by William Cutrer, M.D., and Sandra Glahn, Th.M.

In some countries today where contraceptive methods are unavailable or too expensive, first trimester elective abortion is the technique of choice. On mission trips to Russia, we’ve seen young women who’d had five or more abortions.

Consider the growing percentage of repeat abortions in the U.S.:

1973 – 20% of abortions
1987 – 44% of abortions
1995 – 45% of abortions
Sadly, we seem to be so desensitized to the taking of human life or so convinced that the embryo is something other than human life that our society is apparently growing more lax in the use of contraception. Many reason that if an “unwanted pregnancy” occurs, abortion is an easy, available option.

Birth control as abortion?

But what about the possibility that birth control pills actually cause abortion? This is currently the hot topic in family planning for Christians, and some well-meaning scholars have spoken dogmatically on this subject before we really know all the facts.

Birth control pills, or oral contraceptive pills (OCPs) are designed primarily to prevent ovulation or egg release. Most pills are a combination of an estrogen and a progesterone derivative that cycle a woman artificially without allowing ovulation. OCPs are effective at preventing pregnancy, with rates of effectiveness reported at less than one pregnancy per one hundred women years of use. Their effectiveness is greatly dependent on correct usage, and taking other medications at the same time can also decrease pill absorption and effectiveness.

In addition to preventing ovulation, OCPs thicken cervical mucus, making sperm penetration more difficult. OCPs also change the motion of the cilia (tiny hair-like structures) within the fallopian tubes, altering egg transport. And they thin the uterine lining, making it less favorable to implantation should fertilization occur. While each of these “side effects” actually increases the effectiveness of the pill in preventing pregnancy, the latter could, in fact, have an abortive effect if breakthrough ovulation were to actually occur. The potential risk described would seem to be very low, but the possibility does exist. However, this scenario remains extremely difficult to quantify because of the many variables. Thus, to avoid these potential concerns, OCP users should carefully weigh the available information and certainly be vigilant in taking their pills as prescribed.

Another type of OCP contains only the progesterone type of hormone. This pill clearly has a higher rate of breakthrough ovulation, increasing the risk of a fertilized egg reaching a hostile uterine environment. For this reason, in my practice I never prescribed the “progesterone only” pill, though the clear evidence that abortions are caused is not impressive even here.

Some Christians criticize pill users, arguing with, “I would never want to do anything that would endanger a single human life.” Yet because there is—tragically— a one-in-three chance of any pregnancy miscarrying, in truth the only way to avoid any risk is to be celibate, which is certainly not scriptural for married couples. Simply put, as a result of the fall (Gen. 3), humans are bad at reproducing.

“But,” they may say, “it isn’t my intent to cause an abortion. Does intent matter? Yes, from a strictly ethical point of view, intent is important. From a legal standpoint, there is an enormous difference between first degree/premeditated murder, involuntary manslaughter, and accidental death. The thousands of Christians taking OCPs now do not intend to cause miscarriage. In fact, they intend to prevent pregnancy.

What should we do? Know the medical risks as they are currently understood. Be willing to be teachable if new data reveals different risk. Then prayerfully decide if you can use pills until the question is more fully resolved. If you take them, do so carefully as we know that will diminish the risk. And be gentle with others who make choices that differ from yours.

Educate yourself. If your doctor won’t talk to you about it, find another physician. It’s important to base medical decisions on solid information, not conjecture. When microwaves, sonograms, computer monitors, and cell phones first came out, all were accused of causing miscarriage. Later studies confirmed that none of them actually did.

The ongoing debate

As those who hold to the Bible as our authority, we are used to having absolute answers on many topics. Thus we can feel great discomfort with issues for which answers are unclear. Solid Christian physicians stand on both sides of this issue. Some say birth control pills can cause abortion and thus shouldn’t be used. Others argue that if breakthrough ovulation takes place, the ovary immediately begins producing increased amounts of progesterone that will prepare the uterus for implantation, changing the effect of the pill.

In my own practice, I (Dr. Bill) delivered some babies conceived on the pill. So I know from personal experience that if there is an abortive effect of the pill, it certainly cannot be 100 percent, but the answer at this writing is unclear. If you need absolutes, stay away from the pill, but stay informed and consult your own physician. For now taking them appears to be an ethical option, but there are some unknowns for which we are awaiting further research.