Some Pro-Life Considerations on Hormonal Birth Control, For and Against

edward-cisneros-667919-unsplash

There is so much misinformation and so many half-truths circulating about hormonal birth control. Many pro-life women I know refuse to use hormonal birth control because of its alleged abortifacient effects. I’m pro-life too, but natural family planning and barrier methods weren’t working for me for various personal reasons. I took a good hard look into the science and ethics of using hormonal birth control. Here are some facts and thoughts that shaped my final decision.

Note: My research primarily involved oral contraceptives. I have not extensively researched the exact mechanisms of other contraceptives like implants, patches, or IUDs. Further, much of the secondary literature I’m seeing conflates the effects of emergency contraceptives with the effects of daily birth control, even though they may differ. Please keep these limitations in mind as you read.

The main pro-life argument against hormonal birth control is that it affects (or could affect) the implantation of an embryo in its blastocyst stage. All forms of hormonal birth control thin the endometrium, the lining of the uterus in which the blastocyst must implant. According to many who believe life begins at conception, birth control prevents implantation by depriving the blastocyst of a thick, receptive endometrium, and is thus an abortifacient.

This is actually a big if. Despite pro-life arguments and even current pill literature, there is no conclusive evidence that hormonal birth control affects the endometrium in a way that prevents implantation. It could, but it’s unlikely to. That’s where current research stands, but that’s not the final word on whether pro-life women should use hormonal birth control.

How Hormonal Birth Control Works

At the beginning of the menstrual cycle, the endometrium starts out quite thin. During the follicular phase, follicles begin putting out increasing levels of estrogen that thicken and enrich the uterine lining (or endometrium). High levels of estrogen trigger luteinizing hormones (LH) to release an egg from the follicle — the process known as ovulation. The follicle then continues to produce the hormone progesterone, which also thickens and enriches the endometrium. This is the luteal phase of the menstrual cycle. If implantation fails, the lining is shed, and menstruation begins.

Birth control’s primary contraceptive mechanism is preventing ovulation in the first place, not preventing implantation. When a woman is on hormonal birth control, the amount of artificial progestin and estrogen mimic the elevated hormonal levels during pregnancy, tricking the pituitary gland into preventing ovulation.

How does this potentially affect implantation? Because ovulation is suppressed, the endometrium does not thicken very much, which is why women on birth control have lighter or nonexistent periods.

Occasionally, breakthrough ovulation will occur in women taking contraceptives (particularly if they fail to take them regularly). If ovulation occurs, the endometrium will begin thickening again. This is why it’s possible for women to get pregnant on contraceptives if breakthrough ovulation occurs.

The question is whether the endometrium can thicken enough to give the blastocyst a fighting chance at implantation. Many pro-lifers say absolutely not, pointing out the obvious that the endometrium affected by birth control is observably thinner. This is the “hostile endometrium” theory. Studies show that a thicker, more nutrient-rich endometrium increases the likelihood of blastocysts implanting during in vitro fertilization, bolstering the argument that thinning the endometrium would undoubtedly have a negative effect on implantation.

That makes sense, but here’s where it gets tricky. Naturally, many embryos (even up to two-thirds, some experts surmise) will not implant in even a receptive lining, or will spontaneously abort. And naturally, some blastocysts will implant in what we might think of as a “hostile” endometrium. Were a blastocyst to fail to implant, it would be impossible to name birth control as the culprit — or even claim the nature of the endometrium as a major factor, as new studies show that the quality of the embryo itself plays a role in its implantation.

Even pro-life voices are questioning the very idea of a “hostile endometrium.” According to a 1998 statement by pro-life OBGYNs, blastocysts are by nature invasive. They will implant even in areas more unfriendly than a thin endometrium, like the fallopian tube. They reiterate that current research does not show that birth control affects implantation.

Again, others point out that just because a blastocyst can implant in a thin endometrium or even a fallopian tube does not mean that the quality of the endometrium has no effect on implantation.

So it’s absolutely true that birth control affects the thickness of the endometrium. Many pro-life women are under the impression that only some kinds of birth control affect the endometrium, but this is incorrect. All birth control that hormonally suppresses ovulation affect the thickness of the endometrium (including breastfeeding). The contraceptive mechanism — preventing ovulation — is the same in all hormonal birth control, even in the morning after pills like Ella and Plan B.

(It’s important to note that the morning after pills employ a different contraceptive mechanism than the abortion pill known as RU-486 or mifepristone. The abortion pill blocks the hormones needed to sustain a pregnancy and is not approved for use as emergency contraception to prevent ovulation. The morning after pills do not interfere with an established pregnancy; the abortion pill obviously does. Further, emergency conception may be even less likely to affect implantation than everyday birth control, as there may not be enough time for an emergency dose to alter the endometrium.)

