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Part One of Three Parts (Download PDF file) Eternal Perspective Ministries (EPM)
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Part 2
More Confirming Evidence
Intrauterine Versus Ectopic Pregnancy Ratios
Dr. Walter Larimore is an Associate Clinical Professor of Family Medicine who has written over 150 medical articles in a wide variety of journals. Dr. Larimore, in a February 26, 1998 email to me, stated that if the Pill has no negative effect on the implantation process, then we should expect its reduction in the percentage of normal intrauterine pregnancies to equal its reduction in the percentage of extrauterine or ectopic (including tubal) pregnancies.
However, Dr. Larimore pointed out something highly significant—published data from all of the studies dealing with this issue indicate that the ratio of extrauterine to intrauterine pregnancies among Pill-takers significantly exceeds that of non-Pill-takers. The five studies cited by Dr. Larimore show an increased risk of ectopic pregnancies in Pill takers who get pregnant, 70% to 1390% higher than non-Pill takers who get pregnant.
What accounts for the Pill inhibiting intrauterine pregnancies at a disproportionately greater ratio than it inhibits extrauterine pregnancies? Dr. Larimore, who is a member of Focus on the Family's Physicians Resource Council, believes the most likely explanation is that while the Pill does nothing to prevent a newly-conceived child from implanting in the wrong place (i.e. anywhere besides the endometrium) it may sometimes do something to prevent him from implanting in the right place (i.e. the endometrium).
This evidence puts a significant burden of proof on anyone who denies the Pill's capacity to cause early abortions. If there is an explanation of the data that is more plausible, or equally plausible, what is it?
Dr. Larimore came to this issue with significant vested interests in believing the best about the birth control pill, having prescribed it for years. When he researched it intensively over an eighteen month period, in what he described to me as a "gut wrenching" process that involved sleepless nights, he came to the conclusion that in good conscience he could no longer prescribe hormonal contraceptives, including the Pill, the minipill, Depo-Provera and Norplant.
Dr. Larimore also told me that when he has presented this evidence to audiences of secular physicians, there has been little or no resistance to it. But when he has presented it to Christian physicians there has been substantial resistance. Why? Perhaps because secular physicians do not care as much whether the Pill prevents implantation and therefore tend to be objective in interpreting the evidence. Christian physicians very much do not want to believe the Pill causes early abortions, and therefore tend to resist the evidence. This is understandable. Nonetheless, we should not permit what we want to believe to distract us from what the evidence indicates we should believe.
Three Physicians and a Pharmacist
Dr. Paul Hayes, a prolife Ob/Gyn in Lincoln, Nebraska, pointed me to Leon Speroff's and Philip Darney's authoritative text A Clinical Guide for Contraception. 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:
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.
In an email to me dated February 22, 1997, Dr. Hayes pointed out a semantic aspect of Dr. Speroff's statement, which I, not being a physician, 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 an unfertilized egg, 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 alteration is common in later stages, as demonstrated by references to "terminating a pregnancy" instead of "killing a child." 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 that I was participating in the sale and distribution of a product that was, in fact, causing the loss of life.
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 has 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 breakthrough ovulation occurs.
Not One, but Five Elements of Risk
Sources indicate not only that Pill-induced endometrial changes prevent implantation (what I will call the Pill's first abortive effect), but, and this is a second abortive effect, that even if they do allow implantation they can prevent the proper nourishment or maintenance of the new child, resulting in a premature end of the pregnancy.
In My Body, My Health, the authors point to a third 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.
This is the same "contraceptive" effect Dr. Speroff referred to as "peristalsis within the fallopian tube."
In its 1984 publication "Facts About Oral Contraceptives," the U.S. Department of Health and Human Services stated,
Both kinds of pills…make it difficult for a fertilized egg to implant, by causing changes in fallopian tube contractions and in the uterine lining.
These changes in fallopian tube contractions can cause a failure to implant. This third abortive effect is distinct from the first two, both of which are caused by changes to the uterine lining. (Those who remain unconvinced about the abortive effect of Pill-caused endometrial changes must also address the separate but significant issue of tubal peristalsis.)
There's a fourth potential abortive threat, pointed out to me by a couple that stopped using their pills after reading the package insert. I have that insert in front of me. It concerns Desogen, a combination pill produced by Organon. Under the heading "Pregnancy Due to Pill Failure," 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? I asked this of Dr. William Toffler of the Oregon Health Sciences University, who is also a member of Focus on the Family's Physician's Resource Council. Dr. Toffler informed me that the hormones in the Pill, progestin and estrogen, can sometimes have a harmful effect on an already implanted child. The problem is, since women do not know they are pregnant in the earliest stages, 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"? Wouldn'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."
There is still a fifth risk, which is distinct in that it applies 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.
Why should pregnancy be avoided until three months after a woman has stopped using the Pill? One physician told me it's because the Pill produces an environment that threatens the welfare of a child, and that environment takes months to return to normal. If those effects are still considered a risk up to three months after the Pill was last taken, it also confirms the risks to both the pre- and post-implantation child while the Pill is still being used. Another physician suggested that abnormal eggs are more likely after Pill use and that is one reason for the warning.
(This should serve as a warning to couples that choose to stop taking the pill out of concern for its abortifacient potential. If they remain sexually active, they should use a non-abortive contraceptive for three months to allow time for the endometrium to return to normal. Otherwise, since the abortive mechanism may remain operative after the contraceptive mechanisms no longer are, for that brief period they could actually increase their chances of an abortion.)
The Morning-After Pill: Standard BCPs
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.
On February 24, 1997, the FDA approved the use of high doses of combination birth control pills as "emergency contraception." 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 and its role in sustaining the child that has already been created within her. As World magazine 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 that it simply increases the chances of doing what it already sometimes does—cause an abortion.
A 1999 press release from the American College of Obstetricians and Gynecologists (ACOG) asserts the following:
Many pharmacies…refuse to provide the [emergency contraception] based on the incorrect belief that it is an abortifacient…. [The] EC works by preventing ovulation, fertilization or the implantation of the fertilized egg into the uterus.
Later in the same press release the ACOG argues, "this [refusal to sell EC] makes absolutely no sense" because one large national pharmacy chain that refuses to carry it "already dispenses emergency contraception in the form of other prescription oral contraceptives."
In a USA Today article, "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.
This is another illustration of the role of semantics in minimizing our perception of the true nature of chemical abortions. 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 like saying 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 lived in, and to leave them out in the cold to die.
