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Report on the Ethics of Contraceptive Use

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Registered Members (so far) of the Advisory Committee with editorial rights: Prof Giuseppe Benagiano (Rome); Prof Mark Joseph Calano (Manila); Dr Luca Badini Confalonieri (Coordinator, London); Prof Roger Burggraeve (Leuven); Prof Ricardo Chica (Cartagena, Bolivia); Ass. Prof Kathryn Lilla Cox (Collegeville); Prof Christine Gudorf (Miami); Prof Jan Jans (Tilburg); Prof Paulachan Kochappilly (Bangalore); Prof Michael Lawler (Creighton); Prof. William J. LeMaire (Miami), Prof Gerard Loughlin (Durham, UK); Prof Dietmar Mieth (Tübingen); Dr Irina Pollard (Sydney); Dr Christina Richie (Boston); Prof Todd Salzmann (Creighton); Prof Joseph Selling (Louvain); Prof David Stronck (California State University, East Bay); Dr Agneta Sutton (London); Dr John Wijngaards (London). More members are welcome. Share your knowledge, insight and judgement.

The Ethics of Using Contraceptives: State of the Question

Why does sexuality matter so much? The Christian faith is based on love, and one of the commonest expressions of this is through sexuality. It is up to the people of God, single and married, to carry on pursuing the search for truth.”
Jack Dominian

Almost 50 years ago, the Pontifical Commission on Birth Control finally agreed on a report which the Pope had requested concerning whether artificial contraceptives can ever be an ethical choice. After three years of study and deliberations, the commission argued affirmatively. Our purpose is to produce a concise document that reports on whether the judgement of contemporary Christian scholarship has changed since that 1966 report. The Key Question we are trying to answer is:

Is there a consensus among contemporary Christian scholarship that married Christian couples may responsibly use contraceptives?

Introduction

The Natural Law Argument against Artificial Contraception

The Catholic Church’s official ban on artificial contraception is based on one single argument advanced by Pope Paul VI in his encyclical Humanae Vitae (henceforth HV). The argument starts from the biological fact that a causal link exists between (marital) vaginal sexual intercourse and conception. It then infers from this fact that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life” (HV §11). Not doing so would mean going against the biological “laws of conception” created by God: “an act of mutual love which impairs the capacity to transmit life which God the Creator, through specific laws, has built into it, frustrates His design which constitutes the norm of marriage, and contradicts the will of the Author of life” (HV §13). Therefore, the argument goes, the use of artificial contraceptives is always “intrinsically wrong” and cannot even be justified by appeals to the principle of the lesser evil (HV §14).

HV contends that such an argument, based as it is on an interpretation of the biological evidence of human reproduction, is grounded in the “natural law” and therefore, by definition, is accessible to and can be evaluated by all rational people: “We believe that our contemporaries are particularly capable of seeing that this teaching is in harmony with human reason” (HV §12).

Incidentally, this interpretation of the biological evidence which affirms that every act of sexual intercourse must remain open to the possibility of procreation is also the basis for the absolute rejection under any circumstances of the morality of masturbation, homosexual relationships, and in vitro fertilisation, among other things.[1]“The official teaching rests on the view that the innate purpose of the sexual faculty is twofold: procreation and love union. Every sexual act must be open to procreation, and must be expressive of love. This is the church’s basis for condemning masturbation, contraception, sterilization and homosexual acts. It is also the ground for condemning artificial insemination, even with the husband’s semen (AIH). Contraception is wrong, in the hierarchical magisterium’s view, because it prevents procreation. AIH is wrong because the act of insemination is not the natural act which, by its very nature, is expressive of love.” Charles Curran, Roman Catholic Sexual Ethics: A Dissenting View, Christian Century, December 16, 1987, pp. 1139-1142.

Should HV’s interpretation of the biological evidence turn out to be mistaken, the conclusions that have been drawn from it will need to be revised. Accordingly, the report will assess first and foremost the validity of such an interpretation.

