"Evidence that the Pill causes abortions" OR "An abridged set of quotes from Randy Alcorn's book on the Pill"

(Download the whole book as a PDF for free here: http://www.epm.org/store/product/birth-control-pill-book/)

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.

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.

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 that 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.

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.

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 contra-implantive, 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, NuvaRing and the “Mini-pill,” all of which sometimes or often fail to prevent conception, but succeed in preventing implantation of the six day old Shuman being. (For more details, see “The IUD, Norplant, Depo-Provera, NuvaRing, 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.

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.

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.

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. More evidence has surfaced in the years since.

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 legally be 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 that 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.”

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).”

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.)

A young couple showed me their pill, Desogen, a product of Organon. I looked it up in the PDR. It states one effect of the pill is to create “changes in the endometrium which reduce the likelihood of implantation.”

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.16 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. However, each and every time the third mechanism succeeds, it causes an abortion.

Dr. Walter Larimore and I co-authored a chapter in The Reproduction Revolution, presenting evidence that the birth control pill can, in fact, cause abortions.

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 progesterone output, and by causing endometrial changes that will not support implantation.25   Dr. Goldzieher says as a result of the combined Pill’s action, “possibly the endometrium in such cycles may provide additional contraceptive protection.”

The medical textbook Williams Obstetrics states, “progestins produce an endometrium that is unfavorable to blastocyst implantation.”

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.

A standard medical reference, Danforth’s Obstetrics and Gynecology 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.)

Magnetic Resonance Imaging studies demonstrate that the lining of the endometrium is dramatically thinned in Pill users. Normal endometrial thickness that can sustain a pregnancy ranges in density from 5 to 13 mm. The average thickness in pill users is 1.1 mm.

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.

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.

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 go unexamined 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 ECPs 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.”

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 produces an increase in blood vessels, which allow a greater blood supply to bring oxygen and nutrients to the child. There is also an increase in the endometrial 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.

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 that may appear to be nothing more than a normal, even if delayed, menstruation. 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, which 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 knew.

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.

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 actually 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.

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.

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.”

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.

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.”

In November 2008, a prominent medical organization with pro-abortion views, the American Society for Reproductive Medicine (ASRM), published a review of hormonal birth control in its medical journal. The mechanisms of hormonal birth control were stated as: “inhibition of ovulation, alteration in the cervical mucus, and/or modification of the endometrium, thus preventing implantation.” 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. That this is unknown to and denied by so many Christians is remarkable, to say the least.)

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 weren’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, in fact, not have 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.”52 Dr. David Sterns, in “How the Pill and the IUD Work: Gambling with Life,” states, “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 13% of the time.”53  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.”

This means that though a woman might not get clinically pregnant in 97% of her cycle months (her pregnancy able to be identified and measured through normal medical means), 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 endometrial inhospitality to the newly conceived child.

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.58   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, NuvaRing, 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.

The key point of dispute in these interviews centers on whether the Pill’s prevention of implantation is theoretical or actual.

Ortho-McNeil 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 key point of dispute in these interviews centers on whether the Pill’s prevention of implantation is theoretical or actual.

Dr. Walter Larimore is an Associate Clinical Professor of Family Medicine who has written over 150 medical articles in a wide variety of journals. Dr. Larimore, in a February 26, 1998 email to me, stated that if the Pill has no negative effect on the implantation process, then we should expect its reduction in the percentage of normal intrauterine pregnancies to equal its reduction in the percentage of extrauterine or ectopic (including tubal) pregnancies. However, Dr. Larimore pointed out something highly significant—published data from all of the studies dealing with this issue indicate that the ratio of extrauterine to intrauterine pregnancies among Pill-takers significantly exceeds that of non-Pill-takers. The five studies cited by Dr. Larimore show an increased risk of ectopic pregnancies in Pill takers who get pregnant, in the broad range of 1.7 to 13.9 times higher than non-Pill takers who get pregnant.

What accounts for the Pill inhibiting intrauterine pregnancies at a disproportionately greater ratio than it inhibits extrauterine pregnancies? Dr. Larimore, who is a member of Focus on the Family’s Physicians Resource Council, believes the most likely explanation is that while the Pill does nothing to prevent a newly-conceived child from implanting in the wrong place (i.e. anywhere besides the endometrium) it may sometimes do something to prevent him from implanting in the right place (i.e. the endometrium). This evidence puts a significant burden of proof on anyone who denies the Pill’s capacity to cause early abortions. If there is an explanation of the data that is more plausible, or equally plausible, what is it? Dr. Larimore came to this issue with significant vested interests in believing the best about the birth control pill, having prescribed it for years. When he researched it intensively over an eighteen month period, in what he described to me as a “gut wrenching” process that involved sleepless nights, he came to the conclusion that in good conscience he could no longer prescribe hormonal contraceptives, including the Pill, the Mini-pill Depo-Provera and Norplant. Dr. Larimore also told me that when he has presented this evidence to audiences of secular physicians, there has been little or no resistance to it. But when he has presented it to Christian physicians there has been substantial resistance. Why? Perhaps because secular physicians do not care as much whether the Pill prevents implantation and therefore tend to be objective in interpreting the evidence. Christian physicians very much do not want to believe the Pill causes early abortions, and therefore tend to resist the evidence. This is understandable. Nonetheless, we should not permit what we want to believe to distract us from what the evidence indicates we should believe.

