Introduction
Contraceptive
methods include the rhythm method (or Natural Family Planning), barrier methods
(condoms, diaphragms, vaginal sponges, cervical caps, spermicidal foams, gels,
creams), hormonal contraceptives (birth control pills, Depo-Provera, Norplant),
intrauterine devices, and sterilization.
The RU-486 (or similar American version, Ella) is abortifacient in that
it starves the foetus of nutrition, resulting in death.
Several
related Christian ethical considerations include:
·
Marital and sexual
ethics (the right place of sex only in marriage; the purpose of marriage for
procreation and/or spiritual/marital union, and/or avoidance of temptation)
·
Ethics of contraception
·
Ethics of abortion
·
Medical interventions
for fertility/infertility (fertilization, sterilization)
·
Ethics of surrogacy
A
broader, Biblical understanding of life, sex, and marriage undergirds Christian
convictions about such topics. In this essay, I intend to focus on the moral issues
of one means of contraception that blurs the line between contraception and abortion:
the Intrauterine Device (IUD).
What is the Intrauterine Device and the
Christian View on Its Use?
According
to Human Life International, the IUD functions as a contraception
some of the time but also causes abortion (is an ‘abortifacient’). The device works by prohibiting implantation
of a fertilized egg by irritating the endometrium (the uturus’s lining). A fertilized egg does not implant immediately
in the uturus, and so an IUD that is inserted after copulation even up to two
days later will result in pregnancy only one in one thousand one hundred times.
The
debate over whether the IUD is or is not an abortifacient is not over how it
functions but over whether a fertilized egg is a child or whether human life
only begins at implantation. Those
arguing that the fertilized egg is not human also argue that most fertilized
eggs—allegedly above 70%--never implant.
The implication is that, if this is so, then the loss of fertilized eggs
is a natural process and should not be ascribed a moral dimension.
In
response to this argument, one might begin by examining whether the claim that
human embryos naturally abort so often.
According to Gavin E. Jarvis (Department of Physiology, Development and
Neuroscience at the University of Cambridge), ‘estimates for total prenatal
mortality of 70% or higher are exaggerated and not supported by the evidence.’ HLI replies to this argument that the
fertilized egg is the same before and after implantation: the difference is not
one of life but of hospitality.
What,
then, is an abortion? In the USA, the
definition given by the US Department of Health, Education and Welfare in 1963
was
all the measures which impair the viability of the zygote at
any time between the instant of fertilization and the completion of labor
Two
years later, in 1965, when the American College of Obstetrics and Gynecology
published their first guide to terminology, the definition of an abortion had
changed to ‘Conception is the implantation of a fertilized ovum’.
Apart
from possible birth defects, pelvic infections, sterility, and miscarriages,
certain types of IUD have also resulted in death. Consequently, companies producing various
versions of the IUD have discontinued manufacture: the Dalkon Shield in 1975,
the Lippes Loop in 1985, and the Tatum-T IUD in 1986. While over 70 types of IUD have been produced
since their introduction in 1915 as a contraception, now ‘Because of widespread
negative publicity, only 1% of women using birth control were on the IUD by
1995, but this number had risen to about 9% by 2017.’
The Life in the Womb
Consider
two contrasting statements in antiquity.
The first is Biblical. In
Ecclesiastes, we read:
As you do not know the way the spirit comes to the
bones in the womb of a woman
with child, so you do not know the work of God who makes everything (11.5).
This statement provides insight into a Biblical ethic, evident in
various other texts (see below), about the life of the foetus. The text removes from discussion a claim
about when a foetus might be considered human.
This is the wrong question.
Instead, the foetus is considered God’s creative work. Second, the passage rejects the notion that
the foetus can be reduced to a mere collection of cells. By speaking of ‘the way the spirit comes to
the bones in the womb’, the text is not entertaining some ethic at which it is
at some point just a collection of cells.