The Argument from Authority

In addition, HV does also advance another argument of a different kind. Pope Paul VI stated that the reason he rejected the final report of the Pontifical Commission on Birth Control was because “certain approaches and criteria for a solution to this question had emerged which were at variance with the moral doctrine on marriage constantly taught by the magisterium of the Church” (HV §4). This is a distinctively “intra-Catholic” argument which can only be accepted as valid if the following can be demonstrated:

  •  there has been an uninterrupted “magisterium” in the Catholic Church throughout its history;
  •  whatever has been consistently taught by such a magisterium throughout the centuries is infallible;
  •  the immorality of artificial contraception is an example of just such a teaching which has consistently been taught by an official magisterium throughout church history.

In essence, it is an argument from authority: contraception cannot be morally licit, because previous popes have said it is not. That belief is reiterated later in the encyclical, where Paul VI reminds all Catholic priests that “the pastors of the Church enjoy a special light of the Holy Spirit in teaching the truth. And this, rather than the arguments they put forward, is why you are bound to such obedience” (HV §28).

Such a statement effectively asks the faithful to commit to a moral judgement without the necessary previous stages/conditions of being attentive to the relevant information, being intelligent in understanding its meaning and being rational in evaluating this understanding’s correspondence to reality.

Furthermore, the appeal to a supposed tradition of consistent teaching by church authorities is in tension with the claim that the immorality of artificial contraception is based on the “natural law” of the biology of human reproduction and can therefore be grasped by any rational person, whether or not they are Catholics. The tension results from the potential contradiction between those two “authorities”: on the one hand what the “natural law” evidence from (evolutionary) biology suggests, as we will see, and on the other what a supposedly consistent tradition of Catholic teaching has been saying throughout church history about the meaning and purpose of sexual activity.

The danger here is to regard past teachings by church authorities as correct simply on the basis of whether they have been consistent throughout history, rather than whether the arguments supporting them are sound.

Methodology

In this connection, it is important to underline that, according to the methodology of mainstream Catholic theology which is adopted here, the authority of any tradition within the Catholic Church does not rest simply on the status of the teacher, but on the quality of the evidence (scriptural, historical, and current; and from the data of sense as well as the data of consciousness) adduced.

Ethical or value judgements too need to be based on the relevant evidence. For instance, with regard contraceptives, the moral discernment requires, at the general level, some understanding of the following:

  • the (evolutionary) biology of human reproduction;
  • the meanings and values that human beings attribute to sexuality, as can be discerned by observing both the past (e.g. evolutionary biology, anthropology, and history) as well as the present (e.g. via large scale sociological surveys);
  • the consequences (advantages and disadvantages) of different contraceptive methods.

At a more specific level, the evidence to be considered should ordinarily encompass all the consequences of engaging in unprotected intercourse: including but not limited to their financial, physical, and psychological capacity to raise and educate a child, and so on. Those issues are best determined by the couple in question, with whom the ultimate responsibility of choosing whether and which contraceptives to use resides, as we will see later.

The point of attention here is that because knowledge of both the general and the context-specific evidence is, in principle, open to anybody, so is the resulting moral insight. HV acknowledged as much by stating that the question of contraception pertains to the “natural law” – that is, it can be determined by observing the created order of nature – so that the key arguments in favour or against are accessible to all rational beings. For this reason,

Christians as such, and the people involved in the church’s magisterium as such, have no privileged competency with regard to such questions […]. If one wishes to give moral instructions and teachings concerning such human realities, inasmuch as they are human, one must acquire sufficient competence, receiving information from others who are more competent.[2]Josef Fuchs, Christian Morality: The Word Becomes Flesh, trans. Brian McNeil (Dublin: Gill and Macmillan, 1987), p. 115, quoted in Mark Graham, Josef Fuchs on Natural Law (Washington, D.C.: Georgetown University Press, 2002), p. 163, but consult also pp. 162–6 and 183–5.

The same criteria of compatibility with the relevant evidence from the created order applies to the appeals to the authority of a supposed Christian tradition of consistent teaching on the topic. Past pronouncements by church authorities and theologians on contraception or on the meaning and purpose of sexuality have to be evaluated on the basis of whether their arguments are still valid. To the extent that – as HV acknowledged – the moral discernment with regard to contraception is a matter of the so-called “natural law,” it is accessible to any person in virtue of their rationality. Therefore, traditional as well as contemporary arguments on the subject must be assessed on the basis of their compatibility with the evidence from the natural sciences, and other relevant disciplines such as psychology and sociology.

