized egg, if a woman is taking the Pill it is much less likely to do so.
I asked Hill one more time, "So you're saying this is an actual effect that happens, not just a theoretical one?" He said, "Sure -- you can actually see what it does to the endometrium and it's obvious it makes implantation less likely. The only thing that's theoretical is the numbers, because we just don't know that."
The pills produced by Searle, Ortho, Wyeth and Organon are essentially the same thing, with only slightly different combinations of chemicals. The professional labeling is essentially the same. The medical experts at Searle, Wyeth and Organon were all quick to pick up my abortion-related concerns and attempted to defuse them. Despite this, the pharmacist at Ortho and the medical services people at Organon and Wyeth all three acknowledged as an established fact what their literature says, that the Pill sometimes prevents implantation. Dr. Struthers of Searle appears to deny this, but then explains that if it happens it isn't really an abortion. When I stack up these responses to the wealth of information I've found in my research, I am forced to believe the people at Ortho, Wyeth, and Organon, not Dr. Struthers at Searle.
While I know that some of what she said is wrong (including the notion that preventing implantation is not a real abortion), I hope and pray that Dr. Struthers is correct and that her position is more than just a careful public relations ploy to placate known pro-lifers and religious people. The totality of my research, however, convinces me her position is simply not based on the facts.
I think the key issue is whether the Pill's prevention of implantation is "theoretical" or actual. None of the other three manufacturers spoke of it as anything other than actual except Dr. Struthers at Searle, who said it is "a theoretical mechanism only." Pharmacist Hill at Ortho stated it was "not theoretical," but based on direct, measurable observation of the endometrium. Who is correct?
Imagine a farmer who has two places where he might plant seed. One is rich, brown soil that has been tilled, fertilized and watered. The other is on hard, thin, dry and rocky soil. If the farmer's wants as much seed as possible to take hold and grow, where will he plant the seed? The answer is self-evident. On the fertile ground.
Now, you could say to the farmer that his preference for the rich, tilled, moist soil is based on the "theoretical," because he has probably never seen a scientific study that proves this soil is more hospitable to seed than the thin, hard, dry soil. The farmer might reply, based on years of observation, "I know good soil when I see it -- sure, I've seen some plants grow in the hard, thin soil too, but the chances of survival are much less there than in the good soil. Call it theoretical if you want to, but we all know it's true!"
When Dr. Struthers points out some newly conceived children manage to grow in hostile places, this in no way changes the obvious fact that many more children will survive in a richer, thicker, more hospitable endometrium than in a thinner, more hostile one. In this sense, the issue isn't theoretical at all.
Several articles I read spoke of the mucus's ability to block sperm migration and presented as evidence the fact that the thickness of the mucus is visually observable. Of course, this appearance is not incontrovertible proof that it slows down sperm migration, but it is still considered valid evidence. Why would we question the validity of the endometrium's appearance?
Obviously, when the Pill thins the endometrium, and it certainly does, a fertilized egg has a lesser chance of survival. This means a greater chance of death. Hence, without question a woman's taking the Pill puts any conceived child at greater risk of being aborted than if the Pill wasn't being taken. Other than for reasons of wishful thinking, can anyone seriously argue against this?
We may try to take some consolation in believing that abortions happen only in theory. But we must ask, if this is a theory, how strong and credible is the theory? Once it was only a theory that plant life grows better in rich fertile soil than in thin eroded soil. But it was certainly a theory all good farmers believed in and acted upon, having every reason to believe it was true.
Searle
I asked an excellent pro-life physician, and a good friend, to call a birth control manufacturer concerning the statements in their inserts. He contacted Searle, whose package insert for their pill Demulen, says "alterations in the . . . endometrium (which may reduce the likelihood of implantation) may also contribute to the contraceptive effectiveness." (Note that Searle twice uses the term "may," in contrast to Ortho and Wyeth, which in their information in The PDR state the same effect as a fact rather than a possibility.)
Here is part of a letter dated February 13, 1997, written by Barbara Struthers, Searle's Director of Healthcare Information Services, to my pro-life physician friend:
Thank you for your recent request for information regarding whether oral contraceptives are abortifacients . . . . One of the possible mechanisms listed in the labeling is "changes in the endometrium which may reduce the likelihood of implantation." This is a theoretical mechanism only and is not based upon experimental evidence, but upon the histologic appearance of the endometrium. However, as noted by Goldzieher, the altered endometrium is still capable of sustaining nidation, as shown by pregnancies occurring in cycles with only a few or no tablet omissions.
Dr. Struthers (PhD) makes a valid point that the Pill's effects on the endometrium do not always make implantation impossible. But in my research I never found anyone who claimed they always do. The issue is whether they sometimes do. To be an abortifacient does not require that something always cause an abortion, only that it sometimes does. In fact, whether it's RU-486, Norplant, the mini-pill or the Pill, there is no chemical that always causes an abortion. There are only those that do so never, sometimes, often and usually. Thus, the point that the Pill doesn't always prevent implantation is true, but has no bearing on the question of whether it sometimes prevents implantation, which Searle's own literature indicates. (Children who play on the freeway, climb on the roof or are left alone by swimming pools don't always get killed, but this hardly proves these practices are safe and do not result in fatalities.)
Dr. Struthers goes on to say, "It is unlikely that OCs would decrease the likelihood of endometrial implantation, particularly when one appreciates that the blastocyst is perfectly capable of implanting in various 'hostile' sites, e.g. the Fallopian tube, the ovary, the peritoneum."
Her point is that the child sometimes implants in the wrong place. True enough -- but, again, no one is saying this doesn't happen. The question is whether the Pill sometimes hinders the child's ability to implant in the right place. (Whether the child implants in the wrong place or fails to implant in the right one, the result is the same -- death. But while in the first case the death is not caused by a human agent, in the second case -- by taking the Pill -- it can be.)
Dr. Struthers then says, "Used as directed, the hormone level in modern OCs is simply too low to cause interception, that is, failure of the blastocyst to implant."
