13. Which Methods of Conception Control Are Lawful?

Cautions on applying Biblical principles to scientific discoveries

Before I apply the ethical principles of the previous chapter to the actual methods of “conception control” and the unbiblical methods of so-called “birth control,” I want to give some cautions. My first caution is: do not credit science with the same authority that you credit Scripture. Science is not infallible; the Bible is. Indeed, the conclusions of science are constantly changing. While we can be dogmatic about the ethical principles articulated in the previous chapters, we should be less dogmatic about applying those principles via science. Science is an inductive endeavor, and inductivism can (at best) only give us varying degrees of probability. The probabilities may be quite high, even high enough to make us quite certain, but they do not rise to the level infallibility. The Bible is the only infallible thing in life. So even though I give conclusions on why you should avoid certain methods of conception in this chapter, I do so recognizing that time may prove these conclusions to be wrong or partially wrong. I would not want the theology of the previous chapters questioned if the scientific data behind certain applications is proved to be wrong.

Thus my second caution is to see this chapter as the application of theology, not the theology itself. God expects us to make conclusions about the world around us (see for example Matthew 24:32). We will seek to do that in this chapter by reference to many medical studies, but the reader will need to be convinced that the studies are true before the application will make sense.

This leads to a general rule of thumb – if the scientific studies are fairly strong, apply the theological principles to them with confidence, but if in doubt, err on the side of caution. If you are convinced that something is dangerous for the health of you, your spouse, or your baby, then avoid it. If you are in doubt about whether a method is dangerous to our health or dangerous to a baby’s life, then you should avoid that method, because whatever is not of faith is sin (Rom. 14:23).

My final caveat is to not equate my comfort zone as being authoritative. There are legitimate differences of opinion among BLCC advocates, with some only using the Lactational Amenorrhea Method (LAM) of breast feeding, others using one of the Natural Family Planning methods, others using computer technology that monitors saliva and other factors, others being comfortable with NFP plus a condom, still others being comfortable with a diaphragm, and still others using spermicides in conjunction with the aforementioned methods. The fact that I have not been comfortable with diaphragms or spermicides should not bind the consciences of others. Consider the health risks that I believe exist with those and make your own judgment. The following pages are simply an attempt to educate you on the varying levels of risks to health and life.

Methods typically used by Biblically Limited Conception Control

After examining all of the evidence for and against, I have come to the conclusion that the following methods are allowable. I see no evidence to indicate health risks.

The Billings Ovulation Method (BOM) (sometimes called mucus test method)

Though this newer method of conception control is not as well known in BLCC circles, it is a very effective method. It is quite different from either the Rhythm or the Temperature Methods, and much more accurate. For example, one study in a low socio-economic region of Guatamala had an astounding 90.74% success rate with 54 infertile couples in helping them achieve pregnancy¹⁸⁵ and a 99.3% success rate with 506 couples in helping them to postpone pregnancy.¹⁸⁶ A study done in China showed an effectiveness rate of 98.82%.¹⁸⁷ Merecedes A. Wilson says, “Pregnancy can only result from an act of intercourse during the woman’s approximately 100 hours of fertility when the pre-ovulatory mucus is most receptive to sperm penetration.”¹⁸⁸ The Billings Ovulation Method helps to pinpoint that period with precision, irrespective of length or regularity of menstrual period.

Simplistically, the test puts the vaginal mucus between two fingers and then separates the mucus to test the texture. It is very convenient, very easy to learn, needs absolutely no thermometers or other technology, is non-invasive, and can be used even in the lowest socio-economic regions of earth. What is especially helpful about this method is that it is not dependent upon regularity in menstrual cycles. The signs of fertility will automatically inform the woman of approaching fertility. Mercedes A. Wilson points out that,

The key to nearly all the present research was the discovery, first published in 1977, that there are four types of cervical mucus, S, L, G and P mucus…

The function of the G Mucus is to seal the cervical canal during the infertile days of the cycle. It is present in one variety immediately after menstruation, in another during the post-ovulatory phase of the cycle, and probably in a third during pregnancy.

Type G mucus is thick and sticky and it forms a mechanical and immunological barrier, or plug in the cervix during the infertile period.

However, recently discovered P type mucus seems to degrade and dissolve the G mucus giving space for L and S mucus during the fertile phase.

The L mucus, the first fertile mucus symptom of the cycle is a soft, mucinous secretion that turns into a slippery, watery secretion a few days before ovulation when S type mucus is produced.

Type L (Loaf) mucus is a soft translucent gel, that becomes a little more elastic. It helps sperm climb up to the uterus and it also acts as a filter in which immature, aged or otherwise abnormal sperm cells are prevented from entering the uterine cavity.

The S mucus, the sperm receptive mucus, provides low viscosity channels for the sperm by which they gain access into the cervix and uterine cavity. A certain balance between the S and L secretion seems to be necessary for optimum fertility.

Type S (String) mucus is a clear, stretchy, slipper and watery cervical mucus discharge. Women feel the sensation of wetness and lubrication, as the mucus becomes up to 98 percent water.¹⁸⁹

Noticing the texture of the mucus pinpoints the time of ovulation so accurately that it is an excellent way of getting pregnant. Of course, this accuracy translates into outstanding results in preventing conception as well. For more in depth discussion of this method, go to https://www.familyplanning.net/en/recent-studies. An illustrated book that is very easy to understand was written by Mercedes Arzú Wilson: Love and Fertility (Dunkirk, MD: Family of the Americas Foundation, 1998). The same material can be seen at the end of the following paper: Mercedes A. Wilson, “Natural, Scientific and Highly Effective Treatment for Infertility,” presented in the Conference of the International Institute of Restorative Reproductive Medicine in New Orleans, August 7, 2013.¹⁹⁰

Sympto-Thermal Method (STM) (sometimes called Natural Family Planning)

Perhaps the most popular BLCC method of birth control is the sympto-thermal method (STM). Though opponents mockingly call it “Vatican Roulette,” the Scientific American says that it is actually just as effective as the pill:

The sympto-thermal method (STM) leads to an unintended pregnancy rate of only 0.6 percent annually. This rate is comparable with that of unintended pregnancies in women who use birth control pills, the most popular method of contraception in the U.S.¹⁹¹

This method involves determining the most fertile time of a woman’s monthly cycle by means of charting. There are two main processes that are charted: the body’s basal temperature, which rises after ovulation (anywhere from 0.36 to 0.9 degrees F), and becoming aware of recurring monthly symptoms such as mood and cervical secretions. It is difficult to predict ovulation for those with irregular monthly cycles, but charting will usually show a predictable pattern in most women.

Because of its difficulty in mastering, pregnancies do occur during the first year of the learning curve. Mayo Clinic claims an 87% success rate,¹⁹² though practitioners say that it is higher if people are very careful. There are many sites that describe this method.¹⁹³

This is by far the most common BLCC method, but many have supplemented it with various computer systems such as the Rabbit Ovulation Computer or similar brands. Using the two together can be particularly helpful for achieving pregnancies. For other more advanced technologies that can assist, see next point.

Fertility monitoring technologies

There are a number of fertility monitoring technologies that can be used in conjunction with the above methods.

ClearBlue Fertility Monitor (2020 prices - $215-$260)

Many doctors have recommended this diagnostic kit for monitoring fertility and achieving pregnancy. Using daily urine samples, this monitor tracks two hormones: luteinizing hormone and estrogen. It then shows your fertility level for any given day as low, high, or peak. To achieve pregnancy, time intercourse for the last day of High Fertility and the first day of Peak Fertility. Peak Fertility takes place right before ovulation occurs.

This method is not recommended for breastfeeding, recently pregnant, or recently on the pill women, since these factors affect the hormones in ways that skew the readings on the computer.

OvaCue Fertility Monitor (2020 prices - $299-$349)

This device uses saliva and cervical mucus samples to measure changes in electrolyte concentration (salinity). Unlike monitors that measure hormones (like ClearBlue Fertility Monitor), this one can be used by mothers who have irregular monthly cycles. It claims 98% accuracy in predicting the day of ovulation up to seven days in advance.

