September/October, 1997 Volume XII Number 8

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What do the Pill manufacturers say?

I asked an excellent pro-life physician, and a good friend, to call a birth control manufacturer concerning the statements in their inserts. He contacted Searle, whose package insert for their pill Demulen, says "alterations in the . . . endometrium (which may reduce the likelihood of implantation) may also contribute to the contraceptive effectiveness." (Note that Searle twice uses the term "may," in contrast to Ortho and Wyeth, which in their information in The PDR state the same effect as a fact rather than a possibility.)
Here is part of a letter dated February 13, 1997, written by Barbara Struthers, Searle's Director of Healthcare Information Services, to my pro-life physician friend:

Thank you for your recent request for information regarding whether oral contraceptives are abortifacients . . . . One of the possible mechanisms listed in the labeling is "changes in the endometrium which may reduce the likelihood of implantation." This is a theoretical mechanism only and is not based upon experimental evidence, but upon the histologic appearance of the endometrium. However, as noted by Goldzieher, the altered endometrium is still capable of sustaining nidation, as shown by pregnancies occurring in cycles with only a few or no tablet omissions.

Dr. Struthers (PhD) makes a valid point that the Pill's effects on the endometrium do not always make implantation impossible. But in my research I never found anyone who claimed they always do. The issue is whether they sometimes do. To be an abortifacient does not require that something always cause an abortion, only that it sometimes does. In fact, whether it's RU-486, Norplant, the mini-pill or the Pill, there is no chemical that always causes an abortion. There are only those that do so never, sometimes, often and usually. Thus, the point that the Pill doesn't always prevent implantation is true, but has no bearing on the question of whether it sometimes prevents implantation, which Searle's own literature indicates. (Children who play on the freeway, climb on the roof or are left alone by swimming pools don't always get killed, but this hardly proves these practices are safe and do not result in fatalities.)
Dr. Struthers goes on to say, "It is unlikely that OCs would decrease the likelihood of endometrial implantation, particularly when one appreciates that the blastocyst is perfectly capable of implanting in various 'hostile' sites, e.g. the Fallopian tube, the ovary, the peritoneum."
Her point is that the child sometimes implants in the wrong place. True enough -- but, again, no one is saying this doesn't happen. The question is whether the Pill sometimes hinders the child's ability to implant in the right place. (Whether the child implants in the wrong place or fails to implant in the right one, the result is the same -- death. But while in the first case the death is not caused by a human agent, in the second case -- by taking the Pill -- it can be.)
Dr. Struthers then says, "Used as directed, the hormone level in modern OCs is simply too low to cause interception, that is, failure of the blastocyst to implant."
If this is true, then why does the company's own literature -- produced by their researchers and submitted to the FDA, the medical community, and the public -- suggest the contrary? And why do dozens and dozens of scientific and medical sources I am drawing from in this article definitively state the contrary? If Dr. Struthers is right, not just some but all of these other sources have to be wrong.
Dr. Struthers further states, "Until the blastocyst implants . . . there would be no loss of an embryo and, therefore, no abortion. Thus, the theoretical mechanism of reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition."
Now we cut to the heart of her presuppositions. Having said implantation won't be pevented, she then says even if it is (why add this if it never happens?), the result isn't really an abortion. This statement is profound both in its breadth and its inaccuracy. It's a classic logic-class-illustration of faulty reasoning. It's like saying "Sudden Infant Death Syndrome does not affect toddlers; therefore, it does not involve the deaths of human beings." Such a statement assumes facts not in evidence -- that infants are not people because they are pre-toddlers. In exactly the same way Dr. Struthers begs the question by assuming -- without bothering to provide any evidence (there is none) for this assumption -- that pre-embryo human beings are not really human beings.
But if human life does begin at conception, which is the overwhelming biological (not to mention biblical) consensus, then causing the death of a "blastocyst" is just as much an abortion as causing the death (or she puts it, "loss") of an "embryo." The days-old individual is a smaller and younger person than the embryo, but he or she is no less a person in the sight of God who created him. (People do not get more human as they get older and bigger -- if they did, toddlers would be more human than infants, adolescents more human than toddlers, adults more human than adolescents and professional basketball players more human than anyone.)
Dr. Struthers says the "reduced likelihood of implantation by whatever means would not be considered an abortion by any biological definition." This statement is unscientific in the extreme. The biological definition she ignores is not just some obscure definition of life, but the precise definition which the vast majority of scientists, including biologists, actually hold to -- that life begins at conception. (See Appendix B: When Does Human Life Begin? The Answer of Science. An early abortion is still an abortion, and no semantics change this reality. (Though for some they do manage to obscure it.)
The letter from Dr. Struthers certainly contains some valid information along with the invalid. But how seriously can we take its bottom-line conclusions that the Pill is not an abortifacient? One physician I showed it to said a "healthcare information services director" is a public relations position with a primary job of minimizing controversy, denying blame, putting out fires, and avoiding any bad publicity for products with both with physicians and the general public. Perhaps this assessment was unfair -- I don't know. But on reading her letter I determined to personally call the research or medical information departments of all the major birth control manufacturers and hear for myself what each of them had to say.
When I called Syntex, they informed me that all their "feminine products," including the Pill, have recently been purchased by Searle. So I called Searle's customer service line, identified myself by name, and was asked to explain my question. When I said that it related to the Pill's mechanism of preventing implantation, the person helping me (who didn't identify herself) became discernibly uneasy. She asked me who I was (I gave her my name again) and then asked me to wait while she conferred with her colleagues. After several minutes she got back on the line and said "Dr. Struthers will have to talk to you about this, and she's not in."
Since Dr. Struthers was unavailable, I asked the woman if she could offer me any guidance. She said, uneasiness very evident, "By any chance are you asking about this for religious reasons?" I said, "Yes, that's part of it." She said, "Well, I can tell you that our pills are not abortifacients." I asked "then why does your professional labeling talk about the Pill reducing the likelihood of implantation?" She said, "I can't answer that question. You'll have to talk to Dr. Struthers." I left my number, but Dr. Struthers didn't call me back. Since I already had her position, as stated in her fax to my physician friend, I didn't call her back either.

