Birth Control, Religion, and Ethical Issues

I receive many questions about birth control and women, particularly when it comes to teen girls. Should doctors prescribe it? Is it an abortifacient? Is it theologically sound? I’d like to address some of these concerns.

First of all, there are different types of birth control and they each work differently to prevent pregnancy.

Many Catholics use natural family planning which relies on the “rhythm” method. This requires that couples abstain from intercourse except during the time when a woman is least likely to be ovulating. Since ovulation occurs (usually) two weeks before the next menstrual cycle (or halfway between menstrual cycles), the couple avoids sexual intercourse during this time. They opt for intimacy closer to the menstrual cycle when ovulation is unlikely to occur.

The most common form of birth control prescribed by physicians is oral contraceptives. These are a combination of estrogen and progesterone products. Women take one pill per day every day of the month. Pregnancy is avoided because taking the pills simulates pregnancy. The hormones “tell” the ovaries not to produce eggs so there are no eggs to be fertilized. Very, very rarely, ovulation can occur and fertilization can take place. If this happens, a woman should stop taking the pills because the hormones can harm the embryo.

Many theologians feel that oral contraceptives are abortifacients because a pregnancy can occur and if it does, the embryo can have difficulty implanting in the uterine wall and thus, a miscarriage would ensue. Personally, I feel that birth control pills being equated with other abortifacients is a medical stretch. Having ovulation, fertilization, and then failure to implant into the uterine wall is an extremely rare occurrence. Thus, I feel that physicians prescribing these would not be demonized by the church. That’s my medical opinion.

Intrauterine devices, on the other hand, are another story. An IUD is inserted by a physician into the uterus and the device sits on the uterine wall to “irritate” the uterine tissue so that an embryo cannot attach properly. Thus, the fertilized ovum would fall out. This type of birth control works only after fertilization occurs and therefore is literally an abortifacient.  IUDs are also dangerous because having a foreign body in one’s uterus makes a woman more susceptible to infection, uterine wall rupture, and other problems.‍

Diaphragms and condoms act by blocking sperm, and so no fertilization will take place. These involve no hormones and cannot qualify as abortifacients because the sperm never meets the egg. Some couples prefer not to use these simply because they feel that any type of contraception interferes with God’s plan. They feel that these measures are manipulative. The problem, however, is that timing intercourse via natural family planning can be seen by some as manipulative; after all, the couple is making a decision to avoid pregnancy.

The tougher issue occurs when it comes to prescribing birth control to teens. Some argue that helping a teen girl prevent pregnancy is unethical because it encourages sexual activity—an activity which is clearly harmful to kids.

Others argue that teens are “going to be sexually active” so they need to be “protected” while doing so. Here’s the problem with that argument. Oral contraceptives do prevent pregnancy (if taken correctly) and condoms “work” differently against different infections. They reduce the risk of getting HIV and gonorrhea but aren’t very reliable with Herpes and HPV. So, is it fair for a physician to advise a patient to use something which may or may not work? Here is an enormous ethical dilemma.

I never approach a patient with the belief that she’s going to be sexually active no matter what I say. This just isn’t true. I teach patients about their bodies, sex, infections, and try to give them authority that they need to make healthy decisions (not have sex). Many listen and some really will change their minds about sex if they are given the truth.

The harder decisions come when a fifteen-year-old girl stares me in the face and says, “Thank you very much but I’m going to have sex anyway.” Many of these girls don’t have parents at home, have bounced from foster home to foster home, and are psychologically wounded. And I don’t want them to walk down the street and go to Planned Parenthood.

What is right to do with them?

Give them oral contraceptives, a shot of Depo-Provera, or risk them getting pregnant and having an abortion?

Let me hear from you.

What would you do in these situations?

What do you feel is morally, ethically or medically sound?