Does the Birth Control Pill Cause Abortions?
Eternal Perspective Ministries (EPM)
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"I endorse Randy Alcorn's book with gusto. He has answered the title question with the care and compassion of a pastor, having searched out the facts with the diligence of an experienced researcher. He has provided all women in their reproductive years with an invaluable resource which will allow them to be fully informed about the Pill."
William F. Colliton, Jr., M.D., Clinical Professor of Obstetrics and Gynecology, George Washington University Medical Center
"In this impeccably researched book, Randy Alcorn takes an unblinking look at what medical experts know about how birth control pills work. I painfully agree that birth control pills do in fact cause abortions. Our individual and collective Christian response to this heretofore varnished-over information will have profound consequences for time and eternity. This is a disturbing must-read for all who profess to be prolife."
Beverly A. McMillan, M.D., Ob/Gyn
"Does the birth control pill cause abortions? Using research results from the medical literature, Randy Alcorn has convincingly shown the answer is 'yes.' He has, with care and compassion, given us the truth. The question for us as Christians is how we will respond now that we know."
Linda Martin, M.D., Pediatrician
"By carefully detailing the available medical information concerning the abortifacient effects of oral contraceptives, Randy Alcorn has developed a logical and thoughtful challenge to every prolife person. The conclusions of this study are scientifically accurate. Birth control pills usually prevent pregnancy, but sometimes they cause an abortion. Questions? Objections? Randy has addressed them in a gentle but firm way. This is the manner in which the often fiery debate over prolife subjects should be carried out- unemotionally, intelligently and quietly. The evidence is before us...'How should we then live?'"
Patrick D. Walker, M.D., Professor of Pathology, University of Arkansas for Medical Sciences
"In this challenging book Randy Alcorn has the honesty to face a tough and uncomfortable question. This compelling evidence will make you rethink the question of birth control pills."
John Brose, M.D., Surgeon
"From medical textbooks and pharmacy references, to statements from the Pill-manufacturers themselves, this book proves, beyond any doubt, the abortion-causing action of birth control pills. This book should be read by everyone interested in knowing the truth."
Paul Hayes, M.D., Fellow, American College Obstetricians/Gynecologists
"Randy Alcorn has done exceptional work. The facts in this book parallel much of my own research. I am delighted he would undertake such a work when others seek to avoid the subject. This book is a must for Christians, particularly those in medicine and Christian ministries."
Karen D. Garnett, R.N.
"No prolife physician can rightly prescribe BCPs after reviewing this data. I have started circulating this information."
Randall Martin, M.D., Chairman, Department of Anesthesiology, Columbia Willamette Valley Medical Center
"Scientific papers suggest that escape ovulation occurs 4-15% of all cycles in patients taking birth control pills. Thus, as this booklet points out, early chemical abortions are a real and significant concern."
Paddy Jim Baggot, M.D., Ob/Gyn,
Fellow of the American College of Medical Genetics
"Randy Alcorn has thoroughly studied and written on an area where little published scientific information exists. His responses to this issue, and his outstanding appendices, are must reading."
William M. Petty, M.D., Surgeon, Gynecologic Oncology
"Randy Alcorn has once again demonstrated his tenacity and integrity in pursuing the truth. He has exposed the abortifacient properties of so-called birth control agents. This booklet should be required reading for all discerning Christians who wish to fully live out their faith."
William L. Toffler, M.D., Professor of Family Medicine, Oregon Health Sciences University
"Somehow the concerns about the abortifacient effects of the pill and other hormonal contraceptives never really bothered me. I am amazed now that I could have ignored this issue in the past. I've now discontinued prescribing hormonal contraception."
Stephen K. Toadvine, M.D., Rush-Copley Family Practice, Aurora, IL
Other Books by Randy Alcorn
Lord Foulgrin's Letters (Multnomah Publishers, 2000)
Edge of Eternity (WaterBrook Press, 1998)
Dominion (Multnomah/Questar, 1996)
Deadline (Multnomah/Questar, 1994)
Prolife Answers to Prochoice Arguments (Multnomah, 2000)
Restoring Sexual Sanity (Coral Ridge Ministries, 2000)
In Light of Eternity (WaterBrook Press, 1999)
Is Rescuing Right? (InterVarsity Press, 1990)
Money, Possessions, and Eternity (Tyndale House, 1989)
Sexual Temptation (InterVarsity Press, 1988)
Women Under Stress (with Nanci Alcorn; Multnomah, 1987)
Table of Contents
What's at Stake Here? 9
What is a Contraceptive? 10
My Own Vested Interests in the Pill 12
Examining the Evidence 14
The Physician's Desk Reference 14
Medical Journals and Textbooks 16
What Does All This Mean? 18
Research Findings Back to the 1970's 18
Proabortionists Know: Why Don't We? 20
The Pill's Failure to Prevent Ovulation 21
What do Pill Manufacturers Say? 22
The Pill's Third Mechanism: Real or Not? 28
Pill Manufacturer Employees Speak Up 29
More Confirming Evidence 31
Intrauterine vs. Ectopic Pregnancy Ratios 31
Three Physicians and a Pharmacist 32
Not One but Five Elements of Risk 33
The Morning-After Pill: Standard BCPs 35
Evidence to the Contrary? 36
An Interview with Physicians 37
Letters from Prolife Physicians 38
Letters from a Christian Organization 38
Article in a Christian Magazine 40
Speech by a Prolife Physician 40
Study on Norplant's Damage to Ova 41
Statement by Twenty Prolife OB-GYN Specialists who are pro-Pill 42
Statement by Twenty-Six Prolife OB-GYN Specialists who believe the Pill causes abortions 43
How Often Does the Pill Cause Abortions? 45
Why It's So Difficult to Know for Sure 45
Determining Breakthrough Ovulation Rates 46
When the first mechanism fails, how often does the second work? 47
When the second mechanism fails, how often does the third work? 48
Responding to the Evidence: Questions & Objections 50
"If this is true, why haven't we been told?"50
"I don't trust this evidence." 54
"If we don't know how often abortions happen, why shouldn't we take the Pill?" 55
"Spontaneous miscarriages are common-early abortions aren't that big a deal." 55
"Taking the Pill means fewer children die in spontaneous abortions." 57
"Without the Pill there would be more elective abortions." 57
"Pill-takers don't intend to have abortions." 58
"Why not just use high estrogen pills?" 59
"You can't avoid every risk" 59
"How can we practice birth control without the Pill?" 60
"I never knew this-should I feel guilty?" 63
"We shouldn't lay guilt on people by talking about this." 65
"We shouldn't tell people the Pill may cause abortions because they'll be held accountable." 66
"We've prayed about it and we feel right about using the Pill." 68
"This issue will sidetrack us from fighting surgical abortions." 69
"Prolifers will lose credibility if we oppose the Pill." 70
"This puts physicians in a difficult position." 71
The Problem: A Spiritual Stronghold? 72
The Trend: Chemical vs. Surgical Abortions 75
Chemical Abortions: History & Scripture 76
Time to Search our Hearts and Ways? 77
Appendix A: When Does Each Human Life Begin? The Answer of Scripture 80
Appendix B: When Does Each Human Life Begin? The Answer of Science 81
Appendix C: Abortion & the Early Church Leaders 82
Appendix D: God is Creator and Owner of all People (and has sole rights over all) 83
Appendix E: God has Exclusive Prerogatives Over Human Life and Death 84
Appendix F: Shedding Innocent Blood 84
Appendix G: How God Sees Children 85
Appendix H: Defending the Weak & Helpless 86
Addendum: Other "Contraceptives" 87
IUD, Norplant, Depo-Provera & RU-486 87
The Mini-Pill (Progestin-only) 88
"The Pill" is the popular term for more than forty different commercially available oral contraceptives. In medicine, they are commonly referred to as BCPs (Birth Control Pills), OCs (Oral Contraceptives) and/or OCPs (Oral Contraceptive Pills). They are also called "Combination Pills," because they contain a combination of estrogen and progestin.
