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Birth Control

Birth Control

A Biblical Perspective

Michael Frields M.D., F.A.C.O.G.

Historical Perspective of the Church

For centuries there has been much controversy in the visible church regarding the use of various means to control family size. Until very recently in man’s history, the means have been limited. But as man’s knowledge has increased, especially in the last half-century, numerous contraceptive techniques have been developed. This has resulted in even more complexity in dealing with the issues of family size and birth control. Whether within the context of spiritual life or outside of it, this subject is not uniquely complex as an issue in today’s world. With this issue, as with any other, we as Christians need to apply sound Biblical principles in order to draw correct conclusions. In further discussion of this subject, several facts will be assumed: The Bible is the inspired word of God, is complete in itself, and no other revelation from God exists; although specific answers to all questions are not found within the scriptures, general principles may be derived which will definitively guide all aspects of our lives; Biblical principles are unchanging and transcend time and culture.

When we examine the subject of human reproduction, we find that God has created a capacity for procreation that exceeds the desires and/or capabilities of most individual couples. The biological capacity for reproduction, also known as “fecundity,” is modified by many factors, including heredity, general health, frequency of ovulation, intervals between pregnancies, length of time of lactation after birth, miscarriages, and stillbirths. Fertility, on the other hand, which is defined as the actual frequency of births, is influenced by other factors such as age at marriage, divorce and separation, and frequency of sexual relations. Contraceptive and population control methods such as preconception birth control techniques and post-conception methods (abortion and infanticide) also will influence the fertility rate.

Given the above, we may postulate that if a couple is married in the late teens and has no impairment in the biological capability for fecundation, they are capable of producing between twenty and twenty-five offspring during their reproductive years. As the above mentioned factors come into play, the actual number of offspring will be decreased accordingly. An example of a population in which actual maximal fertility potential was demonstrated can be found in the Hutterites. The Hutterites are a religious sect similar in beliefs and practices to the Mennonites, and they view fertility regulation by any means as sinful and high fertility as a blessing. The fertility of this society was studied in the early twentieth century, and the married Hutterite women were found to give birth to an average of ten children each. If these numbers are extrapolated out to the current time, we would expect to see an average of thirteen or fourteen children each. This would be the result of the marked reduction in both the perinatal and maternal mortality rates which have occurred in the last fifty years. Remember, these numbers are averages and take into account those women who have less than the average number of children or no children at all because of biological impairments.

The concept of family planning comes into play when a couple attempts to reconcile the number of children they desire, or are capable of properly caring for physically and emotionally, with the number that they are biologically capable of bearing. As we have seen, in the majority of couples, the former probably never approaches the latter. It is our task to explore doctrine on the subject and to apply Biblical principles to the current options for family planning which are available to us today.

In order to have a clear comprehension of Biblical doctrine on this subject, two areas must be examined in some detail. First, it is important to have an understanding of current popular thinking, especially commonly held “religious” views, and to examine those in the light of sound Biblical doctrine. Second, it is important to assess certain aspects of current scientific knowledge as it applies to this area, and likewise to examine it in light of Biblical doctrine.

The most widely held “religious” views of family planning and birth control in the western world are the doctrines of the Catholic Church. The current teaching of the Catholic Church in the area of family planning is basically the same as it was centuries ago at its inception. Current doctrines are based on non-scriptural principles as well as scriptural misinterpretations, and may be traced back to the early centuries of the organized Christian Church.

As early as the first century AD, the Stoic argued that sexual passion distracted man from the contemplation of God, and the second century theologian Clement of Alexandria associated sexual intercourse with guilt and argued that it could only be justified by the obvious need to reproduce. Augustine, in the fourth century, in Marriage and Concupiscence, concluded that the male semen both contained the “new life” as well as transmitted Adam’s original sin from generation to generation. He condemned all forms of birth control, including coitus interruptus and periodic abstinence. These views on birth control were the most widely held for the next several centuries.

The thirteenth century writings of Thomas Aquinas have been the most influential on the doctrines of the Catholic Church and have changed little, if any, to the present day. Aquinas’ main interest was in reinterpreting Aristotle and reconciling Aristotelian and Muslim knowledge with Christian doctrine. His conclusions regarding birth control are contained in his voluminous work, Summa Theologica and Summa Contra Gentiles. Aquinas condemned birth control in any form on the grounds that it was “against nature and therefore morally wrong.” In Summa Theologica, Aquinas states, “In so far as the generation of offspring is impeded, it is a vice against nature which happens in every carnal act from which generation cannot follow.” Also, in Summa Contra Gentiles he states, “The inordinate emission of semen is against the good nature, which is the conservation of the species; hence, after the sin of homicide, by which human nature actually existing is destroyed, this kind of sin, by which the generation of human nature is impeded, seems to hold second place.” In summary, Aquinas taught that any sexual act that was not for the expressed purpose of attempting procreation was wrong, and, likewise, any such act which occurred in which there was a potential wasting of the seed of procreation was a sin second in its seriousness only to murder.