In an interview conducted by Denny Hartford, director of Vital Signs Ministries, Pharmacist Larry Frieders, who is also vice president of Pharmacists for Life, said this:   Obviously, the one “back-up mechanism” [of the Pill] that we’re most concerned with is the one that changes the woman’s body in such a way that if there is a new life, that tiny human loses the ability to implant and then grow and be nourished by the mother. The facts are clear—we’ve all known them intellectually. I learned them in school. I had to answer those questions on my state board pharmacy exam. The problem was getting that knowledge from my intellect down to where it became part of who I am. I had to accept that I was participating in the sale and distribution of a product that was, in fact, causing the loss of life.

Later in the same interview, Hartford asked world famous fertility specialist Dr. Thomas Hilgers, “Are there any birth control pills out there that do not have this potential to abort a developing child?” Dr. Hilgers answered,   There are none! At my last count in looking at the Physicians Desk Reference…there were different types of birth control pills…and they have different concentrations of chemicals that make them work. None of these so-called birth control pills has a mechanism which is completely contraceptive. Put the other way around, all birth control pills available have a mechanism which disturbs or disintegrates the lining of the uterus to the extent that the possibility of abortion exists when breakthrough ovulation occurs.

Sources indicate not only that Pill-induced endometrial changes prevent implantation (what I will call the Pill’s first abortive effect), but, and this is a second abortive effect, that even if they do allow implantation they can prevent the proper nourishment or maintenance of the new child, resulting in a premature end of the pregnancy.

In My Body, My Health, the authors point to a third abortive potential of the Pill:   Estrogen and progestin may also alter the pattern of muscle contractions in the tubes and uterus. This may interfere with implantation by speeding up the fertilized egg’s travel time so that it reaches the uterus before it is mature enough to implant.  This is the same “contraceptive” effect Dr. Speroff referred to as “peristalsis within the fallopian tube.” In its 1984 publication “Facts About Oral Contraceptives,” the U.S. Department of Health and Human Services stated,   Both kinds of pills…make it difficult for a fertilized egg to implant, by causing changes in fallopian tube contractions and in the uterine lining.

There’s a fourth potential abortive threat, pointed out to me by a couple that stopped using their pills after reading the package insert. I have that insert in front of me. It concerns Desogen, a combination pill produced by Organon. Under the heading “Pregnancy Due to Pill Failure,” it states:   The incidence of pill failure resulting in pregnancy is approximately one percent (i.e., one pregnancy per 100 women per year) if taken every day as directed, but more typical failure rates are about 3%. If failure does occur, the risk to the fetus is minimal.   Exactly what is this risk to the fetus? I asked this of Dr. William Toffler of the Oregon Health Sciences University, who is also a member of Focus on the Family’s Physician’s Resource Council. Dr. Toffler informed me that the hormones in the Pill, progestin and estrogen, can sometimes have a harmful effect on an already implanted child. The problem is, since women do not know they are pregnant in the earliest stages, they will continue to take the Pill at least one more time, if not two or more (especially if cycles are irregular). This creates the risk the leaflet refers to. So not only is the pre-implanted child at risk, but so is an already implanted child who is subjected to the Pill’s hormones. The risk is called “minimal.” But what does this mean? If someone was about to give your child a chemical and they assured you there was a “minimal risk,” would you allow them to proceed without investigating to find out exactly what was meant by “minimal”? Wouldn’t you ask whether there was some alternative treatment without this risk? Rather than be reassured by the term “minimal,” a parent might respond, “I didn’t know that by taking the Pill I caused any risk to a baby—so when you tell me the risk is ‘minimal’ you don’t reassure me, you alarm me.”

There is still a fifth risk, which is distinct in that it applies to children conceived after a woman stops taking the Pill:   There is some indication that there may be a prolonged effect of the oral contraceptives on both the endometrium and the cervix after a woman has ceased taking the pill. There may well be a greater likelihood of miscarriage in that period also as a result of some chromosomal abnormalities…It is worth noting that the consumer advice from the manufacturers cautions that pregnancy should be avoided in the first three months after ceasing the combined oral contraceptive.

Why should pregnancy be avoided until three months after a woman has stopped using the Pill? One physician told me it’s because the Pill produces an environment that threatens the welfare of a child, and that environment takes months to return to normal. If those effects are still considered a risk up to three months after the Pill was last taken, it also confirms the risks to both the pre- and post-implantation child while the Pill is still being used. Another physician suggested that abnormal eggs are more likely after Pill use and that is one reason for the warning. (This should serve as a warning to couples that choose to stop taking the pill out of concern for its abortifacient potential. If they remain sexually active, they should use a non-abortive contraceptive for three months to allow time for the endometrium to return to normal. Otherwise, since the abortive mechanism may remain operative after the contraceptive mechanisms no longer are, for that brief period they could actually increase their chances of an abortion.)