The true debate, then, is not “which kinds” of hormonal contraceptives are abortifacient. The debate is whether hormonal contraceptives prevent implantation, thus causing an abortion.

According to the most recent research, there is no evidence that hormonal contraceptives prevent implantation.

Confusingly, much of pill literature today still lists preventing implantation as a contraceptive mechanism in hormonal birth control. When birth control first came onto the scene, its contraceptive mechanisms were unknown. Many in the medical community thought that preventing implantation was a primary contraceptive mechanism, but as already stated, later research is debunking that theory. (Note: While secondary resources cite this as relevant to daily hormonal birth control, I’m only finding primary sources about the FDA mislabeling emergency contraceptives.)

Even with this research, however, it’s impossible at this time to conduct an ethical experiment to determine the exact effects of birth control on implantation. It is unlikely and unproven that birth control affects implantation, but it’s impossible to prove a negative. For many pro-lifers, this isn’t strong enough research to support hormonal contraceptives.

In light of this research and counter-research, it seems fair to both sides to say that there is at least a risk of hormonal birth control preventing implantation.

Our Ethical Responsibility

How ethically responsible is a woman for making her endometrium as hospitable as possible?

In other words, is it ever justifiable to put a life at risk?

It’s a kind of question we face every day as mothers in a world full of risk, from deciding to drive our child to the library at the risk of a car crash to eating deli meat while pregnant at the risk of contracting listeriosis. Just as driving and eating deli meat don’t cause a child’s death, taking hormonal birth control is not demonstrated to cause failed implantation, but just like driving and deli meat during pregnancy, it at least opens the possibility of that risk.

For many women, it’s quite simple: they refuse to take the risk of impairing implantation, and use natural family planning, barrier methods, or no prevention at all. They feel it is unethical to do anything that would potentially impair implantation or would at the very least not aid in implantation. Why would a mother do anything to risk her child’s life?

But for many women, the issue isn’t so straightforward. In life, we are often forced to take avoidable risks in order to fulfill another or a greater moral obligation or good. Why do we take risks? Because there are numerous good things that are harder or impossible to get without taking a risk. These goods outweigh the small chance of risk to our children.

To many, birth control obtains a good which outweighs the small risk of affecting implantation. The “good” of birth control varies from woman to woman: some take it for medical reasons; some for sexual enhancement in marriage; some for an even stronger protection against pregnancy; some as part of responsible sexuality; most for a combination of reasons. Each circumstance and each need varies so greatly from woman to woman, which is why it is important to have accurate contraceptive information so that couples can weigh the risks and benefits according to their unique circumstances.

Regardless of our particular stance on birth control, we women make decisions all the time that potentially affect new life. How far does our ethical responsibility go? A tongue-in-cheek article proposes that we campaign against breastfeeding, refuse to give caffeine to women of child-bearing age, and discourage women from exercising due to the increased risk of early miscarriage that breastfeeding, caffeine, and exercise pose.

“Well, that’s silly!” some would argue. “Unlike birth control, breastfeeding, coffee, and exercise aren’t intended to prevent implantation.”

Neither is birth control. Besides, the risk of breastfeeding, coffee, and exercise still exist regardless of our intentions.

How much do our intentions matter in taking this risk, anyway? Birth control is designed to prevent ovulation and fertilization. If a woman takes birth control for those reasons alone, not to cause an abortion, do her good intentions justify taking the risk birth control might pose to an embryo? Is breastfeeding okay, despite its risk of negatively altering the endometrium, as long as a woman isn’t consciously using it as a birth control method? If we’re ultimately responsible for ensuring the very best endometrium for an embryo, should we not abstain from sex until our baby is weaned? Surely the life of an embryo outweighs our newborn’s need for breastmilk, much less our desire for coffee and exercise!

This might seem like splitting hairs, but my point is that when it comes to taking risks in an area as personal and opaque as this, there are numerous moral factors at play, and many inconsistencies and contingencies in our beliefs.

When it comes to birth control, many pro-life Christians want to pretend that this is an area entirely separate from the complexities of life, that it is a black-and-white issue unaffected by any other ethical considerations. On the other hand, many pro-life women are not factoring in all of the risks birth control can have on an embryo.

This is why I support the dissemination of nuanced, factual information regarding birth control from medical, philosophical, and theological perspectives, and agree with the American Association of Pro-Life Obstetricians and Gynecologists that we are free and obligated to follow our consciences in this area.

