Contraception

CONTRACEPTION Dr. Carandang The moral argument about contraception The arguments about contraception fall into several groups: 1. philosophical arguments such as the "natural law" argument 2. arguments based on different ideas of marriage, sex and the family 3. human rights arguments such as o 'procreative liberty' o a woman's right to control her own body o human rights arguments about mass birth control programmes 4. arguments based on the good or bad consequences of birth control 5. arguments about the environmental and resource problems caused by overpopulation 6. religious arguments The moral case for contraception Human rights benefits * it's essential for "procreative liberty" o if people are not allowed a choice over whether or not to have children their autonomy and freedom to control their lives is seriously restricted Health benefits * it prevents the conception of unwanted children o and so reduces the number of possible abortions * it enables women whose health would be at risk if they conceived, to continue to have sex * the use of condoms helps prevent sexually transmitted diseases and HIV Family benefits * it prevents the conception of children that a family cannot support * it enables people to avoid having more children than they want * it improves marriage because o it enables couples to enjoy the unitive function of sexual activity without being anxious about conceiving a child o it enables couples to have fewer children and thus spend more time together and with the children they do have o it reduces the cost of marriage (children are expensive) Benefits for women * it promotes gender equality and the autonomy of women: o pregnancy and child-rearing affect women much more than men o women should have the right to choose or avoid these activities o any restriction of birth control is therefore sexual discrimination o it enables women to enjoy sexual activity on the same basis as men o any restriction of birth control is therefore a denial of women's right to sexual autonomy o without contraception a woman may find herself having regular pregnancies o this leads her to remain economically dependant on her partner * it enables women whose health would be at risk if they conceived, to continue to have sex Demographic benefits * it enables world population to be controlled and thus protects the

environment and reduces poverty o many people think this is a dubious benefit, and point out that fairer use of the world's resources would be a better way of reducing poverty. Also more environmentally friendly behaviour would be a better way of protecting the environment The moral case against contraception Contraception is inherently wrong * Contraception is unnatural * Contraception is anti-life * Contraception is a form of abortion * Contraception separates sex from reproduction Contraception brings bad consequences * Contraception carries health risks * The "contraceptive culture" is dangerous * Contraception prevents potential human beings being conceived * Contraception prevents people who might benefit humanity from being born Contraception brings bad consequences * Contraception can be used as a eugenic tool * Contraception is often misused in mass population control programmes in a racist way * Mass population control programmes can be a form of cultural imperialism or a misuse of power * Contraception may lead to depopulation o This sounds odd to an age concerned about over population but for substantial parts of the last 150 years this was a real fear. Contraception leads * Contraception * Contraception * Contraception enjoyment

to "immoral behaviour" makes it easier for people to have sex outside marriage leads to widespread sexual immorality allows people (even married people) to have sex purely for

Judaism The religious view on birth control is based on two principles: * It is a commandment to marry and have children. * It is forbidden to "waste seed" (to emit semen while at the same time preventing conception) *female birth control pill is allowed in Judaism; contraception, including artificial contraception, is permitted in Judaism in appropriate circumstances *methods of contraception allowed under Jewish law are those that do not damage the sperm or stop it getting to its intended destination. These are "the pill" and the IUD. A passage in the Talmud called "The Beraita of the Three Women" is the basis for much Jewish teaching on contraception. It states that a woman may use a "moch" (a contraceptive device) in three circumstances where a pregnancy would cause harm: * the woman is underage * the woman is pregnant * the woman is still breast-feeding Other Talmudic passages permit women to drink potions that make them infertile,

and this doctrine is now used to permit the use of the birth control pill. The modern Orthodox position permits the use of contraception in these cases: * when pregnancy or childbirth might harm the mother * to limit the number of children in a family for the benefit of the family * to delay or space out having children o but a married couple should not use contraception for the selfish reason of avoiding having children altogether Condoms are particularly unacceptable because they block the passage of semen, and because they reduce the pleasure husband and wife get from sex and so interfere with one of the natural purposes of intercourse. Rabbis disagree about the use of the diaphragm A birth control method that led to breakthrough bleeding would be a concern for Orthodox Jews as sex is not permitted in the presence of blood. This affects some types of pill and some IUDs. Judaism has had a largely positive attitude to sex since God commanded his people to "be fruitful and multiply"; early rabbis explained that this was a limited command, reasonable size family

