Birth Control Pill an Abortifacient?

If you spend much time in pro-life circles you are likely to encounter statements that birth control pills cause abortions. These people are not talking about a woman waking up after a night of drunken stupidity and downing her roommate’s month worth of pills. They are asserting that hormonal contraceptives, as regularly prescribed and taken, have an abortifacient capacity.

The argument goes like this:

The pill works in three ways: it prevents ovulation, it thickens cervical fluid, and it thins the lining of the uterus which prevents implantation.

So, what happens if a woman take the pill, and it fails to prevent ovulation and thicken the cervical fluid? Conception may occur and since the embryo cannot implant, it dies.

Those who oppose abortion and accept this argument are understandably horrified. Couples often feel tremendous guilt for “unknowingly aborting their children” and women who genuinely need hormonal treatments for gynecological problems suffer greatly rather than turning to the pill since it is clearly evil.

I alternate between sadness and anger each time I see this happen because something is missing. Sure, if you test the thickness of the endometrium of a woman on hormonal contraceptives you will find that it is thin. But no one has ever told me how exactly this is different from the thinness of the uterine lining of every healthy woman each and every cycle prior to ovulation.

I have not been able to find any evidence that the uterine lining fails to thicken when breakthrough ovulation occurs. Women get pregnant while on the pill precisely because the uterine lining does not remain thin and “hostile to implantation” once ovulation has occurred. The hormones are all tied together, and I cannot find evidence that the pill is somehow able to change the way that ovulation works when it occurs, and the natural results of ovulation.

I am well aware that I may be missing something, but I have never seen this point addressed in all of the if-you’re-on-the-pill-you’re-killing-your-babies materials that I have read and watched. And I believe that this point is well worth addressing before filling people with guilt, shame, and fear. There are many wonderful reasons to avoid contraception, and we do not need to resort to fear tactics in trying to convince others to be open to life.

If you know that I am wrong, please comment with a common-sense English explanation, and link to a reliable jargon-filled scientific source.

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34 thoughts on “Birth Control Pill an Abortifacient?

  1. Allison

    I think one difference between the thinning of the lining that occurs in one’s body naturally while not on BC is different than the induced thinning on BC for one reason because it is natural. From what I’ve read, implantation naturally would occur later in the phase when the lining is thicker. It’s not going to naturally happen when the lining is thin (like you stated happens to all women during part of their cycle). Meaning generally the egg is not present to be fertilized and implant during that natural phase of the cycle where the lining is thin.

    However, while on BC, it is generally thinner than natural, it never builds back up. That’s why many times “periods” are lighter while on BC.

    I’m no expert on the whole case, but I think that we should err on the side of caution. Is this over stated amongst the pro-lifers? Perhaps. But it’s an important detail not to be left out at the same time. If we can’t be sure that the lining goes to normal with breakthrough ovulation then why not err on the side of caution?

    Are there any studies out there on the rate of breakthrough ovulation while on BC? And then how many of those breakthroughs go on to successful pregnancies? I suspect not.

    Anyways, I found this article’s comments to be interesting. It’s a bit old, but an interesting read anyways.

    1. Rae Post author

      “Periods” are generally lighter when women are on hormonal contraceptives because it is withdrawal bleeding from the break from the hormones rather than true menstruation. Menstruation only follows ovulation, right? If the amount of bleeding is what causes concern, then would you feel better about a woman being on extended-cycle birth control pills and only bleeding, say, once a year?

      Without further explanation I can’t accept the idea that we should “err on the side of caution” when being cautiously erroneous means making people feel guilty for killing their unknown children and expecting women to live with significant pain. But maybe this calls for another post?

      1. Allison

        I’m sorry, I’m a bit confused. What in my post showed that I was worried about the amount of bleeding? Or maybe I’m reading your comment wrong. I was saying that it isn’t a true period. And that these “periods” are lighter because no matter what the lining is thinner.