In June 1996 the Food and Drug Administration announced a new use for standard combination birth control pills:   Two high doses taken within two to three days of intercourse can prevent pregnancy, the FDA scientists said. Doctors think the pills probably work by preventing a fertilized egg from implanting in the lining of the uterus. On February 24, 1997, the FDA approved the use of high doses of combination birth control pills as “emergency contraception.” The article explains,   The morning-after pill refers to a regimen of standard birth control pills taken within 72 hours of unprotected sex to prevent an unwanted pregnancy. The pills prevent pregnancy by inhibiting a fertilized egg from implanting itself in the uterus and developing into a fetus. Of course, the pills do not “prevent pregnancy” since pregnancy begins at conception, not implantation. Acting as if pregnancy begins at implantation takes the emphasis off the baby’s objective existence and puts it on the mother’s endometrium and its role in sustaining the child that has already been created within her. As World magazine points out, “In reality the pill regimen—designed to block a fertilized egg from implanting into the uterus—aborts a pregnancy that’s already begun.” It is significant that this “morning after pill” is in fact nothing but a combination of several standard birth control pills taken in high dosages. When the announcement was made, the uninformed public probably assumed that the high dosage makes birth control pills do something they were otherwise incapable of doing. But the truth is that it simply increases the chances of doing what it already sometimes does—cause an abortion. Princeton University maintains a website in conjunction with the pro-abortion Association of Reproductive Health Professionals. They seek to provide options for women seeking information on “contraception” and “emergency contraception.” In their search engine they instruct users to “get a list of regular birth control pills (also called oral contraceptives) that contain the hormones researchers have found are safe and effective at preventing pregnancy in the few days after sex.” They qualify “preventing pregnancy,” stating, “We can’t always completely explain how contraceptives work, and it is possible that any of these methods may at times inhibit implantation of a fertilized egg in the endometrium.”

One of these letters states that the Pill “rarely, if ever, permits conception.” The term “if ever” is certainly false, since the BCP manufacturers themselves admit 3% of those taking the Pill experience a pregnancy in any given year. In fact, recent research indicates that figure may be considerably higher—up to 4% for “good compliers” and 8% for “poor compliers.”

Dr. William Colliton, who is convinced of the abortifacient nature of the Pill, refers to some anecdotal experience that may contribute toward the general belief of many physicians that no abortions occur while a woman is on the Pill. With regard to clinical evidence he writes that the physician may “note that the typical clinical picture of spontaneous abortion (heavy bleeding, severe cramping, passage of tissue) is rarely, if ever, seen by practicing physicians caring for patients on the Pill.” He then writes,   They seem to overlook the fact that the abortions caused by the BCP occur when the baby is 5 to 14-16 days old and that the lining of the uterus is ‘less vascular, less glandular, thinner’ than normal as they describe it. From the clinical perspective, one would anticipate a non-event. In other words, the fact that a treating physician does not see typical symptoms related to miscarriage is no proof that an abortion has not occurred. After all, a side effect of the Pill is amenorrhea; the uterine environment is changed so that there is “no menstrual flow when on the break from the hormones.” These changes exclude normal symptoms of miscarriage, and therefore the lack of those symptoms proves nothing.

How many abortions does the Pill cause? This is difficult to determine. The answer depends on how often the Pill fails to prevent ovulation, how often the Pill fails to prevent fertilization by sperm, how often conception occurs, and if conception does occur how often the third mechanism prevents implantation.

Despite the fact that definitive numbers cannot be determined, there are certain medical evidences that provide rationale for estimating the numbers of Pill-induced abortions. Determining the rate of breakthrough ovulation in Pill-takers is one key to coming up with informed estimates. In his Abortifacient Contraception: The Pharmaceutical Holocaust, Dr. Rudolph Ehmann says,   As early as 1967, at a medical conference, the representatives of a major hormone producer admitted that with OCs [oral contraceptives], ovulation with a possibility of fertilization took place in up to seven percent of cases, and that subsequent implantation of the fertilized egg would usually be prevented.98   Bogomir M. Kuhar, Doctor of Pharmacy, is the president of Pharmacists for Life. He cites studies suggesting oral contraceptives have a breakthrough ovulation rate of 2 to 10%.World-renowned fertility specialist Dr. Thomas Hilgers estimates the breakthrough ovulation rate at 4 to 10%.Dr. Nine van der Vange, at the Society for the Advancement of Contraception’s November 26-30, 1984 conference in Jakarta, stated that her studies indicated an ovulation rate of 4.7% for women taking the Pill.

J. C. Espinoza, M.D., says,   Today it is clear that in at least 5% of the cycles of women on the combined Pill “escape ovulation” occurs. This fact means that conception is possible during those cycles, but implantation will be prevented and the “conceptus” (child) will die. That rate is statistically equivalent to one abortion every other year for all women on the Pill.

In a segment from his Abortion Question and Answers, published online by Ohio Right to Life, Dr. Jack Willke states:   The newer low-estrogen pills allow “breakthrough” ovulation in up to 20% or more of the months used. Such a released ovum is fertilized perhaps 10% of the time. These tiny new lives which result, at our present “guesstimations,” in 1% to 2% of the pill months, do not survive. The reason is that at one week of life this tiny new boy or girl cannot implant in the womb lining and dies. There are factors that can increase the rate of breakthrough ovulation and increase the likelihood of the Pill causing an abortion. Dr. Kuhar says,   The abortifacient potential of OCs is further magnified in OC users who concomitantly take certain antibiotics and anticonvulsants, which decrease ovulation suppression effectiveness. It should be noted that antibiotic use among OC users is not uncommon, such women being more susceptible to bacterial, yeast and fungal infections secondary to OC use.