SECTION 1

The Meanings and Purposes of Sexual Activity

[T]he morality of sexual actions is […] to be judged by the true exigencies of the nature of human sexuality.[3]Pontifical Commission on Birth Control, Draft of a Document Concerning Responsible Parenthood (Schema Documenti de Responsabili Paternitate), 1966.

The Evidence from Evolutionary Biology

HV argued for the importance of observing nature to understand the meanings and purposes of human sexuality. Since the time it was written, our knowledge of the subject has increased, not the least thanks to studies on evolution and human sexual behaviour.[4]Peter B. Gray and Justin R. Garcia, Evolution and Human Sexual Behavior (Cambridge, MA: Harvard University Press, 2013).

The sexuality and sexual behaviour of the human species is unique in nature because it is they are controlled not simply by hormones, but by human intentionality, i.e. their reason. Therefore, human beings have endowed sexuality with meanings and indeed values.

Most of the available evidence concerning the meanings and values human beings attribute to sexuality is embedded in the past and present historical record. This is captured by historical as well as sociological and cultural studies focusing on people’s reported understanding and evaluation of their sexuality. Later parts of the report will highlight some key relevant findings from those disciplines.

However, the pre-historical evidence on the evolution of human reproductive biology does highlights biological features that have evolved as a response to uses of sexuality for purposes other than procreation.
The most relevant factor for present purposes has been the ground-breaking expansion among primates – including humans – of the female’s sexual receptivity beyond their fertile periods: “Most mammals are sexually receptive only when fertile, whereas the human female’s potential for sexual arousal and orgasm at all times in the menstrual cycle, is no secret”.[5]Irina Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, in Bioscience Ethics (Cambridge, Mass.: Cambridge University Press, 2009), 90–105, at 93. As Pollard noted, at the biological level, this occurred via a “transfer of the physiological control of libido from the female sex hormones (estrogens and progesterone) involved in ovulation and pregnancy, to another set of hormones, in this case the androgens testosterone and androstenedione. A woman’s complement of androgens derived from her ovaries and adrenal glands keep her sexual drive active throughout the menstrual cycle”. Ibid. This was something unknown to Catholic natural law on sexuality, which was for the most part in place by the end of the Middle Ages. Therefore for most if not all of its history the Catholic natural law tradition on sexuality could not even “attempt to understand the significant of this change away from sex oriented exclusively to procreation” Christine E. Gudorf, Body, Sex, and Pleasure: Reconstructing Christian Sexual Ethics (Cleveland, OH: The Pilgrim Press, 1994), 64-65.

Non-Conceptive Sexual Activity – The Socialization of Sexuality

But sexual pleasure is only one of the purposes of non-conceptive sexual activity. Others have to do with human beings’ deeply relational nature, via an evolutionary process which has been termed the socialization of sexuality. The majority of evolutionary biologists agree that

the sexual behaviour of Homo sapiens […] clearly evolved from that of the great apes, and among them, in spite of its conceptive nature, sexuality has already acquired other meanings[6]Giuseppe Benagiano and Maurizio Mori, The Origins of Human Sexuality: Procreation or Recreation?, Reproductive Biomedicine Online 18 Suppl 1 (2009): 50–59, at 52.

among which one could recognise two distinct types:

(i) exchange sex, in which a female obtains direct non-reproductive benefits, like food, in exchange for sex; and (ii) communication sex, sexual activity, not necessarily copulative, to develop social relationship or to diffuse tension and avoid aggression (Manson et al., 1997).[7]Ibid.