If this is true, then why does the company's own literature -- produced by their researchers and submitted to the FDA, the medical community, and the public -- suggest the contrary? And why do dozens and dozens of scientific and medical sources I am drawing from in this article definitively state the contrary? If Dr. Struthers is right, not just some but all of these other sources have to be wrong.
Dr. Struthers further states, "Until the blastocyst implants . . . there would be no loss of an embryo and, therefore, no abortion. Thus, the theoretical mechanism of reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition."
Now we cut to the heart of her presuppositions. Having said implantation won't be pevented, she then says even if it is (why add this if it never happens?), the result isn't really an abortion. This statement is profound both in its breadth and its inaccuracy. It's a classic logic-class-illustration of faulty reasoning. It's like saying "Sudden Infant Death Syndrome does not affect toddlers; therefore, it does not involve the deaths of human beings." Such a statement assumes facts not in evidence -- that infants are not people because they are pre-toddlers. In exactly the same way Dr. Struthers begs the question by assuming -- without bothering to provide any evidence (there is none) for this assumption -- that pre-embryo human beings are not really human beings.
But if human life does begin at conception, which is the overwhelming biological (not to mention biblical) consensus, then causing the death of a "blastocyst" is just as much an abortion as causing the death (or she puts it, "loss") of an "embryo." The days-old individual is a smaller and younger person than the embryo, but he or she is no less a person in the sight of God who created him. (People do not get more human as they get older and bigger -- if they did, toddlers would be more human than infants, adolescents more human than toddlers, adults more human than adolescents and professional basketball players more human than anyone.)
Dr. Struthers says the "reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition." This statement is unscientific in the extreme. The biological definition she ignores is not just some obscure definition of life, but the precise definition which the vast majority of scientists, including biologists, actually hold to -- that life begins at conception. (See Appendix B: When Does Human Life Begin? The Answer of Science. An early abortion is still an abortion, and no semantics change this reality. (Though for some they do manage to obscure it.)
The letter from Dr. Struthers certainly contains some valid information along with the invalid. But how seriously can we take its bottom-line conclusions that the Pill is not an abortifacient? One physician I showed it to said a "healthcare information services director" is a public relations position with a primary job of minimizing controversy, denying blame, putting out fires, and avoiding any bad publicity for products with both with physicians and the general public. Perhaps this assessment was unfair -- I don't know. But on reading her letter I determined to personally call the research or medical information departments of all the major birth control manufacturers and hear for myself what each of them had to say.
When I called Syntex, they informed me that all their "feminine products," including the Pill, have recently been purchased by Searle. So I called Searle's customer service line, identified myself by name, and was asked to explain my question. When I said that it related to the Pill's mechanism of preventing implantation, the person helping me (who didn't identify herself) became discernibly uneasy. She asked me who I was (I gave her my name again) and then asked me to wait while she conferred with her colleagues. After several minutes she got back on the line and said "Dr. Struthers will have to talk to you about this, and she's not in."
Since Dr. Struthers was unavailable, I asked the woman if she could offer me any guidance. She said, uneasiness very evident, "By any chance are you asking about this for religious reasons?" I said, "Yes, that's part of it." She said, "Well, I can tell you that our pills are not abortifacients." I asked "then why does your professional labeling talk about the Pill reducing the likelihood of implantation?" She said, "I can't answer that question. You'll have to talk to Dr. Struthers." I left my number, but Dr. Struthers didn't call me back. Since I already had her position, as stated in her fax to my physician friend, I didn't call her back either.
Organon
Next I called Organon, the maker of the birth control pill Desogen. After explaining my question about their literature that says the Pill sometimes prevents implantation, I was handed over to Erin in medical services. She informed me "the primary mechanism is preventing ovulation." After my follow-up question, she said, "The other mechanisms also happen, but they're secondary." When I asked how often the primary mechanism fails and the secondary mechanisms kick in, she said "there's no way to determine the number of times which happens and doesn't happen."
Reading between the lines, Erin said, "If you're asking if it's an abortifacient . . . [pause]" I interjected, "Yes, I am." She continued, ". . . that's difficult to ever say that." She added, "What happens is, if ovulation occurs, the Pill will thicken the mucus and thin the endometrium so that it doesn't allow that pregnancy." She quickly added, "but it's not like the IUD." (Meaning, I took it, that preventing implantation is the primary function of the IUD, whereas it is only a secondary function of the Pill.)
Wyeth-Ayerst
Wyeth-Ayerst Labs is the maker of six combination Pills. I called and spoke with a medical information coordinator named Adrianne. I read to her the professional labeling of their Pills that says "other alterations include changes . . . in the endometrium (which reduce the likelihood of implantation)." I asked if she knew how often the Pill prevents implantation.
Once again it became obvious that I was pro-life, presumably because no one but a pro-lifer would care about this issue. Adrianne read to me a printed statement that said "these mechanisms are not abortifacient in nature." She carefully explained that inhibiting ovulation and thickening the cervical mucus were contraceptive, not abortive. Of course, I agreed 100%. She then said, reading from the statement in front of her, "while it is true that progestins do alter the uterine lining, this is not considered a contraceptive action of these methods. The fact that these methods are not 100% effective and successful pregnancies have occurred clearly demonstrate that successful implantations can occur."
Over the following ten minutes, Adrianne kept talking about the first two mechanisms. I kept asking about the third. Finally she said, "That occurs, but it doesn't prevent a pregnancy." I thought, that's true, it doesn't prevent a pregnancy, it actually ends a pregnancy, but I knew that wasn't what she meant. I then referred her back to Wyeth's professional labeling and pointed out once more the third mechanism. She followed along with her copy and said, "That third effect happens, but it's not considered a contraceptive action, because sometimes it fails to prevent pregnancy."
(Of course, she had already acknowledged that sometimes the Pill fails to prevent ovulation and sometimes the thickened cervical mucus fails to prevent the sperm from impregnating the egg. In the same way a visible pregnancy proves the third mechanism has failed, it proves the other two mechanisms have also failed. Yet they are still considered to be real mechanisms of the Pill, despite the fact they sometimes fail. Why shouldn't the third effect be treated the same way?)
