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Acts 2008Report 17
Abortion Study Committee
Report of the Abortion Study Committee
The Beginning of life, Oral Contraceptives
and Preventing Pregnancy after Rape
Synod 2005 made two declarations:
1. Since human life begins at conception, wilful abortion is contrary to the sixth commandment, the only possible exception being cases where the life of the mother is in jeopardy, and every reasonable effort has been made to save the life of her unborn child. 2. That the present understanding of the Reformed Churches of New Zealand is that conception Synod also decided to appoint a committee to study the following questions: 1. What is conception and when does it occur? 2. Does the “morning after” pill, and other emergency “contraception” prevent conception 3. Are there steps that may legitimately be taken to prevent conception after rape? The committee was charged to “seek advice from medical doctors in our denomination, and where necessary or desireable, also seek advice from others having expertise with respect to these issues.” Those appointed to serve on the committee were Dr. Oneira Meyer (Pukekohe), Dr. Ralph van Dalen (Hukanui), and Rev. Robert van Wichen (Bishopdale).
We received advice from a number of medical doctors in our denomination, and two doctors who used to be, but now reside overseas. Some invested a significant amount of time researching this topic and we wish to acknowledge their work.
We also undertook our own research. The select bibliography contains many of the books and articles we have read and found helpful.
For the sake of clarity and precision, we will first offer definitions of a number of words:
Ovulation means the release of the ovum (egg) from the ovary.
Fertilization refers to the process in the fallopian tube in which an ovum and sperm unite. The resulting cell is called a zygote. The zygote then divides and becomes an embryo; this process usually takes up to 24 hours to complete. In medical terminology, fertilization and conception are synonymous.
Implantation refers to the process that results in the embryo being attached to the uterine wall. This process usually begins 5-6 days after fertilization and ends 13-14 days after fertilization.
A contraceptive refers to any substance or method that prevents human life coming into existence. When the word appears between quote marks, it means that the substance or method could either be truly contraceptive or also function as an abortifacient. We will argue that a true contraceptive prevents fertilization.
An abortifacient refers to any substance or method that brings human life to an end.
Emergency contraceptives (or the “morning after” pill as it is commonly known) contain either high dosages of estrogen and/or progestogen (that is, any progestational steroid such as progesterone). These include what are known as the levonorgestrel and Yuzpe regimens. Levonorgestrel contains only progestin (a synthetic progesterone). The Yuzpe regimen uses both estrogen and progestin.
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C. The questions to be addressed
We will consider the questions raised by the last Synod.
1. What is conception and when does it occur?
We understand that the purpose of this question was to determine when human life begins. There are
essentially two positions. Firstly, that human life begins with fertilization, and secondly, that human
life begins at implantation.
It matters how we answer this question. The Bible stresses that human life is precious. For example, humanity was made in the image of God. As we read in Genesis 1: Then God said, "Let us make man in our image, in our likeness, and let them rule over the fish of the sea and the birds of the air, over the livestock, over all the earth, and over all the creatures that move along the ground." So God created man in his own image, in the image of God he created him; male and female he created them David marvels at the privilege of being human in Psalm 8: When I consider your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, the son of man that you care for him? You made him a little lower than the heavenly beings and crowned him with glory and honor In Psalm 139 David exuberantly praises God saying, “You created my inmost being; you knit me together in my mother's womb. I praise you because I am fearfully and wonderfully made; your works are wonderful, I know that full well.But the supreme value that God places on human life is conclusively demonstrated by Jesus’ incarnation, crucifixion, resurrection and ascension. In the person of Jesus Christ, God became a man, died for mankind, was raised in glory as man, and has given His Spirit to those He redeemed.
No one has the right to take away the life of anotherTo do so is to forfeit the right to life. As God declared to Noah and his family after the Flood: “Whoever sheds the blood of man, by man shall his blood be shed; for in the image of God has God made man.
