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The Pill is the popular term for a variety of oral contraceptives (OC's) or birth control pills (BCP's).  They are sometimes called combination pills because they contain both estrogen and progestin.  Every year, the pill is used by 14 million American women and around 60 million women worldwide.

The Pill is sometimes prescribed for reasons other than birth control, but most often women take the pill to avoid contraception.  The question debated among Christians is whether the pill sometimes act as an abortifacient.  That is, does the pill have the potential to terminate the life of a zygote (the single cell the results from a fertilized egg)? My modest proposal is that you look into the issue for yourself.

Respected Christian groups like Focus on the Family's Physicians Research Counsel and the Christian Medical and Dental Association have issued non-statement statements, arguing that as of yet no consensus exists on the issue.  Both of the aforementioned groups recognize differing opinions among Christians, and in light of what they consider inconclusive evidence one way or the other, urge more research and study.

Others have found the evidence more conclusive. Randy Alcorn has published a 197 page book explaining why he believes birth control pills do sometimes cause abortions.  For years, Alcorn's wife used the pill and as a pastor, Alcorn recommended it to newlyweds.  So changing his mind was not easy, but over time he did.

According to Alcorn and the physicians he cites, the pill works mainly by prohibiting ovulation, but it also works by thinning the line of the uterine wall (endometrium), making the implantation of a fertilized egg less likely.  The Physician's Desk Reference states with reference to the contraceptive pill, Ortho-Cept: "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 Pill works in three ways, Alcorn argues: preventing ovulation, preventing sperm penetration, and preventing zygote implantation.

Granted, in the vast majority of cases, an egg will not be fertilized.  But sometimes it will.  And using the pill makes successful implantation of the new life less likely.  Alcorn documents journal articles, MRI results, ultra sound technology, and reproductive endorcrinologists who confirm that (1) endometrial thickness is related to functional receptivity and (2) the Pill thins the endometrium.

A number of doctors support Alcorn's thesis, while others, like those who issued a pro-life Ob/Gyn's statement, have called the "hostile endometrium" notion a myth.  A long list of links and statements, both for and against Alcorn’s position, can be found here.

For my wife and me, even the possibility of terminating a fertilized egg made us skittish about the Pill.  We've never used it, though many of our Christian friends have.  I encourage every Christian couple using or contemplating the Pill to research the issue for themselves.  Consult a physician and ask about the possible abortifacient effects of oral contraceptives.  The issue is obviously more complex than a brief summary from a non-medically trained pastor.

Many Christians have little awareness of any controversy surrounding the Pill.  This article is not meant to shame those who have used or are using the Pill.  But at the very least, we owe it to ourselves, our children, and the Lord to prayerfully consider the rights and wrongs of the pills we take and prescribe.


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46 thoughts on “A Modest Proposal: Do Some Reading Before You Pop the Pill”

  1. Jay says:

    Thanks for writing about this, Pastor Kevin. These are the mechanisms of oral contraceptive pills that I was taught in medical school (I am not an Ob/Gyn) and are exactly what the references I use daily say.

    From Micromedex: “[Brand Name Estrogen/Progestin OCP] works primarily by suppressing ovulation. Additionally, COC agents cause cervical mucus changes that block sperm penetration and endometrial changes that reduce the chance of implantation.”

    It only seems to be controversial among Christian. Or maybe I should say among American Protestants (I did my Internal Medicine training at a Roman Catholic institution that forbid prescribing OCP unless it was for a reason other than birth control).

  2. We’ve had three reasons for avoiding the pill:

    1. Questions like this – the possibility that the pill causes abortions.

    2. Possible link between the pill and cancer. Admittedly tenuous, but the possibility seems high enough that we didn’t think it a chance worth taking.

    3. Kids are too much fun!

  3. James says:

    Thank you Kevin for your courage in tackling this subject. Absolutely agree with your conclusion, and reminds us to be faithful to our conscience rather than being faithful to our convenience.

  4. Bob Wiegers says:

    Good post, thanks.