I said, "According to your professional labeling, sometimes your Pills do prevent a fertilized egg from implanting -- is that correct or incorrect?" She paused for a very long time and I heard papers shuffling. Finally she said, "Yes, that's correct, but not always . . . that's why we can't say contraceptives are 100% effective."
I said, "Okay, let me try to summarize, and please correct me if I'm wrong. There are three different ways the Pill operates. #1 usually works. When #1 fails, #2 may work. When #1 and #2 fail, #3 may work. And sometimes all three fail."
She said "Yes, that's correct." She offered to send me information by mail and I gladly accepted the offer. (I had asked Searle and Ortho to do this but they said they didn't have anything they could send me.) She warmly invited me to call back if I needed any more information.
When I received the information in the mail, it contained three things. The first was a cover letter written by Robin Boyle, , R.Ph., Wyeth's Manager of Drug Information. It was clearly a form letter designed for those expressing concerns about abortion, and contained the precise contents that Adrianne quoted to me. Also enclosed was a colorful booklet entitled Birth Control with the Pill, which is designed "to be distributed only with Triphasil sample." In the section "How the Pill Works," it states "The pill mainly prevents pregnancy in two ways." It then speaks of only the first two mechanisms and makes no reference whatsoever to the third, which prevents implantation. (This booklet does not fall under the same FDA requirements of full disclosure that the professional labeling does.)
The detailed, fine print "professional labeling" was also enclosed, and, as reflected in The PDR, it does in fact speak about "alterations include changes in . . the endometrium (which reduce the likelihood of implantation)." It struck me as obvious that virtually everyone receiving this information would read the large print, attractive, colorful, easy-to-understand booklet (which makes no mention of the abortive mechanism), and almost no one would read the extremely small print, black and white, technically worded, and completely unattractive sheet -- the one that acknowledges in the fine print that the Pill sometimes causes abortions by preventing implantation.
It is safe to say that virtually none of Wyeth's consumers will read the highly technical study printed in a 1988 International Journal of Fertility article, by none other than Wyeth's own Regional Director of Clinical Research, who stated one way oral contraceptives work is "by causing endometrial changes that will not support implantation." (Dr. G. Virginia Upton, "The Phasic Approach to Oral Contraception," The International Journal of Fertility, volume 28, 1988, page 129.)
Ortho
On March 24, 1997, I had a lengthy and enlightening talk with Richard Hill, a pharmacist who works for Ortho-McNeil's product information department. (Ortho-McNeil and Searle are the largest birth control pill manufacturers.) I took detailed notes. Hill was not guarded, was most helpful, and never asked me about my religious views or my beliefs about abortion. He informed me "I can't give you solid numbers, because there's no way to tell which of these three functions is actually preventing the pregnancy; but I can tell you the great majority of the time it's the first one [preventing ovulation]."
I asked him, "Does the Pill sometimes fail to prevent ovulation?" He said "yes." I asked, "What happens then?" He said, "The cervical mucus slows down the sperm. And if that doesn't work, if you end up with a fertilized egg, it won't implant and grow because of the less hospitable endometrium."
I asked him how many of the contraceptives available on the market are low dose. He said, "I don't have statistics, but I also work in a pharmacy and I can tell you the vast majority of the time people get low dose pills." He confirmed that there are some "higher dose" pills available, with 50 micrograms of estrogen instead of 20-35 micrograms, but said these were not commonly used. (Remember, even 50 micrograms is only 1/3 of the average estrogen dosage in pills of the 1960's, and is still low dose by those standards.)
I then asked Hill if he was certain the Pill made implantation less likely. "Oh, yes," he replied. I said, "So you don't think this is just a theoretical effect of the Pill?" He said the following, as I took detailed notes:
Oh, no, it's not theoretical. It's observable. We know what an endometrium looks like when it's richest and most receptive to the fertilized egg. When a woman is taking the Pill you can clearly see the difference, based both on gross appearance -- as seen with the naked eye -- and under a microscope. At the time when the endometrium would normally accept a fertilized egg, if a woman is taking the Pill it is much less likely to do so.
I asked Hill one more time, "So you're saying this is an actual effect that happens, not just a theoretical one?" He said, "Sure -- you can actually see what it does to the endometrium and it's obvious it makes implantation less likely. The only thing that's theoretical is the numbers, because we just don't know that."
The pills produced by Searle, Ortho, Wyeth and Organon are essentially the same thing, with only slightly different combinations of chemicals. The professional labeling is essentially the same. The medical experts at Searle, Wyeth and Organon were all quick to pick up my abortion-related concerns and attempted to defuse them. Despite this, the pharmacist at Ortho and the medical services people at Organon and Wyeth all three acknowledged as an established fact what their literature says, that the Pill sometimes prevents implantation. Dr. Struthers of Searle appears to deny this, but then explains that if it happens it isn't really an abortion. When I stack up these responses to the wealth of information I've found in my research, I am forced to believe the people at Ortho, Wyeth, and Organon, not Dr. Struthers at Searle.
While I know that some of what she said is wrong (including the notion that preventing implantation is not a real abortion), I hope and pray that Dr. Struthers is correct and that her position is more than just a careful public relations ploy to placate known pro-lifers and religious people. The totality of my research, however, convinces me her position is simply not based on the facts.
I think the key issue is whether the Pill's prevention of implantation is "theoretical" or actual. None of the other three manufacturers spoke of it as anything other than actual except Dr. Struthers at Searle, who said it is "a theoretical mechanism only." Pharmacist Hill at Ortho stated it was "not theoretical," but based on direct, measurable observation of the endometrium. Who is correct?
Imagine a farmer who has two places where he might plant seed. One is rich, brown soil that has been tilled, fertilized and watered. The other is on hard, thin, dry and rocky soil. If the farmer's wants as much seed as possible to take hold and grow, where will he plant the seed? The answer is self-evident. On the fertile ground.
Now, you could say to the farmer that his preference for the rich, tilled, moist soil is based on the "theoretical," because he has probably never seen a scientific study that proves this soil is more hospitable to seed than the thin, hard, dry soil. The farmer might reply, based on years of observation, "I know good soil when I see it -- sure, I've seen some plants grow in the hard, thin soil too, but the chances of survival are much less there than in the good soil. Call it theoretical if you want to, but we all know it's true!"