The Ten Commandments condemn murderThis protection extends to the unborn. For example in Exodus 20:22-25 we read: If men who are fighting hit a pregnant woman and she gives birth prematurely but there is no serious injury, the offender must be fined whatever the woman's husband demands and the court allows. But if there is serious injury, you are to take life for life, eye for eye, tooth for tooth, hand for hand, foot for foot, burn for burn, wound for wound, bruise for bruise.
We should understand the reference to serious injury to mean “serious injury to either mother or child.” It is, therefore, a weighty matter to make decisions regarding the unborn. While unseen by us, they are seen by God. While we might treat them as being of little moment, especially in the earliest stages of development, they are individuals known by God. This is illustrated in Luke 1:44. John the Baptist is described as leaping for joy in his mother’s womb. Not only does this imply personality, but also pictures an unborn child responding with delight to God.
We believe that life begins at fertilizationBefore explaining why, we will first briefly outline the There are times where we may or even must take human life, for example, in self-defense or when fighting in a just war. The state also has power to execute citizens in certain cases (cf Romans 13:1-5).
As a matter of interest, the Synod of the Dutch Reformed Church of South Africa reached the same conclusion at their Report 17
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arguments advanced in support of the view that life begins at implantation. They are as follows: The embryo cannot survive without implantation in the uterus and therefore is only viable once implanted. According to this view, fertilization is necessary but insufficient for human life to begin.
A significant number of human embryos do not successfully implant. It is estimated that between 25-50% of embryos fail to implant.
However, we consider that this view suffers a fatal flaw, namely, that it assigns an arbitrary starting point for human life. Implantation is simply one of many necessary processes which concur between fertilization and birth. The fertilized ovum or zygote already contains the entire genetic blueprint of an utterly unique individual. The zygote then divides and becomes an embryo and continues to grow and develop. But like every other human being, an embryo also has needs. Just as we need nourishment and warmth, so also unborn children need nourishment and warmth. That is why the embryo must be implanted in the uterine wall to survive and thrive. Effectively it is no more than the embryo moving “home” from the fallopian tube to the womb. There it will have everything it needs to mature (all going well). The identity of the embryo remains the same throughout the whole process—from fertilization to birth.
Furthermore, while the Bible does not tell us explicitly whether life begins at fertilization or implantation, there are a number of texts which strongly suggest that human life begins at fertilization. We will look at just three, the first being Psalm 51:5. There David writes, “Surely I was sinful at birth, sinful from the time my mother conceived me.” The word translated “conceived” comes from the Hebrew verb ~xy. In Psalm 51:7 the piel of ~xy is usedit means “to conceive.” The word suggests an event which closely follows sexual intercourseThus it is best to connect this word with fertilization which takes place hours after sexual intercourse rather than with implantation which takes place several days later. What is particularly striking about this verse is that David describes himself as being sinful from conception, strongly implying individuality even at the earliest stage of human life and development.
Another passage which indicates that human life begins at fertilization is Job 3:3. Job laments, “Let the day perish on which I was to be born, And the night which said, 'A boy is conceived.'” He speaks about the night on which he came into existence as a person. It would be most natural to see as this referring to the night on which he was conceived, rather than a few days later at the time of implantation. The third passage is Song of Songs 8:5. There we read, “…Under the apple tree I roused you; there your mother conceived you, there she who was in labor gave you birth.” Again, the beginning of human life is closely associated with sexual intercourse.
All of this leads us to the conclusion that human life begins at fertilization. Some would challenge this conclusion on the basis that it runs contrary to accepted scientific opinion. However, it would be closer to the truth to say either that there is no consensus or even that the majority of doctors and scientists who have studied this issue would agree with our conclusion. Indeed as one writer has claimed: The reader will note that I am using the orthodox understanding of the term ‘pregnancy’. This definition dates the beginning of the pregnancy from the moment of fertilization. I do not use, nor do I accept the minority view, influenced as it is by the politics of abortion, that dates a pregnancy from the time of implantati In any event, this issue must be resolved principially rather than democratically.
Synod in October 1992. The title of the report adopted was “Abortion.” This was re-affirmed in November 1994.
This is the only time that this word appears in the piel. The other five usages are in the qal (Genesis 30:38-39, 30:41, and 31:10).
