Monday, April 5, 2010

Jumping To Conclusions

There have been accusations for some years now on the Right that the birth-control Pill is not just contraceptive, by preventing ovulation, but also potentially abortifacient, by causing fertilized eggs to not implant in the uterus (which is a pregnancy by our standards, even though some pro-choice groups would seek to define implantation as the start of pregnancy).

However, the argument does not just come down to a semantical game about when pregnancy begins. Even many Pro-Life experts simply do not believe that there is evidence that the "hostile endometrium" theory or anything like that is true, that the arguments for it are medically faulty or at least baseless. Some would suggest that the "Pill=Abortion" bogeyman has been trumped up by right-wing activists who, by trying to implicate mere contraception in the debate, once again show that, for them at least, opposing abortion is really more about controlling women's sexuality than about protecting life, more of a sex issue than a life issue.

I don't know. I haven't studied the science, so I really have no idea. I do find it a bit strange that it is generally those people who also oppose contraception who try to draw the link between the Pill and abortion. But I myself oppose both objectively either way (though, as I've said before, I don't think condom-use for already promiscuous sex makes the situation morally any worse, and in some ways is just common sense).

And I think a culture that practices contraception so liberally will practice abortion almost inevitably. Though I think the link is perhaps more indirect than some on the Right would imply. I don't think there is so much a causative link between accepting contraception and accepting abortion, rather I think it has more to do with attitudes about the meaning of sex and of life in general, and that is what causes a parallel acceptance of both.

But, either way, some of the "Pill as Abortion" crowd's logic is definitely specious, and so even if there really is an abortifacient aspect to the Pill, it makes them lose credibility. Like this, in response to the question "So how do you prove that the pill acts as an abortifacient? ":

The answer to this question can be found by comparing the rate of break-through ovulation and the detected pregnancy rate. The ovulation rate has been reported to be about 27 ovulations in 100 women using the pill for one year. But the detected pregnancy rate is much lower at around 4 pregnancies per 100 women using the pill for one year.

As you can see, there is a big difference between the number of women who ovulation (27) and the number of detected pregnancies (4). What has happened within the woman’s body to reduce the high ovulation rate to such a low number of detected pregnancies? I suggest that one answer to this important question is that pregnancies have begun, because ovulation and fertilization have occurred, but some of these pregnancies are terminated because implantation cannot take place. The pill has damaged the lining of the womb, stopping implantation.
But that makes a lot of assumptions. Out of 1200 ovulations that should have happened (ie, without the Pill) over the course of 12 months to those 100 women, the number of ovulations is not actually reduced to zero, but rather to 27. But the number of detectable pregnancies that occur on the Pill to those same women is only 4. Therefore, they assume 23 eggs have been fertilized but not implanted.

But that simply doesn't follow. Because a woman doesn't have to get pregnant every time she ovulates. Maybe some of the women didn't have sex during ovulation the month that the "breakthrough" occurred. Maybe some of their partners were using condoms. There are lots of other reasons that those 23 ovulations wouldn't necessarily result in pregnancy, especially if these were rare and random ovulations.

They seem assuming that, just because the woman is on the Pill, she must be having sex all the time, during every ovulation, and her partner must not be using condoms. So they are letting their mental image of Pill-using women as sluts bias their logic. "What has happened within the woman’s body to reduce the high ovulation rate to such a low number of detected pregnancies?" I'd argue that nothing has necessarily happened inside her body; it may well have happened outside her body, in the form of her partner also using condoms, or her simply not having sex during the time of those ovulations. That could easily account for a mere 23 ovulations not resulting in detectable pregnancy, in 100 women over the course of a whole year, without needing to invoke any alleged abortifacient action.

They claim that the difference between 27 and 4 is a "big difference," from a "high" ovulation rate to a "low" pregnancy rate...but in reality, 27 ovulations resulting in only 4 pregnancies is quite within the normal range, is what would be expected even without any hormonal contraceptives.

