bioethics

At the Intersection of Faith and Birth Control

At the tail end of college and starting off my career as a nurse, I ran a health care group where we discussed controversial bioethical topics. We talked about everything from euthanasia to stem cell research to suicide to unexpected trauma to same sex attraction to abortion to research principles to birth control. A lot of it stemmed from my own insatiable curiosity to figure out why my faith taught what it taught. I was looking for an escape route. The Church just ended up being a lot wiser than I ever expected.

That group and everything I learned in prepping for it somehow made me a bit of a perceived expert among my friends and acquaintances. I won’t pretend I know everything about every bioethical issue because I most certainly do not. I mostly quote smarter people than myself and people think it makes me wise. But I thought I’d share with you an email correspondence I recently had with my friend who is in her clinical rotations for physician’s assistant school. She recently completed a rotation in a women’s health clinic in Arizona. The experience left her with a lot of questions, especially since she is a faithful, practicing Catholic.

Birth control and the Church famously do not get along. Everyone knows this, even down to Google. But few people are willing to ask “why?” My friend had the courage to do so. I say and mean courage because opening ourselves up to explanation means we’re also opening ourselves up to changing our lives and our practice. Please keep this beautiful woman (and me, please!) in your prayers.

And so, if you dare, my long-winded thoughts about the intersection of faith and birth control as a health care professional:

“So I’ve been reflecting a lot lately (especially during the election) of the use of OCPs… After working in women’s health I recognized so much of where our country lacks in education and the “quick fix” we go into prescribing them. Part of me was angered but part of me also sees how they truly do affect health, especially in unique situations and how they can benefit a women’s life (benefit is not the word I want to use here — I just can’t think of a better on this morning. I know OCPs DO NOT benefit woman hood, more so quite the opposite but I was taking too long to think of a word). It was a hard understanding to come through and I’m still sifting through the weeds and praying about it. Obviously our Catholic faith has a huge impact on how I will practice as a future provider and I’m still walking the line of what the true thing is to do.

ANYWAYS, after that long explanation I would love to have your input on the intersection of faith and birth control. Furthermore, I was wondering what books you know of that explore this issue (because you are a walking library). I would love to sift through this over coffee sometime as well, because I truly feel like our vocation (jobs) are meant to help people but where do we draw the line and what not, ya know?!?

Also, what are your thoughts on using OCP for control and regulation — do you think it is just supporting the movement and blocking our ability to appreciate the natural physiology of the body or do you think for convenience it could be acceptable.

Thanks for all of your help along this crazy, beautiful journey of life. I look up to you in so many ways and am thankful for your true, pure and beautiful friendship.

– Anonymous P.A. school friend

(Doesn’t that last line just make your heart melt!? It sure did mine. But I’m a words of affirmation sort of lady. Anyway.)

Dearest Anonymous P.A. school friend,

Thank you so much for your email! Our Catholic faith and its unpopular view of birth control is probably one of the harder tenets of the faith I’ve ever had to ponder. You and I both know its not even popular among our own faithful, but as Fulton Sheen schooled me the other morning in his excellent book, Life of Christ, “The majority is not always right.” Popular opinion does not create truth. It’s merely popular opinion, and history quickly tells us of times where the majority was very wrong. And even though most health care professionals, the public, and especially my undergraduate professors do not agree with me, I know from a lot of reading and even more praying that the Church is right when it comes to birth control.

It is important to remember that no object is inherently evil. Oral contraceptive pills (OCPs) are not evil in themselves. A gun is a merely a tool until it is used by a person for an evil such as the Orlando shooting this year. Then we call it evil. Yet, a gun can also be used for profound good, such as by a hunter to shoot a deer and provide for his family. An object is never evil within itself. A tool can only aid evil, a sin, bad, whatever term you are most comfortable using. People commit evil, not things. And we commit a sin when we use tools like guns in a way that contradicts the will of God. The will of God can be a nebulous, vague term, but what I’m saying here is will the of God is to treat our bodies in the way He designed, to protect them as a gift with utmost dignity, and to treat the bodies of our brothers and sisters in Him the same. Killing a person violates that dignity quite clearly.

OCPs can be a wonderful tool to treat a variety of diseases. Progesterone has sustained and saved the pregnancies of at least two of my friends. Without it, they would have suffered a miscarriage. My heart aches thinking what the world would be like without their sweet little boys in the world! OCPs can be a wonderful tool. As Pope Paul VI wrote in Humanae Vitae, the very encyclical that re-emphasized the Church’s position on contraception,

“the Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever.”