This is suggested by the qal of ~xy which carries the meaning “in heat.” In the Old Testament, the qal is only used with respect to animals mating.
John Wilks, ‘The Impact of the Pill on Implantation Factors—New Research Findings’, Ethics and Medicine 16:1 (2000): 15-16.
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2. Does the “morning after” pill, and other emergency “contraception” prevent
conception and/or act as an abortifacient?
Before attempting to answer this question, we need to distinguish how a contraceptive works as
opposed to an abortifacient. A contraceptive works by preventing the fertilization of the ovum by the
sperm through whatever means (whether a barrier, a chemical or a drug). An abortifacient works by
preventing the implantation of the embryo or destroying the developing embryo
For ease of reference, we have broken this section into two parts. The first part will consider the use of hormonal “contraceptives” generally and the second part will examine the use of the “morning after” and other emergency “contraception.” a) Hormonal “contraceptives” generally
The “morning after” pill or other forms of hormonal emergency “contraception” are types of hormonal
“contraceptives.Here we must flag an important and debated issue. On one side, it has been argued
that many such “contraceptives,” while primarily contraceptive, are also potentially abortive (to a
greater or lesser degree). In other words, the main effect of many pill formulations is contraception,
but a possible side effect is abortion. In the words of Nicholas Tonti-Filippini:
The development of the moral tradition in regard to contraception has assumed that contraception was, in fact, contraception. It now appears that many if not all of the pharmacological contraceptives are at least in part abortifacient, and the newer preparations under development tend to be entirely abortifacient, notwithstanding that they are promoted as contraceptives The strongest evidence in support of this view is that hormonal “contraceptives” appear to thin the endometrical lining, thereby reducing the likelihood of implantation.
This view must be taken seriously, particularly given how hormonal “contraceptives” have developed over time. Early hormonal pills were designed to operate as contraceptives. But the high doses of hormones they employed had unpleasant side-effects. To mitigate those side-effects, different formulations were developed. However, this may have changed the way that they worked and raises the question whether they have the potential to function as abortifacients.
Yet the use of hormonal “contraceptives” have been defended by others within the pro-life community. They argue that some oral “contraceptives” are truly contraceptive, and that the risk of them being an abortifacient is completely unsubstantiated. An article by four Christian doctors on hormone “contraceptives” (which include oral “contraceptives”) put it this way: The hormone contraceptives include four basic types: combination oral contraceptives (COCs), injectables (Depoprovera), progestin only pills (minipill, or POPs), and implants (Norplant)….Most hormone contraceptives are noted to work by 3 methods of action: 1) Primarily, they inhibit ovulation….
2) Secondarily, they inhibit transport of sperm through the cervix….
3) They cause changes in the uterine lining (endometrium) which have historically been assumed to decrease the possibility of implantation, should fertilization occur. This This definition could be debated. For example, Joel Goodnough argues that for something to be considered an abortifacient, it must be designed and intended to cause abortion. He writes that an oral contraceptive pill “is not an abortifacient simply because it may have the potential to abort.” (“Redux: Is the Oral Contraceptive Pill an Abortifacient,” 37). However, we consider that it is more helpful to define these terms objectively.
These employ estrogen and/or progesten. The essential differences between ordinary oral “contraceptives” and emergency “contraceptives” are twofold. Firstly, ordinary “contraceptives” are taken regularly and taken after sexual intercourse in one or two doses. Secondly, emergency “contraceptives” use significantly higher doses of estrogen and/or progesten than ordinary “contraceptives.” For the purpose of this report, ordinary and emergency “contraceptives” are to be distinguished from drugs which are clearly abortifacient such as epostan, prostaglandins, misoprostol (alone or combined with other substances such as methotrexate and tamoxifen).
Nicholas Tonti-Filippini, “The Pill: Abortifacient or Contraceptive?” The Linacre Quarterly 62 (1995): 17-18. This view is strongly endorsed in articles by William Colliton, Walter L. Larimore, John Wilks and Renee Mirkes; full citations for their articles can be found in the bibliography.
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presumption is commonly known as the "hostile endometrium" theory.
