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Pro-life debate: whether the pill can cause abortion

WASHINGTON (BP)–Have pro-life Christians unknowingly aborted their tiny preborn children during the last four decades? Are some continuing to do so?

Some evangelicals, including medical professionals, say they probably have. Some say there is no such evidence. Others say they are unsure.

The horrifying possibility — as well as the debate and uncertainty — surrounds the use of one of the most popular contraceptives on the market: the birth control pill.

The pill, available in the United States since the early 1960s, actually is a combination of two hormones, estrogen and progestin, that acts as a contraceptive in its first two mechanisms, or actions. Its primary means of contraception is to prevent ovulation, the release of an egg from the woman’s ovaries. A secondary effect is the thickening of the cervical mucus, which impedes a sperm’s path to an egg.

A third mechanism — and the one that has generated controversy — is the pill’s thinning effect on the uterine lining, the endometrium, creating a less hospitable environment for the implantation of a recently conceived child.

For pro-lifers — who accept conception, not implantation, as the beginning of a human life — the potential rejection of a tiny child by the lining of the uterus is a major problem.

The question for pro-life couples, doctors, counselors, pastors and ethicists is: Does the birth control pill cause abortions?

Randy Alcorn, a pro-life leader, author and former pastor, researched the issue in the 1990s and wrote a book with that question as the title.

Alcorn hoped the answer would be no, he says. His wife and he had used birth control pills early in their marriage, and as a pastor he had recommended the method to young couples.

His book cites medical books and journals, pill manufacturers’ materials and research findings, as well as statements from physicians and pharmacists, in concluding that use of the pill sometimes results in abortion.

“My research has convinced me the evidence is compelling. It is only the numbers that are uncertain,” Alcorn writes.

While he cites estimates of “breakthrough” ovulation rates by pill users at anywhere from 2 percent to 20 percent, Alcorn quotes a doctor’s assertion there is no way of calculating how often rejection of the tiny child by the weakened uterine lining occurs, thereby resulting in an abortion.

After Alcorn’s book was published in its first of five editions in 1997, 20 pro-life OB/GYNs released a statement suggesting his conclusion was wrong. Shortly thereafter, 26 other pro-life OB/GYNs issued a document taking issue with their colleagues and contending the pill possesses an “abortifacient nature.”

The Christian Medical and Dental Association and Focus on the Family’s Physicians Resource Council have issued statements acknowledging the controversy but taking no definitive position. CMDA says, “Current knowledge does not confirm or refute conclusions that routine use of hormonal birth control causes abortion.”

William Cutrer, an associate professor of Christian ministry at Southern Baptist Theological Seminary, says Alcorn is “overstating what the evidence can now support.” It is a “theoretical possibility” that birth control pills can cause abortion, but “no one knows” if or to what extent it takes place, the obstetrician and former pastor says.

He respects researchers and Christian physicians on both sides of the question, Cutrer says. If “breakthrough” ovulation occurs, some contend larger amounts of progestin are produced to ready the endometrium for implantation, he says, noting also that implantation occurs even where there is not a highly receptive host, as with ectopic pregnancies lodged in a fallopian tube.

If a couple chooses not to use birth control pills because of concern they may cause abortions, “That’s fine with me,” Cutrer says. “It’s when people are told that birth control pills are abortifacient, when we don’t have the data, that I have a problem.”

Bioethicist Ben Mitchell says although scientific evidence is lacking, he tries “to discourage couples from using birth control pills by educating them about the potential of the pill to cause abortions in some cases. Until more data is in, the decision should be considered a matter of Christian liberty.

“Christians, unlike the general populace, begin with the presumption in favor of having children,” said Mitchell, a consultant to the Ethics & Religious Liberty Commission and an associate professor of bioethics at Trinity International University in suburban Chicago. “We have a procreative privilege and responsibility. Contraception may be permissible in certain circumstances. Abortion, even by prescription drugs, is not. Since there are relatively effective non-abortifacient alternatives, the pill is unnecessary for contraceptive purposes.”

Orman Simmons, a Southern Baptist OB/GYN who practices in Little Rock, Ark., refuses to prescribe the pill as a contraceptive. “My gut feeling is there probably are pregnancies that occur as a result of pill failure that may go to term or they may abort due to poor endometrial lining preparation,” Simmons says. “I am so pro-life that I can’t distinguish whether there is pill failure or patient failure.”

Alcorn argues for such caution, even by those who question his conclusion. “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? Shouldn’t we give the benefit of the doubt to life?”