In 1278 AD, four years after the death of Aquinas, the Dominican Order adopted his teachings as their official doctrine. The ultimate co-mingling of scripture and human thought on this subject occurred at the Council of Trent in the sixteenth century when Summa Theologica of Aquinas was placed on the altar with the Holy Scriptures and held equal in authority.

In more recent history, Pope Pius XI, in his encyclical Casti Connubii in 1930, condemned all methods of birth control except periodic abstinence as a “grace sin.” This teaching was reaffirmed by Pope Pius XII in 1951. In 1966, Pope Paul further reaffirmed this position of the Catholic Church on birth control in his encyclical Humanae Vitae in which he used papal authority to state that “every conjugal act has to be open to the transmission of life.”

The Bible has very little to say about the subject of birth control specifically. In fact, there is only one Biblical reference which alludes to a specific technique or method. This is found in Genesis 38, which gives the account of Onan. The Catholic Church has used this reference to support its view of birth control. In Genesis 38:9-10, we read, “...when he went into his brother’s wife, he wasted his seed on the ground, in order not to give offspring to his brother. But what he did was displeasing in the sight of the Lord; so He took his life also.” Out of context, it appears that what Onan did in “spilling his seed on the ground” (also known as “coitus interruptus,” or the “withdrawal” method of birth control) was the basis for God’s harsh judgment upon him. However, when we study the reference in its context, we come to a much different conclusion. Genesis 38 gives the account of Judah and Tamar. In Genesis 38:1-5, Judah, one of the sons of Jacob, married a Canaanite woman named Shua, and together they had three sons, Er, Onan, and Shelah. In 38:6, Judah selects Tamar to be the wife of his firstborn son, Er. In verse 7, the Lord takes the life of Er because he was evil (the specific sin is not stated). Then in verse 8, Judah instructs Onan to marry Tamar and “...perform your duty as a brother-in-law to her and raise up offspring for your brother.” This seemingly unusual request is actually in obedience to the Levirate Law which is described in Deuteronomy 25:4-5 as follows:

When brothers live together and one of them dies and has no son, the wife of the deceased shall not be married outside the family to a strange man. Her husband’s brother shall go in to her and take her to himself as wife and perform the duty of a husband’s brother to her. And it shall be that the first-born whom she bears shall assume the name of his dead brother, that his name may not be blotted out from Israel.

The correct interpretation of Genesis 38:9 becomes apparent when taken in the context of the Levirate Law stated in Deuteronomy 25:4-5. God took Onan’s life because of disobedience to the law, and not because of anything inherent in the physical act of coitus interruptus.

Coitus Interruptus as a method of birth control has been described in even the earliest historical documents. There is also evidence of its practice in preliterate societies. Until the last two centuries, there were only two other effective means of controlling family size: abortion and infanticide. The objection to the use of these methods from a Biblical standpoint should be obvious, but to put this subject into perspective, at least a cursory discussion is necessary. To do this, the time when life itself begins must first be considered.

Our understanding of human reproduction has made great strides even in the past few years. However, the association between sexual union and resulting pregnancy has been an integral part of man’s basic knowledge, and is recognized even in aboriginal societies. The cellular basis for reproduction requiring the union of a sperm and an egg, also known as gametes, has been known for about three hundred years. These gametes are now known to contain twenty-three chromosomes, or half the normal forty-six chromosomes found in all other human cells. Each gamete has representative genetic material from the corresponding parent. When the sperm and egg unite in the process of fertilization, the normal number of chromosomes is reestablished, and the new cell, now known as a zygote, has a compliment of chromosomal or genetic material which is unique, unlike any individual ever to have been conceived in the past or ever to be conceived in the future. The time at which a new life begins is, therefore, at the very moment of conception. The humanness of life within the womb is indisputable from a Biblical perspective. Psalms 139:13-16 confirms this:

...for Thou didst form my inward parts; Thou didst weave me in my mother’s womb. I will give thanks to Thee, for I am fearfully and wonderfully made; Wonderful are Thy works, and my soul knows it very well. My frame was not hidden from Thee, when I was made in secret, and skillfully wrought in the depths of the earth. Thine eyes have seen my unformed substance.