A thorough review of the medical literature uncovers ample data to support the first two methods of action, which are contraceptive actions….However, there is no direct evidence in the literature to support the third proposed method of action An extensive review of pertinent scientific writings indicates that there is no credible evidence to validate a mechanism of pre-implantation abortion as a part of the action of hormone contraceptives But we can go further. Many hormonal contraceptives have the same contraceptive effect as breastfeeding, namely endometrial thinning. That would indicate that it is legitimate to use them The issue here is simply this: “Do oral “contraceptives” prevent implantation of the embryo?” Within the pro-life community, some say “Yes,” others say “No.” Even within our own denomination, both views are evident. It is beyond the scope of this report to enter further into that debate, and we would not encourage Synod to make a definitive ruling on this matter at this time. But we believe it is important that people be made aware of the debate and its implications. The advice offered by the American Association of Pro-Life Obstretricians and Gynecologists is sound: At the current time, we feel that each individual physician should evaluate the available information, and then follow the leading of his/her conscience in this matter We would add that this is true for each couple as well. They should seek to be sufficiently informed about the use of oral “contraceptives,” preferably before deciding to use them. It may be that Synod also decides that further work in this area is warranted.
We would, however, discourage the use of Mirena, a common hormonal contraceptive (at least until considerably more is known about how it really works). Mirena is an intra-uterine “contraceptive” device. It slowly releases levonogestrel (a progestin) directly into the uterus. Some of the levonogestrel is absorbed into the bloodstream and thus may have a truly contraceptive effect. However, it would appear that its primary mechanism is not the prevention of fertilization, but the prevention of implantation. This is not to say that Mirena does not have other legitimate medical uses; we are simply focussing here on its use as a contraceptive.
b) The “morning after” pill or emergency “contraception”
When it comes to the “morning after” pill or emergency “contraception,” the situation is clearer.
There is a real and appreciable risk that they can function as abortifacients. Four quotes will help you
understand the nature of the problem. The first quote comes from Family Health International:
Combined oral contraceptive pills…are the most commonly used method of emergency
contraception. High doses of [progesterone only pills]…can also be used for this purpose. The
precise mechanism of action is not clear, especially with regard to mechanisms other than
interfering with ovulation. If used before ovulation, the main mechanism of action is the
suppression or delay of ovulation; as a result, fertilization is prevented. (emphasis adde
Susan A. Crockett, Donna Harrison, Joe DeCook, and Camilla Hersh. “Hormone Contraceptives, Controversies and Clarifications.” American Association of Pro-Life Obstretricians and Gynecologists, http://www.aaplog.org/decook.htm. Cited April 1999. A fifth hormonal contraceptive could be added—Mirena, an intra-uterine contraceptive device; specific reference is made to Mirena later in the report. This view is also defended by Joel Goodnough and Tom Eskes; full citations for their articles can be found in the bibliography.
Ibid. However, they did note an increased risk of ectopic pregnancies with some hormone contraceptives.
Cathy Ramey, “Doesn’t Breastfeeding Do the Same Thing as the Pill?” Eternal Perspective Ministries http://www.epm.org/articles/BreastfedAbortions.html. Viewed 13 May 2008.
“The Oral Contraceptive Controversy,” American Association of Pro-Life Obstetricians and Gynecologists, http://www.aaplog.org/oral.htm, accessed 24 April 2008.
“Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs)” Family Health International, http://www.fhi.org/en/RH/Pubs/factsheets/mechact.htm, accessed 24 April 2008. FHI appears to hold the view that pregnancy begins at implantation.
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Christian doctor Joel Goodnough writes, “The mechanism of action in the “morning after” pill is not at all clear. It may prevent ovulation in some cases and prevent implantation in others, depending on when in the menstrual cycle it was taken.
[The] abortifacient capacity of the pill is recognized by those who support abortion. Consider the following, taken from the Guttmacher Report. “The best scientific evidence suggests that ECP’s [emergency contraceptive pills] most often work by suppressing ovulation. But depending on the timing of intercourse in relation to a woman’s hormonal cycle, they—as is the case with all hormonal contraceptive methods—also may prevent pregnancy either by preventing fertilization or by preventing implantation of a fertilized egg in the uterus.