    I think you meant to say “conception” in your 2nd paragraph instead of “take the pill to avoid contraception” :-)

  5. Barbara says:

    Not to be too picky but in the second paragraph I think you mean ‘most women take the pill to avoid conception’ – not contraception. Interesting food for thought. Glad I am passed the age where I have to consider more complicating factors. One more bonus of getting older, we need all the pluses we can come up with!

  6. Ethan says:

    Maybe I’m a horrible reader, but where is the part about terminating a fertilized egg? All I read was that the three effects are preventative measures…

    I’m not trying to be defensive, as my wife and I decided not to use the pill anymore after using it for about 6 months (though for other reasons than the one stated here). I just don’t understand how it would be abortion. Are you saying if the egg does happen to become fertilized, it would then be terminated by the effects of the pill?

  7. Beulah Land says:

    Thank you for addressing this subject. So many people just don’t know or choose to ignore these things. There ARE other methods of birth control that can be very effective. Also, the pill can cause increased risk of stroke and blood clots in the body. Thanks for being courageous. I hope to do the same.

  8. Kelli says:

    Thanks so much for this post on a topic that needs to be discussed much more. As a newlywed, who was on the pill for about a year, there is so much pressure to be on it because that’s just “what everyone does”. I found health care professionals to be very misleading about the possible side effects of the pill and would encourage anyone considering it to do your own research, as stated above. Don’t rule out the possible emotional and physical side effects of the pill either. These can have a tremendous effect on your emotional well-being and there comes a point when it simply isn’t worth it, especially considering the ethical concerns discussed above.

  9. Ryan Phelps says:

    I heard Alcorn use an analogy, with respect to not using the pill (or other possible abortifacients), that was helpful. Say you’re out in the woods hunting and you think you see a deer. But as you look longer at the deer, you realize that what you’re looking at might not be a deer, but might actually be a human. If there’s any chance that it might be human, do you shoot? No way.

  10. Thank you for a well-written, non-critical article on this topic.

  11. Harold Simmons says:

    It is difficult to enter your free book contest and respond by 5:00 PM Eastern Time when your email is not received until 11:45 PM Central Time.
    Anyway the book I always enjoy is Sproul’s “The Holiness of God”
    and I was going to add “The Good News We Almost Forgot” because being in a non-creedal church you do not always think of these type of teachings and their value.

  12. John E. says:

    No matter where you stand on this issue, Kevin’s post is absolutely ridiculous. I can’t believe that anyone would applaud him. He says, “look into the issue for yourself.” What?! Aren’t you a pastor? If it’s wrong, at least say it is. If it isn’t, don’t bother posting.

  13. kathy says:

    I don’t know if the issue is the “abortaficient” characteristics of the pill. Family planning is necessary (maybe that is the real issue?), and couples choose every month whether or not to try for pregnancy, whether it’s through the pill, condoms, or just abstinence.

    The issue with the pill is the tricking of the body and the long-term effects that have not been discovered. Does it inhibit future potential pregnancies when it’s no longer in use? Does it permanently alter the delicate hormonal balances of a woman’s body? Is it detrimental to the way we were created and the way we were meant to procreate?

    If we don’t know the answers to those questions, then we shouldn’t be using it. There are many other ways to plan for a family that don’t involve drugs.

  14. John HC Niederhaus says:

    Lifesitenews.com had a couple of articles about the pill back in Decemmber. Here’s one: http://www.lifesitenews.com/news/surgeon-birth-control-pill-a-molotov-cocktail-for-breast-cancer/
    and the other one is: http://www.lifesitenews.com/news/archive/ldn/2009/mar/09031311
    Both are worth reading.

  15. Ethan Larson says:

    Thank you SO much for writing/prodding about where few users and advisors are willing to openly investigate. “Non-statement statements” and “were not sure” are insufficient responses given the moral potentials clearly stated in the “fine print” few are willing to read, and, to respond to appropriately. Pragmatism reigns in questions of life and death …and this by Christians.