When the first mechanism fails, how often does the second work? We’ve seen that various sources and studies put breakthrough ovulation among Pill-takers at rates of 2-10%, 4-10%, 4.7%, 7%, 14%, 10%, and 20%. The next question is, how many times when ovulation occurs does the second mechanism, the thickened cervical mucus, prevent sperm from reaching the egg? There is no way to be sure, but while this mechanism certainly works sometimes, it may not work most of the time. Drs. Chang and Hunt did experiments on rabbits that could not be done on human beings. They gave the rabbits estrogen and progestin to mimic the Pill, then artificially inseminated them. Next, they killed the rabbits and did microscopic studies to examine how many sperm had reached the fallopian tubes and could have fertilized an egg. Progestin, the hormone that thickens cervical mucus, might be expected to prevent nearly all the sperm from traveling to the tubes. However, it did not. In every rabbit that had taken the progestin, there were still thousands of sperm which reached the fallopian tubes, as many as 72% of the number in the control group. The progestin-caused increase in thickness of cervical mucus did not significantly inhibit sperm from reaching the egg in the rabbit.

This is certainly not definitive proof, since there can be significant physiological differences between animals and humans. However, animals are routinely used for such experiments to determine possible or probable results in humans. Though I have read several studies on human sperm transport, they seemed to offer no helpful information related to this subject. Dr. Melvin Taymor of Harvard Medical School admits, “Sperm transport in women appears to be very complex.” The study by Chang and Hunt, while not persuasive in and of itself, at least raises questions about the extent of the contraceptive effectiveness of thickened cervical mucus. When ovulation takes place, how often will the thickened mucus fail to prevent conception? The answer is certainly “some of the time.” It may also be “much of the time,” or even “most of the time.”

The next question is, in those cases when the second mechanism doesn’t work, how often does the significantly altered and less hospitable endometrium caused by the Pill interrupt the pregnancy? The Ortho Corporation’s 1991 annual report estimated 13.9 million U.S. women using oral contraceptives. Now, how often would one expect normally fertile couples of average sexual activity to conceive? Dr. Bogomir Kuhar uses a figure of 25%. This is confirmed by my research. In “Estimates of human fertility and pregnancy loss,” Michael J. Zinaman and associates cite a study by Wilcox in which “following 221 couples without known impediments of fertility, [they] observed a per cycle conception rate of 25% over the first three cycles.” Multiplying this by the low 2% ovulation figure among Pill takers, and factoring in a 25% conception rate, Dr. Kuhar arrives at a figure of 834,000 birth-control-pill-induced abortions per year.  Multiplying by 10%, a higher estimate of breakthrough ovulation, he states the figure of 4,170,000 abortions per year. (Using other studies, also based on total estimated number of ovulations and U.S. users, Dr. Kuhar attributes 3,825,000 annual abortions to IUDs; 1,200,000 to Depo-Provera; 2,925,000 to Norplant.) There are several objections to this method of computation. First, it assumes all women taking the Pill, and their partners, have normal fertility rates of 25%, when in fact some women taking the Pill certainly are less fertile than this, as are some of their partners. Second, the computation fails to take into account the Pill’s thickening of the cervical mucus, which may significantly reduce the rate of conception. Third, it fails to consider the 3% rate of sustained pregnancy each month among Pill-takers, which obviously are not Pill-induced abortions. Of course, everything depends on the true rate of breakthrough ovulation, and the true rate of contraception due to thickened cervical mucus, both of which remain unknown. Even if the range of abortions is less than indicated by Dr. Kuhar’s computation, however, the total numbers could still be very high.

Several medical researchers have assured me scientific studies could be conducted on this. So far, though, the issue of Pill-induced abortions hasn’t received attention. Since no conclusive figures exist, we are left with the indirect but substantial evidence of the observably diminished capacity of the Pill-affected endometrium to sustain life. Since there is nothing to indicate otherwise, it seems possible that implantation in the inhospitable endometrium may be the exception rather than the rule. For every child who does implant, many others may not. Of course, we don’t know the percentage that will implant even in a normal endometrium unaffected by the Pill. But there is every reason to believe that whatever that percentage is, the Pill significantly lowers it.

Let’s try a different approach to the numbers. According to Pill manufacturers, approximately fourteen million American women take the Pill each year. At the 3% annual sustained pregnancy rate, which is firmly established statistically, in any year there will be 420,000 detected pregnancies of Pill-takers. (I say “detected” pregnancies, since pregnancies that end before implantation will never be detected but are nonetheless real.) Each one of these children has managed to be conceived despite the thickened cervical mucus. Each has managed to implant even in a “hostile” endometrium. The question is, how many children failed to implant in that inhospitable environment who would have implanted in a nurturing environment unhindered by the Pill? The numbers that die might be significantly higher than the numbers that survive. If it were four times as high, that would be 1,680,000 annual deaths; if twice as high, 840,000 deaths. If the same numbers of children do not survive the inhospitable endometrium as do survive, it would be 420,000 deaths. If only half as many died as survived, this would be 210,000; if a  quarter as many died as survived 105,000—still a staggering number of Pill-induced abortions each year. Perhaps the figure is even lower than the lowest of these. I certainly hope so. Unfortunately, I have seen no evidence to substantiate my hope.

