The HHS Birth Control Mandate - a Statement for Study

Here is a statement I have composed for study by my fellow Lutherans.  I welcome your comments.  I hope what I have written makes it clear that this is a much more complicated issue than most of us first thought.  The average Lutheran is totally unprepared to argue and defend any kind of statement about this issue.  In fact, I am not even fully prepared yet to publicly defend my own studied position on the subject.  That is why I am submitting it here for scrutiny from my wise readers.  I do not find this matter of an urgent enough nature that we should be making any statements of a more public nature that we have not fully thought through and that we are not prepared to defend.  I'm not sure it would even be prudent to make a statement about this to the general public once we do reach the point when we are more prepared... but I'll have to address that argument on another day.  So, here you go... pick it apart!

A Statement Regarding the
HHS Birth Control Mandate and Religious Liberty

The recent decision of the U.S. Department of Health and Human Services mandates that nearly all private health plans, including those of religious employers, must provide all prescribed birth control drugs and devices for women free of charge.
"Freedom of religion" extends beyond worship in churches.  We cannot force our religious beliefs on others, but neither should the government expect us to act contrary to our religious beliefs.  Jesus bids us, ‘Render to Caesar the things that are Caesar's, and to God the things that are God's’ (Mark 12:17). We are to pray for and support our government wherever and whenever we can, but our consciences and lives belong to God.
While Christians are called to obey political authorities (Romans 13:1-7), when human authority violates God’s will, Christians are bound to “obey God rather than men” (Acts 5:28-29).  The Lutheran doctrine of the two kingdoms does not promote quietism, but affirms that civil government is to be concerned with things other than the gospel and should not exercise its authority in the church (CA XXVIII.11-12), and commands the Christian to use political laws and public redress for the benefit of temporal life (Ap XVI).
It is important, however, to remember as Christians that God does not guarantee us religious freedom in this broken world.  In fact, it has been a common "alien work" of God throughout history to allow religious persecution to draw us closer to Him.  Christianity has often flourished the most during times when the Church has faced her greatest persecutions.  
Our consciences belong to God and cannot be taken captive.  They can jail us and even kill us, but they cannot take Christ from us or force us to act against our consciences.  
Few people realize that this mandate is not about "contraception."  This government mandate requires that nearly all private health plans, including those of religious employers, must provide all prescribed birth control drugs and devices for women free of charge.  What most people do not know is that all of these currently available prescribed birth control drugs and devices for women can act in a way that causes the death of the unborn through silent abortions.  
So, how can the government claim that abortion-causing drugs are not included in this mandate?  Many people define "conception" as implantation rather than fertilization, since "pregnancy" is commonly identified as the point in time when a test detects the hormones which signal implantation. [1]
However, even providing non-abortifacient "contraception" would still violate the consciences of religious people of many faiths. This includes not only Roman Catholics, but many other Christians who retain the teaching that all churches shared until just a few decades ago, that preventing conception violates the divine ordinance to "be fruitful and multiply."  At least until 1959, the majority of LCMS pastors and seminary professors did not deviate from this teaching that it is a faithless act to refuse the blessing of a child. [2] 
To understand that obeying this mandate also would violate the religious consciences of those who have no objection to contraception, it is important to first understand the distinction between "contraception" and "birth control."  "Contra-ception" works "against conception."  According to this proper definition, contraception only prevents the union of an egg and a sperm.  This process is known scientifically as "fertilization". [1] "Birth control" includes methods that not only work as contraceptives, but which can also cause the death of a conceived human being.  Many methods of "birth control" are, therefore, improperly referred to by the general public and many doctors as "contraception."  
This distinction makes it clear that, contrary to the language used in the government mandate, this is not simply about religious employers being forced to provide free "contraception" - although that would still violate the religious freedom of many people.  The broader concern to all religious persons who are pro-life is the fact that ALL of the currently available prescribed birth control drugs and devices for women are also abortifacient.  In other words they all can also act by causing the death of the unborn through a backup mechanism which causes a silent abortion. [3]
Many people are unaware that birth control pills, injections, implants, and IUDs do not only work to prevent conception.  As a backup mechanism, all of these methods can also work after conception to prevent the implantation of an embryo, causing a "silent abortion."  One of the newest drugs called "Ella" can also destroy the placenta of a developing fetus in the womb, like the "abortion pill" ru486.
Do not let the language fool you.  These methods are not just "contraceptive."  A general rule of thumb to help you remember is that all "contraception" (birth control) drugs and IUDs are actually abortifacient methods of birth control.
  If we were to use terms with their literal meanings, contraception = prevention of life before it is conceived, and birth control = the taking of life before birth. Unfortunately, people have come to use these terms interchangeably.  
Here we are using the terms in their literal sense.  But don't let the language of the mandate or the common language used in the media fool you.  This mandate expects religious employers to provide all prescribed birth control drugs and devices for women - all of which can cause abortion.
Pro-life Christians who confess that life begins at conception are, therefore, also compelled to confess that these drugs and procedures violate the commandment of God: "You shall not murder."
Oppose this government mandate and urge all who value religious freedom to contact their elected representatives to urge them to reverse this government action.  Treasure the freedom to put our faith into action in the public square while we still have it and, in response to Christ’s call, demonstrate His mercy through our love and compassion for all people.  And show this love and compassion for the unborn by not being afraid to speak up about the abortifacient nature of all the currently available prescribed birth control drugs and devices for women.  Pray for your government representatives and leaders, for doctors and pastors, for your friends and enemies, and for the unborn.
Most of all, remember that nothing can separate us from the love of God in Christ Jesus.   They can jail us and even kill us, but our consciences will always remain free as we continue to profess before the world the joyful good news that Jesus Christ, True God and True Man, conceived in the womb of the Virgin Mary, suffered and died on the cross and rose again from the dead on the third day, so that all, believing in Him have forgiveness of sins, life and salvation.  
[1]  Read  Semantics Don’t Change Truth: The social motivations behind new definitions.
[2]  See Genesis 1:28 and 38:9-10, etc..  To learn more about the history and reasons behind this recent change in belief, read Godly Seed - a book published late last year by prominent historian Dr. Allan Carlson; and Birth Control and the Lutherans: The Missouri Synod as a Case Study by Alan Graebner in the Journal of Social History Vol. 2, No. 4 (Summer, 1969), pp. 303-332; and further resources available at the Lutherans and Procreation blog.
There are also many Lutherans who still haven't ever deviated from this teaching, and a growing number of Lutherans from the LCMS, ELS, and WELS returning to this historic teaching. There is a group of almost two-hundred like-minded Lutherans, mostly pastors and their wives, who support each other on a discussion group called "Quiverfull Lutherans."  If you agree and would like to be a part of that group, please contact ehtoothdoctorgmailcom.
[3]  This includes all birth control drugs (preparations commonly known as "the Pill", hormone patches, implants, and injections, and so-called "morning after pills" (such as Plan B and Ella), and all intrauterine devices (copper and hormone IUDs).  Below is a list of currently prescribed birth control drugs and devices for women and the FDA mandated product information statements which clearly point out their abortifacient nature.  We are in the process of updating this to include all the newest formulations, and I will post a new version when we have completed the update.  Keep in mind that drug companies are still coming up with new drugs and devices.  If the formulations are similar to the ones on this list, the same statements apply.  If they are entirely new drugs or devices, read the package insert and/or diligently research the modes of action before ever using them.