Consider the following in a medical journal article that responds to the question, "Must a Catholic hospital inform a rape victim of the availability of the 'morning-after pill'?"
Diethylstilbestrol, and other estrogens used after unprotected coitus, acts to prevent implantation of a fertilized ovum in the uterine mucosa…Thus these drugs are neither contraceptives nor abortifacients. From a medical viewpoint, pregnancy begins at the completion of implantation, and the accurate way to describe the action of the morning-after pill is "pregnancy interception."
"Pregnancy interception" is still another term that obscures what really happens in a chemical abortion. Define pregnancy however you wish, but it does not change the fact there is a living child prior to implantation.
Webster's 1984 ninth edition New Collegiate Dictionary defines the word conception as "the act of becoming pregnant." Yet many sources I have consulted, including the above, admit the Pill can allow conception and prevent implantation, but insist on describing this as "preventing pregnancy."
The truth is, whatever prevents implantation kills the same unique human being as any later abortion procedure. The terms this is couched in may make it sound better, but they cannot change what it really is.
Evidence to the Contrary?
Is there any evidence refuting the abortive potential of the Pill? I have searched far and wide to find such evidence myself, and have also asked a number of physicians to provide me with any they have or know of. What I have managed to find, I will now present.
In several cases, I deliberately do not state the names of Christian physicians and organizations that have written some of the letters and articles I am citing. I know this is unusual, but I am determined not to create unnecessary hostility or disunity. I have no desire to put any brother or sister in Christ on the spot, nor do I want to run the risk of making them more defensive of their position. In cases where I have not mentioned names, I must ask the reader to trust that I have the actual documents in front of me.
An interview with Physicians
"Advances in Oral Contraception" in The Journal of Reproductive Medicine, is a question and answer session with eight physicians. The prolife physician who gave this to her pastor underlined statements that in her mind refute the notion 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."
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 mode. A more significant segment of the same article is this:
Are factors besides anovulation [not ovulating] 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 they only qualify the mountain of other evidence, they do not refute it. Dr. Christie acknowledges the antiimplantation 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. Obviously, for every measurable pregnancy there are a number of breakthrough ovulations.
Dr. Goldzieher, whose own work, cited elsewhere in this book, acknowledges the antiimplantation effect, affirms that, "it certainly is absent in some cases." Ironically, this quotation assumes the very thing the physician giving the letter to her pastor was trying to assure him wasn't true. When you say the effect of preventing implantation is absent in some cases, you are implying it is present in some cases. (In any case, a physician wrote to me that the high-dose Enovid Goldzieher refers to is no longer made.)
Again, no one claims 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.
Letters from Prolife Physicians
I have before me a four-page letter from a prolife physician, assuring the recipient that the Pill, Norplant and Depo-Provera are not abortifacients, while RU-486, the "morning after pill" and the "minipill" are abortifacient. The letter is well crafted, 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!
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. Unfortunately, beliefs do not constitute evidence.
When I submitted to him a half dozen of the sources I've cited in this book, a prolife physician 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 mucus.
I do not question this physician's sincerity, but I do question his 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 number three never works? The logic escapes me. If number three didn't involve an abortion, I don't think anyone would deny it happens. It appears this denial is not prompted by any real evidence, but by the desire the evidence not be true.
Letters from Christian Organizations
A number of people have sent me responses from Christian organizations they have received after writing to ask if the Pill really causes abortions. These letters raise various arguments, which I address in the "Objections" section at the end of this book.
One of these letters states that the Pill "rarely, if ever, permits conception."
The term "if ever" is certainly false, since the BCP manufacturers themselves admit 3% of those taking the Pill experience a pregnancy in any given year. In fact, recent research indicates that figure may be considerably higher-up to 4% for "good compliers" and 8% for "poor compliers."
The letter goes on to say, "criticism of oral contraception heaps needless guilt upon women who literally cannot use any other method of contraception—guilt which seems especially unnecessary…"
The letter does not deal with the issue of what is true nearly as much as the issue of how bad some people feel when they hear that the Pill causes abortions. The letter, from a fine organization, goes on to say this:
Our programming staff has come to the conclusion that it might be wisest to avoid further discussions of this subject on the air. The last time we offered such a broadcast, the ensuing mail revealed how very wide is the array of opinions that exists among committed believers is this area...It seems we are bound to offend someone as soon as we open our mouths, and we continue to receive criticism from listeners with differing perspectives despite our attempts to present a balanced treatment of the subject. This is why we have no plans for future programs of this kind.
I believe the writer honestly thought he answered the inquiry. In fact, he did little more than point out the variety of opinions within the Christian community, without offering evidence to suggest which might be right. While the letter gave the clear impression that the Pill does not cause abortions, it did not cite any evidence to indicate it does not, and did nothing to refute the substantial evidence that it does.
Another letter, written by a different person at the same organization, was emphatic:
We have consulted with medical advisors who have reviewed a wealth of competent, scientific research on this issue. In their opinion, these studies suggest that the Pill does not act as an abortifacient; rather it works solely by preventing ovulation. Even in the rare event that conception takes place, they do not believe that it is accurate to attribute the possibility of the conceptus failing to implant to the action of the Pill.
Some recipients of such a letter will come away assured they now know the truth about the Pill—it never causes abortions. Unfortunately, while sounding credible, the letter makes a provably false statement (that the Pill "works solely by preventing ovulation"). Furthermore, it does not offer a single reference to so much as a quote, name, book, article, lecture or any source whatsoever to back up its claims.
We called the organization to inquire concerning the identity of any of this "wealth of competent, scientific research" that supports this definitive statement that the Pill doesn't cause abortions. I was very eager to examine such material. Both writers of these letters are no longer with this organization, and the person we spoke with was not aware of any such research and could not point us toward it. (Certainly, if such information exists, the research departments of the Pill manufacturers are not aware of it. If they were, they would cite it when called by people like myself whose minds would be relieved by any evidence that the Pill doesn't cause abortions.)
Though I am not questioning integrity or motives, it is particularly unfortunate when a Christian organization gives incomplete, inaccurate and misleading information to those inquiring about the Pill because they sincerely want to avoid jeopardizing the lives of unborn children.
Article in a Christian Magazine
Writing in a popular women's magazine, a Christian family physician states that some people have expressed concern that non-barrier birth control methods may prevent implantation. He then says this:
While not at all like the deliberate destruction of the growing fetus that occurs during a "therapeutic" abortion, this interruption of the earliest stages of human life could be considered an unintentional abortion.