In his brochure “How the Pill and the IUD Work: Gambling with Life,” Dr. David Sterns asks:   Just how often does the pill have to rely on this abortive “backup” mechanism? No one can tell you with certainty. Perhaps it is as seldom as 1 to 2% of the time; but perhaps it is as frequently as 50% of the time. Does it matter? The clear conclusion is that it is impossible for any woman on the pill in any given month to know exactly which mechanism is in effect. In other words, the pill always carries with it the potential to act as an abortifacient.

Perhaps the annual numbers of Pill-induced abortions add up to millions, perhaps hundreds of thousands, perhaps tens of thousands. When we factor in abortions caused by other birth control chemicals, including the Mini-Pill, Norplant, NuvaRing and Depo-Provera, the total figures are almost certainly very high. When prolifers routinely state there are 1.5 million abortions per year in America (I have often said this myself), we are leaving out all chemical abortions and are therefore vastly understating the true number. Perhaps we are also immunizing ourselves to the reality that life really does begin at conception and we are morally accountable to act like it.

Let’s make this more personal by bringing it down to an individual woman. If a fertile and sexually active woman took the Pill from puberty to menopause, she would have a potential of 390 suppressed ovulations. Eliminating those times when she wouldn’t take the Pill because she wanted to have a child, or because she was already pregnant, she might have 330 potentially suppressed ovulations. If 95% of her ovulations were suppressed, this would mean she would have sixteen breakthrough ovulations.

If she is fertile and sexually active, a few of those ovulations might end up in a known pregnancy because the second and third mechanisms both fail. Of the other fourteen ova, perhaps nine would never be fertilized, some prevented by the number two mechanism, the thickened cervical mucus, and some attributable to the normal rate of nonpregnancy. And perhaps, as a result of the number three mechanism, she might have five early abortions because though conception took place, the children could not be implanted in the endometrium.

If the same woman took the Pill for only ten years, she might have one or two abortions instead of five. Again, we don’t know the exact figures. Some would say these estimates are too high, but based on my research it appears equally probable they are too low.

There is no way to be certain, but a woman taking the Pill might over time have no Pill-induced abortions, or she might have one, three or a dozen of them.

We have not even taken into account here the other abortive mechanisms of the Pill documented earlier, including the peristalsis within the fallopian tube that decreases the chances of implantation, and the chemical dangers to an already conceived child whose mother unknowingly continues to take the Pill. Neither have we considered the residual effect of the Pill that can inhibit implantation as much as a few months after a woman has stopped using it.

The evidence, not wishful thinking, should govern our beliefs. The numbers have not been decisively determined, and may never be this side of eternity. Based on what we do know, we must ask and answer this question: is it morally right to unnecessarily risk the lives of children by taking the Pill?

“If we don’t know how often abortions happen, why shouldn’t we take the Pill?” How are we as Christians to make ethical decisions in the absence of scientifically incontrovertible proof that the Pill causes abortion at least some of the time? In light of the fact that we have very substantial evidence (I believe most unbiased researchers would say overwhelming evidence) but not absolute proof the Pill can cause abortions, as Christians who agree that we do not have the right to take a child’s life, is it ethical to prescribe or use the Pill?

Dr. Walter Larimore addresses this issue in an excellent article published in Ethics and Medicine journal. He says that in a climate in which there is legitimate debate, opponents of the Pill argue that “a moral birth control method must be exclusively contraceptive; e.g., it must (1) work exclusively…by preventing conception from occurring and (2) cause no harm to the conceived child.” Since the Pill may cause early abortions, whether a small or a large number, it should not be used. On the other side, defenders argue that the Pill may not cause abortions, and since it may not, we should feel free to use and prescribe it. Some also say that if the Pill causes abortions, these are only “mini-abortions” which occur “prior to or just following implantation.”119 They therefore suggest that there is no ethical dilemma to be resolved. (This would be true, of course, only if human life does not begin at conception, but at implantation—a contention for which many of us believe there is no logical, scientific or biblical evidence.) In my experience, all but the most hard-core defenders of the Pill—and only prolife defenders, since prochoice defenders invariably recognize the Pill can prevent implantation—will acknowledge that it can cause at least a small number of abortions. The moral question, then, is this: since we are uncertain about how many abortions it causes, how should we act in light of our uncertainty?