  16. Ron Marlin says:

    Kevin,

    This is nonsense. You put up this post and you don’t think you’re going to burden someone’s conscience about an issue where it shouldn’t be burdened? Totally irresponsible. You may present this material in a non critical way, but it’s a back door promotion of your personal opinion with the little caveat “look into it yourself”.

    Use of the pill is a matter of conscience you should stay out of…

  17. Ethan Larson says:

    Alcorn’s “shooting a deer” illustration cuts through the uncertainty. My Father taught me to never point a gun at anything you don’t intend to kill. He taught me that there is not only a safety but a moral obligation to keep a gun unloaded and locked up, because you are dealing with something that can kill. You “treat every gun as if it is loaded” because life is too precious to risk. Please pardon the expression, but how could anyone even risk “abortifacient roulette”? What “chance” is low enough to risk that? Enough hand wringing. Decide.

  18. Jonty says:

    The Christian Institute have published research and assessment of the various contraceptive methods here

    http://www.christian.org.uk/wp-content/downloads/contraceptionguide.pdf

    They also highlight concerns about the pill but have suggestions as to how it can be used safely by ‘tricycling’, also recommended by several Christian doctors I’ve spoken to

  19. Looselycult says:

    Thank you Ron for being the lone voice in the wilderness. I agree this does seem like a back door tact, which is essentially a form of legalism in disguise.

  20. Deborah says:

    We need to do some arithmetic as well as some reading.

    A woman has 13 cycles per year.

    If, when taking the Pill, ovulation occurs in just 2.7% of cycles, that’s once in three years.
    Ovulation does not equate to conception: even couples who are trying to conceive will only succeed in one-third of ovulatory cycles. So a woman taking the Pill might expect an ovum to be fertilised in 0.9% of cycles – roughly once in eight years!

    We know from experience that many women do get pregnant while taking the Pill, so it evidently doesn’t prevent implantation in every case of fertilisation. It may not prevent implantation at all – the evidence is very weak. But if, for example, we say that it has an anti-implantation effect in 50% of cases, this means that this will happen, on average, once every 16 years!

    If you are worried about risks that small, then don’t use the Pill. But most people aren’t that obsessional; we act according to the consequences that we can reasonably foresee, and let God take care of unlikely events.

  21. Jay says:

    Deborah

    It may indeed be unlikely that the pill terminates an otherwise normal pregnancy by preventing implantation. But if we multiply your estimate of one termination per woman per 16 years by the number of couples who utilize BCPs, the numbers look much worse. Having qualms against that is not obsessional.

    Given that the “consequences” of less reliable forms of birth control are creatures made in God’s image, I think we should be less “obsessional” about preventing pregnancy.

    Respectfully,

    Jay

  22. Deborah says:

    Jay

    I was (obviously) looking at it from the point of view of the individual couple. They aren’t responsible for anyone else.

    If you are taking a global (or population) view, then the total numbers might be enough to concern you. But the only logical way to deal with this would be to ban hormonal contraceptives altogether. Human nature being what it is, the inevitable consequence of less reliable methods of birth control is more abortions. The Pill prevents far more abortions than it causes.

  23. Jay says:

    Deborah

    I agree with you (but can’t prove) that, given human nature, the pill probably prevents more abortions than it causes. But I hope that’s not true among those who believe God’s promises (even in the face of unplanned pregnancy).

    I disagree that banning hormonal contraceptives is the only logical way (from my point of view) to deal with this. It’s impossible to completely regulate human depravity. I think an alternative is to have Christian leaders urge their people to understand how these things work. Like Pastor Kevin just did.

    Thanks,

    Jay

  24. Kevin says:

    Does anyone know when and why serious Reformed Christians began approving of any contraceptive methods, much less those with an abortifacient potential?

  25. Gabe says:

    “…your sons will be like olive shoots around your table. Thus is the man blessed who fears the LORD.” Psalm 128:3b-4. Has anyone ever seen olive shoots? When did having many children stop being a blessing? Or has it? Do we see children the same way God does?

