The writings of Catholic moral theologians on abortifacient contraception are often lack readily-available information on the medical aspects of this topic, including varying rates of break-through ovulation, health benefits and risks, and the percent risks of an abortifacient event. Some physicians and researchers have used their knowledge to write articles on the ethics of abortifacient contraception. But moral theologians usually present a sparse sampling of the relevant medical information. I’m working on a book that addresses these medical aspects of abortifacient contraception, in great detail. For now, here’s a brief article.
Chemical contraceptives are abortifacient; they are capable of causing the death of the developing human embryo subsequent to conception (fertilization). This type of abortifacient event — the post-fertilization loss of the prenatal human person — is not rare. Based on the analysis in my forthcoming book, the number of abortifacient losses of prenatals from all forms of abortifacient contraception is several times higher than the loss of life due to medical and surgical abortions, worldwide.
For oral contraceptives (OCs) specifically, abortifacient events are not uncommon. The process begins with break-through ovulation (BTO), which is the failure of the OC to do what it is designed to do: prevent the release of the ovum (egg). When break-through ovulation occurs, fertilization is a possibility. The odds of fertilization is based a number of factors, including the frequency of sexual intercourse. OCs are not very effective in their post-ovulation, pre-fertilization mechanisms of action (e.g. thickening cervical mucus).
There are two types of OCs, POPs (progestogen-only pills), which contain only a progestin, and COCs (combined oral contraceptives), which contain a progestin and an estrogen. The only widely-available POP in the U.S. today is NET (norethindrone), which has a high break-through ovulation rate: 34.9% per cycle (based on pooled data from a set of studies). The previous generation POP, which contains LNG, has a higher BTO rate: 65.5% per cycle.
The average number of cycles per year is 12.8. So a break-through ovulation rate per cycle of 34.9% becomes a per year rate of about 447%. This implies, on average, 4 or 5 break-through ovulations. That is 4 or 5 chances for conception and an abortifacient loss to occur every year. (Note that data from medical studies on this topic are always approximations, no matter how many data points are used.)
COCs have lower break-through ovulation rates. But the most common types of COCs (second generation progestins) have yearly break-through ovulation rates ranging from 28 to 110% — with perfect use. Perfect use mean taking the pill every day, at about the same time of day, and not taking any medications that interfere with OCs (antibiotics, antifungals, etc.). Also, vomiting or diarrhea can interfere with the absorption of the pill, making it less effective.
Some of the third generation progestins have lower BTO rates, less than 28% per year. But they also have a higher risk of death from venous thromboembolisms (Spitzer 1996), and unknown risk profiles for some other diseases.
Imperfect use is anything other than perfect use. The most common imperfect use is not taking the pill for 1 to 3 days. The usual reason for imperfect use is the side effects of OCs: nausea, vomiting, abnormal pains, headache, diarrhea, anxiety, etc. Also, certain medications (OTC and prescription) conflict with OCs and render the OCs less effective at preventing ovulation. These meds include antibiotics, antifungals, and antacids. Sometimes taking these types of medications is a medical necessity. Thus, imperfect use is not due to a lack of responsibility. With imperfect use, the break-through ovulation rate increases by 2 to 3 times.
The suggestion made by some moral theologians that, if a woman would only take OCs as directed, the chances of an abortifacient loss would be acceptably low, is based on a false premise: that imperfect use is due to lack of responsible behavior. To the contrary, OCs have substantial side effects, which cause women, reasonably, to stop taking the pill until the side effects diminish. And side effects are common. One study found that 47% of oral contraceptive users miss one or more pills, and that 22% of OC users miss two or more pills per cycle. Since we are taking about a life or death issue for innocent prenatal children, we cannot make the assumption that every woman using OCs will have perfect use and a low rate of break-through ovulation.
In addition, not every woman fits the statistical average. Some women have short cycles. The result is more cycles per year, and a higher chance of break-through ovulation. Some women have a higher rate of break-through ovulation due to the way that their body in particular responds to these types of hormones. And we cannot know which women fit this latter case.