"Could be considered an unintentional abortion"? How could it be considered anything else? "Not at all like the deliberate destruction of the growing fetus"? It may not be deliberate, but that doesn't make it utterly unlike later abortions. It is unlike them in intent, but exactly like them in effect—both kill a child. (The child who dies is also "growing," just like the "fetus" in later abortions.)
The same physician says this concerning the Pill:
The possibility of an "unfriendly uterus" preventing pregnancy has long been mentioned in the standard FDA-approved product literature for oral contraceptives, but a number of researchers aren't convinced this takes place. Overall, the likelihood of such unintentional abortions appears to be extremely remote, if not infinitesimal.
The author does not cite studies from any of these unconvinced researchers, nor does he identify them. The only evidence he presents for abortions being "extremely remote" is that "the fertilized egg actually appears to be quite proficient at burrowing into the lining of the uterus." He says that this is demonstrated by women who become pregnant after missing a single dose of the Pill and even after not missing any at all.
Once again, the fact that implantation sometimes takes place despite the Pill's creation of an inhospitable endometrium in no way negates the fact that it occurs more often in a hospitable endometrium.
Speech by a Prolife Physician
A reader sent me a photocopied page from an article, but unfortunately the name and date of the publication isn't included and I have been unable to trace it. The article is an excerpt from a speech by a prolife 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 without 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 studies reported in medical journals over decades, consistently affirm there is an anti-implantation effect of the Pill, 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 prolife physician as evidence of anything but the human tendency to deny something we do not wish to believe. (If a reader knows Dr. Mastroianni, and he does have evidence for his beliefs, I would very much like to see it, and will gladly revise this book accordingly.)
Clinical Experience
Dr. William Colliton, who is convinced of the abortifacient nature of the Pill, refers to some anecdotal experience that may contribute toward the general belief of many physicians that no abortions occur while a woman is on the Pill. With regard to clinical evidence he writes that the physician may "note that the typical clinical picture of spontaneous abortion (heavy bleeding, severe cramping, passage of tissue) is rarely, if ever, seen by practicing physicians caring for patients on the Pill."
He then writes,
They seem to overlook the fact that the abortions caused by the BCP occur when the baby is 5 to 14-16 days old and that the lining of the uterus is 'less vascular, less glandular, thinner' than normal as they describe it. From the clinical perspective, one would anticipate a non-event.
In other words, the fact that a treating physician does not see typical symptoms related to miscarriage is no proof that an abortion has not occurred. After all, a side effect of the Pill is amenorrhea; the uterine environment is changed so that there is "no menstrual flow when on the break from the hormones." These changes exclude normal symptoms of miscarriage, and therefore the lack of those symptoms proves nothing.
Study on Norplant's Damage to Ova
One physician presented me with a study of Norplant, which he believes calls into question the concept of an inhospitable endometrium:
As with other hormonal contraceptives, Norplant use is associated with suppressed endometrial development…Ovulation inhibition is the primary mechanism of Norplant's contraceptive action. Ovulation may occur, however, in about 45% of the cycles of long-term users of Norplant…at least two alternative mechanisms can be postulated…the hostility of the cervical mucus to sperm penetration, and impaired maturation of the oocyte, rendering it nonfertilizable because of low levels of follicle—stimulating hormone and LH that occur during use of Norplant.
The authors believe that given their method of study "it would have been possible to identify menstrual abortions if they had occurred." They state such evidence was absent. The article ends by saying; "We conclude from these data that postfertilization interruption of early pregnancy (menstrual abortion) does not play a role in the mechanism of action of Norplant."
Because both contain progestin, the physician who showed me the study felt the conclusion pertained not only to Norplant, but the Pill. There are several problems here. First, the study was done on Norplant, not the Pill. While both have progestin, they are not the same product—Norplant's operative chemical is progestin only, while the combination pill also contains estrogen. The chemical amounts, how they assimilate into the body and other factors differ between the two products. This study's results do not correspond to those of many other studies of Norplant, and it may or may not be authenticated by further studies. In any case, studies on Norplant and the Pill are not interchangeable.
Second, the fact remains that some women taking Norplant get pregnant. Obviously, then, ova are not always damaged, and are not always incapable of being fertilized. Hence, the "damaged egg" mechanism, like all others, does not always work.
Third, this study was done on only thirty-two women. This is too small a sampling to reach definitive conclusions. Studies with small test groups may be helpful as confirmations of established research, but they are not sufficient to warrant significant changes in conclusions, apart from larger studies showing them to be valid.
Fourth, if it has any pertinence at all to the Pill, which is uncertain, this study would have to be weighed against all the other sources, not to mention common sense, that connect an atrophied endometrium to a smaller likelihood of implantation. All the Pill manufacturers, who have done by far the most research on the matter, conclude that the Pill produces an inhospitable endometrium that reduces the likelihood of implantation. It would take considerably more evidence than this small study—and evidence directly pertaining to the Pill, not Norplant—to stack up against the established evidence that the Pill causes abortions.
Statement by 20 Prolife OB-GYN Specialists who are pro-Pill
A strong statement against the idea that the Pill can cause abortions was issued in January 1998, five months after the original printing of this book. (And, it has been suggested to me, largely in response to it.) According to a January 30, 1998 email sent me by one of its circulators, the statement "is a collaborative effort by several very active pro-life OB-GYN specialists, and screened through about twenty additional OB-GYN specialists."
The statement is entitled "Birth Control Pills: Contraceptive or Abortifacient?" Those wishing to read it in its entirety, which I recommend, can find it at our EPM web page, at www.epm.org/doctors.html. I have posted it there because while I disagree with its major premise and various statements in it, I believe it deserves a hearing.
The title is somewhat misleading, in that it implies there are only two ways to look at the Pill: always a contraceptive or always an abortifacient. In fact, I know of no one who believes it is always an abortifacient. There are only those who believe it is always a contraceptive and never an abortifacient, and those who believe it is usually a contraceptive and sometimes an abortifacient. (This misleading title sets up a straw man argument, since it is easy to prove the Pill does not always cause abortions.)
The paper opens with this statement:
Currently the claim that hormonal contraceptives [birth control pills, implants (Norplant), injectables (DepoProvera)] include an abortifacient mechanism of action is being widely disseminated in the pro-life community. This theory is emerging with the assumed status of "scientific fact," and is causing significant confusion among both lay and medical pro-life people. With this confusion in the ranks comes a significant weakening of both our credibility with the general public and our effectiveness against the tide of elective abortion.