Fertile-Focus Saliva Ovulation Test (2020 prices - $28-$35)

This device allows you to see physical changes that occur in a woman’s saliva throughout her cycle. Estrogen produces crystal patterns known as “ferning” in the saliva. A dab of saliva is placed on the lens window and allowed to dry. An LED light illuminates the sample, and it is viewed using a 50x magnifying lens. The company claims that you can predict ovulation up to 72 hours in advance.

Lactational Amenorrhea Method (LAM)

This is not just breast feeding, but a specific kind of scheduled breastfeeding¹⁹⁴ that has proven to be very effective in the first six months (numerous studies show a 98% plus effectiveness rate, with many claiming 99.7% effectiveness in the first six months¹⁹⁵) with varying degrees of effectiveness after that.¹⁹⁶ Jewish commentators reference Hosea 1:8 in reference to their use of breastfeeding for suppression of ovulation (Niddah, 31b). See pages 93 and following for a brief discussion of this method. Various scholarly papers rate this method’s effectiveness.¹⁹⁷ We were never able to practice strict LAM protocol and were somewhat skeptical of the results that we saw in other people’s attempts. Nevertheless, there is a large group of couples that believe that this works for them. See chapter 6 for the impact of the Fall on this natural method of spacing babies. It does appear that the body was designed for this to be effective upwards of three years, but many factors make it not fully reliable.

Male Condom

Condoms are fairly inexpensive and readily available. Though some people have allergies to latex (the most common kind), there are two alternatives – polyurethane and polyisoprene. The CDC reports an effectiveness rate for condoms of about 98%.¹⁹⁸

A combination of the above

Obviously a combination of the above methods would increase effectiveness. The nice thing about all of these methods is that God could overrule if He so chose.

Methods used by some BLCC advocates, but avoided by us because of potential health issues.

Spermicide

As has already been discussed, the ancients (including Hebrews) commonly used spermicides.¹⁹⁹ Lemon juice in particular was popular and has been shown in modern clinical trials to be a very effective antispermicidal.²⁰⁰ However, many BLCC advocates have avoided all use of spermicides because of the fear (whether well-founded or not) that it might result in infections or other problems for the wife.

A combination of the above with condom and spermicide

Obviously a combination of spermicide with the regularly used BLCC methods would increase effectiveness, but the dangers of spermicides should be considered.

A combination of the above with spermicide and either a cervical cap or a cervical diaphragm.

Because this is so rarely used by BLCC advocates, I will defer discussion of it to the next section. However, because both the cervical cap and the cervical diaphragm are barrier methods designed to prevent conception, this could be consistent with BLCC principles if the health concerns addressed in the next section prove to be non-concerns. Though I am not dogmatic on my view that there are health concerns, I would urge readers to at least consider the evidence presented in the next section.

Methods avoided by most BLCC because of controversies over health issues and potential of abortifacient mechanisms

Methods that have been shown to have major health issues

Health problems with menstrual sex

We have already seen that God prohibited menstrual intercourse (though not necessarily manual pleasuring of each other during the menses). God’s laws were never arbitrary. Even the ceremonial laws were given for health. While food laws are no longer binding, they certainly have health benefits. While circumcision is no longer binding, there is medical evidence of its benefits. Though not marrying a sister or cousin is not a moral law, it certainly has health benefits. God governed Israel in ways that benefited them spiritually and physically, and I believe the same is true of menstrual sex. Modern medical science suggests the following health risks to women who engage in menstrual sex:

1. There is risk of women developing Anti-Sperm Antibody (ASA), one of the causes of infertility and other female health problems.²⁰¹
2. While there is evidence that orgasm during menses can help women who experience pelvic torment and cramping,²⁰² recent studies have shown that there are significant health problems with intercourse, including increased volume of blood flow and risks of Endometriosis (not to be confused with PID/endometriosis – below).²⁰³
3. R. A. Hatcher has documented minor risks for pelvic congestion if the intercourse does not head to orgasm for the woman, thereby increasing the dysmenorrhea a woman may experience.²⁰⁴ He also notes risk for contracting Pelvic Inflammatory Disease (PID – see below).
4. Some studies have shown an increase in vulvar skin irritation. Evidence is conflicting on whether this is due to the way menstrual blood can be an irritant to some people, the menstrual blood diluting natural and artificial lubrication and thereby setting up more friction, or some other mechanism.
5. Because a woman’s cervix is more open during menses, there is both theoretical and statistical risk of ascending infections and Pelvic Inflammatory Disease (PID). The potential of the penis introducing bacteria (from the penis itself or simply from the entrance to the vagina) up against the cervix at a time when it is more open and at a time when the wall of the uterus is more prone to infection should be considered. While there is still debate on this subject, studies do seem to show a significant increase in both STDs and bacterial infections.²⁰⁵ Dr. DeSouza summarizes the evidence, stating:

Naturally during menstruation, the veins of the uterus are congested and are prone to rupture easily. Vaginal walls swell as well during menstruation. This explains the dull pain in the vagina during menses and is 100% normal. Having intercourse during your period can increase the chances of irritation to the swelled up walls. The advantages of endorphins at this point mask the danger of period sex where irritation of the vaginal walls and introduction to infection are major risks. Any wound or bleeding is a fine gateway to infection.

The cervix is slightly opened during menstruation to let out blood. This heightens the risk of infection, not being limited only to the vagina, but additionally to the uterus. The penetration of the penis into the vagina during menstruation is no more than the introduction to germs at a time when the body is unable to fight them (studies have shown that immunity is decreased during menstruation).²⁰⁶

Health issues with anal sex

ABC advocates will frequently defend anal sex as a form of birth control and/or creativity in sexual relationships, and claim that the Bible gives it as an area of liberty. However, I believe the Bible is clearly against all anal sex. Most of the NCC and BLCC opposition to this ABC position has tended to focus exclusively on controversial arguments such as 1) the meaning of the phrase, “against nature” in Romans 1:26, 2) the meaning of the phrase, “abandoning the natural use of the female” in Romans 1:27, 3) the Hebrew word for “perversion” (תֶּבֶל), which the dictionary defines as sexual “confusion,” 4) and on Biblical references to “uncleanness,” “filthiness,” and “unclean spirit.” While I believe there is much merit in these interpretations, I see no need to interact with all the exegetical controversies when the Biblical principles related to health completely rule out any anal sex. Consider the following serious medical problems:

Anal Cancer

The first significant health concern with anal sex is a huge increase in cancer. I have found numerous studies that link anal intercourse (of either men or women) with a huge increase of anal cancer. Various studies showed an increase in cancer from 200% to 1700%, depending on frequency. Donald DeMarco summarizes a few of these numerous studies in his to-the-point comments:

Now that sodomy is talked about as a human right to be exercised by male same-sex couples without discrimination, we may ask the pertinent question: what happens when sperm is deposited in the rectal area rather than in the vaginal area?

Male sperm, being blissfully unresponsive to political ideologies or cultural trends, go right ahead and behave strictly according to their nature. They penetrate the nucleus of whatever body cell (somatic cell) they might encounter. This fusing, however, does not result in fertilization, the first stage in the life of a new human being, but, as scientists have shown, can and does result in the development of cancerous malignancies. In an article entitled, “Sexual Behaviour and Increased Anal Cancer,” published in Immunology and Cell Biology, authors Richard J. Ablin and Rachel Stein-Werblowsky, report that “anal intercourse is one of the primary factors in the development of cancer.” According to the prestigious New England Journal of Medicine, “Our study lends strong support to the hypothesis that homosexual behaviour in men increases the risk of anal cancer.” In addition, the International Journal of Cancer finds that, “Being single and having practiced anal intercourse appears to be associated with anal cancer and case reports have suggested a recent increase in the number of cases of anal cancer.” The medical references are legion.

Also, we may ask: what happens when the male immunosuppressant is deposited in the rectal area? Scientists tell us that when this occurs, an “immunopermissive environment” is created.

