The Think Tank

Attempts to control conception and birth are ancient. About 1850 years before Christ was born a document now called the Kuhn Gynecological Papyrus was drafted in ancient Egypt. It described the insertion of acacia gum into the vaginal canal as a birth control method. Many effective and ineffective methods of birth control have been elaborated over the millennia since then. Modern methods all seem to fall into a few broad categories: hormonal methods, physical devices, surgical procedures and behavioral alterations. Some thoughtful young people research these methods carefully before contemplating marriage. Many more young people badly need to. There are many issues surrounding their use, their comparative safety and their effectiveness. In this short presentation we can make only the most summary generalizations.

Researching birth control methods is unusually difficult. Bookstores, libraries and on-line sources abound with “information”. The problem is that strong moral and ethical positions and huge monetary incentives control how scientific data is interpreted and which scientific data is shared. Most of you are aware of the moral issues and vaguely sense that pharmaceutical fingers are tugging at your purse. There simply are no purely objective sites you can go to. The best approach is to admit to your own Biblical or philosophical beliefs before you begin your research. Then select information sources that coincides with your beliefs. After you’ve found a few, add in a source or two that you suspect will come from a contrasting philosophical position. The more sources you compare, the more objective your own conclusions will become.

Lets begin our summary here with hormonal methods. These involve pills taken orally, injections intramuscularly, patches worn dermally or rings inserted vaginally. These methods introduce a combination of estrogen and a progestin hormone which inhibits the process of ovulation in the female. Some methods simply decrease ovulation frequency using only a progestin hormone. They all involve increased circulation of powerful hormones throughout the female’s body. For this reason cancer frequency has been intensively studied in pill-users. Major decreases in cancer frequency are seen for endometrial and ovarian cancers. Slight increases in cancer frequency are seen for a variety of other cancers. Cardiovascular problems have been documented as well. The major problem is that the human female is so complex functionally that it is difficult to know what other side effects to look for. Increasing the concentration of a single signal molecule like estrogen is bound to have additional effects we’ve not yet discovered. One reason for the popularity of the hormonal methods is that they are 99% effective in avoiding pregnancies.

The Pro-life movement has argued forcefully that one side-effect of hormonal birth control is a decrease in thickness of the uterine lining during the woman’s altered cycle. This doesn’t matter unless a rare breakthrough ovulation occurs. Newer, safer pills have a breakthrough ovulation rate of about 3-7% annually. So conception does rarely occur in couples using the pill. When it does, a uterus with decreased thickness, decreased vasculature and decreased glandular secretions is less prepared to receive and retain the fertilized egg. At this point, then, the pill’s role is altered from contraception to contragestion—that is, it promotes abortion of the conceptus. Most physicians quickly point out that spontaneous abortions without a pill are of greater or equal frequency than pill-induced abortions anyway. So the issue, as expected, is ethically complicated.

The intra-uterine device is a hybrid form of birth control that utilizes both chemical and physical features. All of them have this general “T” shape and are inserted into the uterus of the female in a doctor’s office. Some are wound with copper wire because copper ions are known to be spermicidal. Others are impregnated with a progestin hormone that thickens cervical mucous, thins the uterine lining and inhibits ovulation. We’ve already discussed progestin effects. Thickened cervical mucous further impedes the progress of sperm to reach the egg. The added presence of the plastic uterine device is contragestive. If a breakthrough ovulation occurs, the presence of the implant makes it likely that the conceptus will not implant properly and will be aborted. IUDs have more well documented side effects than plain hormonal methods do. But they are again, 99% effective in preventing unwanted pregnancies.