  26. Kevin says:

    Two issues really. One is whether we have a Biblical view of child bearing (including God’s active involvement in conception, e.g. Ruth 4:13, God’s sovereignty in conception, God’s design for gender & marriage, and God’s blessing/command to bear children). The other is man’s choice of methods (IF we ascertain that it is our responsibility to decide).

    At the very least (ignoring the former issue altogether) we should lean far away from any method that would kill a conceived child.

    Caveat: My wife and I have 15 children, so you know where we land on this. ;>D

  27. Tony says:

    There is a far greater and real chance that your child will die in a car crash than by using birth control. Yet, Randy Alcorn doesn’t touch the subject of highway driving, he only goes after birth control because of the word “abortion.” You might not be able to get by without driving but, for the sake of your child, you could avoid the highways even if it is more inconvenient.

    If you are going to make decisions based on the remote chance that it will result in your child’s death you shouldn’t drive on the highway, let your kid near a pool, or, as Randy points out, take them dear hunting (a birth control using hunter might get confused).

    This is only an issue because of the emotion around, not the meaning of, the word abortion.

  28. Bob Lemon says:

    Those who endorse not using safe methods of birth control always seem to forget that having and raising children involves the stewardship of our time and finances. Some fathers may be able to give 15 children the proper time commitment each one needs, some fathers may make enough money to provide for that many children as well. However, not everyone is cut out to be a Duggar and it is irresponsible to lay this matter on the conscience of Christians via personal opinion (particulary a Pastor). I have seen families bludgeoned with this mentality in the Christian circles they are in, who end up having 7 or 8 kids…need financial assistance from the church and they cannot invest the time to properly instruct and discipline each child because they are stretched too thin. This in turn causes a lot of stress on the marriage and difficulty in the home. Of course, all the big family reality shows on TLC fail to mention these types of situations, and so do some of the commenters on this blog post. In the end, each Christian family should decide for themselves how many children they think they can prayerfully and biblically handle without a guilt trip from brethren citing Psalm 128 and suggesting they should have as many children as physically possible because, well, don’t you want a lot of arrows in your quiver? and children are a blessing from the Lord, etc. etc. While it is true that children are a blessing from the Lord, it is not true that God expects you to have double digit offspring. Sorry, but that is misuse and abuse of Scripture.

  29. Bob Lemon says:

    Also, I agree with Tony. This line of reasoning about the pill is the same line of reasoning that leads to staying off the highways…if you’re going to be consistent…

  30. CMM says:

    Very well done. This is a touchy personal issue, and it’s good to see it handled so well.

    As far as the article geting into deciding “matters of conscience” for people, I don’t see what there is to be upset about. He is merely informing people that there is a risk involved in taking the Pill. Use it at your own (or wife or family’s) risk, or choose not to use it. Drive your kid around in the car at your own risk, or choose not to. Examples of potentially risky behavior are endless. But I think we need to be informed of the risk.

  31. Kevin says:

    I believe the takeaway from Kevin’s post is that [if you practice birth control] you should consider not using the pill (which, in medical terms, can “abort” a conceived child by preventing implantation in the womb) and instead opt for other methods which prevent conception. It seems that since there are other conception-preventing options, then we as believers should choose those instead of options are potentially conception-ending (of which the pill, the IUD, and physical abortion would fall under).

    As far as percentages goes, one of the major issues of the pill is that each woman responds differently, and can even respond differently to the pill at different times. If the 2.7% is the average in women, doesn’t that indicate some are higher? Also, the pill may prevent ovulation one month (and thus prevent conception), and another month prevent implantation of a conceived child (and thus end conception). There’s the rub.

    Also, another major issue is that doctors disagree about the result or impact of the pill. That should give us pause, and cause us to consider other options in and of itself. The doctors themselves are not wholly convinced. How can we be? Just read up on the pill as Kevin suggests. It is worth the study.

    To the highway and hunting illustrations:
    We choose the safe route. We use seat belts, avoid dangerous intersections. We wear bright orange when hunting. We seek to mitigate risk. If there was even a 2.7% risk of being killed (or killing another) in driving or hunting, we would all find different means of travel and recreation.