        Did you read the comments on the blog post I posted? There’s one commenter in there that explains why the “periods” are lighter and why that person felt in general the lining does not build up enough to support a fertilized egg.

        I guess to me, it only makes sense that at times fertilized eggs are not allowed to implant while on BC. I can’t find the source, but at one time I did read how much thinner the lining was compared to naturally and it was quite a significant difference. And they also posted the normal minimum needed for an egg to implant, which while on BC wasn’t thick enough.

        I’ll be interested to see what CCL has to say. Because as it stands, I’m sure you can tell I’m on the side of thinking that there is the potential for abortion.

        1. Rae Post author

          Hmm… I thought that you were concerned that the light bleeding indicated a thinner uterine lining was being shed. I do not think that the light bleeding can serve as an indication of thickness since it is only caused by a change in hormones rather than the regular shedding of the uterine lining.

          I did read the comments. I assume that you are referring specifically to one of Jason Dulle’s? I would have found his conjectures much more convincing had he provided evidence rather than simply stating his doubts, discomforts, and conclusions. I also find Lydia McGrew’s counter quite compelling.

          It seems to me that we are both lacking information, and that unless such information can be provided the best thing to do is to admit that we are lacking information rather than presenting the idea that “the pill causes abortions” as fact.

          1. practicinghuman

            Forgive the ignorance here, but I thought that there are coupled hormones which increase the likelihood of painful periods. I also thought that women who tend to have extremely heavy periods are more likely to have painful periods at irregular spacing. If you have someone who regularly has extremely painful periods at spacing often longer than 4 weeks, the lighter period comes from having better spacing of the monthly cycle. I know people who use any number of measures to regulate painful periods, but it seems that one main medical goal is to space periods more evenly.

          2. Rae Post author

            I don’t know about stats, but I used to have perfectly regular, *very* heavy periods 27-29 days apart. What you describe sounds more like PCOS, and I know more about endo though, so you could be right.

  2. Kathleen

    I don’t know the answer, Rae, but I’m really interested in finding out, so I sent your post to Vicki Braun at CCL central. If the answer is out there, she’ll know.

  3. Kathleen

    I stopped taking birth control pills before I got married for this very reason. It’s not an issue anymore since we’re trying to conceive and because three years of being on the pill significantly reduced my cramps. But I’d still like to know what the answer is, and if you figure it out please do a follow-up post!

  4. Trena

    Regarding practicinghuman’s comment: I had regular periods every month. My cycles were always 29 to 30 days and my period would last five to six days. I was very regular but they were very, very, very heavy and painful. That is why I used the pill. It kept my period regular but I was to the point that I barely bled. After being on the pill for more years then I want to remember, I finally woke up and realized that it was just supressing my body so I stopped.

    I don’t know the answer to your question but hopefully CCF Central will have more info.

  5. Claire

    I have just joined in the conversation and have not yet taken a look at your most recent post. I only have two things to add, for whatever they are worth.

    #1: in his classes in medical school, around about 2002 or 2003, my husband learned that the Pill has “abortifacient properties” and the unnatural stripping of the endometrium layer was listed as one of these. They were told that conclusive studies to provide any kind of stats (including just how many abortions have resulted from this) would be almost impossible to conduct.

    #2: I remember reading an article a few years back (maybe 5 years ago?) in which a critic of NFP accused NFP practitioners (and promoters) of causing abortions because it encouraged intercourse during less fertile times of a woman’s cycle. If ovulation was to occur at an unexpected time, implantation would be less of a risk because of this issue of “thinner uterine lining.”

    At the time (and now), I pretty much thought that was hogwash, because in Phase III, one can be fairly certain that ovulation is close to impossible, if you chart properly. However, there are instances of very early ovulation (say, in Phase I), and it likely that even if fertilization occurred, the lining would still be too “thin” for proper implantation.

    For whatever all that is worth! I am sorry that I am unable to provide links for either of my comments.

    1. Rae Post author

      Thanks for your comment!

