Semantics Matter: What Does the Pill Do?

With legislation set to go into effect requiring private employers to provide abortifacients as an insurance benefit, Liberty University English professor Karen Swallow Prior has called attention to the increasingly sloppy usage of relevant terms in the controversy. Unclear and confusing language in this instance is not inconsequential but actually muddies the moral waters. And an important aspect of this problem, Dr. Prior writes, is the need “for some political, scientific, and moral clarity on the birth control pill.” What does “the pill” do, and what does it not do?

Oral contraceptive pills (OCPs), a familiar daily sight to millions of American women since acquiring FDA approval as a contraceptive in the 1960s, typically contain low doses of two hormones. OCPs fool a woman’s hormonal regulatory mechanisms in order to inhibit ovulation. But what happens if ovulation and then fertilization do occur? Image credit: motorolka/Shutterstock through www.theatlantic.com

What is the difference between contraception and abortion? Historically, until pro-abortion activists began to push for a change of definition,1 conception was synonymous with fertilization—the union of a sperm and an egg. A human life begins at fertilization. Therefore, contraception has traditionally meant prevention of fertilization. In practical terms, this requires preventing contact between sperm and ova (eggs). Oral contraceptives (OCPs) accomplish this with reasonable success primarily by preventing ovulation. OCPs fool a woman’s hormonal regulatory systems with low daily doses of hormones. But if an accidental ovulation occurs and an egg is produced and fertilized, do OCPs prevent implantation of an embryo in the uterus?

This question, in the past, was primarily discussed among conservative pro-life professionals. As our knowledge has increased, it has become clear to most of us that OCPs neither prevent implantation nor damage the unborn child exposed to them. Lately, this question is attracting much more attention. Why?

As most of our readers are aware, the new health care law—aka Obamacare—opens the door for non-elected bureaucrats to demand “morning after pills”—often called “emergency contraceptives”—be routinely covered as an employee health benefit. These medications are abortifacients intended to prevent or disrupt the implantation of an embryo, thereby leading to the death of the child.2 Many Christians believe their duty to God requires that they not pay for abortions, even those accomplished invisibly and quietly using medications. Therefore, many Christian colleges and Christian-owned businesses have filed lawsuits begging our courts to protect several constitutional freedoms that Obamacare violates. (See Will the Supreme Court Uphold Religious Freedom in America? to learn more.)

When various medical organizations agreed to change the definition of conception to make it synonymous with implantation, deceptive words entered our language.

As public debate has heated up, Dr. Prior notes there has been increasingly sloppy use of terminology. Of course, these semantic games didn’t just begin. When various medical organizations agreed to change the definition of conception to make it synonymous with implantation, deceptive words entered our language. Since several days elapse between fertilization and implantation, this change allowed health care providers to administer abortifacients under the guise of contraception. Ethically, this is killing a human being with impunity on the basis of a semantic technicality.

Since Obamacare has been on the firing line, the media and scientists are now paying more attention to how ordinary oral contraceptives (OCPs) work. Dr. Prior writes, “Some pro-lifers, this one included, find it at least a little bit suspect that now, in the midst of controversy around this issue . . . scientists are suddenly backtracking on long-held views about how the birth control pill works.”

OCPs, in addition to preventing ovulation, thin the lining of the uterus. Does OCP-induced thinning of the uterine lining render it unreceptive to an embryo? If so, then OCPs would be abortifacients also. If people can be convinced that oral contraceptives—which enjoy wide acceptance—have been doing the same thing as the “morning after pill” all along, then support for mandated medical coverage for abortifacients may well slide in to favor on the slippery slope of morality by public consensus.

Though some pro-lifers err on the side of caution, most physicians—including myself and the American Association of Pro-Life Obstetricians and Gynecologists—are convinced that OCPs do not cause embryo loss. Why would this be? It turns out that the lining of the uterus is never prepared for the implantation of an embryo—whether a woman is “taking the pill” or not—prior to ovulation. OCPs prevent ovulation, but when a “breakthrough ovulation” occurs it is possible to get pregnant. Once fertilization occurs—whether the woman is “on the pill” or not—the post-ovulation ovary continues producing the hormones needed to prepare the lining of the uterus for implantation. God’s design is such that while the fertilized egg is traveling down the fallopian tube, the uterus is preparing to receive it. Ordinary OCPs do not disrupt this process, but “emergency contraceptives” do.

The author of The Atlantic article mentions that the “morning after pill” delays ovulation and implies there is thus little moral difference between it and conventional OCPs. We disagree. When a “morning after pill” is taken before ovulation and succeeds in delaying ovulation until all living sperm scattered through the woman's reproductive tract have died, then it prevents fertilization. If this were the only mechanism by which “morning after pills” worked then—insofar as the risk of destroying a human life is concerned—they would be morally indistinguishable from conventional OCPs.3

Yet inhibition of ovulation is only one of the ways “emergency contraceptives” work. If ovulation has already occurred and the ovum has gotten or gets fertilized, then the only way for “emergency contraceptives” to prevent the continuation of the pregnancy is to prevent or disrupt the implantation. Some people claim that “emergency contraceptives” merely thin the lining of the uterus the same way ordinary OCPs do and that they therefore work in the same way. If that were the case, however, then “emergency contraceptives” would be quite unreliable. Drugs used as “emergency contraceptives” are effective because they do not simply thin the uterine lining the way ordinary OCPs do, but actively interfere with the embryo's implantation.

It is important to have our terminology straight as the public debate on this topic continues, lest semantics be used to distort truth.

“Reproductive freedom” is a concept that has received a great deal of attention since the advent of pharmacological contraceptives. Men and women make many choices in life, including whether to obey God’s moral law that reserves sexual activity to marriage. But when an inconvenient or unwanted pregnancy occurs, regardless of life circumstances, that “freedom” should not include the right to murder another human being. The embryonic human life produced has a right to live, and killing him or her by either dismembering the body (one common method of conventional abortion) or by using powerful drugs to deny him or her the opportunity to grow in the mother’s uterus is reprehensible, and “reproductive freedom” should never include those options. And if the law of the land for forty years since Roe v. Wade has allowed women to abort their babies in the name of “reproductive freedom,” our constitutionally protected freedoms should at least prevent private citizens and the businesses and institutions in their care from having to pay for women to kill their unborn children.