Humanae Vitae, 15

OCPs can be a perfectly good thing! If it’s curing a disease, it’s completely morally licit (OK) to use. However, we have found that OCPs often mask symptoms or are easily prescribed when maybe more research into a woman’s irregularities or more natural means like a change in diet may have the same benefits. Furthermore, like any medical interventions, they have inherent risks. The garden variety of side effects off the top of my head are depression, blood clots, changes in pheromones and therefore attraction, and possibly increasing risks of cancer. I’ve seen a woman my own age with irreparable damage to her liver from an OCP and countless women with blood clots. The risks of OCPs cannot be understated as they often are. But OCPs are not an evil within themselves.

The evil, the sin, comes from us. Ideally, sex is to be reserved for marriage. We say that marriage is an outward, worldly sign of God’s love for His church. Since His love for His Church and her people is unconditional, our outward signs of that love – marriage and sex – are also to be unconditional. Husband and wife are to give themselves to each other in a love that is fully human, total, faithful, and fruitful (Humanae Vitae, 9). It is human is that it is given fully aware of one’s choice, not done out of instinct or lust. It is total in that husband and wife are holding nothing back from each other. It is faithful in that they are committed to one another for life. And lastly, It if fruitful in that in each time husband and wife have sex, they are open to life.

Now, biologically, we know it is not possible to become pregnant every time one has sex. Can you imagine!? Even perfectly fertile couples can try for a couple months before successfully becoming pregnant, and obviously, we do not ovulate while pregnant. That’d be weird. And too, we do not have to take every opportunity possible to become pregnant. Sometimes finances, stresses from the current number of children, etc. would limit the resources available to the future child, so couples can hold off on having sex when they would be fertile. Just as it takes two to tango, it takes two to make a baby. Men are always fertile, and women are fertile for an average 4-day span per cycle (we’ll say per month because it’s easier). The fertile window for a couple is 6 days a month. That’s plenty of other days to have sex, be open to life if a new life were to happen, and yet considerably reduce one’s actual risk of becoming pregnant.

Too, our bodies are so good at naturally regulating pregnancies as well. During times of great stress such as being sick, our cycles are lengthened or we do not ovulate. The hormones of breast feeding prevent ovulation. God does not want us to ever be burdened by children. No, they are His greatest gift! Even in how He created us, we can see that in His wisdom He does not want us to merely be baby-making machines. He created us with an intelligence to understand His creation, and when we understand how our natural fertility works as a couple, we can avoid pregnancy rather easily.

It’s fascinating to consider pregnancy rates before and after contraception, which entered the market in the 1960s. If we look at the total fertility rates (TFR), an estimated number of children a woman is expected to have in her lifetime, the TFR for 2016 for the United States is 1.87. That’s only a bit lower than the TFR during the Great Depression in the 1930s where it was 2.1 or 2.0. Birth control wasn’t available in the 1930s, but the significant stress of the time plus likely malnutrition likely contributed to the lower birth rate. Yet in the economic boom after World War II, the TFR reached its peak of 3.7.  I think we often picture the Duggar family for every family in a world without birth control, but historically, we see that idea is quite false. Even without birth control, the average family had a recorded average maximum of 3-4 children.

Yet, the Church in her wisdom wants couples to be open to life every time they have sex. We don’t have to get pregnant every time we have sex. That’s physiologically impossible, seeing as the average person has sex about every week. Yet we ought to be open to life if a baby were to be conceived. Really, it raises the bar on whomever I sleep with. Whoever I have sex with must also be willing to be a father to any child I bear. This used to be the standard thought, but now with such routine contraception use, many women don’t think about the man they’re sleeping with as a future father to their children and visa versa. With our culture that tends to place all blame from any pregnancy on the woman, this idea of both members are responsible is radical. And this is why an infertile couple still perfectly is in line with the Church’s teaching on sex and babies: they’re open to life; they’re just not conceiving.

Just as God wants us to be open to the gift life, He really wants us to be open to His gifts in all moments of our lives. Yet, how many times do we ignore His grace? How many times do we ignore His direction? How many times do we ignore the opportunities available to us to serve Him? How many times do we ignore His children in given day in our families, our friends, our co-workers, and strangers? Not being open to life either in thought or in deed by contraception has the same root of sin as every thing else: we want to be God and be in control. Too, it can stem from a lack of trust, thinking that God will not provide adequately for us.

