Contraceptives and the Morning After Pill
How the Birth Control Pill Works
Do birth control pills cause abortions?
In order to prevent pregnancy, birth control pills employ several mechanisms. First, the synthetic hormones may convince a woman’s body that she is pregnant. This can stop the ovaries from releasing an egg. The Pill also makes it difficult for the sperm to reach the egg, because the hormones thicken the cervical mucus, making it difficult for the sperm to live and move.
The Pill also creates changes in the uterus and fallopian tubes that can interfere with the transport of sperm. Despite the hormones’ ability to prevent the release of eggs, sometimes a “breakthrough ovulation” takes place. How often this happens depends upon several factors, such as which kind of pill the woman is taking, how consistently she takes her pills, and even how much she weighs. Even with correct and consistent use of the Pill, some formulas allow ovulation in less than 2 percent of cycles, while others allow a woman to ovulate during 65 percent of her cycles.
When a woman ovulates, she can become pregnant. However, the Pill has mechanisms that can cause an abortion before a woman knows that she has conceived. If a sperm does fertilize the egg, the newly conceived baby (zygote) may be transported more slowly through the fallopian tubes because of how they have been altered by the Pill. Thus, the child may not reach the uterus, where he or she needs to implant and receive nourishment for the next nine months. Because the fallopian tubes are changed, the baby may accidentally implant there, causing an ectopic or “tubal” pregnancy, which is fatal to the baby, and can also be life-threatening for the mother.
If the baby is able to travel safely to the uterus, he or she may not be well received. One reason for this is that the chemicals in the Pill thin out the lining of the woman’s uterus (the endometrium). As a result, the baby may not be able to implant. At other times the child will attach to the wall, but he or she will be unable to survive because the normally thick and healthy uterine wall has shriveled and is therefore unable to nourish the baby. The Pill also impacts the woman’s progesterone level. This causes the lining of the uterus to break down and eventually shed as it would in a menstrual cycle, further denying the baby’s attempt to implant.
Many doctors are concerned about the fact that women often are not informed that the birth control pill can cause an abortion as well as prevent pregnancy. One medical journal declared, “If any mechanism of any OC [Oral Contraceptive] violates the morals of any particular woman, the failure of the physician or care provider to disclose this information would effectively eliminate the likelihood that the woman’s consent was truly informed and would seriously jeopardize her autonomy. Furthermore, there is
a potential for negative psychological impact on women who believe human life begins at fertilization, who have not been given informed consent about OCs, and who later learn of the potential for postfertilization effects of OCs. The responses to this could include disappointment, anger, guilt, sadness, rage, depression, or a sense of having been violated by the provider.”
Unfortunately, not all doctors are aware that the Pill can act as an abortifacient. Dr. Walter Larimore admitted that he prescribed the Pill for nearly twenty years—and used it in his own marriage before anyone informed him that it could have such an effect.
When another doctor clued him in, he said that he had never heard of such a thing, and that the claims seemed to be “outlandish, excessive, and inaccurate.” He began a search of the medical literature, “to disprove these claims to my partner, myself, and any patients who might ask about it.” However, what he discovered compelled him to stop using the Pill in his medical and personal life. Reviewing the information, he realized how many doctors (and patients) were ignorant of the abortifacient potential of the Pill. It was a humbling realization, considering that ever since the 1970s, the patient package insert for birth control pills explained how the drug reduces the likelihood of implantation.
After informing his colleagues, Dr. Larimore noted, “several said that they thought it would change the way family physicians informed their patients about the Pill and its potential effects.” Because many physicians felt that it was unfair to leave women in the dark, some of them submitted a proposal to the American Medical Association (AMA) calling for a vote on whether doctors should tell patients that birth control pills can act as abortifacients. However, in 2001 the AMA voted overwhelmingly against the proposal.