In teaching college ethics courses, I have framed the question this way: If a hunter is uncertain whether the movement in the brush is caused by a deer or a person, should his uncertainty lead him to shoot or not shoot? If you’re driving at night and you think the dark figure ahead on the road may be a child, but it may just be the shadow of a tree, do you drive into it or do you put on the brakes? What if you think there’s a 50% chance it’s a child? 30% chance? 10% chance? 1% chance? How certain do you have to be that you may kill a child before you should modify your preferred action (to not put on your brakes) and resort to putting on your brakes? My question is this: shouldn’t we give the benefit of the doubt to life? Let’s say that you are skeptical of all this research, all these studies, all these medical textbooks and journal articles, and all the Pill manufacturers’ clear statements that the Pill sometimes prevents implantation (and therefore results in the death of a child). You might ask yourself if the reason for your skepticism is your personal bias and vested interests. But let’s assume you are genuinely uncertain. Is it a Christlike attitude to say “Because taking the Pill may or may not kill a child, I will therefore take or prescribe the Pill”? If we are uncertain, shouldn’t we take the ethical high ground by saying our uncertainty should compel us not to take or prescribe the Pill? My research has convinced me the evidence is compelling. It is only the numbers that are uncertain. Can we really say in good conscience, “Because I’m uncertain exactly how many children are killed by the Pill, therefore I will take or prescribe it”? How many dead children would it take to be too many? It seems to me more Christlike to say, “Because the evidence indicates the Pill can sometimes causes abortions, I will not use or prescribe it and will seek to inform others of its dangers to unborn children.”

In this sense, taking the Pill is analogous to playing Russian roulette, but with more chambers and therefore less risk per episode. In Russian roulette, participants usually don’t intend to shoot themselves. Their intention is irrelevant, however, because if they play the game long enough they just can’t beat the odds. Eventually they die. The Russian roulette of the Pill is done with someone else’s life. Each time someone taking the Pill engages in sex, she runs the risk of aborting a child. Instead of a one in six chance, maybe it’s a one in thirty or one in a hundred or one in five hundred chance; I’m not sure. I am sure that it’s a real risk—the scientific evidence tells us the chemical “gun” is loaded. The fact that she will not know when a child has been aborted in no way changes whether or not a child is aborted. Every month she continues to take the Pill increases her chances of having her first—or next—silent abortion. She could have one, two, a half dozen or a dozen of these without ever having a clue.

We put our children and ourselves at risk every time we drive a car. If we let our kids go swimming we take risks. Our child’s ability to grow, mature and gain confidence—and trust in God— in a world of risks partially depends on our willingness to take reasonable risks with them. But we are also careful not to take unnecessary risks. Our risks are wise and calculated. Because we love our children we expose them only to a measured level of risk—they ride in the car, yes, but we belt them in and drive carefully. As they grow up they learn to make their own decisions as to what level of risk is wise and acceptable.

The younger our children are, the fewer risks we take with them. We might leave an eight-year-old free to roam the house, while we wouldn’t a toddler. When we are talking about a newly conceived human being, if we take the Pill it is his life we are risking. The reason we’re doing so is not for his growth and maturity, but for our convenience. We are unnecessarily putting him at risk of his very survival. Through the choice to take certain chemicals into our bodies via the Pill, we may be robbing him of the single most important thing we can offer a newly-conceived child—a hospitable environment in which he can be nourished and grow. We would not consider withholding food and a home and physical safety from our children who are already born. We would not be careless about what we eat and drink and the chemicals we ingest and the activities we do that could jeopardize our preborn child six months after conception. Then neither should we put our child at unnecessary risk six days after conception. Yes, we can’t know for certain our child is even there at six days. But if we’ve been sexually active we know she may be there. And therefore we should do nothing that could unnecessarily jeopardize her life. A sexually active woman runs a new risk of aborting a child with every month’s supply of the Pill that she takes. Of course, the decision to take the Pill isn’t just a woman’s but her husband’s, and he is every bit as responsible for the choice as she is. As the God-appointed leader in the home, in fact, he may be even more responsible.

How much risk is acceptable risk? Part of it depends on the alternatives. There is no such thing as a car or a house that poses no risk to your children. But there is such a thing as a contraceptive method that does not put a child’s life at risk. There are safe alternatives to the Pill that do not and cannot cause abortions. No matter what level of risk parents decide to take with their children, surely we should agree that they deserve to know if evidence indicates they are taking such a risk. To be aware of the evidence that taking the Pill may cause abortions and not to share that information with parents is to keep them in the dark and rob them of exercising an informed choice about their own children.

I have only one agenda here and it is not a hidden one. My position is one I believe all Christians should agree on regardless of their differing positions on family planning. That position is this: no family planning which sacrifices the lives of a family member can be morally right and pleasing to God.

There are health benefits to women who choose not to take the Pill. As anyone who has read the inserts packaged with birth control pills knows, there are serious risks to women who take oral contraceptives, including increased incidence of blood clots, strokes, heart attacks, high blood pressure, sexually transmitted diseases, pelvic inflammatory disease, infertility, breast cancer, cervical cancer, liver tumors, and ectopic pregnancy. These and other risks are spelled out under each BCP listing in the Physician’s Desk Reference. The health issue is not my central concern in this book, but it is certainly worth considering. When there are other effective forms of family planning available that do not place the woman at risk, it seems that women are paying a high price when they use the Pill. Of special note is the danger of breast cancer, which is one of the leading cancer killers of women and occurs in one out of nine women. Compelling data exists from the past two decades that shows a 25-30% increased risk for breast cancer in women who use hormonal birth control. In 2005 the International Agency on Research of Cancer, a branch of the World Health Organization, labeled hormonal contraceptives as a group one carcinogen in the same class as asbestos and radium. This important warning regarding the breast cancer/birth control link has not been publicized; rather it has been concealed from the public, according to Dr. Angela Lanfranchi, a surgical oncologist and breast cancer expert. Dr. Lanfranchi compares the concealment of this health risk to the long-delayed acknowledgment of the smoking/lung cancer link.

