NFP: Medical "Exceptions" by Sara Fox Peterson

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peterson_saraPeople who speak publicly about the Church’s teachings on sex and marriage will tell you that one of the question they hear most often is, “But what about people who have a medical reason to use contraception?” There is probably no aspect of the Church’s teaching on the immorality of contraception that is more often misunderstood – by priests and lay people alike – than that which applies in the case of a couple who has a serious medical reason not to become pregnant.

Drugs and procedures that, as a side effect of treating a disease, make a couple unable to conceive are morally permissible because the purpose of such drugs and procedures is to control the damage done to the body by the disease – not to suppress the normal, healthy, God-given fertility of the couple.

Humanae Vitae states it this way: “On the other hand, 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.”

A relatively straightforward example of the use of such “therapeutic means” would be a woman with cancer of the uterus.  In such a case it is definitely morally acceptable for a surgeon to treat the cancer by removing the woman’s uterus even though she will be infertile after this operation.   The purpose of removing the woman’s uterus is to rid her body of disease and the fact that she will no longer be able to conceive is an unintended side-effect.

This is very different, however, than a woman who has a disease or medical condition that makes pregnancy itself extremely dangerous or even life threatening for her or the child who might be conceived.  All too often such women are told – by their doctors, relatives, friends and, sadly, even their priests – that because they have a “medical reason” not to become pregnant it is acceptable for them to use contraception or be surgically sterilized.

A woman whose life would be jeopardized by pregnancy certainly has very grave reasons to avoid conceiving, but, as always, both the end (in this case avoiding pregnancy) and the means by which this is done must be morally good and the Church is absolutely clear that drugs, devices and procedures whose sole purpose is to make a couple unable to conceive are never morally acceptable:

. . .the direct interruption of the generative process already begun and, above all, all direct abortion, even for therapeutic reasons, are to be absolutely excluded as lawful means of regulating the number of children . . . Similarly excluded is any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation – whether as an end or as a means. (Humanae Vitae)

The regulation of births represents one of the aspects of responsible fatherhood and motherhood. Legitimate intentions on the part of the spouses do not justify recourse to morally unacceptable means (for example, direct sterilization or contraception).” (Catechism of the Catholic Church 2399)

Contraception is to be judged so profoundly unlawful as to be never, for any reason, justified.  To think or to say the contrary is equal to maintaining that in human life, situations may arise in which it is lawful not to recognize God as God.” (Pope John Paul II – Osservatore Romano, October, 10, 1983)

Of course it can be hard to objectively consider the morality of what a doctor tells us is necessary to protect our own or our spouse’s health or life, particularly when the alternative requires a great deal of faith and self-sacrifice, but a simple way to determine whether a proposed treatment that impacts a woman’s fertility is morally acceptable or not is to consider whether the same treatment would be necessary for a single or celibate woman.  If the answer is no, then the proposed drug or procedure is immoral.

This is can be very difficult to accept because few of us have really been trained to actually put our lives on the line out of obedience to the God.  Remember, though, that Christ has told us in no uncertain terms that we must take up our crosses be crucified along with Him if we are to join Him in paradise and that every one of us is called to the heroic virtue of sainthood.  Refusing sterilization or contraception when a couple has a truly life-or-death reason to avoid pregnancy is unquestionably an act of heroic virtue in this day and age and so it should be no surprise that the temptation to do what the world tells us is “reasonable” can be very strong in this situation.

If we look honestly at such a couple’s situation, however, we begin to see that like every immoral act, the “reasonableness” of contraception is based on a lie.

There are only two ways for a couple to be completely certain that they will not conceive:

One is total abstinence.

The other is castration – the total removal of either the woman’s ovaries or the man’s testes.

Stated another way, contraception, even surgical sterilization, will not guarantee that a couple will not conceive.  The chance may be very, very small, but I do know real, live people who have conceived despite having been sterilized.  It does happen. Statistically, conservative use of NFP is as effective as sterilization for avoiding pregnancy, but to claim that anything short of total abstinence or castration will result in certain ‘safety’ from pregnancy is to engage in self-deception.

So the decision that couples with the gravest of reasons to avoid pregnancy need to come to is whether they truly require absolute certainty that they will not conceive – in which case total abstinence is the only real option – or whether the small degree of uncertainty that will remain, no matter what they do, if they continue to be sexually active is something that they can entrust to God.

For couples facing this situation, here are a few practical suggestions:

  • Find a priest who understands these issues, is entirely loyal to the pope and the magisterium and can be of support to you. You are in great need of honest, reliable spiritual guidance and encouragement and unfortunately this is something that too many priests are unable or unwilling to provide on these particular issues. If you do not know such a priest get in touch with a local NFP teacher* and ask for a recommendation.
  • If at all possible find a physician who understands and accepts the Church’s teachings regarding contraception*.  Physicians sometimes exaggerate the risks of pregnancy – for a variety of reasons – and it may be that the danger is not quite so great as you have been led to believe (or perhaps it is, but even so it is very helpful to have the support of a doctor who isn’t pushing sterilization at every opportunity). Even if it requires more travel than you would otherwise undertake this would be well worth your time and effort.
  • If it has been several years since you learned NFP or if you have never had formal instruction, meet privately with a certified NFP teacher* and explain your situation.  The support and guidance of someone who is knowledgeable about the practical aspects of NFP and confident in its effectiveness can lighten your cross considerably.
  • Seek the intercession of the communion of saints – particularly those who faced related situations in their own lives.  Blessed Gianna Beretta Molla (who will be canonized May 16, 2004) is a wonderful, if very challenging, role model and a powerful intercessor for modern wives and mothers facing difficult decisions about fertility and childbearing.
  • Unite your suffering and uncertainty to Christ’s in the garden of Gethsemane.  Even Christ Himself begged God to take the cup of suffering away from Him.  He knows your fear and pain and He can give you the graces necessary to carry this cross and be obedient to the Father’s will.  All you have to do is ask.