Prior to their union, however, gametes have no potential in and of themselves. Their lack of inherent importance may also be inferred by their vastly excess quantities and degree of wastage. In each act of intercourse, approximately one-half billion sperm are deposited. This is equivalent to about one-tenth of the current world population. The total number of sperm produced in a lifetime exceeds one trillion! Each woman is born with approximately four hundred thousand eggs which are potentially capable of ripening. During her fertile life span, the maximum number of eggs actually capable of coming to maturity is only about four hundred, and out of this number, only a small percentage actually have the exposure to potential fertilization. Also, although both male and female become fertile at approximately the same age, male fertility is still present long after the female is sterile, leaving years of sperm production without any chance of producing offspring. Therefore, we must conclude that prior to conception, even these immediate precursor cells have no inherent worth or justification for preservation.

It is at this point that we are able to draw a very clear distinction regarding methodology of birth control and Biblical doctrine. There is a very clear-cut point before which any act of intervention may be deemed acceptable from a Biblical standpoint, and beyond which any intervention must be condemned. That point is obviously at the moment of conception. Onan’s act of coitus interruptus is the only effective method of birth control which was available during Biblical times (and even for centuries following) that is considered to be a pre-conception method of birth control. The only other effective means of controlling family size at that time were abortion and infanticide. These are obviously post conception methods, and must be condemned on Biblical grounds as unjustifiable homicide.

In summary, the most widespread “religious” views of birth control, those of the Catholic Church, are a mixture of human thinking and philosophy which have been given equal authority with scripture. Misinterpretation of scripture has also contributed to a wrong conclusion regarding birth control. Proper interpretation of scripture is consistent with current scientific knowledge, and leads us to the conclusion that pre-conception methods of birth control are acceptable and permissible, and that post-conception methods of birth control are tantamount to murder and are to be condemned. With this preface, we may proceed with an evaluation of the current methods of birth control available to us today, and draw conclusions regarding acceptability in light of sound Biblical principles.

Birth Control Methods

The methods of birth control which will be considered will all meet the previously mentioned requirements. Specifically, all the methods discussed will prevent conception rather than interfere with pregnancy after conception occurs. Other aspects which will be discussed are risk factors, adverse effects, beneficial effects, and costs. The following table lists the methods to be discussed in order of effectiveness:


Percent Effective

Oral Contraceptive


Intrauterine Device




Foam and Condoms


Condoms Alone


Foam Alone






No Method



The above figures are approximate and may vary widely depending upon the study which is considered as well as how faithful instructions for use are followed. The figures are meant to be used as a guide to the relative effectiveness of the methods listed. It must be remembered that any of the methods may ‘fail”, and a pregnancy occur, regardless of the relative effectiveness of the method. As with all statistics, these figures apply to large groups of individuals, and success is either all or nothing when applied to individuals.


An understanding of how any of these methods of birth control work will require a basic understanding of the normal female menstrual cycle and how conception occurs. Much of this knowledge has come to light only in the past ten to twenty years. While they are quite complex, the hormonal and physiologic interrelationships may be simplified somewhat. Some assumptions will be made which may not apply to all individuals, but which will demonstrate the general principles.


For sake of discussion, the normal menstrual cycle length will be defined as twenty-eight days. The beginning of this cycle will be defined as the first day of the menstrual flow. A normal flow length will be defined as five days. The day of ovulation will be defined as day fourteen of the twenty-eight day cycle. The interrelationship of three organs will be considered: The uterus or womb, the ovary, and the pituitary gland (the so-called ‘master gland” of the body which controls all the hormone secreting glands of the body and is located at the base of the brain).


The uterus is the organ in which a child grows and is nurtured from shortly after conception until the time of birth. It is normally about the size of a clenched fist, and is located in the lower abdominal cavity or pelvis. The uterus has three openings. The lowermost opening is known as the cervix and is the outflow tract of the uterus. The upper two openings are the entrances to the uterus and are known as the fallopian tubes. The uterus is lined by a special tissue known as the endometrium. The endometrium is about one-fourth of an inch thick, and it is this tissue which sloughs off the wall of the uterus each month to from the five days of menstrual flow. Its integrity is dependent upon the hormones which are secreted by the ovary. When the hormone levels are adequate, the tissue grows and thickens. When the hormone levels are low, the endometrial tissue then dies and sloughs off.