About fourteen million American women use the Pill each year. Across the globe it is used by about sixty million. The question of whether it causes abortions has direct bearing on untold millions of Christians, many of them prolife, who use and recommend it. For those who recognize God is the Creator of each person and the giver and taker of human life, this is a question with profound moral implications. After coming to grips with the importance of this issue, and hearing conflicting opinions for the last few years, I determined to research this question thoroughly and communicate my findings, whether or not I liked what I found.
I wanted, and still want, the answer to this question to be "No." I came to this issue as a skeptic. Though I heard people here and there make an occasional claim that the Pill caused abortions, I learned long ago not to trust everything said by sincere Christians, who are sometimes long on zeal but short on careful research. While I'm certainly fallible, I have taken pains to be as certain as possible that the information I am presenting here is accurate. I've examined medical journals and other scientifically-oriented sources-everything from popular medical reference books to highly technical professional periodicals. I've checked and double checked, submitted this research to physicians, and asked clarifying questions of pharmacists and other experts. Few of my citations are from prolife advocates. Most are physicians, scientists, researchers, pill-manufacturers and other secular sources.
I am not a physician or a scientist, but I am an experienced researcher. If I were conducting medical research, obviously the fact that I am not a physician or scientist would disqualify me. But I have attempted no medical research. I have simply hunted down, read, and organized the research findings of others. I have then evaluated their cumulative findings and added my own insights in areas where I am more qualified, including biblical studies.
The first edition of this book came out in 1997. While I had to dig deep to find information on the subject back then, in the past few years there has been an explosion of relevant inquiry into it. According to Dr. John Wilks, a pharmacist, "new research appears almost monthly to illuminate further and sometimes confuse [the] emerging medical discipline associated with fertilization and implantation technology."[i]
Since it is critical that I cite credible medical and scientific sources, there is no way to avoid using medical terminology in this book. I have tried to minimize this by using only brief quotations and whenever possible avoiding technical terms.
This little book cannot be all things to all people. Its readers will include high school students, young married couples and medical lay people who want simple straightforward answers devoid of technical terms. It will also include physicians, pharmacists and research scientists who would neither read, respect nor benefit from a simplistic and sketchy presentation on such a significant issue.
Some readers want and need as much documentation and explanation as possible. Others are satisfied with one or two evidences for any claim. If the reader feels a point has been adequately made to him, he can simply skim or move on to the next heading that interests him. Meanwhile, those who desire to work through the details can do so. Those who desire a less detailed version of this book can go to Appendix E in the new expanded and revised version of my book ProLife Answers to ProChoice Arguments (Multnomah Publishers, 2000). Dr. Walt Larimore and I co-authored a different and even more abbreviated presentation that appears as a chapter in The Reproduction Revolution.[ii] The book in your hands is the most thorough and best-documented presentation of my conclusions on this subject matter.
Before going further, let me affirm a truth that is a foundational premise of all I am about to address: each human being is created by God at the point of conception. This is the clear teaching of the Bible and is confirmed by the scientific evidence. If you are not completely convinced of this, please stop now and read the first two appendices. They both answer the question, "When Does Human Life Begin?" Appendix A gives the answer of Scripture and appendix B the answer of science. You may also wish to read the other appendices to bring a biblical perspective to the importance of the issue dealt with in this book.
Because there is so much at stake, and because there is a great spiritual battle surrounding this issue, I suggest readers pause and pray, asking God to show you his mind and his heart.
Conception is the point at which the twenty-three chromosomes from the female's egg and the twenty-three from the male's sperm join together to form a new human life, with forty-six chromosomes and his or her own distinct DNA.
Often the newly-conceived person is referred to as a "fertilized egg." This term is dehumanizing and misleading. Neither egg (ovum) nor sperm alone is in any sense a human being, but merely the product of a human being. However, at the point of fertilization someone brand new comes into existence, a singularly unique human being. As the sperm no longer exists, neither in essence does the egg. It is replaced by a new creation with unique DNA, rapidly growing and dividing on its own. This new human being is no more a mere "fertilized egg" than it is a "modified sperm." He is a newly-created person, with the equivalent of hundreds of volumes of distinct genetic programming.
Historically, the terms conception and fertilization have been virtually synonymous, both referring to the very beginning of human life. A contraceptive, then, just as it sounds, was something which prevented fertilization (i.e. contradicted conception). Unfortunately, in the last few decades alternative meanings of "conception" and "contraception" have emerged, which have greatly confused the issue.
Eugene F. Diamond, M.D., wrote an excellent article in Focus on the Family's Physician magazine. Dr. Diamond states,
Prior to 1976, a "contraceptive" was understood to be an agent that prevented the union of sperm and ovum. In 1976 the American College of Obstetricians and Gynecologists (ACOG), realizing that this definition didn't help its political agenda, arbitrarily changed the definition.
A contraceptive now meant anything that prevented implantation of the blastocyst, which occurs six or seven days after fertilization. Conception, as defined by Dorland's Illustrated Medical Dictionary (27th Edition), became "the onset of pregnancy marked by implantation of the blastocyst."
The hidden agenda in ACOG's redefinition of "contraceptive" was to blur the distinction between agents preventing fertilization and those preventing implantation of the week-old embryo. Specifically, abortifacients such as IUDs, combination pills, minipills, progestin-only pills, injectables such as Provera and, more recently, implantables such as Norplant, all are contraceptives by this definition.[iii]
(Note that Dr. Diamond identifies combination pills, collectively known as "the Pill," as abortifacients. Whether or not he is correct is what this book is about.)
The redefinition of "contraceptive" Dr. Diamond speaks of has gradually crept into the medical literature. Because of the change, some medical professionals will state the Pill is only a contraceptive, even if they know it sometimes acts to prevent implantation. But the old meaning of contraceptive, the one more scientifically accurate and distinct, is also still widely used.
I have in front of me a recently-issued metallic circular "Pregnancy Calculator," produced by Wyeth-Ayerst Laboratories, a leading manufacturer of the Pill. These are routinely used by Ob/Gyns to calculate a pregnant woman's due date. The calculator points to the first day of the last menstrual period, then points to 14-15 days later as "Probable Day of Conception." However, implantation (also called nidation) does not happen until day 21 of the new cycle, six or seven days after conception. Hence, the Pill-manufacturer that makes the pregnancy calculator still defines "conception" in its historical sense, not that adopted by the ACOG.
According to the meaning conception always had––which is the meaning still held to by the vast majority of the public and many if not most medical professionals––there is no way any product is acting as a contraceptive when it prevents implantation. (Call it a contraimplantive, if you wish, but when it works in that way it is not a contraceptive.)
In this book, I will use "conception" in its classic sense-as a synonym for fertilization, the point at which the new human life begins. Contraceptives, then, are chemicals or devices that prevent conception or fertilization. A birth control method that sometimes kills an already conceived human being is not merely a contraceptive. It may function as a contraceptive some or most of the time, but some of the time it is also an abortifacient.
The problem of "contraceptives" that are really abortifacients is not a new one. Many prolife Christians, including physicians, have long opposed the use of Intra-Uterine Devices (IUDs), as well as RU-486 ("the abortion pill") and the Emergency Contraceptive Pill (ECP). Some, though not all, have also opposed Norplant, Depo-Provera, and the "Mini-pill," all of which sometimes or often fail to prevent contraception, but succeed in preventing implantation of the six day old human being. (For more details, see "The IUD, Norplant, Depo-Provera, RU-486, and the Mini-Pill," in the addendum following the appendices.)