(Nota Bene: A few of the phrases above are borrowed from writings on this subject by Pastor Gifford Grobien, Pastor Roger James, and President Matthew Harrison.  Most of the writing is my own, but it became quite difficult with all the writing and editing I've done on this and other statements on the issue to remember exactly what pieces of the puzzle came from where.  It would also be very cumbersome to have footnotes for such citations all over the place, adding to the confusion of the whole issue.  I know Pr. Grobien doesn't mind, and I don't expect President Harrison or my own pastor will either.  I know we're all simply interested in the truth getting out on all this, so everyone else please feel free to borrow whatever you like from what I have written as well. No attributions necessary.)

Abortifacient Effects of Chemical, Hormonal, and IUD Birth Control Products According to FDA Labeling  
Compiled by Ryan C. MacPherson, PhD, July 2008 from:
Physicians' Desk Reference, 62nd ed. (Montvale, NJ: Thompson Healthcare, 2007),
a standard compilation of the FDA-required labels for over 4,000 approved drugs. 
Partially updated by Erich J. Heidenreich, DDS on March 21, 2012

Combination Oral Contraception (COC) Pills [also known as “Oral Contraception Pills” (OCP), all of which are commonly referred to as “The Pill”]
“Combination oral contraceptives act by suppression of gonadotropins. Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entering into the uterus) and the endometrium (which reduce the likelihood of implantation)” (repeated at pp. 777 [Yasmin], 785 [Yaz], 1046 [Mircette], 1057 [Seasonique], 2402 [Ortho Cyclen and Ortho Tri-Cyclen], 2411 [Ortho Tri-Cyclen Lo], and 3367 [Lybrel]).