The ovaries are the female sex glands that are located in the pelvic cavity on either side of the uterus and near the ends of the fallopian tubes. The ovaries have two functions: they produce two female hormones, known as estrogen and progesterone, and they produce ova or eggs. The hormone and egg production are in turn under the influence of the pituitary gland. When a woman is born, she has approximately four hundred thousand eggs stored in the ovaries, any one of which may eventually develop into a mature egg. Only a maximum of about four hundred of these eggs will ever mature, and in most women the number will be far less.


At the beginning of the twenty-eight day cycle, the hormone levels are at their lowest. Under the influence of the pituitary gland hormones, known as “follicle stimulating hormone” or “FSH”, and the “luteininzing hormone” or “LH” the ovarian tissue is stimulated to secrete estrogen hormone which it does in increasing amounts over the next twenty-eight days. The estrogen hormone causes growth of the endometrium of the uterus in potential preparation to accept a fertilized egg. Simultaneously, the pituitary hormones also cause one of the immature eggs to come to maturity over the next fourteen days. At day fourteen of the cycle, an egg is released, and the tissue surrounding it left behind in the ovary forms a gland known as the “corpus luteum”. This corpus luteum of the ovary then begins to secrete a second hormone called “progesterone”. Progesterone hormone works in conjunction with estrogen hormone to further prepare the endometrium over the next fourteen days to accept a fertilized egg.


The pituitary gland, as mentioned above, produces the hormones FSH and LH which stimulate the production of hormones by the ovaries as well as stimulate the maturation of eggs, also known as the process of “ovulation”. The pituitary hormones have an interesting relationship with the ovarian hormones which regulate each other’s secretion patterns. This relationship is known in biology as the “negative feedback inhibition” mechanism. When the levels of the ovarian hormones estrogen and progesterone are low, the pituitary gland begins to secrete more of its hormones, FSH and LH. This is the situation which is present at the beginning of the cycle which we have defined as the first day of the menstrual flow. The FSH and LH hormones in turn cause the ovary to produce more estrogen and progesterone as well as to begin the process of ovulation. Remember that estrogen and progesterone in turn will stimulate the lining of the uterus to grow during this time also. The process of ovulation culminates on day fourteen of the cycle with release of a mature egg. When the levels of estrogen and progesterone have become elevated to critical values, the secretion of FSH and LH are then suppressed, and the levels of these hormones begin to fall. This process begins at the time of ovulation and continues over the next fourteen days. As the levels of FSH and LH fall, the ovaries are no longer stimulated, and the levels of estrogen and progesterone begin to fall in turn. As the levels of estrogen and progesterone begin to fall, the lining of the endometrium can no longer survive, since its integrity is intimately dependent upon the presence of these hormones. The endometrium will eventually die and begin to slough off as the beginning of the menstrual flow. This process will occur at the end of the twenty-eight day cycle, and a new cycle will begin.


Oral Contraceptives


An understanding of the above normal menstrual cycle allows us to understand the mechanism of action of birth control pills or “oral contraceptives”. Oral contraceptives are made up of two hormones which are present in minute quantities. These two hormones are estrogen and progesterone. The pill is begun on day five of the menstrual cycle while the levels of all hormones (FSH, LU, estrogen, and progesterone) are at their lowest. The pills are continued for a total of twenty-one days on a daily basis. The hormones in the pill are absorbed very readily and begin their effects immediately. These effects are identical to the effects of the naturally occurring hormones as the body is not able to distinguish between the two. The hormones in the pill affect the pituitary gland by suppressing the secretion of FSH and LH. This occurs because the pituitary gland senses that there is an adequate level of estrogen and progesterone in the body, and further production is not necessary. This inhibition of production of LH and FSH leads to prevention of egg maturation and ovulation. Without ovulation, obviously, pregnancy cannot occur. The prevention of ovulation, therefore, is how oral contraceptives prevent pregnancy.


Simultaneously with ovulation prevention, the estrogen and progesterone hormones in the pill cause the endometrium to be stimulated just as the body’s own hormones do. This occurs for twenty-one days, and at the end of this time when the pill is discontinued, the hormone levels fall and the endometrium dies and sloughs off to begin a new cycle. Therefore, administering the pill for twenty- one days, and discontinuing it for seven days before beginning a cycle again results in a cycle length of twenty-eight days, just as in a typical natural cycle.