Nicholas Tonti-Filippini is just as direct as Wilks in expressing his concern: In Australia, the practice of using combined the estrogen-progesterone pill in high dosage as a morning-after pill is becoming more common. One of the high dose pills is used. Two pills are taken immediately and two more are taken twelve hours later. The result is a very high estrogen and progestogen peak followed soon after by a heavy bleed. The probable mechanism is abortifacient. It is possible that ovulation is suppressed depending on when the medication is taken in the [menstrual] cycle. The stage of the cycle and the time between intercourse and taking the pills would obviously be crucial in determining whether it is the contraceptive effect that works prior to the abortifacient effect and hence prevents fertilization It would appear that emergency “contraception” could potentially have an abortive effect if taken after ovulation has occurred. The problem is that it is not yet clear enough how emergency “contraceptives” work once ovulation has occurred, though there growing indications that they may prove to be truly contraceptiveA recent Australian study reached the conclusion that levonorgestrel emergency contraceptive probably has little or no effect on postovulation events. But it also indicated that more work is needed. The closing paragraph of the report reads as follows: The small number of participants in our study [99 women] does not enable us to make a definitive statement on the hypothetical postfertilization effect of [LNG emergency contraceptive]….A larger study is needed to prove our hypothesis that the [LNG emergency contraceptive] has a major contraception effect when taken prior to but not after ovulation and that it does not interfere with postfertilization events.
3. Are there steps that may legitimately be taken to prevent conception after
There are possibly two. Firstly, the “morning after” pill or other hormonal emergency contraception
could be taken provided two pre-conditions are met. Firstly, ovulation is unlikely to have occurred.
Secondly, the contraception is taken or administered within several hours of the rape.
Joel Goodnough, “Redux: Is the Oral Contraceptive Pill an Abortifacient,” 41.
John Wilks, “The Impact of the Pill” 21.
Nicholas Tonti-Filippini, “The Pill: Abortifacient or Contraceptive?” 10-11.
One line of research strongly indicates that emergency contraception may have no effect on an embryo (refer to M.E Ortiz and others, “Post-coital administration of levonorgestrol does not interfere with post-fertilization events in the new-world monkey Cebus apella” Human Reproduction 19:6 (2004): 1352-1356. However Rafael Mikolajczyk and Joseph Stanford point out that with respect to the study done on Cebus monkeys that “results from non-human studies do not necessarily extrapolate to humans. For example, the mechanisms of action in animals for the intrauterine device have been shown to differ markedly from mechanisms of action in humans.” (“Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action” Fertility and Sterility 88:3 (2007): 565-571). Natalia Novikova, Edith Weisberg, Frank Z. Stancyzk, Horacio B. Croxatto, and Ian S. Fraser, “Effectiveness of levonorgestrel contraception given before or after ovulation—a pilot study.” Contraception 75 (2007): 117. They were aware of the significance of their research. They wrote, “A most important question today is whether LNG [emergency contraceptive] has an effect on postfertilization events. If the LNG [emergency contraceptive] is ineffective once fertilization has occurred, it would become an acceptable contraceptive option for many people who consider that human life begins at fertilization.” (116) Report 17
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We recognise that there is an element of risk. But as Tonti-Filippino conceded: A certain amount of risk-taking is obviously permissible in life. Every time we travel by automobile we risk human lives. The question is one of the level of risk. If those risks were increased, at some point they would become unconscionable. That is to say they become disproportionate. The same must be said of the risk of a contraceptive-abortifacient in the circumstances of rape. At some point the risk of losing a life rather than preventing the generation of a life becomes disproportionate When ovulation has occurred or is thought to have occurred, the risk becomes disproportionate The rape victim and her family need to be frankly but sympathetically advised of the risk associated with emergency contraception. For example, they need to be told that it is unclear precisely how emergency contraception works, but that if it is taken after ovulation has occurred, there is a substantial risk that it works as an abortifacient.