But what about the widely-used Birth Control Pill, with its combined estrogen and progestin? Is it exclusively a contraceptive? That is, does it always prevent conception? Or does it, like other products, sometimes prevent implantation, thus producing an early abortion? That is the central question of this book.
To make the issue personal, let me tell you my own story. In 1991, while researching my book ProLife Answers to ProChoice Arguments, I heard someone suggest that birth control pills can cause abortions. This was brand new to me-in all my years as a pastor and a prolifer, I had never heard it before. I was immediately skeptical.
My vested interests were strong in that Nanci and I used the Pill in the early years of our marriage, as did many of our prolife friends. Why not? We believed it simply prevented conception. We never suspected it had any potential for abortion. No one told us this was even a possibility. I confess I never read the fine print of the Pill's package insert, nor am I sure I would have understood it even if I had.
In fourteen years as a pastor, doing considerable premarital counseling, I always warned couples against the IUD because I'd read it causes early abortions. I typically recommended young couples use the Pill because of its relative ease and effectiveness.
At the time I was researching ProLife Answers, I found only one person who could point me toward any documentation that connected the Pill and abortion. She told me of just one primary source that supported this belief and I came up with only one other. Still, these two sources were sufficient to compel me to include this warning in my book:
Some forms of contraception, specifically the intrauterine device (IUD), Norplant, and certain low-dose oral contraceptives, often do not prevent conception but prevent implantation of an already fertilized ovum. The result is an early abortion, the killing of an already conceived individual. Tragically, many women are not told this by their physicians, and therefore do not make an informed choice about which contraceptive to use...Among prolifers there is honest debate about contraceptive use and the degree to which people should strive to control the size of their families. But on the matter of controlling family size by killing a family member, we all ought to agree. Solutions based on killing people are not viable.[iv]
At the time, I incorrectly believed that "low-dose" birth control pills were the exception, not the rule. I thought most people who took the Pill were in no danger of having abortions. What I've found in my recent research is that since 1988 virtually all oral contraceptives used in America are low-dose, that is, they contain much lower levels of estrogen than the earlier birth control pills.
The standard amount of estrogen in the birth control pills of the 1960's and early 70's was 150 micrograms. Danforth's Obstetrics and Gynecology[v] says this:
The use of estrogen-containing formulations with less than 50 micrograms of estrogen steadily increased to 75% of all prescriptions in the United States in 1987. In the same year, only 3% of the prescriptions were for formulations that contained more than 50 micrograms of estrogen. Because these higher-dose estrogen formulations have a greater incidence of adverse effects without greater efficacy, they are no longer marketed in the United States.
After the Pill had been on the market fifteen years, many serious negative side effects of estrogen had been clearly proven.[vi] These included blurred vision, nausea, cramping, irregular menstrual bleeding, migraine headaches and increased incidence of breast cancer, strokes and heart attacks, some of which led to fatalities.
Beginning in the mid-seventies, manufacturers of the Pill steadily decreased the content of estrogen and progestin in their products. The average dosage of estrogen in the Pill declined from 150 micrograms in 1960 to 35 micrograms in 1988. These facts are directly stated in an advertisement by the Association of Reproductive Health Professionals and Ortho Pharmaceutical Corporation.[vii]
Likewise, Pharmacists for Life confirms:
As of October 1988, the newer lower dosage birth control pills are the only type available in the U.S., by mutual agreement of the Food and Drug Administration and the three major Pill manufacturers: Ortho, Searle and Syntex.[viii]
What is now considered a "high dose" of estrogen is 50 micrograms, which is in fact a very low dose in comparison to the 150 micrograms once standard for the Pill. The "low-dose" pills of today are mostly 20-35 micrograms. As far as I can tell from looking them up individually in medical reference books, there are no birth control pills available today that have more than 50 micrograms of estrogen. An M.D. wrote to inform me that she too made a similar search and could find none. If they exist, they are certainly rare.
Not only was I wrong in thinking low-dose contraceptives were the exception rather than the rule, I didn't realize there was considerable documented medical information linking birth control pills and abortion. The evidence was there, I just didn't probe deep enough to find it. Still more evidence has surfaced in the years since.
I say all this to emphasize I came to this research with no prejudice against the Pill. In fact, I came with a prejudice toward it. I certainly don't want to believe I may have jeopardized the lives of my own newly-conceived children, nor that I was wrong in recommending it to all those couples I counseled as a pastor. It would take compelling evidence for me to overcome the reluctance I brought to this, and to change my position.
Still, I resolved to pursue this research with an open mind, sincerely seeking the truth and hoping to find out the Pill does not cause abortions. I ask you to take a look with me at the evidence and decide for yourself.
A warning is in order, since many readers come to this issue with vested interests on one of two sides. Those who oppose contraceptives per se may be biased toward the notion that the Pill causes abortions. Since they are against the Pill anyway, believing that it causes abortions gives them one more reason, perhaps the best reason of all, to oppose it. Hence, they may tend to accept uncritically any arguments against the Pill.
Likewise, readers who have used the Pill or recommended it and Christian physicians who prescribe and make a significant amount of income from the Pill-including most OB-GYNs and family practitioners-will naturally have vested interests in believing the Pill does not cause abortions.
Those coming with either bias should resist the temptation to believe something about the Pill simply because they want to. Hard as it may be, let's attempt to evaluate the evidence fairly and objectively.
The Physician's Desk Reference is the most frequently used reference book by physicians in America. The PDR, as it's often called, lists and explains the effects, benefits and risks of every medical product that can be legally prescribed. The Food and Drug Administration requires that each manufacturer provide accurate information on its products, based on scientific research and laboratory tests. This information is included in The PDR.
As you read the following, keep in mind that the term "implantation," by definition, always involves an already conceived human being. Therefore any agent which serves to prevent implantation functions as an abortifacient.
This is PDR's product information for Ortho-Cept, as listed by Ortho, one of the largest manufacturers of the Pill:
Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus, which increase the difficulty of sperm entry into the uterus, and changes in the endometrium which reduce the likelihood of implantation.[ix]
The FDA-required research information on the birth control pills Ortho-Cyclen and Ortho Tri-Cyclen also state that they cause "changes in...the endometrium (which reduce the likelihood of implantation)."[x]
Notice that these changes in the endometrium, and their reduction in the likelihood of implantation, are not stated by the manufacturer as speculative or theoretical effects, but as actual ones. (The importance of this will surface later in the book.)
Similarly, Syntex, another major pill-manufacturer, says this in the Physician's Desk Reference[xi] under the "Clinical Pharmacology" of the six pills it produces (two types of Brevicon and four of Norinyl):
Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entry into the uterus), and the endometrium (which may reduce the likelihood of implantation).
Wyeth says something very similar of its combination Pills, including Lo/Ovral and Ovral: "other alterations include...changes in the endometrium which reduce the likelihood of implantation."[xii] Wyeth makes virtually identical statements about its birth control pills Nordette[xiii] and Triphasil.[xiv]
A young couple showed me their pill, Desogen, a product of Organon. I looked it up in the PDR.[xv] It states one effect of the pill is to create "changes in the endometrium which reduce the likelihood of implantation."
The inserts packaged with birth control pills are condensed versions of longer research papers detailing the Pill's effects, mechanisms and risks. Near the end, the insert typically says something like the following, which is directly from the Desogen pill insert:
If you want more information about birth control pills, ask your doctor, clinic or pharmacist. They have a more technical leaflet called the Professional Labeling, which you may wish to read. The Professional Labeling is also published in a book entitled Physician's Desk Reference, available in many bookstores and public libraries.
Of the half dozen birth control pill package inserts I've read, only one included the information about the Pill's abortive mechanism. This was a package insert dated July 12, 1994, found in the oral contraceptive Demulen, manufactured by Searle.[xvi] Yet this abortive mechanism was referred to in all cases in the FDA-required manufacturer's Professional Labeling, as documented in the Physician's Desk Reference.
