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.