On Birth Control

If you are unfamiliar with the fact that there is a debate about birth control pills in the pro-life community, go read

http://ccli.org/nfp/contraception/mdexplains.php
http://www.epm.org/articles/bcp5400.html
http://www.verymom.com/archives/2006/01/18/birth-control/

And then, once you've seen what the issue is all about, go read

http://www.findarticles.com/p/articles/mi_qa4004/is_200104/ai_n8930311

(especially pages 3-6).

A quick summary: birth control pills work in three ways. Their primary mechanism is to prevent ovulation. This usually works, but not always, as evidenced by the fact that there is an average of about 1 (detectable) pregnancy per 100 women on the pill, per year. So "break-through" ovulation occurs sometimes (more about this later.) The second mechanism is that the pill thickens cervical mucous, making sperm less likely to find the egg. I was not able to find any statistics on how effective this mechanism is- is it very likely or only sligtly likely to prevent conception? Who knows. The third mechanism- and this is what all the discussion is about- is that most doctors believe that the pill causes changes in the endometrial lining which make implantation of a small baby (fertilized egg) less likely, thus causing an abortion. There seems to be some questioning of this third effect (see the fourth link posted above), but for the sake of discussion here I'll agree that, yes, the pill causes changes in the uterine lining that make implantation of an embryo less likely (though not impossible.)

For those of us who are pro-life and believe that life begins at conception- even before the fertilized egg implants in the uterus- this third mechanism of the pill causes some concern. In fact, many committed Christians, including several friends I know and love, choose to not use the pill for this very reason. Many pro-life folks feel betrayed by their doctors when they find out these facts for the first time, because they are frequently not discussed when a physician prescribes the pill. Some feel horrified that they may have inadvertantly contributed to an unknown number of deaths of pre-implant embryos during their time on the pill. So clearly this issue is not a trivial one for those who take pro-life ethics seriously.

(Quick side note: "abortion" is an emotionally charged term for those of us in pro-life world. Medically, the term "abortion" just means an end to pregnancy, so it is common to distinguish between "elective abortion," which is what we protest (ie what Roe vs. Wade was all about) and "spontaneous abortion," which is just a medical term for a miscarriage. Later I'm going to discuss the ramifications of the term "abortion" in this issue, so just be patient for that, and in the meantime, I'll try to use words that all of us pro-lifers can agree on (note I used "small baby" above.) :-))

So how can I call myself pro-life, but still use birth control pills? I DO believe life begins at conception. And I think that the pill CAN cause changes in the endometrial lining that make implantation of a fertilized egg less likely. BUT- I think women on the pill probably have fewer early (failure-to-implant) miscarriages than women who use no birth control!!

How can that be, you ask? Well, let's compare woman A, who is sexually active and uses no birth control, to woman B, who is sexually active and on the pill. In any given cycle, woman A has a certain chance of conceiving, and a certain chance that her new little baby (fertilized egg) will not implant on the uterine wall and thus be miscarried. These two statistical rates can vary, depending where you look, but I'll use estimates from the anti-pill side, where possible. According to Very Mom's post, which is quoting a book called "Breastfeeding and Natural Child Spacing," in a cycle in which a woman ovulates there is a 25-50% chance of conception (assuming normal fertility). Furthermore, once a child is conceived, the rate of very early miscarriage (ie, failure to implant) is fairly high. According to http://www.medicinenet.com/miscarriage/article.htm , "About 15% of fertilized eggs are lost before the egg even has a chance to implant (embed itself) in the wall of the uterus. A woman would not generally identify this type of miscarriage." (Incidentally, I've seen much higher estimates of this, upward of 50%, but didn't see enough studies to back them up. Reliable figures on this seem to be very hard to come by, as I presume it's a tough thing to measure. But I'll use this 15% figure as it seems, if anything, quite conservative.)

So, combining these two rates, in a given month, a sexually-active, normally fertile woman has a 3% to 8% chance of having a miscarriage of this type (failure to implant.)

Now let's look at woman B: sexually active, normally fertile, and on the pill. According to the book referenced on Very Mom's website, breakthrough ovulation on the pill occurs at a rate of 2% to 10%; the book does a calculation using the figure of 5%, so I will too. Now, recall, to have a failure-to-implant miscarriage on the pill, THREE things have to happen in sequence:
1) woman B must ovulate (5% chance)
2) she must conceive (25-50% chance)
3) the embryo must fail to implant (we're not sure about this rate; the claim is that, because she is on the pill, the rate is much higher than the typical 15%).