In summary, according to multiple references throughout the Physician's Desk Reference, which articulate the research findings of all the birth control pill manufacturers, there are not one but three mechanisms of birth control pills: 1) inhibiting ovulation (the primary mechanism), 2) thickening the cervical mucus, thereby making it more difficult for sperm to travel to the egg, and 3) thinning and shriveling the lining of the uterus to the point that it is unable or less able to facilitate the implantation of the newly-fertilized egg. The first two mechanisms are contraceptive. The third is abortive.
Naturally, compliance by the patient in regularly taking the Pill is a huge factor in its rate of suppressing ovulation. But, as we will see later in this book, breakthrough ovulation happens even among those who never miss a pill.
When a woman taking the Pill discovers she is pregnant––according to the Physician's Desk Reference's efficacy rate tables, listed under every contraceptive, this is 3% of pill-takers each year-it means that all three of these mechanisms have failed. The third mechanism sometimes fails in its role as backup, just as the first and second mechanisms sometimes fail. Each and every time the third mechanism succeeds, however, it causes an abortion.
Dr. Larimore and I co-authored a chapter in The Reproduction Revolution, presenting evidence that the birth control pill can in fact cause abortions.[xvii] Dr. Susan Crockett and four colleagues presented the opposing view.[xviii] Dr. Crockett believes any abortifacient effect is so minimal as to be unworthy of concern. She discounts the repeated PDR references to adverse endometrial changes that sometimes prevent implantation, saying, "Hormone contraceptive literature is written for marketing purposes ('this contraception will prevent pregnancy') and for legal protection ('you can't sue if you miscarry-we warned you'), as well as for patient education."[xix]
Proponents of the view that there is an abortifacient effect (including the author) counter that the disclosure of such information is mandated by no less an authority than the FDA. While such information may serve a legal purpose, its inclusion is clearly more than a marketing ploy or a legal caveat. Those convinced the manufacturers' claims that the Pill sometimes prevents implantation are not truthful statements based on science but false statements motivated by public relations have the responsibility to address both the companies and the FDA with this serious accusation. They should not, however, expect consumers to simply disregard them in favor of a more desirable belief. [xx]
Dr. Brian Clowes, a researcher with Human Life International, points out that stated PDR failure rates don't tell the whole story:
These failure rates are indicative only of the number of human embryos that reach the stage of a verifiable implanted pregnancy [sustained pregnancy]; no indication is given of the scale of loss of human embryos that fail to implant at the endometrial level under the hormonal influence of these drugs. This occurrence essentially amounts to early chemical abortion.[xxi]
The Pill alters what are known as epithelial and stromal integrins, which appear to be related to endometrial receptivity. These integrins are considered markers of normal fertility. Significantly, they are conspicuously absent in patients with various conditions associated with infertility and in women taking the Pill. Since normal implantation involves a precise synchronization of the zygote's development with the endometrium's window of maximum receptivity, the absence of these integrins logically indicates a higher failure rate of implantation for Pill-takers. According to Dr. Stephen G. Somkuti and his research colleagues,
These data suggest that the morphological changes observed in the endometrium of OC users have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs.[xxii]
Shoham and his research associates reported findings in a Fertility & Sterility journal article. Their studies indicate a "mid-luteal endometrial thickness of 11 mm or more...was found to be a good prognostic factor for detecting early [sustained] pregnancy," and no [sustained] pregnancies could be identified "when the endometrial thickness was less than 7 mm."[xxiii]
Drs. Chowdhury, Joshi and associates state,
The data suggests that though missing of the low dose combination pills may result in 'escape' ovulation in some women, however, the pharmacological effects of pills on the endometrium and cervical mucus may continue to provide them contraceptive protection."[xxiv]
(Note in both the proceeding and following citations "contraceptive" is used in the sense it was redefined by the ACOG, so it now includes the endometrium's diminished capacity to accept implantation of the already conceived child.)
In a study of oral contraceptives published in a major medical journal, Dr. G. Virginia Upton, Regional Director of Clinical Research for Wyeth, one of the major birth control pill manufacturers, says this:
The graded increments in LNg in the triphasic OC serve to maximize contraceptive protection by increasing the viscosity of the cervical mucus (cervical barrier), by suppressing ovarian progresterone output, and by causing endometrial changes that will not support implantation.[xxv]
Dr. Goldzieher says as a result of the combined Pill's action, "possibly the endometrium in such cycles may provide additional contraceptive protection."[xxvi]
The medical textbook Williams Obstetrics states, "progestins produce an endometrium that is unfavorable to blastocyst implantation."[xxvii]
Drs. Ulstein and Myklebust of the University of Bergen, Norway state,
The main effect of oral contraception is inhibition of ovulation. Furthermore the changes in the cervical mucus and the endometrium are considered to be of importance to contraceptive effectiveness.[xxviii]
Drug Facts and Comparisons says this about birth control pills in its 1996 edition:
Combination OCs inhibit ovulation by suppressing the gonadotropins, follicle-stimulating hormone (FSH) and lutenizing hormone (LH). Additionally, alterations in the genital tract, including cervical mucus (which inhibits sperm penetration) and the endometrium (which reduces the likelihood of implantation), may contribute to contraceptive effectiveness.[xxix]
A standard medical reference, Danforth's Obstetrics and Gynecology[xxx] states this: "The production of glycogen by the endometrial glands is diminished by the ingestion of oral contraceptives, which impairs the survival of the blastocyst in the uterine cavity." (The blastocyst is the newly-conceived child.)
It is well documented that the cellular structure of the endometrium is altered by the Pill, producing areas of edema alternating with areas of dense cellularity, which constitute an abnormal state not conducive to a pregnancy.[xxxi]
Magnetic Resonance Imaging studies demonstrate that the lining of the endometrium is dramatically thinned in Pill users. Normal endometrial thickness which can sustain a pregnancy ranges in density from 5 to 13 mm. The average thickness in pill users is 1.1 mm.[xxxii] [xxxiii]
Writing in the Australian magazine Nexus, Sherrill Sellman describes the Pill's effects as follows:
...[causing] alterations to the lining of the womb, converting the proliferative nature of the endometrium-which is naturally designed to accept and sustain a fertilized ovum-to a secretory endometrium, which is a thin, devasculating lining, physiologically unreceptive to receiving and sustaining a zygote.[xxxiv]
In her article "Abortifacient Drugs and Devices: Medical and Moral Dilemmas," Dr. Kristine Severyn states,
The third effect of combined oral contraceptives is to alter the endometrium in such a way that implantation of the fertilized egg (new life) is made more difficult, if not impossible. In effect, the endometrium becomes atrophic and unable to support implantation of the fertilized egg....the alteration of the endometrium, making it hostile to implantation by the fertilized egg, provides a backup abortifacient method to prevent pregnancy.[xxxv]
A 1999 Guttmacher Institute publication includes the following statement concerning the "Emergency Contraceptive Pill" (ECP):
The best scientific evidence suggests that ECP's most often work by suppressing ovulation. But depending on the timing of intercourse in relation to a woman's hormonal cycle, they-as is the case with all hormonal contraceptive methods-also may prevent pregnancy either by preventing fertilization or by preventing implantation of a fertilized egg in the uterus.[xxxvi]
Note what isn't said directly, but which is nonetheless indicated for all who have eyes to see-one primary way this product works is by causing the death of an already conceived child. These technical terms blow by most readers, including physicians. It is only when you stop and think about the significance of preventing implantation that you come to terms with what it really means. Most people, including most prolife Christians, simply don't stop and think. It's significant to note that while ECP's may be more efficient in preventing implantation than the Pill, their stated means of operation are actually the same.