The other step that might be considered is the insertion of a copper intra-uterine device (IUD). Its main action is spermicidial and therefore contraceptiveHowever, Edwin Hui is right when he says, “most people believe that all IUDs operate at least in part as an abortifacient by interfering with the implantation of the fertilized egg.Hence, we would discourage the use of IUDs because their effect on the embryo remains unknown at this time. It may eventually transpire that IUDs are truly contraceptive, but the consensus at this time seems to be that there is a real and appreciable risk that they sometimes operate as an abortifacient. This may be an area that Synod may consider warrants further study.
One comment would be in order. If an IUD was to be effective in preventing fertilization, it would need to be inserted within several hours of the rape (say 2-4 hours). This window is much narrower than that commonly allowed within the medical fraternity. Many doctors will prescribe the use of an IUD up to five days after sexual intercourse. Clearly by that time, fertilization is highly likely to have occurred and hence the IUD not only would function as an abortifacient, but also be intended to operate as an abortifacient.
This issue is as difficult as it is emotive, and demands great patience and humility. A woman who is raped faces a terrible dilemma: she does not want to become pregnant, but in avoiding pregnancy, she must not kill her own baby. It is not for her to take away the life of one to whom God has given life. Hence loving and consistent support will be needed whether or not the emergency “contraception” is taken. The rape victim may struggle with guilt for taking steps to prevent pregnancy (with its attendant risk) or with the burden of carrying her rapist’s child if she does not. Should a woman have a child as a result of rape, she may need even greater help and support from her family, friends and church. This tension highlights the horror of rape and the need for us to be circumspect in our judgment. This is just one of the many traumatic consequences of rape D. Recommendations
1. That Synod receive this report. 2. That Synod affirm that human life begins at fertilization, not implantation. 3. That Synod declare that the “morning after” pill and other hormonal emergency “contraception” may sometimes function as abortifacients, and therefore should only be used with great care. 4. That Synod discourage the use of IUDs as emergency contraceptives. “The Pill:Abortifacient or Contraceptive? A Literature Review,” 17-18.
Yet it must be remembered that emergency contraception may prove to be completely ineffective once fertilization has occurred.
I-cheng Chi, “What We Have Learned from Recent IUD Studies: A Researcher’s Perspective” Contraception 48 (1993): 81-108.
Edwin C. Hui, At the Beginning of Life: Dilemmas in Theological Bioethics (Illinois: InterVarsity Press, 2002), 371.
For example, physical trauma, the risk of infection (both treatable and untreatable), and perhaps seriously, the emotional and social scars that it will leave.
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5. That Synod determine whether further study is warranted, and if so, in what areas. Oneira Meyer, Ralph van Dalen and Robert van Wichen.
Authors unknown. “Emergency Contraceptive Pills (ECPs) FAQ” Family Health International, no
pages. http://www.fhi.org/en/RH/FAQs/ECP_faq.htm. Accessed 24 April 2008.
———“Mechanisms of the Contraceptive Action of Hormonal Methods and Intrauterine Devices (IUDs). Family Health International, no pages. http://www.fhi.org/en/RH/Pubs/factsheets/mechact.htm. Accessed 24 April 2008.
Brown, George F. “Long-Acting Contraceptives: Rationale, Current Development, and Ethical Implications.” Special Supplement, Hastings Centre Report 25:1 (1995) S12-S15.
Cahill, Lisa Sowle. “‘Abortion Pill’ RU 486: Ethics, Rhetoric, and Social Practice.” Hastings Center Chi, I-cheng. “What We Have Learned From Recent IUD Studies: A Researcher’s Perspective.” Contraception 48 (1993) 81-108.
Colliton, William F. “Birth Control Pill: Abortifacient and Contraceptive.” American Association of Pro-Life Obstetricians and Gynecologists http://www.aaplog.org/collition.htm. Accessed 24 April 2008.
———“Response to Joel Goodnough MD, “Redux: Is the Oral Contraceptive Pill an Abortifacient?” Ethics and Medicine 17:2 (2001): 110-115.