First, it does not say ‘when’ but ‘the way’ this happens. Second, it says that the humanity of the
foetus is to be assumed. The ethics
around the unborn, whether a typical child or one conceived in violence,
threatening the mother’s life, or deformed in some way, begins with the
acceptance that we are speaking of a human life. Any attempt to dehumanize the foetus in order
to justify its killing is no different from dehumanizing some other group, such
as the Jews in Nazi Germany, to do the same.
The second statement is from Aristotle:
As to the exposure and rearing of children, let there be a
law that no deformed child shall live, but that on the ground of an excess in
the number of children, if the established customs of the state forbid this
(for in our state population has a limit), no child is to be exposed, but when
couples have children in excess, let abortion be procured before sense and life
have begun; what may or may not be lawfully done in these cases depends on the
question of life and sensation (Politics 7.XVI).
Aristotle’s
description of his ideal state would control its population’s size, using infanticide,
eugenics, and abortion. Yet he also says
that this is to be done before the foetus has ‘life and sensation’. He did not understand life in the womb,
assuming that it was when movement could be sensed. Termination of the foetus’s existence was to
be done before this.
Today,
we know that the foetus’s life begins at conception. What the foetus is at this point is what it
becomes. Nothing is added. All that is needed is the right hospitality
in the womb to reach birth and the right care after birth for the child to
reach independence. So, what do we mean
by ‘viability’? Some use this to mean
the viability of the foetus to live apart from the mother, but the foetus is
viable in itself as long as it is not put to death. An elderly person with Altzheimer’s who must
be fed, or a quadriplegic with a fully functioning mind, is not ‘viable’ in the
sense a foetus is not viable, but all three are viable if shown the care needed
to sustain life.
Biblical Texts Affirming the Humanity
of the Foetus
Biblical
texts support the notion that the foetus is alive in the womb. The focus is not on trying to determine some
stage of viability. Rather, what the
Bible recognises is God’s providential
care of the life in the womb. What
God values, humanity should value. Not
only is the foetus a human life, it is also a God-given life. The following texts suggest as much:
•
Exodus 21:22-25
"When men strive together and hit a
pregnant woman, so that her children come out, but there is no harm, the one
who hit her shall surely be fined, as the woman's husband shall impose on him,
and he shall pay as the judges determine.
23 But if there is harm, then you shall pay life for
life, 24 eye for eye, tooth
for tooth, hand for hand, foot for foot,
25 burn for burn, wound for wound, stripe for stripe.
A person unintentionally causing a
woman to give birth early is to be fined when no harm results but life is paid
with life if it does, according to the lex
talionis.
•
Psalm 71.6 Upon you I have leaned from
before my birth;
you are he who took me from my
mother’s womb.
My praise is continually of you.
On the one hand, God
providentially cares for the foetus. On the
other, the foetus leans on God’s providential care. A caring relationship exists between God and
the child before birth.
•
Psalm 139:13-16
For you formed my inward parts; you knitted me
together in my mother's womb. 14
I praise you, for I am fearfully and wonderfully made. Wonderful are your
works; my soul knows it very well. 15
My frame was not hidden from you, when I was being made in secret, intricately
woven in the depths of the earth. 16
Your eyes saw my unformed substance; in your book were written, every one of
them, the days that were formed for me, when as yet there were none of them.
God’s care for the unborn does not begin at birth or
even some later time but exists throughout the time of the formation of the
foetus. The psalmist is saying that the
celebration of the personhood of the foetus does not begin when it is fully
formed but already while it is being formed.
God omniscience and predestination of the individual’s life covers the
entire span of life, from conception to death.
In fact, the psalmist celebrates God’s presence in places beyond this
life just as he celebrates God’s presence in the formation of the foetus: ‘If I ascend to heaven, you are
there! If I make my bed in Sheol, you
are there!’ (v. 8). Human personhood and
worth is not limited to some notion of viability that we entertain.
•
Ecclesiastes
11.5 As you do not
know the way the spirit comes to the bones in the womb of a woman with child, so you do not know the work of God who
makes everything.
