History of Attitudes towards Contraception
While the desire to avoid pregnancy or an STI is an individual choice that has multiple positive benefits for population, gender and disease issues, the ethics of contraception remains a polemic and hotly debated topic, notably amongst Roman Catholics and other Christian denominations. Historically, controversy has surrounded contraception for as long as people have used it, and to some extent the framework of contemporary debates was established many centuries before the technological advances and rapid expansion in use of contraception in the twentieth century. This article will trace the historical origins of the objections to contraception amongst Christian theologians and examine the ethics of contraception from policy and moral viewpoints.
Contraception, Gender Equality and the Millennium Development Goals
Access to contraception is not just a “woman’s issue” but one that impacts her family, and has important consequences for gender equality, poverty, national economic development and health resources. International organisations such as the United Nations Population Fund (UNFPA) have stressed that access to contraception is a human right and is essential to protecting women's health. The UNFPA estimates that contraceptives prevent 215, 000 pregnancy related deaths each year, and the loss of 60 million years of healthy life. In 2008, however, 200 million women who wished to delay or avoid pregnancy were unable to access contraception with the majority concentrated in sub-Saharan Africa. Lack of contraception exposes women to the risk of unsafe and potentially fatal abortions: approximately 68, 000 women died in 2008 from an unsafe abortion. 1/3 of all maternal mortality deaths could be avoided with safe and effective contraceptives.
Universal access to contraception is one indicator of the fifth Millennium Development Goal (MDG) focusing on maternal mortality. This is due to the proven correlation between improvements in maternal health and poverty reduction, with associative benefits for gender equality (MDG 3). The United Nations estimates that this target may not be reached by 2015: “access to reproductive health remains a distant dream in many countries”. As the UNFPA argues, public and international investment in contraception services and programmes can effectively contribute to progress towards MDGs 1, 2, 3, 4, 5 and 6:
“By reducing needed spending for public services and allowing governments and households to invest more in each child, contraceptive services help governments achieve Goal 1 (eradicating extreme poverty and hunger), Goal 2 (achieving universal primary education) and Goal 4 (reducing child mortality). Contraceptive services, including the provision of male and female condoms, help prevent HIV transmission (Goal 6). Helping women gain control of the number and timing of their children promotes Goal 3, women’s empowerment and gender equality.”
Objections to Contraception: the Origins
These benefits of contraception have come up against strong criticisms from religious groups concerned by its implications for sexual morality. Abstinence, the religious counterweight to contraception, is advocated instead as a solution, evoking equal degrees of controversy and ire amongst pro-contraception campaigners, especially those working in developing countries. The following section will trace the history of Christian objections against contraception.
There are no explicit statements about contraceptive practices in either the Old or New Testament. Anticontraception campaigners refer however to the following passages as justifications for their objection:
a) “Be fruitful and multiply and fill the earth” (Genesis 1: 28): this has been interpreted within the anti-contraception context as signifying that procreation is divinely ordained and commanded. By employing an artificial barrier between God’s will and procreation, the couple is committing a serious sin. Objections to this interpretation state that the passage refers to God’s blessing rather than an expressed command.
b) “And Er, Judah's firstborn, was wicked in the sight of the Lord; and the Lord slew him. And Judah said unto Onan, "Go in unto thy brother's wife and marry her, and raise up seed to thy brother. And Onan knew that the seed should not be his; and it came to pass, when he went in unto his brother's wife, that he spilled it on the ground, lest he should give seed to his brother. And the thing which he did displeased the Lord; therefore He slew him also.” (Genesis 38: 8-10). God’s wrath has been interpreted as punishment for Onan practicing coitus interruptus, ‘spilling the seed’’ without allowing it to fulfill its procreative function.
Despite the lack of any biblical interdictions, early Christian writers objected to contraceptive practices as part of their broader condemnation of non-procreative sexual acts and general denigration of sexuality, even within the confines of marriage. The fifth-century Church Father, Augustine, Bishop of Hippo (d. 430) argued for instance that while there was no sin committed when a married couple had sex with the intention of procreation (without mutual pleasure or enjoyment), it was a grave sin to perform any sexual act designed to avoid getting pregnant. His contemporaries agreed and by as early as the sixth century, the acceptable times, places and positions of marital sex were defined. The missionary position was advocated as the most acceptable due to the erroneous belief that the sperm would ‘spill’ out in any other position. Sex during pregnancy was forbidden since it could not lead to procreation.