When Dr. Struthers points out some newly conceived children manage to grow in hostile places, this in no way changes the obvious fact that many more children will survive in a richer, thicker, more hospitable endometrium than in a thinner, more hostile one. In this sense, the issue isn't theoretical at all.
Several articles I read spoke of the mucus's ability to block sperm migration and presented as evidence the fact that the thickness of the mucus is visually observable. Of course, this appearance is not incontrovertible proof that it slows down sperm migration, but it is still considered valid evidence. Why would we question the validity of the endometrium's appearance?
Obviously, when the Pill thins the endometrium, and it certainly does, a fertilized egg has a lesser chance of survival. This means a greater chance of death. Hence, without question a woman's taking the Pill puts any conceived child at greater risk of being aborted than if the Pill wasn't being taken. Other than for reasons of wishful thinking, can anyone seriously argue against this?
We may try to take some consolation in believing that abortions happen only in theory. But we must ask, if this is a theory, how strong and credible is the theory? Once it was only a theory that plant life grows better in rich fertile soil than in thin eroded soil. But it was certainly a theory all good farmers believed in and acted upon, having every reason to believe it was true.
Wednesday, October 28, 2009
Does the birth control pill cause abortions? "PART 2"
A wealth of scientific evidence
As a woman's menstrual cycle progresses, her endometrium gradually gets richer and thicker in preparation for the arrival of any newly conceived child who may be there to attempt implantation. In a natural cycle, unimpeded by the Pill, the endometrium experiences an increase of blood vessels, allowing an increased blood supply to bring oxygen and nutrients to the child. There is also an increase in the endometrium's stores of glycogen, a sugar that serves as a food source for the blastocyst (newly conceived child) as soon as he or she implants.
The statements in The Physician's Desk Reference, and others to follow, testify that the Pill keeps the woman's body from creating the most hospitable environment for a child, resulting instead in an endometrium that is thin and depleted, deficient in both food (glycogen) and oxygen. This deficiency may result in the child's death by starvation and suffocation. (Scientifically, one does not have to have a stomach to starve or lungs to suffocate.)
Typically, the blastocyst (new person) attempts to implant at six days after conception. If implantation is unsuccessful, she starves to death and is flushed out of the womb in an early miscarriage. (When the miscarriage is the result of an environment created by a foreign device or chemical, it is actually an abortion.)
The March 1996 issue of Fertility and Sterility presents significant research results, then states,
These data suggest that the morphological changes observed in the endometrium of OC users have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs [oral contraceptives]. (Somkuti, et al., "The Effect of Oral Contraceptive Pills on Markers of Endometrial Receptivity, Fertility and Sterility, Volume 65, #3, 3/96, page 488.)
In an extensive study, Chowdhury & Joshi point to the diminished capacity of the endometrium as part of the effectiveness of the Pill ("Escape ovulation in women due to the missing of low dose combination oral contraceptive pills," Contraception, 1980; 22:241).
In a study of oral contraceptives published in a major medical journal Dr. G. Virginia Upton, Regional Director of Clinical Research for Wyeth International (one of the major birth control pill manufacturers), says this:
The graded increments in LNg in the triphasic OC serve to maximize contraceptive protection by increasing the viscosity of the cervical mucus (cervical barrier), by suppressing ovarian progesterone output, and by causing endometrial changes that will not support implantation. ("The Phasic Approach to Oral Contraception," The International Journal of Fertility, volume 28, 1988, page 129.)
Dr. Goldzieher (Hormonal Contraception, page 122) says as a result of the combined Pill's action "possibly the endometrium in such cycles may provide additional contraceptive protection. ' (Note that the author redefines "contraceptive," which historically meant something which prevents conception, yet is used here of preventing implantation of an already conceived person.)
The medical textbook Williams Obstetrics (Cunningham, et al, Stamford, CT: Appleton & Lange, 1993, page 1323) states, "Similar to estrogens, progestins produce an endometrium that is unfavorable to blastocyst implantation."
Drug Facts and Comparisons says this about birth control pills in its 1996 edition:
Combination OCs inhibit ovulation by suppressing the gonadotropins, follicle-stimulating hormone (FSH) and lutenizing hormone (LH). Additionally, alterations in the genital tract, including cervical mucus (which inhibits sperm penetration) and the endometrium (which reduces the likelihood of implantation), may contribute to contraceptive effectiveness.
"The Pill: How does it work? Is it safe?" (The Couple to Couple League, PO Box 111184, Cincinnati, OH, 45211) states on page 4:
When the Pill fails to prevent ovulation, the other mechanisms come into play. Thickened cervical mucus may make it more difficult for the sperm to reach the egg: however, if the egg is fertilized, a new life is created. The hormones slow the transfer of the new life through the fallopian tube, and the embryo may become too old to be viable when it does enter the uterus.
If the embryo is still viable when it reaches the uterus, underdevelopment of the uterine lining caused by the Pill prevents implantation. The embryo dies and the remains are passed along in the next bleeding episode which, incidentally, is not a true menstruation, even though it is usually perceived as such.
A standard medical reference, Danforth's Obstetrics and Gynecology (Philadelphia: J.B. Lippincott Co., 1994, 7th edition, page 626) states this: "The production of glycogen by the endometrial glands is diminished by the ingestion of oral contraceptives, which impairs the survival of the blastocyst in the uterine cavity."
In her article Abortifacient Drugs and Devices: Medical and Moral Dilemmas (Linacre Quarterly, August 1990, page 55), Dr. Kristine Severyn states,
The third effect of combined oral contraceptives is to alter the endometrium in such a way that implantation of the fertilized egg (new life) is made more difficult, if not impossible. In effect, the endometrium becomes atrophic and unable to support implantation of the fertilized egg. . . . the alteration of the endometrium, making it hostile to implantation by the fertilized egg, provides a backup abortifacient method to prevent pregnancy.