This environment, in which the immune system is not working as it should, is favourable for the perpetration of spermatozoa-induced tumors and other pathologies. It is as if, in this instance, the immune system becomes confused and welcomes its enemies. C. Rabkin et al., in the American Journal of Epidemiology, found a decreasing immunocompetence in a substantial proportion of HIV-positive homosexual men, particularly those with a history of intraepithelial abnormalities.

Depositing sperm in the “wrong place” (like pouring motor oil into the gas line), by nature’s standards, is courting disaster. Nature, we might add, demands respect. It does not make accommodations to politically based ideologies or individual preferences. From nature’s standpoint, there is no equality between heterosexual and male homosexual intercourse.

Furthermore, the vagina is totally impermeable to viruses. By contrast, the rectum is designed to absorb up to the last possible useful nutrient that we have eaten. There is an enormous lymphatic network (involving blood vessels) in the lining or mucosa of the rectum. Therefore, the rectal area is designed to absorb, and will absorb, the ingredients of male semen if they are in the vicinity. Little wonder why Gay, bisexual, and other men who have sex with men (MSM) are more severely affected by HIV than any other group in the United States.²⁰⁷

Whatever interpretation one gives of the phrases “against nature” or “leaving the natural use of the woman,” it is clear from what we have just seen that anal sex is not intended by God to be natural.

Severe damage to anus and rectum

The second major health problem with anal sex is the severe damage that can result to both anus and rectum. Unlike the vagina, the anus lacks natural lubrication and lacks layers of protective cells and other protective mechanisms. This almost guarantees damage to the intestinal wall, which in turn guarantees that bacteria can enter the bloodstream. Various studies have shown that even slow and gentle penetration can lead to damage. The American College of Pediatricians states,

Yet human physiology makes it clear that the body was not designed to accommodate this activity. The rectum is significantly different from the vagina with regard to suitability for penetration by a penis. The vagina has natural lubricants and is supported by a network of muscles. It is composed of a mucus membrane with a multi-layer stratified squamous epithelium that allows it to endure friction without damage and to resist the immunological actions caused by semen and sperm. In comparison, the anus is a delicate mechanism of small muscles that comprise an “exit-only” passage. With repeated trauma, friction and stretching, the sphincter loses its tone and its ability to maintain a tight seal. Consequently, anal intercourse leads to leakage of fecal material that can easily become chronic.>

The potential for injury is exacerbated by the fact that the intestine has only a single layer of cells separating it from highly vascular tissue, that is, blood. Therefore, any organisms that are introduced into the rectum have a much easier time establishing a foothold for infection than they would in a vagina. The single layer tissue cannot withstand the friction associated with penile penetration, resulting in traumas that expose both participants to blood, organisms in feces, and a mixing of bodily fluids.²⁰⁸

Suppression of the woman’s immune system

The third major health factor is that anal sex impairs the woman’s immune system. While there is some contrary evidence on this subject,²⁰⁹ the overwhelming evidence of both animal and human studies is that any introduction of sperm into the rectum increasingly impairs the whole body’s immune system.²¹⁰ This is necessarily so because of God’s design for reproduction. “If sperm didn’t have the ability to ‘turn off’ the immune system and bypass the protective bacteria residing in the female vagina, they would be destroyed before they could reach their objective.”²¹¹ The story of how God designed this is worth summarizing, if for no other reason than to praise and glorify God. Donald DeMarco states,

From a purely immunological point of view (from the standpoint of an all-out defensive strategy), a woman’s body would reject the oncoming sperm, recognizing it as a foreign substance. But this is precisely the point at which nature, we might say, becomes wise. If our immune system regards sperm as a potential enemy, then fertilization would never take place, and the human race would have come to an early demise with the passing of Adam and Eve.

But something extraordinary occurs, which makes fertilization and the continuation of the human race possible. Traveling alongside the sperm in the male’s seminal fluid is a mild immunosuppressant. Immunologists refer to it as consisting of “immunoregulatory macromolecules.” This immunosuppressant is a chemical signal to the woman’s body that allows it to recognize the sperm not as a non-self, but as part of its self. It makes possible, despite the immune system’s usual preoccupation with building an airtight defence system, a “two-in-one-flesh” intimacy.²¹²

A paper published in Frontiers In Immunology journal states,

There are specific locations in human tissues and organs where alloantigens and autoantigens are tolerated by the immune system. This tolerance can exist indefinitely or for defined periods of time like pregnancy. This uncoupling of the adaptive immune response confers a physiological state known as immune privilege (Streilein, 1995)²¹³.

The vagina possesses this immune privilege, but the rectum does not. Experts in immunology are still uncovering the myriad ways that God’s design of the vagina protects the female body from the sperm’s immune suppression.²¹⁴ Also, the sperm itself must be protected from the vagina’s immune system. The American College of Pediatricians says,

Furthermore, ejaculate has components that are immunosuppressive. In the course of ordinary reproductive physiology, this allows the sperm to evade the immune defenses of the female.”²¹⁵

It is the complex anti-immune-system properties of sperm that make it so dangerous to engage in anal sex. The American College of Pediatrics cites two studies showing that injection of semen into the rectum impairs the immune system of both rabbits²¹⁶ and humans.²¹⁷ Numerous other studies have shown that sperm injected (whether artificially or with sex) into the rectum impairs the body’s immune system.²¹⁸ The quote given earlier by Donald DeMarco gives a nice summary statement of why this is so dangerous.

The development of AntiSperm Antibodies (ASA)

The fourth major problem with anal sex is that the wife over time becomes allergic to the husband’s sperm. AntiSperm Antibodies are produced whenever sperm is introduced into the rectum. A 2013 Textbook on clinical reproductive techniques points out that, in contrast to vaginal coitus where

…the atraumatic introduction of sperm into the reproductive tract as a result of intercourse or artificial insemination does not seem to be a factor in the production of sperm antibodies, … introduction of sperm to the mucous membranes outside of the reproductive tract, can induce antibody formation. Proposed examples of such events include trauma to the vaginal mucosa during intercourse or the deposition of sperm into the gastrointestinal tract by way of oral or anal intercourse.²¹⁹

Note the same connection of ASA to oral sex.

Kaposi’s Sarcoma

Kaposi’s sarcoma still puzzles researchers, but some studies propose that “massive semen exposure and inhalant nitrites [used to relax the anus sphincter] may promote transformation of endothelial cells of both lymphatic and vascular origin.”²²⁰

Miscellaneous other problems

It doesn’t take much reading of the literature to see numerous issues resulting from anal intercourse, including anal tears, fissures, ulcers, abscesses, fungal and bacterial infections of rectum, penis, and vagina, and urethral infections leading to bladder and ascending infections, including PID.

The bottom line is that anal sex is not healthy. This parallels the Old Testament arguments (already cited) against “confusion.” It also shows the wisdom of the Old Testament prohibitions of that which is unclean or filthy. Excrement was to be buried outside the camp, not played with (Deut. 23:12-14). Paul points out that “leaving the natural use of the woman” (vaginal sex) for that which is not natural (anal sex) eventually predisposes both men and women to homosexuality (Rom. 1:24-28).

Health problems with Vascectomy

Many have thought that vasectomies hurt no one and are a convenient way to stop having children, but there are serious health concerns with this procedure.

AntiSperm Antibodies (ASA)

One of the key concerns is the development of AntiSperm Antibodies (ASA) within the male. Various studies show that between 60-80% of men develop a form of allergy to their own sperm. A 2013 textbook on clinical reproductive techniques states,

As long as the sperm are contained within the lumen of the male reproductive tract, they are sequestered from the immune system, and no antibodies form to their surface antigens.