*A directory of NFP teachers and “NFP-only” physicians throughout the US and Canada can be found at www.omsoul.com

copyright 2004 Sara Fox Peterson

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4 Comments

  1. Statistically, conservative use of NFP is as effective as sterilization for avoiding pregnancy

    I’m not sure I understand how you’re arriving at this conclusion. You state elsewhere that 2/1000 women will conceive despite correct charting, and 3/100 will conceive due to charting errors. The failure rate of sterilization is about 1/1000, so strictly speaking, perfect-use NFP is about twice as likely to result in a pregnancy as sterilization (although the two are roughly on the same order of magnitude).

    More important, though, is that 3/100 typical-use pregnancy rate. I don’t think it’s fair to just hand-wave that away and assume nobody will ever have charting mistakes. Obviously, the people who made those errors didn’t realize they were making them at the time. — it’s not like they deliberately decided to make a charting mistake, the way one chooses whether or not to use barrier birth control or take birth control pills. NFP is undeniably more complex to use than other forms of birth control, and some errors will be unavoidable.

    Sterilization, by contrast, has no typical-use discrepancy. In actual practice, significantly fewer women will become accidentally pregnant with sterilization vs NFP. It may be worthwhile for other reasons, but I’m not sure it’s completely honest to claim it’s as effective as sterilization.

  2. Sara Fox Peterson on

    NFP is undeniably more complex to use than sterilization, but couples who are highly motivated to avoid pregnancy make charting and interpretation errors extremely rarely.

    The study I cited in the column you mention looked at NFP use by a diverse group of couples, in a first world country, whose reasons for and commitment to avoiding pregnancy almost certainly varied widely. The total unintended pregnancy rate for that study was just under 3%, but trials of NFP in which couples uniformly have very serious reasons to avoid pregnancy, such as [url=http://www.woomb.org/omrrca/bulletin/vol27/no4/chinaEvaluation.html]this trial[/url] in communist China and another conducted among predominantly very poor women in India* find much lower total pregnancy rates (5/1000 or 0.5% and 2/1000 or 0.2% respectively).

    Even more significantly, however, in real life the 1/1000 pregnancy rate that you cite for sterilization simply does not hold true. Although user error is not an issue, there are differences in the way that the surgical sterilization is performed and also in how an individual’s body responds to such surgery. In practice the overall pregnancy rates following surgical sterilization vary, but a quick search turned up rates of up to [url=http://journals.lww.com/obgynsurvey/Abstract/1996/12000/The_Risk_of_Pregnancy_After_Tubal_Sterilization_.7.aspx ]36.5/1000 (3.65%) for tubal ligation [/url] and[url=http://www.ncbi.nlm.nih.gov/pubmed/12742564] )42/1000 (4.2%) for vasectomy[/url].

    Yes occasional charting errors and, as a result occasional unintended pregnancies, are unavoidable with NFP even for highly motivated couples. But pregnancy after surgical sterilization is not nearly so rare as it is often assumed to be and so the two do remain comparable in terms of effectiveness.

    *This study does not appear to be available online, but the citation is Ghosh Ak, Saha S., Chattergee G.. Symptothermia vis-a-vis fertility control. J Obstet Gynaecol Ind 1982; 32: 443-447

  3. Reply from Sara Fox Peterson:

    NFP is undeniably more complex to use than sterilization, but couples who are highly motivated to avoid pregnancy make charting and interpretation errors extremely rarely.

    The study I discussed in the column you mention looked at NFP use by a diverse group of couples, in a first world country, whose reasons for and commitment to avoiding pregnancy almost certainly varied widely. The total unintended pregnancy rate for that study was just under 3%, but trials of NFP in which couples uniformly have very serious reasons to avoid pregnancy, such as [url=http://www.woomb.org/omrrca/bulletin/vol27/no4/chinaEvaluation.html]this trial[/url] in communist China and another conducted among predominantly very poor women in India* find much lower total pregnancy rates (5/1000 or 0.5% and 2/1000 or 0.2% respectively).

    Even more significantly, however, in real life the 1/1000 pregnancy rate that you cite for sterilization simply does not hold true. Although user error is not an issue, there are differences in the way that surgical sterilization is performed and also in how an individual’s body responds to such surgery. In practice the overall pregnancy rates following surgical sterilization vary, but a quick search turned up pregnancy rates of up to [url=http://journals.lww.com/obgynsurvey/Abstract/1996/12000/The_Risk_of_Pregnancy_After_Tubal_Sterilization_.7.aspx ]36.5/1000 (3.65%) for tubal ligation [/url] and[url=http://www.ncbi.nlm.nih.gov/pubmed/12742564] )42/1000 (4.2%) for vasectomy[/url].

    Yes occasional charting errors and, as a result, occasional unintended pregnancies are unavoidable with NFP even for highly motivated couples. Still, pregnancy after surgical sterilization is not nearly so rare as it is often assumed to be and careful, conservative use of NFP can definitely be comparable in terms of effectiveness.

    *This study does not appear to be available online, but the citation is Ghosh Ak, Saha S., Chattergee G.. Symptothermia vis-a-vis fertility control. J Obstet Gynaecol Ind 1982; 32: 443-447

  4. Hi Sara! It’s Julie, your fellow NFP student from your days in Annapolis. I’m trying to get back in touch with you.

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