Contraception: The moral of the story

Here I go with another contraversial topic and I can guarantee that some people will disagree with me on this one. There has been lively debate for decades, over what I’m about to say; It is my personal belief that from the moment a sperm fertilises an egg, it is a baby. I know in reality it is just a few cells. It doesn’t have a nose or a brain or a heart for that matter. But for me, the fact that those few cells, given time and the right environment, WILL become a fully formed baby, means that I consider the fertilsed egg a baby. I think the Australian pharmacist John Wilks puts forward a pretty good argument to support my case (read the 6th question about the pill being an abortifacient).

Now, I promise I won’t judge you if you have differing opinions to mine. That is not what I’m about. There have been many court cases that have tried to define when life begins. Some think it’s when the heart starts beating, some think it’s when the baby can live by itself outside of the womb (even this is highly debatable, most say this starts from around 23-28 weeks gestation) and my nan says the baby “comes alive” when you first feel it move.

I will be writing about the moral considerations of how some contraceptives work. So this discussion will probably only be interesting to you if you believe the same as me. But please feel free to read along anyway, even if your beliefs are different. And rest assured, with anyone I come across and in my practice as a midwife, I care for all women with the same dignity and respect, no matter what they believe.

The reason my interest in this topic was reignited, was because I saw that About.com are hosting a blog carnival called “Contraception and your overall health”. So I thought this would be a good time to blog about one aspect of contraception, for possible inclusion in the blog carnival.

There are so many widely available options for contraception nowadays. There is the pill, condoms (male and female), cervical cap, implants, injections and intrauterine devices (IUD) just to name a few. I wonder how many people think about the way these contraceptive devices actually prevent a pregnancy, prior to commencing use? My guess is that people would probably be more interested in knowing how effective each option is, rather than how it actually works. Though if, like me, you believe a fertilised egg is a baby, and if you have an issue with abortion (another unbelievably contentious topic), then there are some things you need to consider.

Most methods of contraception, except for barrier methods such as condoms or cervical caps, work by manipulating your body with a combination of one or both of the hormones progesterone and osetrogen. The actions of the hormones is to suppress ovulation (no eggs are released), thin the lining of the uterus (so a fertilised egg cannot imbed) and thicken cervical mucous (so sperm cannot enter the uterus). One popular IUD called “Mirena”, also claims to inhibit the sperm from entering the fallopian tube and reaching or fertilising the egg.

The issue I have, given that I believe a fertilised egg is a baby and I would never want to abort a baby, is that you can never know for sure what particular action of the hormones is responsible for not allowing a pregnancy to occur. If I could be sure that one method of contraception would suppress ovulation completely, thicken cervical mucous to the point that absolutely no sperm could enter or totally inhibit sperm from entering and fertilizing the egg, then I would choose that method. But as long as there is the tiniest inkling of doubt about whether a fertilized egg is being destroyed, then I could not choose that method. Therefore, according to my beliefs, I should not really choose any contraception that causes a thinning of the uterine lining because in theory, an egg COULD possibly be fertilised but have nowhere to imbed, thus causing an unknown abortion. I’ll admit there is only a slim chance of this happening because the other actions of the hormones are there to hopefully stop fertilisation. But it COULD happen.

So have I ever used contraception that could have possibly caused an abortion? Yes. Am I sad about that? Yes. Why did I do it? Silly reason really. I started using the pill when I was about 14, though not for contraceptive reasons, because I had acne. When it came time to start thing about contraception, I opted for the pill because it was familiar to me. I knew how to take it. I knew what effect it would have on me. I didn’t have to interrupt “the moment” by putting on a condom. So I took the pill for quite a few years. Though the pill is not the only abortifacient contraceptive. It upsets me to think of the babies I might have caused not to exist.

I understand the reasons people choose different types on contraception. I’ve thought about it a lot. I even got really excited when I first heard about “Mirena” because I thought it sounded like the perfect option (cheap, lasts 5 years, can be removed easily when you want your fertility to return, and no interruption at that crucial intimate moment), until I read the fine print and realised it too could cause harm to a fertilised egg.

So what options does someone who doesn’t like the possibility that her contraceptive option could abort a fertilized egg? There are barrier methods such as condoms, cervical caps, diaphragms, spermicide or contraceptive sponges. You can also use breastfeeding (lactational amenorrhoea), withdrawal method or charting temperature and vaginal mucous to assess fertile days and use barrier methods or abstinence during the fertile period. These last three methods however, have a high failure rate compared to barrier or hormonal contraception. Keep in mind though, that the only contraception with a 100% success rate is abstinence, and let’s face it, not many of us are willing to go there.

It is a very difficult decision. And one that deserves more thought than most people give it. Please don’t hear me putting the guilts on you, remember I am in the same unthoughtful boat. No matter what your morals or beliefs are, I hope you have been challenged by this post, as I have been challenged with my increased knowledge and realisation of how some contraceptives work.

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