Established fact even in the Seventies
One of the things that surprised me in my research was that though many recent sources testify to the Pill's abortive capacity, it has been well established for more than two decades. The following eight sources were all written in the 1970's. (Keep in mind that the term "blastocyst" refers to the newly conceived human being -- "it" is not a thing, but a person, a "he" or "she."
Dr. Daniel R. Mishell of the USC School of Medicine said,
Furthermore, they [the combination pills] alter the endometrium so that glandular production of glycogen is diminished and less energy is available for the blastocyst to survive in the uterine cavity. ("Current Status of Oral Contraceptive Steroids," Clinical Obstetrics & Gynecology 19:4, December 1976, page 746.)
[While serving as] president of the Food and Drug Administration (FDA), Dr. J. Richard Crout said this of combination birth control pills:
Fundamentally, these pills take over the menstrual cycle from the normal endocrine mechanisms. And in so doing they inhibit ovulation and change the characteristics of the uterus so that it is not receptive to a fertilized egg. (FDA Consumer, HEW publication number 76-3024, reprinted from May, 1976.)
In 1970, J. Peel and M. Potts's Textbook of Contraceptive Practice (Cambridge University Press, 1970, page 8) acknowledged,
In addition to its action on the pituitary-ovarian axis the combination products ["the Pill"] also alter the character of the cervical mucus, modify the tubal transport of the egg and may have an effect on the endometrium to make implantation unlikely.
In their book Ovulation in the Human, P.G. Crosignani and D.R. Mishell (Academic Press, Inc., 1976, page 150), stated that birth control pills "alter the cervical mucus . . . as well as affect the endometrium, reducing glycogen production by the endometrial glands which is necessary to support the blastocyst."
The 1977 sixth edition of the Handbook of Obstetrics & Gynecology, then a standard reference work, states on pages 689-690,
The combination pill . . . is effective because LH release is blocked and ovulation does not occur; tubal motility is altered and fertilization is impeded; endometrial maturation is modified so that implantation is unlikely; and cervical mucus is thickened and sperm migration blocked.
(Notice that in this case four mechanisms are mentioned, and the prevention of implantation is listed before the prevention of conception by the thickened cervical mucus.)
The book My Body, My Health (Stewart, Guess, Stewart, Hatcher; Clinician's Edition, Wiley Medical Publications, 1979, page 169-70) states,
In a natural cycle, the uterine lining thickens under the influence of estrogen during the first part of the cycle, and then matures under the influence of both progesterone and estrogen after ovulation. This development sequence is not possible during a Pill cycle because both progestin and estrogen are present throughout the cycle. Even if ovulation and conception did occur, successful implantation would be unlikely.
It was not just obscure medical journals and textbooks which contained this information in the 70's. The popular magazine Changing Times explained, "The pill may affect the movement of the fertilized egg toward the uterus or prevent it from imbedding itself in the uterine lining." ("What We Know About the Pill," Changing Times, July 1977, page 21).
Pro-abortionists know it: Why don't we?
If most pro-lifers have been slow to catch on to this established medical knowledge (I certainly have been), many proabortionists are fully aware of it. In February 1992, writing in opposition to a Louisiana law banning abortion, Tulane Law School Professor Ruth Colker wrote,
Because nearly all birth control devices, except the diaphragm and condom, operate between the time of conception . . . and implantation . . . the statute would appear to ban most contraceptives. (The Dallas Morning News, February 6, 1992, 23A)
Colker referred to all those methods, including the Pill, which sometimes prevent implantation.
Similarly, in 1989 attorney Frank Sussman, representing Missouri Abortion Clinics, argued before the U.S. Supreme Court that "The most common forms of . . . contraception today, IUDs and low-dose birth control pills . . . act as abortifacients" (New York Times, National Edition, April 27, 1989, pages 15 & B13). (Remember, by that time all Pills were "low dose" compared to the Pill of the 60's and 70's and 97% were low dose by recent standards, in that they had less than 50 micrograms of estrogen.)
This is such well-established knowledge that the 1982 revised edition of the Random House College Dictionary, on page 137, actually defines "Birth Control Pill" as "an oral contraceptive for women that inhibits ovulation, fertilization, or implantation of a fertilized ovum, causing temporary infertility." When the Pill successfully inhibits implantation of a fertilized ovum, it causes an abortion. (I'm not suggesting, of course, that Random House or any dictionary is an authoritative source. My point is that the knowledge of the Pill's prevention of implantation is so firmly established scientifically that it can be presented as standard information in a household reference book.)
I found on the World Wide Web a number of sources that recognize the abortive mechanism of the Pill. For instance, the "Marie Berry Archive" has an article called "Remembering to Take the Pill." It states matter-of-factly, "Combination oral contraceptives . . . inhibit two other hormones -- H and FSH -- preventing the lining of the uterus or endometrium from developing and thus not allowing ova implantation" http://www.escape.ca/~jdk/mb0996.htm .
Another article, "Oral Contraceptives: Frequently Asked Questions," says "The combined oral contraceptive pill . . . impedes implantation of an egg into the endometrium (uterine lining) because it changes that lining" (http://www.nau.edu/~fronske/bcp.html). Again, most sources on the web are not authoritative, but these two articles, both carefully written, do reflect what is a widespread consensus about the abortive action of the Pill. (This reality does not present a problem to most of these researchers and writers, because of their belief systems.)
For years proabortionists have argued that if the Human Life Amendment, which recognizes each human life begins at conception, was to be put into law, this would lead to the banning of both the IUD and the Pill. When hearing this I used to think, "As usual, they're misrepresenting the facts and agitating people by pretending the Pill would be jeopardized by the HLA."
I realize now that while their point was to agitate people against the Human Life Amendment, they were actually correct in saying that if the amendment was passed and taken seriously, the Pill would violate it because it takes the life of an already conceived human being. They never claimed condoms or diaphragms would be made illegal by the Human Life Amendment. Why? Because when they work, those methods are 100% contraceptives -- they never cause abortions. It's because they know that the Pill sometimes prevents implantation that prochoice advocates could honestly make the claim that an amendment stating human life begins at conception would label the Pill as a product that takes human life.
