Birth Control & Abortion

Here's an enormous change of subject for you!

I've been sitting on two topics on women's issues that I've long had in the queue for my blog. I've now found the time for them. I'll do one today, the other sometime later. Both relate in one way or another to my old debate with Jennifer Roth: Is There A Secular Case Against Abortion? The Carrier-Roth Debate (2000), which I blogged about a few months ago (in The Abortion Controversy).

The first of these issues is a claim I made in that debate, which I reproduce in full here (emphasis added):

However, abortion statistics, such as appear in any World Almanac, only measure medical procedures, including the use of prescription abortifacients like the "Abortion Pill." What is rarely understood in this issue is the fact that the most popular means of birth control actually partly relies upon inducing early abortion, and is very likely responsible for many times as many abortions as occur in counted procedures. Hormonal medications of this sort include "The Pill," and Norplant, as well as the numerous herbal solutions which share the same or similar chemical properties and are thus employed in third world countries as a less expensive alternative to the manufactured pharmaceuticals that they mimic. All these chemicals operate simultaneously on many levels, primarily by preventing ovulation and hindering sperm, but also by preventing implantation (and thus causing expulsion) of an egg that, despite all else, is fertilized anyway. In other words, all chemical forms of birth control, including the pill, cause abortions--and no one can know whether or when they have worked by their primary means or in this last-resort manner. This means that any discussion about the morality or legality of abortion necessarily entangles us in the morality and legality of the use of the pill and related implants and injections. This is all the more true given that women can deliberately cause this early-abortion effect up to three days after intercourse by taking a double or triple dose of their ordinary birth control pills.

In response to this, many years ago someone wrote to me that they had found a scientific article claiming there was no evidence of this. Though they knew there had to be something fishy about that (since they, like me, had read literature claiming the contrary) they wanted to know what was up with this article. The paper in question, by doctors Roberto Rivera, Irene Yacobson, and David Grimes, is "The mechanism of action of hormonal contraceptives and intrauterine contraceptive devices," in the American Journal of Obstetrics and Gynecology 181.5 (November 1999): pp. 1263-69.

I'll now tell you more or less what I told this inquirer.

I had read in medical literature that birth control causes abortion (and how), but I could not remember where. So I was keen to see what these scientists had to say. Unfortunately, the AJOG article contains no original research on the question. It's simply a summary of other studies, most of which were not actually investigating whether the pill causes abortion. From this broad survey of past studies, Rivera et al. argue that we have no direct scientific evidence of induced abortions nor, if there is any, the rate of occurrence. Yet at the same time they show that it has been scientifically proven that all chemical birth control causes various physiological conditions that have been independently proven to cause abortions. So anyone of sense need merely do the math.

Since a large dose of birth control pills a whole day after sex is medically prescribed as having a high probability of preventing pregnancy, I find it very strange that they would ever dare claim "no scientific evidence indicates that prevention of implantation actually results from the use of these methods," and even though there is ample scientific evidence that chemical birth control has "effects on the endometrium that might prevent implantation of a fertilized ovum," they nevertheless conclude, "so far, no scientific evidence has been published supporting this possibility" and therefore (so they argue) "no scientific evidence supports an abortifacient effect."

So how the hell does a post-coital multi-dose prevent pregnancy? Seems to me there is only one way it could: by preventing implantation of a fertilized embryo. After all, the sperm will have merged with an egg and conceived, producing what most right-to-lifers call a child, well before the passage of twenty four hours. If you are not on the pill there is little to stop it. So the only way a post-coital dose could prevent pregnancy is by causing an abortion: it has to kill an embryo post-conception, one way or another. Unless they are going to invoke something like baby-loving time-reversing faeries, there is no other way around this conclusion [Except one, now noted in the comments section below: if the sperm gets in before ovulation, then the pill can work the way it normally does...but outside of that, or missing ovulation altogether, if it works at all, it has to be death for an embryo].

In truth, this study only claims that no one has actually "checked to make sure." I'm not surprised. It's not easy to check. Even the few studies that have been done (which they survey) did not have the means to ascertain this fact. But more importantly, it is not a study that any pharmaceutical company wants to fund, seeing as its results could draw negative attention from the pro-life movement. But as far as anyone of sense is concerned, the evidence (indeed, abundant scientific evidence) is clear: chemical birth control prevents the implantation of at least some fertilized embryos. Which then die. Given how many hundreds of millions of women use these chemicals, even if the percentage is small, you're still looking at a lot of dead embryos.