On this note of us wanting to be in control and not trusting God, contraception is really nothing new. We first see in Genesis the story of a man using contraception (coitus interuptus or pulling out) when sleeping with his brother’s wife in Genesis 38:9-10. The Lord punishes him with death. Truth be told, I don’t understand all the nuances of this little story, but it is an example of contraception in the ancient world. They used a variety of methods, including early spermicidal agents from acacia gum. Those artificial methods of preventing pregnancy is something St. Paul comments on in Galatians 5:19-21 when he lists the works of the flesh (aka the temptations of the flesh). In verse 20, he mentions “sorcery” or “witchcraft.” But he’s not talking about spells and such. He’s talking about contraception. The Galatians would take mixtures to induce sterility, and St. Paul preaches against the practice when he includes pharmakeia in the list. That word is where we get the English word pharmacy and pharmacist, and it gets translated to sorcery or witchcraft. (From our Orthodox brothers, this article covers this a bit. Too, the early Church fathers condemned birth control.)

Birth control used to be illegal until the mid-1900s. Margaret Sanger is often the name is associated with the growing birth control movement in the United States, but many other organizations were involved. In the early 1900s, Christians were united in thinking birth control was a sin. The 1908 Lambeth conference of the Bishops of the Anglican Church (Church of England) stated:

“…the Conference records with alarm the growing practice of the artificial restriction of the family and earnestly calls upon all Christian people to discountenance the use of all artificial means of restriction as demoralising to character and hostile to national welfare.”

Lambeth conference, 1908 

By 1930, they allowed contraception in some circumstances. By 1968, however, when considering Pope Paul VI’s encyclical and the growing use of birth control among its members said other methods of contraception were acceptable.

Yet, it’s curious that in their 1958 meeting, the conference said, the responsibility for deciding the number and frequency of children was a personal matter between God and the parents “in such ways as are acceptable to husband and wife.” Nothing against our Anglican brothers and sisters, but that very line screams, “I want to control my life, not God.” What acceptable to God isn’t always necessarily acceptable to us. I could write a litany of things I perceive to be unacceptable in my life right now, but the Lord has them in place for whatever His acceptable reason.

And too, it’s not that the Church wants us to procreate with rabbits, as Pope Francis said in early 2015. As Pope John Paul II stated in 1994:

“Truly, in begetting life the spouses fulfill one of the highest dimensions of their calling: they are God’s co-workers. Precisely for this reason they must have an extremely responsible attitude. In deciding whether or not to have a child, they must not be motivated by selfishness or carelessness, but by a prudent, conscious generosity that weighs the possibilities and circumstances, and especially gives priority to the welfare of the unborn child. Therefore, when there is a reason not to procreate, this choice is permissible and may even be necessary. However, there remains the duty of carrying it out with criteria and methods that respect the total truth of the marital act in its unitive and procreative dimension, as wisely regulated by nature itself in its biological rhythms. One can comply with them and use them to advantage, but they cannot be “violated” by artificial interference.”

Pope John Paul II 

Instead of focusing the size and growth of our families on in ways that are acceptable to just us, the Church wants us to include God in that picture, praying earnestly about what we can and cannot handle, respecting our natural biologies and mutual fertility, and being open to receiving new life even in times of infertility.

Many other churches talk of prayerfully considering contraception and the Orthodox Church forcefully opposes contraception that has abortifacient qualities. Yet, the most common contraceptive methods have abortifacient qualities, and it saddens me that our Christian brothers and sisters often don’t recognize that. I don’t blame them in the least! A lot of it has to do with semantics.

In 1965, the American College of Obsetricians and Gynecologists (ACOG) adopted Dr. Bent Boving’s definition of pregnancy. Boving was a Swedish researcher who in 1959 at a Planned Parenthood-Population Council symposium noted,

“Whether eventual control of implantation can be reserved the social advantage of being considered to prevent conception rather than to destroy an established pregnancy could depend upon something so simple as a prudent habit of speech.”

– Dr. Bent Boving

He proposed that conception be defined as implantation, and that is the definition that the majority of medical professional use, based on ACOG’s definition. Yet, implantation happens 6-10 days after ovulation, and an ovum only lasts 12-24 hours without being fertilized, so clearly something different must happen before an ovum implants to survive. That event is fertilization, true conception, and the start of a biologically unique cell that fits all the scientific definitions of life.

Despite what a lot of scientists say and discredit, something, someone, unique happens at fertilization. It’s actual conception. A new set of chromosomes, a cell now rapidly dividing, an independent cell comes into being. If this cell were found on a previously unlivable planet or noted to be cancerous, scientists would jump all over this thing! But this cell can be horribly inconvenient, scary, costly, etc. So, we don’t claim that he or she alive until implantation, a week after he or she comes into being, when so much time has passed that he or she is no longer a single-celled zygote nor a 16-cell morula but a blasocyst with an outer cell mass that implants into the endometrial lining to become the placenta and an inner cell mass that continues to grow and develop into a fully formed human.