Brand Name (Manufacturer),  Progestational Component,  Estrogenic Component
Ortho Cyclen (Ortho), 0.250 mg norgestimate, 0.035 mg ethinyl estradiol
Ortho Tri-Cyclen (Ortho), 0.18 mg norgestimate, 0.035 mg ethinyl estradiol
Ortho Tri-Cyclen Lo (Ortho), 0.180 mg norgestimate, 0.025 mg ethinyl estradiol
Lybrel (Wyeth), 90 mcg levonorgestrel, 20 mcg ethinyl estradiol
Mircette (Duramed), 0.15 mg desogestrel x 20, 0.02 mg ethinyl estradiol x 20, 0.01 mg ethinyl estradiol x 5
Seasonique (Duramed), 0.15 mg levonorgestrel, 0.03 mg ethinyl estradiol
Yaz (Bayer), 3 mg drospirenone, 0.020 mg ethinyl estradiol
Yazmin (Bayer), 3 mg drospirenone x 21, 0.030 mg ethinyl estradiol x 21

Combination Patch
“Although the primary mechanism of this action is inhibition of ovulation, other alterations include changes in the cervical mucus (which increase the difficulty of sperm entering into the uterus) and the endometrium (which reduce the likelihood of implantation)” (p. 2390).
Ortho Evra (Ortho), 6.00 mg norelgestromin, 0.75 mg ethinyl estradiol
Progestin-Only Pills (POP) (also known as the “mini-pill”)
“Ortho Micronor® progestin-only contraception prevents conception by suppressing ovulation in approximately half of users, thickening the cervical mucus to inhibit sperm penetration, lowering the midcycle LH and FSH peaks, slowing the movement of the ovum through the fallopian tube, and altering the endometrium” (p. 2399). The “failure rate” (i.e., on-pill sustained pregnancy rate) is 0.5% in perfect use vs. “close to 5%” in typical use (p. 2399). Of these pregnancies, “up to 10%” are ectopic (p. 2400).
Ortho Micronor (Ortho) 0.35 mg norethidrone
Emergency Contraception Pills (ECP)
“Plan B® is believed to act as an emergency contraceptive principally by preventing ovulation or fertilization (by altering tubal transport of sperm and/or ova). In addition, it may inhibit implantation (by altering the endometrium). It is not effective once the process of implantation has begun” (p. 1056).
“When taken immediately before ovulation is to occur, Ella postpones follicular rupture. The likely primary mechanism of action of ulipristal acetate for emergency contraception is therefore inhibition or delay of ovulation; however, alterations to the endometrium that may affect implantation may also contribute to efficacy.” (08/2010 FDA approved labeling)
Brand Name (Manufacturer), Progestational Component       
Plan B One Step (Duramed), 0.75 mg levonorgestrel
Next Choice, 0.75 mg levonorgestrel