The question of whether the presentation of research and medical opinions, such as those in this book, causes "confusion" is interesting. Does it cause confusion, or does it bring to light pertinent information in an already existing state of confusion? Would we be better off to uncritically embrace what we have always believed than to face evidence that may challenge it?
Is our credibility and effectiveness weakened through presenting evidence that indicates the Pill can cause abortions? I'll come back to this and related objections later, but I think we need to commit ourselves to discovering and sharing the truth regardless of whether it is well-received by the general public or the Christian community.
The physicians' statement's major thesis is this—the idea that the Pill causes a hostile endometrium is a myth:
Over time, the descriptive term "hostile endometrium" progressed to be an unchallenged assumption, then to be quasi-scientific fact, and now, for some in the pro-life community, to be a proof text. And all with no demonstrated scientific validation.
When I showed this to one professor of family medicine he replied, "This is an amazing claim." Why? Because, he pointed out, it requires that every physician who has directly observed the dramatic pill-induced changes in the endometrium, and every textbook that refers to these changes, has been wrong all along in believing what appears to be obvious: that when the zygote attaches itself to the endometrium its chances of survival are greater if what it attaches to is thick and rich in nutrients and oxygen than if it is not.
This is akin to announcing to a group of farmers that all these years they have been wrong to believe the myth that rich fertilized soil is more likely to foster and maintain plant life than thin eroded soil.
It could be argued that if anything may cause prolifers to lose credibility, at least with those familiar with what the Pill does to the endometrium, it is to claim the Pill does nothing to make implantation less likely.
The authors defend their position this way:
[The blastocyst] has an invasive nature, with the demonstrated ability to invade, find a blood supply, and successfully implant on various kinds of tissue, whether "hostile," or even entirely "foreign" to its usual environment—decidualized (thinned) endometrium, tubal epithelium (lining), ovarian epithelium (covering), cervical epithelium (lining), even peritoneum (abdominal lining cells)…The presumption that implantation of a blastocyst is thwarted by "hostile endometrium" is contradicted by the "pill pregnancies" we as physicians see.
This is very similar to the argument of Dr. Struthers at Searle, the Pill-manufacturer. Unfortunately, it misses the point, since the question is not whether the zygote sometimes implants in the wrong place. Of course it does. The question, rather, is whether the newly-conceived child's chances of survival are greater when it implants in the right place (endometrium) that is thick and rich and full of nutrients than in one which lacks these qualities because of the Pill. To point out a blastocyst is capable of implanting in a fallopian tube or a thinned endometrium is akin to pointing to a seed that begins to grow on asphalt or springs up on the hard dry path. Yes, the seed is thereby shown to have an invasive nature. But surely no one believes its chances of survival are as great on a thin hard rocky path as in cultivated fertilized soil.
According to the statement signed by the twenty physicians, "The entire 'abortifacient' presumption, therefore, depends on 'hostile endometrium'." Actually this isn't true, since one of the apparent abortifacient effects of the Pill is what Dr. Leon Speroff and others refer to as peristalsis within the fallopian tube. This effect speeds up the blastocyst's travel so it can reach the uterus before it's mature enough to implant. Even if the endometrium was not altered to become inhospitable, this effect could still cause abortions. (It would be accurate to say that the abortifacient belief is based mainly, though not entirely, on the concept of an inhospitable endometrium.)
In fact, one need not embrace the term "hostile" endometrium to believe the Pill can cause abortions. It does not take a hostile or even an inhospitable endometrium to account for an increase in abortions. It only takes a less hospitable endometrium. Even if they feel "hostile" is an overstatement, can anyone seriously argue that the Pill-transformed endometrium is not less hospitable to implantation than the endometrium at its rich thick nutrient-laden peak in a normal cycle uninfluenced by the Pill?
A professor of family medicine told me that until reading this statement he had never heard, in his decades in the field, anyone deny the radical changes in the endometrium caused by the Pill and the obvious implications this has for reducing the likelihood of implantation. This is widely accepted as obvious and self-evident. According to this physician, the fact that secular sources embrace this reality and only prolife Christians are now rejecting it (in light of the recent attention on the Pill's connection to abortions) suggests they may be swayed by vested interests in the legitimacy of the Pill.
The paper states "there are no scientific studies that we are aware of which substantiate this presumption [that the diminished endometrium is less conducive to implantation]." But it doesn't cite any studies, or other evidence, that suggest otherwise.
In fact, surprisingly, though the statement that was sent to me is five pages long it contains not a single reference to any source that backs up any of its claims. If observation and common sense have led people in medicine to a particular conclusion over decades, should their conclusion be rejected out of hand without citing specific research indicating it to be incorrect?
On which side does the burden of proof fall—the one that claims the radically diminished endometrium inhibits implantation or the one that claims it doesn't?
The most potentially significant point made in the paper is this:
The ectopic rate in the USA is about 1% of all pregnancies. Since an ectopic pregnancy involves a preimplantation blastocyst, both the "on pill conception" and normal "non pill conception" ectopic rate should be the same—about l% (unaffected by whether the endometrium is "hostile" or "friendly.") Ectopic pregnancies in women on hormonal contraception (except for the minipill) are practically unreported. This would suggest conception on these agents is quite rare. If there are millions of "on-pill conceptions" yearly, producing millions of abortions, (as some "BC pill is abortifacient" groups allege), we would expect to see a huge increase in ectopics in women on hormonal birth control. We don't. Rather, as noted above, this is a rare occurrence.
The premise of this statement is right on target. It is exactly the premise proposed by Dr. Walter Larimore, which I've already presented. While the statement's premise is correct, its account of the data, unfortunately, is not. The five studies pointed to by Dr. Larimore, cited earlier, clearly demonstrate the statement is incorrect when it claims ectopic pregnancies in women on hormonal contraception are "practically unreported" and "rare."
This book makes no claims as to the total numbers of abortions caused by the Pill. But the statement signed by the twenty physicians affirms that if the Pill caused millions of abortions we would "expect to see a huge increase in ectopics in women on hormonal birth control." In fact, that is exactly what we do see—an increase that five major studies put between 70% and 1390%.
Ironically, when we remove the statement's incorrect data about the ectopic pregnancy rate and plug in the correct data, the statement supports the very thing it attempts to refute. It suggests the Pill may indeed cause early abortions, possibly a very large number of them.