Crockett, Susan A., Donna Harrison, Joe DeCook, and Camilla Hersh. “Hormone Contraceptives, Controversies and Clarifications.” American Association of Pro-Life Obstetricians and Gynecologists http://www.aaplog.org/decook.htm. Cited April 1999.
Diamond, Eugene F. “Every Child Should Be Born Wanted—A Dubious Goal.” Linacre Quarterly Dipierri, Denise. “RU 486, Mifepristone: A Review of a Controversial Drug.” Nurse Practitioner 19:6 Dutch Reformed Church of South Africa Synod, “Report on Abortion.” Adopted October 1982 and re- Eskes, Tom K.A.B. “Editorial: The Pill is not an Abortive Agent.” European Journal of Obstetrics and Gynecology and Reproductive Biology 72 (1997) 1-2.
Goodnough, Joel E. “Redux: Is the Oral Contraceptive Pill an Abortifacient?” Ethics and Medicine Guillebaud, John. Contraception, Your Questions Answered, 2nd ed. Churchill Livingstone, 1993 ———Contraception Today, 3rd ed. Martin Dunitz, 1997 (reprinted 1998).
Harper, Cynthia C, and Ellertson, Charlotte E. “The Emergency Contraceptive Pill: A Survey of Knowledge and Attitudes Among Students at Princeton University.” American Journal of Obstetrics and Gynecology 173:5 (1995): 1438-1445.
Hui, Edwin C. At the Beginning of Life: Dilemmas in Theological Bioethics. Illinois: InterVarsity Larimore, Walter L. “The Growing Debate About the Abortifacient Effect of the Birth Control Pill.” Ethics and Medicine 16:1 (2000): 23-30.
Mikolajczyk, Rafael T. and Joseph B. Stanford, “Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action.” Fertility and Sterility 88:3 (2007): 565-571.
Mirkes, Renee. “The Oral Contraceptive Pill and the Principle of Double Effect.” Ethics and Medicine Morgan, Huw. Let Them Live. Welwyn: Evangelical Press, 1985.
Novikova, Natalia, Edith Weisberg, Frank Z. Stancyzk, Horacio B. Croxatto, and Ian S. Fraser, “Effectiveness of levonorgestrel contraception given before or after ovulation—a pilot study.” Report 17
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Contraception 75 (2007): 112-118.
Odendaal, H. J. et al. Ginekologie. Kenwyn: Juta & Kie, 1986.
Ortiz, M. E., R. E. Ortiz, M. A. Fuentes, V. H. Parraguez and H. B. Croxatto, “Post-coital adminstration of levonorgestrel does not interfere with post-fertilization events in the new-world monkey Cebus apella.” Human Reproduction 19:6 (2004): 1352-1356.
Ramey, Cathy. “Doesn’t Breastfeeding Do the Same Thing as the Pill?” Eternal Perspective Ministries http://www.epm.org/articles/BreastfedAbortions.html. Viewed 13 May 2008.
Slabber, C. F., W. E. Brummer and A. A. Visser. Verloskunde (“Obstetrics”), 2nd ed. Academia, 1985.
Theron, F. C. J. F. Grobler. Kontrasepsie, Teorie & Praktyk (“Contraception, Theory and In Practice”), 2nd ed. Academica, 1992.
Tonti-Filippini, Nicholas. “The Pill: Abortifacient or Contraceptive?” The Linacre Quarterly 62 Wilks, John. “The Impact of the Pill on Implantation Factors—New Research Findings.” Ethics and ———“Response to Joel Goodnough MD, “Redux: Is the Oral Contraceptive Pill an Abortifacient?” Ethics and Medicine 17:2 (2001): 103-109.
American Association of Pro-Life Obstetricians and Gynecologists .
Eternal Perspective Ministries .
Family Health International .
[re-typed from the letter from the patient – below is the original] I would like to thank you for changing my life. I give God the credit, but he used your hands and mind to do his work. When I met you, I was 42 years old and not aging very gracefully. I came in for some restylane and was very happy with the results. You helped make a scar less noticeable and give my face a more youthful appear