Once again, I'm not a scientist, I don't know if the arguments that the Pill is also abortifacient have any merit, though I would oppose it either way simply for being contraceptive. But faulty logic like that above...certainly doesn't help to give the claim credence, and makes them look like they judge all these things based less on sound reasoning, and more on naive caricatures of sexually-active women. I think that Statement of Pro-Life OB/GYNs arguing that the Pill is not, in fact, abortifacient seems a lot less biased to say the least, though I can't really judge the science.

Update: Please read the comments section to this post too, there's been some really good substantive discussion there about the whole issue of the Pill's alleged "abortifacient" properties...


sortacatholic said...

This is an intriguing question, but it's rather irrelevant to Catholic moral life. humanae vitae's absolute prohibition of contraceptive methods other than periodic abstinence derives from an anthropological-theological conclusion and not necessarily biological observations. The anthro-theological bases of HV would trump even the most rigorous case that the Pill does not interfere with uterine implantation.

HV is a stumbling block for many. Empirically, I'm not convinced that birth control use necessarily leads to bad marriages as many NFP advocates are wont to say. HV requires a high level of fideism, which is sometimes difficult when one has a very rationalistic mind. To deny HV is to deny the grand mechanisms of salvation history, especially the anthropological assumptions of Hebrew Scripture and the Incarnation. The unequivocal defenses of HV heard on EWTN and on orthodox websites bar no holds.

A Sinner said...

I 100% agree with you.

As I said, even it if isn't's still immoral as contraception.

Michael D said...

I agree that the reasoning of the article was specious and biased, I mean 4 pregnancies out of 27 ovulations? That's almost 15% percent. Women in their lifetimes, if on average they conceive twice have about a .5% rate of conception assuming 500 ovulations. A rate of 15% should seem suspicious, if anything, because it is extraordinarily high. That study was obviously unhelpful.

However, that does not mean the issue is settled. The pill is specifically designed to have several effects, only one of which is suppression of ovulation. Obviously, not all women's bodies are the same, so many ova "slip through the cracks" as it were. To combat this, Pill manufacturers added other "safeguards" against pregnancy, including thickening of cervical mucous and movement of Fallopian tubes, which make it difficult for sperm to fertilize the ovum, and, more importantly for this discussion, reworking of the endometrial lining, to prevent implantation. Companies manufacturing the pill specifically design it such that fertilized eggs won't be able to implant. Whether this happens often or not is irrelevant, the fact is, the Pill is specifically designed by its manufacturers to have abortifacient properties, even if that isn't its primary goal.

Of course, as an Orthodox site, we all agree that contraception is in itself wrong, so this issue doesn't seem to be anything more than a semantical dispute. As you yourself say, "Even it if isn't abortifacient, it's still immoral as contraception."

However, this does have pragmatic effects in the civil discourse. I remember reading the testimony of some Pro-life Protestant preacher who used the Pill as a contraceptive with his wife, until he found out its potential as an abortifacient. Apparently, he was very outraged, and rallied a bunch of his followers together on some crusade against the pill. Even if it seems like a semantical dispute for the Orthodox, in the civil dispute it has significant consequences for winning ideological allies.

Michael D said...

Randy Alcorn, that's the name of the Protestant Pro-lifer I mentioned.

A Sinner said...

Yes, but it's Randy Alcorn's conclusions which are disputed by, for example, that group of Pro-Life OB/GYNs...

There may be evidence that the Pill is designed to prevent implantation. I'm not sure. The point is that the point is debated, and that the question shouldn't be ideological.

It's wrong either way, but there is no reason to try to "prove" that the Pill has abortifacient properties if, in fact, it doesn't.

Attempts to prove it as if this is an apologetics question rather than a scientific question can wind up making the people arguing look disingenuous, as in the example I provided, and cost them credibility.

I'm not entirely convinced the evidence is there, but if it should stand on it's own. It shouldn't need to be shored-up by false logic. That's what caused all those problems in "Climategate". Scientific questions should not be made into ideological ones.