      I remember seeing an article similar to the one you described. It struck me as rather absurd, because even if the assertions were correct (and I am not convinced that they are) what is the alternative? If a couple simply used no form of birth control and the woman ovulated early, then there would be the same “risk” of failed implantation due to thin uterine lining. So are we supposed to suggest that all couples abstain unless they are entirely healthy and are able to perfectly time intercourse for immediately after ovulation which has been determined to occur late enough in the cycle? Should we tell new mothers that they are not allowed to resume sexual intercourse until 3 months after they have weaned the baby, so that it is certain that should ovulation occur they will have long enough luteal phases to allow for implantation?

      I strongly believe in seeking health both for ourselves and our children, but at some point the desire to be perfectly pro-life can cause us to place undue burdens on others. It is very comforting for me to know that I can seek ultimate openness to life in my own life while not judging or burdening others by simply making certain that I never hold up a universal standard which is stricter than the Church’s.

  6. Rachel

    If you have access to it, the November 2008 issue of the health journal “Fertility and Sterility” published the American Society for Reproductive Medicine (ASRM) statement, “Hormonal contraception: recent advances and controversies.” They clearly indicated that one of the hormonal effects of the Pill is to “prevent implantation”. I’m sure they used plenty more medical jargon, though.

    I remember reading some other medical articles awhile back by a pro-life doctor who hypothesized about the pre-implantation effects of hormonal contraception. As someone else noted, it would be virtually impossible to test this hypothesis, as breakthrough ovulation on the pill is relatively rare, and it is impossible to determine whether fertilization occurs in any woman. As you probably know, pregnancy tests only measure the level of the HCG hormone released by a woman’s body–in response to the implantation of the embryo. How are we to know if implantation has not occurred?

    In layman’s terms, besides the “hostile endometrium” theory, I would think that the hormone imbalance caused by the Pill would make the woman’s body in general unable to support early pregnancy. The Pill is basically a truckload of synthetic estrogen, and estrogen tends to work against progesterone (the “pregnancy hormone”) in a woman’s body. Many women suffer from estrogen excess, simply because of all of the environmental estrogens that exist in pesticides, plastics, and in the water (from all the women who are on the Pill and whose bodies can’t process the truckloads of estrogen they consume and excrete it into their urine). Women on the Pill are typically estrogen-dominant. A woman with progesterone deficiency, the result of estrogen dominance, will often suffer from recurrent miscarriage, and because high levels of progesterone are necessary to sustain early pregnancy, I wouldn’t be surprised if many pregnancies end very early because of the mother’s use of the Pill.

    It’s important to be sensitive to women who are on the Pill, and to avoid scare tactics or casting blame. At the same time, we MUST be honest about the effects of hormonal contraception on human life. As Allison said, if we suspect that there is even a small chance that the drug we are taking might end our child’s life, we ought to err on the side of caution and find a different way to responsibly space our children. As Mother Teresa said, “It is a poverty to decide that a child must die so that you may live as you wish.”

    1. Rae Post author

      Unfortunately I cannot access the article because I am not in school and too far from a good university. If you could quote a small relevant section that would be great, otherwise I will have to wait a month or two to look into it.

      There are many different formulations of artificial hormones available. All of the ones that I considered were a combination of synthetic estrogens and progesterones and the progestin-only pills actually seem to have a much greater likelihood of breakthrough ovulation and thus possibility of allowing conception but not implantation.

      I believe that women should be as fully informed as possible. But there is a world of difference between telling women who consider the pill for birth control that there is a *possibility* that it might allow breakthrough ovulation and not implantation, and telling women who suffer severe pain that they cannot use artificial hormones because “they *are* an abortifacient.”

      1. Rachel

        I apologize for the delay in my response. As someone else mentioned, being able to ‘follow’ replies to my comment via email would be very helpful!

        As far as the “Fertility & Sterility” article, I don’t have access to it either–I have just read it cited by pro-life/anti-pill advocates in the discussion of the potential abortifacient problem.