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Next I called Organon, the maker of the birth control pill Desogen. After explaining my question about their literature that says the Pill sometimes prevents implantation, I was handed over to Erin in medical services. She informed me "the primary mechanism is preventing ovulation." After my follow-up question, she said, "The other mechanisms also happen, but they're secondary." When I asked how often the primary mechanism fails and the secondary mechanisms kick in, she said "there's no way to determine the number of times which happens and doesn't happen."
Reading between the lines, Erin said, "If you're asking if it's an abortifacient . . . [pause]" I interjected, "Yes, I am." She continued, ". . . that's difficult to ever say that." She added, "What happens is, if ovulation occurs, the Pill will thicken the mucus and thin the endometrium so that it doesn't allow that pregnancy." She quickly added, "but it's not like the IUD." (Meaning, I took it, that preventing implantation is the primary function of the IUD, whereas it is only a secondary function of the Pill.)

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Wyeth-Ayerst Labs is the maker of six combination Pills. I called and spoke with a medical information coordinator named Adrianne. I read to her the professional labeling of their Pills that says "other alterations include changes . . . in the endometrium (which reduce the likelihood of implantation)." I asked if she knew how often the Pill prevents implantation.
Once again it became obvious that I was pro-life, presumably because no one but a pro-lifer would care about this issue. Adrianne read to me a printed statement that said "these mechanisms are not abortifacient in nature." She carefully explained that inhibiting ovulation and thickening the cervical mucus were contraceptive, not abortive. Of course, I agreed 100%. She then said, reading from the statement in front of her, "while it is true that progestins do alter the uterine lining, this is not considered a contraceptive action of these methods. The fact that these methods are not 100% effective and successful pregnancies have occurred clearly demonstrate that successful implantations can occur."
Over the following ten minutes, Adrianne kept talking about the first two mechanisms. I kept asking about the third. Finally she said, "That occurs, but it doesn't prevent a pregnancy." I thought, that's true, it doesn't prevent a pregnancy, it actually ends a pregnancy, but I knew that wasn't what she meant. I then referred her back to Wyeth's professional labeling and pointed out once more the third mechanism. She followed along with her copy and said, "That third effect happens, but it's not considered a contraceptive action, because sometimes it fails to prevent pregnancy."
(Of course, she had already acknowledged that sometimes the Pill fails to prevent ovulation and sometimes the thickened cervical mucus fails to prevent the sperm from impregnating the egg. In the same way a visible pregnancy proves the third mechanism has failed, it proves the other two mechanisms have also failed. Yet they are still considered to be real mechanisms of the Pill, despite the fact they sometimes fail. Why shouldn't the third effect be treated the same way?)
I said, "According to your professional labeling, sometimes your Pills do prevent a fertilized egg from implanting -- is that correct or incorrect?" She paused for a very long time and I heard papers shuffling. Finally she said, "Yes, that's correct, but not always . . . that's why we can't say contraceptives are 100% effective."
I said, "Okay, let me try to summarize, and please correct me if I'm wrong. There are three different ways the Pill operates. #1 usually works. When #1 fails, #2 may work. When #1 and #2 fail, #3 may work. And sometimes all three fail."
She said "Yes, that's correct." She offered to send me information by mail and I gladly accepted the offer. (I had asked Searle and Ortho to do this but they said they didn't have anything they could send me.) She warmly invited me to call back if I needed any more information.
When I received the information in the mail, it contained three things. The first was a cover letter written by Robin Boyle, , R.Ph., Wyeth's Manager of Drug Information. It was clearly a form letter designed for those expressing concerns about abortion, and contained the precise contents that Adrianne quoted to me. Also enclosed was a colorful booklet entitled Birth Control with the Pill, which is designed "to be distributed only with Triphasil sample." In the section "How the Pill Works," it states "The pill mainly prevents pregnancy in two ways." It then speaks of only the first two mechanisms and makes no reference whatsoever to the third, which prevents implantation. (This booklet does not fall under the same FDA requirements of full disclosure that the professional labeling does.)
The detailed, fine print "professional labeling" was also enclosed, and, as reflected in The PDR, it does in fact speak about "alterations include changes in . . the endometrium (which reduce the likelihood of implantation)." It struck me as obvious that virtually everyone receiving this information would read the large print, attractive, colorful, easy-to-understand booklet (which makes no mention of the abortive mechanism), and almost no one would read the extremely small print, black and white, technically worded, and completely unattractive sheet -- the one that acknowledges in the fine print that the Pill sometimes causes abortions by preventing implantation.
It is safe to say that virtually none of Wyeth's consumers will read the highly technical study printed in a 1988 International Journal of Fertility article, by none other than Wyeth's own Regional Director of Clinical Research, who stated one way oral contraceptives work is "by causing endometrial changes that will not support implantation." (Dr. G. Virginia Upton, "The Phasic Approach to Oral Contraception," The International Journal of Fertility, volume 28, 1988, page 129.)