In summary, oral contraceptives act to prevent pregnancy by preventing ovulation which, in turn, precludes conception. This certainly meets the criterion for an acceptable method of birth control by acting prior to conception. While it is true that the oral contraceptive is not one hundred percent effective, and that a small number of pregnancies do occur even though the pill is taken correctly, studies have clearly demonstrated that pregnancies conceived while on the pill have no increased likelihood for miscarriage or other pregnancy related problems.


Since its development, a significant degree of controversy has surrounded the pill regarding its safety. These feelings were supported by studies of large groups of women who used the original pill for several years who were shown to have a significantly higher likelihood of developing certain serious disease processes. These were primarily increased incidences of heart attacks, strokes, pulmonary emboli (blood clots traveling to the lung), and thrombophlebitis (inflammation of and clots forming in veins, usually confined to the lower extremities). As more information about these problems became available, it was apparent that certain factors were responsible for increasing the likelihood of these serious disease processes occurring.


The dose of the hormone estrogen was found to be the main contributing factor in the occurrence of serious side effects. Over the next twenty years after the pill was first released for use in the United States, the dose of estrogen (as well as the dose of progesterone) was gradually decreased. Contraceptive effectiveness was maintained, while the incidence of serious side effects dropped dramatically. The dose of hormone in the standard oral contraceptives prescribed today is only approximately twenty percent of the dose of the original pills.


Another factor which influenced the safety of the pill was found to be the age of the user. Up to the age of thirty-five, the risk of taking the pill increased minimally. Between the ages of thirty-five and forty the risks began to increase at a higher rate. After age forty, the risks of the pill began to increase dramatically.


Yet another factor which was identified as a significant risk was that of smoking while using oral contraceptives. This appears to increase the risk of pill taking at all ages, but quite dramatically after the age of thirty-five. Again, the primary risks were related to cardiovascular disease.


In correlating all the knowledge regarding risk factors in the taking of oral contraceptives, it became apparent that in groups of women selected who were under the age of thirty-five, who did not smoke, and who were given a low dose pill, the risk of cardiovascular side effects was not any greater than for the general population. This has led to the following current recommendations regarding the use of oral contraceptives: the use of lowest possible dose of hormone; not using the pill after age forty in non-smokers; not using the pill after age thirty in smokers; not using the pill in those who have a condition known to be aggravated by the hormones in the pill.


Following the above guidelines for pill use has significantly reduced and in fact virtually eliminated the increased risks of serious and potentially life-threatening side effects observed in the past as a result of taking the pill. However, there are still several side effects which some women experience while taking the pill which are not considered to be life-threatening or potentially serious. The following is a partial list of symptoms which may be a direct result of taking the pill: nausea, breast tenderness, weight gain, headaches, increased skin pigmentation, abnormal uterine bleeding, and cessation of menstrual flow. Any or all of these symptoms may appear in any given pill user. In actuality, only a small percentage of women experience any of these symptoms with the low dose pills, and most of these symptoms will improve or resolve with time. There is still the occasional patient who will choose to discontinue the pill because of side-effects which she chooses not to tolerate.


In addition to adverse side-effects, it has become apparent in the last few years that the administration of oral contraceptives is associated with several beneficial effects. Often times, the pill is prescribed solely for its beneficial effect on certain conditions and not for its action as a contraceptive. For example, women who take the pill will have a very predictable cycle length of twenty-eight days and a total flow of rarely longer than five days, and often as short as one to three days. The amount of total flow is often markedly reduced also. This is a very desirable effect in women who have irregular menstrual periods or heavy or prolonged flow. As a direct result, women who normally fight anemia from heavy periods have this problem corrected by taking the pill and often avoid surgical treatment. Women who have painful periods (as long as not other underlying cause exists) often have no menstrual cramps at all, even if they were incapacitated by cramps before taking the pill. It also has been noted that women who have fibrosystic breast disease with cyclic breast tenderness often improve after being on the pill for several months.


The relationship of cancer and pill taking was in question for several years after the pill became widely used, but results of long-term studies have recently become available which shed some very interesting light on this subject. It is now very clear that there is no increased incidence of cancer of any organ system in women who use the pill, regardless of length of use. On the contrary, women who use the pill for even a short time have a subsequent decrease in the incidence of certain malignancies. Cancer of the uterus is decreased in incidence by fifty percent, and cancer of the ovary is decreased by forty percent. The incidence of other malignancies is not changed significantly by pill use.


