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Standing at the Counter: A Defense for the Morality of Hormonal Birth Control

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Since the birth control pill was first approved for use by the Food & Drug Administration in 1960, it has been a controversial and integral part of American women’s lives. A study by the Centers for Disease Control in 2002 found that, in women of reproductive age, 82 percent had ever used the birth control pill. Despite its popularity, there is still debate over its use and justification. There are those who believe that hormonal contraceptives encourage immoral and destructive behavior in the very people who are supposed to model morality to society, and are not permissible under any circumstances. I contend, however, that not only is using hormonal contraceptives morally acceptable, there are circumstances in which using hormonal birth control is morally imperative.

Recent trends in the United States showcase the controversy surrounding hormonal birth control. In July 2002, a pharmacist by the name of Neil Noesen refused to fill (or even transfer) a customer’s prescription for birth control pills because he felt doing so would be morally incompatible with his personal beliefs. This was not the first time Noesen had had a run-in with customers seeking contraceptives; in fact, Noesen often would simply ignore these customers and refuse to tell other pharmacists on duty about their presence – either by putting customers calling for information about birth control on hold and leaving them there, or by leaving them to wait at the counter without help.

Since Noesen’s case, a rising number of pharmacists have begun to refuse to fill or refill their customer’s prescriptions for hormonal birth control based on moral or religious objections. Some have even held their costumers’ prescriptions hostage, refusing to send them to another pharmacy in the area that will dispense the medication.

And the pharmacists are not alone in their contempt: some general practice physicians and gynecologists are beginning to refuse their patients information about and services for birth control (including emergency contraception). Many pro-life organizations have joined the campaign, with some leading the movement to prove that hormonal birth control is immoral. On June 6, 2008, the American Life League, a Catholic pro-life organization, hosted the “The Pills Kills Babies” Day, which called for protests outside clinics providing birth control services in18 states, saying that “ALL seeks to raise awareness about the abortifacient nature of the pill, which is responsible for killing preborn [sic] children in their earliest days.”

The argument that unites pharmacists, physicians, and pro-life groups in their disapproval is their belief that hormonal contraceptives (any method that influences a woman’s fertility through the use of the female hormones of estrogen or progestin, or a combination of both, including the Pill, shots, patches, implants, etc.) have an abortifacient quality; that is, these birth control methods may chemically end a pregnancy in its early stages. Specifically, these groups believe that hormonal contraceptives thin the lining of uterus (where an egg implants once it is fertilized), preventing the fertilized egg from attaching and therefore causing a chemical abortion. And since these groups believe (based on religious grounds or another personal belief system) that abortion is immoral, they believe that hormonal birth control is also immoral.

At the heart of this argument against the morality of birth control are two questions: how does hormonal birth control work, and when does life begin?

According to the American Journal of Obstetrics and Gynecologists, hormonal birth control prevents pregnancy in two ways: by preventing ovulation (the release of an egg for fertilization), and by preventing fertilization of the egg through thickening the mucous naturally present in a woman’s reproductive organs (thereby keeping the sperm from reaching the egg). The authors specifically address the concerns of the pro-life groups by reinforcing two points: first, that hormonal birth control is highly effective at preventing fertilization, and secondly, that there is no scientific evidence that supports the idea that the uterine lining is affected to the point that a fertilized egg could not attach (sustained by the fact the women can and do get pregnant while using hormonal birth control methods, although these women represent a very small percentage).

It has been established that there is no scientific evidence that hormonal contraception prevents the implantation of a fertilized egg in a woman’s womb. However, there is still the question of when life begins. The National Institute of Health and the American College of Obstetricians and Gynecologists define pregnancy as beginning at implantation and concluding at delivery.

This is because pregnancy is confirmed by the level of a special hormone present in the blood or urine after implantation; there is no way to confirm conception prior to this point. It is also important to note that a fertilized egg, without implanting in the uterine lining, has no expectation of survival (or development) on its own, and that it is estimated that between one-fifth and one-third of all fertilized eggs naturally pass through a woman’s body without implanting. Based on these facts, it is scientifically impossible to argue that pregnancy begins prior to implantation, and therefore life cannot definitively be said to begin before implantation.

Even assuming that an egg can be fertilized despite the actions of hormonal birth control, and that such birth control could prevent the implantation of the fertilized egg (although, again, there is no evidence to prove this happens), it is still scientifically incorrect to say that hormonal birth control is an abortifacient. There is no pregnancy without implantation, and so no abortion can happen without a pregnancy. Based on this criterion for the morality of hormonal birth control (as established by pro-life organizations themselves), it can be concluded that this contraceptive method is in fact morally permissible.

However, there are other reasons that hormonal birth control can be considered morally acceptable. First, there is one issue that pro-life and pro-choice proponents alike can agree on: that abortion is not an ideal option in a society that values life. So, under the basic assumption that causing the end of a life is wrong, and that preventing the taking of a life is right, then it follows that hormonal birth control is a moral imperative, because it prevents a woman from needing an abortion in the first place.