Embryos aren't babies, of course. But that is exactly the fact that needs to be conveyed in the public arena, with a good hard bitch slap on anyone who thinks the contrary. The math is simple, but the work is hard. I am pro-choice because I know embryos aren't people. And I know that because I have responsibly researched the relevant science and philosophy. But understanding why an embryo isn't a person requires figuring out what a person actually is, which requires working out just why persons are valuable, and all this must be done on a foundation of a sound survey of the relevant scientific evidence. And that's a lot of work. Apparently most people are lazy. Rhetoric and trickery are easy, and thus evidently more commonly preferred.

Hence I do not approve of my fellow pro-choicers playing word games simply to avoid admitting the pill kills embryos, just because pro-lifers call them people. A prominent example is the Planned Parenthood page Ask Dr. Cullins: Birth Control. Just like here, some will say that killing an unimplanted embryo isn't really abortion, which is to hide the facts behind semantics. Or they will tempt non sequiturs, like claiming the pill does not prevent implantation because "it is very unlikely that an egg would be released or fertilized while a woman is using them," even though it is a scientifically documented fact that at least one in every hundred women using them gets pregnant. That might sound "unlikely" to a single girl, but on a global scale that's no trivial number of pregnancies.
If the pill fails to stop fertilization in 1 in 100 women, in how many other women did it also fail to stop fertilization, yet also prevented pregnancy by preventing implantation? To utter in the same breath that "in theory, it's possible" for the pill "to prevent implantation" and then claim that it does not prevent implantation because it reliably prevents fertilization, is far too shady to be considered honest. And yet this rhetorical trick appears even from the AJOG authors, who argue that because chemical birth control "is highly effective in inhibiting ovulation and sperm penetration, the possibility of fertilization is negligible," and yet "unintended pregnancies occur with all" chemical methods, which "provides incontrovertible evidence that fertilization and implantation can occur, albeit rarely." Knowing, as they must, that the percentage is better than 1 in 100, they are clearly resting on a rather Orwellian interpretation of the word "negligible."

This looks a lot like hiding behind the ignorance generated by a disinterest in conducting studies that would confirm an obvious but unsavory truth, and then twisting words around to make what we do know sound as palatable as possible. "Of course it doesn't happen. Except when it does. Which is almost never. And besides, no one's ever proved it. Except with obvious facts. But who needs those?" (and with that you're to imagine happy little faeries singing in the background, floating on tufts of love, plucking on harps of sugar candy)

Sorry, but that's just bullsh*t. Even the AJOG paper admits that "in women who received emergency contraceptive pills before midcycle, most biopsies showed" that "the endometrium also exhibited a lag in the development or maturity" of the relevant cells and "implantation would be unlikely in this type of endometrium." In fact, they document that even on regular chemical dosages, abundant scientific evidence confirms the same or similar implantation-hindering effects on the endometrium, all the time. There is no rational way to deny the conclusion that follows from this fact.

Since the effects on the endometrium are fully documented and conceded by these authors, and since as a matter of established physiology these changes will certainly reduce the probability (which is a fancy word for frequency) of successful implantation of fertilized embryos, and since it is an equally established fact that chemical birth control often fails to prevent fertilization, I do not see how the authors of this paper can honestly get away with dismissing the obvious outcome as "unknown." That's like shooting a machinegun into a darkened room and saying that because no one turned the light on, the effect on actual people living in that room must be negligible. I don't buy it. And neither will any pro-lifer. So what is gained? Since the deception is obvious, all this rhetoric does is amplify distrust. So why resort to it?

I must say the cynic in me wonders whether Big Pharma funded this study for the specific purpose of preventing pro-lifers from getting on their case. It qualifies as such a beautiful work of obfuscation: do no actual research, just summarize what's been done--which is, practically speaking, nothing--and then from "nothing" assert conclusions as hopeful as one can remotely justify, despite common-sense evidence more strongly supporting the contrary--which, to pass peer review, the paper dutifully includes, but then quickly buries under all those excessively hopeful pronouncements that since no one's seen it, maybe it doesn't happen (cross those fingers, knock on wood, rub that rabbit's foot raw).

I've seen this trick before..."Well, no one has seen evolution, so there's no evidence anything evolved." It's the same sad game. And all who resort to it should be ashamed.