This is an overview of the information in The Christian and Birth Control book, published by Christian Life Resources. To purchase the book click on the link at the bottom of this page.
It is more than coincidental that this topic has been left for last in the book. Use of what is commonly called the birth control pill, or “the pill,” has been a hotly-debated issue for Christians since it appeared on the American scene in the 1950s. There are important theological and medical issues related to this topic, yet they are sometimes lost in the discussion which can be as embroiled in emotion as it is in medicine.
Advocates of birth control sing praises of both the pill’s effectiveness rating when used correctly and its ease of use. The combination “pill” (which uses two hormones, estrogen and progestin, to suppress ovulation) has a 99.7% effectiveness rate when used correctly and a 91% effectiveness rate when typically used, according to the FDA, 2013. Opponents of artificial birth control decry the pill as contributing to a cheapening of the procreative process in the marriage relationship and tampering with the natural order of things.
Both sides of the issue draw on strong personal feelings often rooted in deep religious convictions about human reproduction and the role of God in the process. As a result, emotions and rhetoric often cloud the desired objective analysis of the medical facts, theological implications of those facts and the motives involved.
In the first chapter, we established that motive is the primary determinant over the God-pleasing use of birth control. If birth control is harmful to health or life, then a Christian will not use it because it violates God’s command to protect and care for our bodies and the bodies of others. If birth control becomes a means to “safely” participate in sexual activity outside of the marriage relationship, then it is sinful to use.
The use of any form of birth control is acceptable only within the marriage relationship. While that may sound like an antiquated idea in this sexually-liberal age, it does not change the fact that sexual relations were intended by God to take place within the marriage relationship, tied to the life-long commitment of a man and woman to each other. As we look at this most popular method of birth control we again speak of it only within the context of a Christian married couple seeking to exercise stewardship over the procreative blessing from God.
Before going further, however, a word must be said about other benefits derived from the pill. We recognize that in addition to being a tool for birth control, the pill helps many women regulate irregular menstrual cycles. Oral contraceptives also improve severe acne problems in women. To the extent that the pill provides such health benefits there is no objection. Users of the pill for such purposes, however, will want to carefully consider its “birth control” effect if they are sexually active in their marriage relationship.
From the beginning of this book, I referred to the quest to find birth control that is the most effective and easy to use, as well as reversible when a couple wishes to have a child. I think it is a fair statement that oral contraceptives are perhaps the easiest form of birth control to use. They require basically two skills: (1) the ability to swallow a small pill; and (2) the discipline to perform that task daily and on schedule.
The pill is also very easily reversible. Once a woman stops taking the pill, her ovulation cycle generally returns to normal in a short time. Some studies have suggested that the older the woman, the longer it takes for her to regain her ability to conceive. Overall, the time span is relatively short.
The two issues with the pill involve complications resulting from its use and its potential as an abortifacient. As with nearly all medication, there may be complications when using it. Complications have ranged from blood clots to suspicions of contributing to breast cancer. The pharmaceutical guides provide a litany of conditions that may cause side effects involving use of the pill. That is why this form of birth control is still only available by prescription. It is presumed that a woman will discuss her medical history with her doctor to help her determine possible risks when taking this pill.
The alleged abortive nature of the pill is our primary concern. Without going into the medical details of related studies, the following quotes from leading pro-life groups should give you an idea of the diverse interpretation related to the information as it is now known:
Pharmacists for Life: “The abortifacient mechanism (of the pill) comes into play anywhere from 2 to 10% of female cycles per year.” [Infant Homicides Through Contraception]
Paper Signed by 20 Pro-Life Ob Gyns: “. . . if a family, weighing all the factors affecting their own circumstances, decides to use (the Birth Control Pill), we are confident that they are not using abortifacients.”
The challenge that we face is to ascertain which of these two points of view can be determined to be correct. In fact, a casual observer in this debate might rightfully question how such divergent views can be held by two pro-life entities on an issue of such importance. The sad reality is that there is precious little research available on the matter.