Breakthrough ovulation & backup mechanisms
One of the most common misconceptions about the Pill is that its success in preventing discernible pregnancy is entirely due to its success in preventing ovulation. If a sexually active and fertile woman taking the Pill does not get pregnant in 97-99% of her cycles it does not mean she didn't ovulate in 97-99% of her cycles.
Many months the same woman would not have gotten pregnant even if she wasn't using the Pill. Furthermore, if the Pill's second mechanism works, conception will be prevented despite ovulation taking place. If the second mechanism fails, then the third mechanism comes to play. While it may fail too, every time it succeeds it will contribute to the Pill's perceived contraceptive effectiveness. That is, because the child is newly conceived and tiny, and the pregnancy has just begun six days earlier, that pregnancy will not be discernible to the woman. Therefore every time it causes an abortion the Pill will be thought to have succeeded as a contraceptive. Most women will assume it has stopped them from ovulating even when it hasn't. This illusion reinforces the public's confidence in the Pill's effectiveness, with no understanding that both ovulation and conception may have in fact not been prevented at all.
In his article "Ovarian follicles during oral contraceptive cycles: their potential for ovulation," Dr. Stephen Killick says, "It is well established that newer, lower-dose regimes of combined oral contraceptive (OC) therapy do not completely suppress pituitary and ovarian function" (Fertility and Sterility, October 1989, page 580).
Dr. Thomas Hilgers, renowned fertility expert, personally heard Dr. Ronald Chez, a scientist with the National Institute of Health (NIH), publicly state that the pills of today, with their lower estrogen doses, allow ovulation up to 50% of the time. Dr. Chez was at that time the head of the pregnancy research development branch of the NIH. (Having read this, I sought direct confirmation from Dr. Hilgers; I have a letter from him acknowledging that he did in fact hear Dr. Chez say this.)
Dr. David Sterns, in "How the Pill and the IUD Work: Gambling with Life" (American Life League, PO Box 1350, Stamford, VA 22555), states that "even the early pill formulations (which were much more likely to suppress ovulation due to their higher doses of estrogen) still allowed breakthrough ovulation to occur 1 to 3% of the time." He cites an award winning study by Dutch gynecologist Dr. Nine Van der Vange in which she discovered in Pill-takers "proof of ovulation based on ultrasound exams and hormonal indicators occurred in about 4.7% of the cycles studied."
To check this out myself, I obtained a copy of Dr. Van der Vange's original study, called "Ovarian activity during low dose oral contraceptives," published in Contemporary Obstetrics and Gynecology, edited by G. Chamberlain (London: Butterworths, 1988). On pages 323-24, Dr. Van der Vange concludes,
These findings indicate that ovarian suppression is far from complete with the low dose OC . . . Follicular development was found in a high percentage during low-dose OC use. . . . ovarian activity is very common for the low dose OC preparations. . . . the mode of action of these OC is not only based on ovulation inhibition, but other factors are involved such as cervical mucus, vaginal pH and composition of the endometrium.
This means that though a woman might not get measurably pregnant in 98% of her cycle months, there is simply no way to tell how often the Pill has actually prevented her ovulation. Given the fact that she would not get pregnant in many months even if she ovulated, and the fact that there are at least two other mechanisms which can prevent measurable pregnancy (one contraceptive and the other abortive), a 97% apparent effectiveness rate of the Pill might mean only a 70-90% effectiveness in actually preventing ovulation. (We could go much lower if we took the 50% figure stated by Dr. Chez of the National Institute of Health, but to be conservative I am choosing the higher rates of ovulation.) The other 7-27% of the Pill's "effectiveness" could be due to a combination of the normal rates of nonpregnancy, the thickening of the cervical mucus and -- at the heart of our concern here -- the endometrium's hostility to the fertilized egg.
As a woman's menstrual cycle progresses, her endometrium gradually gets richer and thicker in preparation for the arrival of any newly conceived child who may be there to attempt implantation. In a natural cycle, unimpeded by the Pill, the endometrium experiences an increase of blood vessels, allowing an increased blood supply to bring oxygen and nutrients to the child. There is also an increase in the endometrium's stores of glycogen, a sugar that serves as a food source for the blastocyst (newly conceived child) as soon as he or she implants.
The statements in The Physician's Desk Reference, and others to follow, testify that the Pill keeps the woman's body from creating the most hospitable environment for a child, resulting instead in an endometrium that is thin and depleted, deficient in both food (glycogen) and oxygen. This deficiency may result in the child's death by starvation and suffocation. (Scientifically, one does not have to have a stomach to starve or lungs to suffocate.)
Typically, the blastocyst (new person) attempts to implant at six days after conception. If implantation is unsuccessful, she starves to death and is flushed out of the womb in an early miscarriage. (When the miscarriage is the result of an environment created by a foreign device or chemical, it is actually an abortion.)
The March 1996 issue of Fertility and Sterility presents significant research results, then states,
These data suggest that the morphological changes observed in the endometrium of OC users have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs [oral contraceptives]. (Somkuti, et al., "The Effect of Oral Contraceptive Pills on Markers of Endometrial Receptivity, Fertility and Sterility, Volume 65, #3, 3/96, page 488.)
In an extensive study, Chowdhury & Joshi point to the diminished capacity of the endometrium as part of the effectiveness of the Pill ("Escape ovulation in women due to the missing of low dose combination oral contraceptive pills," Contraception, 1980; 22:241).
In a study of oral contraceptives published in a major medical journal Dr. G. Virginia Upton, Regional Director of Clinical Research for Wyeth International (one of the major birth control pill manufacturers), says this:
The graded increments in LNg in the triphasic OC serve to maximize contraceptive protection by increasing the viscosity of the cervical mucus (cervical barrier), by suppressing ovarian progesterone output, and by causing endometrial changes that will not support implantation. ("The Phasic Approach to Oral Contraception," The International Journal of Fertility, volume 28, 1988, page 129.)
Dr. Goldzieher (Hormonal Contraception, page 122) says as a result of the combined Pill's action "possibly the endometrium in such cycles may provide additional contraceptive protection. ' (Note that the author redefines "contraceptive," which historically meant something which prevents conception, yet is used here of preventing implantation of an already conceived person.)
