Thursday, April 3, 2008

Family Planning Post #8: IUDs

Intrauterine Devices

The intrauterine device (IUD) is a small t-shaped plastic device that contains either copper or synthetic progesterone and is inserted into the uterus by a physician. It tends to be very effective with a less than 1% failure rate.

According to the American Pregnancy Association, it works in this way:
The progesterone intrauterine device releases a constant low dose of a synthetic hormone continually throughout the day. Both the progesterone IUD and copper IUD prevent pregnancy in one of two ways:

  • The released progesterone or copper creates changes in the cervical mucus and inside the uterus that kills sperm or makes them immobile.
  • Changes the lining of the uterus, preventing implantation should fertilization occur. Ethical Considerations.

The link to the "Ethical Considerations" reads this way:

"It is possible that you may not have been aware that any ethical questions existed concerning contraception. The contraceptive methods that involve the changing of the lining of the uterus to prevent implantation from occurring create an ethical or moral consideration for some people.

Some people believe that life begins at conception whereas others believe it begins at implantation. The ethical consideration develops for individuals who believe that life begins at conception.

When contraceptive methods fail to prevent ovulation or fertilization, the changing of the uterine lining is used to prevent the fertilized egg or “life” from implanting in the uterine wall. It is this action that leaves people believing they have crossed an ethical boundary."

First of all, can I just say I am SO THANKFUL for a mainstream medical website that even mentions that there is an ethical issue to be considered? The American Pregnancy Association is not taking a stance on the issue, but it is actually providing helpful information for people who are deciding how they're going to think about this stuff by letting them know that there is a question to be asked.

In an earlier post, I spent a good deal of time developing a foundation for why I believe that the point of fertilization is the point at which the life has begun and personhood is imparted. This ethical consideration helps us see exactly why that foundation is necessary.

For Catholics and Evangelicals alike, the question regarding whether or not IUDs are acceptable seems to be a no-brainer... if you are informed. I am not suggesting here that people who use IUDs necessarily have no brains. The problem is that so many people are not informed. Once you know how it works, it seems to clear up any ethical dilemma you may have. Basically, the IUD is abortifacient (because it works to prevent the fertilized egg--human life--from implanting in the uterus) and should not be used. Here are a bunch of quotes in support of this reasoning:

"For many years the exact nature of the contraceptive action of the IUD was not known. It is now well-established, however, that the primary action of these devices is to produce an inflammation of the uterine wall, which prevents the implantation of a fertilized ovum. According to Dr. Thomas W. Hilgers of the Mayo Graduate School of Medicine in Rochester, Minnesota, 'It is evident that the IUD exerts its birth-preventative effects primarily through the destruction, at a uterine level, of the preimplantation blastocyst.' Consequently, 'the primary action of the IUD must be classed as an abortifacient,' according to Dr. Hilgers.23" --John Jefferson Davis, Evangelical Ethics, p. 33

"The IUD is quite effective but I don't recommend it. The IUD is merely a formed piece of plastic placed within the uterus. It apparently works this way: Conception occurs in the fallopian tube, just as if one were using no contraception. Yet when the so-called pre-embryo--the tiny developing baby--reaches the uterus, it is unable to implant (attach to the wall of the uterus). Thus, it aborts without the woman ever knowing it. The abortion risk, coupled with a risk of infection within the uterus that can lead to infertility, renders this method unacceptable, in my view. Some research has suggested that the IUD may work in some other way than I have described, and that it actually prevents pregnancy rather than terminating it. However, until we have more data, I would recommend erring on the side of caution." --William Cutrer, M.D. [OBGYN] and Sandra Glahn, Sexual Intimacy in Marriage, p. 255

"Unacceptable forms of family planning include all forms of induced abortion. Thus, the intrauterine device or 'IUD' is an unacceptable method, because its primary function is to create an unstable environment for the fertilized egg to implant in the uterine wall by depleting the endometrial lining, making it incapable of supporting the life of the child." --Andreas J. Kostenberger, God, Marriage and Family: Rebuilding the Biblical Foundation, p. 136.

"Since the mid-1970s, there has been general agreement that the primary action of the IUD is to prevent a newly conceived human life from implanting in the uterus.25 When a drug or device prevents the implantation of a newly conceived human life, it has to be classified as an abortifacient, something causing an abortion." --Kippley and Kippley, The Art of Natural Family Planning, p. 11

"Christian couples must ensure that the methods chosen are really contraceptive in effect, and not abortifacient. Not all birth control is contraception, for some technologies and methods do not prevent the sperm from fertilizing the egg, but instead prevent the fertilized egg from successfully implanting itself in the lining of the womb. Such methods involve nothing less than an early abortion. This is true of all IUDs and some hormonal technologies. A raging debate now surrounds the question of whether at least some forms of the Pill may also work through abortifacient effect, rather than preventing ovulation. Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." --Dr. Albert Mohler, President of The Southern Baptist Theological Seminary in an article titled "Can Christians Use Birth Control?"

Dr. Mohler offers a key insight in his statement. "Christian couples must exercise due care in choosing a form of birth control that is unquestionably contraceptive, rather than abortifacient." This evaluation tool will be helpful to keep in mind as we move forward to discuss other birth control options.

In addition to the risk of aborting a baby, there are many other significant risks associated with IUDs that are often downplayed in the doctor's office. John Jefferson Davis seems to do a good job of summarizing some of them:

"Significant medical complications continue to attend the use of even the newest forms of the IUD. Studies indicate that users of these devices are three to five times more likely than nonusers to develop pelvic inflammatory disease.24 Such pelvic inflammations can cause permanent sterility. 'Infertility following IUD use is an important potential risk,' notes Dr. Robert A. Hatcher. Thus, states Hatcher, 'I find myself searching more diligently for alternatives and leaning away from the use of IUDs in women who hope to bear children later.'25

Accidental pregnancies in women using IUDs have an unusual risk of being ectopic ('tubal') or resulting in a septic (infected) abortion.26 The spontaneous abortion rate for users of IUDs is approximately three times that for pregnancies not complicated by such devices.27 If a woman becomes pregnant with an IUD in place, the chances are more than one in twenty that the pregnancy will be ectopic.28" (Evangelical Ethics, pp. 33-34)

So, if the sperm do connect with and fertilize the egg, and if the fertilized egg (aka newly-formed human life) is not aborted due to the alteration of the uterine lining, there is a good chance that it will be spontaneously aborted in miscarriage or that it will implant in the wrong place (ectopic pregnancy) and likely die. Yikes!

Hopefully, I have provided helpful information for you as you evaluate this form of birth control. My goal was to provide secular as well as Christian (both Catholic and Evangelical) perspectives on the mechanisms and ethical considerations regarding the IUD. There is much more information available, so feel free to do additional research.

I've saved the most challenging two for last... hormonal technologies (the pill, the patch, vaginal rings, and injections like Depo-Provera and Lunelle) and sterilization (tubal ligation and vasectomy).

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