    To Bob Lemon:
    The premise is that the pill is not one of the “safe methods of birth control” because it can kill a conceived baby. The risk is there.

    I understand the premise of stewardship of time and finances for every parent. This, however, does not rise or fall with the number of children. We all have seen terrible parents of a few kids (in time and finances) as well as those with many. I would suggest that the issue is not the number of children, but the ignoring of other principles in life. The God-given blessing of children is not a standalone principle, but one intended by God to coincide with obedience (and preparation) in other area of life. For example, the Bible seems to indicate that before a man gets married, he should prepare his field, and then build his house. Do we encourage young men to become financially grounded and stable before marriage? That is a major key to marriage. Also, are we willing to live within the means and at the level which God provides? Do we limit children because of our choice of cars, houses, and out-to-eat habits? As a father of 15, I can attest to the fact that it can be done, and done without government assistance, and with Mom at home. I just don’t drive the nicest car, and we don’t have all the fringe benefits that some consider standard (cable, cell phones for all the kids, extended vacations, etc.).

    I would suggest, further, that the Bible in no way juxtaposes stewardship against having children. It assumes that we will receive and be rightly responsible for that which God gives us. I have found nothing in Scripture that encourages people to seek to prevent children in order to practice stewardship. We are to practice stewardship of time and money, etc. as God gives us children in His wisdom and sovereignty. Each time I read through the Bible (I try to do so each year), I am more and more amazed at how we have re-written the “truth” to fit our views, rather than embracing Almighty God and His plan as He has revealed Himself in His Word.

    The arguments you and others pose also leave out the wisdom of God and replace it with the wisdom of man. God is wiser, and therefore can be trusted to accomplish things beyond our own wisdom through His choice of children. I would attest that children have a sanctifying affect on their parents. God uses children to help us become more like Christ, including more selfless. That does require our obedient cooperation (which again is not in any way determined by the number of children one has). God knows me and my limits far better than I do myself (AND I have a sinful inclination to self and self-deception!).

    No one has even hinted at the suggestion that people “should have as many children as physically possible…” In Scripture, some had many, and some had few. What I suggest (which is far beyond Kevin’s post) is that God should decide, and I believe that a fair reading and studying of Scripture gives no indication otherwise. From the beginning of creation (“be fruitful and multiply”) through the end of the NT (where widows are told to “marry, bear children, and manage the home”), the Bible is consistent about God’s design in marriage, and the idea of the blessing of children (and even many children, if God would choose to bless in that way). That is not an abuse of Scripture. That is an accurate assessment of what it says.

    To Kevin DeYoung:
    Thank you for your most gracious article. Some may accuse you of being soft, but it is SO hard to bring up this topic in our current culture when we have been so immersed in the world’s views. Praise God for your courage and kindness in your writing. I wish to emulate your graciousness.

    This is a HUGE topic of discussion and there is so much more that the Scripture teaches. May we each be driven to the Word.

  32. Olivia Sanders says:

    Often, when I read other readers’ comments, I never fail to be taken aback by the harshness of a few select readers’ criticism. I just wanted to briefly say that–to the contrary–I appreciate the way you communicate with wisdom, discretion, and humility. Thanks and please keep it up!

    Kevin (11:17am)–I enjoyed reading your thoughtful comment from the perspective as a dad of 15. It was certainly eye-opening!

  33. anonymous says:

    Feel free to delete this comment. I have no intention to be critical here but wanted to help. In the first sentence of the second paragraph, I think you meant to say “avoid conception”, but “avoid contraception” is written. I realized the typo as I was discussing the article with a friend. This is purely someone attempting to maintain the integrity of this article. Thank you!

  34. Jennie says:

    Thanks Kevin…many Christians I have found, follow culture and just pop the pill when they get married (or before). And many neglect very important discussion with their spouse, like, “How can we honor the Lord with our bodies, our sex life, and our reproductive life?” How can we be wise and God fearing in this area of life?

