Second, it is unwise to make this decision too early in life, because it is not uncommon for a couple to later desire more children, or for someone to remarry after being divorced or widowed and desire to have children with their next spouse. I personally know of many couples who underwent just such a surgery after having a few children and later deeply regretted their decision and wished they had not done it.

Third, some Christians are legalistic on this issue and declare that there is essentially never a good reason for such a permanent measure. However, life in a fallen world is complicated and painful. A pastor and his wife, good friends of mine, suffered eighteen miscarriages before he had a vasectomy to stop what had become for them incredible physical and emotional pain. Also, my wife, Grace, had complications with the birth of our first daughter, Ashley, and had to have an emergency C-section. The doctor advised us to continue using C-sections, but after five C-section surgeries and one miscarriage we prayed James 1:5 and fasted and then decided that she would undergo a tubal ligation in conjunction with the birth of our last child. We have remained convinced that we made a wise decision for the sake of her health. Additionally, we are open to adoption or fostering in the future if God calls us to that, since we do consider children a blessing.

To summarize, levels 1 to 3 are options that Christian couples can consider without concern of terminating a fertilized egg, thereby taking a human life.

Level 4: Potentially Abortive Birth Control

At the next birth control level we tread into murkier waters, where it is more difficult to discern what is biblically right. “The pill” is a categorical term for more than forty types of oral contraceptives, which are also referred to as birth control pills and sometimes combination pills because they contain a mixture of estrogen and progestin. These hormonal contraceptives are designed to override the female body’s normal cycle and “trick” the woman’s brain into believing she’s already pregnant, thus preventing the release of an egg from the ovaries.

Birth control pills were introduced to America in the 1950s. In 1965 the U.S. Supreme Court declared unconstitutional the nineteenth century law prohibiting the use of contraceptives.65 Today, fifty to sixty million women worldwide take the pill each day, and it is the most widely prescribed drug in the world.66

Generally speaking, hormonal birth control methods run the risk of causing an abortion. Because female hormones direct the process of ovulation, synthetic hormones can be used to keep an egg from being released so that sperm are not able to fertilize it. These same synthetic hormones can also prevent a fertilized egg from implanting in a woman’s uterus and growing into a baby. Combined pills are generally very effective, as long as they are taken correctly: “With careful use, fewer than 1 woman in every 100 will get pregnant in a year. With less careful use, 3 or more women in every 100 will get pregnant in a year.”67 However, research indicates that those numbers may be considerably higher, up to 4 percent among “generally consistent and conscientious users” and up to 8 percent “among those who use the pill inconsistently and incorrectly.”68

Hormonal Methods

Hormonal methods of birth control tend to be more effective than others but also pose greater health risks. They include systems with estrogen and progestin such as combination oral contraceptives, the vaginal ring, and the contraceptive patch, as well as estrogen-free methods such as the mini-pill (progestin-only pills), contraceptive injectables, and some intrauterine devices (IUDs). These are the same drugs used in emergency contraceptive pills. There are no hormonal methods available for men.