        The full text of another very important and understandable article on this topic, “Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent,” can be found here: . That article reviews literature for a variety of different forms of oral contraceptives and the relevant details. You are correct in noting the different effects of different pills, Rae, and this article provides further detail.

        Re: the “hostile endometrium” theory, here is what the article has to say:

        “To assess the clinical significance of an altered endometrium, it was helpful to examine data that compared endometrial thickness with the receptivity of the endometrium to preembryos during in vitro fertilization procedures. Magnetic resonance imaging scans of the uteri of women reveal that the OC users have endometrial linings that are consistently thinner than the endometrial linings of nonusers,48-50 up to 58% thinner.[...] Larger, more recent, and more technically sophisticated studies all concluded that endometrial thickness is related to the functional receptivity of the endometrium. Furthermore, when the endometrial lining becomes too thin, then implantation does not occur. The minimal endometrial thickness required to maintain a pregnancy in patients undergoing in vitro fertilization has been reported, ranging from 5 mm to 9 mm to 13 mm, whereas the average endometrial thickness in women taking OCs is 1.1 mm. These data would seem to lend credence to the Food and Drug Administration–approved statements that “…changes in the endometrium…reduce the likelihood of implantation.” We considered this level II.2 (good to very good) evidence.”

        The article also discusses integrin changes in women on oral contraceptives and links them to preventing implantation:

        “Integrins are a family of cell adhesion molecules that are accepted as markers of uterine receptivity for implantation.[...]These 3 integrins are conspicuously absent in the endometrium of most patients with luteal phase deficiency, endometriosis, and unexplained infertility.

        In addition, integrin expression is significantly changed by OCs. Integrins have been compared using endometrial biopsy specimens from normally cycling women and women taking OCs. In most OC users, the normal patterns of expression of the integrins are grossly altered, leading Somkuti et al to conclude that the OC-induced integrin changes observed in the endometrium have functional significance and provide evidence that reduced endometrial receptivity does indeed contribute to the contraceptive efficacy of OCs. They hypothesized that the sex steroids in OCs alter the expression of these integrins through cytokines and therefore predispose to failure of implantation or loss of the preembryo or embryo after implantation. We considered this level II.3 (good) evidence (Table 1).
        If breakthrough ovulation occurs while using the COC, then to some extent ovarian and blastocyst steroidogenesis could theoretically “turn on” the endometrium, causing it to normalize prior to implantation in the ovulatory cycle. However, after discontinuing use of COCs, it usually takes several cycles for a woman’s menstrual flow to approach the volume of women who have not taken hormonal contraception, suggesting that the endometrium is slow to recover from its COC-induced atrophy. Furthermore, in women who have ovulated secondary to missing 2 low-dose COCs, the endometrium in the luteal phase of the ovulatory cycle has been found to be nonsecretory.”

        Finally, the article links the integrin issue with other factors in leading to an increased risk of ectopic pregnancy (categorized as a “preimplantation effect,” and one that also leads to the end of unborn life).:

        “As discussed earlier, one of the postulated actions of the OCs is a slowing of tubal peristalsis (via smooth muscle relaxation); therefore, a reduction in tubal peristalsis that is associated with an upregulation of the V3 integrin in the epithelium of the fallopian tube could theoretically lead to an increased risk of ectopic pregnancies in women taking OCs.
        Therefore, COC use seems to be associated with an increased risk of ectopic implantation or unrecognized loss of preembryos. We considered this level II.2 (good to very good) evidence (Table 1).

        Ectopic pregnancy is a particular form of postfertilization loss that involves substantial risks to the woman, and thus the absolute risk of ectopic pregnancy for women taking OCs will be of interest to clinicians and patients.
        The risk of ectopic pregnancy is higher with POPs, and ectopic pregnancy has been discussed at length by a number of investigators as a clinically significant potential complication of POPs.”