Islam Islamic medicine has known about and Al-Razi (d 923 or 924) refer Islam is strongly pro-family and sexual ethics forbid sex outside within this context

birth control for centuries - Avicenna (980-1037) to different methods of contraception. regards children as a gift from God. Muslim marriage, birth control should be understood

no single attitude to contraception within Islam; however eight of the nine classic schools of Islamic law permit it. But more conservative Islamic leaders have openly campaigned against its use The Qur'an "You should not kill your children for fear of want" (17:31, 6:151) and interpret this as including a ban on contraception as well as infanticide In practice most Muslim authorities permit contraception to preserve the health of the mother or the well-being of the family. There are a number of hadith which indicate that the Prophet knew of birth control and approved of it in appropriate circumstances. Hadith are said to describe and approve of the withdrawal method ("'azl"). - method may deprive the woman of both sexual fulfilment and of having children, and so should not be used without the woman's agreement. is acceptable, so long as it does not have a permanent effect methods that cause very early abortion are not accepted. sterilisation is wrong - partly because it prevents children permanently and partly because of a text forbidding men to castrate themselves. Humanism Most humanists assess the rights and wrongs of birth control by looking at the consequences of birth control and say that where contraception leads to good results it is ethically right to use it. They argue that if contraception "results in every child being a wanted child, and

in better, healthier lives for women, it must be a good thing." (British Humanist Association) Humanists are not convinced by the "natural law" argument. * Humanists who do not believe in God dismiss the argument that contraception interferes with God's plan for the universe. * Humanists who do not accept that there is a "natural order" to the universe dismiss the natural law argument as being based on a false premise * Humanists who accept that there is a "natural order" to the universe and that contraception interferes with that natural order, see that as no reason to object to contraception. They argue that since humanity interferes with the natural order of the universe all the time, what matters is whether the consequences of that interference are good or bad. Humanists don't think that it's right for contraception to be used to permit promiscuity - they think that people should take a responsible attitude to their sexual behaviour; but they do so because promiscuity leads to bad consequences and not because it offends any moral principle.

Christianity and contraception *all churches disapproved of artificial contraception until the start of the 20th century. *different Christian churches hold different views about the rightness and wrongness of using birth control; meaning of marriage, sex and the family *agreement that sex outside marriage as morally wrong; abstaining from sex would be morally better than having sex and using birth control *Roman Catholic Church only allows "natural" birth control For most of the last 2000 years all Christian churches have been against artificial birth control. Protestant attitudes to birth control began to change in the 19th century as theologians became more willing to accept that morality should come from the conscience of each individual rather than from outside teachings. Changing attitude to sex: Instead of seeing sex as something rather dangerous, many Christians began to regard sex as one of God's great gifts�Sex was a force that could preserve the institution of marriage if couples didn't feel threatened by the possibility of having children they could not support. Influenced by this, the Protestant churches concluded that as the use of birth control often led to stronger families and better marriages, churches should let believers use birth control as their own consciences dictated This change came slowly - Anglicans were the first church to issue a statement in favour of contraception, which they did at the Lambeth Conference in 1930 Nowadays most Protestant denominations permit artificial birth control to some extent. Roman Catholicism What is morally wrong is using such things with the intention of preventing conception. The Church teaches that using artificial contraception is wrong because: * it is against "natural law" * it breaks the natural connection between the procreative and the unitive purposes of sex