If it's true, then the evidence will show that. If it's not, then it won't. This isn't about winning the debate, it's about trying to find out the facts of the matter.

*And we're orthodox with a lower-case o. I haven't jumped ship yet, lol...

Michael D said...

Apologies, I will pay closer attention to my capitalizations in the future.

sortacatholic said...


To combat this, Pill manufacturers added other "safeguards" against pregnancy, including thickening of cervical mucous and movement of Fallopian tubes, [...] [and] reworking of the endometrial lining, to prevent implantation.

Your observations, though correct, actually offer ammunition to those who deny HV's periodic abstinence. Theoretically the Pill continually effects a woman's natural infertile periods. Many who doubt or disregard HV's moral prescriptions do so because they recognize the biological similarity between the Pill's inducement of sterility and natural periodic sterility.

I've often wondered why NFP seminars often dodge this bullet. As said, HV (and Theology of the Body) are narratives based squarely on revelation. Perhaps the engaged should be given exegetical and theological instruction first before claims about the effectiveness of NFP and instructions on its use.

A Sinner said...

I've read that too; that the Pill isn't really any "worse" than a woman's natural infertile period each month. That it's quite possible that there could be a freak ovulation during that period as well which might have a harder time implanting.

But is simply extending that natural period (which NFP relies on) really "abortifacient"...

I don't know. To be honest, the threat seems to be being exaggerated for ideological reasons, as if a scare tactic.

Michael D said...

Well, the pill induces the woman's body to behave hormonally as if she were pregnant, but that's hardly the same as saying it behaves similarly to a woman's natural infertile periods. Suppressed ovulation occurs naturally when a woman is already pregnant, inducing that state artificially by taking the pill lends itself to a whole other host of moral implications. The issue here, morally, being the real meaning of "abortion."

Technically, any conception that is not carried to term is an "abortion," but things like a miscarriage are involuntary abortions, as opposed to elective abortions (surgical, chemical, etc.) The point being, that when a woman who is pregnant's body fails to suppress ovulation, and that ovum is fertilized, but her endometrial lining prevents implantation of the second egg, that is an involuntary abortion, and no moral approbation could possibly be assigned her. Whereas, it could be argued that a woman who has artificially simulated pregnancy hormonally by taking the pill is morally responsible for such an abortion, just as if she had had some surgical procedure to terminate the pregnancy.

NFP is really not meant to be used as an alternative to contraception, but I suppose there are pragmatic concerns that could justify teaching it as such (to Protestants or whatever). Scientific studies on the Potomac River in DC have determined that certain male fish are becoming androgynous due to the increased estrogen levels in the river, and scientists have linked this increase to proliferation of birth control pills. There are certainly pragmatic concerns for restriction of access to the Pill (sewers and other runoff drain directly into the river). Of course, A Sinner will probably claim that this study exemplifies the kind of ideological bias that is present in the climate change debate, C'est la vie.

As for those who would argue against HV; if people can justify in their own minds how taking hormonal supplements to alter their body chemistry is the same as relying on their natural, infertile period, then I can't really say anything to change their minds. If they refuse to accept the divinely conceived order of their bodies, and instead demand the ability to alter it as they please, then their problem stems much deeper than simply that of contraception.

A Sinner said...

No, I think the fish study is an interesting one. I certainly know that even tiny amounts of mercury from dental fillings have to be specially treated and not just allowed to go down the drain. I wouldn't accuse them of ideological bias unless i found out that the study was done by, say, the Anti-Contraception Alliance or something like that. Then I'd be a little suspicious.

I'm not trying to justify the use of the pill, and would frankly be fine with banning it (as long as condoms and other barrier methods were still tolerated legally for those who do choose to fornicate).

The difference between involuntary and voluntary is an important one, but one must ask whether a woman on the Pill is intending the abortion any more than the woman who has sex only during her infertile periods.

I don't think either is assuming the freak ovulation will occur, but both are risking a less favorable endometrium for the embryo if it does. Should a woman abstain during her infertile period to avoid that risk? The Church doesn't teach that, because the risk is so small and unintended.