Contraceptive Technology, dealing with the impact of OCPs on a woman's endometrium, states "secretions within the uterus are altered as is the cellular structure of the endometrium leading to the production of areas of edema alternating with areas of dense cellularity."[xxxvii]
As a woman's menstrual cycle progresses, her endometrium gradually gets richer and thicker in preparation for the arrival of any newly-conceived child who may be there to attempt implantation. In a natural cycle, unimpeded by the Pill, the endometrium experiences an increase of blood vessels, which allow a greater blood supply to bring oxygen and nutrients to the child. There is also an increase in the endometrium's stores of glycogen, a sugar that serves as a food source for the blastocyst (child) as soon as he or she implants.
The Pill keeps the woman's body from creating the most hospitable environment for a child, resulting instead in an endometrium that is deficient in both food (glycogen) and oxygen. The child may die because he lacks this nutrition and oxygen.
Cell-signaling, communications between Integrins in the womb and surrounding the traveling egg, are disrupted and hamper healthy implanting of the embryo into the endometrium. In a 1997 Keio Journal of Medicine, this effect on the endometrium is portrayed in a graphic analogy:
Consider the example of a space shuttle, low on fuel and oxygen, urgently needing to dock with the space station. The mother ship and the shuttle communicate with each other so that the shuttle knows which docking bay to go to. Importantly, the mother ship knows which bay to make ready. Successful communication is imperative. If this electronic communication fails (disrupted embryo-uterine 'cell-talk') the shuttle may go to the wrong docking bay, fail to attach to the mother ship, drift away, with the result that the crew dies from a lack of food and oxygen. Alternately, the shuttle might go to the right bay but find that all the docking apparatus is not in place. Again, the attachment between the two fails due to faulty communication and the crew dies.... To continue the analogy, the Integrins could be thought of as grappling hooks that 'hold' the human embryo onto the womb whilst the process of implantation is completed.[xxxviii]
Typically, the new person attempts to implant at six days after conception. If implantation is unsuccessful, the child is flushed out of the womb in a miscarriage. While there are many spontaneous miscarriages, whenever the miscarriage is the result of an environment created by a foreign device or chemical, it is an artificially induced miscarriage, with is in fact an abortion. This is true even if the mother does not intend it, is not aware of it happening, and would be horrified if she were.
If the embryo is still viable when it reaches the uterus, underdevelopment of the uterine lining caused by the Pill prevents implantation. The embryo dies and the remains are passed along in the next bleeding episode which, incidentally, is not a true menstruation, even though it is usually perceived as such.[xxxix]
One of the things that surprised me in my research was that though many recent sources testify to the Pill's abortive capacity, it has been well established for three decades. In 1966 Dr. Alan Guttmacher, former director of Planned Parenthood, said this about the Pill's effect on the uterine lining:
The appearance of the endometrium differs so markedly from a normal premenstrual endometrium that one doubts it could support implantation of a fertilized egg.[xl]
The following nine sources are all from the 1970s. (Keep in mind that the term "blastocyst" refers to the newly-conceived human being-"it" is not a thing, but a person, a "he" or "she.")
Dr. Daniel R. Mishell of the USC School of Medicine said,
Furthermore, [the combination pills] alter the endometrium so that glandular production of glycogen is diminished and less energy is available for the blastocyst to survive in the uterine cavity.[xli]
Dr. J. Richard Crout, president of the Food and Drug Administration (FDA), said this of combination birth control pills:
Fundamentally, these pills take over the menstrual cycle from the normal endocrine mechanisms. And in so doing they inhibit ovulation and change the characteristics of the uterus so that it is not receptive to a fertilized egg.[xlii]
In 1970, J. Peel and M. Potts's Textbook of Contraceptive Practice acknowledged this:
In addition to its action on the pituitary-ovarian axis the combination products [BCPs] also alter the character of the cervical mucus, modify the tubal transport of the egg and may have an effect on the endometrium to make implantation unlikely.[xliii]
In their book Ovulation in the Human, P. G. Crosignani and D. R. Mishell stated that birth control pills "affect the endometrium, reducing glycogen production by the endometrial glands which is necessary to support the blastocyst."[xliv]
The Handbook of Obstetrics & Gynecology, then a standard reference work, states,
The combination pill...is effective because LH release is blocked and ovulation does not occur; tubal motility is altered and fertilization is impeded; endometrial maturation is modified so that implantation is unlikely; and cervical mucus is thickened and sperm migration blocked.[xlv]
Note that in this case four mechanisms are mentioned, including tubal motility, which we will address later. Note also that prevention of implantation is listed before the prevention of conception by the thickened cervical mucus.
In 1979 a spokesperson for Ortho Pharmaceutical Corporation, stated,
The lining of the uterus does not become fully developed so that even if an egg does ripen and is fertilized, there is little likelihood that it would become implanted.[xlvi]
It was not just obscure medical journals and textbooks which contained this information in the 70's. The popular magazine Changing Times explained, "The pill may affect the movement of the fertilized egg toward the uterus or prevent it from imbedding itself in the uterine lining."[xlvii] Likewise, the book My Body, My Health stated,
In a natural cycle, the uterine lining thickens under the influence of estrogen during the first part of the cycle, and then matures under the influence of both progesterone and estrogen after ovulation. This development sequence is not possible during a Pill cycle because both progestin and estrogen are present throughout the cycle. Even if ovulation and conception did occur, successful implantation would be unlikely.[xlviii]
If most prolifers have been slow to catch on to this established medical knowledge (I certainly have been), many proabortionists are fully aware of it. In February 1992, writing in opposition to a Louisiana law banning abortion, Tulane Law School Professor Ruth Colker wrote,
Because nearly all birth control devices, except the diaphragm and condom, operate between the time of conception...and implantation...the statute would appear to ban most contraceptives.[xlix]
Colker referred to all those methods, including the Pill, which sometimes prevent implantation.
Similarly, attorney Frank Sussman, representing Missouri Abortion Clinics, argued before the Supreme Court in 1989 that "The most common forms of...contraception today, IUDs and low-dose birth control pills...act as abortifacients."[l]
Remember, by that time all Pills were "low-dose" compared to the Pill of the 60's and 70's. In fact, 97% were low-dose even by recent standards, in that they had less than fifty micrograms of estrogen.
The Pill's ability to prevent implantation is such well-established knowledge that the 1982 edition of the Random House College Dictionary, on page 137, actually defines "Birth Control Pill" as "an oral contraceptive for women that inhibits ovulation, fertilization, or implantation of a fertilized ovum, causing temporary infertility." (I'm not suggesting, of course, that Random House or any dictionary is an authoritative source. My point is that the knowledge of the Pill's prevention of implantation is so firmly established that it can be presented as standard information in a household reference book.)
I found on the World Wide Web a number of sources that recognize the abortive mechanism of the Pill. (Again, web sources are not authoritative-my point is to demonstrate a widespread awareness of the Pill's abortive properties.) For instance, "Oral Contraceptives: Frequently Asked Questions," says, "The combined oral contraceptive pill...impedes implantation of an egg into the endometrium (uterine lining) because it changes that lining."[li]
For years proabortionists have argued that if the Human Life Amendment, which recognizes each human life begins at conception, was to be put into law, this would lead to the banning of both the IUD and the Pill. When hearing this I used to think, "They're misrepresenting the facts and agitating people by pretending the Pill would be jeopardized by the HLA."
I realize now that while their point was to agitate people against the Human Life Amendment, they were actually correct in saying that if the amendment was passed and taken seriously, the Pill's legality would be jeopardized. They never claimed condoms or diaphragms would be made illegal by the Human Life Amendment. Why? Because when they work, those methods are 100% contraceptives-they never cause abortions. It's because they know that the Pill sometimes prevents implantation that abortion advocates could honestly claim that an amendment stating human life begins at conception would effectively condemn the Pill.