The medical textbook Williams Obstetrics (Cunningham, et al, Stamford, CT: Appleton & Lange, 1993, page 1323) states, "Similar to estrogens, progestins produce an endometrium that is unfavorable to blastocyst implantation."
Drug Facts and Comparisons says this about birth control pills in its 1996 edition:
Combination OCs inhibit ovulation by suppressing the gonadotropins, follicle-stimulating hormone (FSH) and lutenizing hormone (LH). Additionally, alterations in the genital tract, including cervical mucus (which inhibits sperm penetration) and the endometrium (which reduces the likelihood of implantation), may contribute to contraceptive effectiveness.
"The Pill: How does it work? Is it safe?" (The Couple to Couple League, PO Box 111184, Cincinnati, OH, 45211) states on page 4:
When the Pill fails to prevent ovulation, the other mechanisms come into play. Thickened cervical mucus may make it more difficult for the sperm to reach the egg: however, if the egg is fertilized, a new life is created. The hormones slow the transfer of the new life through the fallopian tube, and the embryo may become too old to be viable when it does enter the uterus.
If the embryo is still viable when it reaches the uterus, underdevelopment of the uterine lining caused by the Pill prevents implantation. The embryo dies and the remains are passed along in the next bleeding episode which, incidentally, is not a true menstruation, even though it is usually perceived as such.
A standard medical reference, Danforth's Obstetrics and Gynecology (Philadelphia: J.B. Lippincott Co., 1994, 7th edition, page 626) states this: "The production of glycogen by the endometrial glands is diminished by the ingestion of oral contraceptives, which impairs the survival of the blastocyst in the uterine cavity."
In her article Abortifacient Drugs and Devices: Medical and Moral Dilemmas (Linacre Quarterly, August 1990, page 55), Dr. Kristine Severyn states,
The third effect of combined oral contraceptives is to alter the endometrium in such a way that implantation of the fertilized egg (new life) is made more difficult, if not impossible. In effect, the endometrium becomes atrophic and unable to support implantation of the fertilized egg. . . . the alteration of the endometrium, making it hostile to implantation by the fertilized egg, provides a backup abortifacient method to prevent pregnancy.
Established fact even in the Seventies
One of the things that surprised me in my research was that though many recent sources testify to the Pill's abortive capacity, it has been well established for more than two decades. The following eight sources were all written in the 1970's. (Keep in mind that the term "blastocyst" refers to the newly conceived human being -- "it" is not a thing, but a person, a "he" or "she."
Dr. Daniel R. Mishell of the USC School of Medicine said,
Furthermore, they [the combination pills] alter the endometrium so that glandular production of glycogen is diminished and less energy is available for the blastocyst to survive in the uterine cavity. ("Current Status of Oral Contraceptive Steroids," Clinical Obstetrics & Gynecology 19:4, December 1976, page 746.)
[While serving as] president of the Food and Drug Administration (FDA), Dr. J. Richard Crout said this of combination birth control pills:
Fundamentally, these pills take over the menstrual cycle from the normal endocrine mechanisms. And in so doing they inhibit ovulation and change the characteristics of the uterus so that it is not receptive to a fertilized egg. (FDA Consumer, HEW publication number 76-3024, reprinted from May, 1976.)
In 1970, J. Peel and M. Potts's Textbook of Contraceptive Practice (Cambridge University Press, 1970, page 8) acknowledged,
In addition to its action on the pituitary-ovarian axis the combination products ["the Pill"] also alter the character of the cervical mucus, modify the tubal transport of the egg and may have an effect on the endometrium to make implantation unlikely.
In their book Ovulation in the Human, P.G. Crosignani and D.R. Mishell (Academic Press, Inc., 1976, page 150), stated that birth control pills "alter the cervical mucus . . . as well as affect the endometrium, reducing glycogen production by the endometrial glands which is necessary to support the blastocyst."
The 1977 sixth edition of the Handbook of Obstetrics & Gynecology, then a standard reference work, states on pages 689-690,
The combination pill . . . is effective because LH release is blocked and ovulation does not occur; tubal motility is altered and fertilization is impeded; endometrial maturation is modified so that implantation is unlikely; and cervical mucus is thickened and sperm migration blocked.
(Notice that in this case four mechanisms are mentioned, and the prevention of implantation is listed before the prevention of conception by the thickened cervical mucus.)
The book My Body, My Health (Stewart, Guess, Stewart, Hatcher; Clinician's Edition, Wiley Medical Publications, 1979, page 169-70) states,
In a natural cycle, the uterine lining thickens under the influence of estrogen during the first part of the cycle, and then matures under the influence of both progesterone and estrogen after ovulation. This development sequence is not possible during a Pill cycle because both progestin and estrogen are present throughout the cycle. Even if ovulation and conception did occur, successful implantation would be unlikely.
It was not just obscure medical journals and textbooks which contained this information in the 70's. The popular magazine Changing Times explained, "The pill may affect the movement of the fertilized egg toward the uterus or prevent it from imbedding itself in the uterine lining." ("What We Know About the Pill," Changing Times, July 1977, page 21).
Pro-abortionists know it: Why don't we?
If most pro-lifers have been slow to catch on to this established medical knowledge (I certainly have been), many proabortionists are fully aware of it. In February 1992, writing in opposition to a Louisiana law banning abortion, Tulane Law School Professor Ruth Colker wrote,
Because nearly all birth control devices, except the diaphragm and condom, operate between the time of conception . . . and implantation . . . the statute would appear to ban most contraceptives. (The Dallas Morning News, February 6, 1992, 23A)
Colker referred to all those methods, including the Pill, which sometimes prevent implantation.
Similarly, in 1989 attorney Frank Sussman, representing Missouri Abortion Clinics, argued before the U.S. Supreme Court that "The most common forms of . . . contraception today, IUDs and low-dose birth control pills . . . act as abortifacients" (New York Times, National Edition, April 27, 1989, pages 15 & B13). (Remember, by that time all Pills were "low dose" compared to the Pill of the 60's and 70's and 97% were low dose by recent standards, in that they had less than 50 micrograms of estrogen.)