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On March 24, 1997, I had a lengthy and enlightening talk with Richard Hill, a pharmacist who works for Ortho-McNeil's product information department. (Ortho-McNeil and Searle are the largest birth control pill manufacturers.) I took detailed notes. Hill was not guarded, was most helpful, and never asked me about my religious views or my beliefs about abortion. He informed me "I can't give you solid numbers, because there's no way to tell which of these three functions is actually preventing the pregnancy; but I can tell you the great majority of the time it's the first one [preventing ovulation]."
I asked him, "Does the Pill sometimes fail to prevent ovulation?" He said "yes." I asked, "What happens then?" He said, "The cervical mucus slows down the sperm. And if that doesn't work, if you end up with a fertilized egg, it won't implant and grow because of the less hospitable endometrium."
I asked him how many of the contraceptives available on the market are low dose. He said, "I don't have statistics, but I also work in a pharmacy and I can tell you the vast majority of the time people get low dose pills." He confirmed that there are some "higher dose" pills available, with 50 micrograms of estrogen instead of 20-35 micrograms, but said these were not commonly used. (Remember, even 50 micrograms is only 1/3 of the average estrogen dosage in pills of the 1960's, and is still low dose by those standards.)
I then asked Hill if he was certain the Pill made implantation less likely. "Oh, yes," he replied. I said, "So you don't think this is just a theoretical effect of the Pill?" He said the following, as I took detailed notes:

Oh, no, it's not theoretical. It's observable. We know what an endometrium looks like when it's richest and most receptive to the fertilized egg. When a woman is taking the Pill you can clearly see the difference, based both on gross appearance -- as seen with the naked eye -- and under a microscope. At the time when the endometrium would normally accept a fertilized egg, if a woman is taking the Pill it is much less likely to do so.