One of the most common misconceptions about the Pill is that its success in preventing discernible pregnancy is entirely due to its success in preventing ovulation. In fact, if a sexually active and fertile woman taking the Pill does not get pregnant in 97% of her cycles it does not mean she didn't ovulate in 97% of her cycles.
In many of her cycles the same woman would not have gotten pregnant even if she wasn't using the Pill. Furthermore, if the Pill's second mechanism works, conception will be prevented despite ovulation taking place. If the second mechanism fails, then the third mechanism comes into play. While it may fail too, every time it succeeds it will contribute to the Pill's perceived contraceptive effectiveness. That is, because the child is newly-conceived and tiny, and the pregnancy has just begun six days earlier, that pregnancy will not be discernible to the woman. Therefore every time it causes an abortion the Pill will be thought to have succeeded as a contraceptive. Most women will assume it has stopped them from ovulating even when it hasn't. This illusion reinforces the public's confidence in the Pill's effectiveness, with no understanding that both ovulation and conception may have in fact not been prevented at all.
In his article "Ovarian follicles during oral contraceptive cycles: their potential for ovulation," Dr. Stephen Killick says, "It is well established that newer, lower-dose regimes of combined oral contraceptive (OC) therapy do not completely suppress pituitary and ovarian function."[lii]
Dr. David Sterns, in How the Pill and the IUD Work: Gambling with Life," states that "even the early pill formulations (which were much more likely to suppress ovulation due to their higher doses of estrogen) still allowed breakthrough ovulation to occur 1 to 3% of the time."[liii] He cites an award winning study by Dutch gynecologist Dr. Nine Van der Vange in which she discovered in Pill-takers "proof of ovulation based on ultrasound exams and hormonal indicators occurred in about 4.7% of the cycles studied."[liv]
I obtained a copy of Dr. Van der Vange's original study, called "Ovarian activity during low dose oral contraceptives," in which she concludes,
These findings indicate that ovarian suppression is far from complete with the low dose OC...Follicular development was found in a high percentage during low-dose OC use...ovarian activity is very common for the low dose OC preparations...the mode of action of these OC is not only based on ovulation inhibition, but other factors are involved such as cervical mucus, vaginal pH and composition of the endometrium.[lv]
This means that though a woman might not get measurably pregnant in 97% of her cycle months, there is simply no way to tell how often the Pill has actually prevented her ovulation. Given the fact she would not get pregnant in many months even if she ovulated, and that there are at least two other mechanisms which can prevent measurable pregnancy-one contraceptive and the other abortive-a 97% apparent effectiveness rate of the Pill might mean a far lower effectiveness in actually preventing ovulation. Though we can't know exactly how much lower, it might be a 70-90% rate. The other 17-27% (these numbers are picked at random since we do not know) of the Pill's "effectiveness" could be due to a combination of the normal rates of nonpregnancy, the thickening of the cervical mucus and-at the heart of our concern here-the endometrium's inhospitality to the newly-conceived child.
Endometrial thickness is not the only consideration. There are a variety of hormonal factors that operate in conjunction with endometrial proliferation. Dr. Wilks explains "the process of implantation, rather than being an accidental event dependent on chance, is in fact a multi-factorial, cascading bio-molecular, physiological and hormonal event."[lvi] A "hormonal dialogue" occurs between a healthy endometrium and the newly-conceived child. (I refer to this elsewhere in this book.)
No one is in a better position to address the question of how birth control pills work than the companies that produce them. In this section I quote from their materials and recount conversations with representatives of various Pill manufacturers.
I asked a good friend and excellent prolife physician to call a birth control pill manufacturer concerning the statements in their inserts. He contacted Searle, whose package insert for the pill Demulen, says "alterations in the...endometrium (which may reduce the likelihood of implantation) may also contribute to the contraceptive effectiveness." (Note that Searle twice uses the term "may," in contrast to Ortho and Wyeth, which in their information in the PDR state the same effect as a fact rather than a possibility.)
Here is part of a letter dated February 13, 1997, written by Barbara Struthers, Searle's Director of Healthcare Information Services, to my prolife physician friend:
Thank you for your recent request for information regarding whether oral contraceptives are abortifacients...One of the possible mechanisms listed in the labeling is "changes in the endometrium which may reduce the likelihood of implantation." This is a theoretical mechanism only and is not based upon experimental evidence, but upon the histologic appearance of the endometrium. However, as noted by Goldzieher, the altered endometrium is still capable of sustaining nidation, as shown by pregnancies occurring in cycles with only a few or no tablet omissions.[lvii]
Dr. Struthers (PhD) makes a valid point that the Pill's effects on the endometrium do not always make implantation impossible. But in my research I've never found anyone who claims they always do. The issue is whether they sometimes do. To be an abortifacient does not require that something always cause an abortion, only that it sometimes does.
In fact, whether it's RU-486, Norplant, Depo-Provera, 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 hardly proves these practices are safe and never result in fatalities. Thus, the point that the Pill doesn't always prevent implantation is true, but has no bearing on the question of whether it sometimes prevents implantation, as suggested by Searle's own literature.
Dr. Struthers goes on to say, "It is unlikely that OCs would decrease the likelihood of endometrial implantation, particularly when one appreciates that the blastocyst is perfectly capable of implanting in various 'hostile' sites, e.g. the fallopian tube, the ovary, the peritoneum."
Her point is that the child sometimes implants in the wrong place. True enough-but, again, no one is saying this doesn't happen. The question is whether the Pill sometimes hinders the child's ability to implant in the right place. Whether the child implants in the wrong place or fails to implant in the right one, the result is the same-death. But in the first case a human agent does not cause the death. In the second case, it does-by use of the Pill.
Dr. Struthers then says, "Used as directed, the hormone level in modern OCs is simply too low to cause interception, that is, failure of the blastocyst to implant."
If this is true, then why does the company's own literature-produced by their researchers and submitted to the FDA, the medical community, and the public-suggest the contrary? And why do dozens and dozens of scientific and medical sources definitively state the contrary? If Dr. Struthers is right, not just some but all of these other sources have to be wrong.
Dr. Struthers further states, "Until the blastocyst implants...there would be no loss of an embryo and, therefore, no abortion. Thus, the theoretical mechanism of reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition."
It is here that her presuppositions become clear. Having said implantation won't be prevented, she then says even if it is, the result isn't really an abortion. This statement is profound both in its breadth and its inaccuracy. It's a classic logic-class-illustration of faulty reasoning. It's like saying "Sudden Infant Death Syndrome does not affect toddlers; therefore, it does not involve the deaths of human beings." Such a statement assumes facts not in evidence: that infants are not people because they are pre-toddlers. In exactly the same way Dr. Struthers assumes-without offering any evidence-that pre-embryo human beings are not really human beings.
But if human life does begin at conception, which is the overwhelming biological consensus, then causing the death of a "blastocyst" is just as much an abortion as causing the death (or as she puts it, "loss") of an "embryo." The days-old individual is a smaller and younger person than the embryo, but he or she is no less a person in the sight of God who created him. People do not get more human as they get older and bigger-if they did, toddlers would be more human than infants, adolescents more human than toddlers, adults more human than adolescents and professional basketball players more human than anyone.
Dr. Struthers says the "reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition." This statement is unscientific in the extreme. The biological definition she ignores is not just some obscure definition of life, but the precise definition which the vast majority of scientists, including biologists, actually hold to-that life begins at conception. (See Appendix B: When Does Human Life Begin? The Answer of Science.) An early abortion is still an abortion, and no semantics change this reality, even if they manage to obscure it.
The letter from Dr. Struthers certainly contains some valid information along with the invalid. But how seriously can we take its bottom-line conclusions that the Pill is not an abortifacient? I showed her letter to one physician who told me a "healthcare information services director" is a public relations position with the primary job of minimizing controversy, denying blame, putting out fires, and avoiding any bad publicity for products, both with physicians and the general public. Perhaps this assessment was unfair-I don't know. But after reading her letter I determined to personally call the research or medical information departments of all the major birth control manufacturers and hear for myself what each of them had to say.