Of the 43 million sexually-active women of reproductive age in the United States, 89 percent are currently using contraceptives, and the birth control pill is one of the most popular forms of contraception. It is estimated that contraceptive use among women prevents 632,300 abortions that would have resulted from unplanned pregnancies each year.

Therefore, as one of the most effective (most, if not all, of hormonal methods have a 97% or better efficacy rate) and most frequently-used contraceptive methods in the United States, birth control can be seen as a moral good in preventing abortion among those women who are sexually active and do not wish to have a child.

Another case for the morality of birth control: that it should be widely used among teenagers for the good of themselves and greater society. For this group, the availability of birth control has consistently been controversial over the years because pro-life organizations encourage abstinence for young people. Pro-life groups maintain that the availability of hormonal contraceptives encourages teenagers to have sex (because it enables them to separate sex from reproduction), which they believe is immoral and irresponsible behavior. Although the morality of sexual activity before marriage among young people does play a part in this argument, it is a discussion that would distract from the topic of the morality of birth control. Instead, this argument will focus on teenage contraceptive use and ramifications of unplanned teen pregnancy on the teen herself and society as a whole.

The Department of Health and Human Service’s 2005 United States Youth Risk Behavior Survey establishes that American teenagers can and do have sex regardless of its moral implications: approximately 46% of teenagers between the ages of 15 and 19 have had sex at least once.

Among the 3.1 million teenage women who are sexually active, over half use the Pill as their contraceptive method. It is estimated that each year, because of contraceptive use (and, by inference, hormonal birth control), 386,000 unplanned teen pregnancies are averted. However, teenage women still experience unplanned pregnancies – in fact, the United States has one of the highest teen pregnancy rates in the developed world (twice as high as in England or Canada, and eight times as high as in Japan), partly because of limited access or knowledge of contraceptives (hormonal or otherwise). Teen mothers are less likely than their childless counterparts to go to college, which limits their potential earning capacity. They are more likely to end up reliant on the welfare system, which transfers a huge cost onto U.S. taxpayers (for example: about $7 billion in 1996 alone). And there is a health toll as well: children of teenage mothers are more likely to be born prematurely or have a low birth weight, and are more likely to be victims of parental abuse.

Taking the financial, educational, and physical consequences of teen pregnancy on the mother and child into account, as well as the economical and social burden of caring for unplanned children placed on society, it can only be concluded that unplanned pregnancy in teenage women is not beneficial either to the individual good or the common good of society. It has also been established that, aside from abstinence (which almost half of America’s teenagers admit they do not practice), hormonal birth control is the most effective tool for preventing the problems that result from teen pregnancy, as it can prevent the pregnancy itself. Consequently, not only is widespread, readily available hormonal contraception for teenagers morally permissible, it is also needed to ensure the greater good.

Nevertheless, it is vital to acknowledge that this argument can be taken somewhat further than is advisable: that a teenager should not be allowed to have children under any circumstances. I would posit, however, that forcing someone not to have a child is just as immoral as forcing someone to have a child. Either option is a violation of one’s right to personal choice (and a potential violation of one’s body, which is immoral in almost any circumstance), and is almost certainly immoral. It is enough to be considered morally right in our society to provide the better choice along with all the other choices, and allow the individual to decide for him or herself.

Finally, there is another situation in which the use of hormonal contraceptives is of vital moral importance: in cases of sexual assault. It has been found that 5 percent of sexual assaults result in the victim becoming pregnant (roughly 32,101 cases of rape-related pregnancies in women over the age of 18 each year – the majority of which end in abortion). Emergency contraception (a form of the Pill known as Plan B that has higher amounts of female hormones) has been found to prevent 86 percent of pregnancies when taken up to 72 hours after unprotected sex. Therefore, it is logical to argue that emergency contraception would prevent a large number of rape-related pregnancies in women who are informed about the drug and choose to use it. In this case, where in the United States the moral wrongness of sexual assault is nearly universally understood, the priority should be to limit any further violation to a woman’s person. Even the Catholic Church, an institution notoriously against the proliferation and use of birth control methods, recognizes the right of a rape victim to “defend herself not only against the act of rape but also against the effects of the aggressor’s sperm – i.e., pregnancy.”

Yet there are several documented cases of rape victims who have been denied prescriptions for or access to emergency contraception by pro-life medical professionals under the guise that the drug is an abortifacient. As we have already exposed this reasoning as being scientifically insupportable, it follows that providing the rape victim with her options regarding emergency contraception – and the drug itself if she so chooses – is ethically acceptable. It is also morally imperative in order to prevent an unwanted pregnancy and further psychological and physical harm.

Hormonal birth control – however controversial – remains the choice of the individual. There is no compelling evidence to suggest that it is anything other than beneficial to those who conscientiously choose to use it, or to the society that allows its use. Likewise, there is no evidence to suggest that hormonal birth control itself is an immoral choice. This leads me to conclude that the pro-life stance on hormonal contraception is more of an objection to an individual’s sexual choices, and this is not valid justification for medical professionals to leave women standing at their counters, waiting for help that will not come.

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Written by sfaile

August 25, 2008 at 5:26 pm