The pharmaceutical guide outlines three modes of activity. The pill: (1) suppresses ovulation and thereby prevents release of an egg; (2) thickens the mucus in the cervix to inhibit passage of sperm into the uterine cavity; and (3) changes the endometrium lining to prevent implantation of a fertilized egg. It is this third mechanism which concerns the Christian community because it would kill the fertilized egg, and therefore be an abortifacient.
Now, one would think that if the mechanisms are as clearly defined as this, there would be little question about its appropriateness. What is surprising is that, while the third mechanism is listed as abortifacient, there are no substantial studies to dispute or support this statement. The national office of Christian Life Resources spent two years researching this matter. We read through reams of studies and talked to pharmaceutical companies, doctors and researchers. In the end, we regret to report that it is impossible for either side of this debate to speak with absolute certainty the activity of the pill expressed in the statements above.
Problem number one: Definition. In the early 1990s, some medical societies and pharmaceutical companies issued statements redefining conception as implantation of a fertilized egg into the womb. Until then, conception was understood to be the point of fertilization. We view the redefining as self-serving because agencies and individuals who wish to avoid the reality that preventing the implantation of a fertilized egg is and has always been considered an abortion. Today it is increasingly common to read that various forms of birth control devices previously considered abortifacient are now no longer considered abortifacient. All that really changed was the definition.
Problem number two: Lack of Evidence. Because of the tremendous efficiency of the pill in preventing ovulation, no one has undertaken a study of what happens to the endometrium lining where breakthrough ovulation has taken place. Opponents of the pill argue that studies of women using the pill indicate a thinning of the woman’s endometrium lining which makes it unable to sustain a fertilized egg and thereby causes an abortion. While that may be true, we have yet to find a study indicating the integrity of the endometrium lining of a woman on the pill who does have breakthrough ovulation. The fact that some women on the pill do still become pregnant and deliver healthy babies indicates that perhaps the lining is not inhibited in its ability to sustain the new life.
Problem number three: Carelessness. Those who oppose the pill often make extrapolations based on studies of non-ovulating women and proceed to burden the consciences of women with the idea that they have aborted some of their children. Using statistical probabilities from studies that still have not directly tackled the issue of the ovulating woman on the pill they have pronounced outlandish statistics suggesting that women may have aborted their children as often as 30% of the time. In their careless use of the statistics, they burden consciences while lacking even one confirmed observation that this has ever taken place. Claims that the pill always works to prevent ovulation are again based on careless considerations of very few facts. We have only seen one or two very small studies that tracked ovulation of women on the pill. Those studies, while promising, hardly settle the matter. We find many doctors ignorant of the facts that do exist about the pill. We also find many users of the pill absolutely trusting in their doctor’s ignorance. This reflects society’s troubling acceptance of a mechanism that works without truly knowing how.
Other health issues are also raised related to use of the pill. Prominent in those claims is evidence which suggests that use of the pill increases the likelihood of ectopic pregnancy. Again, we find qualified physicians who disagree with those studies, claiming they are flawed or incomplete.
Where does that leave us? Even reputable pro-life physicians are found on both sides of this issue. Our research leads us to conclude that neither side of this issue can speak with absolute certainty.
The Pill and Cancer
In July of 2005 the International Agency for Research on Cancer (IARC) classified combination oral contraception (COC) pills as a group 1 carcinogen. A group 1 classification means that a substance has a “sufficient or limited evidence in humans” to cause cancer.
It was inconclusive whether COC pills cause cancer or provide an environment for cancer cells to grow.
The 500-plus-page IARC report produced by the World Health Organization indicated incidences of breast cancer and cervical cancer increased with the oral use of combined hormonal contraceptives. Generally, after ten years following the use of these contraceptives, the cancer rate returned to normal. There was an additional increase in most types of liver cancer by users of combined hormonal contraceptives, but such data may have been based on high dosages of the hormonal content of earlier forms of combined hormonal contraceptives which does not accurately reflect pill dosages in use today.