I have been told that the above statement from prolife physicians was sent to every prolife pregnancy center in the country in an attempt to reassure them that the talk about the Pill sometimes causing abortions is inaccurate and misguided. Unfortunately, the statement itself was poorly researched and misleading. However, pregnancy centers receiving the statements did not know this. Many were understandably impressed with the list of prolife physicians apparently agreeing with the statement. Unfortunately, it appears that very few of these physicians actually researched the issue. They appear to have relied almost completely on the sincerely believed but faulty research of a few.
Statement by 26 Prolife OB-GYN Specialists who believe the Pill causes abortions
In response to the strong statement put forth by twenty of their well-respected colleagues, another collaborative statement was issued at the 1998 mid-winter gathering of the American Association of Prolife Obstetricians and Gynecologists (AAPLOG). Opening the debate, Dr. Pamela Smith stated,
…it has become glaringly apparent that now is the time for us, as an organization, to sail into the dangerous and uncharted waters that we have perhaps intentionally avoided. These are the "waters" of prolife principles as they relate to fertility control.
I have intentionally used the words "fertility control" rather than contraception for a number of reasons. Foremost of which is the raging moral, biological and scientific debate, almost exclusively within the prolife community, as to whether the mechanism of certain fertility control measures are contraceptive or abortifacient at a microscopic level.
The AAPLOG convention concluded with a document that includes the following statement:
The undersigned [26 OB-GYN specialists] believe that the facts as detailed in this document indicate the abortifacient nature of hormonal contraception. This is supported by the scientific work of the Alan Guttmacher Institute which can, in no way, be confused with a right-to-life organization. We also want to make it clear that we have no desire to cause confusion and division among prolife forces. However, we do want to make it clear that we do desire that all women using the Pill are truthfully and fully informed about all its modes of action [including abortifacient].
A complete article entitled "Birth Control Pill: Abortifacient and Contraceptive" by William F. Colliton, Jr., M.D., FACOG, which includes the above statements can be found at the EPM web page www.epm.org/26doctor.html.
It should go without saying that the latter statement should not be regarded as more credible simply because it has been signed on to by six more OB-GYNs than the prior one. The point is not numbers (26 people can be wrong as easily as 20) but accuracy of research and evidence. I believe that on close inspection (unfortunately this rarely takes place) nearly all objective parties would agree that the second statement is based on sounder science than the first.
I do not know how many pregnancy centers have received or read this second document. I do know, as of late in 2000, many sincere prolifers are still citing the earlier statement and continue to make inaccurate statements such as "There's really no evidence the Pill can cause abortions" or even "it's been proven by doctors that the Pill is never an abortifacient." I wish these statements were true. Unfortunately, they are not.
How often Does the Pill Cause Abortions?
Why It's So Difficult to Know for Sure
How many abortions does the Pill cause? This is difficult to determine. The answer depends on how often the Pill fails to prevent ovulation, and how often when ovulation fails and pregnancy occurs, the third mechanism prevents a fertilized egg from implanting.
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 email:
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.
Determining Breakthrough Ovulation Rates
Despite the fact that definitive numbers cannot be determined, there are certain medical evidences that provide rationale for estimating 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, 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. He cites studies suggesting oral contraceptives have a breakthrough ovulation rate of 2 to 10%.
World-renowned fertility specialist Dr. Thomas Hilgers estimates the breakthrough ovulation rate at 4 to 10%.
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.
In another study, 14% of Pill-taking women experienced escape ovulation. However, this involved only twenty-two women, with three experiencing escape ovulation, so the study is too small to draw definite conclusions. In another study with a small sampling, 10% of the control group, which didn't miss a pill, experienced escape ovulation, while 28% of those missing two pills ovulated.
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.
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 increase the likelihood of the Pill causing an abortion. Dr. 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.
When the first mechanism fails, how often does the second work?
We've seen that various sources and studies put breakthrough ovulation among Pill-takers at rates of 2-10%, 4-10%, 4.7%, 7%, 14%, 10%, and 20%. The next question is, how many times when ovulation occurs does the second mechanism, the thickened cervical mucus, prevent sperm from reaching the egg? There is no way to be sure, but while this mechanism certainly works sometimes, it may not work most of the time.
Drs. Chang and Hunt did experiments on rabbits that could not be done on human beings. They gave the rabbits estrogen and progestin to mimic the Pill, then artificially inseminated them. Next, they killed the rabbits and did microscopic studies to examine how many sperm had reached the fallopian tubes and could have fertilized an egg.
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. The progestin-caused increase in thickness of cervical mucus did not significantly inhibit sperm from reaching the egg in the rabbit.
This is certainly not definitive proof, since there can be significant physiological differences between animals and humans. However, animals are routinely used for such experiments to determine possible or probable results in humans. Though I have read several studies on human sperm transport, they seemed to offer no helpful information related to this subject. Dr. Melvin Taymor of Harvard Medical School admits, "Sperm transport in women appears to be very complex." The study by Chang and Hunt, while not persuasive in and of itself, at least raises questions about the extent of the contraceptive effectiveness of thickened cervical mucus.
When ovulation takes place, how often will the thickened mucus fail to prevent conception? The answer is certainly "some of the time." It may also be "much of the time," or even "most of the time."
When the second mechanism fails, how often does the third work?
The next question is, in those cases when the second mechanism doesn't work, how often does the significantly altered and less hospitable endometrium caused by the Pill interrupt the pregnancy?
The Ortho Corporation's 1991 annual report estimated 13.9 million U.S. women using oral contraceptives. Now, how often would one expect normally fertile couples of average sexual activity to conceive? Dr. Bogomir Kuhar uses a figure of 25%. This is confirmed by my research. In "Estimates of human fertility and pregnancy loss," Michael J. Zinaman and associates cite a study by Wilcox in which "following 221 couples without known impediments of fertility, [they] observed a per cycle conception rate of 25% over the first three cycles."
Multiplying this by the low 2% ovulation figure among Pill takers, and factoring in a 25% conception rate, Dr. Kuhar arrives at a figure of 834,000 birth-control-pill-induced abortions per year. Multiplying by 10%, a higher estimate of breakthrough ovulation, he states the figure of 4,170,000 abortions per year. (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.)
There are several objections to this method of computation. First, it assumes all women taking the Pill, and their partners, have normal fertility rates of 25%, when in fact some women taking the Pill certainly are less fertile than this, as are some of their partners. Second, the computation fails to take into account the Pill's thickening of the cervical mucus which may significantly reduce the rate of conception. Third, it fails to consider the 3% rate of sustained pregnancy each month among Pill-takers, which obviously are not Pill-induced abortions.