The effect that the pill has on reproduction has also been questioned in the past, but recent studies have eliminated any concerns. Women who take the pill for one month or ten years have no change in their ability to conceive after going off the pill. It has been shown that the incidence of pelvic infections is decreased while taking the pill, and since pelvic infections are a significant cause for infertility, it has been suggested that pill taking may offer a protective effect on future fertility.


Since the mechanism of action of the oral contraceptive is to literally “turn the ovary off”, it also results in the marked reduction of benign diseases of the ovary such as ovarian cysts and tumors. It is estimated that this reduces the numbers of operations and hospitalizations for treatment of these conditions by several thousand per year in the United States alone, with a resulting substantial monetary savings. The cost of the pill itself is approximately fifteen dollars per cycle.


In summary, based on our understanding of the mechanism of action of the pill, it is an acceptable method of temporary birth control from a Biblical standpoint. Oral contraceptives are the most effective temporary method of birth control available today, as well as having a very high margin for safety if used according to current guidelines. If well tolerated, the pill is not only safe and effective, but also offers several health benefits.


The Intrauterine Device


This method of birth control has been used in humans for approximately two centuries, but only in the last two decades has a relatively safe system for administration been perfected. The intrauterine device, or IUD, is just as the name implies. It is a device which fits inside the uterine cavity and is left in place for a relatively long period of time; as a result of its presence, pregnancy is prevented. Until recently, it has been readily and widely available in the United States. However, during the past two years, its availability has been markedly reduced because of medico legal problems. Although only one manufacturer still produces a type of IUD, the IUD is still fully approved by the FDA, and is still readily available worldwide.


The mechanism of action of the IUD has been controversial until the past few years. Until technology was advanced enough to allow for accurate measurements of certain hormone levels in minute quantities, the mechanism of action was purely theoretical. Until recently, it was though [sic] that the IUD prevented pregnancy by either preventing implantation of a fertilized egg, or that it disrupted a fertilized egg after implantation occurred. No other “logical” explanation could be devised. Several experimental studies failed to support these theories, and as a result of the correlation of information from these studies, the mechanism of action of the IUD was understood.


As mentioned previously in the discussion of the normal menstrual cycle, ovulation occurs on approximately day fourteen of a twenty-eight day cycle. When ovulation occurs, fertilization follows within six to twenty-four hours. Within a few days after ovulation occurs, the embryo begins secreting a hormone known as Human Chorionic Gonadotropin, or HCG. This hormone serves to notify the body, mainly the corpus luteum of the ovary from where the egg came, that conception has occurred. As a result, the corpus luteum continues to function to produce progesterone hormone which in turn continues to keep the endometrial lining alive and functioning. The endometrium is the site of implantation of the fertilized egg and must continue to survive so that the pregnancy may proceed normally. If this process is not set in motion by the presence of HOG, then the endometrium will slough off at the normal twenty-eight day interval, and pregnancy cannot continue. Modem technology has devised a way to detect the presence of this hormone in the mother’s bloodstream even before the twenty-eighth day of the cycle. The measurement of this hormone is the basis for modern pregnancy tests, and are highly accurate. Studies have been performed in women in whom IUDs are in place in which serial measurements of the level of HCG hormone have been made during the last half of the menstrual cycle, and it has been shown that this hormone is not detected. The conclusion which must be drawn is that conception does not occur in women who use IUDs.


The cycle length in a woman who conceives and subsequently miscarries is inevitably lengthened, even if it is by only a few days. Studies in women who use the IUD have failed to show any significant lengthening of the menstrual cycle when compared to a similar group of women who do not use the IUD. This observation fails to support the theory that implantation and subsequent disruption of a fertilized egg occurs in users of the IUD.


Another study was done in which women who had an IUD in place, and who were to undergo a tubal ligation for sterilization, were allowed to have intercourse within several hours prior to the procedure. At the time of the surgery, the inside of the tubes were washed out and the washings were checked for sperm. Sperm were not found in the tubal washings of any of these women with an IUD in place. As a control, the same study was done on an equal number of women who had no IUD in place, and sperm were found in a significant number of these washings.


Other studies have demonstrated that an inflammatory reaction develops in the endometrial lining within a few hours after an IUD is inserted. This inflammatory reaction results in the body sending white blood cells to the endometrium, which are a part of the body’s defense mechanism against foreign invaders, and which secrete substances which are highly toxic to sperm and render them inactive.