One reason why certain doctors may not tell women about the abortifacient nature of the Pill is that some physicians do not believe that pregnancy begins with fertilization. Until the 1960s, when the Pill was invented, it had been taken for granted that the union of the sperm and egg signaled the beginning of pregnancy. In 1963 even the United States government published health information declaring that anything that impairs life between the moment of fertilization and the completion of labor is to be considered an abortion.
Because many women would never have agreed to use a drug or device that could cause an early abortion, those in favor of such contraceptives knew that the issue had to be resolved. In 1964 a Planned Parenthood doctor speaking of another type of abortifacient birth control recommended that scientists not “disturb those people for whom this is a question of major importance.” He added that judges and theologians trust the medical community, and “if a medical consensus develops and is maintained that pregnancy, and therefore life, begins at implantation, eventually our brethren from the other faculties will listen.”
One year later the American College of Obstetricians and Gynecologists (ACOG) decided to redefine pregnancy. In its words, “conception is the implantation of a fertilized ovum.” Instead of defining conception as fertilization, ACOG decided that life begins nearly a week later, at implantation. At the time they said that this was because pregnancy could not be detected before then. Today science is able to detect pregnancy before implantation, but the ACOG still won’t correct its definition. The original change had nothing to do with a scientific discovery in women’s health, reproduction, or biology. Unfortunately, doctors today are split on the issue.
Regardless of a doctor’s personal opinions, few women are ever informed about this issue. Feminist author Germaine Greer wrote, “Whether you feel that the creation and wastage of so many embryos is an important issue or not, you must see that the cynical deception of millions of women by selling abortifacients as if they were contraceptives is incompatible with the respect due to women as human beings.”
. Walter L. Larimore and Joseph B. Stanford, “Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent,” Archives of Family Medicine 9 (February 2000), 127.
. Larimore and Stanford, 127.
. Physicians’ Desk Reference (Montvale, N.J.: Thomson, 2006), 2414.
. Larimore and Stanford, 131.
. Larimore and Stanford, 133.
. Federal Register 41:236 (December 7, 1976), 53,634.
. Larimore and Stanford, 133.
. Public Health Service Leaflet no. 1066, U.S. Dept. of Health, Education, and Welfare (1963), 27.
. Sheldon Segal, ed., et al., “Proceedings of the Second International Conference, Intra-Uterine Contraception,” October 2–3, 1964, New York City, International Series, Excerpta Medica Foundation, No. 1 (September 1965).
. College of Obstetricians and Gynecologists, “Terms Used in Reference to the Fetus,” Terminology Bulletin 1 (Philadelphia: Davis, September 1965).
. Shu-Juan Cheng, et al., “Early Pregnancy Factor in Cervical Mucus of Pregnant Women,” American Journal of Reproductive Immunology 51:2 (February 2004), 102–105.
. J.A. Spinato, “Informed Consent and the Redefining of Conception:
A Decision Ill-Conceived?” The Journal of Maternal-Fetal Medicine 7:6 (November-December 1998), 264–268.
. Germaine Greer, The Whole Woman (New York: Anchor Books, 1999), 99.
What a Woman Should Know about Birth Control
by Chris Kahlenborn, MD
All methods of birth control are efforts to separate sexual intercourse from procreation. This separation supports sexual relationships that are much weaker than traditional marriage—hooking up, cohabitation, adultery, and serial monogamy. These relationships erode society by leading to divorce, unexpected pregnancy, abortion, single parent households, abuse, and poverty. The consequences of birth control clearly demonstrate an unhealthy, anti-culture and anti-life, impact that raises major ethical concerns. Use of birth control is like intentionally eating unhealthy, nutrition-less, food just for the pleasure of eating. A steady diet will kill you. In much the same way, a steady diet of birth control kills relationships.
The birth control pill is used by over 10 million women in the US and about 4 million of those are under age 25.1 The Pill consists of a combination of two types of artificial hormones called estrogens and progestins. It works by inhibiting ovulation and sperm transport and by changing the lining of the inside of a woman’s uterus (called the endometrium) so that if the woman does conceive she may have an early abortion.