When I called Syntex, they informed me that all their "feminine products," including the Pill, had recently been purchased by Searle. So I called Searle's customer service line, identified myself by name, and was asked to explain my question. When I said that it related to the Pill's mechanism of preventing implantation, the person helping me (who didn't identify herself) became discernibly uneasy. She asked me who I was, so I gave her my name again. Then she asked me to wait while she conferred with her colleagues. After several minutes she got back on the line and said "Dr. Struthers will have to talk to you about this, and she's not in."
Since Dr. Struthers was unavailable, I asked the woman if she could offer me any guidance. She said, uneasiness evident, "By any chance are you asking about this for religious reasons?" I said, "Yes, that's part of it." She said, "Well, I can tell you that our pills are not abortifacients." I asked "then why does your professional labeling talk about the Pill reducing the likelihood of implantation?" She said, "I can't answer that question. You'll have to talk to Dr. Struthers." I left my number, but Dr. Struthers never called me back.
Next I called Organon, the maker of the birth control pill Desogen. After explaining my question about their literature that says the Pill sometimes prevents implantation, I was transferred to Erin in medical services. She informed me "the Pill's primary mechanism is preventing ovulation." After my follow-up question, she said, "The other mechanisms also happen, but they're secondary." When I asked how often the primary mechanism fails and the secondary mechanisms kick in, she said "there's no way to determine the number of times which happens and which doesn't."
Reading between the lines, Erin said, "If you're asking if it's an abortifacient...[pause]" I interjected, "Yes, I am." She continued, "...that's difficult to ever say that." She added, "What happens is, if ovulation occurs, the Pill will thicken the mucus and thin the endometrium so that it doesn't allow that pregnancy." She quickly added, "but it's not like the IUD." I understood her to mean that preventing implantation is the primary function of the IUD, whereas it is only a secondary function of the Pill.
Wyeth-Ayerst Labs is the maker of six combination Pills. I called and spoke with a medical information coordinator named Adrianne. I read to her the professional labeling of their Pills that says "other alterations include changes...in the endometrium (which reduce the likelihood of implantation)." I asked if she knew how often the Pill prevents implantation.
Once again it became obvious that I was prolife, presumably because no one but a prolifer would care about this issue. Adrianne read to me a printed statement that said "these mechanisms are not abortifacient in nature." She carefully explained that inhibiting ovulation and thickening the cervical mucus were contraceptive, not abortive. Of course, I agreed 100%. She then said, reading from the statement in front of her, "while it is true that progestins do alter the uterine lining, this is not considered a contraceptive action of these methods. The fact that these methods are not 100% effective and successful pregnancies have occurred clearly demonstrate that successful implantations can occur."
Over the following ten minutes, Adrianne kept talking about the first two mechanisms. I kept asking about the third. Finally she said, "Yes, that [interfering with implantation] occurs, but it doesn't prevent a pregnancy." I thought, that's true, it doesn't prevent a pregnancy, it actually ends a pregnancy, but I knew that wasn't what she meant. I then referred her back to Wyeth's professional labeling and pointed out once more the third mechanism. She followed along with her copy and said, "That third effect happens, but it's not considered a contraceptive action, because sometimes it fails to prevent pregnancy."
Of course, she had already acknowledged that sometimes the Pill fails to prevent ovulation and sometimes the thickened cervical mucus fails to prevent the sperm from fertilizing the egg. In the same way a visible pregnancy proves the third mechanism has failed, it proves the other two mechanisms have also failed. Yet they are still considered to be real mechanisms of the Pill, despite the fact they sometimes fail. Why shouldn't the third effect be treated the same way?
I said, "According to your professional labeling, sometimes your Pills do prevent a fertilized egg from implanting-is that correct or incorrect?" She paused for a very long time and I heard papers shuffling. Finally she said, "Yes, that's correct, but not always...that's why we can't say contraceptives are 100% effective."
I said, "Okay, let me try to summarize, and please correct me if I'm wrong. There are three different ways the Pill operates. #1 usually works. When #1 fails, #2 may work. When #1 and #2 fail, #3 may work. And sometimes all three fail."
She said "Yes, that's correct." She offered to send me information by mail, and I gladly accepted the offer. (I had asked Searle and Ortho to do this but they said they didn't have anything they could send me.) She warmly invited me to call back if I needed any more information.
When I received the information in the mail, it contained three things. The first was a cover letter written by Robin Boyle, R.Ph., Wyeth's Manager of Drug Information. It was clearly a form letter designed for those expressing concerns about abortion, and contained the precise contents that Adrianne quoted to me. Also enclosed was a colorful booklet entitled Birth Control with the Pill. In the section "How the Pill Works," it states "The pill mainly prevents pregnancy in two ways." It then speaks of only the first two mechanisms and makes no reference whatsoever to the third, the prevention of implantation.
The detailed, fine print "professional labeling" was also enclosed, and, as reflected in The PDR, it states "alterations include changes in...the endometrium (which reduce the likelihood of implantation)."
It struck me that virtually everyone receiving this information would read the large print, attractive, colorful, easy-to-understand booklet (which makes no mention of the abortive mechanism), and almost no one would read the extremely small print, black and white, technically worded, and completely unattractive sheet-the one that acknowledges in the fine print that the Pill sometimes prevents implantation (thereby causing an abortion).
It is safe to say that virtually none of Wyeth's consumers will read the highly technical study printed in a 1988 International Journal of Fertility article, by none other than Wyeth's own Regional Director of Clinical Research, who stated one way oral contraceptives work is "by causing endometrial changes that will not support implantation."[lviii]
On March 24, 1997, I had a lengthy and enlightening talk with Richard Hill, a pharmacist who works for Ortho-McNeil's product information department. (Ortho-McNeil is one of the largest Pill manufacturers.) I took detailed notes.
Hill was unguarded, helpful, and straightforward. He never asked me about my religious views or my beliefs about abortion. He did not couch his language to give me an answer I wanted to hear. He couldn't, since he had no idea what biases or presuppositions I might have.
Hill informed me "I can't give you solid numbers, because there's no way to tell which of these three functions is actually preventing the pregnancy; but I can tell you the great majority of the time it's the first one [preventing ovulation]."
I asked him, "Does the Pill sometimes fail to prevent ovulation?" He said "yes." I asked, "What happens then?" He said, "The cervical mucus slows down the sperm. And if that doesn't work, if you end up with a fertilized egg, it won't implant and grow because of the less hospitable endometrium."
I asked him how many of the contraceptives available on the market are low-dose. He said, "I don't have statistics, but I also work in a pharmacy and I can tell you the vast majority of the time people get low-dose pills." He confirmed that there are some "higher dose" pills available, with 50 micrograms of estrogen instead of 20-35 micrograms, but said these were not commonly used. (Remember, even 50 micrograms is only 1/3 the average estrogen dosage in pills of the 1960s.)
I then asked Hill if he was certain the Pill made implantation less likely. "Oh, yes," he replied. I said, "So you don't think this is just a theoretical effect of the Pill?" He said the following, which I draw directly from my extensive notes of our conversation:
Oh, no, it's not theoretical. It's observable. We know what an endometrium looks like when it's rich and most receptive to the fertilized egg. When a woman is taking the Pill you can clearly see the difference, based both on gross appearance-as seen with the naked eye-and under a microscope. At the time when the endometrium would normally accept a fertilized egg, if a woman is taking the Pill it is much less likely to do so.
I asked Hill one more time, "So you're saying this is an actual effect that happens, not just a theoretical one?" He said, "Sure-you can actually see what it does to the endometrium and it's obvious it makes implantation less likely. The only thing that's theoretical is the numbers, because we just don't know that."
