by Dr. Mary Pearson
Editor’s note – this is the fuller version of the article which, because of space limitations, appeared in an abbreviated version in the January-February 2010 (Volume XXX, Number 4) issue of the Institute’s Newsletter
I write with these disclaimers: I am a family practitioner, not an embryologist. I have written at the urging of my husband to provide guidance for those who seek to limit the number of children they will have, or to time their advent to an auspicious time, both in a pro-life manner. What follows is in no way an exhaustive discussion of what is best or safest for you or anyone else, nor do I lay out risks or benefits.
Some Christians, of course, believe that all birth control is wrong; that each married couple should reproduce as much as they can to build the Kingdom of God. Others believe that any hormonal or mechanical means of birth control is inherently wrong because it has been declared wrong by a religious leader. I cannot address or argue with these brothers and sisters except to say that it seems Scripture puts a good deal of emphasis on providing for our children materially, emotionally, educationally and spiritually. Most of us are not capable of providing that level of care to ten or twelve children. It also does not address the concerns of those who, due to illness or genetic trait, do not wish to reproduce out of compassion for the suffering it might cause their offspring, but still wish to keep the Scriptural command of intimacy with their spouse. Scripture commands such intimacy with our spouse on a regular basis and failure to keep this command results in temptation and a diminished closeness in the marriage.
I shall start with the least controversial means of birth control which is natural family planning. Natural family planning is based on the recognition of certain characteristics of female fertility. There are different methods of natural family planning and it is well beyond the scope of this article to review them all. Suffice it to say that some of the older methods were not very precise but the more modern methods are very good, with efficacy rates as high as 96% (Obstetrics and Gynecology 1999; 93:872-6.)
Natural family planning can also be helpful to couples who have suffered from infertility. Even couples who have failed to achieve pregnancy through artificial insemination often are able to conceive with natural family planning.
Barrier means of contraception such as condoms, diaphragms and the vaginal sponge prevent conception. They never cause an abortion in any form. Often a barrier contraceptive is made more effective by the additional use of a spermacide. This kills the sperms, preventing it getting to the egg, but it does not harm a fertilized egg.
Similarly, sterilization – a vasectomy or tubal ligation never cause an abortion. The obvious limitation of sterilization is they should be considered permanent.
Hormonal means of contraception are more controversial. In order to explain why this is confusing and controversial, I’ll need to tell you more about the science of embryology. You probably all remember that the sperm fertilizes the egg. That can occur within one hour of intercourse. The union of the egg and sperm causes development of a zygote: a unique cell with DNA from both mom and dad. This zygote travels down the fallopian tube into the uterus looking for a healthy landing spot and implants into the uterine wall. This is called conception. By the time the embryo implants the cell has divided several times, and is now called a blastocyst instead of a zygote.
So, does life begin at fertilization or conception? Clearly by the time of fertilization a unique DNA structure has been created. That is when many pro-life people would say a unique life begins. However, others would argue that the blastocyst cannot support life until it is implanted into the mother’s womb. All pro-life people would argue that once conception (implantation) has occurred a unique life has developed and should be protected. For those of you who are interested in more technical information, I would recommend the book Before We Are Born, a lovely textbook by Dr. Kenneth Moore on embryology and birth defects.
The reason it is important to understand these distinctions is that hormonal birth control can affect either fertilization or conception or both. Therein the controversy lies. It is also difficult to research some of these issues. Research is expensive and technically difficult, and the pro-life community as a whole has tended to be focused on preventing abortions, which sadly continue to abound.
Birth control pills, rings and patches containing estrogen and progesterone primarily work by preventing ovulation (the production of eggs by the ovary). That is why these pills are also used to prevent ovarian cancer, regulate periods, and prevent severe cramps.
Progesterone-only pills, and depo provera work, in part, by preventing ovulation (the depo provera shot can stop ovulating up to a year in some women) and partly by thickening the cervical mucus (a process which occurs naturally during parts of a woman’s cycle. This is why there is actually only a narrow window of time in which an egg can be fertilized.
There is some controversy as to whether some birth control pills might occasionally not prevent ovulation and work instead by preventing implantation. Theoretically this is possible, but does not seem to be the primary mechanism of action. Christian Medical and Dental Association (CMDA) recommends more research into the exact mechanism of hormonal contraceptives, but does not recommend against their use.
IUDs and the “morning after pill” seem to work much of the time by preventing fertilization, but about thirty per cent (depending on type) work by preventing implantation.
Now that you understand the difference between fertilization and conception, you can understand why people argue about whether these means of contraception are abortofacient (cause abortions) or not. It depends on when you think human life begins. For myself, because I think life begins at fertilization, I do not recommend or prescribe in my medical practice either IUDs or “morning after pills”. Most of the newer types of IUDs have hormonal components as well. This increases the percentage of time that it works by preventing fertilization.
For those of you who would like more detailed information, I would refer you to the Christian Medical and Dental Association CMDA website www.cmda.org. There is an excellent section on ethics and reproductive technology. I would also acknowledge with gratitude the precise work Facts and Comparisons, that precise and unbiased medication reference.