Ethical concerns: It is estimated that a sexually active woman will experience at least one very early abortion every year that she is on the Pill.2 Both pro-abortion and pro-life groups acknowledge that the Pill causes early abortions.3
Medical side effects: The birth control pill increases the risk of breast cancer by over 40% if it is taken before a woman delivers her first baby.4 This risk increases by 70% if the Pill is used for four or more years before the woman’s first child is born.5 Other side effects that women have experienced include high blood pressure, blood clots, stroke, heart attack, depression, weight gain, and migraines. Diabetics who take oral contraceptives may note increased sugar levels. Some women who stop taking the Pill do not have a return of their fertility (menstrual cycles) for a year, or even longer. Although the Pill decreases ovarian and some uterine cancers, it increases breast, liver, and cervical cancer.4 At least three studies have noted that the AIDS virus is transmitted more easily to women who are taking the Pill if their partner(s) have the HIV virus. 6 , 7 , 8
“The Shot” and Norplant
Commonly known as “the shot,” Depo-Provera, a long acting progestin hormone, is injected into a woman’s muscle every three months. It works by decreasing ovulation, by inhibiting sperm transport and by changing the lining of a woman’s uterus. Norplant is another progestin in silastic (rubber-like) tubes that are placed under her skin, and left there for up to five years.
Ethical concerns: By changing the lining of the uterus, Norplant and Depo-Provera both can cause an early abortion when conception does occur. Women who use Norplant will probably experience more than one such abortion each year since the average woman ovulates in more than 40% of her cycles while using Norplant.9 Depo-Provera may theoretically cause just as many abortions as Norplant since it is also a type of progestin.
Medical side effects: The results of two major world studies have shown that women who take Depo-Provera for two years or more before age 25 have at least a 190% increased risk of developing breast cancer.10 In addition, Depo-Provera may reduce a woman’s bone density, and worsen her cholesterol level. One study found that women who had received injectable progestins (i.e., usually Depo-Provera or norethisterone enanthate) for at least five years suffered a 430% increased risk of developing cervical cancer.11 Several studies have shown that women who receive injectable progestins have a much higher rate of contracting the AIDS virus if their partner is infected, with one study showing a 240% increased risk.12 Norplant, which was developed later than Depo-Provera, has received less scrutiny, but may carry just as high a risk as Depo-Provera. Over 50,000 women have participated in law suits against the manufacturer of Norplant, citing complaints of irregular bleeding, scarring, muscle pain, and headaches.13
Other Hormonal Contraceptives
The same artificial hormones used in the Pill, Depo-Provera, and Norplant are packaged in a variety of other delivery systems: the Patch, the “Morning after Pill,” the monthly injection Lunelle, hormone impregnated IUDs and vaginal inserts, and others. More are in development. Most are so new that their side effects have not been well researched. They use the same chemicals as the Pill and can be expected to have generally the same effects. All the hormonal contraceptives can also cause extended periods of unintended infertility after they are discontinued.
The Condom and the Diaphragm
The condom has a failure rate that is estimated to be between 10-30%.14, 15 There are several reasons: breakage or slippage during use, manufacturing defects, and defects caused by shipping and storage in a hot or very cold place.
Medical side effects: The condom does not adequately stop the transmission of the AIDS virus. CM Rowland, PhD, editor of Rubber Chemistry and Technology, tells us that electron micrographs (pictures taken with a very powerful microscope) reveal voids (holes) in the condom that are up to 50 times bigger than the HIV particle.16
The diaphragm is a barrier method of birth control so it theoretically does not cause early abortion. At least one study has noted that women who use barrier methods such as the diaphragm or condom, or the withdrawal method, had a 137% increased risk of developing preeclampsia.17 Preeclampsia, a complication occurring in some pregnant women, is a syndrome of high blood pressure, fluid retention, and kidney damage, which may eventually lead to prolonged seizures and/or coma. It is theorized that exposure to the male’s sperm plays a protective role against preeclampsia.