This is such well-established knowledge that the 1982 revised edition of the Random House College Dictionary, on page 137, actually defines "Birth Control Pill" as "an oral contraceptive for women that inhibits ovulation, fertilization, or implantation of a fertilized ovum, causing temporary infertility." When the Pill successfully inhibits implantation of a fertilized ovum, it causes an abortion. (I'm not suggesting, of course, that Random House or any dictionary is an authoritative source. My point is that the knowledge of the Pill's prevention of implantation is so firmly established scientifically that it can be presented as standard information in a household reference book.)
I found on the World Wide Web a number of sources that recognize the abortive mechanism of the Pill. For instance, the "Marie Berry Archive" has an article called "Remembering to Take the Pill." It states matter-of-factly, "Combination oral contraceptives . . . inhibit two other hormones -- H and FSH -- preventing the lining of the uterus or endometrium from developing and thus not allowing ova implantation" http://www.escape.ca/~jdk/mb0996.htm .
Another article, "Oral Contraceptives: Frequently Asked Questions," says "The combined oral contraceptive pill . . . impedes implantation of an egg into the endometrium (uterine lining) because it changes that lining" (http://www.nau.edu/~fronske/bcp.html). Again, most sources on the web are not authoritative, but these two articles, both carefully written, do reflect what is a widespread consensus about the abortive action of the Pill. (This reality does not present a problem to most of these researchers and writers, because of their belief systems.)
For years proabortionists have argued that if the Human Life Amendment, which recognizes each human life begins at conception, was to be put into law, this would lead to the banning of both the IUD and the Pill. When hearing this I used to think, "As usual, they're misrepresenting the facts and agitating people by pretending the Pill would be jeopardized by the HLA."
I realize now that while their point was to agitate people against the Human Life Amendment, they were actually correct in saying that if the amendment was passed and taken seriously, the Pill would violate it because it takes the life of an already conceived human being. They never claimed condoms or diaphragms would be made illegal by the Human Life Amendment. Why? Because when they work, those methods are 100% contraceptives -- they never cause abortions. It's because they know that the Pill sometimes prevents implantation that prochoice advocates could honestly make the claim that an amendment stating human life begins at conception would label the Pill as a product that takes human life.
Breakthrough ovulation & backup mechanisms
One of the most common misconceptions about the Pill is that its success in preventing discernible pregnancy is entirely due to its success in preventing ovulation. If a sexually active and fertile woman taking the Pill does not get pregnant in 97-99% of her cycles it does not mean she didn't ovulate in 97-99% of her cycles.
Many months the same woman would not have gotten pregnant even if she wasn't using the Pill. Furthermore, if the Pill's second mechanism works, conception will be prevented despite ovulation taking place. If the second mechanism fails, then the third mechanism comes to play. While it may fail too, every time it succeeds it will contribute to the Pill's perceived contraceptive effectiveness. That is, because the child is newly conceived and tiny, and the pregnancy has just begun six days earlier, that pregnancy will not be discernible to the woman. Therefore every time it causes an abortion the Pill will be thought to have succeeded as a contraceptive. Most women will assume it has stopped them from ovulating even when it hasn't. This illusion reinforces the public's confidence in the Pill's effectiveness, with no understanding that both ovulation and conception may have in fact not been prevented at all.
In his article "Ovarian follicles during oral contraceptive cycles: their potential for ovulation," Dr. Stephen Killick says, "It is well established that newer, lower-dose regimes of combined oral contraceptive (OC) therapy do not completely suppress pituitary and ovarian function" (Fertility and Sterility, October 1989, page 580).
Dr. Thomas Hilgers, renowned fertility expert, personally heard Dr. Ronald Chez, a scientist with the National Institute of Health (NIH), publicly state that the pills of today, with their lower estrogen doses, allow ovulation up to 50% of the time. Dr. Chez was at that time the head of the pregnancy research development branch of the NIH. (Having read this, I sought direct confirmation from Dr. Hilgers; I have a letter from him acknowledging that he did in fact hear Dr. Chez say this.)
Dr. David Sterns, in "How the Pill and the IUD Work: Gambling with Life" (American Life League, PO Box 1350, Stamford, VA 22555), states that "even the early pill formulations (which were much more likely to suppress ovulation due to their higher doses of estrogen) still allowed breakthrough ovulation to occur 1 to 3% of the time." He cites an award winning study by Dutch gynecologist Dr. Nine Van der Vange in which she discovered in Pill-takers "proof of ovulation based on ultrasound exams and hormonal indicators occurred in about 4.7% of the cycles studied."
To check this out myself, I obtained a copy of Dr. Van der Vange's original study, called "Ovarian activity during low dose oral contraceptives," published in Contemporary Obstetrics and Gynecology, edited by G. Chamberlain (London: Butterworths, 1988). On pages 323-24, Dr. Van der Vange concludes,
These findings indicate that ovarian suppression is far from complete with the low dose OC . . . Follicular development was found in a high percentage during low-dose OC use. . . . ovarian activity is very common for the low dose OC preparations. . . . the mode of action of these OC is not only based on ovulation inhibition, but other factors are involved such as cervical mucus, vaginal pH and composition of the endometrium.
This means that though a woman might not get measurably pregnant in 98% of her cycle months, there is simply no way to tell how often the Pill has actually prevented her ovulation. Given the fact that she would not get pregnant in many months even if she ovulated, and the fact that there are at least two other mechanisms which can prevent measurable pregnancy (one contraceptive and the other abortive), a 97% apparent effectiveness rate of the Pill might mean only a 70-90% effectiveness in actually preventing ovulation. (We could go much lower if we took the 50% figure stated by Dr. Chez of the National Institute of Health, but to be conservative I am choosing the higher rates of ovulation.) The other 7-27% of the Pill's "effectiveness" could be due to a combination of the normal rates of nonpregnancy, the thickening of the cervical mucus and -- at the heart of our concern here -- the endometrium's hostility to the fertilized egg.
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.
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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