Just look at items one and two: combining these probabilities, woman B only has a 1% to 3% chance of conceiving at all! So even if the pill increased the chance of a fertilized embryo failing to implant to something like 90%, there is STILL a greater risk that woman A will have this type of miscarriage than woman B. (Also note that the figure would be even lower if we incorporated the unknown rate at which mechanism #2, thickened cervical mucous, decreases chances of conceiving in the first place.)

Does this reasoning make sense to everyone? In other words, once woman B conceives she might be more like to miscarry, but, she is much less likely to conceive in the first place; so, overall, her risk of miscarriage is LOWER than that of woman A.

Now, some here will object and say, "But, God is in control of the process for woman A, whereas woman B has taken an action to make her body less receptive for an unborn child, and that's where the wrongdoing lies."

I would counter by saying, God is sovereign, and still completely in control of the process in woman B's body.

Some will object and say, "But, it's not okay to Increase the Risk of miscarriage- even a little bit!!" (This seems to be Randy Alcorn's line of thought.) And I would counter by saying that although that looks like a plausible argument on the surface, in reality, none of us live our lives according to this principle. Think about it: if the ethical standard is, "Take no action for the sake of convenience that will risk the loss of life, even a little bit," then what business do we have putting our kids in the car? (The fourth link above talks about this a lot, but I thought about it before I read that article. ;-)) Thousands of kids are killed in car accidents every year. But, for the sake of convenience, we drive around. Life is all about balancing risks with advantages, and taking certain risks, carefully and with consideration, is NOT an automatic violation of pro-life ethics. I buckle my seatbelt (and I'll use carseats for my kids someday), but I still use a car. I wouldn't let kids go swimming without a lifeguard, but I would let my kids go swimming- despite the fact that some number (hundreds maybe?) drown every year. And I don't use drugs or cigarettes, for my own good of course, but also in consideration of my unborn children someday. Those are activities which seem to me to be things whose bad (risks) outweigh good (my pleasure.) But, I still drink some coffee and take tylenol and don't take folic acid supplements- all of which might increase the risk of an early miscarriage, in the event that I should conceive.

The bottom line is, the pill seems to be a good choice to meet the contraceptive needs of our family. We believe that it is prudent to wait to have children until there is at least a good chance (by human calculations) that we will have enough income to feed them without utilizing government handouts (even though we believe that God would provide if I DID become pregnant unintentionally.) Barrier methods typically have considerably higher failure rates than the pill- rates I'm not really comfortable with- and NFP, frankly, seems far too restrictive for our love life. (It wasn't easy to practice abstinence until marriage, but by God's grace we did it. And now that we're married, we like to practice... well, let's just say, Frequent Non-Abstinence.) And in spite of what some say are increased risks for loss of life on the pill, I am persuaded that the risk is either nonexistent (according to my number-crunching above) or so small that it is an acceptable risk worth taking. I may be wrong in my judgment, and if so, I am sure God will set me straight when I meet Him face to face. But for now, these are my reasons for feeling justified in using a form of birth control others find unacceptable.

PS I said I would comment on the use of the term "abortion" in this discussion. In contrast to Randy Alcorn's line of reasoning, I would respectfully submit that there is a whole world of difference between intentionally ending a life that you know exists (ie, elective abortion) vs. taking an action whose side effect is to reduce the risk that life will continue (assuming that he is right that there IS a real risk involved.) Let's say a mom puts her kid in a car seat and drives to the mall to get her nails done. Her action is one of convenience (she could have walked to the mall and thus avoided the risk of her child dying in a car accident) and arguably her action is selfish (getting her nails done is somewhat frivolous and for her own pleasure, not for that of her child.) Let's say that the worst happens, and this child is, in fact, killed in a car accident. Would we call the mom a murderer, in the same way that we would accuse a mom of murder who intentionally drives her kid off a bridge? I don't think so. Taking the pill is convenient, and maybe some would even argue that it's selfish, but, we pro-lifers take the pill to stop ovulation, not to cause a miscarriage. We are balancing the (possible? slight?) risk of miscarriage with our contraception needs in the same way that the mom balances the (slight) risk of a car accident with her desire to get her nails done. Life is about balance.

PPS I would totally welcome (respectful) dialogue about this post, critique of any of the reasoning I used here, etc. If nothing else, it would answer my curiosity about whether or not more than 2 people read this blog. :-D And again, let me emphasize that I have an enormous amount of respect for those on the other side of this issue- especially those who sacrifice their own convenience (i.e. would like to use the pill, but don't) for the sake of their convictions. God is always pleased when we stand up for what we believe to be right, after seeking Scripture, facts, other believers, and guidance from the Holy Spirit. So I hope and pray that nothing I've written here is offensive to other Christians. If it is, let me know.