A spermicide is an agent that is designed to kill the man’s sperm and is often sold as a gel or as an ingredient in the vaginal sponge. Toxic Shock Syndrome has been associated with the spermicide sponge.18 One researcher has noted that couples who have used certain spermicides within a month of conception have experienced a doubling in the rate of birth defects, as well as a doubling of the rate of miscarriage.19
The IUD (Intrauterine Device)
This is a T-shaped device made of hard plastic. It may also contain copper or contraceptive hormones. A doctor inserts it into a woman’s uterus. It works by irritating the lining of the uterus and obstructing sperm transport.
Ethical concerns: When conception occurs with an IUD in place, the IUD can prevent implantation, or destroy the new embryo by copper poisoning or by attack from the body’s immune system, thus causing an early abortion.20
Medical side effects: These include uterine perforation, which may lead to a hysterectomy, and infection, such as a pelvic or tubo-ovarian abscess. Use of all IUDs has been associated with an increased incidence of PID (Pelvic Inflammatory Disease) and of ectopic pregnancy.20 An ectopic pregnancy is one in which the unborn child implants himself/ herself in a location other than in the mother’s uterus, usually in the fallopian tube. According to Rossing and Daling, two prominent researchers, women who had used an IUD for three or more years were more than twice as likely to have a tubal pregnancy as women who had never used an IUD. Among these long-term users of an IUD, risk of ectopic pregnancy remained elevated for many years after the device was removed. Ectopic pregnancy remains the leading cause of maternal death in the United States. The IUD may also cause back aches, cramping, dyspareunia (painful intercourse), dysmenorrhea (painful menstrual cycles), and infertility.
Tubal Ligation and Vasectomy
Surgical sterilization attempts to achieve permanent sterility through closing a woman’s fallopian tubes (called “tubal ligation”) or a man’s vas deferens (called “vasectomy”) by tying the tube closed and in some cases by cutting, burning, or removing part of the tube.
Medical side effects: Tubal ligation does not always prevent conception. When conception does occur, it is associated with a much higher incidence of ectopic pregnancy,22 which, as was noted, is the leading cause of death in pregnant women. In addition, women who undergo the procedure may experience complications from the anesthesia or from surgery. Complications include bladder puncture, bleeding, and even cardiac arrest after inflation of the abdomen with carbon dioxide.23 Some women who have undergone a tubal ligation experience a syndrome of intermittent vaginal bleeding associated with severe cramping pain in the lower abdomen.24 Reduced intimacy, lower libido, and a greater risk for hysterectomy often follow tubal ligation; deep regret for having been sterilized is common.
About 50% of men who undergo a vasectomy will develop anti-sperm antibodies.25 In essence, their bodies will come to recognize their own sperm as “the enemy.” This could lead to a higher incidence of autoimmune disease. Several studies have noted that men who undergo a vasectomy have a higher incidence of developing prostate cancer, especially 15-20 years after their vasectomy,26, 27, 28, 29 although one large study did not find a link.30
The best option before marriage is abstinence. The obvious benefits include greater self-respect, freedom from the risk of venereal disease, as well as monetary savings and no chance of a surprise pregnancy.
Within marriage it should be noted that an openness towards having children yields specific medical benefits. Every additional child a woman bears reduces her risk of breast cancer, some uterine cancers, and ovarian cancer.
NFP: Natural Family Planning
Natural Family Planning is a totally natural method by which couples can manage their fertility. In NFP a woman determines when she is either fertile or infertile by observing the consistency of her cervical mucus. The WHO (World Health Organization) has performed several large-scale trials that have demonstrated an unintended pregnancy rate of between 0.3 and 3%, which is as good as any artificial form of birth control except sterilization. One very large trial involving about 20,000 Indian women showed an unintended pregnancy rate of less than 0.3%.32
Some obvious benefits of NFP are that it is virtually cost-free and there is no increased risk of cancer. Couples who use NFP have a divorce rate that is less than 5%33__far lower than the national rate of about 50%.
