One
of the most amazing things about the stir caused by the recently leaked
HHS proposal is how little, make that no, effort has been made to
investigate whether the claim by the anti-abortion establishment about
the mode of action of hormonal birth control is even true. A subsequent draft of the regulations without the redefinition of abortion has been released, but the underlying question — can contraception prevent implantation? — still stands.
Now, of course, for
pro-choice people, this is a moot point. Even if hormonal birth control
could prevent a fertilized egg from implanting in the womb, that’s not
abortion because pregnancy doesn’t begin until implantation. To enter
into this discussion is to first set aside the medical and legal
definition of pregnancy and indulge the extremists. That’s why this
discussion never really happens. But what would we find if we did
indulge them?
According to the Code of Federal Regulations, The
American College of Obstetricians and Gynecologists and the National
Institutes of Health, pregnancy begins when a fertilized egg implants
in the womb. Until it affixes to the woman’s womb a fertilized egg can
not receive nutrients from the woman’s body, which is essential for it
to grow. Implantation is also the only way in which a pregnancy can be
determined, there is no test that can tell when an egg has been
fertilized—there is no way of knowing whether or not this has happened.
Implantation is what sets in motion all the signs that pregnancy has
begun. On this one point, science, medicine and the law agree:
implantation is the moment at which pregnancy starts. The only
dissenting group is the pro-life movement, which dismisses this
definition. It, instead, would like pregnancy to start at the
unknowable moment the sperm fertilizes an egg. Once sperm meets egg,
any effort to prevent the egg from implanting in the womb is considered
an abortion by the pro-life movement. This is one of the arguments they
offer up as justification for the campaigns to keep women from using
birth control. Their claim is that most birth control methods prevent
fertilized eggs from implanting in the womb, which to them, though not
to science, is an abortion. But even that is not true. There is no
evidence that birth control methods actually do what pro-life groups
claim.
Prompted, in part, by the growing efforts of
anti-abortion groups to define birth control as abortion, the American
Journal of Obstetrics and Gynecology in 1999 reviewed the available
research on "the mechanism of action" of the contraceptive methods that
so dismay pro-lifers. The authors take up the pro-life concerns
directly writing, "Recently, some special interest groups have claimed,
without providing any scientific rationale, that some methods of
contraception may have an abortifacient effect."
After reviewing
the available literature, the authors conclude that hormonal
contraceptive methods (oral contraceptives, the patch, the ring, the
shot) cause a number of changes in a woman’s body which prevent
pregnancy. Primarily, what they do is simply prevent ovulation. In
other words, take the pill and in almost all instances a woman won’t
release an egg. No egg, no chance of pregnancy. The secondary way these
contraceptives function, the authors report, is by preventing
fertilization. So, on the very slim chance that a woman using a
hormonal method does produce an egg another mechanism of action kicks
in. Hormonal contraceptives also thicken the mucus lining of women’s
reproductive organs which hamper the ability of the sperm to even get
to the egg. And if a rogue sperm reaches the egg, hormonal
contraceptives prevent it from penetrating the egg. Specifically, they
stop the shell encasing the egg from disintegrating so a sperm can’t
actually do the deed of fertilization. This is what is known about how
hormonal birth control works.
What gets pro-lifers so worked up
is that they insist on believing that a fertilized egg can be stopped
from implanting in the womb. First off, hormonal contraceptives stop
fertilization. What if, through some extraordinary, unknown, and
seemingly unknowable process, an egg got fertilized? The researchers
consider the question and report , "No direct evidence exists showing
that implantation is prevented by progestin-only methods" and "The
evidence does not support the theory that the usual mechanism of action
of IUDs is destruction of fertilized ova in the uterus," say the
authors. After reviewing all the research available on the modes of
action of all contraceptives in question the authors summarize their
report by explaining that "Even though the precise mechanism of action
of modern contraceptive is not yet fully known, scientific evidence
suggests the main mechanisms of action for each method. Inhibition of
ovulation and effects on the cervical mucus are the primary mechanisms
of the contraceptive action of hormonal methods. Evidence indicates
that the primary mechanism of action of IUDs is the prevention of
fertilization."
"All of these methods, directly or indirectly,
have effects on the endometrium [the lining of the uterus] that might
prevent implantation of a fertilized ovum," the researchers
acknowledge. But as they quickly point out, "So far, no scientific
evidence has been published supporting this possibility." There’s just
no evidence that any birth control method prevents a fertilized egg
from attaching to the womb, even though that’s the basis for the
pro-life claims.