Brand Name (Manufacturer), Progesterone agonist/antagonist
Ella (Watson Pharma), 30 mg ulipristal acetate
Note:  Ella, Plan B One-Step, Next Choice and generic Levonorgestrel Tablets are the only dedicated product specifically marketed for emergency contraception.  However, Aviane, Cryselle, Enpresse, Jolessa, Lessina, Levora, Lo/Ovral, LoSeasonique, Low-Ogestrel, Lutera, Lybrel, Nordette, Ogestrel, Portia, Quasense, Seasonale, Seasonique, Sronyx and Trivora have been declared safe and effective for use as ECPs by the United States Food and Drug Administration. Plan B One-Step and Next Choice are available over-the counter to women and men aged 17 and older. You can buy these pills by prescription if you are younger. Ella is available by prescription only.
Note: Important information on the deadly effects of “Ella” on the placenta of a developing fetus: http://www.frcblog.com/tag/donna-harrison/
Donna Harrison, MD, is a member of Emmaus Lutheran Church (LCMS) in South Bend, Indiana. She is an OB-GYN and the current president of the American Association of Pro-life Obstetricians.  Read her scientific remarks at the FDA hearing on Ella here:  http://www.frcblog.com/2010/06/3487/
Progestin-Only Injections
“Depo Provera … inhibits the secretion of gonadotropins, which prevents follicular maturation and ovulation and causes endometrial thinning. These actions produce its contraceptive effect” (p. 2612).
Depo Provera (Pharmacia; Upjohn), 104 mg/0.65mL medroxyprogesterone acetate (MPA)
Intrauterine Devices (IUD)
“The contraceptive effectiveness of ParaGard is enhanced by copper continuously released into the uterine cavity. Possible mechanism(s) by which copper enhances contraceptive efficacy include interference with sperm transport or fertilization, and prevention of implantation” (p. 1052).
“The local mechanism by which continuously released levonorgestrel enhances contraceptive effectiveness has not been conclusively demonstrated. Studies of MIRENA prototypes have suggested several mechanisms that prevent pregnancy [i.e., prevent “clinical pregnancy,” which is not said to be established until implantation in the uterus]: thickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium. … MIRENA has mainly local progestogenic effects in the uterine cavity. Morphological changes of the endometrium are observed, including stromal pseudodecidualization [endometrial thinning], glandular atrophy, a leucocytic infiltration and a decrease in glandular and stromal mitosis” (p. 765).
ParaGard Copper T380A IUD, 176 mg copper wire coiled around a polyethylene T-frame
Mirena IUD (Bayer), levonorgestrel (progestational component), released at 20 mcg/day from a polyethylene T-frame



Erich Heidenreich, DDS said...

Playing devil's advocate for a moment, here are some studies that would appear to bolster the government's case that at least oral contraceptives could somehow be considered as "medicines" if they are used for their overall effect on the mortality and morbidity risks of women. This does not change the fact that pregnancy is not a disease, and that "birth control" per se is not a medicine. The vast majority of people are using this medicine solely for the purpose of preventing pregnancy and cannot claim to be using it for any supposed medicinal purposes. The government mandate appears to not be about the avoidance of disease, but rather avoidance of pregnancy. Emergency oral contraceptives and IUDs have none of the supposed benefits to health proposed by the studies I will now list:

1) Vessey M, Yeates D, Flynn S. (2010 Sep). "Factors affecting mortality in a large cohort study with special reference to oral contraceptive use.". Contraception 82 (3): 221–9. doi:10.1016/j.contraception.2010.04.006. PMID 20705149.

This study indicates that, overall, the use of oral contraceptives appears to slightly reduce all-cause mortality, with a rate ratio for overall mortality of 0.87 (confidence interval: 0.79–0.96) when comparing ever-users of OCs with never-users.

2) Bast RC, Brewer M, Zou C, et al. (2007). "Prevention and early detection of ovarian cancer: mission impossible?". Recent Results Cancer Res. 174: 91–100. doi:10.1007/978-3-540-37696-5_9. PMID 17302189.

This study found that the use of oral contraceptives (birth control pills) for five years or more may decrease the risk of ovarian cancer in later life by 50%.

3) Speroff, Leon; Darney, Philip D. (2005). "Oral Contraception". A Clinical Guide for Contraception (4th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 21–138. ISBN 0-781-76488-2.

This book claims that combined oral contraceptive use may reduce the risk of ovarian cancer by 40% and the risk of endometrial cancer by 50% compared to never users. The risk reduction appears to increase with duration of use, with an 80% reduction in risk for both ovarian and endometrial cancer with use for more than 10 years. The risk reduction for both ovarian and endometrial cancer may persist for more than 20 years.

4) Huber JC, Bentz EK, Ott J, Tempfer CB (September 2008). "Non-contraceptive benefits of oral contraceptives". Expert Opin Pharmacother 9 (13): 2317–25. doi:10.1517/14656566.9.13.2317. PMID 18710356.

This study indicates that taking oral contraceptives reduces the risk of colorectal cancer, and improves conditions such as pelvic inflammatory disease, dysmenorrhea, premenstrual syndrome, and acne.

5) Nelson, Randy J. (2005). An introduction to behavioral endocrinology (3rd ed.). Sunderland, Mass: Sinauer Associates. ISBN 0-87893-617-3.

This book claims birth control pills reduce symptoms of polycystic ovary syndrome, and decrease the risk of anemia.