So when certain moral theologians tell women they may use abortifacient contraception because the break-through ovulation rate is low with perfect use, those ethicists are risking the lives of the unborn based on a set of assumptions that cannot occur reliably and regularly in real life. Break-through ovulation is not rare. Rates vary from one woman to another. Imperfect use is common and, at times, unavoidable.
There is no such thing as zero percent break-through ovulation. If a study size is small (few women, few cycles), a failure to find break-through ovulation does not indicate that the OC is 100% effective in preventing ovulation. It just means the study size was too small. Data pooled from multiple studies does not support a claim of zero percent ovulation. Break-through ovulation will occur, especially with lengthy use of OCs.
The failure rate is the pregnancy rate. (In the field of contraception, a woman conceiving human life is termed “failure”. Is that irony, or just sad?) In any case, the failure rate or Pearl Index is the number of women who become pregnant out of 100 women using the method for one year. When studies are done on OC failure rates, they inevitably find low rates of 1 to 3%. But when the general population is studied, there is no such thing as 1 to 3 percent. Certain subpopulations of women, categorized by age, marital status, and economic status, have failure rates as high as 24 to 48%. What kind of break-through ovulation rate allows a pregnancy rate to be so high? (A high one.) The overall failure rate for OCs is 8.1%. This implies a break-through ovulation rate much higher than rates found in some studies.
Now when the use of OCs continues over 5 to 10 years, the probabilities of an abortifacient loss become a near-certitude. Women on the pill for 5 to 10 years have conceived and lost at least a few of their own prenatal children. The math suggests that women on some types of OCs will have 5 to 10 prenatal losses due to abortifacient mechanisms of action over the course of 5 to 10 years. Some women use OCs for 15 to 20 years. About 105 million women worldwide use oral contraceptives. The number of prenatal lives lost is certainly in the tens of millions per year.
So please do not use the name of Jesus Christ and His Church as a rationalization for the deaths of these unborn innocents. The Church has never approved of the use of abortifacient contraception, while sexually active, as if millions of anticipated prenatal deaths were somehow justifiable.
There used to be a webpage on the USCCB.org site, claiming that abortifacient contraception could be used for medical reasons. The page was not a document from any Bishop. The page was not signed by any author. It was an FAQ page. And that page was taken down. The claim that this page represents a magisterial teaching is absurd.
Assertions by the USCCB on the contraceptive mandate, which mention use of abortifacient contraception for medical purposes, do not address the question of whether a married couple must refrain from sex while using the medication. Abortifacient contraception can be used by a woman who is not sexually active, so that the pill has neither a contraceptive, nor an abortive effect.
It is disingenuous, to say the least, to claim that Humanae Vitae 15 implies approval for the use of abortifacient contraception, while sexually active. That passage is a good fit for a hysterectomy to treat a medical disorder. It in no way approve of abortifacients while sexually active. So it is intellectually dishonest to answer a question on the medical use of abortifacient contraception with an unsupported claim that the Church permits it.
Pope John Paul II: “The close connection which exists, in mentality, between the practice of contraception and that of abortion is becoming increasingly obvious. It is being demonstrated in an alarming way by the development of chemical products, intrauterine devices, and vaccines which, distributed with the same ease as contraceptives, really act as abortifacients in the very early stages of the development of the life of the new human being.” [Evangelium Vitae, 13]
Pope Saint John Paul II made his teaching on intrinsically evil acts extraordinarily clear in Veritatis Splendor, and in Evangelium Vitae. No purpose or intention, and no circumstance, however dire, can justify the deliberate choice of an intrinsically evil act. And the use of abortifacient contraception is intrinsically evil as a type of contraception, and as a type of very early abortion.
Pope John Paul II: “Contraception is to be judged objectively so profoundly illicit that it can never, for any reason, be justified. To think, or to say, anything to the contrary is tantamount to saying that in human life there can be situations where it is legitimate not to recognize God as God. Users of contraception attribute to themselves a power that belongs only to God, the power to decide in the final instance the coming into existence of a human being.” [Address on Responsible Procreation]
The idea that John Paul II would approve of the deaths of prenatal children, by the use of abortifacient contraception, as long as the person has a medical purpose in mind, is absurd. His condemnation of intrinsically evil acts, and in particular of abortion, allows for no such conclusion. Contraception, abortion, and abortifacient contraception are each and all intrinsically evil and always gravely immoral.