Of course, everything depends on the true rate of breakthrough ovulation, and the true rate of contraception due to thickened cervical mucus, both of which remain unknown. Even if the range of abortions is less than indicated by Dr. Kuhar's computation, however, the total numbers could still be very high.
Several medical researchers have assured me scientific studies could be conducted on this. So far, though, the issue of Pill-induced abortions hasn't received attention. Since no conclusive figures exist, we are left with the indirect but substantial evidence of the observably diminished capacity of the Pill-affected endometrium to sustain life. Since there is nothing to indicate otherwise, it seems possible that implantation in the inhospitable endometrium may be the exception rather than the rule. For every child who does implant, many others may not. Of course, we don't know the percentage that will implant even in a normal endometrium unaffected by the Pill. But there is every reason to believe that whatever that percentage is, the Pill significantly lowers it.
Let's try a different approach to the numbers. According to Pill manufacturers, approximately fourteen million American women take the Pill each year. At the 3% annual sustained pregnancy 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 be conceived despite the thickened cervical mucus. Each has managed to implant even in a "hostile" endometrium.
The question is, how many children failed to implant in that inhospitable environment who would have implanted in a nurturing environment unhindered by the Pill? The numbers that die might be significantly higher than the numbers that survive. If it were four times as high, that would be 1,680,000 annual deaths; if twice as high, 840,000 deaths. If the same numbers of children do not survive the inhospitable endometrium as do survive, it would be 420,000 deaths. If only half as many died as survived, this would be 210,000; if a quarter as many died as survived 105,000—still a staggering number of Pill-induced abortions each year. Perhaps the figure is even lower than the lowest of these. I certainly hope so. Unfortunately, I have seen no evidence to substantiate my hope.
Even if we believe these fatality numbers are too high, we must avoid the tendency to minimize the value of any human life. I've been told by people, "There's no way six million Jews died in the holocaust. At most it was half a million." My response is, "I think there's reason to believe the figure is much more than half a million. But suppose it was a lot less. How many deaths of the innocent does it take to qualify as a tragedy?" Similarly, we might ask, "How many children have to be killed by the Pill to make it too many?"
In his brochure "How the Pill and the IUD Work: Gambling with Life," 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.
Perhaps the annual numbers of Pill-induced abortions add up to millions, perhaps hundreds of thousands, perhaps tens of thousands. When we factor in abortions caused by other birth control chemicals, including the Mini-Pill, Norplant and Depo-Provera, the total figures are almost certainly very high. When prolifers 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 this 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, 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 ova, perhaps nine would never be fertilized, some prevented by the number two mechanism, the thickened cervical mucus, and some attributable to the normal rate of nonpregnancy. And perhaps, as a result of the number three mechanism, she might have five early abortions because though conception took place, 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. 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 a woman taking the Pill might over time have no Pill-induced abortions, or she might have one, three or a dozen of them.
We have not even taken into account here the other abortive mechanisms of the Pill documented earlier, including the peristalsis within the fallopian tube that decreases the chances of implantation, and the chemical dangers to an already conceived child whose mother unknowingly continues to take the Pill. Neither have we considered the residual effect of the Pill that can inhibit implantation as much as a few months after a woman has stopped using it.
The evidence, not wishful thinking, should govern our beliefs. The numbers have not been decisively determined, and may never be this side of eternity. Based on what we do know, we must ask and answer this question: is it morally right to unnecessarily risk the lives of children by taking the Pill?
Responding to the Evidence: Questions & Objections
In the process of research I've had countless conversations with fellow Christians, including physicians and pastors. These are the questions and objections people have most often raised.
"If this is true, why haven't we been told?"
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 any ethical 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?
Dr. T. B. Woutersz, an employee of Wyeth Laboratories, made an amazing admission about birth control pill studies in his article "A Low-Dose Combination Oral Contraceptive":
Despite extensive clinical studies conducted by manufacturers of marketed products, only these published papers of study cohorts are available for the benefit of the prescribing physician. All other published papers represent selected, partial reports of individual investigators. This does not afford a physician much opportunity to make an educated selection of an oral contraceptive.
The individual who brought this to my attention is also a Wyeth employee, who asked not to be identified. In a letter dated August 11, 1997 this person told me, "Many, probably most, birth control studies are not published. They are never published in their entirety. This is a very competitive business. Companies are not obligated to publish proprietary information."
This helps explain why it was so difficult for me to obtain research information from the Pill-manufacturers. They have their own research departments with dozens of full-time researchers who must produce thousands of pages of findings every year. But these findings are distilled down into very small packets of information, including the three operative mechanisms stated in the PDR, the third of which is prevention of implantation. I did not manage to get from any of the manufacturers any detailed studies to confirm exactly how they came to their conclusions. I had to search out on my own the research information in medical journals, which is usually based on much smaller samplings with a great deal less funding behind them.
The published indications of Pill-caused abortions is substantial. But it is spread out in dozens of obscure and technical scientific journals. Consequently, not only is the most significant evidence not in print, but relatively few physicians—and almost no one in the general public—have ever seen the most compelling evidence that is in print. If they have heard anything at all, it has only been piecemeal. The evidence that has managed to make it to publication has fallen through the cracks and failed to get the attention of physicians.
Many well-meaning physicians, including Christians, and including Ob/GYNs and Family Practitioners, simply are not aware of this evidence. I know this, because that's exactly what a number of them have told me. This is not entirely surprising. Consider the staggering amount of medical knowledge that currently exists. Now picture the average physician who is both conscientious and overworked, swamped with patients. He might read medical journals in an area of special interest, but there is no way any human being can be fully appraised of the tens of thousands of medical studies conducted each year in this country.
When patients hear someone suggest the Pill causes abortions, they will often come to their physician, who may be prolife, and ask 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."
Most physicians assume that if the Pill really caused abortions, they would surely know it. In most cases they are not deliberately misleading their patients. Unfortunately, the bottom line is that their patients do end up misled. Based on their physician's reassurances, they don't look into the matter further—nor would most know where to look even if they wanted to. In reality, the dedicated physician is extremely busy and confident that the Pill only prevents conception; typically he too does not take the time to do the necessary research.
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 devoted a cover story to the subject, the information would reach a popular level in a way it never has before. But Time and most of its readers would have little interest in the subject. Perhaps eventually a major Christian magazine will present this research to the people who should care the most. So far this has not happened.