If there is a breach in this so called blood:testis barrier, an immune response may be initiated. The most common causes of a breach in the reproductive tract, which could initiate antibody formation, include vascectomy, varicocele repair, testicular biopsy, torsion, trauma, and infection. Antibodies are secreted into the fluids of the accessory glands, specifically the prostate and seminal vesicles. At the time of ejaculation, the fluids from these glands contributed to the seminal plasma. They then come into contact with the sperm and may cause them to clump…

The clinical value of antisperm antibody testing is predicated on the observation that the presence of a significant concentration of antibodies may impair fertilization. It has been reported that antibody-positive sperm may have difficulty penetrating cervical mucus. Although, in these cases, intrauterine insemination (IUI) or IVF may improve the prognosis for fertilization, antibody levels exceeding 80% coupled with sub-par concentration, motility or morphology may necessitate the addition of ICSI in order to truly make a difference.²²¹

Pain

Men who have gotten vascectomies have confided in me that it has caused them a great deal of pain. Studies indicate that at least 7% of men have chronic pain after a vascectomy,²²² and some studies show up to 52% experience pain.²²³

Risk of heart attack

Though there may be very low risk of heart attack connected with vascectomies, a 1979 study on monkeys indicated an increase in atherosclerosis or coronoary artery disease. Studies since then have contradicted that, so the verdict is not yet conclusive.

Risk of prostate cancer

The risk of prostate cancer is also in question. The Journal of the American Medical Association published two studies suggesting that men with a vasectomy may be at risk for developing prostate cancer. For a period of time the American Urological Association recommended annual prostate checks for those who have had a vasectomy. They have since revoked that recommendation. Other studies have shown no significant increase of risk. The conclusions are still being debated.

Risk of a rare form of Alzheimers

Yet another hotly debated risk is a rare form of Alzheimer’s. Only one paper has suggested a link between vasectomies and primary progressive aphasia (PPA). The proposed mechanism for this association was that antisperm antibodies were somehow cross-reacting with the brain. The jury is still out, but it is interesting that other studies have found genetic material from multiple male partners in the brains of promiscuous women.

Health problems with the IUD

Why even talk about the health risks of the IUD if it is already ethically ruled out by being abortifacient? Because women sometimes use the Mirena IUD to treat heavy menstrual bleeding in conjunction with the condom or other BLCC methods. In these situations it would not be acting as an abortifacient and would be treating menstrual complications. Nevertheless, there are several problems with Mirena (as well as the 17 varieties of IUD available in other countries).²²⁴ I will discuss the general problems first, then I will deal with each of the IUDs currently available in the United States.

Perforation of the uterus, bladder, intestines, etc.

The first major health risk of IUDs is that they sometimes get dislodged and can end up perforating the uterus, bladder, intestines, and other organs.²²⁵

PID

The second major health risk associated with IUDs is Pelvic Inflammatory Disease (PID). One medical dictionary states, “IUD usage has been strongly associated with the development of PID. Bacteria may be introduced to the uterine cavity while the IUD is being inserted or may travel up the tail of the IUD from the cervix into the uterus. Uterine tissue in association with the IUD shows areas of inflammation that may increase its susceptibility to pathogens.”²²⁶

Other side effects

Mayo Clinic has listed a number of other side effects, including ovarian cysts.²²⁷

Since it may be questioned whether every IUD has problems, I will seek to discuss each one in turn. The problems of the Dalkon Shield are quite well known, but it is no longer available in the United States, so I will restrict my comments to the three other IUDs currently available in America.

Specific details on Paragard, Mirena, and Skyla

Paragard

Numerous health issues have been documented in connection with Paragard. These include the following:

• Migration of the IUD: The Journal of Medical Case Reports states, “Migration of IUCDs into the urinary bladder, rectum, colon, peritoneum, omentum, appendix, wall of the iliac vein and ovary has been reported.”²²⁸ Lawsuits have been filed for severe complications from this migration and a mass tort lawsuit is in process. Complications of the lawsuits include perforation of the colon (requiring removal of a section).
• Impact on hormones: Though Paragard is a non-hormonal IUD, many studies show a major impact upon hormones due to the increased levels of copper in the blood. For example there are huge increases of estrogen. Since the copper IUD prompts the release of leukocytes and prostaglandins by the endometrium, and since prostaglandins control hormone regulation, there is an indirect impact they have on hormones, potentially creating imbalances. Numerous advocacy groups have been created by women who have been hurt by this IUD to educate women on its dangers.²²⁹
• Copper toxicity: Paragard’s main actions come from the release of copper into the uterus. If this copper build up gets to toxic levels, it can lead to changes in nutrients (destruction of vitamin C, depletion of zinc levels, lower iron, unusual rise of Vitamin A), elevated levels of estrogen, migraines, PMS, chronic fatigue, yeast infections, bone loss, etc.
• Migrains, PMS, chronic fatigue.
• The barium sulfate in the IUD (to make it detectable via x-ray) can lead to cramping, nausea, ringing in ears, fast heart rate, etc.
• A slim possibility of pseudotumor cerebri (PTC) has been suspected in connection with Paragard, though studies are inconclusive. At least 50 of the lawsuits against Mirena (below) are seeking to show that Mirena is responsible for pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension (IIH). This is a neurological disorder characterized by increased levels of cerebrospinal fluid in the skull. This puts pressure on the optic nerve, which leads to progressive vision loss and permanent blindness. Though not proved, some are suspecting that the changes in hormones created by Paragard may link it to this disease, though this is hotly contested. I personally doubt the connection, but it is important to know that lawsuits are progressing for this disease, and some researchers are convinced of a connection.

Mirena

Between November 1 of 1997 and June 30 of 2012, the FDA’s adverse event database received 45,697 reports of Mirena side effects. Of these side effects, 5,079 involved dislocation of the IUD and 1,421 involved migration to other sites of the abdomen requiring surgery to fix. Even more common were reports of vaginal hemorrhaging. The FDA noted a 44.3% increase in Pelvic Inflammatory Disease (PID) during that same period. I have discovered almost 500 federal lawsuits filed against Bayer related to severe complications of the IUD. The complications experienced by these women include perforation of the cervix or uterus, migration of the IUD to other organs, perforation of the intestines, intestinal obstruction, miscarriage, abscesses, infertility, infection, severe abdominal pain, Pelvic Inflammatory Disease (PID), ectopic pregnancies, and more. Many of these lawsuits have recently been grouped into a class action lawsuit. The FDA issued a warning in 2009, stating,

The program overstates the efficacy of Mirena, presents unsubstantiated claims, minimizes the risks of using Mirena, and includes false or misleading presentations regarding Mirena. Thus, the program misbrands the drug in violation of the Federal Food, Drug, and Cosmetic Act.²³⁰

Even organizations that are friendly to Mirena (and the Mirena website itself) report the following complications:

• Migration of the IUD: This of course is not unique to Mirena - see under Paragard (above) for documentation by the Journal of Medical Case Reports. Mirena’s own website states, “Mirena may attach to or go through the wall of the uterus and cause other problems.”²³¹
• PID: The Mirena site boasts that less than 1% of users get Pelvic Inflammatory Disease (PID), but the FDA warning letter shows that “5% or more of clinical trial patients” had chronic abdominal pain, pelvic pain, and back pain.²³² Mirena’s own website notes that more than 10% of Mirena users experience chronic pelvic and/or abdominal pain.²³³
• Complications in case of pregnancy: The Mirena site states that if pregnancy occurs while the Mirena IUD is inserted, it “can be life threatening and may result in loss of pregnancy or fertility.”
• Ovarian cysts: The Mirena site states that “Ovarian cysts may occur but usually disappear,” but the FDA points out that Mirena’s own clinical trials showed that more than 10% of the women in the clinical trials showed ovarian cysts.²³⁴
• Ectopic Pregnancies: Mirena now advises that there is a danger of ectopic pregnancy.²³⁵ Since there is a 0.8% risk of pregnancy, and since about half of those pregnancies are ectopic, a rough risk factor of 0.4% can be estimated as ectopic. Without removal of the IUD all pregnancies pose a danger to the life of the mother.
• Impact on bleeding: “Bleeding and spotting may increase in the first 3 to 6 months and remain irregular. Periods over time usually become shorter, lighter or may stop.”²³⁶ The FDA warning letter states that more than 10% of the women in the clinical trials showed “Very common adverse reactions” including “uterine/vaginal bleeding … and ovarian cysts.”
• Miscellaneous: The FDA warning report stated that “5% or more of clinical trial patients include, among others, abnormal/pelvic pain, nausea, headache, nervousness, back pain, weight increase, breast pain/tenderness, acne, decreased libido, and depressed mood.”²³⁷
• Benign Intracranial Hypertension (BIH) was linked to Mirena in 1995 and continues to be a concern stated by the National Institutes of Health.²³⁸
• There is a possible connection between pseudotumor cerebri (PTC), which is also known as idiopathic intracranial hypertension (IIH). This is a neurological disorder characterized by increased levels of cerebrospinal fluid in the skull. This puts pressure on the optic nerve, which leads to progressive vision loss and permanent blindness. Though lawsuits prove nothing (there are 50 lawsuits against Bayer for this condition), there is at least an odd connection between patients with this condition and IUDs. It may prove to be nothing, but there is enough evidence of a smoking gun that scientific investigations are currently being conducted. At the May 2015 annual meeting of the Association for Research in Vision and Opthalmology (ARVO), researchers reported that Mirena users were 9 times more likely to develop this brain injury than those on other birth control methods.

