Oral Contraceptive Controversy
The American Association of Pro-Life Obstetricians and Gynecologists is frequently approached by individuals wondering if the Association has a position on the sometimes-alleged abortifacient effect of oral contraceptives. This effect refers to any possible disturbance of the normal function of the early conceptus, or its interaction with the uterus, from the moment of fertilization to the peri-implantation period, which may result in the loss of early human life. This is an issue that has been considered at some length by the board of AAPLOG.
Included here are two papers, carefully researched and compiled by several members of the AAPLOG board (Birth Control Pill: Abortifacient and Contraceptive and Hormone Contraceptives Controversies and Clarifications). These papers come to different conclusions about the possible abortifacient effect of oral contraceptives, reflecting in a microcosm the controversy that has recently surrounded this issue in the larger pro-life community. At the current time, we feel that each individual physician should evaluate the available information, and then follow the leading of his/her conscience in this matter.
Why does this controversy exist? Why is there not a consensus on this issue in our organization, or in the larger pro-life community?
In short, it is because our current scientific tools limit us. In the case of a surgical abortion we can directly attribute the death of an embryo or fetus to a suction dilatation and curettage of the pregnant uterus. With the administration of mifepristone (RU486) or methotrexate in an early gestation we can easily recognize the causal link with death by biologic plausibility coupled with the overwhelming statistical association with observed embryonic death. No one disputes these conclusions.
On the other hand, the methods available to us to evaluate the in vivo processes of human fertilization, tubal transport and implantation are relatively crude. We are not currently sophisticated enough to evaluate oral contraceptives (or even IUDs) for a possible effect on the pre-implantation human being in the same rigorous fashion that we can evaluate the effects of a suction dilatation and curettage, mifepristone or methotrexate on an implanted human being.
Thus we find ourselves in a situation where speculation, deduction, and educated guessing must be employed. There are times when our knowledge of the truth is incomplete, and we must peer through the fog to make, and act upon, judgments about the information available to us. In these settings, individuals wholeheartedly committed to the truth can come to different conclusions. So it is with us. The cliché, “agree to disagree” is much abused in our post-modern society. Frequently it is used as a surrogate to express the belief that there is no such thing as truth, or that truth is what any individual makes it. We heartily reject these sentiments. There is truth about this matter-even if we cannot clearly see it yet. As individuals committed to the protection of human life from the moment of conception, we have come to differing conclusions about the effect, or non-effect, of oral contraceptives on the early conceptus. It is in a situation such as this where we are at our best when we “agree to disagree” in a spirit of humility, while remaining open to new information which may further enlighten us.
One further word of explanation: There are those who disagree with the use of all pharmaceutical or barrier methods of birth control. This position is held on the basis of theological and philosophical concerns that we have not addressed here, and which must be evaluated on their own merits apart from the considerations that we have taken up in this forum.
For further reading:
Crockett SA, Harrison D, DeCook J, Hersh C. Hormone contraceptives: controversies and clarifications. In Kilner JF, Cunningham PC, Hager WD eds. The reproductive revolution: a Christian appraisal of reproductive technologies, sexuality and the family. Eerdmans, Grand Rapids, MI and Paternoster, United Kingdom, 2000.
Larimore WL, Alcorn R. Using the birth control pill is ethically unacceptable. In Kilner JF, Cunningham PC, Hager WD eds. The reproductive revolution: a Christian appraisal of reproductive technologies, sexuality and the family. Eerdmans, Grand Rapids, MI and Paternoster, United Kingdom, 2000.