Conversely, the study also reported the regular use of combined hormonal contraceptives contributed to a decline in endometrial and ovarian cancers.
Simply stated, as a group 1 carcinogen, combination hormonal birth control pills are deemed to be cancer-causing. Is this risk serious enough to justify not using COC pills?
Given high concentrations, nearly any substance can create a health hazard. The IARC also lists alcoholic beverages as “group 1” carcinogens for the following types of cancer:
- Oral cavity
- Upper digestive tract
- Colon and rectum
- Liver and bile duct
Obviously, in most cases, casual or infrequent use does not appear to cause a hazard. Prolonged and excessive use of alcohol, however, is medically and visibly a health hazard. Would this reasoning, therefore, make “moderate” use of COC pills safe or safer?
The life, death and health ramifications of this kind of decision compels me to counsel on the side of caution. Hormonal methods of birth control are designed essentially to trick the body to prevent a pregnancy (or end a pregnancy). Questions remain about whether – or how often – COC pills act as an abortifacient. That is one concern.
According to the IARC report, the evidence suggests COC pills present a real or substantial cancer risk. The risk is likely influenced by environment, practice and body chemistry. Users of COC pills cannot be told with verifiable certainty whether such use has definitely – or even likely – caused the abortion of a child. We can say COC pills may possibly have aborted a child.
The same can be said of the health consequences of the use of COC pills.We cannot say with certainty that the use of the pills will or will likely result in users contracting cancers. We can say, however, that users have an increased risk of contracting cancer.
For example, a study on cervical cancer showed the risk of a regular user of COC pills contracting cervical cancer rises 13.7% in developed countries and 18.4% in less-developed countries. That is a huge jump but numerically the jump is from 7.3 to 8.3 cases per 1,000 and 3.8 to 4.5 cases per 1,000 respectively. The increase of roughly one case per thousand does not seem like a huge risk – unless you are that one case!
So, to ask the time-honored question, “What does this mean?” Because of the great value God places on human life I choose to err on the side of caution whenever possible. So long as viable and effective alternatives exist I suggest looking seriously at the alternatives.
The premier selling point of COC pills is convenience. It can switch fertility on or off without surgery. Yet, is convenience worth the risk? Would fathers suggest the risk to their daughters? Could we as stewards of life justify the risk to the Author of life?
Barrier methods and conscientiously-observed natural family planning methods carry no chemical complications and no apparent health risks. It permits the enjoyment of sexual pleasure without the suggestion of danger to an unborn child or the woman who might someday carry a child.
If at all possible I would counsel against the use of COC pills or any method designed to chemically fool the body. Evidence suggests by doing so for any extended period of time has consequences elsewhere.
The tragedy in all of this is how a drug can be so widely used and yet used so ignorantly. A matter of this seriousness demands more than blind acceptance just because it seems so effective. The problem, however, is that pharmaceutical companies don’t want to study this issue for what may be discovered. The government won’t study this for fear of rocking a fairly-steady and well-accepted product. Independent agencies don’t have the resources to study it.
So, what are we to do? Objectively speaking, we find insufficient evidence to suggest that a woman sins when using the pill for birth control or that a doctor sins in prescribing it. At the same time, we cannot overlook the sad reality that the most important data is yet to be gathered. While I can state this objective reality, I must confess to a personal uncomfortableness with the pill. I never have been a big fan of chemically-bluffing the body, though I don’t believe it is fundamentally wrong. I am, however, deeply troubled by the lack of evidence indicating with reasonable certainty that the pill is not an abortifacient. I am encouraged by small studies indicating the pill does a great job to inhibit ovulation. Yet, I am bothered by the lack of studies that tell me what happens when ovulation does take place.