        As I said in my earlier comment, I believe it is important to be honest and objective about the risk of early abortion associated with any form of hormonal contraceptive. Especially when one looks at actual-use and the high rates of breakthrough ovulation in some forms of the pill (sometimes as high as 65%), the likelihood of a sexually-active woman on the pill for a number of years experiencing breakthrough ovulation, conception, and early abortion/”postfertilization effects” goes up. You just cannot say that there is “little” risk of experiencing abortifacient effects of the Pill, and in terms of Catholic moral teaching there certainly are not proportional circumstances in which a woman, even experiencing severe complications of endometriosis, can run the risk of early abortion of their unborn child. Saying this is not a judgment on women on the pill, nor is it intended to be fear-inducing, but our responsibility towards the truth and the dignity of human life requires that we are honest in explaining that this is an unacceptable risk and that other treatment options for endo ought to be pursued.

        1. Rae Post author

          For some reason I just saw your comment today! I am sorry that I missed it.

          This quote seems to indicate that there are reasons to do more research, but terms like “suggesting” and ” will be of interest” seem to me to be keywords for “inconclusive evidence”.

          The thing is, women who take artificial hormones for pain purposes aren’t going to take low dose pills, and they aren’t going to be skipping them. Thus the breakthrough ovulation rate is going to be extremely low. Add in the fact that many of these women will already have issues with sub-fertility (meaning they wouldn’t get pregnant anyway– even the PPVI institute only has 56.7% success with achieving pregnancy with women with endometriosis and the rate of hypothetical unnecessary miscarriage is incredibly low. But there is an even more important factor to consider, namely, what are the risks of the alternatives? And there are actual studies on the risks of painkillers that show a much larger problem. Furthermore surgeries are more likely to cause scarring which can cause ectopic pregnancy etc. etc.

          I completely agree that women should know the facts. I just don’t see suggestions of possible problems with no actual stats as facts.

  7. Kacie

    Yep. When I tell women this, they are usually confused and taken aback, sometimes a little frightened. Then they find research that says that the pill does NOT cause abortions, which of course does not take this sort of abortion into account. It takes work to find this research, and most women don’t want to hear it.

  8. Dawn Farias

    Hmmm… you seem to be focused on the thickness of the uterine lining at the time of ovulation. This the wrong time in the cycle to be making comparisons between pill users and non. Implantation occurs a week or more after ovulation. That would be the time to compare the linings and determine if the pill really does thin them and therefore make implantation of a fertilized egg impossible.

    Women get pregnant while on the pill precisely because the uterine lining does not remain thin and “hostile to implantation” once ovulation has occurred. The hormones are all tied together, and I cannot find evidence that the pill is somehow able to change the way that ovulation works when it occurs, and the natural results of ovulation.

    Again, it seems you’re focusing on ovulation (when we should be focusing on the uterine environment at implantation, many days later) and I’m probably not understanding why, so you’ll have to talk s.l.o.w.l.y for me. LOL.

    I would have said that women get pregnant on the pill because the pill failed at that time. After all, abstinence is the only thing that’s 100% (I feel like I should skip around with a lollipop and sing while I say that…).

    Also, can you please put in a plugin for “follow the comments” on your blog? I would adore you that much more if you did that! Puh-leeze!

    1. Rae Post author

      You’re entirely correct. I wasn’t precise enough, partly because I have not been to medical school and a main point which I didn’t convey well with this post is that we shouldn’t state things as fact when we don’t know them. But, from what I do know, it is actually the same hormones that trigger ovulation that also make the uterine lining thicken up, and then 7-10 days later implantation happens.

      And I’ll see what I can do about making it easy to follow comments. :-)

      1. Dawn Farias

        main point which I didn’t convey well with this post is that we shouldn’t state things as fact when we don’t know them.


        it is actually the same hormones that trigger ovulation that also make the uterine lining thicken up, and then 7-10 days later implantation happens.

        I see where you are coming from now. If the hormones successfully triggered ovulation then they should, later in the cycle, successfully trigger thickening of the uterine lining. If a pregnancy occurred then we know ovulation was successful, hence the uterine wall would have thickened and thus, the pill could not act as an abortificient. Yes?