(See the comment, above)
•
Isaiah 44.24a Thus says the LORD, your Redeemer, who formed you from
the womb....
To express His providential
care of Israel, God speaks to the people in the singular—as ‘Jacob’, His
servant—and of His work in both creation and redemption. His care is like that of His care in the
womb. When providence is part of the
notion of care, care is expanded beyond present existence (viability) to include
God’s purposes, beginning from the moment of creation and passing through
formation. As Israel was sent into exile
and redeemed by God, he was, one might say, also in God’s care when he was no
longer viable. The metaphor works for
Israel only if it is also true regarding God’s care of the foetus above and
beyond viability.
•
Jeremiah 1:5 "Before I
formed you in the womb I knew you, and before you were born I consecrated you;
I appointed you a prophet to the nations."
If we only had this verse to speak
of God’s providential formation and consecration prior to birth, we might limit
it to the special case of Jeremiah or a prophet doing God’s work. Other passages already noted, however, show
that the belief extended to all foetuses.
•
Galatians 1:15 But when he who had
set me apart before I was born….
In this passage, Paul applies the
thought and wording in Jeremiah 1.5 to himself.
•
Luke 1:41-44 And when Elizabeth
heard the greeting of Mary, the baby leaped in her womb. And Elizabeth was
filled with the Holy Spirit, 42
and she exclaimed with a loud cry, "Blessed are you among women, and
blessed is the fruit of your womb! 43
And why is this granted to me that the mother of my Lord should come to
me? 44 For behold, when the
sound of your greeting came to my ears, the baby in my womb leaped for joy.
What has been said about the foetus’s status before God in
other passages is now illustrated in the personhood and spirituality of John
the Baptist and Jesus in the womb.
Christian Convictions on Contraception
and the IUD
The Orthodox Church
While
different views have been held in Orthodox circles about contraception, the
Orthodox Church continues to hold the Early Church’s view that all abortion is
wrong. The following excerpts from For the Life of the World: Toward
a Social Ethos of the Orthodox Church address
teaching representative of the Orthodox Church (approved by the Ecumenical
Patriarch in 2020) on contraception and abortion:
The Orthodox Church has no dogmatic objection to the use of
safe and non-abortifacient contraceptives within the context of married life,
not as an ideal or as a permanent arrangement, but as a provisional concession
to necessity. The sexual union of a couple is an intrinsic good that serves to
deepen the love of each for the other and their devotion to a shared life. By
the same token, the Church has no objection to the use of certain modern and
still-evolving reproductive technologies for couples who earnestly desire
children, but who are unable to conceive without aid. But the Church cannot
approve of methods that result in the destruction of “supernumerary” fertilized
ova. The necessary touchstone for assessing whether any given reproductive
technology is licit must be the inalienable dignity and incomparable value of
every human life (For the Life of the World 24).[12]
A human being is more than the gradually emergent result of
a physical process; life begins at the moment of conception. A child’s claim
upon our moral regard then is absolute from that first moment, and Christians
are forbidden from shedding innocent blood at every stage of human development.
The Church recognizes, of course, that pregnancies are often terminated as a
result of poverty, despair, coercion, or abuse, and it seeks to provide a way
of reconciliation for those who have succumbed to these terrible pressures.
Inasmuch, however, as the act of abortion is always objectively a tragedy, one
that takes an innocent human life, reconciliation must involve the
acknowledgment of this truth before complete repentance, reconciliation, and
healing are possible. Moreover, the Church must be ready at all times—inasmuch
as it truly wishes to affirm the goodness of every life—to come to the aid of
women in situations of unintended pregnancy, whether as the result of rape or
of consensual sexual union, and to come also to the aid of expectant mothers
suffering from penury, abuse, or other adverse conditions, by providing them
material and emotional support, spiritual succor, and every assurance of God’s
love, both during and after pregnancy (For the Life of the World 25).