I asked Hill one more time, "So you're saying this is an actual effect that happens, not just a theoretical one?" He said, "Sure -- you can actually see what it does to the endometrium and it's obvious it makes implantation less likely. The only thing that's theoretical is the numbers, because we just don't know that."
The pills produced by Searle, Ortho, Wyeth and Organon are essentially the same thing, with only slightly different combinations of chemicals. The professional labeling is essentially the same. The medical experts at Searle, Wyeth and Organon were all quick to pick up my abortion-related concerns and attempted to defuse them. Despite this, the pharmacist at Ortho and the medical services people at Organon and Wyeth all three acknowledged as an established fact what their literature says, that the Pill sometimes prevents implantation. Dr. Struthers of Searle appears to deny this, but then explains that if it happens it isn't really an abortion. When I stack up these responses to the wealth of information I've found in my research, I am forced to believe the people at Ortho, Wyeth, and Organon, not Dr. Struthers at Searle.
While I know that some of what she said is wrong (including the notion that preventing implantation is not a real abortion), I hope and pray that Dr. Struthers is correct and that her position is more than just a careful public relations ploy to placate known pro-lifers and religious people. The totality of my research, however, convinces me her position is simply not based on the facts.
I think the key issue is whether the Pill's prevention of implantation is "theoretical" or actual. None of the other three manufacturers spoke of it as anything other than actual except Dr. Struthers at Searle, who said it is "a theoretical mechanism only." Pharmacist Hill at Ortho stated it was "not theoretical," but based on direct, measurable observation of the endometrium. Who is correct?
Imagine a farmer who has two places where he might plant seed. One is rich, brown soil that has been tilled, fertilized and watered. The other is on hard, thin, dry and rocky soil. If the farmer's wants as much seed as possible to take hold and grow, where will he plant the seed? The answer is self-evident. On the fertile ground.
Now, you could say to the farmer that his preference for the rich, tilled, moist soil is based on the "theoretical," because he has probably never seen a scientific study that proves this soil is more hospitable to seed than the thin, hard, dry soil. The farmer might reply, based on years of observation, "I know good soil when I see it -- sure, I've seen some plants grow in the hard, thin soil too, but the chances of survival are much less there than in the good soil. Call it theoretical if you want to, but we all know it's true!"
When Dr. Struthers points out some newly conceived children manage to grow in hostile places, this in no way changes the obvious fact that many more children will survive in a richer, thicker, more hospitable endometrium than in a thinner, more hostile one. In this sense, the issue isn't theoretical at all.
Several articles I read spoke of the mucus's ability to block sperm migration and presented as evidence the fact that the thickness of the mucus is visually observable. Of course, this appearance is not incontrovertible proof that it slows down sperm migration, but it is still considered valid evidence. Why would we question the validity of the endometrium's appearance?
Obviously, when the Pill thins the endometrium, and it certainly does, a fertilized egg has a lesser chance of survival. This means a greater chance of death. Hence, without question a woman's taking the Pill puts any conceived child at greater risk of being aborted than if the Pill wasn't being taken. Other than for reasons of wishful thinking, can anyone seriously argue against this?
We may try to take some consolation in believing that abortions happen only in theory. But we must ask, if this is a theory, how strong and credible is the theory? Once it was only a theory that plant life grows better in rich fertile soil than in thin eroded soil. But it was certainly a theory all good farmers believed in and acted upon, having every reason to believe it was true.

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Still more evidence

Three Physicians
Dr. Paul Hayes, a pro-life Ob/Gyn in Lincoln, Nebraska, pointed me to Leon Speroff's and Philip Darney's authoritative text A Clinical Guide for Contraception (Williams & Wilkins, 1992). Dr. Hayes calls Dr. Speroff, of the Oregon Health Sciences University in Portland, "the nation's premier contraceptive expert and advocate." Speroff's text, written for physicians, says this on page 40:
Since the effect of a progestational agent will always take precedence over estrogen (unless the dose of estrogen is increased many, many fold), the endometrium, cervical mucus, and perhaps tubal function reflect progestational stimulation. The progestin in the combination pill produces an endometrium which is not receptive to ovum implantation, a decidualized bed with exhausted and atrophied glands. The cervical mucus becomes thick and impervious to sperm transport. It is possible that progestational influences on secretion and peristalsis within the Fallopian tube provide additional contraceptive effects.

As a leading scientific expert on the Pill, Dr. Speroff must be taken seriously when he states that the Pill creates "an endometrium which is not receptive to ovum implantation." This means that the Pill does in fact cause abortions.
In an e-mail to me dated February 22, 1997, Dr. Hayes pointed out a semantic aspect of Dr. Speroff's statement which I, as a nonphysician, wouldn't have noticed:
I was struck dumb when I read this, at the fact that Dr. Speroff would expect me, as a doctor, to accept the 'implantation' of an 'ovum.' Call it a fertilized ovum, or a blastocyst, or a zygote, or any one of a number of other dehumanizing names for a baby, but don't warrant to me, in a textbook for doctors, that what implants is just an ovum!
Dr. Hayes's point is that "ovum" used without a qualifier always means unfertilized ovum, and that Dr. Speroff is misusing the term consciously or unconsciously to minimize the taking of human life inherently involved in the preventing of implantation. This type of semantic manipulation is common in later stages, as demonstrated by references to "terminating a pregnancy" instead of "taking a child's life." It is further illustrated in the fact that Dr. Speroff includes as a form of "contraception" the destruction of an already conceived person.
In an interview conducted by Denny Hartford, director of Vital Signs Ministries, Pharmacist Larry Frieders, who is also Vice-president of Pharmacists for Life, said this:
Obviously, the one "back-up mechanism" [of the Pill] that we're most concerned with is the one that changes the woman's body in such a way that if there is a new life, that tiny human loses the ability to implant and then grow and be nourished by the mother. The facts are clear -- we've all known them intellectually. I learned them in school. I had to answer those questions on my state board pharmacy exam. The problem was getting that knowledge from my intellect down to where it became part of who I am. I had to accept the fact that I was participating in the sale and distribution of a product that was, in fact, causing the loss of life. ("The New Abortionists," Life Advocate, March 1994, page 26)