1 Faust JM. Image change for condoms. ABC News Report. [Internet E-mail]. 6/8/97.
2 Kahlenborn C. “How do the pill and other contraceptives work?” Breast Cancer, Its Link to Abortion and the Birth Control Pill. Dayton, OH: One More Soul; 2000; 315-335.
3 Alderson Reporting Company. Transcripts of oral arguments before court on abortion case. New York Times. April 27, 1989; B12.
4 Kahlenborn C, et al. “Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-analysis” Mayo Clinic Proceedings. 2006: 81(10):1290-1302
The study re-enforces the classification of OCs as Type 1 carcinogens by the International Agency for Cancer Research (WHO).
5 Romieu I, Berlin J, et al. Oral contraceptives and breast cancer. Review and meta-Analysis. Cancer. 1990; 66: 2253-2263.
6 Allen S. et al. Human immunodeficiency virus infection in urban Rwanda. JAMA. 1991; 266: 1657-1663.
7 Simonsen et al. HIV infection among lower socioeconomic strata prostitutes in Nairobi. AIDS. 1990; 139-144.
8 Mati et al. Contraceptive use and the risk of HIV in Nairobi, Kenya. Inter. J. of Gyn. and Ob. 1995; 48: 61-67.
9 Croxatto HB, Diaz S, et al. Plasma progesterone levels during long-term treatment with levonorgestrel silastic implants. Acta Endocrinologica 1982; 101: 307-311.
10 Skegg DCG, Noonan EA, et al. Depot medroxyprogesterone acetate and breast cancer [A pooled analysis of the World Health Organization and New Zealand studies]. 1995; JAMA: 799-804.
11 Herrero et al. Injectable contraceptives and risk of invasive cervical cancer: evidence of an association. Int. J. of Cancer. 1990; 46: 5-7.
12 Ungchusak et al. Determinants of HIV infection among female commercial sex workers in northeastern Thailand: Results from a longitudinal study. J. of Ac. I. Def. Syn. and H. Retro. 1996. 12: 500-507.
13 Taylor D. Spare the Rod. The Guardian ( U.K.) March 12, 1996; 11.
14 Collart D. Biochemistry & Molecular Biology. Condom failure for protection from sexual transmission of the HIV-a review of the medical literature. 5393 Whitney Ct., Stone Mountain, GA 30088.
15 Rahwan R. Chemical Contraceptives, Interceptives and Abortifacients, 1995. College of Pharmacy, Ohio State University.
16 Rowland CW., The Washington Post (letter) June 25, 1992.
17 Klonoff-Cohen HS et al. An epidemiologic study of contraception and preeclampsia. JAMA. 1989; 262: 3143-3147.
18 Faich G et al. Toxic shock syndrome and the contraceptive sponge. JAMA. 1986; 255: 216-218.
19 Jick et al. Vaginal spermicides and congenital disorders. JAMA. 1981; 245:1329-1332.
20 Ortho Pharmaceutical. Description of Paraguard. Physician Desk Reference. 1997: 1936-1939.
22 Gaeta TJ et al. Atypical ectopic pregnancy. Am J Emer Med. 1993; 11: 233-234.
23 Dunn HP, Unexpected Sequellae of Sterilization. International Review of Natural Family Planning, 1:4 (Winter, 1977) 318.
24 Townsend DE et al. Post-ablation-tubal sterilization syndrome. Obstet Gynecol. 1993; 82: 422-424.
25 Rosenberg et al. Vasectomy and the risk of prostate cancer. American J. of Epidemiology. 1990; 132: 1051-1055.
26 Giovannucci E et al. A prospective cohort study of vasectomy and prostate cancer in US men. JAMA. 1993; 269: 873-877.
27 Giovannucci E et al. A retrospective cohort study of vasectomy and prostate cancer in US men. JAMA. 1993; 269: 878-882.
28 Hayes RB et al. Vasectomy and prostate cancer in US Blacks and Whites. American J. of Epidemiology. 1993; 137: 263-269.