In the end, people will ask me what I would do. I cannot yet bring myself to recommend the birth control pill, but I also cannot condemn it at this time. I think people should know the questions concerning it and make the difficult decision for themselves as they have to make difficult decisions all the time. As for me, I find it difficult to recommend the pill with its potential as an abortifacient when I can more comfortably recommend other birth control methods that clearly do not carry such a risk, such as natural family planning and barrier methods. Granted, these are not always as easy to use as taking a pill every morning but their mode of activity is much better understood.
What is needed is a groundswell of pressure on the medical and pharmaceutical community to conduct studies necessary to remove the nagging questions. If the studies confirm that when breakthrough ovulation occurs the fertilized egg would have just as good a chance for implantation and survival as it would if the pill were not used, then the pill truly would be a wonderful instrument of contraception. Absent of that data we can only make educated guesses.
We offer an explanation of various types of hormonal oral contraceptives as follows:
In late 2003, the FDA approved “Seasonale,” the first extended-cycle oral contraceptive. This form of birth control pill is specifically designed to reduce the frequency of a woman’s period – from one time per month to four times a year. This type of birth-control pill involves taking 12 weeks of active pills and a week’s worth of inactive pills. Clinical studies showed some users experienced increased breakthrough bleeding and spotting. This product should not be used if a woman smokes/uses tobacco or is over 35 years of age because smoking raises the risk of stroke, heart attacks, blood clots and high blood pressure from hormonal birth control. “Seasonique,” also produced by the same company, has active pills and but replaces the placebo week with a low-dosage week of estrogen. As with other hormonal forms of birth control, no clear evidence exists as to the efficacy of the third mechanism. Until conclusive evidence is produced to answer this question, Christian Life Resources cannot condone or encourage the use of these forms of birth control.
The FDA approved “Ovcon 35,” the first chewable oral contraceptive tablet, in March 2004. In early 2006, a 24-day oral contraceptive, “Loestrin (R) 24 Fe,” was approved by the FDA. The manufacturer later replaced that product with “Minastrin 24 Fe,” a chewable tablet which provides 24 days of active hormones and four days of iron containing placebo pills. In December, 2006, the FDA approved “Femcon FE,” a chewable birth control pill.
The spearmint-flavored “Femcon Fe” contains the same active ingredients as found in other combination oral contraceptives and works on a 28-day regimen (21 active tablets containing a progestin and an estrogen, as well as 7 inactive tablets). As with other hormonal forms of birth control, no clear evidence exists as to the efficacy of the third mechanism. Until conclusive evidence is produced to answer this question, Christian Life Resources cannot condone or encourage the use of these forms of birth control.
Yaz, a low-dose birth control contraceptive, was released to the American market in 2006. The drug is the low-dose version of its FDA-approved birth control pill Yasmin. Since its arrival on the U.S. market, a number of women who used the drug have suffered wide-ranging side effects including upper respiratory infections, high potassium levels, headaches, migraines, vaginal yeast infections and unusual vaginal discharge. More severe side effects from Yaz include anaphylactic reactions and severe and fatal blood clots. Despite the severe side effects and studies questioning the drugs’ safety, Yaz and Yasmin birth control pills have not been recalled by the FDA, and the drugs still remain on the market with only a four-sentence label change noting an increased risk of blood clots for all birth control pill users, not just Yaz. As with other hormonal forms of birth control, no clear evidence exists as to the efficacy of the third mechanism. Until conclusive evidence is produced to answer this question, Christian Life Resources cannot condone or encourage the use of these forms of birth control.
“Lybrel,” a low-hormone birth control pill that stops women’s periods, was approved by the FDA in May 2007. As with other hormonal forms of birth control, no clear evidence exists as to the efficacy of the third mechanism. Until conclusive evidence is produced to answer this question, Christian Life Resources cannot condone or encourage the use of these forms of birth control.
To learn more about the pill, purchase The Christian and Birth Control from the online CLR store, click here.