Advertisements

12 thoughts on “Some Pro-Life Considerations on Hormonal Birth Control, For and Against

  1. Lauren Sutton

    I personally think that the idea of life at conception is very questionable. After believing many fundy things growing up one of the criteria I now use to judge a belief that the Bible is ambiguous on is just how ridiculous things will get if you follow it to it’s logical end.
    If I were forced, (as the Christian medical community basically has been) to say when life began I would say when the fertilized egg successfully implants.
    Is removal of an ectopic pregnancy an abortion? No. There is absolutely no chance of life there even though there is a fertilized egg present.
    Biblically, I think this could be argued via the “life is in the blood” phrase that is regularly used in Leviticus. Once a fertilized egg implants, it has a blood source. (Right?)
    To be perfectly open, I have not researched this hunch at all. But it seems like we have to perform some contortions to stick with life beginning when an egg is fertilized.

    Like

    • Bailey Steger

      This is something I’ve thought about but like you, haven’t researched. I have to say life begins at conception in the sense that there is no other way life can begin, and I’m not comfortable separating life from personhood. But I am intrigued by the argument that pregnancy begins at implantation and want to at least give it a fair hearing. Your connection to Leviticus is interesting; I’d never heard that! I personally don’t use the Bible as an authoritative voice on science, but when life begins isn’t a strictly scientific issue for me either. Thanks for your thoughts!

      Like

  2. Leigh McKay

    This is one of the most clear, straightforward explanations of the issue I’ve ever read. (And I’m engaged with no plans to be pregnant for the foreseeable future so have been doing a *lot* of reading!)

    I think I’ve reached the point where I feel comfortable with using hormonal BC, for the reasons you stated. I’m still most interested in the copper IUD (although the thought of inflammation/awful bleeding makes me shudder) because some of the female members of my family have experienced not-fun side effects from the pill– mostly, loss of sex drive and mood swings. For me, I suspect there will be some practical experimentation. Maybe I’ll try out the pill for a while and switch to another method if I don’t like the way my body feels?

    Being sexually inexperienced makes this more difficult. I think it will be hard to determine if, for example, the pill is hurting my sex drive when I haven’t driven the thing before :P

    Another random thought on NFP: I think I’d be more gung-ho about that plan if the required abstinence periods weren’t smack at the point where intercourse is the easiest and most enjoyable for the woman. That kind of sucks.

    I totally understand if you want to keep your BC decisions between you and Erich, but if you’re comfortable sharing, I’d love to hear more about what method(s) you guys have settled on postpartum, and which you might be planning to try in the future.

    Like

    • Bailey Steger

      I was really interested in the copper IUD for the same reasons, but kept hearing stories about ectopic pregnancies and tearing of the uterus, so I was too overwhelmed to process that.

      Yeah, you’d either have to abstain or use a barrier method with NFP/FAM, which is super annoying to complicate or abstain from sex when it’s FINALLY not as complicated for the woman!

      I don’t mind sharing! I just didn’t want my final decision to be a part of the article’s argument, if that makes sense. I’m breastfeeding and using the mini pill, which is a progestin only pill. I was so nervous about hormones, but I haven’t experienced any side effects. It’s really obnoxious to have to take it at the exact same time every day, but other than that, it works really well for us! I haven’t decided what to do once I get my period back, but I’ll probably go with the Pill.

      Like

    • Anne

      I have had the copper IUD for over 10 years now (off and on to have 2 more kids) and it has been the best decision I ever made for my marriage. This came after 6 years of tensions in my couple caused by natural methods and then the pill killing my libido.
      I was reluctant to try it for a long long time over its potentially abortifacient nature. But after lots of research, I found out that copper ions works primarily as a spermicide and only rarely as an obstacle to implantation (through ionizing the uterus lining). Given that over 50% of fertilized eggs don’t naturally implant, the rate of loss with an IUD is actually lower than when using no BC at all, because it does prevent fertilization.
      In terms of side effects, the only ones I experienced were some mild cramping and spotting the first month or so. After that, everything felt completely normal.
      I never formulated it like the commenter above, but I suppose I also fall into the category of Christians who believe that implantation is a prerequisite to Life. After all, the female body only recognizes a pregnancy after implantation. That’s when she starts secreting the hormones necessary to sustaining life. Before that, the egg (fertilized or not) is expelled through regular menses without any symptoms of a miscarriage.
      The only issue I have with the copper IUD is that Paraguard is the only brand offered in the US and is very expensive without insurance. If you ever travel to Canada, copper IUDs are only around $60 and they have different sizes and brands to choose from.

      That’s just my 2 cents about IUDs, but I also wanted to thank you Bailey for another brave and insightful post. You have the talent of going where Christians are afraid to go… and those conversations are incredibly necessary.