SKYLA

Bayer (also the maker of Mirena) received FDA approval for their new IUD called SKYLA on January 9, 2013. It will be marketed as Jaydess in Europe. Skyla claims to be effective up to three years after placement. It is slightly smaller than Mirena and contains less hormone. The initial claims were that it is safe, with incidences of uterine perforation during clinical trials being less than 0.1%. However, evidence is coming out that not all is well with this product either. Entirely aside from abortifacient properties, consider the following health risks:

• A study published in the journal of Acta Oncologica in June of 2015 found that Skyla is most definitely connected with cancer. Of the 98,843 women studied, 2,015 were diagnosed with breast cancer. Use of LNG-IUS was associated with a greater risk of lobular cancer and ductal breast cancer compared to the general population. The study concluded that there was a 73% likelier chance of being diagnosed with lobular breast cancer as compared to the general female population.
• A 12% increase in ovarian cysts.²³⁹
• The Center For Disease Control²⁴⁰ has listed the following problems with Skyla: unexplained vaginal bleeding, uterine cancer, breast cancer.
• Ectopic and intrauterine pregnancies continued to be an issue as with other IUDs.
• Expulsion, embedment, life threatening infections, PID, and perforation of the uterus appears to be more common than in the clinical trials.
• RXList gives the following non-fatal side effects: “Common side effects of Skyla include pain, bleeding, dizziness, inflammation or itching of the vulva or vagina, abdominal or pelvic pain, irregular menstrual periods, changes in menstrual periods, acne, dry skin, ovarian cysts, nausea, vomiting, bloating, weight gain, depression, mood changes, headache, changes in hair growth, loss of interest in sex, breast tenderness or pain, or back pain.”²⁴¹

Health problems with the pill

There are various forms of “the pill,”²⁴² but all the health problems listed below (with the exception of miscellaneous side effects) are true of all of them. Those who are not convinced by the evidence that it is abortifacient, may still be convinced not to use the pill because of the health issues associated with it. Likewise, since the pill is sometimes prescribed for medical purposes other than conception, it is still important to understand the side effects that can happen. The following, though not exhaustive, should raise concerns.

Cancer

Several studies have reported an increase in cancer with those who are on the pill. In 2000, the National Toxicology Advisory Panel put the estrogen found in birth control pills on its list of carcinogens. Apparently there are metabolites of estrogen that directly damage DNA, causing mutations and cancer. Another factor may be the fact that the estrogen and progesterone in oral contraceptives depress lymphocyte responses in women.²⁴³ One study concluded that “inhibition of the immune response by progesterone may be mediated through the glucocorticoid receptors on leucocytes.”²⁴⁴ The National Cancer Institute’s findings in 2003, which noted “a significant increase” in breast, cervical, and liver cancers among oral contraceptive users, were corroborated in a 2005 study by the World Health Organization. WHO subsequently classified birth control pills as a “Group 1 Carcinogen,” which is the highest-risk category of carcinogens. Likewise, WebMed said, “A study published in the Journal of the American Medical Association found that women with a strong family history of breast cancer may have up to an 11 times higher risk of breast cancer if they have ever taken the pill.” Since then several studies have confirmed these findings,²⁴⁵ even though some contend that the risk is small and that the pill protects against other forms of cancer.²⁴⁶ The National Cancer Institute has tried to outline which cancer risks are increased and which are reduced while on the pill.²⁴⁷ Some new studies even seem to contradict these findings. For example, in a 2015 study published in the British Journal of Clinical Pharmacology, researchers showed that the combination estrogen progestin pill increases the risk of brain cancer (glioma) by 50%. Long term use doubled that risk. Women on progestin-only pills are at an even higher risk of brain cancer.²⁴⁸ The overall evidence seems to point to a reduction in endometrial and ovarian cancers and an increase in breast, cervical, and liver cancers in women on the pill.

Stroke

Studies show an increased risk of stroke by 190%.²⁴⁹

Significant thinning of the endometrial lining of uterus

A 1991 study using Magnetic Resonance Imaging scans showed “a 57% reduction in the thickness of the endometrial lining in women who used BCPs” over those who do not.²⁵⁰

Psychological effects

The new findings on psychological impacts of the birth control pill²⁵¹ should not be surprising, since we have known about these side effects in athletes who use steroids.

Miscellaneous

In addition to these new findings is the long list of side effects of the pill that are routinely published by the Pharmaceuticals. Some are minor; some are serious.

Side effects of combination pills

Combination pills have some additional risks. With the additional synthetic progesterone called drospirenonone, these pills create a higher risk of heart attack, pulmonary embolism, stroke, and blood clots, including deep vein thrombosis and pulmonary embolism.²⁵²

Health problems with the spermicides

There is a thirty year track record with spermicides, and most of them are safe for the majority of the population. Though I have steered away from chemicals in our conception control, there are people in the BLCC camp who use them without negative side effects. However, there are health risks that a couple should be aware of. The array of spermicides is bewildering, with Advantage-S, Conceptrol, Crinone, Delfen Foam, Emko, Encare, Endometrin, First-Progesterone VGS, Gynol II, Prochieve, Today Sponge, Vagi-Gard Douche Non-Staining being available in the USA, and with Menfegol and Octoxynol-9 now removed from the market in the USA but available elsewhere. There are also contraceptive sponges or suppositories that use benzalkonium chloride and/or sodium cholate, nonoxynol, or octoxynol. I will not document the health risks of every form of spermicide, but will give enough information that the reader can do their own research.

Natural

To my knowledge, there are no known side effects of lemon, lime, vinegar, lactic acid, or neem oil, all of which have been shown to be effective as spermicides.²⁵³ See my comments on this above.

The spermicides using Benzalkonium chloride

Drugs.com lists brief stinging on-site as a common side effect. Much less commonly there can be “severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).”²⁵⁴

The spermicides using nonoxynol-9

Johnson and Johnson/Merck report some cases of genitourinary irritation and damage to the vaginal wall and the cervical epithelium; urinary tract infections, yeast infection, and bacterial vaginosis.²⁵⁵

The spermicides using oxtoxynol-9

Same side effects listed as nonoxynol-9.

The spermicides using menfegol

This drug has both spermicidal and bactericidal effects. I have not found any systemic side-effects, though there are rare occurrences of rashes, feeling hot, and vaginal discharge. The FDA has not approved menfegol for the USA.

The spermicides using progesterone (in addition to other ingredients)

Crinone and spermicides that include progesterone have reported a number of side effects. The FDA reports that those who use Crinone once a day have experienced abdominal pain (12%), perineal pain (17%), headache (17%), constipation (27%), diarrhea (8%), nausea (22%), vomiting (5%), depression (11%), libido decrease (10%), nervousness (16%), somnolence (27%), breast enlargement (40%), dyspareunia (6%), nocturia (13%). These risks seem fairly significant to me and would seem to rule out its use.