Evolutionary biologists also agree that “Extended sexuality is a common mate retention tactic in monogamous primates”[8]Melissa Emery Thompson and Martin N Muller, Comparative Perspectives on Human Reproductive Behavior, Current Opinion in Psychology 7 (February 2016): 61–66.. Indeed,

Because we are a socialized species, copulation has a greater significance than just the transmission of the genotype and serves many other functions […]. On the positive side, sexual pleasure is particularly important, so much so that evolutionary pressures have engineered the human female’s escape from dependence on ovulation for sexual satisfaction. Continued sexual receptivity favours pair-bonding, essential for the maintenance of long-term relationships and the raising of offspring. Self-esteem reinforces the sufficiency and security of the human being and for that reasons helps in raising the offspring. On the negative side, sexual behaviour may be used to establish dominance in relationships, express hostility or be used for material gain (it is said that prostitution is the oldest profession in human society). The sociobiological functions of sexuality go far beyond reproduction and pair-bonding. They influence the shaping and linking of groups of individuals into communities and communities into societies, that is, in anthropological terms, the humanization of biological relationships. Procreational sex in becoming recreational sex also becomes the glue of society.[9]Irina Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, in Bioscience Ethics (Cambridge, MA: Cambridge University Press, 2009), 90–105.

That evolution means that, from the strictly biological viewpoint, human sexuality has as an intrinsic purpose not just procreation, but also non-conception. For human beings, the recreational (and not necessarily procreative) purpose is intrinsic to sex and fulfils essential sociobiological functions.[10]Paul R. Abramson and Steven D. Pinkerton, With Pleasure: Thoughts on the Nature of Human Sexuality (Oxford University Press, 2002). Indeed,

human sexuality began to lose its exclusive reproductive meaning very early in the evolution of the genus Homo and, with a concealed ovulation and a female accessible to the male during the entire menstrual cycle, the need became that of avoiding, rather than seeking conception during intercourse.[11]Giuseppe Benagiano and Maurizio Mori, The Origins of Human Sexuality: Procreation or Recreation?, Reproductive Biomedicine Online 18 (2009): 50–59, at 50.

As it has been noted, “contraception is not a human invention; rather pregnancy-avoidance mimics our extraordinary evolutionary heritage”[12]Irina Pollard, Pollard’s Response To Leavitt’s Commentary, Eubios Journal of Asian and International Bioethics 7, no. 5 (1997): 134–35..

Nature, then, shows how Homo sapiens is among very few species in which sexual behaviour is engaged in for purposes beyond the merely reproductive one. Humans have attributed to such a distinctive sexual behaviour meanings and values beyond those pertaining to passing on their genotype: “Early human societies throughout the world understood this and developed many ways of thoughtfully preventing unwanted conceptions.”[13]Ibid. Indeed, “we know that humans have tried to practise contraception ever since they began to leave written records. According to Potts and Campbell (2002), modalities to avoid conception after intercourse are described in Egyptian papyri (Ebers, 1550 BC; Petre, 1500 BC), the Greek writings of Soranus (Gynecology, c.AD 100) and in the Latin works of Pliny the Elder (AD 23–79) and Dioscorides (De Materia Medica, c.AD 58–64).” Benagiano and Mori, The Origins of Human Sexuality, 2009. p. 53..

Finally, developmental biology shows that “human sexuality begins to unfold early in [the biological] development [of children], well before reproduction is possible”[14]Peter B. Gray and Justin R. Garcia, Evolution and Human Sexual Behavior (Cambridge, MA: Harvard University Press, 2013), p. 112..

The Relationship between Sex and Procreation

Humanae Vitae’s Interpretation of the Evidence from the Biology of Human Reproduction

The heart of the argument of HV is a particular interpretation of the biological evidence concerning the relationship between sex and procreation. HV observes that the biological relationship which exists between sex and procreation is statistical, direct and causal. It then goes on to interpret this fact as implying that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life”. Its key affirmations are as follows:

The fact is, as experience shows, that new life is not the result of each and every act of sexual intercourse. God has wisely ordered laws of nature and the incidence of fertility in such a way that successive births are already naturally spaced through the inherent operation of these laws. The Church, nevertheless, in urging men to the observance of the precepts of the natural law, which it interprets by its constant doctrine, teaches that each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life.
[This] is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act.
The reason is that the fundamental nature of the marriage act, while uniting husband and wife in the closest intimacy, also renders them capable of generating new life—and this as a result of laws written into the actual nature of man and of woman.[15]HV §§11-12