      Like

      • Bailey Steger

        This comment is extremely helpful, thanks!

        I was so nervous about posting this and proofread it a million times in order to put off posting it! It’s such a hard topic, and it really shouldn’t be.

        That’s so nice that Canada offers more options and brands! Women just need more OPTIONS, because the current options just aren’t cutting it for many of us. I feel lucky that the mini pill works for me, because I know it messes up lots of other women, and the Paraguard has it’s own scary list of side effects. And scientists need to hurry up and make effective male contraception, because then we wouldn’t have this worry about a potential link between abortion and birth control.

        Like

      • ArieltheHuman

        Leigh, I highly recommend the Nuvaring. It is less hormones going into your body than the pill, since it less right by the area it needs to affect rather than having to go through the digestive system. So less chance for side affects. I started on it when I was engaged and noticed nothing but a lighter period. It worked great for us for 3 years at which point we transitioned to NFP, which I liked because I learned a lot about my body, but we did get pregnant on it eventually :-P
        Anyway, another perk of the ring is that you only have to deal with it/remember it exists once a month, instead of every day like the pill. It doesn’t work for everyone but it is less invasive than the copper IUD which is why I went for it.

        On another note, Bailey this post is amazing. Thank you for all your research. I’ll be saving it and sharing it with many friends I’m sure!

        Like

  3. A

    I appreciate the thoughtful post! I’m getting married soon myself, and though I’m still in favor of using a fertility-awareness-based method, I’ve been doing a little reading about hormonal/mechanical methods, and am not quite as strongly against them as I used to be. I am kind of salty that the pro-life resources I always read growing up were a bit selective in how they talked about the Pill—insinuating that it regularly causes miscarriages, or emphasizing the increased breast cancer risk without mentioning the *decreased* risk of ovarian cancer, etc. And I only recently learned that Plan B isn’t the same thing as the abortion pill—that’s what I had always heard, growing up! Ugh. If pro-lifers want to be taken seriously, they need to get their science straight and not cherry-pick the data/studies they’re reporting. Like I said, I still lean toward a natural method, party because of what I see as the negative sociological consequences of widespread contraceptive use. But I don’t think that all Christian married couples who have considered all their options and decided to use the Pill, IUD, shot, implant, or whatever, are sinning.

    I do want to add a wee bit to your thoughts on NFP/FAM—you said, “Yeah, you’d either have to abstain or use a barrier method with NFP/FAM.” If you don’t like condoms or complete abstinence, one other option is to abstain from PIV sex but engage in nonpenetrative activities during the fertile time. :)

    Like

    • Bailey Steger

      This is why I just want good information to be available. Like you said, there are other non-medical, non-abortion related issues regarding contraception too and many great (and awful) reasons for and against. It’s too complicated to have so much misinformation going around in and from the pro-life community!!

      Like

  4. villemezbrown

    I wasn’t going to comment because the connection between pro-life and and birth control has never been a thing for me, but I went through my own contraceptive journey just the same. I always assumed I would use the pill, and I did for a few years, but now I don’t like the long term effects or the general idea of artificial hormones. The hormones in our body are such an incredibly complex, delicate, interrelated system that affects everything from our mood to weight-gain and blood-sugar, I feel we do not have nearly the knowledge we need to muck about with it. My mom had a really bad experience with the IUD, though I know there are much more advanced and safer IUD options now. I used spermicide for a while until I read some very negative information about that around the same time it started to cause worse and worse pain and burning sensations every time I used it! I experimented with fertility awareness and I’m glad I did because I learned a lot about my own body and cycle, but I never felt confident enough in my ability to follow that method. So now I use condoms. I have found it really interesting the overwhelming negative feeling about barrier methods, and I am actually kind of curious about that. Is it that it’s an interruption? I guess I never really saw it that way, or at least it didn’t bother me at all. Or does it make it more uncomfortable? I will admit you need condoms that do NOT have spermicidal lubricant (burning and pain problems mentioned above), and it helps a lot if you add some lube. I can’t help but wonder if some, if not most, of this negative feeling about condoms is coming from the men. I have heard that a lot of men are really opposed to using them, though I don’t really know if that’s true.

    Adele

    Like

    • Bailey Steger

      From what I’ve heard from other women, your sentiments are very common. Unless you’re going with a simple barrier method, so many of the birth control options have huge risk factors and side effects.

      In my neck of the woods, I hear people hating on condoms because yeah, guys (and women) don’t like the feel or the hassle, and since I know so many women who have vaginismus from purity culture, barrier methods make sex that much harder and more painful when it’s already hard and painful.

      Like

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s