Later in the same interview, Hartford asked world famous fertility specialist Dr. Thomas Hilgers, "Are there any birth control pills out there that do not have this potential to abort a developing child?" Dr. Hilgers answered,

There are none! At my last count in looking at the Physicians Desk Reference . . . there were 44 different types of birth control pills. . . . and they have different concentrations of chemicals that make them work. None of these so-called birth control pills have a mechanism which is completely contraceptive. Put the other way around, all birth control pills available have a mechanism which disturbs or disintegrates the lining of the uterus to the extent that the possibility of abortion exists when break-through ovulation occurs. (Life Advocate, March 1994, page 28-29)

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Three more risks of the Pill to preborn children

In My Body, My Health (Stewart, Guess, Stewart, Hatcher; Clinician's Edition, Wiley Medical Publications, 1979, page 169-70), the authors point to still another abortive potential of the Pill:

Estrogen and progestin may also alter the pattern of muscle contractions in the tubes and uterus. This may interfere with implantation by speeding up the fertilized egg's travel time so that it reaches the uterus before it is mature enough to implant.

In its 1984 publication "Facts About Oral Contraceptives," the U.S. Department of Health and Human Services stated,

Though rare, it is possible for women using combined pills (synthetic estrogen and progestogen) to ovulate. Then other mechanisms work to prevent pregnancy. Both kinds of pills make the cervical mucus thick and 'inhospitable' to sperm, discouraging any entry to the uterus. In addition, they make it difficult for a fertilized egg to implant, by causing changes in Fallopian tube contractions and in the uterine lining.

As noted by the previous source, these changes in Fallopian tube contractions can speed up the fertilized egg's travel time, and bring it to the endometrium when it is too immature to implant. This is another abortive possibility distinct from and in addition to the endometrium's inhospitality to the blastocyst.
But that's not all. There's yet another threat posed to a young child by the Pill. It was pointed out to me by a couple from my church who stopped using their pills after reading the package insert. I have in front of me that insert. It concerns Desogen, a combination birth control Pill produced by Organon. Near the end of the two page paper it has a heading called "Pregnancy Due to Pill Failure," under which it states:

The incidence of pill failure resulting in pregnancy is approximately one percent (i.e., one pregnancy per 100 women per year) if taken every day as directed, but more typical failure rates are about 3%. If failure does occur, the risk to the fetus is minimal.

Exactly what is this risk to the fetus? When I asked Dr. Bill Toffler of the Oregon Health Sciences University, he informed me that the hormones in the Pill, progestin and estrogen, can (though often they don't) have a harmful effect on an already implanted child. The problem is, since women do not know they are pregnant in the earliest stages, before realizing they are pregnant they will continue to take the Pill at least one more time, if not two or more (especially if cycles are irregular). This creates the risk the leaflet refers to. So not only is the pre-implanted child at risk, but so is an already implanted child who is subjected to the Pill's hormones.
The risk is called "minimal." But what does this mean? If someone was about to give your child a chemical and they assured you there was a "minimal risk," would you allow them to proceed without investigating to find out exactly what was meant by "minimal"? Wuldn't you ask whether there was some alternative treatment without this risk? Rather than be reassured by the term "minimal," a parent might respond, "I didn't know that by taking the Pill I caused any risk to a baby -- so when you tell me the risk is 'minimal' you don't reassure me, you alarm me."
So, in addition to the risk of abortion due to an atrophied endometrium, we must add the risk of the Pill causing Fallopian tube contractions that throw off the crucial timing of the blastocyst's arrival at the endometrium, as well as the chemical risk to an already implanted child.
If that isn't enough, there's still another risk, this one to children conceived after a woman stops taking the Pill:

There is some indication that there may be a prolonged effect of the oral contraceptives on both the endometrium and the cervix after a woman has ceased taking the pill. There may well be a greater likelihood of miscarriage in that period also as a result of some chromosomal abnormalities. . . . It is worth noting that the consumer advice from the manufacturers cautions that pregnancy should be avoided in the first three months after ceasing the combined oral contraceptive. (Nicholas Tonti-Rilippini, "The Pill: Aortifacient or Contraceptive? A Literature Review," Linacre Quarterly, February 1995, page 8-9)

Why should pregnancy be avoided three months after no longer using the Pill? Is it because the Pill produces effects that threaten the life and welfare of a child? If those effects are not considered no longer a risk until three months after the Pill was last taken, what does this say about the risk they pose to any child conceived when the Pill fails to stop ovulation?