The Evidence from the Biology of Human Reproduction

Women are infertile for around 22 days a month; before menstruation and after menopause; and while pregnant or lactating (see Appendix). Statistically, then, conception is the exception and not the rule for intercourse. Moreover, we now know that even after insemination/conception there is a relatively high percentage of embryo wastage prior to implantation:

human fecundity rate; that is, the probability of achieving a clinically recognized pregnancy within any given menstrual cycle, is about 25% and high levels of fertilization failure or early developmental death, are the norm. This high attrition rate is due to abnormalities in the gametes and faulty development, leading to embryo death prior to implantation.
[H]umans are unique in the very high frequency of chromosome abnormalities and consequent early embryo wastage. [T]he natural in utero selection process […] eliminates 95% of chromosomally unbalanced conceptions.[16]“Clinically recognized pregnancy loss [i.e. after a successful embryo implantation], is usually quoted as 15-20%. It is this clinical fraction of failed pregnancies that has been extensively studied cytogenetically and in which a chromosome abnormality rate of at least 50% has been established. This contrasts markedly with a 5% chromosome abnormality rate found in stillbirths, illustrating clearly the natural in utero selection process that eliminates 95% of chromosomally unbalanced conceptions. [I]t can be seen that 50-60% of developmental anomalies at birth are of unknown etiology while known causes can be assorted into chromosomal aberrations, mutant genes and environmental factors. Of the known categories, 20-25% are multifactorial inheritances.”

In total, “as few as 30% of all human conceptions survive to birth, with a large majority of these failures lost in the very early stages of pregnancy.”[17]Pollard, Pollard’s Response to Leavitt’s Commentary. In other words, from the biological or “natural” point of view, the relationships between insemination, conception, implantation and successful pregnancy to term are statistical, and in such a way that the final outcome – live birth, as the successful outcome of “procreation” – is the exception, not the rule.

A final point is that the “rhythm” method of family planning recommended by HV appears to carry increased risks of serious congenital anomalies.[18]Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, 2009.

Interpreting the Biological Evidence on the Relationship between Sex and Procreation

Accordingly, HV’s affirmation that those biological processes somehow “signify” an “inseparable connection” between the “unitive” and “procreative” significance of conjugal intercourse is unwarranted on two levels: 1) with regard to its interpretation of the biological facts, and 2) with regard to its understanding of the role of humans in the created order.

[1] As noted in the previous section, the “natural law” as can be glanced from the (evolutionary) biology of human reproduction shows that sexual intercourse has only a statistical relation to conception and procreation:

While the Encyclical acknowledges the “unitive sense” of marital intercourse, it claims that inseparable from it there is a “procreative sense.” [O]n contemporary biology, if insemination may be said to be inseparable from normal intercourse, conception cannot be said to be inseparable from insemination. The discharge of two million spermatozoa into the vagina does not mean or intend two million babies. Most of the time it does not mean or intend any babies at all. The relationship of insemination to conception is not the relation of a per se cause to a per se effect. It is a statistical relationship relating a sufficiently long and random series of inseminations with some conceptions.
So there arises the question whether this statistical relationship of insemination to conception is sacrosanct and inviolable. Is it such that no matter what the circumstances, the motives, the needs, any deliberate modification of the statistical relationship must always be prohibited? If one answers affirmatively, he is condemning the rhythm method. If negatively, he permits contraceptives in some cases. Like the diaphragm and the pill, the menstrual chart and the thermometer directly intend to modify the statistical relationship nature places between insemination and conception. [M]arital intercourse of itself, per se, is an expression and sustainer of love with only a statistical relationship to conception.[19]As Bernard Lonergan noted, “So there arises the question whether this statistical relationship of insemination to conception is sacrosanct and inviolable. Is it such that no matter what the circumstances, the motives, the needs, any deliberate modification of the statistical relationship must always be prohibited? If one answers affirmatively, he is condemning the rhythm method. If negatively, he permits contraceptives in some cases. Like the diaphragm and the pill, the menstrual chart and the thermometer directly intend to modify the statistical relationship nature places between insemination and conception. [M]arital intercourse of itself, per se, is an expression and sustainer of love with only a statistical relationship to conception.” REF.

If anything, “the natural law in this matter would call for a randomness of sexual acts, a principle which would be specifically violated by rhythm”.[20]Charles E. Curran and Robert E. Hunt, Dissent in and for the Church: Theologians and Humanae Vitae (Sheed & Ward, 1970), p. 165..