* it turns sex into a non-marital act * it gives human beings the power to decide when a new life should begin that power belongs to God * it leads to widespread immorality * it damages the institution of marriage * it reduces male respect for women * it gives human beings the idea that they can have complete power over the body * it allows the implementation of eugenic programmes *the physical expression of love between husband and wife in intercourse can't be separated from the reproductive implications of both the act and marriage. *Sex is intimately involved in God's design for the universe, something profoundly important that involves a person's mind and spirit as well as their body. Pope John Paul II - confirmed the Church's position, "the natural regulation of fertility is morally correct; contraception is not morally correct." Principle of Personalized Sexuality Principal Values: 1. pleasure 2. love 3. reproduction 4. symbolism Central View: humans created in God�s image, a wise and loving Creator Requirement: all 4 must come together, otherwise will harm human dignity and therefore unethical Principle of Stewardship and Creativity � develop technology to achieve rational over nature balanced by respect for the built in wisdom and teleology of nature (ecological) Principle of Moral Discernment � some actions are intrinsically wrong because they are contrary to basic human needs vs. the short-range advantage Principle of the Common Good � individual advantage vs. social effects *Life-giving and Love-giving Natural family planning involves using self-control to regulate sexual activities in harmony with nature. The natural methods of family planning are: * abstention: this method is 100% reliable * rhythm method: having sex at times of the woman's menstrual cycle when she is unable to conceive. o this method is calendar based, reliability is around 85% * body function methods: these use other functions of the woman's body, such as mucous patterns and temperature patterns to determine when the chance of conception is low, these methods are up to 98% reliable Natural family planning is not unethical or disobedient to God because: * it uses a mechanism God designed * it is natural because it is based on the natural human property of selfcontrol o self-mastery is a power which God gave only to human beings o they should use self-mastery rather than methods which work against nature # it does not completely prevent conception - the sexual act remains "open" to the creation of a new life # it does not add anything artificial to the sexual act to change it The Catholic Church teaches that there is an inseparable connection between sexual

intercourse and conceiving children, and that it is wrong for human beings to use artificial methods to break this connection. Connection between the "unitive significance" and the "procreative significance" of sexual intercourse. * Procreation: When a man and a woman have sexual intercourse the natural end - the end God had in mind - is that a child is conceived if the timing is right. * Uniting: When a man and a woman have sexual intercourse they unify themselves as one flesh (Despite the use of the word "flesh" this means a mental and spiritual union as well as a physical union.) Birth control and the unity of the couple � one flesh * The unifying function of sexual intercourse depends on each partner giving themselves completely to the other * Two people who intend to prevent the conception of a child are holding back part of the gift contained in the sexual act o either they give everything except their fertility, or they only accept the other if their fertility has been prevented

Aristotle�s final causes + Natural Law Gen 1:28 Gen. 38:1-10 - Immoral behaviour - Health concerns - Love, sex, accountability and committment to ponder: Why was the woman given sexual desire even for the times of the month when she is not fertile? Misuse does not imply immorality But must not harm the woman or the abort the fertilized egg Evangelical Prospective 1Tim 5:8 � care for family Scripture: Purpose for Sex Procreation (Gen 1:28) command or a blessing? Companionship � Gen 2:18 Unity � analogy for the church Pleasure � Eccle 9:9, Song of Solomon Raising of Godly Children Curb fornication/adultery 1Thess 4:3 ============ Bioethics III Essential Elements of Human Sexuality Dr. Cuaresma

The sexual instinct or tendency is innate (inborn); theological (ordained towards an end � procreation); transcends psychologically (ordained towards another person away from self); does not need intelligence but is regulated by the latter. Man is sexual, but has other qualities besides being sexual Sex is an objective reality in accord with God�s plan for man; therefore it is good in itself. Sex life ought to be regulated morally according to Natural Law. Sexuality is the biological vehicle for self-giving between man and woman. Human love involves everything � all the dimensions of �being�, including the affective and spiritual The sexual instinct is ordained essentially to the propagation of the species, to the transmission of life. Therefore, the unitive and procreative aspects of sexual love must not be separated. Responsible Parenthood (Humane Vitae) The meaning of �responsible parenthood� is primarily influenced by the level of knowledge of the biological processes involved in reproduction It is important for spouses (according to their respective capacities) to know the mechanism of the female cycle Knowledge of these mechanisms must not lead them to interfere with the cycle It ought to move them to respect these natural processes If, on the other hand, we examine the innate drives and emotions of man, responsible parenthood expresses the dominion which reason and will must exert over them Knowledge of biological means �must lead to education in self-control� Irresponsibility in this aspect can have grave consequence If we consider the relevant physical, economic, psychological and social conditions, responsible parenthood is exercised by those who prudently and generously decide to have a large family or by those who, for serious reasons and with due respect for the moral law, choose not to have children for the time being or even for an indeterminate period Important problems in the decision to limit the number of children: The existence of a serious motive for avoiding the birth of another child; Respect for the moral law while searching for the most adequate means of avoiding the birth Periodic continence or absolute continence Regulation of Birth The sexual act, properly exercised within marriage only, is ordained primarily to the propagation of life �Marriage and married love are, ordained to the procreation and education of children� Not all acts are fertile because there are fertile and infertile periods within the female sexual cycle In their primary mission of transmitting human life, the consent and joint effort�, will strive �to form correct involves a consideration of their own good, and the good born or yet to come, an ability to read the signs of the both material and spiritual levels, and finally consider of society and of the Church.