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The new Morning After Pill: Standard BC pills

In June, 1996 the Food and Drug Administration announced a new use for standard combination birth control pills:

Two high doses taken within two to three days of intercourse can prevent pregnancy, the FDA scientists said. Doctors think the pills probably work by preventing a fertilized egg from implanting in the lining of the uterus. ("FDA panel: Birth control pills safe as morning after drug," The Virginian-Pilot, June 29, 1996, A1, A6.)

On February 24, 1997, the FDA approved the use of high doses of combination birth-control pills as "emergency contraception" (Peter Modica, "FDA Nod to `Morning-After' Pill Is Lauded," Medical Tribune News Service, February 26, 1997). The article explains,

The morning-after pill refers to a regimen of standard birth control pills taken within 72 hours of unprotected sex to prevent an unwanted pregnancy. The pills prevent pregnancy by inhibiting a fertilized egg from implanting itself in the uterus and developing into a fetus.

Of course, the pills do not "prevent pregnancy" since pregnancy begins at conception, not implantation. (Acting as if pregnancy begins at implantation takes the emphasis off the baby's objective existence and puts it on the mother's endometrium's role in sustaining the child that has already been created within her.) As World magazine (March 8, 1997, page 9) points out, "In reality the pill regimen -- designed to block a fertilized egg from implanting into the uterus -- aborts a pregnancy that's already begun."
It is significant that this "morning after pill" is in fact nothing but a combination of several standard birth control pills taken in high dosages. When the announcement was made, the uninformed public probably assumed that the high dosage makes birth control pills do something they were otherwise incapable of doing. But the truth is it simply increases the chances of doing what it already sometimes does -- cause an abortion.
In a April 29, 1997 USA Today cover story (page 1A), "Docs spread word: Pill works on morning after," Marilyn Elias wrote,

U.S. gynecologists are launching a major nationwide campaign to make sure women know about the best-kept morning-after contraceptive secret: common birth control pills. . . . Some oral contraceptives may be taken after intercourse -- two in the first dose up to 72 hours after sex, then two more 12 hours later -- and will prevent 75% of pregnancies . . . Critics call the morning-after method de facto abortion, but Zinberg says the pills work before an embryo implants in the uterus so there's no abortion.

Again, the truth is these pregnancies aren't prevented, they are terminated. It's semantic gymnastics to redefine abortion in such a way that killing the fertilized egg doesn't qualify. Life does not begin at implantation, it begins at conception. To suggest that a fertilized egg is not a living person just because she has not yet settled into her home (the endometrium), and therefore it's fine to make her home hostile to her life, is as fallacious as suggesting the homeless are not really people since they aren't living in a house, and it's therefore all right to burn down homes they might otherwise have inhabited and leave them out in the cold to die.
After all is said and done, the Pill appears to be different only in degree, but not in kind from every other birth control chemical, including RU-486, Depo-Provera, Norplant, the mini-pill and the morning after pill. It may not cause as many abortions as these, but like all of them, it does in fact cause abortions.

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Evidence to the contrary?

Is there any evidence refuting the abortive potential of the Pill? I have not only searched far and wide to find such evidence myself, I have also asked a number of physicians to provide me with any they have or know of. Beyond the letter from Dr. Struthers at Searle, dealt with previously, I have seen very little of such evidence.
One source is "Advances in Oral Contraception" in The Journal of Reproductive Medicine (January 1983, page 100 ff.). The article is a question and answer session with eight physicians. The pro-life physician who gave this to her pastor underlined several statements that in her mind do not support the evidence that the Pill causes abortions. This is one of them:

Do the OCs with 30 micrograms of estrogen act primarily by preventing implantation rather than suppressing ovulation?
Dr. Christie: "Our studies in Europe and Canada showed that the 150/30 pill's main mode of action is inhibition of ovulation." (page 101)

This statement is not in conflict with the evidence I've presented. No one disputes whether the inhibition of ovulation is the Pill's main mode of action, only whether preventing implantation is a secondary or tertiary mode. A more significant segment of the same article is this one:

Are factors besides anovulation affected by the contraceptive action of the Pill?
Dr. Christie:
Yes -- cervical mucus, maybe nidation, the endometrium, so it's not in the appropriate condition for receiving a fertilized ovum. The authorities agree that with the LH and FSH changes, no ovulation occurs; the egg isn't there to be fertilized.
Dr. Goldzieher:
Some time ago Pincus found, when studying Enovid 5 and 10, that conceptions occurred with these pills. To me his evidence indicates that there must not be much of an antiimplantation effect on the endometrium if a woman can skip a very-high-dose OC for a few days and become pregnant. If there is an antiimplantation effect, it certainly is absent in some cases.