Furthermore, the principle of double effect NEVER justifies an act that is intrinsically evil. The first criterion for the principle of double effect is that the act cannot be intrinsically evil. Some incompetent authors have claimed that if an act meets all of the conditions in the principle of double effect, then it is not intrinsically evil. (They omit from their list of conditions, that the act not be intrinsically evil.) That claim is a grave error.
The approach of other authors is to redefine the act itself, so that the deliberate use of abortifacient contraception, while sexually active, is somehow said to be not a contraceptive or abortive act. This is done by a series of baseless assertions, such as the claim that it is moral to put the lives of the unborn at risk, if you have a good intention. To the contrary, a moral act must have three good fonts: intention, object, circumstances. A good intention and a difficult circumstance cannot transform an intrinsically evil act into a different type of act, one that is morally defensible.
Medical studies have proven that OCs have the following medical benefits: decreased risks of colorectal, endometrial, ovarian, lymphatic, and hematopoietic cancers; decreased risk of pelvic inflammatory disease; decreased risk of ectopic pregnancy; and treatment of acne; treatment of endometriosis; and possibly other medical benefits. If abortifacient contraception were moral for a medical purpose, every wife would be able to use abortifacient contraception, while remaining sexually active, and this would be, supposedly, approved by the Church.
You might object, saying, “No physician will prescribe OCs just to reduce risk of those many diseases.” But why wouldn’t a physician do so? These benefits are well-proven. And, in any case, are the Ten Commandments nullified by a note from your doctor? “Thou shalt not kill. Unless you have a prescription.” Either it is moral to use abortifacient contraception, for a medical purpose, while sexually active, or not.
You might object, saying, “Oral contraceptives also have negative medical effects.” Oh, really? Did you know that they also kill the unborn? So then, why are you approving of them? My position is that abortifacient contraception is intrinsically evil as a type of contraception and a type of abortion, and the bad effects outweigh the good. The use of abortifacient contraception, while sexually active, is not moral because abortion is intrinsically evil. In addition, the deaths of prenatal human persons, considered in the circumstances of the act, morally outweighs the medical benefits. You cannot kill innocent human persons in order to obtain an improvement in health for yourself. So the act has two bad fonts.
But what if the rate of prenatal deaths from abortifacient contraception is low for some women? It is low for some women, moderate for others, and high for still others. But you cannot be certain what the rate is in your case. And when a woman uses abortifacient contraception for 5, 10, or 15 years, even a low abortifacient rate results in multiple prenatal deaths. Then, for higher rates (which are quite common), the number of prenatals lost to the abortifacient can be as high as 1 or more per year.
Would abortifacient contraception be moral if the abortifacient rate were low? No, it would not. That is like saying that shooting at your neighbor with a gun is moral because you are a bad shot. There is only a small chance that you will kill him. We are talking about the lives of innocent children at a very young age. How can so many Catholic authors be so callous in justifying their deaths?
Is abortifacient contraception justified by the high rate of natural loss of prenatals, in early development? No, it is not. That is like saying that a person is very ill and has a good chance of dying, therefore you can do something that further endangers his life. Even if the person’s impending death is certain, it is not moral to kill him. If a man is dying of cancer, and the doctors say he will die within a few weeks, can you smother him with a pillow? No, you cannot. Neither can you use abortifacients to kill the unborn, on the pretext that the newly-conceived embryo has a high natural risk of death. (Also, the chances of natural loss for the embryo are not as high as some sources claim.)
Consider other examples of medical purposes in magisterial teaching:
Direct abortion is not justified by the medical purpose of saving the mother’s life. Euthanasia is not justified by the medical purpose of reliving all suffering. Masturbation is not justified by the medical purpose of obtaining a specimen for diagnosis of a disease. The use of condoms is not justified by the medical purpose of avoiding disease transmission. Therefore, the use of abortifacient contraception, while sexually active, is not justified by any medical purpose.