[2] HV’s affirmation is further unwarranted because it assumes a mistaken understanding of the role and agency of human beings vis-à-vis the created order. It affirms that human beings are not allowed to do violence to the biological laws themselves by interfering with the intrinsic relationship of intercourse to procreation.

However, this assumes that “biological laws” have a mind and intentionality of their own, which humans’ intentionality must obey without possibility of interfering with them. This “non-intervention” argument, positing a sort of “let nature take its course” principle, is a fundamentally mistaken interpretation of both the created world and of humans’ role in it.

First, the order of creation and its natural laws seem, at their most fundamental level of quantum mechanics, to have an essentially probabilistic basis.[21]See the classic explanation by Richard Feynman, that “what we are proposing […] is that there is probability all the way back: that in the fundamental laws of physics there are odds.” Probability and Uncertainty: The Quantum Mechanical View of Nature, in The Character of Physical Law (Cambridge, Mass.: The M.I.T. Press, 1965), 127–48 (emphasis added). At the physical, chemical, and biological levels, the created order is a complex system of cycles of recurrence, all of which – including the most apparently stable – are subject to conditions which all have their probabilities of occurring and perduring.[22]Cynthia SW Crysdale, Revisioning Natural Law: From the Classicist Paradigm to Emergent Probability, Theological Studies 56, no. 3 (1995): 464–84, at 476 and 477. This also applies to the biological laws of human reproduction.

Secondly “just as there are schedules of probability within natural cycles, which set the conditions for other natural occurrences, so natural cycles set conditions for human choices, and human actions, or lack thereof, set conditions for the emergence of natural phenomena.”[23]Ibid. at 477-478.

As a consequence, and thirdly, “the fact that humans are agents of reason, and therefore have an autonomy that other portions of the created order do not have, means that humans have a unique role in affecting probabilities”.[24]Ibid. at 476. In effect, [E]ach set of causal relationships [in nature] is subject to a set of probabilities. Human choices and human norms involve choosing how to affect probabilities, not merely choosing not to intervene in natural processes.[25]Ibid. at 483. For example, any medical intervention generally affects probabilities – of healing, survival, death, etc.

More to the point, for human beings to choose not to intervene in natural processes also affects the latter probabilities, just as choosing to intervene does.

Human beings always “interfere” with natural processes, whether by deciding to “tamper” with them or by “letting nature take its course.”
Given the above, then, the moral questions are not whether to interrupt nature’s course or not, but which actions are in accord with the meaning of human life and dignity and which contravene these….[26]Ibid. at 478. For a religious believer,

Doing the right thing involves discerning, with an acceptance of the limitations of one’s foresight, how God might want me/us to affect the future conditions of the world. God’s will, rather than being a matter of conforming to an already established pattern in the world, involves creating patterns as part of a web of conditioning probabilities. The moral task involves not conforming to nature but transforming it.[27]Ibid. at 479.

Therefore,

To the degree that natural law demands that one be attentive to the created order, the moral theologian must take stock of the manifolds of non-intelligent schemes of recurrence that condition human being. Thus knowledge of the natural world—reproductive processes, ecological systems, medical diagnoses—is an imperative for responsible ethics.[28]Ibid. at 484.

Responsible moral discernment, then, will often require

attend[ing] to chemical, biological, and zoological schemes of recurrence as conditioning factors in human existence, both within the human subject and between that subject and her environment, without seeking to derive moral norms directly from these natural processes. It will take as an important task, not defining ways in which persons should conform to nature, but clarifying the values implicit in interventions in nature, and stipulating which transformations are ultimately conducive to human flourishing and which are not.[29]Ibid.

In conclusion, not only is it impossible to infer simply from the (statistical) relationship between sexual intercourse and conception an absolute judgment of value about the morality of contraception. It is also impossible to argue that, with regard to the specific case of the biological laws of human reproduction, the natural capacity human beings have to influence the essentially statistical basis of the laws of nature should not be exercised.

