By BRIAN CLOWES

(Editor’s Note: Brian Clowes has been director of research and training at Human Life International since 1995. For an electronic copy of chapter 21 of The Facts of Life, “Contraception,” or any patient information pamphlet for birth control pills, e-mail him at bclowes@hli.org.)

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The moral doctrine of the Church judges human behavior, but is silent on chemical compounds. Most people do not know that it is permissible for Catholic women to use the birth control pill under carefully defined conditions when the intent is not to impair their fertility.

Sometimes a young woman will take the Pill for non-contraceptive purposes, such as clearing up severe cases of acne or reducing hirsutism (excess body hair growth). Other health problems that the Pill might ameliorate are primarily gynecological in nature, such as painful periods, pre-menstrual syndrome, heavy bleeding, or endometriosis (an abnormal growth of endometrial, or uterine lining cells, outside the uterus).

When used for these purposes, the Pill is serving a therapeutic purpose and can in this instance legitimately be called health care. However, there is always the possibility that the prompt suppression of symptoms will lead to neglect of investigation and cure of the underlying disease or disorder.

When used for the purpose for which it was designed, the Pill does not heal the reproductive system, but instead cripples it. If used for its intended purpose, it cannot reasonably be called either health care or therapeutic. It is, in fact, the polar opposite of health care, given the great number of serious and incidental side effects that women frequently suffer from its use.

So from the Church’s perspective, it is morally licit to use the Pill for off-label therapy under the principle of double effect if other treatments are not available or feasible. In this case, the good effect is the treatment of a serious ailment, and the unintended evil effects arise in the form of a myriad of health risks and the neutralization of fertility. This last effect would not be an “evil” if the woman in question was firmly committed to living a chaste life.

How Pills Work to Reduce Acne. Acne in women is often caused by the production of the male sex hormone (androgen) testosterone in the ovaries, which leads to a production of excess sebum oil. This oil clogs pores and promotes acne breakouts.

Dermatologists have been using combined oral contraceptives (COCs) to treat severe acne for more than 30 years. COCs are composed of two active compounds: Estrogen and a synthetic progesterone, or progestin.

From the viewpoint of suppressing acne, there are two types of COC. The first is the class of androgenic pills, which contain androgen-based progestins such as norgestrel, norethindrone acetate, and levonorgestrel, and which often actually promote acne. The second class of Pill is anti-androgenic, which means that they fight acne by promoting the production of sex hormone binding globulin, which binds free (biologically active) testosterone by up to 50 percent and in turn reduces the production of sebum oil.

To this date, three brands of anti-androgenic COCs have been approved by the Food and Drug Administration for the purpose of suppressing acne. These are Ortho Tri-Cyclen (estrogen and norgestimate), Estrostep (estrogen and norethindrone), and YAZ (estrogen and drospirenone). The anti-androgenic progestins in these pills lower androgen levels and reduce acne after a period of about three to six months of continuous use.

Any woman considering using birth control pills to reduce acne should examine the standardized patient information pamphlets that come with Ortho Tri-Cyclen, Estrostep, and YAZ. These can be found in several formats on the web. The pamphlets show that each of these pills has a large number of serious negative side effects, including stroke, heart attack, and deep vein thrombosis. Other side effects include sudden onset blindness, severe headaches, jaundice, depression, and dramatic weight changes.

The side effects are not necessarily limited to those that are short-term: The World Health Organization’s International Agency for Research on Cancer has determined that the Pill is a Group 1 carcinogen, its most dangerous classification.

Women who face this situation should ask their physicians to research the single-purpose anti-acne medications that are widely available. Why face the hazards of birth control pill use unnecessarily?

Moral Considerations of Pill Use for Non-Contraceptive Purposes. Although the use of the Pill for non-contraceptive purposes is licit, there are certain serious moral considerations.

The primary problem is that a young single woman who is not sexually active but who is taking the Pill for cosmetic reasons may be tempted to engage in sexual activity because she believes that she is “safe” from pregnancy. In fact, the very fact that she believes herself to be temporarily sterile, when viewed against the background of immense societal pressures to “have sex,” may push her over the edge. If he knows about it, her boyfriend may also see her contraceptive use as a “green light” for sexual activity and put pressure on her to comply with his desires.

At times, the temptation for a woman to engage in premarital sexual activity might be overwhelming in compromising situations, and belief that the Pill will make her “safe” might be the deciding factor. After all, many young women do not participate in sexual activity because they are frightened of the consequences of unmarried pregnancy.

The results of sexual activity in this case would be the same as for every other sexually active woman. Every experienced crisis pregnancy worker has counseled young women who come in for pregnancy tests and said: “Well, my doctor (or parents) put me on the Pill anyway, so I decided to start having sex.”

In other words, use of the Pill is a very serious temptation to sin and will probably result in one or more of the galaxy of problems that follow: Sexually transmitted diseases, serious side effects, loss of reputation and self-respect, deterioration of relationships and, of course, unplanned pregnancy because of the failure rate of the Pill among younger first-year users.

“Early Abortions”

Married Couples. Single women using the Pill for non-contraceptive purposes have a relatively straightforward decision to make — simply make a firm resolution to abstain, and then stick with it.

The situation becomes more complicated for married couples. Sometimes a married couple has a truly serious reason for the wife not to become pregnant. Usually this reason is a foreseeable health problem where a pregnancy would seriously threaten her life as determined by a qualified physician. In such rare situations, the husband and wife should seek a second opinion from a known pro-life doctor. Such a couple can use periodic abstinence to avoid pregnancy, an effective method that is acceptable to different religions.

But what about the wife who suffers from serious gynecological problems that could be regulated by the Pill? The problem would have to be very serious indeed for her to have recourse to the Pill. In general, if she would be unable to have sexual relations for a long period of time due to her health difficulties, and if all other treatment alternatives had been exhausted, it would be licit for her to take the Pill until the problem was suppressed.

If the problem is long-term in nature, it would be wise to consult with a pro-life OB surgeon (visit the website of the American Association of Pro-Life Obstetricians and Gynecologists to find one near you).

The couple, however, would still have to abstain. As we have seen, the manufacturer’s standardized patient information pamphlets show that all of the available pills today have two general mechanisms of action — contraceptive and abortifacient.

Furthermore, studies have shown all of the currently available birth control pills cause an average of one or two “early abortions” each year, and the evil of the loss of life due to a possible abortion certainly outweighs the good of marital relations.

Summary. In general, great prudence should be exercised when a woman, either married or unmarried, uses the Pill for authentically therapeutic purposes. Unmarried women especially must avoid near occasions of sin and maintain a relentless vigilance and discipline in the face of temptations that they may face.

Husbands and boyfriends of women who use the Pill for therapy must also maintain self-control. They should also be a source of strength and support for their wives and girlfriends as those they love struggle with difficult health problems. It is difficult to think of a more general example of sacrificial love than that of a husband who forgoes sexual relations for an extended period of time for the sake of the health and well-being of his wife.