Once implantation occurs, the placenta begins to form and release human chorionic gonadotropin (HcG), the hormone in pregnancy tests. It can usually be found 6 days after implantation. Yet, even without the proof of HcG, we will admit that pregnancy has already occurred and we just didn’t have proof yet. Same should be true of conception at fertilization, but that fact has been clouded by semantics.

Therefore, if we’re talking implantation, a lot of contraceptives aren’t abortifacients because they do not mess with an implanted pregnancy. But they do affect implantation because they alter the endometrial lining. The endometrium in its natural state is built up into spirals, looking ready to “catch” the blastocyst-sized child and implant him or her. But the endometrium under the influence of OCPs is blunted, thinner, and less able to allow the blastocyst-sized child to implant. Of note, this is how and why may women report lighter periods while on OCPs. Their endometrium is less thick, so there’s less to shed, so there’s less bleeding. That’s why a lot of women don’t bleed at all on Nexplanon and Mirena: the endometrium is just so thin, it’s doesn’t need to shed.

Is this abortion? Does this count as “abortifacient qualities?” According to Merriam-Webster, an abortion is a “spontaneous expulsion of a human fetus during the first 12 weeks of gestation.” Too, that’s the medical definition of miscarriage, which is called spontaneous abortion. When a fertilized ovum, a blastocyst, a human that has been alive and growing for 5-9 days, cannot implant into the endometrial lining, passes through the uterus, and dies due to lack of nutrients, that’s a spontaneous abortion or miscarriage.

Miscarriage is a tough, tough topic. My friends who have had miscarriages still carry a weight from the loss of their child. Morally, if a woman is doing everything she can to become pregnant and sustain the pregnancy to the best of her ability, there’s absolutely no personal guilt or blame in having a miscarriage, even if it feels that way. Same with an ectopic pregnancy. Same with a stillborn. Same with all these awful, difficult prenantal losses. Sometimes, the growing baby is just not able to come to term, and I don’t think we’ll ever fully understand why on this side of heaven.

But does anything change morally if she’s on the pill or purposefully altering her endometrial lining? What if she knows full well the risks of an altered endometrial lining? What if she doesn’t? What if she’s on a OCP for hormonal control for a documented medical condition? What if she’s not and she’s just not ready to have children? What if, what if, what if!?

This is where we enter into a very difficult moral gray area as Catholic medical professionals. Honestly, I love babies personally, but professionally they freak me out. It’s just a whole new world I know a smidgen about, and I’m constantly looking to learn. You should have seen me when we birthed a baby in the department on Thanksgiving! I was frozen. The Labor and Delivery nurse was basically throwing that baby around.

How do we balance all of this!?

Truth me told, I don’t know, and I’m figuring it out myself. I had to have a teary-eyed conversation with my boss just the other day about things like this, and it was relieving to know it’s nothing I had to lose my job over. That’s always been the fear. And too, when I got into grad school, one of my letters of recommendation was from the ethics program I did, and I felt a lot better about getting in with them knowing I’m quite, quite Catholic.

But, I do know this: I think the vast majority of women want to know what’s going on with their bodies. I think the vast majority of women are resentful that most pregnancy-related problems fall on their shoulders. I think women deserve equality in relationships, and equal participation in fertility helps that. And I know the emphasis on artificial birth control and now artificial birth via in vitro fertilization is decreasing our knowledge about fertility. Infertility rates have increased from 10.8% of married women in 1982 to 15.3% in 2002. And what if it’s a simple fix of adding progesterone on certain days or changing a diet or something else? Isn’t that safer and better for mom and baby? (Spoiler: IT IS!)

So, though I’m not there yet, I plan in my practice to emphasize diagnostic charting and not to routinely prescribe birth control unless I have a known underlying disease that it can help it. Too, these birth control methods do nothing to prevent sexually transmitted infections and HIV. Condoms do.

Which brings me to a quick note about the Church and condoms. Pope Francis during the Zika virus scare earlier this year and Pope Benedict in 2009 both spoke on condoms and disease prevention. They did not approve routine use, but said they were acceptable as part of the solution. Condoms, like all birth control, are not perfect. Condoms if used properly reduce transmission by 80%. The largest drops in African countries from AIDs comes not just from introducing condoms but also including behavior modification like reducing casual sex. It’s not just an old man in a hat waving an arthritic finger when it comes to causal sex. It’s also documented medical literature like this article. We’ve had good sex education in other countries for decades, and there’s still huge sexually transmitted disease problems. Clearly, we need another solution, and it’s not condoms. It’s behavior modification.

So, I hope that gives you the overview you desire. As for further reading, I hope this piece of my walking library helps:

I’ll be continuing to pray for you. I love you, and yes, let’s get coffee. 😀

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