In correlating all of the above information, it is apparent that the IUD works by initiating an inflammatory reaction in the lining of the uterus which results in the release of substances from white blood cells which are toxic to sperm and prevent them from reaching the ovary where fertilization may occur. The IUD, then, works to prevent conception, rather than to disrupt a pregnancy after conception occurs. As a result of this mechanism of action, the IUD may be considered an acceptable method of birth control from a Biblical standpoint.


Although it may be an acceptable method of birth control, the IUD is not without drawbacks. As a result of its inflammatory inducing property, the IUD predisposes to a significantly higher risk of uterine infection. This, in turn, can lead to tubal damage resulting in an inability to conceive in the future when pregnancy is desired. Indeed, fertility rates are lower in past IUD users compared to non-users. Therefore, the IUD should not be used as a method of birth control for women who have not completed their families, but may be appropriate in women who desire no further children and in whom no other method of birth control is appropriate or acceptable. Other drawbacks of the IUD include the possibility of increased menstrual flow and increased pain with the menstrual period. The cost of the IUD is currently between $150 and $200 per insertion. The only IUD currently available in the United States must be replaced every year. More acceptable IUDs which have been available in the past and which should become available in the near future need only be replaced every three years, and are significantly less expensive on a per year basis.


Barrier Methods


Barrier methods of birth control include all those methods which prevent sperm from reaching the cervix and thus traveling up the uterus and tubes to meet and egg. This consists ideally of a physical barrier used in conjunction with a spermicidal agent, although each may be used alone if a lower effectiveness level is acceptable. The most widely used combinations consist of a diaphragm used with a spermicide or a condom used with a spermicide.


A spermicide is a chemical agent which has the property of effectively incapacitating sperm on contact. The spermicide may be contained in one of several vehicles, and include foam, suppositories, creams, jellys, and a spermicidal impregnated foam rubber sponge. Each of these vehicles are designed to hold the spermicide in the vagina for a given period of time, and personal preference dictates which type is chosen, since effectiveness rates are equal. For maximum effectiveness to be achieved, it is advisable to apply the spermicide to the vagina at least fifteen minutes before and no longer than two hours before any sexual contact occurs. The sponge may be inserted up to twenty-four hours before intercourse, but this practice is associated with a higher incidence of vaginal irritation and vaginal infections.


The condom is a thin rubber sheath which is placed over the penis shortly before intercourse and is designed to keep the semen from being deposited into the vagina. There are several varieties of condoms available, and variations include the presence of a spermicidal or non-spermicidal lubricant on the outside of the condom. The thinner condoms produce less interference with sensitivity, but are also more expensive. The ease with which the condom breaks or leaks accounts for its failure rate of twenty percent. This is why it is advisable to use a spermicide in conjunction with the condom, and if used properly and consistently, this will result in an effectiveness rate equal to that of the diaphragm.


The diaphragm is a flexible, domed, round rubber device which measures on average three inches in diameter. It is designed to be used with a jelly which acts as both a lubricant as well as a spermicide. It should be inserted properly into the vagina between fifteen minutes and two hours before any sexual contact. It should be left in place for six to eight hours after intercourse, then properly cleansed and stored. The proper size and style must be determined by an appropriate health care professional, and the size should be rechecked after any significant weight gain or loss. The diaphragm should be replaced at least every two years, or sooner if any signs of deterioration are evident. The main drawback of the diaphragm is its difficulty of use, but this may be overcome with proper instruction and practice. The cost of the diaphragm is approximately fifteen dollars, and fitting runs between twenty-five and fifty dollars.


In summary, barrier methods of birth control are reasonably effective and relatively inexpensive. The primary advantage is the lack of systemic side effects. The primary disadvantages are the interference with spontaneity and the reduction of physical sensation. These methods meet the criteria for being a pre-conception method of birth control and are therefore acceptable from a Biblical standpoint.


Natural Family Planning Techniques


The natural family planning, or NFP, techniques rely on the avoidance of intercourse at the time of the menstrual cycle when the woman is fertile. As we have seen in our previous discussion of the menstrual cycle, ovulation occurs in the middle of a twenty-eight day cycle, or on day fourteen. When ovulation occurs, the egg is capable of being fertilized for only six to twenty-four hours. On first consideration, it would seem to be relatively easy to avoid sexual contact for this brief period of time in order to prevent pregnancy. However, several factors make this a somewhat difficult task. The two primary factors which reduce the predicted effectiveness of this method are the fact that sperm live for approximately seventy-two hours, and that the prediction for ovulation is often elusive.