The Church does recognize, however, that in the course of
some pregnancies there arise tragic and insoluble medical situations in which
the life of the unborn child cannot be preserved or prolonged without grave
danger to the life of the mother, and that the only medical remedy may result
in or hasten the death of the unborn child, contrary to all that the parents
had desired. In such situations, the Church cannot pretend to be competent to
know the best way of proceeding in every instance, and must commend the matter
to the prayerful deliberations of parents and their physicians. It can,
however, offer counsel, as well as prayers for the healing and salvation of all
the lives involved. Furthermore, the Church laments the ubiquity of the loss of
life in utero through miscarriage and stillbirth, understanding these
experiences as particularly powerful forms of bereavement for the family, and
it must revise those of its prayers that suggest otherwise, and rise to the
sensitive and loving pastoral care that loss of pregnancy requires (For the Life of the World 26).
The Roman Catholic Position on
Contraception
Roman
Catholicism is opposed to both abortion and all forms of contraception other
than natural family planning. As this
article is about the IUD, which is a form of contraception that at times also
aborts fertilized eggs, the Church is against its use. Catholic teaching on both contraception and
abortion is not simplistic but the articulation of theological and moral
convictions as new developments arise.
Catholic
moral reasoning is evident in the Papal Encyclical of Pope Paul VI in 1968
entitled, Humanae Vitae (HV). HV begins by identifying new issues that had
come into focus at the time and that relate to family planning and
contraception. First, it mentions
challenges associated with the increase of population and pressures placed on
our resources and economies. This is not
only a social concern but also a challenge within a large family. A second issue identified is the dignity of
women in society (apparently referring to the roles they play outside the
family). A third issue is the ‘value of
conjugal love in marriage and the relationship of conjugal acts to this
love.’ The fourth, new issue to
consider is ‘man’s stupendous progress in the domination and rational
organization of the forces of nature’ affecting ‘every aspect of his own life’,
including the regulation of the transmission of life—contraception.
HV
(10) argues that marital love entails responsible parenthood. This means that reason and duty are exercised
over biological forces, emotional drives, social and familial factors regarding
procreation. Each sexual act is
purposive, having an ‘intrinsic relationship to the procreation of human life’
(11). This procreative purpose of
marriage is inseparable from the unitive purpose in marital intimacy (12). These two purposes of marriage are
God-given. Thus, sex fulfilling a
function of marital unity without also
aimed toward the procreative purpose of sex frustrates God’s design as the
Author of life (13).
Upon
this reasoning, the Catholic Church condemns contraception and sterilization,
whether temporary or permanent (14).
This does not rule out using reason in natural family planning and
infertile periods for marital intimacy to express their love for one another
(16). Further considerations about birth
control include how it opens culture up to infidelity and lower standards of
morality, reduces a man’s reverence for a woman inasmuch as she becomes an
object for his satisfaction and desires, and opens society up to government’s
oversight in applying its standards to matters of family responsibility (17).
An Evangelical Position on IUDs
In
discussing Protestantism, the focus in this section will be on an Evangelical
position. Evangelicalism is not a
‘Church’ or denomination but a movement across a spectrum of theological
traditions. It is therefore difficult to
speak of ‘the’ Evangelical view in the way that we can for the Orthodox or
Roman Catholic Churches. Yet it is a
traditional movement on the same trajectory of historic, orthodox Christian
faith. The mainline denominations of Protestantism, on the other hand, have
progressively rejected historic Christianity on key theological and ethical
issues in favour of the views and practices of contemporary culture. The result is that, today, mainline
denominations are open to abortion. These denominations are led more by
adaptation to Western culture than by Christian teaching. This essay on Christian reasoning about
contraception, abortion, and the use of the IUD should pursue Christian ethics
through the Evangelical writers, therefore.