It definitely is taught that she shouldn't deliberately CAUSE infertility unnaturally...but the question is whether that contraceptive act can also be interpreted morally as extending to a (greater) culpability for any non-implantation that some say might occur in such a circumstances if there were a freak ovulation.

Causing the infertility is certainly immoral, but the question is, once that is induced...whether additional effects that naturally follow from such a state are culpable. If the causation is proximate or remote at that point.

I don't really know, it seems to be a debated point, as does even the question of whether any of these non-implantations of break-through ovulations really are occurring or if they are attributable to the Pill's effects.

Michael D said...

Well, if you pushed a rock down a hill, and it rolled over someone's leg, would you be morally culpable for that? Even if the pushing is only the proximate cause and the natural effects of gravity cause it to roll over that other person's leg? Of course you would still be culpable. Even if you didn't know of the person's presence, and therefore could not have foreseen the injury, you would still be culpable. Likewise, a woman who takes the Pill is responsible for any abortionifacient consequences that might occur henceforth.

A Sinner said...

I'm not so sure, though I'm interested in your points, my mind isn't totally made up yet.

There are risks in everything we do, but at a certain point they're so small that they need not enter into our moral considerations, even if what were are doing is also wrong in itself.

Part of it comes down to both the gravity of the risk and the probability it will occur. Surely abortion is a grave risk, but is the probability high enough in this case to hold a person culpable of abortion who didn't intend it? If they know there is that tiny chance?

In fact, we are required to avoid sufficiently grave risks if there is a sufficiently large chance it will happen...even if what we are doing is a NEUTRAL or even Good activity.

Now, the Church doesn't seem to consider the risk of non-implantation during infertile periods to be a probable enough risk, as it allows sex during the naturally infertile period.

If the risk of abortion were sufficiently during the infertile period would be forbidden, period, as too risky. But it isn't treated that way, because the risk is so very low.

Likewise, then, I don't think a person would be held culpable of abortion, of murder, even if they were the one who unnaturally caused the infertile period, unless it can be demonstrated that the rate of non-implantation is extremely probable, is much higher than the rate during the normal infertile period.

I guess it might be said that the good of marital NFP sex outweighs the risk in a way that Pill sex can't (because it isnt good in itself). But when the risk in question is a threat to human life...I doubt that risk is "small enough to be outweighed by the good of marital sex, but not so small as to be totally discounted." Usually, if the probability is large enough to be counted AT ALL...then risk of Death isn't outweighed by any good except saving lives.

To make an analogy, giving alcohol to people under 21 is illegal. But even if you are over 21, there is a small chance you will be allergic and die upon drinking it. But that chance is not high enough to ban alcohol completely. If you gave alcohol to someone over 21, and they had the super-rare allergy and wouldn't be held accountable. Yet, if you give it to someone under 21, and they were allergic and died...would you be responsible for the death?

Again, secular law might hold you accountable, but morally speaking, you wouldn't have committed the sin of Murder, but merely the lesser sin of breaking the law about giving alcohol to minors. Because the risk of the death-by-allergy isn't high enough to need to take into consideration morally (if it were, then alcohol would simply be illegal, period).

If the risk of this non-implantation scenario during periods of less-favorable endometrium were sufficiently high...then sex during infertile periods would be banned completely, regardless of what caused the infertile period. But if the risk is so small that it doesnt have to be taken into account when the infertile period is caused naturally, I don't see why it would have to be taken into account just because it is caused unnaturally. The unnatural causation doesn't change the Risk you're taking or its moral weight, does it?

We might use an analogy with cigarettes and marijuana. One is moral in moderation, the other is not (though only because it is breaking a law). There is a small chance that you could get cancer from just one cigarette, but the risk is so small the Church wouldn't call that a sin. Likewise, I don't think you'd be held culpable of self-mutilation on the off-chance that smoking one joint DID give you cancer, even though smoking the joint was wrong. Because the question is the probability of the Risk, not the morality of the act in which the Risk is present.