One time honored way of preventing pregnancy is to physically keep the sperm from ever reaching the egg. The cheapest, most simple way of doing this is the use of the condom on the human penis, or the use of a diaphragm that covers the cervical opening in the female. Although these simple methods are sometimes accompanied by the use of chemical (spermicidal) foams, such chemicals aren’t necessary so there is no alteration of body chemistry occurring here. In 1844, the Goodyear Tire Company began producing latex condoms in the US. Since that time technical advances have been made in their design but they still prohibitively reduce pleasure for some men who prefer not to use them. Since they occasionally tear or have holes in them, they are only about 85% efficient at preventing pregnancies. Since combining devices, like use of two condoms or a condom plus a diaphragm increases these approximate values, a single number like 85 is less meaningful than the values given for other birth control methods. These methods are entirely contraceptive—when they fail, implantation is not inhibited in any way.

Since the early 1900s, surgery on humans and animals has become safer, more tolerable and more elective. Two commonly used surgical procedures have become highly effective methods of avoiding pregnancy. Cutting or closing off of the vas deferentia in males or the uterine tubes in females is 99% effective in avoiding pregnancy. Scarring and other minor complications cause physicians to regard these procedures as practically irreversible. This makes them a very different sort of option from hormonal and physical methods of control which are considerably more reversible. Life circumstances change. Unwanted pregnancies can later be wanted. That is why surgical procedures are generally used to arbitrarily end one’s reproductive life. For a woman who sees herself as a servant of Christ, it becomes very, very difficult to know when in her life her Lord desires such reproductive ability to end short of menopause. For a male, vasectomy raises the same issue. Since vasectomy breaks the link between sexual pleasure and it’s normal consequences, it becomes a purely hedonistic choice for many men.

Surgical procedures differ radically between men and women. Entering the abdominal cavity of the female is more traumatic and potentially complicating than a tiny incision in the scrotal sac of a male. There is considerably more opportunity for post-surgical sepsis in the female than in the male. Also a botched procedure in the male results in a normal pregnancy whereas failure to completely close off the uterine tube of the female can result in a pregnancy beginning outside of the uterus. These can be highly complicated, usually concepticidal and can be life threatening to the female parent.

One method of birth control that goes back centuries in time is the simple behavioral alteration of male withdrawal from the female before his neurological climax and thus before his ejaculation of sperm. While this approach to birth control involves no purchases, no chemicals or physical devices and no preparation it’s efficiency at preventing pregnancy is generally listed as somewhere around 80%. This is due to the occasional shedding of sperm in pre-ejaculatory drops of semen that precede the male’s climax. Also the growing intensity of pleasure as the sexual climax approaches sometimes causes the occasional last-minute change of mind that compromises the entire control measure! So in summary, withdrawal’s simplicity is accompanied by the lowest level of efficiency at avoiding pregnancy.

Not all birth control methods are easily categorized. The Symptothermal method is a combination of behavioral and mechanical intervention that has become a popular minimalist approach to contraception in recent years. On a daily basis, a woman charts her vaginal temperature, her levels of mucus secretions, and her cervical surface through the days of her menstrual cycle. Careful monitoring will provide enough data after a few cycles to accurately detect when ovulation occurs. Avoiding sexual activity for 4-5 days around time of ovulation is a dependable way of avoiding pregnancy once a woman knows the pattern of her cycle. Skill and careful monitoring can increase the efficiency from the typical 84% to 95% or higher. The couple then has to decide how to handle control of conception during the 4-5 day fertility period in the middle of the woman’s cycle.

The conception and formation of offspring is one of the most powerful ways in which man is made in God’s image. It is a high and holy privilege. Tampering with this marvelous gift has always raised serious theological questions among Christian thinkers. Some couples do not believe it is morally acceptable to attempt to control birth at all. Rarely, a couple feels forced into birth control because of health issues of the maternal parent. Many couples view it as a temporary option to avoid raising a child while completing a career goal or escaping deep financial debt. Each child of God needs to reverently consider how God’s view of their reproductive life compares with their own. Each child of God who is determined to use birth control needs to reverently determine which method is safest for the user’s health and safest for the conceptus that may result from its occasional failure. May God always grant us to have as much respect for human life as enabled Him to die for it.