    I have been encouraged over the 10 years since I married to see many friends who were once very easy-going about taking the pill (or other forms of BC) reconsider what their decisions mean from a heart standpoint.

  35. Melanie says:

    Thank you for posting this! My husband and I decided before we got married (we’ve been married for 2 months) not to use the Pill or any other form of hormonal birth control. We found a site called http://christianfamilyplanning.net/ that offers training in Fertility Awareness, working with your cycle to prevent conception without harming life. It has been such a wonderful help to us as we seek to honor God in this area!

  36. Kevin says:

    Melanie – Great to hear. Just encourage you find if the Word hints at “family planning.” Doesn’t hurt to look into it. “Be fruitful and multiply” seems to encourage just that, not prevention. Happy hunting!

  37. dawn errington says:

    For straight forward well researched info on this topic
    http://www.christian.org.uk/wp-content/downloads/contraceptionguide.pdf
    Hope this is helpful

  38. Kevin says:

    The guide mentioned is pro-life friendly. It does start with the assumption that whether to bring children into the world is our decision, and not God’s sovereign choice. (Not something hinted at in the Word.) The guide is pro-life, but it is not a Biblical presentation of the topic.

    I would suggest reading the Bible through, specifically with the idea of looking for how the Bible presents children, conception, explicit statements about God’s control of conception (opening & closing of the womb, giving conception), God’s necessary control of conception to be able to fulfill His promises to Abraham, the virgin birth, the roles of men and women, the purpose of marriage, and yes, even the commands/blessings of God in Genesis 1. There’s more than one would first assume about this (many say the Bible is silent – not so!).

    Happy hunting.

  39. Alison says:

    Thank you to the author of this articles for your insights and bravery raising a controversial topic.

    5 years ago when I was preparing for marriage, I also stumbled across the same ethical issue.
    When asking a doctor about the pill, she said ‘it works in 2 main ways – one, it stops the release of the egg, two, if conception does happen, the lining of the uterus is thinned out so it doesn’t attach’.

    If we believe life begins at conception, it does raise a few issues that I think people need to think and pray about.

    After doing some research, my husband and I have decided to err on the side of caution by using ‘barrier’ methods of contraception. Both our children have been planned. Even if you have the 2% fallibility rate/year (if used regularly and properly), the ‘consequence’ is a new life, a blessing from God.

    I have found this topic is one that causes people to get quite upset – and I’ve only broached it with a few friends for that reason.

    Hopefully this comment helps anyone trying to decide what birth control method is best for them.

  40. Amy says:

    I think the analogy of shooting a gun at what may be a human isn’t quite accurate.

    Most Christians agree they would never kill a fertilized egg. The question is whether Christians should use birth control when the experts can’t decide if it causes abortions. So maybe a better analogy would be this…

    You’re in a stage play, and you have to shoot a gun at your daughter on stage, but you don’t know if your gun is loaded with blanks or with real bullets. The experts tell you they are blanks, but they have been known to lie, and twist the information. They admit that once in a while a real bullet is in the barrel. Your friends can’t agree if they are blanks or bullets. Your pastor tells you to just pray and decide for yourself if you should shoot or not. What do you do? Phew! The prop guy just came running in with another option! It’s a different kind of gun that doesn’t even take real bullets so there’s no chance of harming your daughter! It’s rather awkward and difficult to use, but you’re told you’ll get used to it. So…. Which gun do you use?

    I’ve just been thinking this through. Des this analogy fit this debate? Help me tweak it, folks. I know it’s harsh, but the what’s at stake is harsh, isn’t it?

  41. Davina Lompa says:

    Ich tue Abbitte, dass sich eingemischt hat… Ich hier vor kurzem. Aber mir ist dieses Thema sehr nah. Ist fertig, zu helfen.johnnydel

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Kevin DeYoung


Kevin DeYoung is senior pastor of University Reformed Church (PCA) in East Lansing, Michigan, near Michigan State University. He and his wife Trisha have six young children. You can follow him on Twitter.

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