Health problems with cervical diaphragm

Though I treat this as an area of liberty, the cervical diaphragm was a concern to me because it must remain over the cervix for 6-8 hours after intercourse (but no more than 24 hours without danger), and for those engaged in regular intercourse, it becomes almost continuous other than quick washing. This constant covering of the cervix is worrisome. It could result in several other potential problems, including toxic shock syndrome (though rare), UTIs, vaginal infection, allergic reactions, and the issues associated with the spermicidal drug, nonoxynol-9 (see previous discussion), which usually must be used along with the cervical diaphragm to be effective.²⁵⁶ Others in the BLCC camp have no problem with the diaphragm, stating that the risks are extremely minimal. Interestingly, the ancient Jewish moch, or pessary, was a safer form of diaphragm, though the evidence of problems for either is not conclusive. Unless conclusive evidence from Scripture comes to light, I consider this to be an area of liberty. The potential dangers are:

1. Urinary tract infection.²⁵⁷
2. Toxic shock syndrome is rare (2.4 cases out of 100,000) and usually occurs when it is left in for more than 24 hours.²⁵⁸

Cervical Cap

The cervical cap (Prentif, Dumas, Vimule, Oves, Lea’s Shield, FemCap) has a number of improvements over the diaphragm. For example, the Femcap website shows seven benefits over the diaphragm:

1. “To minimize the irritation caused by spermicide, the FemCap is designed with a unique groove facing the vagina. This groove stores the bulk of the spermicide and minimizes irritation or leakage. The storage of the bulk of spermicide in this groove ensures immediate and prolonged exposure of sperm to the spermicide as soon as it is deposited into the vagina.”
2. “In clinical trials, the effective rate of the second generation FemCap (the only FemCap approved by the FDA) has been proven to be over 92% successful in preventing pregnancy. It is estimated that the FemCap’s success rate may be up to 98% with proper use.”
3. It can stay in place up to 48 hours as opposed to 24 hours max for diaphragm.
4. Unlike the diaphragm, whose metal ring puts pressure on the vaginal wall and urethra, the Femcap does not.
5. Removal is easier than diaphragm and less likely to cause vaginal abrasions.
6. No need for measurement in the doctor’s office.
7. much lower risk of UTIs than diaphragm.²⁵⁹

However, other sites say that it’s effectiveness in preventing pregnancy is far lower than natural methods. I have seen studies that show anywhere from 84% to 91% effectiveness for women who have never given birth, and 68% to 74% effectiveness for women who have given birth to a baby. The two most commonly cited problems with the cervical cap are:

1. Allergic reactions to material (same as diaphragm)
2. Reactions to spermicide.

Female Condom

The first generation of female condom was made of polyurethane, while the second generation is made of synthetic nitrile. The United States government’s Medline Plus lists female condoms as being 95% effective when perfectly used and 75% to 82% effective in preventing pregnancy in typical use.²⁶⁰ The only side effects that have been documented are irritation and occasional allergic reactions.

“Birth control” methods that appear to be abortifacient

Though the ethical acceptability of the pill is still hotly debated by prolife people,²⁶¹ I am convinced that the evidence shows a significant risk of abortion.²⁶² If the Scripture calls us to avoid all “birth control” methods “which tend to the unjust taking away the life of any,”²⁶³ we should avoid Yaz, Yasmin, The Minipill, the Patch (Ortho Evra), Depo-Provera injections, Norplant, and any other chemical formulations that prevent implantation should ovulation and fertilization take place.

Of course, not all agree that “hormonal contraceptives” are abortifacient. The American Association of Pro-life Obstetricians & Gynecologists have two position papers, one arguing that oral contraceptives are not abortifacient and the other arguing that they are.²⁶⁴ The association has not taken a position. Instead they say, “There are times when our knowledge of the truth is incomplete, and we must peer through the fog to make, and act upon, judgments about the information available to us.” However, in the years since those two papers were written, a great deal more research has been done, and it is my conviction that the evidence appears to point to the conclusion that every form of the pill is indeed abortifacient. I say “appears to” because science is always changing and we need to be careful about making scientific conclusions definitive in our ethics.

Many Christian Pharmacists have been convinced by the evidence that the pill does indeed produce abortions as a backup mechanism. Patrick McCrystal (BSc (Pharmacy), QUB, M.P.S.I.), is of the opinion that “millions of pill-induced abortions [occur] worldwide.”²⁶⁵ If you are similarly convinced that these scientific conclusions are correct, then you need to avoid using them. If any of these prescriptions simply prevent fertilization, then they are contraceptives. If they prevent implantation (or even in a percentage of cases they prevent implantation), then they would be abortifacient (or have abortion as a partial function). However just because a hormone method may be proven to not be abortifacient does not mean it is ethical to use them – health issues must also be considered, which has already been done in the previous section.

The hormone “contraceptives” can be divided up into five basic groups: combination oral contraceptives (COCs), injectables (Depoprovera), progestin only pills (minipills, or POPs), implants (Norplant, Implanon), and hormonal IUDs. Most hormone contraceptives have three mechanisms of action: First, they inhibit ovulation. Second, they inhibit transportation of sperm through the cervix by thickening the cervical mucus. Third, they cause changes in the uterine lining (endometrium), making it a thinner, less glandular, and less vascular lining. A 1991 study using Magnetic Resonance Imaging scans showed “a 57% reduction in the thickness of the endometrial lining in women who used BCPs” over those who do not.²⁶⁶

No one questions these three functions. What is being hotly debated today is whether the third function makes these drugs act as “backup abortifacients.” Let’s consider the arguments for and against.

Does the thinning of the endometrium keep a fertilized egg from being able to attach?

The first argument against the pill is that it thins the walls of the womb, and that this thinning of the endometrium makes it hostile to implantation by a fertilized egg.²⁶⁷ Thus, the assumption is that most fertilized eggs will be cast off (aborted) as a result of the third mechanism of the pill. Many Ob/Gyns signed onto a statement written by Dr. William F. Colliton, in which he estimates the number of abortions that can be directly attributable to the Birth Control Pill as 1,894,620 per year.²⁶⁸ If this estimate is true, then it is astonishing that evangelicals would defend its use.

There are evangelical doctors who do question that conclusion. Four members of the American Association of Pro-Life Obstetricians & Gynecologists have produced a paper that seeks to question this thesis.²⁶⁹ In that paper they try to debunk this first issue by citing a lone study by Zanatu²⁷⁰ who reports on two women with prolonged infertility (8 to 14 months) after Depo-Provera injections: “We successfully induced ovulation with the sequential administration of clomiphene citrate and human chorionic gonadotropin, and pregnancy immediately followed.” Note that this was just one study, but if it were proved to be true, it would suggest that once ovulation has occurred, the burst of natural estrogen and progesterone from the corpus luteum simply override even the most potent hormone contraceptive, producing a receptive endometrium, and resulting in a normal implantation and ongoing pregnancy.

Evidence like this has led many prolife doctors and midwives to believe that there is no abortion potential with the five forms of hormonal “contraceptive.” Some go so far as to say that the minipill and the IUD will increase the chances of implantation if there is a fertilization, but the scientific evidence for their contention appears to be slim. Randy Alcorn responds to this theory by saying,

Some physicians have theorized that when ovulation occurs in Pill-takers, the subsequent hormone production “turns on” the endometrium, causing it to become receptive to implantation. [23] However, there is no direct evidence to support this theory, and there is at least some evidence against it. First, after a woman stops taking the Pill, it usually takes several cycles for her menstrual flow to increase to the volume of women who are not on the Pill. This suggests to most objective researchers that the endometrium is slow to recover from its Pill-induced thinning. [24] Second, the one study that has looked at women who have ovulated on the Pill showed that after ovulation the endometrium is not receptive to implantation. [25]²⁷¹

My own research has made me conclude that the overwhelming majority of studies still appear to point to the traditional view that hormonal contraceptives do indeed have abortion as a backup mechanism, linking the thinning of the endometrium as a leading reason for this failure to implant.²⁷² The FDA labels on the drugs themselves list it as a backup mechanism.²⁷³ An interesting 2012 study²⁷⁴ of women who had infertility came to the conclusion that the infertility came from years of being on oral contraceptives. Those who had been on the pill for five years had a 500% greater chance of having an endometrium that could not sustain an artificially implanted egg. The effect was similar for those who had been on the pill for ten or more years. Even when hormones were used to try to reverse the thinning of the endometrium, women had half the success rate of carrying the fertilized egg. Long before this study came out, the evidence was still quite strong. The Polycarp Research Institute stated,