Some doctors feel there are benefits of the Pill that have no relation to issues of pregnancy. Doctors prescribe it to regulate hormones connected to conditions such as ovarian cysts. Among many other uses, it is prescribed to get women “on schedule” who desire ultimately to go off the Pill and have children. Ironically, the Pill can cause chronic anovulation and thus infertility in some women. Also, residual effect of the Pill during the first few months after the woman stops taking it may endanger a newly conceived baby. These extraneous uses of the Pill are not based on scientific study of women’s physiology and some physicians feel strongly that using the Pill for these problems is not medically sound. Data suggests that the Pill in these scenarios does nothing more than conceal underlying hormonal problems that if diagnosed and treated, could provide the woman with significant relief.    As long as sexually inactive women are aware of the physical risks to themselves, which can be significant, they may choose to take the Pill for its other benefits. The moral problem is when, regardless of the reasons for taking it, a sexually active woman takes the Pill and thereby runs the continuous risk of aborting a child.

To be honest, I haven’t known exactly how to respond to our years of using the Pill, and my recommending it to couples in premarital counseling. My prayer has been something like this—“Lord, I’d like to think this wasn’t a sin, given our ignorance. But based on your Word I suspect it probably was. Since I am usually more guilty than I think, not less, I should assume I have sinned rather than presuming I have not. Please forgive me. I thank you that the price you paid means I need not labor under the guilt of my wrong choices in the past. Help me now to demonstrate the condition of my heart by living out consistently my convictions about the sanctity of human life you have created. Help me never to dare play God by usurping your sole prerogatives as the giver and taker of life. And help me do what I can to encourage my brothers and sisters not to do so either.”

I believe in light of our knowledge that the Pill can cause abortions, we should no longer use or recommend it, and should take the opportunity to explain, especially to our brothers and sisters in Christ, why we cannot.   “Let us examine our ways and test them, and let us return to the LORD.” (Lamentations 3:40)   “He who conceals his sins does not prosper, but whoever confesses and renounces them finds mercy.” (Proverbs 28:13)

I concur that further study is needed and I would be delighted if that study contradicted the existing evidence and somehow demonstrated that the Pill is incapable of causing abortions. I would like nothing more than to say, “Though it appeared for a time that the Pill likely causes abortions, new findings refute that notion and assure us it does not.” I would gladly retract this book and announce through every means available, “Great news, spread the word—children have not been dying as a result of the Pill; they are not at risk!”

Unless and until such a study surfaces, however, the evidence I’ve presented here, though indirect, is cumulatively very substantial. Some will say “Indirect evidence isn’t good enough.” My response is, “Show me the evidence, direct or indirect, that the Pill never causes abortions.” (Don’t show me evidence that it sometimes doesn’t cause abortions, since that isn’t the question.)

Can we live with ourselves if we disregard this evidence and say “I won’t speak out against the Pill until I have incontrovertible proof it causes abortions and lots of them”? If there is doubt, shouldn’t we give the benefit of the doubt to children?

“Does the birth control pill cause abortions?” I do not want to believe it, but I do believe the answer is “yes.” But even if I wasn’t sure I would have to say the evidence compels me to oppose the Pill unless definitive evidence is produced to indicate it does not cause abortions.

There are some very disturbing questions we need to ask. Can God, who creates each human life at the point of conception, fully bless the efforts of prolife organizations, volunteers and staff members, of sidewalk counselors and pastors and doctors—any of us—when we turn right around and use, prescribe or recommend a product that sometimes takes the life of an unborn child? Are we consistently prolife or only selectively prolife? Do we oppose later abortions while not really caring about the earliest ones? Is the only difference between us and those we call “proabortion” that they are willing to embrace the killing of bigger and older children while we are willing to embrace the killing only of smaller and younger children? Are we moral relativists and gradualists different only in degree but not in kind with those we call abortionists?

Because we have grown so accustomed to the Pill, will we turn our heads away from the risks it poses to our children? Do we dare to play God by infringing upon his sole and sacred prerogatives over human life?

Looking back, I believe I was in denial on this issue from the time I first heard about it in 1991. Why didn’t I dig deeper? Why didn’t I research it more carefully? I can come up with many other reasons to explain it away, but perhaps the bottom line is, I just didn’t want it to be true. But there are many things I don’t want to be true that still are. I don’t want to believe there is an eternal hell; or that as a Christian I will be held accountable for my works at the judgment seat of Christ; or that millions of children go to bed hungry each night; or that abortion kills children; or that the Pill causes abortions. I don’t want to believe any of these things, but I believe each of them nonetheless because the evidence demonstrates them to be true.