        UNLESS, the pill causes something to happen AFTER ovulation that would prevent the thickening of the uterine wall. There could very well be some other mechanism at work that prevents one (thickening) but not the other (ovulation). Which is what we are not clear on right now and leads us to err on the side of caution, but doesn’t allow us to make people feel terribly scared and ashamed.

        Got it. I think. ;)

        1. Dawn Farias

          My husband graduated college a year ahead of me and we moved out of state. At my new university I was required to have 2 science credits but one had to be biological. At my previous school I had the 2 credits but both were in chemistry, a math based science that, while not great at, I could at least ‘get’.

          I was so bummed about taking biology but even more so when we got to the female human’s cycle processes. My goodness. It is a painful memory that I obviously still carry around with me to this day.

  9. Lauren W

    Actually, there is surprisingly no real correlation to the thickness of your uterine lining and how “heavy” or “long” your periods are unless you have an abnormally thick uterine lining, which Provera can also help with in the short term if you don’t want to be on BC. Some women have short heavy periods, some women have long light periods. And everyones definition of heavy and light are different so unless you are physically measuring what comes out of your body, or you get an ultrasound, you can’t really say how thick your lining is. Some women naturally never have their lining thicken and go on to have succesful pregnancies. I have had a succesful pregnancy while on BC, and it’s actually the hormones in BC that can cause miscarriage, which is funny because no one mentions that.

    1. Rae Post author

      The part about “physically measuring” made me laugh because I actually tried that at one point when I was having very heavy bleeding. I was using menstrual cups and a larger cup in an out-of-the-way place in the bathroom for collecting… but then my husband saw it and that was the end of that. :-)

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  11. Holly

    I guess my biggest scientific proof or theory for refraining from hormone therapy that includes BCPs is that my doctor, who is a scientist that specializes in female reproductive system opposes this blanket treatment. Her point is that BCPs mask symptoms and use a combination of hormones in predetermined dosages that may not be the best for individual women. She prescribes no medication that prevents implantation and instead goes to great lengths to determine the best treatment for each patient. Sometimes that requires personal responsibility and care of the patient herself- there are ways to treat different disorders without using birth control pills. Why take the chance that you are creating a hostile environment for a conceived child?

    Granted, doctors like mine are few and far between, but the science for treating these hormone issues is solid- it’s called NAPRO technology and is proven effective without the side effects of the Pill and gets to the heart of one’s particular health concerns.

    I guess my biggest question is why would we be careful about the food we consume, but then pump our bodies full of artificial hormones? There has to be a better way. And there is.


    1. Rae Post author

      I’ve read the entire book and just re-read that section (thanks for the link!) and I don’t see that it actually addresses my point here. He just assumes that there is “hard, thin, dry and rocky soil” without answering why on earth this should be believed in cases where ovulation has occurred.

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  13. Josh

    Little late to the party, but hopefully you’re still tracking comments on this.

    I’ve provided a link below which deals directly with the question you’re asking. My synopsis:
    1. Yes, BCPs thin the endometrium during a non-ovulatory cycle.
    2. No, there isn’t any evidence that, during an ovulatory cycle, BCPs counteract the natural function of the ovulating follicle to thicken the endometrium and prepare it for the ovum just released (in a comprehensive review of 40 years of peer-reviewed research).
    3. The hormones that thicken the endometrium come from the follicle that releases the egg – i.e. if the body allows a follicle to develop and release an egg, there is no question that the follicle is releasing the hormones to prepare the endometrium.
    4. While there had never been (in 1999) a study conducted that focused on endometrium thickness solely in ovulatory cycles, there was no evidence to the show that the endometrium ignored the hormones from the ovulating follicle (the same process that bring the endometrium from thin to thick every month for non-BCP taking females). Furthermore, the indirect evidence that does exist seems to point to normal function of the endometrium.

    Hope this is helpful. I will post again if I find any further research.



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