Medical semantics have also played a critical role in obscuring the Pill's abortive mechanism. As documented earlier in this book, in 1976 the word "contraceptive" was redefined by the American College of Obstetricians and Gynecologists (ACOG), to include agents that prevent implantation. Changes in terminology typically occur to draw more careful scientific distinctions, whereas this one served only to blur the distinction between two clearly separate things, fertilization and implantation. Several prolife Ob/GYNs told me they are convinced this move, happening three years after the Supreme Court's 1973 legalization of abortion, was a deliberate attempt to obscure concerns about birth control chemicals that sometimes cause early abortions.
Because of the semantic change, medical professionals can honestly say that the Pill is only a contraceptive, even if they know it sometimes acts to prevent implantation. For example, Dr. Linda J. Martin wrote to Pediatric News pointing out that while an August 1997 article had claimed the emergency contraception pill could "prevent up to 800,000 abortions a year," exactly the opposite was the case—"they would in fact cause 800,000 abortions a year." Her logic was that life begins at conception, not implantation. The physician who wrote the article, Dr. James Trussel, responded, "Both the National Institutes of Health and the American College of Obstetricians and Gynecologists define pregnancy as beginning with implantation. Therefore, emergency contraceptive pills are not abortifacient."
This is a dramatic but increasingly common example of semantic depersonalization—using an arbitrary redefinition to relegate a child to nonexistence. What might properly be called a "contraimplantive" mechanism is called instead a "contraceptive" mechanism. An article on 'morning after' pills explains that they are "ordinary birth control pills containing the hormones estrogen and progestin, but are taken in a higher dose up to 72 hours after unprotected intercourse." The article explains that the pills prevent implantation, but the large font pull quote from Dr. Jack Leversee of the University of Washington School of Medicine assures readers, "We are not doing away with a pregnancy; we are preventing it from ever becoming a pregnancy."
Undiscerning prolifers may read such statements and be reassured that these pills don't cause abortions. Attaching new meanings to old words such as conception and pregnancy has succeeded in making it sound like the Pill and other hormonal contraceptives don't kill human beings. It has done nothing, however, to change the fact that sometimes that's exactly what they do.
Even when the information about the Pill rises to the surface here and there, 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. (I know this from my own experience.) This is likely why so few individuals or organizations have researched or drawn attention to this subject. Among other things, organizations fear a loss of financial support from donors who would object to criticism of the Pill.
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 do many physicians prescribing it. I do not mean by this that most physicians prescribe it primarily for financial gain; I do mean it is a significant part of the total income of many practices.
An appendix in The Woman's Complete Guide to Personal Health Care, by Debra Evans, is entitled "A Physician Looks at Doctors' and Pharmacists' Profits from Prescribing Birth Control Pills." The writer carefully calculates the costs of various procedures and comes up with a cost summary per patient. Added to this is the fact that each woman with a family will take her children to the family practitioner who prescribes her contraceptives, and usually her husband will go to that doctor. Using averages for frequency of visits, and factoring in word of mouth or patient-to-patient referral, the writer calculates that income linked to patients for whom the doctor prescribes birth control pills range from 55 to 74% of his total income.
Because of the Pill's popularity, physicians who stop prescribing it will likely lose many patients and their families to other doctors. Even many prolife physicians resist the notion that the Pill causes abortions and are unlikely to change their position or even share with their patients evidence such as that presented in this book. (Thankfully, there are certainly exceptions to this.)
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 some, perhaps 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, and companies do not want these people to stop using their pills. This concern for good public relations was exceedingly evident to me in my conversations with staff members 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 the Physician's Desk Reference all mention that the Pill prevents implantation, but very few of their package inserts and none of their colorful consumer booklets say anything about it.
Dr. James Walker, in his paper "Oral Contraception: A Different Perspective," 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.
On the most basic level, 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 while lying and misleading to cover those deaths. (I will address this in the Conclusion.)
"I don't trust this evidence."
One physician told me that he thinks the evidence I've cited is simply incorrect. He said, "I don't trust these medical studies. I just don't think they're accurate."
I asked him if he had any objective reason for his distrust. He cited the study I dealt with earlier concerning Norplant. Since he said he didn't trust dozens of medical sources connecting the Pill with prevention of implantation, I asked him why he trusted a single source not even dealing with the Pill, while rejecting those sources offering evidence to the contrary.
This illustrates a tendency we all have, but which we should all resist—the tendency to believe whatever we can use to defend our position, and to disbelieve whatever contradicts our position. We must be willing to seriously examine evidence that goes against the grain of what we believe, so that rather than reading our position into the evidence, we allow the evidence to determine our position.
The same physician, a committed prolife advocate, wrote to me that breast-feeding results in "an atrophic thin endometrium." He then stated, "So, in theory, if you state oral contraceptives may cause an abortion, logically the same could be said for breast-feeding." He told me that, to be consistent, if I was going to call the Pill an abortifacient I would have to say the same of breast-feeding.
I submitted this argument to another Ob/Gyn, Dr. Paul Hayes. In a August 15, 1997 email Dr. Hayes responded,
It is an erroneous misuse of words to say that breast-feeding creates an atrophic endometrium. Lack of ovulation during breast-feeding accounts for a state of the endometrium that is inactive, precisely because no ovulation is taking place. This is unlike the Pill where ovulation can take place…but the effect of the progestin is to make an atrophic lining, inhibiting nidation. There is no comparison between the two.
"If we don't know how often abortions happen, why shouldn't we take the Pill?"
How are we as Christians to make ethical decisions in the absence of scientifically incontrovertible proof that the Pill causes abortion at least some of the time? In light of the fact that we have very substantial evidence (I believe most unbiased researchers would say overwhelming evidence) but not absolute proof the Pill can cause abortions, as Christians who agree that we do not have the right to take a child's life, is it ethical to prescribe or use the Pill?
Dr. Walter Larimore addresses this issue in an excellent article published in Ethics and Medicine journal. He says that in a climate in which there is legitimate debate, opponents of the Pill argue that "a moral birth control method must be exclusively contraceptive; e.g., it must (1) work exclusively…by preventing conception from occurring and (2) cause no harm to the conceived child." Since the Pill may cause early abortions, whether a small or a large number, it should not be used.