One
of the factors separating the liberal, mainline denominations (all declining
since the 1960s and so no longer ‘mainline’) from Evangelicals is the stance
taken on abortion, and therefore on certain methods of contraception. As John Jefferson Davis notes, Protestants
followed Catholics in rejecting contraception up to the early 20th
century. Only in 1930 did Anglican
bishops say that contraception may be used, but not out of motives to do with
selfishness, luxury, or convenience. The acceptance of contraceptives by
Protestants was furthered in 1960 with the development of the Pill.
Evangelical Protestants (e.g., John
Jefferson Davis,
Albert Moller,
Andreas Köstenberger, Wayne
Grudem, John
S. Feinberg and Paul D. Feinberg, Alvin
Low) follow
Orthodox and Catholic ethics regarding the IUD as abortifacient and therefore morally
wrong. This is also the view of the Christian
Medical Fellowship (CMF) in the United Kingdom and the
Christian Medical and Dental Association (CMDA) in the USA. In ‘The Beginning of Human Life’ (16 June,
2006), the CMDA stated in its position paper that ‘The life of a human being
begins at the moment of fertilization (fusion of sperm and egg).’ It defines human life as follows:
A living human
being is a self-directed, integrated organism that possesses the genetic
endowment of the species Homo sapiens who has the inherent active biological
disposition (active capacity and potency) for ordered growth and development in
a continuous and seamless maturation process, with the potential to express
secondary characteristics such as rationality, self-awareness, communication,
and relationship with God, other human beings, and the environment.
In
other words, a fertilized egg is a human being before implantation in the
uterus. Moreover,
It is artificial and arbitrary to use other proposed
biological “markers” (such as implantation, development of a primitive streak,
absence of potential for twinning, brain activity, heartbeat, quickening,
viability, or birth and beyond) to define the beginning of human life.
Dr. Al Moller, president of the Southern
Baptist Theological Seminary, notes that Evangelicals at first were
uncritically open to birth control technologies, including the IUD. Writing in 2004, he noted that this was
changing as Evangelicals thought more seriously about this. This trend began before then
as medical professionals came to understand how the IUD worked. Realising that it was not just a contraception
but also an abortifacient, Evangelicals have come to reject the IUD. Franklin E. Payne, Jr., Associate Professor
at the Medical College of Georgia, says,
...
abortifacients are not an ethical choice. These methods include surgical
abortion by various means and at various stages of fetal development, the
intrauterine contraceptive device (IUD), the “mini pill” (containing a
progestin only), subcutaneous injection of estrogens and progestins, the
“morning after” pill (a high dose of estrogen or progestin), and the new French
abortifacient, RU-486.[30]
Moller concludes:
For evangelicals, much work remains to be done. We must
build and nurture a new tradition of moral theology, drawn from Holy Scripture
and enriched by the theological heritage of the church. Until we do, many
evangelical couples will not even know where to begin the process of thinking
about birth control in a fully Christian frame. It is high time evangelicals
answered this call.
The
development of an Evangelical position on IUDs took several decades. This was due to more than one factor. The broad acceptance of the use of
contraceptives by Protestants from the 1960s required both differentiation
regarding what the different methods entailed and consensus building across
groups making up the fraternity. The
separation of Evangelicals from mainline Protestant denominations that
increasingly rejected historic Christianity played out over the same decades
and led to opposite views on the morality of abortion—and therefore different
views on abortifacient contraceptives.
Another factor pressuring Evangelicals to come to a view on
contraceptives was the legalisation in Western countries of abortion. Evangelical consensus is also difficult to
come by inasmuch as many so-called Evangelical churches are non-denominational
and independent. Forming an ‘Evangelical position’ can at times be rather like
herding cats. Finally, during the 20th century, medical researchers
increasingly clarified what the science of different contraceptive methods
entail. Just how the IUD operates was for a long time uncertain. Even so, we can say that there is a fairly
strong and consistent view among Evangelicals today that abortion is immoral as
it is the taking of a human life, that the IUD can work as an abortifacient
technology, and that the IUD is therefore not a moral option.
A
brief overview of the history may be helpful.