The pills produced by Searle, Ortho, Wyeth and Organon are essentially the same thing, with only slightly different combinations of chemicals. The professional labeling is essentially the same. The medical experts at Searle, Wyeth and Organon were all quick to pick up my abortion-related concerns and attempted to defuse them. Despite this, not only the pharmacist at Ortho but the medical services people at Organon and Wyeth acknowledged as an established fact what their literature says, that the Pill sometimes prevents implantation. Dr. Struthers of Searle appears to deny this, but then explains that if it happens it isn't really an abortion. When I stack up these responses to the wealth of information I've found in my research, I am forced to believe the people at Ortho, Wyeth, and Organon, not Dr. Struthers at Searle.
While I know that some of what she said is wrong-including the notion that preventing implantation is not a real abortion-I hope and pray that Dr. Struthers is correct and that her position is more than just a careful public relations ploy to placate known prolifers and religious people. The totality of my research, however, convinces me her position is not based on the facts.
The key point of dispute in these interviews centers on whether the Pill's prevention of implantation is theoretical or actual. None of the other three manufacturers spoke of it as anything but actual except Dr. Struthers at Searle, who said it is "a theoretical mechanism only." Pharmacist Hill at Ortho categorically stated it was "not theoretical," but based on direct, measurable observation of the endometrium. Who is correct?
Imagine a farmer who has two places where he might plant seed. One is rich, brown soil that has been tilled, fertilized and watered. The other is on hard, thin, dry and rocky soil. If the farmer wants as much seed as possible to take hold and grow, where will he plant the seed? The answer is obvious––on the fertile ground.
Now, you could say to the farmer that his preference for the rich, tilled, moist soil is based on the "theoretical," because he has probably never seen a scientific study that proves this soil is more hospitable to seed than the thin, hard, dry soil. Likely, such a study has never been done. In other words, there is no absolute proof. The farmer might reply to your skeptical challenge based on his years of observation: "I know good soil when I see it-sure, I've seen some plants grow in the hard, thin soil too, but the chances of survival are much less there than in the good soil. Call it theoretical if you want to, but anyone who knows plants and soil knows it's true!"
In fact, this "theoretical" presumption has greatly influenced reproductive medicine. Specialists who engage in in vitro fertilization (IVF) treat the woman hormonally in order to create a glycogen-rich, supportive endometrium. William Colliton, clinical professor of Obstetrics and Gynecology at George Washington University and Medical Center points out that "this is the type of endometrium desired by IVF practitioners to accomplish embryo transfer from the petri dish to the womb."[lix]
Searle's Dr. Struthers correctly points out some newly-conceived children (she would not use this term, of course) manage to survive in hostile places. But this in no way changes the obvious fact that many more children will survive in a richer, thicker, more hospitable endometrium than in a thinner, more inhospitable one. In this sense, the issue isn't theoretical at all.
Several articles I've read spoke of the mucus's ability to block sperm migration and presented as evidence the fact that the thickness of the mucus is visually observable. Of course, this appearance is not incontrovertible proof that it slows down sperm migration, but it is still considered valid evidence. Why would anyone accept this, yet question the evidentiary value of the endometrium's appearance?
Obviously, when the Pill thins the endometrium, and it certainly does, a zygote has a smaller likelihood of survival, a greater likelihood of death. Hence, without question a woman's taking the Pill puts any conceived child at greater risk of being aborted than if the Pill wasn't being taken. Other than for reasons of wishful thinking or good public relations, how can anyone seriously argue against this?
We may try to take consolation in believing that the Pill causes abortions only in theory. But we must ask, if this is a theory, how strong and credible is the theory? If the evidence is only indirect, how compelling is that indirect evidence? Once it was only a theory that plant life grows better in rich, fertile soil than in thin, eroded soil. But it was certainly a theory good farmers believed and acted on. (It is also a theory that IVF practitioners and their insurance companies-who will only pay for the most successful protocol in IVF technology-have embraced. Shouldn't that tell us something?)
On July 2, 1997, I interviewed Karen Witt, who worked for Whitehall-Robins, sister company of Wyeth-Ayerst, from 1986 until August 1995. Both companies are divisions of American Home Products, one of the world's largest pharmaceutical corporations.
Mrs. Witt was a sales representative who called on doctors, providing them with product samples and medical information. She worked with many popular products, including Advil and Robitussin. When the parent company acquired Wyeth-Ayerst, sales representatives were instructed to start providing physicians with samples of birth control pills. As part of their training, they were taken through a new manual that included an "Oral Contraceptive Backgrounder."
The manual, a copy of which I have in front of me, states "the combined pill is virtually 100% effective due to a combination of the following three factors." The third of these factors is "Suppressed Endometrium," explained in this way:
The altered hormone patterns ensure that the endometrium fails to develop to the extent found in the normal cycle. Therefore, even if "escape ovulation" should occur, the endometrium is not in a favorable state for implantation.[lx]
When she saw this, Karen Witt realized for the first time that the Pill caused abortions. This violated her convictions. She was also concerned about something else, which she explained to me as follows:
In company meetings information on the Pill was covered in a totally different way than other products. Our training had always been open and relaxed, and we went through detailed instruction on how every product works; we were expected to explain how they worked to physicians. But the approach to the birth control pills was completely different-the approach was, "don't worry about how they work, the point is they do; don't ask questions, just give out the samples." [lxi]
Karen went to her boss to express her concern, first about the Pill causing abortions, and second about the directive not to communicate important medical information to the physicians she dealt with. As a direct result of expressing these concerns, she said "I was labeled a troublemaker." Soon, she was fired from her job of nine and a half years.
During this process, Mrs. Witt became deeply concerned as she spoke with various company employees and observed what she considered to be an agreement to remain silent about the abortive effect of their Pills.
Karen Witt pointed out to me something I'd already discovered in my dealings with Wyeth-Ayerst. The consumer pamphlet they produce, Birth Control with the Pill, has a section entitled "How the Pill Works" which lists only the first two mechanisms, not the third. Though both their professional labeling and their salesperson training acknowledge the third way the Pill works, in the literature given to consumers, it is simply left out.
After numerous interactions with various people at Wyeth-Ayerst, Mrs. Witt became convinced this was a deliberate cover-up on the part of the company-a cover-up not only from the general public, including users of their products, but a cover-up from physicians and pharmacists.
Mrs. Witt said to me, "I am not at all quick to use the term 'conspiracy.' But I believe there is a definite conspiracy of silence on the part of the manufacturer about the abortive effects of the Pill."
Completely unrelated to my interaction with Mrs. Witt, I was contacted by another sales representative with a major Pill manufacturer. He talked to me on the condition that I would not identify him or his company. When I asked why, he said, "They play hard ball." His story was closely parallel to Mrs. Witt's except he is still employed by the company. He believes that if he was identified he would experience retaliation from his employer.
This man read a draft of Does the Birth Control Pill Cause Abortions? posted at our website (www.epm.org). He called to tell me, "What you're saying about the Pill is true, and my manufacturer knows it. Management takes pride in the fact that our pills excel at the 'prevention of nidation'––that exact phrase is routinely used in our product training sessions. They never use the word 'abortion,' but by preventing nidation [implantation], that's what the pills do."
He said that years before the practice of using several BCPs as a "morning after" abortifacient became public, his company had instructed sales reps to inform physicians of how their pills could be used for that purpose. Because of his refusal to promote the Pill, this man was, in his words, "demoted from sales representative." Though at one point he was asked for his resignation, he says the company now seems to reluctantly accept his right to personal convictions, annoying though they be. However, he feels he is being monitored as to what he says and to whom.
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Please include the following statement on any distributed copy: by Randy Alcorn,
Eternal Perspective Ministries, 2229 E. Burnside #23, Gresham, OR 97030, 503-663-6481, www.epm.org