A number of different research papers have studied this issue and it has been widely described in the medical literature concerning in vitro fertilization where it has been noted that the newly conceived child is much less likely to implant on a thinner uterine lining than a thicker one. Originally an older smaller study (Fleisher et al ⁹, 1985) did not find that the thickness of the endometrium played an important role in in vitro implantation rates, however, other studies have found a positive trend (Rabinowitz et al ¹⁰(1986); Ueno et al ¹¹ {1991}) or a statistically significant effect (Glissant et al ¹², 1985) of the decreasing thickness of the endometrium in relationship to a decreased likelihood of implantation. Larger and more recent studies (Abdalla et al ¹³(1994); Dickey et al ¹⁴(1993); Gonen et al ¹⁵(1989); Schwartz et al ¹⁶ (1997); Shoham et al ¹⁷{1991}) have reaffirmed this important connection. Most studies have found that a decrease of even one millimeter in thickness yields a substantial decrease in the rate of implantation. In two studies, when the endometrial lining became too thin, no implantations occurred (Abdalla¹³; Dickey¹⁴).²⁷⁵

Consider the following question and the carefully nuanced answer by Dr. Bill Toffler. He shows a three-way split that exists at Focus on the Family’s Physicians Resource Council (PRC), but he is absolutely convinced that these hormone contraceptives are abortifacient (in the third backup mechanism).

Question: What is your opinion of the progestin only pill (mini-pill) as a form of birth control while nursing? My ob-gyn suggested the progestin only pill to me and I raised with him my ethical concerns regarding the way it changed the lining of the uterus, and the possible abortive effect it might have on any conceived child. He told me he would recommend it as it was progestin (the hormone that sustains a pregnancy), and there was actually a higher chance of me getting pregnant while taking it as opposed to the combination pill because it didn’t have an abortive effect on any conceived child. He went so far as to say that it had in fact been prescribed to women who had certain infertility issues because it helped them to have enough progestin in their bodies to sustain a pregnancy. He said that while solely breastfeeding, the progestin only pill simply sustained the conditions already in place in a woman’s body due to the nursing. Instead of an effectiveness of 85%, the regulated levels of progestin could be up to 93% effective. He did warn me that it was only suitable to take while I was nursing, and he was only happy to give me a prescription for as long as I intended to breastfeed. He also told me that as soon as I stopped nursing, I was to stop taking the mini-pill. The prescription he gave me was for Micronor and the generic for it is Nora-Be.

Answer: I am one of the physicians on the Physicians Resource Council (PRC) at Focus on the Family. I also do not prescribe oral “contraceptive” pills (OCPs) or “birth control” pills (BCPs) for the purpose of preventing pregnancy for the very reasons you mention.

At the PRC we discussed the potential abortifacient properties of OCPs/BCPs for more than three years. We examined all of the literature available to answer the concerns you raise. The bottom line is that we could not develop a clear consensus. One or two physicians felt that these pills never cause an abortion in any woman at any time, some felt that they did rarely (if ever), some felt that they clearly could and would in at least some women in some cycles. For those of us in this latter group, the frequency with which this occurs is clearly going to vary depending on the amount, potency and mix of hormones.

At the same time, of all the pills available, the so-called mini-pill probably causes this to happen more than most (if not all) others. The reason is that it is the least reliable in suppressing ovulation. Therefore, its mechanism of action is more likely to be post-ovulatory—that is, abortifacient. In addition, some of the logic expressed by your physician seems to be mixing issues.

Specifically, taking progesterone (in a progesterone deficient state) to support an early gestation is clearly different than taking a pill on a cyclic basis with withdrawal from the active hormone for 7 days each month. Withdrawing exogenous hormone for 7 days (as happens with the mini-pill) may well cause withdrawal bleeding which really represents sloughing of the lining of the womb. Thus, the mini-pill does not suppress ovulation reliably and often “works” by a post-ovulation effect—either thinning and/or causing a sloughing of the lining of the womb.

In fact, at least two OB-Gyns on the PRC (who are not particularly concerned about birth control pills in general) absolutely agree that the mini-pill is more likely to allow breakthrough ovulation; thus, they will NOT prescribe the mini-pill to postpartum mothers (or to anyone else) for “contraceptive” purposes.

For more information on the birth control pill, see Randy Alcorn’s book Does the Birth Control Pill Cause Abortions?²⁷⁶

If Dr. Toffler is correct, this clearly rules out the minipill and the hormone IUD (which also uses progestin). It also shows the problems with all hormonal contraceptives.

While prolife organizations remain split,²⁷⁷ there may be new technology that will soon be able to completely resolve this debate.²⁷⁸ Australian researcher, Alice Cavanagh has worked extensively with a maternal protein called “early pregnancy factor” (EPF), something first described in 1974 by Morton and colleagues. Cavanagh says,

Prevailing orthodoxy held that maternal recognition of pregnancy did not occur until implantation; prior to this, the embryo was thought to be merely a silent passenger in the maternal reproductive tract. It is now known that there is extensive cross-talk between mother and embryo throughout the pre-implantation period. However, EPF is still one of the earliest manifestations of this changed physiological status of the mother, opening a unique diagnostic window on this stage of pregnancy.²⁷⁹

EPF could be valuable in discriminating between failure to fertilize and failure to implant.²⁸⁰

In a fascinating 2013 paper,²⁸¹ Cavanagh and colleagues show that

OF [Ovum Factor] is first released upon penetration of the ovum by the fertilizing spermatozoon. OF continues to be produced at least until blastulation.

I have not discovered any large-scale studies that have used this new technology to settle the debate. When such studies appear, the prolife lines may be much more tightly aligned in a BLCC direction. Preliminary results seem to vindicate our position that the birth control pill is indeed abortifacient,²⁸² but much more extensive studies may need to be done. Rather than constantly updating this book, I would refer the reader to websites that are tracking this newest research. Pharmacists for Life has called for a large-scale clinical trial to evaluate EPF in women taking birth control pills to see if fertilized eggs are indeed being cast off.²⁸³

Doesn’t the fact that people occasionally get pregnant on the birth control pill prove that it does not stop implantation? No. Randy Alcorn shows the fallacy in this argument:

I have received a number of letters from readers, one of them a physician, who say something like this: “My sister got pregnant while taking the Pill. This is proof that you are wrong in saying that the Pill causes abortions-obviously it couldn’t have, since she had her baby!”

Without a doubt, the Pill’s effects on the endometrium do not always make implantation impossible. I have never heard anyone claim that they do. To be an abortifacient does not require that something always cause an abortion, only that it sometimes does.

Whether it’s RU-486, Norplant, Depo-Provera, the morning after pill, the Mini-pill, or the Pill, there is no chemical that always causes an abortion. There are only those that do so never, sometimes, often, and usually.

Children who play on the freeway, climb on the roof, or are left alone by swimming pools don’t always die, but this does not prove these practices are safe and never result in fatalities. We would immediately see this inconsistency of anyone who argued in favor of leaving children alone by swimming pools because they know of cases where this has been done without harm to the children. The point that the Pill doesn’t always prevent implantation is certainly true, but has no bearing on the question of whether it sometimes prevents implantation, which the data clearly suggests.²⁸⁴

Some have suggested that levonorgestrel (LNG) only suppresses ovulation and therefore is a true contraceptive. However, a 2006 study by Doctors Mikolajczyk and Stanford of the Department of Medicine in Public Health at the University of Bielefeld (Germany) used data from multiple clinical studies with advanced mathematical models and showed that the “real effect” of this pill was to prevent implantation.²⁸⁵ The ovulation breakthrough rate of COC pills is under 2% while the ovulation breakthrough rate of POP pills is 33-56%, but both have breakthrough rates.