What’s most striking about all this, is
that, really, it should be a relief to pro-lifers. Birth control
doesn’t have any effect on the egg once fertilized. The primary and
secondary ways in which these methods work should be completely
acceptable by the pro-life movement. In fact, though, they’ve taken
just the opposite stance. Their argument usually sounds like this: We
can’t really know for sure that in some cases, however rare, a
fertilized egg isn’t kept from fulfilling its God decreed destiny of
implanting in the womb. And the dutiful scientist, limited by the
research facts, must acknowledge that though there is no evidence to
suggest that such a thing happens, it’s impossible to rule it out. So
there! Says the pro-lifer. It can’t be ruled out. You can’t prove a
negative. It’s a little bit like deriding gravity as a hypothesis. Yes,
the last ten times you dropped that spoon, it crashed down on the
table. But what about the eleventh time? Or the eleven hundredth? Or
the eleven millionth? There is also know way of knowing how breast
feeding works as a means of birth control, which it does in the exact
way hormonal methods menitioned above do, or whether fertilized eggs to
breast feeding women are prevented from implanting. Applying the same
exact standard here, pro-lifers would even be against the birth control
method God designed. They propagate "education" campaigns, with great
vehemence and assuredness, about the "abortifacient" method of birth
control—all this, because while there is no evidence to show these
methods actually prevent implantation of a fertilized egg, there is
also no evidence to show they do not. "Insufficient evidence exists on
whether cellular or biological changes in the endometrium could
actually prevent implantation," say the authors. However, their point
is that it doesn’t matter. "The possibility of fertilization during
combined oral contraceptive use is very small. Hence, endometrial
changes are unlikely to play an important role, if any, in the observed
contraceptive effectiveness of combined oral contraceptives." Thus
pro-life campaigns against birth control are based not on scientific
evidence, but rather on wishful thinking. Indeed, on a slim
hypothetical chance, the pro-life movement has successfully opposed
legislation that would have provided millions of women access to
effective birth control methods. If the science isn’t on your side,
then, the pro-life side seems to believe, ignore it.
Even some
pro-life physicians, sparked by the recurring actions by the pro-life
movement as a whole against birth control, stepped in to offer their
medical views on the concerns their fellow pro-lifers raise. In 1998,
twenty-two pro-life Ob/Gyns published an analysis entitled "Birth
Control Pills: Contraceptive or Abortifacients?" and four of these
pro-life physicians followed up with a more detailed paper on hormonal
contraceptives in general. The physicians open their statement boldly
warning, "Currently the claim that hormonal contraceptives [birth
control pills, implants (norplant), injectables (depoprovera)] include
an abortifacient mechanism of action is being widely disseminated in
the pro-life community. This theory is emerging with the assumed status
of "scientific fact," and is causing significant confusion among both
lay and medical pro-life people. With this confusion in the ranks comes
a significant weakening of both our credibility with the general public
and our effectiveness against the tide of elective abortion." The
authors explain that any effects on the uterine lining that the
pro-life movement uses to support the claim that fertilized eggs are
being prevented from implanting would be insignificant and has no role
in the ability for a fertilized egg to implant. Fertilized eggs are
able to implant in much more hostile conditions than those resulting
from the mode of action from the pill. They report "The presumption
that implantation of a blastocyst is thwarted by "hostile endometrium"
is contradicted by the "pill pregnancies" we as physicians see. Pill
company literature estimates 3 to 5 pregnancies per l00 women per year
for pill users. Many of these women take the "pill" an additional month
or two before finding out they are pregnant. These pregnancies
generally progress with no more difficulty than non-pill pregnancies.
To our knowledge, there are no studies showing that the spontaneous
abortion rate in these cases is any greater than in pregnancies with a
"friendly endometrium." The pro-life physicians conclude that there is
no evidence to support that the contraceptive methods in question act
in the ways that would be unacceptable to the pro-life individual who
believes life begins at fertilization. They state it as plainly as they
can, "the ‘hormonal contraception is abortifacient’ theory is not
established scientific fact. It is speculation, and the discussion
presented here suggests it is error" and continue "if a family,
weighing all the factors affecting their own circumstances, decides to
use this modality, we are confident that they are not using an
abortifacient."
Yet, their campaigns against birth control
continue today with more intensity than even before this intervention
from the most expert on the pro-life side. Of course, arguing over
inconvenient biological truths is, in many ways, besides the point when
it comes to pro-life disenchantment with birth control. Don’t be
misled. This fracas is not caused by a simple scientific
misunderstanding. Otherwise, they’d rush to support birth control
methods that don’t ’cause abortions,’ even in their implausible view.
Like the diaphragm, condom, cervical cap, and spermicides. But the
pro-life forces aren’t on record anywhere in favor of methods that keep
sperm and egg apart. It appears impossible to find a single instance in
which a pro-life group has anything good to say about any birth control
method except natural family planning—a technique most notable for its
high failure rate. Remember, even the lowly condom disturbs them.
