The Pill: Contraceptive or Abortifacient?

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It's an important distinction, both linguistically and scientifically.

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It's time for some political, scientific, and moral clarity on the birth control pill. It's time to distinguish clearly—in terminology, thinking, and public policy—between contraception and abortion.

We can begin with terminology, which has become increasingly sloppy in news analysis and public discourse. "Birth control" includes any device or practice that prevents birth, including elective abortion. "Contraception," by definition (but not necessarily in common usage), prevents conception (not implantation of the fertilized egg in the uterine wall); and "conception" refers to the joining of the sperm and ovum (not implantation). It is unfortunate (if not downright Orwellian) that "contraception" is used so loosely, particularly within the context of public policy and national health care.

For example, let's look at news coverage of Hobby Lobby's opposition to one provision of Obamacare. A recent story describes the position of the arts-and-crafts chain's pro-life owners this way: "The company opposes providing some contraceptives to employees through its company health care plan on religious grounds, saying some contraceptive products, like the morning after pill, equate to abortion." But the company isn't saying that contraception equates to abortion; it is simply acknowledging the way the morning after pill is routinely described as acting, which can include preventing implantation after conception.

In addition to the linguistic clarity about contraception, clearer scientific understanding of how the pill works is needed. Many years ago, as a teenager, I decided to go "on the Pill," as they say. I remember clearly my physician's explanation of how the birth control pill worked: first, it was supposed to prevent ovulation; second, in case ovulation did occur, the pill's backup mechanism was designed to prevent the sperm from fertilizing the egg; finally, the backup to the backup was to render the uterine wall inhospitable to any accidental zygote that may have formed if the first two steps failed. At the time, I shrugged off the last part almost as easily as the first two, having not yet arrived at the strong pro-life convictions I hold today.

But now I—along with about half of the nation—am pro-life, and the distinction between contraception and abortion is the difference between life and death. The labeling of birth control pills, in their various forms, for years has included information similar to that given to me by my doctor, information that has caused strongly pro-life people, as I am, to consider the birth control pill—and the morning after pill, which operates on the same principles—to be, potentially, an abortifacient and, therefore, to be rejected within a pro-life philosophy. My own relationship with the birth control pill is a picture with more strokes of gray than black and white. I didn't go off it immediately after adopting my anti-abortion view but did in time with increased knowledge and conviction about its potentially abortifacient elements. Many conversations with like-minded friends reveal similar inner conflicts and downright confusion.

So it is no small thing for scientists to be saying now that perhaps the birth control pill does not sometimes operate as an abortifacient. An article this summer in the New York Times examined this changing position of doctors on how the Pill works. The research cited by the Times

found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents' definition of abortion-inducing drugs.

Some pro-lifers, this one included, find it at least a little bit suspect that now, in the midst of controversy around this issue that directly threatens around this aspect of the Obama administration's attempts at national health care overhaul, scientists are suddenly backtracking on long held views about how the birth control pill works. Note in the passage quoted from the New York Times above the acknowledgement that the issue is a "divisive" one "in an election year." Later, the article acknowledges that the "controversy over emergency contraception is figuring in...debates over the Obama administration's health care law."

It may be nearly impossible to prove exactly how hormonal contraception works within the current state of science. Yet some evidence is clear and compelling that the long held understanding is correct, as one blogger explains:

We know from studies such as the 2007 "Changes in measured endometrial thickness predict in vitro fertilization success" that the thickness of a woman's endometrium—the lining of her uterus—determines the likelihood of the successful implantation of an embryo. If an embryo—a living human by all characteristics - does not implant, it is passed out of the uterus in what's popularly called a miscarriage, or a spontaneous abortion. (If you're interested, this study also showed that oral contraceptive use also altered the quality of the endometrium, the markers associated with "endometrial receptivity.")

We've known for quite a while that the use of oral contraceptives has the capacity to thin a woman's endometrium. The 1997 study "The effects of monophasic and triphasic oral contraceptives on ovarian function and endometrial thickness" found that "endometrial thickness in OC users was significantly smaller than in controls", that is, than in women who were not using oral contraceptives.

A 2001 study of one the most popular oral contraceptives on the market, Yasmin, found that ... oral contraceptives have the effect of thinning the endometrium.

Such evidence is compelling enough for many pro-lifers to err on the side of life.

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Karen Swallow Prior is professor of English at Liberty University. She is the author of Booked: Literature in the Soul of Me and a contributing writer for Christianity Today

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