The moral criminalization of all forms of contraceptive sex established the framework for subsequent Christian denunciations. Married couples who performed contraceptive sex were occasionally accused of being “parricides”, that is, killers of their (future) children. The association of contraception with homicide was widely held amongst theologians by the late Middle Ages, with only isolated pockets of criticism pointing out that not each sexual act produces a child. Contraception (referred to as “poisons of sterility, a term borrowed from Aristotle, see below) was defined as a “sin against nature” (it perverts God’s will), a mortal sin that demanded extensive penance (for homicide, fornication or lechery depending on the confessor’s discretion) in order for the penitent sinner to be forgiven.
Remarkably, medieval theologians of this period realized that couples often made recourse to contraceptives for reasons other than out of sexual immorality and sinful lust. Poverty is first listed as a factor for using contraceptives in the early fourteenth century when the Dominican Peter de Palude (d. 1342) notes that coitus interruptus may be employed by some husbands “to avoid having more children than he can feed”. (Noomen, p. 220). The possible health risk to a woman’s life was also recognized as a motive (though not a justification).
Knowledge about Contraception in the Middle AgesThe theological interest in regulating sexual acts within marriage during the central middle ages was to a large part fuelled
In Book II of the Canon of Medicine, Avicenna lists the contraceptive properties of several plants: for example, mint “placed as a suppository before the hour of coitus prohibits impregnation”. Avicenna was widely read by European theologians, including Albert the Great (1206-1280), bishop of Regensburg and the teacher of the Dominican Thomas Aquinas. While there was a general prohibition on disseminating information on contraception, it would appear from the popularity of Avicenna in medieval medical schools and the numerous Latin commentaries by notable and respected theologians that this prohibition was not entirely respected or followed. As the historian of contraception Noomen argues, however, while knowledge of contraceptive practices may have been known amongst medical circles, it is difficult to discern to what extent this was shared with patients: “ An … important restraint on use would have been the unwillingness of doctors or druggists to provide the information to patients. There is nothing to indicate that an ordinary physician would not have considered contraception a sin and his cooperation in the sin immoral… but one cannot believe that all physicians or apothecaries observed the proclaimed Christian standard.” (Noomen, p. 213)
Twentieth-Century Objections: Casti Connubi and Humanae VitaeWith the advances in reproductive technology by the mid-twentieth century, Christian churches were under pressure by internal reformers to revise the prohibition on contraceptive sex. The case of reformers was strengthened by the development of the oral contraceptive pill by the 1950s which mimicked a woman’s natural period of infertility during the menstrual cycle. The Church of England at its annual Lambeth conference in 1930 declared that “the Conference agrees that other methods may be used, provided that this is done in the light of Christian principles.” By 1958, Anglicans were allowed to use contraception provided that it was done in line with Christian princniples and consciousness.
Reacting to this reversal of the Anglican church on contraception, the Roman Catholic Pope Pius XI (r. 1922-1939) published an encyclical Casti cunnubi, which reiterated the ban on contraception:
"any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offence against the law of God and of nature, and those who indulge in such are branded with the guilt of a grave sin."
One concession made to married couples was the practice of “the rhythm method” since the sexual act during a woman’s natural infertile period did not contradict God’s will. The Second Vatican Council (1962-65) was convened to address a number of urgent issues facing the Church, amongst which contraception was ranked highly. There was significant division amongst the leading theologians: for example, Dr. Hans Kung of Switzerland (who taught theology along with Joseph Ratzinger, the future Pope Benedict XVI, at the University of Tübingen), argued that there was no good theological or scriptural basis for a ban. The issue was eventually not discussed at the Second Vatican Council due to the level of debate and instead, the decision was left to the succeeding pope, Paul VI (r. 1963-1978). In his encyclical, Humanae Vitae, Paul VI confirmed the ban on contraception stating that:
“Each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life.”