For further research, I recommend the following readings:

Those who contest the abortifacient qualities of OCPs

1. Goodnough, Joel. “Redux: Is the Oral Contraceptive Pill an Abortifacient?” Ethics & Medicine (Spring 2001) 17(1):37-51. He tries to disprove Randy Alcorn’s contention that 10-30% of the time OCP’s allow ovulation.
2. Crockett, Susan; DeCook, Joseph; Harrison, Donna; Hersh, Camilla. “Hormone Contraceptives: Controversies and Clarifications.” Fennville, MI: ProLife Obstetricians, April 1999. This is one of the first attempts to counter the idea that the pill is abortifacient.

Those who say that OCP’s are abortifacient as a backup mechanism

1. Wilks, John; Colliton, William F., Jr.; and (a response by) Joel Goodnough. “Response to Joel Goodnough, MD, ‘Redux: Is the Oral Contraceptive Pill an Abortifacient?’” Ethics & Medicine (Summer 2001) 17(2):103-115. This is Wilks’ response to Goodnough’s article above.
2. Larimore, Walter L.; Stanford, Joseph B. “To the Editor.” Ethics & Medicine (Fall 2001) 17(3):133-36. This is another response to Goodnough, showing inaccuracies in medical facts and moral reasoning.
3. Alcorn, Randy. “To the Editor.” Ethics & Medicine (Spring 2002) 18(1):5-9. This is Randy’s Alcorn’s response to Goodnough.
4. Mirkes, Sister Renee. “The Oral Contraceptive Pill and the Principle of Double Effect.” Ethics & Medicine (Summer 2002) 18(2):11-22. Yet another response to Goodnough.
5. John Wilks, “The Impact of the Pill on Implantation Factors – New Researching Findings,” in Ethics & Medicine (2000), volume 16(1), pp. 15-22.
6. Alcorn, Randy. Does the Birth Control Pill Cause Abortions? A Condensation. Gresham, OR: Eternal Perspective Ministries, 2000.
7. Larimore, Walter L. “The Abortifacient Effect of the Birth Control Pill and the Principle of ‘Double Effect’.” Ethics & Medicine (2000) 16(1):23-30.

A debate between two sides

1. Bevington, Linda K.; Larimore, Walter L.; Alcorn, Randy; Crockett, Susan A.; DeCook, Joseph L.; Harrison, Donna; Hersh, Camilla. “Bioethical Decisions When Essential Scientific Information Is in Dispute: A Debate on Whether or Not the Birth Control Pill Causes Abortions.” In The Reproduction Revolution: A Christian Appraisal of Sexuality, Reproductive Technologies, and the Family, ed. John F. Kilner, et al. Grand Rapids, MI: Eerdmans; and United Kingdom: Paternoster, 2000: pp. 177-191. This is an extended debate between two evangelical teams on whether the pill is abortifacient.

While science (especially contested science) is not the foundation for ethics, the worrisome statistics we have looked at certainly need to be considered. I avoid all hormonal “contraceptives” because I am convinced by the evidence that they either endanger the life of babies and mothers or “tend to the unjust taking away the life.”²⁸⁶

Hormonal contraceptives increase the incidence of ectopic pregnancies

A second reason to consider the pill to be a risk to the life of babies is that they increase the incidence of ectopic pregnancies. Various studies have shown that all hormone contraceptives increase the occurrence of ectopic pregnancies (pregnancies where the fertilized egg stays outside the womb – usually in the fallopian tubes). If this is indeed true, then these forms of contraceptives have major ethical issues, since they increase the death of the young and increase danger to the mother.

To be fair, four pro-life OBGYNS who defend the pill have tried to rebut this argument, saying,

Our own review of the literature has shown this increased ectopic rate to be true of progestin only pills (POPs) and Norplant. However, we have found absolutely no data in the literature that supports an increased ectopic to intrauterine pregnancy ratio for women using combined oral contraceptives (COCs) or Depoprovera…

Although there are many references alluding to increased rates of ectopic pregnancies for tubal ligation, IUDs, POPs, and post-coital contraception, a search through over a dozen well-recognized medical texts, and multiple journal articles written by experts in obstetrics, gynecology, and contraception has yielded no authoritative opinions that implicate COCs in the etiology of ectopic pregnancy.²⁸⁷

In the process of defending Combination Pills, these authors have conceded that every other form of hormonal “birth control” and every form of IUD does indeed increase ectopic pregnancies, and thus they unwittingly endanger both child and mother (see above for health of mother issues on all hormone contraceptives). Is it true that Combination Pills are exempted? Randy Alcorn says,

Two medical studies allow review of this association. [26] Conducted at seven maternity hospitals in Paris, France, [27] and three in Sweden, [28] the studies evaluated 484 women with ectopic pregnancies and control groups of 389 women with normal pregnancies who were admitted to the hospital for delivery during the same time period. These studies were designed, in typical fashion for “case control” studies, to determine the risk factors for a particular condition (here, ectopic pregnancy) by comparing one group of individuals known to have the condition with another group of individuals not having the condition. Both of these studies showed an increase in the extrauterine/intrauterine pregnancy ratio for women taking the Pill. Researchers who have reviewed these studies have therefore suggested that “some protection against intrauterine pregnancy is provided via the Pill’s post-fertilization abortifacient effect.” [29]

What accounts for the Pill inhibiting intrauterine pregnancies at a disproportionately greater ratio than it inhibits extrauterine pregnancies? 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)…

“In fact, ‘a huge increase in ectopics’ is exactly what we do see - an increase that five major studies put between 70% and 1390%.”²⁸⁸

In my opinion there is sufficient evidence to rule out the pill on this point alone.

Does the IUD inhibit ovulation or is it also implicated in abortion?

Does the IUD inhibit ovulation or does it also utilize the third mechanism of casting off a fertilized egg? There are three IUDs currently used in the USA (though a wider variety are in use in England and Europe). We will consider each one.

Paragard

Paragard is a copper IUD that is free of hormones. It is often the IUD of choice for women who do not want the complications of hormones and who want the ability to immediately get pregnant the next month after it is removed. But it too is abortifacient. Dr. Sara Pentilicky, a gynecologist and family planning specialist at the University of Pennsylvania stated,

With Paragard, you don’t actually stop ovulating like you do with the pill, so when I take it out, you should be able to get pregnant the next month without any trouble.²⁸⁹

Notice her statement that you do not stop ovulating. Contracept.org agrees with this conclusion, saying that Paragard is actually an abortifacient:

However, it is also known that the ParaGard IUD does not prevent ovulation. Some sperm may in fact reach the egg, resulting in fertilization. When fertilization does occur, ParaGard is thought to act as birth control by preventing the embryo from implanting in the uterus.²⁹⁰

Mirena

Mirena is an IUD that consists of a T-shaped plastic frame that releases small amounts of synthetic progestin hormone for up to five years. It has all the same functions of progestin noted above. The official Mirena website states that it has three actions:

• Thickening cervical mucus to prevent sperm from entering your uterus.
• Inhibiting sperm from reaching or fertilizing your egg.
• Thinning the lining of your uterus to prevent implantation.

The Mayo Clinic says that Mirena only “partially suppresses ovulation.”²⁹¹ One year after insertion of this IUD, 45% of women were ovulating. Four years later, 75% of women were still ovulating. The statistics stand against those who claim that it is successful in suppressing ovulation.

Skyla

The best that WebMD can promise is that this device “may also stop the release of an egg from your ovary (ovulation), but this is not the way it works in most women.”²⁹² If this is the case, it has abortion as a backup mechanism. The company’s own clinical trials reveal that ovulation was seen in 34 out of 35 women in the first year, and in 26 out of 27 women in the second year, and in all 27 women in the third year. It clearly does not suppress ovulation.

In closing

While my survey of the literature has not been exhaustive, hopefully it has given enough leads that you can make your own conclusions. Though science is not infallible, the infallible principles of the Word of God that we have already looked at can help us to make wise conclusions with the scientific knowledge that we currently have. My own assessment of the facts have led me to a very, very conservative perspective on conception control, as outlined in the first few chapters of the book. May God guide you in your own studies. Amen.