The prediction of ovulation has long been done solely on the “calendar”, a process which has many pitfalls. As has been previously stated, the average cycle length is twenty-eight days, and ovulation is expected to occur most typically on day fourteen of the cycle. The consistent interval, however, is not the first fourteen days of the cycle, but rather the fourteen days between ovulation and the onset of the next cycle. In other words, when ovulation occurs, the next cycle will be expected to begin fourteen days later, presuming pregnancy has not occurred. In women who have longer cycles, for example thirty-five, ovulation would be expected to occur on day twenty-one after the onset of the menstrual flow. A woman who has a cycle length which varies from one month to the next would ovulate on a different day of each cycle. For these patients, to predict in advance with any degree of accuracy when the next ovulation will occur based on the calendar alone is almost impossible. Therefore the calendar method alone will be effective only for those women whose cycle length is very consistent.


Other methods have been devised to more accurately pinpoint the time of ovulation and increase the effectiveness rate of this method. If a woman takes her basal body temperature daily (the temperature of the body immediately upon awakening), a rise in the temperature of approximately one-half degree will occur on the day of ovulation and will be persistently elevated until the time for the next menses to begin. When the temperature has risen to the higher level, the woman may presume that she has ovulated, and within two or three days is past the fertile time until the next cycle. The drawback to this technique is that it will determine ovulation only in retrospect and does not have adequate predictive value before ovulation has occurred. It also requires a high degree of compliance for an indefinite period of time. It is also not reliable for all women as all women do not have a clear-cut rise in temperature at the time of ovulation, and interpretation may be difficult.


Another method which has been devised for pinpointing ovulation is the “cervical mucous method” which relies on the observation that the mucous secreted by the cervix changes in appearance and consistency around the time of ovulation. Becoming proficient at interpreting the changes in the cervical mucous usually requires that a woman be shown the changes that occur and correlate them with other evidence of ovulation, such as the basal body temperature measurements, over a several month period of time until such time as she feels comfortable with her own ability to interpret the changes.


The newest method of determining the time of ovulation involves measuring the levels of LH hormone in the urine. The level of LH will rise dramatically shortly before ovulation, and several manufacturers have devised kits which are fairly easy to use which will accurately pinpoint this event. The disadvantage of this technique is cost, as each monthly kit costs forty to fifty dollars.


Regardless of which techniques to determine the time of ovulation are used, certain guidelines must be followed to insure a low risk of pregnancy. Given the fact that sperm are capable of fertilization up to seventy-two hours, abstinence must be practiced for at least three days prior to expected ovulation. Since the egg may be fertilized for up to twenty-four hours after ovulation, an additional day must be added to the time of abstinence. Since the exact time of ovulation may be determined to within only two to three days, at least three more days must be added to the time of abstinence. As a margin for error, an additional day should be added both before ovulation as well as after ovulation. This comes to a total of nine days of abstinence which must be practiced in order to avoid conception as reliably as possible. It should be noted that this time of required abstinence coincides with the time of the cycle when most women’s sexual drive is at its peak. Because of this, many couples who use NFP techniques also combine a barrier method during the time when abstinence would otherwise be practiced.


It is interesting to note that periodic abstinence, whether solely dependent on the calendar method or in conjunction with any of the previously mentioned techniques, is the only method of family planning that the Catholic Church condones. Contrary to this, periodic abstinence is the only method of birth control which is contrary to Biblical principle. In I Corinthians 7:5 we read, “Stop depriving one another, except by agreement for a time that you may devote yourselves to prayer, and come together again lest Satan tempt you because of your lack of self-control” In this passage, Paul is giving advice to married couples regarding the inadvisability of sexual abstinence, and clearly states that the only appropriate reason for refusal of sexual intercourse by a spouse is for devoting time for prayer, and that time should be short and by mutual consent only.




God has given to man the capacity to reproduce far beyond the need or desire of most individual couples. Neither by commandment nor by example is there any Biblical principle mandating that we maximize our reproductive capacity. Likewise, as long as we follow Biblical principles respecting the sanctity of life from the moment of conception forward, there is no principle which precludes the use of any method or technique which will prevent conception. On the other hand, it is apparent that with all of the pre-conception methods of birth control which have been presented, the possibility of method failure exists which will result in pregnancy. In this context, no pregnancy should ever be resented or considered undesirable or unwanted, but should be received with joy and, as stated in Psalms 127:3, should be considered “a gift of the Lord.”


Copyright © 1997-2007 by Dr. Michael Frields


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