In 1970, the Christian Medical Society produced a statement entitled, ‘A
Protestant Affirmation on the Control of Human Reproduction’ that affirmed the
use of contraceptives. Sex was and is
understood to be morally proper only in marriage (between a man and a woman, of
course), and it was understood to have several purposes: the consummation of
marriage, procreation, the expression of love within the covenant of marriage,
and enjoyment and pleasure. The latter two reasons allow for the use of
contraceptives to prevent pregnancy, whereas the procreative reason for sex in
marriage allows a couple to regulate their family for various reasons (number
of children, spacing of children, finances, transmission of inheritable
diseases, etc.).
The
early, 1970 statement did not distinguish types of contraception and did accept
use of the IUD. With the Patient
Protection and Affordable Care Act, passed in 2010, free contraception became
available to women, whether married or not.
This forced Evangelicals to consider the ethics of contraception in
greater depth, and they voiced concerns that Christian institutions were being
forced to pay health insurance covering immoral sexual acts and forms of
contraception that disregarded the sanctity of the foetus’s life. One form of unacceptable birth control that
sometimes aborted a fertilized egg was the IUD.
Conclusion
This
essay on Christian ethics and the use of the intrauterine device (IUD)
demonstrates that there is a consensus among Orthodox, Roman Catholic, and
Evangelicals that the IUD is not an option for Christians. The reasoning rests on the convictions that a
fertilized egg is a human being and that the termination of human life is morally
wrong. Around the edges of this
conviction, some further moral questions arise.
For example, what is the ethics regarding abortion when the mother’s
life is in danger, or when a woman is raped, or when there is incest? Such moral quandaries lead to various views among
Christians (not discussed here), but they are not to be considered apart from the
conviction that the fertilized egg is a human being, not just a mass of
cells. Throughout the history of the Church,
abortion has been regarded as immoral, the taking of a human life. As the mechanism by which the IUD operates has
come to be better understood, its occasional function as an abortifacient has led
Christians to agree that it is morally unacceptable.
Addendum
Other Statements on Use of the IUD
Assemblies of God, ‘Sanctity of Human Life: Abortion and Reproductive Issues,' General Presbytery, August 9-11, 2010
‘The Assemblies of God, finding no clear
scriptural mandate, does not take an official stand on the appropriateness of
contraception within a heterosexual marriage for purposes of regulating the
number of children, determining the time of their birth, or safeguarding the
health of the mother. These are matters of personal conscience as godly
spouses prayerfully covenant with God about the growth of their families. While
there are important ethical issues in determining to have a family, the
prevention of pregnancy is understood to be qualitatively different from the
termination of pregnancy since the sperm has not fertilized the ovum and human
life has not yet begun. The biological processes themselves teach us that in
God’s creative design not every sperm or ovum is intended to survive and unite.
It should be remembered, however, that some methods commonly regarded as
contraception, such as the IUD and the morning-after pill, are actually agents
that abort, rather than prevent, pregnancy’ (https://ag.org/Beliefs/Position-Papers/Abortion-Sanctity-of-Human-Life).
Southern Baptist Convention, 'On the Ethical Realities of
Reproductive Technologies and the Dignity of the Human Embryo,' June 12, 2024
‘Every human being is made in God’s image
(Genesis 1:27-28) and is thus to be respected and protected from the moment of
fertilization until natural death, without regard to developmental stage or
location...’ (https://www.sbc.net/resource-library/resolutions/on-the-ethical-realities-of-reproductive-technologies-and-the-dignity-of-the-human-embryo/).
Nebuchadnezzar says: ‘As soon as he had created me, the lord, the god
who created me, the god Marduk, fashioned my form inside (my) mother (so that)
when I was born I myself was (fully) formed.’
See: http://oracc.org/ribo/Q005473/.
Wayne Grudem, Christian Ethics: Living a
Life that is Pleasing to God, Rev. ed. (Wheaton, IL: Crossway, 2024). See ch. 21: ‘Abortion’ and ch. 29: ‘Birth
Control’.