Christian couples who are using the Pill, isn’t it time to sit down and have a heart-to-heart talk? As a matter of conscience and conviction, do you believe you can or should continue with the Pill? Is it time to consider other alternatives? Time to search the Scriptures together, pray together, look at the facts presented here, and ask God’s guidance for your family? The choice is yours to make—make it prayerfully, with a Christ-centered commitment to putting principle above convenience. Pastors, counselors, physicians, nurses, pharmacists and others: what will you do with this information? Our churches, our patients, our counselees, and our families look to us for leadership. Let’s take our God-given role seriously and provide that leadership. At the very least we must present people with both the scientific facts and the biblical principles, so they can be informed enough to make wise and godly decisions. We dare not be silent in the face of the lives of children created in the image of God. “Speak up for those who cannot speak up for themselves; defend the rights of the poor and needy” (Proverbs 31:8-9). (See Appendix H: Defending the Weak and Helpless)

I also encourage pastors to speak out directly on this issue in their churches. I was a pastor for fourteen years, and I realize this will not be easy. Some people will be angry and defensive—I know, I’ve gotten some of their letters. But others will be thankful and appreciative, and will seek God’s face and genuinely deal with this issue. We owe our people the truth, and the opportunity to respond to it. In any case, the issue is not whether people will applaud our decision to address this subject. The issue is whether the Audience of One desires us to do so. If he does, all other opinions are irrelevant.

Appendix I: Other “Contraceptives” that Cause Abortions

The IUD, Norplant, Depo-Provera, NuvaRing, and RU 486 Prolifers have long opposed using the IUD, because it does not prevent conception, but keeps the already-conceived child from implanting in his mother’s womb. A paper by Irving Sivin challenges this understanding. Since other evidence has suggested it is an abortifacient, the jury appears to still be out on the IUD. However, because the stakes are so high, the uncertainty argues against using the IUD. RU-486, the anti-progestin abortion pill, is a human pesticide causing a mother’s womb to become hostile to her own child, resulting in an induced miscarriage.

Depo-Provera is a progestin (medroxyprogesterone) injected every three months. It sometimes suppresses ovulation, but also thins the lining of the uterus, apparently preventing implantation. Norplant is another progestin (levonorgestrel) enclosed in five or six flexible closed capsules or rods, which are surgically implanted beneath the skin. It often suppresses ovulation, but sometimes ovulation occurs, and when it does an irritation to the uterine wall may often prevent implantation.

NuvaRing is a flexible 2” ring in diameter that is inserted vaginally once a month. It releases a continuous low dose of hormones and changes the endometrium which reduces the likelihood of implantation.

The Emergency Contraceptive Pill (ECP) also known as the “Morning-After Pill,” can suppress ovulation, but its main function is to keep any fertilized egg from implanting in the uterus.

All of these birth control methods either sometimes or often alter the mother’s womb in a way that causes it to reject the human life that God designed it to nourish and sustain. Christians properly reject these methods because they know that human life begins at conception, six days before implantation begins. Therefore, anything that interferes with implantation kills a person created in the image of God. These birth control methods are often referred to as “contraceptives,” but they are not exclusively contraceptives. That is, they do not always prevent conception. Either sometimes or often they result in the death of already-conceived human beings.

The Mini-Pill (Progestin-only) Progestin-only pills, which have no estrogen, are often called “Mini-pills.” Many people confuse Mini-pills with the far more popular combination estrogen-progestin pills, which are the true “Birth Control Pill.” Drug Facts & Comparisons is a standard reference book for physicians. It says this under “Oral Contraceptives”:   Oral contraceptives (OCs) include estrogen-progestin combos and progestin-only products. Progestin-only [pills]…alter the cervical mucus, exert a progestational effect on the endometrium, apparently producing cellular changes that render the endometrium hostile to implantation by a fertilized ovum (egg) and, in some patients, suppress ovulation.136   Note that progestin-only pills have as a primary effect to make the uterine lining, the endometrium, “hostile to implantation by a fertilized ovum.” In other words, they cause an abortion of a human being roughly a week after his or her conception.

I have been told that many users of the Mini-pill think their ovulations are being suppressed. In fact, some new mothers have gone on the Mini-pill in order to prevent pregnancy while breast-feeding. However, in his book Gynecology: Principles & Practices, R.W. Kistner says, “Certainly the majority of women using the progestin-only pill continue to ovulate.” In his book Hormonal Contraception: Pills, Injections & Implants, Dr. Joseph W. Goldzieher, states, “Endometrial resistance to implantation is an important mechanism of the minipill.” A 1981 Searle leaflet, packaged with their progestin-only pill, says that product “makes the womb less receptive to any fertilized egg that reaches it.”

The Physician’s Desk Reference describes “Progestogen-Only Oral Contraceptives” by saying they “are known to alter the cervical mucus and exert a progestational effect on the endometrium, interfering with implantation.” Clearly the progestin-only pill, by its effects on the endometrium, causes abortions and must be added to the list of abortive birth control methods. Like all the aforementioned products, the changes the Mini-pill creates in the mother’s endometrium make the womb hostile to the newly-conceived child, instead of hospitable to him, as God designed the mother’s womb to be.