On the other side, defenders argue that the Pill may not cause abortions, and since it may not, we should feel free to use and prescribe it. Some also say that if the Pill causes abortions, these are only "mini-abortions" which occur "prior to or just following implantation." They therefore suggest that there is no ethical dilemma to be resolved. (This would be true, of course, only if human life does not begin at conception, but at implantation—a contention for which many of us believe there is no logical, scientific or biblical evidence.)
In my experience, all but the most hard-core defenders of the Pill—and only prolife defenders, since prochoice defenders invariably recognize the Pill can prevent implantation—will acknowledge that it can cause at least a small number of abortions. The moral question, then, is this: since we are uncertain about how many abortions it causes, how should we act in light of our uncertainty?
In teaching college ethics courses, I have framed the question this way: If a hunter is uncertain whether the movement in the brush is caused by a deer or a person, should his uncertainty lead him to shoot or not 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? What if you think there's a 50% chance it's a child? 30% chance? 10% chance? 1% chance? How certain do you have to be that you may kill a child before you should modify your preferred action (to not put on your brakes) and resort to putting on your brakes?
My question is this: 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, all these medical textbooks and journal articles, and all the Pill manufacturers' clear statements that the Pill sometimes prevents implantation (and therefore results in the death of a child). You might ask yourself if the reason for your skepticism is your personal bias and vested interests. But let's assume you are genuinely uncertain. Is it a Christlike attitude to say "Because taking the Pill may or may not kill a child, I will therefore take or prescribe the Pill"? If we are uncertain, shouldn't we take the ethical high ground by saying our uncertainty should compel us not to take or prescribe the Pill?
My research has convinced me the evidence is compelling. It is only the numbers that 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 or prescribe it"? How many dead children would it take to be too many?
It seems to me more Christlike to say, "Because the evidence indicates the Pill can sometimes causes abortions, I will not use or prescribe it and will seek to inform others of its dangers to unborn children."
"Spontaneous miscarriages are common—early abortions aren't that big a deal."
One physician pointed out to me that there are many spontaneous abortions and miscarriages. Because of this, he felt we should not be troubled by pre-implantation abortions caused by the Pill. They are just some among many.
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.
In-vitro fertilization implantation data is not applicable to natural implantation. Concerning the latter, as documented in their book Conception to Birth, Drs. Kline, Stein and Susser put forward certain assumptions then state,
…the preimplantation data would indicate that at least 50 per cent of all fertilizations will not result in a live birth…the probability of loss in the interval between the preimplantation and postimplantation periods alone is 30 per cent.
In their article "Estimates of human fertility and pregnancy loss," Michael J. Zinaman and associates cite different studies showing spontaneous abortion rates of 15% to 20%, 13% to 22%, 12 to 14%, and 20-62%.
This confirms that there are in fact many early miscarriages. Since this is true, however, does it therefore follow, "Because God permits—or nature causes—millions of spontaneous abortions each year, it's okay if we cause some too"?
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). His prerogatives are unique to Him. He is the Creator; we are the creatures. He has the right to take human life, but we do not. (See Appendix D: God is Creator and Owner of all people.)
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." Spontaneous abortions of women not taking contraceptives are not our responsibility. Abortions caused by contraceptives we choose to take and prescribe are.
The same principle applies when someone concludes 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 our choosing to kill that child. This is a fundamental and radical difference. (See Appendix E: God has exclusive prerogatives over human life and death.)
I have several letters from Christian physicians and organizations that use the term "micro-abortion" in reference to the possibility that the Pill prevents implantation. Such semantics minimize the abortion, as if it isn't "real" or important like surgical abortions of bigger children. We should avoid such dehumanizing terms. Though the child is very small the child is still a child and therefore the abortion is just as big in its importance.
Just because many children die very young doesn't make their deaths insignificant. True, we may lose several children we don't even know about, through early spontaneous miscarriages. But that in no way justifies choosing to take something into our bodies that puts other children at risk.
"Taking the Pill means fewer children die in spontaneous abortions."
A letter from one Christian organization (which I prefer not to name) says this:
It has been pointed out that a woman who is not taking birth control pills is actually more likely to experience the loss of an embryo—some studies indicate that up to 80% of conceived embryos naturally fail to implant—than one who is on the pill, which rarely, if ever, permits conception.
The logic seems to be that when we use a chemical that kills some children we can take consolation in knowing that this same chemical prevents many other children from ever being conceived and therefore from ever dying. This is convoluted logic, and again it puts us in the place of God.
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 fewer children conceived. This is an illusion—it's not that lives are 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 prolife thing we could do would be to eliminate all pregnancy. We could then congratulate ourselves that we also eliminated abortion. In the process, of course, we will have eliminated children. Similarly, reducing the number of people in society could lower the number of people with cancer. But we would hardly think of that as a cure—especially if the means we used to have less people involved killing some of them.
"Without the Pill there would be more elective abortions."
A prolife physician pointed out in a letter to her pastor that 50% of unwanted pregnancies end in abortion. Therefore a million more unwanted pregnancies each year could mean a half million more abortions each year. In other words, the logic is it's better to use the most effective birth control means possible even if it does cause abortions, because if it isn't used there will be even more.
Suppose for a moment this were true. What is the logic? "Let's go ahead and take action that will kill some children now because at least if we do there may be other children, more of them, who won't get killed." The same approach could be used to deny drowning children access to a crowded life raft. This sort of pragmatism rings hollow when we put certain human lives at risk, without their consent, for the supposed good of others.
Ultimately, however, the premise is not true, since unfortunately it is only a small minority who would even consider not taking the Pill because it causes early abortions. The only people who will stop taking the Pill for this reason are not only prolife, but deeply committed to their beliefs. This book won't have much if any impact in the secular world. I do hope it will encourage some of God's people to live by a higher moral code than the world does.
A person who as a matter of conscience will not risk the life of a newly-conceived child—whose presence in her womb she can't even yet feel—will surely not turn around and kill a child just because she has an unplanned pregnancy. Among people who stop taking the Pill to protect unborn children, there may be more unplanned pregnancies, but they will result in births, not abortions.
"Pill-takers don't intend to have abortions."
I've frequently been told 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 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. (Which is a sad commentary on the lack of informed consent by Pill-takers.) But the fact remains that while the intentions of those taking the Pill may be harmless, the results can be just as 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. 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. Eventually they die.
The Russian roulette of the Pill is done with someone else's life. 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. I am sure that it's 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 prolife physician told me he felt comfortable still prescribing the Pill because "It's primarily contraceptive and only secondarily abortive."