These statements are significant, but do they only qualify the mountain of other evidence, they do not refute it. Dr. Christie acknowledges the anti-implantational effect of the Pill, but says that with the proper chemical changes no ovulation occurs. He is surely not claiming that these chemical changes always happen in the intended way, nor is he denying that ovulations occur among Pill-takers. He is well aware that pregnancies occur (as Dr. Goldzieher confirms in the very next sentence), and for every measurable pregnancy there are obviously a number of breakthrough ovulations.
Dr. Goldzieher, whose own work, cited elsewhere in this booklet, acknowledges the antiimplantation effect, is affirming that "it certainly is absent in some cases." He bases this on the fact that pregnancies do occur. This is akin to Dr. Struthers' point that the blastocyst sometimes implants in 'hostile' sites such as the Fallopian tubes and the ovaries, and also in the Pill-affected endometrium. The point, a valid one, is that the conceived child sometimes implants in more hostile environments. But this is no way undermines the obvious fact that he will more often implant in a more favorable environment.
Once again, no one is claiming that the Pill's diminishing of the endometrium always makes implantation impossible. Obviously it doesn't. The issue is whether it sometimes does. That plants can and do grow through cracks in driveways does not negate the fact that they will more likely grow in the tilled fertile soil of the garden. The Pill's changing the endometrium from fertile to inhospitable does not always result in an abortion, but sometimes it does. (And "sometimes" is all it takes to be an abortifacient.)
I have before me an article, a four page letter from a pro-life physician, assuring the recipient that the Pill, Norplant and Depo-Provera are not abortifacients, while RU486, the "morning after pill" and the "minipill" are. She is not certain about the IUD. The letter is well written, but it is missing a crucial element -- it does not cite a single study or produce any evidence whatsoever to back up any of its claims. (The sole reference is to a textbook that may somewhere within it -- no page numbers indicated -- offer evidence that the IUD does not really cause abortions.) In the absence of any such evidence, I am forced to conclude that this letter is simply a sincere expression of the physician's personal beliefs about birth control methods. Unfortunately, beliefs do not constitute evidence.
I was also sent a photocopied page from an article, but unfortunately the name and date of the publication isn't included and I have no way to trace it. The article is an excerpt from a speech by a pro-life physician named Dr. Mastroianni:

"It's also important," Dr. Mastroianni added, "when talking about oral contraception, to dispel any idea that the pill acts as an abortifacient. Propaganda has led some people to believe that somehow the pill works after fertilization, and that's further from the truth than anything I can think of. The pill works by inhibiting ovulation, as well as by thickening the cervical mucus and therefore inhibiting sperm migration."

This confident claim is made wihtout the offer of any evidence to support it. (Leveling the accusation of "propaganda" is not the same as presenting evidence, or refuting it.)
When the scientific and medical sources, including not just reference books but original studies reported in medical journals over decades, consistently affirm there is a third effect of the Pill that does in fact work after fertilization, how can a physician state this to be "further from the truth than anything I can think of"? When these sources consistently and repeatedly conclude there are at least three ways the Pill works (one of which is clearly abortive), how can someone definitively say there are really only two?
I do not consider this quotation from a well-meaning pro-life physician as evidence of anything but the human tendency (which I confess to as well) to deny something we do not wish to believe. (If a reader knows Dr. Mastroianni, and he does have evidence for his beliefs not cited in his presentation or this article, I would very much like to see it.)
When I submitted to him a half dozen of the sources I've cited in this booklet, a pro-life physician I very much respect wrote this to me:

It is known fact that 6% of women on bcps will become pregnant while on the pill, meaning that cervical mucous failed, ovulation occurred, and implantation was successful. This implies that when bcps don't work, it is because they totally fail, and that when mechanisms 1 and 2 don't work, implantation is not prevented by the bcps causing an early abortion. If I believed bcps worked by causing abortion, I wouldn't recommend them. I firmly believe that when they work, they work by preventing ovulation and by creation of thick cervical mucous.

I do not question this physician's sincerity, but I do question the logic. We do not know how often mechanism number one, two or three actually work, we only know that sometimes all three fail. But because number one and two sometimes fail, no one therefore concludes that they always fail. So why conclude that because number three sometimes fails, therefore it always fails?
How can we look at a known pregnancy, which proves the failure of all three mechanisms, then conclude that number one and number two normally work, but that number three must never work? The logic escapes me. If number three were not abortifacient in nature, I don't think anyone would deny that it happens. The denial is not prompted by the evidence but by the desire that what the evidence indicates not be true.