spouses by �mutual judgments��. which of their children already time and of their own in the good of the family,

Regulation of Birth �Birth control� Illicit methods ? artificial methods Licit methods ? natural methods Illicit Methods Any act performed before, during or after sexual intercourse which is intended to prevent procreation � whether as an end or as a means, is like wise immoral (Humanae vitae, no. 14) Contraceptive methods which interfere with the normal development of the conjugal union, whether mechanical, physical or chemical or directed in any way or at any moment against procreation Licit methods Reasonable motive for spacing births, arising from the physical or psychological condition of the husband or wife, or external circumstances Take advantage of of the natural cycles of the reproductive system and use their marriage precisely those times that are infertile Periodic Continence �Ogino-Knaus Method� Normal cycle: 28 days Ovulation: around 14 days Fertilization cannot occur before day 11 nor after day 16 Women is maximally fertile for 5 or 6 days/month �Ogino-Knaus Method� In actual practice it is complicated (with a high failure rate) Reasons: It is difficult to ascertain the exact day of ovulation �spontaneous� or �reflex� ovulations occasionally occurs Temperature Method Lowest point of registry before elevation of basal temperature coincides with ovulation Billings Method Vaginal mucus becomes humid, and secretions of the uterine cervix more watery during pre-ovulatory period Cervical mucus changes from sticky to viscous forming filaments ? sign of fertility Ethical consideration Periodic continence is the only licit method of avoiding conception while performing sexual union because it conforms with human nature and the dignity of the person Periodic continence cannot be practiced according to whim Artificial Contraceptive Techniques Classification: According to the mechanism of action (antigametes, contraceptives, antiimplants, chemical or mechanical methods�) According to effectivity (maximal, minimal, etc) a) Sterilization Tubal sterilization (salpinguectomy) Ligation or electrocoalgualtion of both fallopian tubes Highly effective; irreversible Vasectomy Bilateral ligation of the vas deferens which impedes the passage of the spermatocytes b) Intrauterine Device (IUD) Inert material polyethylene in different forms, introduced into the uterine

cavity Act by producing, a mechanical effect or local irritation Produce inflammation of the uterine mucosa which impedes the implantation of the ovum; alters the mechanism of transport of the spermatocytes Has antiimplantation and abortive effects Morally rejected like any abortifacient c) Physical barriers and Chemical methods Impede fertilization. These are illicit as they separate the 2 aspects of matrimony (unitive & procreative) Gel or preservative Vaginal Diaphragm Vaginal spermicides, creams, gels, aerosols, foams Condoms Coitus interruptus (withdrawal) and the vaginal douche are also methods employed for contraception. These are considered morally illicit d) Contraceptive hormones (1) (2) inhibition of ovulation (3) affects motility of the fallopian tubes advancing or delaying the moment of arrival of the zygote to the uterus. Implantation does not occur because the embryo arrives before the time of settling down and dies (4) undergoes changes which impede implantation of the zygote (5) becomes highly viscous and forms a plug impeding the entry of spermatocytes into the uterus Mechanism of action: a) Inhibits ovulation b) Prevents fertilization c) Impedes implantation (a) and (b) are contraceptive effects (c) abortive Male contraceptive pill Suppresses spermatogenesis taken once daily �Morning Before� pill Progesterone taken 4 hours after intercourse Post Coital or �Morning After� pill High doses administered over a period of 72 hours. Interferes with viable pregnancy by interfering with the endometrium. If pregnancy continued, the baby is at risk of suffering abnormalities RU 486 (Post implantation menstruation inducer) Destroys fetus from up to 9 weeks of pregnancy Can cause serious birth defects when it fails to induce abortion; can be fatal Works by blocking ovarian progesterone, the hormone that is needed for intrauterine survival Methotrexate New substitute for RU 486 Induce immune response to pregnancy, attacks new life as though it were an infection