6) Vercellini, P.; Eskenazi, B.; Consonni, D.; Somigliana, E.; Parazzini, F.; Abbiati, A.; Fedele, L. (2010). "Oral contraceptives and risk of endometriosis: A systematic review and meta-analysis". Human Reproduction Update 17 (2): 159–170. doi:10.1093/humupd/dmq042. PMID 20833638.

This study indicates that the use of combined oral contraceptives is associated with a reduced risk of endometriosis, giving a relative risk of endometriosis of 0.63 during active use, yet with limited quality of evidence according to a systematic review.

Erich Heidenreich, DDS said...

Granted, the weighing of these supposed health benefits against the risks of oral contraceptives is tricky business, but proponents of birth control would argue that such decisions are something best left to doctors and their patients. In addition, it can be argued that the morbidity and mortality risks of oral contraceptives are lower than the morbidity and mortality risks of pregnancy and birth. Evidence exists on both sides.

It is even argued that those who use oral contraceptives cause the death of fewer babies than those who do not. It is generally accepted that one in five pregnancies ends in spontaneous abortion. Women who use oral contraceptives are successful most months in preventing conception. The number of silent abortions caused by oral contraceptive use can be argued to be much less than the number of silent spontaneous abortions experienced by a woman who uses no birth control.

I really hate playing devil's advocate, but I believe it is very important to understand your opponents' arguments. The goal is to make their arguments better than they can and then point out what is wrong with those arguments.

However, I must confess that another point I am trying to make is that the bioethics of this whole question is quite complex. I hope that by understanding what we are up against you can see the truth of my assertion that it this is a much easier debate to settle for those such as myself who oppose contraception entirely, abortifacient or not, based on the historical Biblical belief, supported by natural law, that contraception violates the primary inviolable purpose of sexual intercourse. Whether you agree with the historic Biblical and natural law arguments or not, I don't think anyone can disagree with my assertion.

Gregory K. Laughlin said...

I'm coming to believe that the best Christians may hope for is that the U.S. will evolve some sort of system of toleration toward our beliefs which was exhibited in the 19th century in the Ottoman Empire. See http://en.wikipedia.org/wiki/Millet_(Ottoman_Empire). Obviously, the HHS mandate does not lend any basis for such hope. In any event, I'm not sure how that would work in a nation in which Christians are so divided.

Erich Heidenreich, DDS said...

I'm not even going to bother hoping for anything. I'll keep speaking up for the truth, but I place no trust in princes. I trust my Lord and Savior, Jesus Christ, to bring us through every trial and tribulation, giving us the strength to endure whatever persecutions come for following Him.

I pray for peace and tranquility, I pray for the governing powers, but I reserve my most heartfelt prayers for my children who I believe will be suffering much worse than we are now until our Lord returns. Give us strength, Lord, and have mercy upon us!

Erich Heidenreich, DDS said...

A friend pointed out that I wrote, "All over-the-counter methods of contraception are still all purely conception-prevention measures." That is not true. "Plan B" is available over the counter for adults, though it is still only available by prescription for minors.

I included that fact in the catalog of abortifacient birth control methods, but neglected to correct that in the article. Here is how I corrected the article above:

Do not let the language fool you. These methods are not just 'contraceptive.' A general rule of thumb to help you remember is that all 'contraception' (birth control) drugs and IUDs are actually abortifacient methods of birth control. If we were to use terms with their literal meanings, contraception = prevention of life before it is conceived, and birth control = the taking of life before birth. Unfortunately, people have come to use these terms interchangeably.

This highlights one more aspect of just how complicated an issue this is. I have studied this for years and still find myself at a loss to write accurately on the subject. Just think how much easier all this would be to understand if we simply stuck with the historic position of Christianity that we have no business interfering with the procreative purpose of sexual relations. Trying to inform people of what is abortifacient and what is not, and how to know, is virtually impossible. Most people are not even capable of understanding these things, even if knowledgeable people like me don't make mistakes in explaining it (which obviously we do).

Gregory K. Laughlin said...

I agree both with where you place your hope (in our Lord and not in princes) and in your concern about the difficult future our children will likely face. I pray that they will, like St. Polycarp, "play the man" when tried and tempted to declare Kyrios Kaisar rather than Kyrios Christos. Having said that, there is, I think, nothing wrong with hoping for at least toleration.

As to the concept of a millet, I found the following very interesting in that regard, of which I was given notice this morning: http://www.crisismagazine.com/2012/the-catholic-ghetto-as-a-last-resort. While I am not Catholic, I appreciate the concept.