Contraceptive Counseling

By David Stevens, MD, MA (Ethics)
Church Report
January 2007

 

Bill and Susan have done well on their pre-marriage testing; they are reading the books you suggested; and they are communicating at a deeper level than most of the couples you counsel. It is going to be a joy to perform their wedding.

 

However, during one of your counseling sessions Susan surprises you with this question, “Pastor, which birth control do you recommend we use? I’ve heard some forms can cause abortion.” Your hand involuntarily moves towards your Rolodex as you try to remember the name of a Christian doctor to refer them. Seminary did not offer a course on contraception!

 

First, you should be aware of some key medical information. Fertilization typically takes place in the fallopian tube. Most of the Christian doctors and ethicists I know mark fertilization as the beginning of human life. Trying to point to some other time in development does not make sense from a scientific or Biblical perspective. After fertilization, the new life travels down the tube, taking up to 6 days to reach the uterus and implant. While some “contraceptives” primarily work to prevent fertilization, we must pay particular attention to those that interfere with these early days of development. Most of us consider interference in development as morally unacceptable.

 

Here is a simple principle to guide your advice. Reject contraceptives that can halt or harm development after the moment of fertilization. The Bible teaches that we are made in God’s image, thus making each life sacred (Genesis 1:26-27, 9:5-6). It also teaches that we are persons of God’s favor and purpose prior to birth (Psalm 51:5, 139:13-16). Man is not to unjustly take human life (Deut 5:17). Christ himself became an embryo and thus sanctified every stage of human existence. Just imagine, God was once a single cell embryo!

 

So how do we apply these principles?

 

Forms of contraception that prevent the union of the sperm and egg are morally acceptable for most Protestants. These methods do not destroy life. They include the most commonly prescribed combination birth control pills - those that contain both estrogen and progesterone. Increasingly, these hormones are also delivered in non-pill forms such as skin patches and vaginal rings. These methods work primarily by preventing ovulation each month. (Read more on this below.) Used correctly, they are greater than 95% effective.

 

DepoProvera is an injectable contraceptive that releases larger doses of progesterone over a three-month period. It primarily works by preventing ovulation as well.

 

Barrier methods are also morally acceptable, but are not as effective. They prevent the sperm from reaching the egg. These methods include condoms, vaginal sponges, diaphragms, cervical caps, spermicidal jellies, etc. It is important that couples know that these methods are not as reliable as hormonal contraception. If 100 couples use male condoms correctly for a year, about 15 will get pregnant. Correct use of spermicide alone would result in 26 pregnancies per year. The diaphragm used with a spermicidal jelly reduces the pregnancy rate to 5%. Of course, all of these methods require planning and discipline to use correctly. The actual pregnancy rate may be higher.

Natural family planning (previously called the “rhythm method”) is increasingly being practiced by Protestant couples. New techniques have made it more reliable. There are now ovulation predictor tests available over-the-counter in drug stores. The failure rate is between 5 and 15%.

 

Other forms of contraception are more likely to have a “post-fertilization effect.” They may interrupt the first few days of development prior to implantation. They should not be used. The “min-pill” contains only a low dose of progesterone. It works primarily by preventing the developing embryo from implanting in the uterus. IUD’s (intrauterine devices) are inserted in the woman’s uterus. While they can prevent fertilization, at least some of the time, they create a hostile environment that interferes with the embryo implanting in the uterus.

 

There are variations on these methods and new ones are being developed every day. The important thing is to teach the couple which questions to ask. Ideally, you can refer them to a physician who shares their worldview. (Find a Christian doctor at .) Couples should tell their doctor up front that they do not want a method that has a post-fertilization effect. They should expect explanations of how specific methods work.

 

You may talk to prolife couples who have been taught that combination pills have a post-fertilization effect. The Christian Medical Association convened a committee of experts to investigate the issue. Their conclusion was there is not sufficient evidence to conclude that the contraceptives that contain both estrogen and progesterone have an abortifacient effect. Neither is there evidence to the contrary. As a matter of proper counseling, couples should be informed of the lack of clarity on this issue. At this point, beware of those who say they are certain of the science. There is much we do not know about the days of human development prior to implantation.

 

Complicated, isn’t it! However, you can counsel about the underlying moral principles then encourage couples to read The Contraceptive Guidebook by Cutrer and Glahn. It is medically reliable and Biblically sound. It looks at these methods in more depth.

 

Contraceptive counseling is an important part of premarital counseling. Engaged couples need and value your advice. With a little preparation, you will not let them down.

 

David Stevens, M.D., M.A., is the executive director for the Christian Medical & Dental Associations, the largest faith-based organization of doctors in the nation. For more information, log on to: www.cmda.org.