Even in instances of the “greater good” may be considered, Paul VI argued that:
“Neither is it valid to argue, as a justification for sexual intercourse which is deliberately contraceptive, that a lesser evil is to be preferred to a greater one, or that such intercourse would merge with procreative acts of past and future to form a single entity, and so be qualified by exactly the same moral goodness as these. Though it is true that sometimes it is lawful to tolerate a lesser moral evil in order to avoid a greater evil or in order to promote a greater good," it is never lawful, even for the gravest reasons, to do evil that good may come of it” - in other words, to intend directly something which of its very nature contradicts the moral order, and which must therefore be judged unworthy of man, even though the intention is to protect or promote the welfare of an individual, of a family or of society in general.”
This definitive statement on contraception has been upheld by subsequent popes. For example:
"By describing the contraceptive act as intrinsically illicit, Paul VI meant to teach that the moral norm is such that it does not admit exceptions. No personal or social circumstances could ever, can now, or will ever, render such an act lawful in itself" – Pope John Paul II, Moral Theology Congress, Rome, 1988
Pope Benedict XVI attracted international protest in his March trip to Africa where he declared that condoms were not only the wrong answer to the continent’s problems with HIV/AIDS, but that they in fact aggravated the problem (thereby going against conclusive scientific evidence proving the contrary - see WHO fact sheet below).
Modern Catholic Practices
According to a 2004 study examining modern catholic sexual practices, the organization ‘Catholics for a Free Choice’ found high usage of contraceptive practices in predominantly catholic countries:
- Between 1990 and 1999, 74% of Argentine women used some modern method of contraception.
- Approximately 70% of married Catholic women in Bolivia have used some form of modern birth control.
- Over 90% of Catholics in Columbia have used modern contraception at some point.
- Between 1990 and 1998, the number of Chilean women using contraceptives increased from 19% to 26%.
In addition, the study found that
- In Kenya, 40% of Catholic women admitted to using modern contraceptives;
- In Mexico, 91% of polled Catholics agree that adults should have access to contraceptives;
- In the Philippines, 94% of respondents said it is important “to have the ability to control one’s fertility or plan one’s family.”
Other Religions’ Attitudes towards Contraception
Buddhism is not against contraception provided that it occurs prior to conception. For Buddhists, consciousness begins with the fertilization of the egg and any practice that kills the fertilized egg (emergency contraception) is not permitted. Although there is little regulation on sexual activity in Buddhism, Buddha’s teachings disapproved of the pursuit of sensual pleasure: this has been interpreted as signifying that Buddhists should not use contraception for the pursuit of sexual satisfaction.
Contraception is permitted in Judaism although conditions are imposed depending on schools of Judaism. The Genesis story of Onan influences the approach to contraception: provided that the seed is not ‘spilled’, liberal schools of Judaism have no objection. For this reason, the contraceptive pill is recommended since it does not damage or hinder the sperm. Orthodox Judaism allows contraception in cases of family economic constraint, potential health risks to the mother, and family planning.
Eight out of the nine classic schools of Islamic law allow contraception, and indeed, knowledge of contraception has a long history in Islamic thought and culture as the works of Avicenna (see above) attests. Concerns about sexual immorality have however led more conservative Islamic leaders to publicly forbid modern contraceptives. They found their views on the following passage from the Qur’an: "You should not kill your children for fear of want" (17:31, 6:151). While contraception is not in theory outlawed, permanent sterilization is seen as sinful since the purpose of marriage is to beget children.
There are no prohibitions against contraception in Hinduism.
- Goal 5: improve maternal health, MDGs
- UNFPA and the Guttermacher Institute, "Contraception: An Investment in Lives, Health and Development", In Brief, (December 2008).
- Catholics against contraception
- Catholics for Choice, “Catholic Attitudes on Sexual Behaviour and Reproductive Health” (2004): "Truth and Consequence, A Look behind the Vatican's Ban on Contraception", (2008). [access on www.catholicsforchoice.com]
- ENCYCLICAL LETTER, HUMANAE VITAE OF THE SUPREME PONTIFF PAUL VI
- John Noonan, Contraception: A history of its treatment by Catholic Theologians and Canonists (Harvard University Press: 1965)
- James Brundage, Law, Sex, and Christian Society in Medieval Europe (Chicago: 1991)
- Buddhism and contraception, BBC
- Catholic arguments in favour
- "Be fruitful and multiply"