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How often does the Pill cause abortions?

Though it is clear that the Pill does in fact cause abortions, it is difficult to determine the numbers of times it does this. This depends on how often the Pill fails to prevent ovulation, and how often when ovulation succeeds and pregnancy occurs, the third mechanism prevents a fertilized egg from implantation.
I posed the question to Dr. Harry Kraus, a physician and writer of popular novels with medical themes. This was his response in a December 23, 1996 e-mail:

You have asked a very good question, but one which is impossible to answer in concrete statistics: How often do birth control pills prevent pregnancy by causing the lining of the uterus to be inhospitable to implantation? You will not see an answer to that question anywhere, with our present state of the science. The reason is that we can only detect early pregnancy by a hormone, beta-hcg (Human chorionic gonadotropin) which is produced by the embryo after implantation. After fertilization, implantation does not take place for approximately six days. After implantation, it takes another six days before the embryo (trophoblast) has invaded the maternal venous system so that a hormone (beta-hcg) made by the embryo can reach and be measured in the mom's blood. Therefore, the statistic you seek is not available.

Keeping in mind that definitive numbers cannot be determined, there are nonetheless certain medical evidences that provide rationales for some physicians and pharmacists to estimate the numbers of Pill-induced abortions.
Determining the rate of breakthrough ovulation in Pill-takers is one key to coming up with informed estimates.
In his Abortifacient Contraception: The Pharmaceutical Holocaust (Human Life International, 1993, page 7), Dr. Rudolph Ehmann says,

As early as 1967, at a medical conference, the representatives of a major hormone producer admitted that with OCs [oral contraceptives], ovulation with a possibility of fertilization took place in up to seven percent of cases, and that subsequent implantation of the fertilized egg would usually be prevented.

Bogomir M. Kuhar, Doctor of Pharmacy, is the president of Pharmacists for Life. In his booklet Infant Homicides Through Contraceptives (page 26), he cites studies suggesting oral contraceptives have a breakthrough ovulation rate of 2 to 10%. Fertility specialist Dr. Thomas Hilgers estimates the rate at 4 to 10%, adding that minipills allow ovulation 50-60% of the time ("The New Abortionists," Life Advocate, March 1994, page 29).
Dr. Nine van der Vange, at the Society for the Advancement of Contraception's November 26-30, 1984 conference in Jakarta, stated that her studies indicated an ovulation rate of 4.7% for women taking the Pill.
How do these percentages translate into real numbers? The Ortho Corporation's 1991 annual report estimated 13.9 million U.S. women using oral contraceptives. Multiplying this by the low 2% ovulation figure, and factoring in studies showing a 25% overall conception rate for normally fertile couples of average sexual activity, Dr. Kuhar arrives at a figure of 834,000 birth-control-pill-induced abortions per year. Multiplying by the high 10%, the figure is 4,170,000 per year. The low figure is over 50% the number of surgical abortions (1.5 million), the high is 250% that number. (Using other studies, also based on total estimated number of ovulations and U.S. users, Dr. Kuhar attributes 3,825,000 annual abortions to IUDs; 1,200,000 to Depo-Provera; 2,925,000 to Norplant.)

J.C. Espinoza, M.D., says,

Today it is clear that in at least 5% of the cycles of women on the combined Pill "escape ovulation" occurs. This fact means that conception is possible during those cycles, but implantation will be prevented and the "conceptus" (child) will die. That rate is statistically equivalent to one abortion every other year for all women on the Pill. (Birth Control: Why Are They Lying to Women?, page 28.)

In a segment from his Abortion Question and Answers, published online by Ohio Right to Life, Dr. Jack Willke states:

The newer low-estrogen pills allow "breakthrough" ovulation in up to 20% or more of the months used. Such a released ovum is fertilized perhaps 10% of the time. These tiny new lives which result, at our present "guesstimations," in 1% to 2% of the pill months, do not survive. The reason is that at one week of life this tiny new boy or girl cannot implant in the womb lining and dies.

There are factors that can increase the rate of breakthrough ovulation and thereby increase the likelihood of the Pill causing an abortion. Dr. Bogomir Kuhar says,

The abortifacient potential of OCs is further magnified in OC users who concomitantly take certain antibiotics and anticonvulsants which decrease ovulation suppression effectiveness. It should be noted that antibiotic use among OC users is not uncommon, such women being more susceptible to bacterial, yeast and fungal infections secondary to OC use. (Contraceptives can Kill Babies, American Life League, 1994, page 1.)

© 1997 Advocates for Life Ministries