29 Rosenberg L et al. Vasectomy and the risk of prostate cancer. American J. of Epidemiology. 1990; 132: 1051-1055.
30 John EM et al. Vasectomy and prostate cancer: results from a multiethnic case-control study. JNCI. 1995; 87: 662-669.
32 Ryder RE. “Natural Family Planning”: Effective birth control supported by the Catholic Church. BMJ. 1993; 307: 723-6.
33 Kippley JF, Kippley SK. The Art of Natural Family Planning (Fourth Edition). Couple to Couple League, Cincinnati, USA, p. 245.
Do “morning-after pills” cause abortions?
A pro-life OB/GYN takes issue with the NY Times reportJune 06, 2012 04:09 ESTBy Catherine Harmon
Yesterday the New York Times published a report on the alleged abortion-inducing properties of “emergency contraceptives” such as Plan B and Ella. These drugs carry FDA-mandated labels stating that in addition to delaying ovulation, they may also prevent the implantation of a fertilized egg in a woman’s uterus. That second assertion may not be supported by the latest scientific evidence, according to the NYT’s Pam Belluck: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. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.
The notion that morning-after pills prevent eggs from implanting stems from the Food and Drug Administration’s decision during the drug-approval process to mention that possibility on the label — despite lack of scientific proof, scientists say, and objections by the manufacturer of Plan B, the pill on the market the longest. Leading scientists say studies since then provide strong evidence that Plan B does not prevent implantation, and no proof that a newer type of pill, Ella, does. Some abortion opponents said they remain unconvinced.
One of those unconvinced abortion opponents is obstetrician-gynecologist Dr. Donna Harrison, who is director of research and public policy for the American Association of Pro-Life Obstetricians and Gynecologists and who was interviewed by Belluck for the NYT article. At National Review Online, Harrison describes Belluck’s piece as “a wonderful example of convolution of facts to obscure reality.”
First of all, Plan B and Ella are very different drugs with very different mechanisms of action. Plan B is a progesterone. Progesterone is a hormone that must be in a woman’s body for her to be able to allow the embryo to implant and develop the placental connections between the embryo and the mother. But Plan B is a very large dose of progesterone, higher than the woman’s body would normally make. It is the effect of that high dose which is under debate.
Ella is a second-generation derivative of the abortion drug RU-486, and is equipotent with RU-486 in blocking the action of progesterone at the level of the ovary and endometrium, one of the facts I explain in my paper on this topic. Indeed, if taken before a woman ovulates, Ella will interfere with progesterone action and prevent the egg from being released. But the critically important question is what happens when you take Ella after ovulation. And the answer is clear. Ella blocks the action of progesterone at the level of the ovary, and blocks the action of progesterone at the endometrium, both of which interfere with implantation. Ms. Belluck is in factual error in her article. The European Medical Association technical review articles state that Ella is embryocidal. That means that Ella kills embryos. I attended the FDA Advisory Committee Hearing on approval of Ella, at which data were presented which demonstrated that Ella is around 95 percent effective in preventing a clinically recognized pregnancy. One of the Advisory Committee members repeatedly pointed out to the manufacturers that there was no way the effectiveness of Ella could be explained by delaying ovulation alone. This fact does not take an FDA Advisory Committee member to figure out. If Ella works even when a woman takes it after ovulation, then of course it doesn’t work in that woman by preventing ovulation.
Regarding what, if any, affects Ella may have if taken after ovulation, the NYT reports that “the F.D.A.…and others say evidence increasingly suggests it does not derail implantation, citing, among other things, several studies in which women became pregnant when taking Ella after ovulating.” This assertion may obfuscate the reality of Ella’s abortifacient properties, says Harrison:
Ms. Belluck failed to mention is that 90 percent of those pregnancies “miscarried” and the other 10 percent were “lost to follow-up”. So what the studies supporting the FDA approval of Ella actually show is that even the dose of Ella used as “emergency contraception” is high enough to interfere with the early development of the embryo in such a fashion as to increase the miscarriage rate if a pregnancy is recognized.
The NYT article can be read here. Dr. Harrison’s response can be read here.