The Evidence from Psychology and Sociology

The “Global Study of Sexual Attitudes and Behaviors” provides a large amount of empirical evidence about the meaning that people give to sexual activity. One finding among many others:

Sex in companionate relationships [“companionate” marriage is the marriage which “emphasizes equality between intimate partners”, p. 146] tends to value positively sexual competencies, interests, and performance between intimate sex partners. In other words, sex in companionate relationships serves not only reproductive purposes, but also expresses the quality of the relationship.[5]

[What else emerges from recent sociological studies concerning the meanings and values that people (and couple) give to sexuality?] [Theology section?]

Theologians reflecting on the purposes of sex have also included pleasure, strengthening mutual commitment, etc [unfinished].[30]Margaret A. Farley, Just Love: A Framework for Christian Sexual Ethics (New York ; London: Continuum, 2006); Gudorf, Body, Sex, and Pleasure; Shaji George Kochuthara, The Concept of Sexual Pleasure in the Catholic Moral Tradition, vol. 152 (Gregorian Biblical BookShop, 2007).

The Ethics of Sexual Activity and of Contraceptive Use

It has been noted that sexual activity has a plurality of meanings and outcomes beyond biological reproduction and the transmission of the genotype (3.1). These can be affirmed and celebrated within marriage. Contraception can facilitate the other meanings of sexual activity, such as love, play, comfort, celebration and companionship.

The non-conceptive meanings of sexuality are so important that Paul the apostle advised couples in Corinth thus: “Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control” (1 Cor 7:5). In the same vein, Vatican II made the following observation: “where the intimacy of married life is broken off, it is not rare for the faithfulness to be imperiled and its quality of fruitfulness ruined” (GS, §51).

It has also been noted that human beings can and indeed regularly intervene into natural processes (4.3). The latter include the biological processes of human sexuality.

The discernment of when and how to intervene is to be done on a case by case basis by the people involved. However, some general guidelines can be provided. The 1966 Majority Report stated:

It is proper to man (sic), created to the image of God, to use what is given in physical nature in a way that he may develop it to its full significance with a view to the good of the whole person […].
This intervention of man (sic) into physiological processes, an intervention ordained to the essential values of marriage and first of all to the good of children is to be judged according to the fundamental principles and objective criteria of morality.[31]§ 1.2.2.2.

In a similar vein, but more recently, it has been suggested that the same criteria be used to evaluate the morality of sexual activity as they are used to evaluate the morality of any other human endeavour. Specifically, several conditions or norms have been highlighted for the correctness of sexual activity and relationship: “do no unjust harm, free consent, mutuality, equality, commitment, fruitfulness, and social justice”.[32]Margaret A. Farley, Same-Sex Relationships and Issues of Moral Obligation, Anglican Theological Review 90, no. 3 (2008): 541–47. A similar position is adopted by Marvin M. Ellison, Making Love Just: Sexual Ethics for Perplexing Times (Fortress Press, 2012).

The same can be said with regard to the responsible use of contraceptives. Here the relevant criteria are those for a responsible parenthood:

Let them [husband and wife] thoughtfully take into account both their own welfare and that of their children, those already born and those which the future may bring. For this accounting they need to reckon with both the material and the spiritual conditions of the times as well as of their state in life. Finally, they should consult the interests of the family group, of temporal society, and of the Church herself.[33]GS §50, see also HV §10.

The 1966 Majority Report also stated that “the morality of sexual actions is […] to be judged by the true requirements of the nature of human sexuality”. Given what we know about the non-conceptive purposes of sexuality, this report reiterates the conclusion that “the morality of sexual acts between married people […] does not […] depend upon the direct fecundity of each and every particular act,” but in the context of the “fecundity”, fruitfulness, or generativity of the marital relationship overall. The authors proposed that “the regulation of conception by using means, human and decent, favoring fecundity in the totality of married life and toward the realization of the authentic values of a fruitful matrimonial community” could be beneficial for both the couple and society.[34]Majority Report of the Birth Control Commission, 1966: part 1 ch. III. When couples choose for themselves if family planning could enhance their relationship as committed Christians, then they would be liberated to serve the world and the Church in other ways.[35]Majority Report of the Birth Control Commission, 1966: part II ch 1. The option for contraception would give “married life its unitive value, and do so in service of its procreative function”.[36]Majority Report of the Birth Control Commission, 1966: part II ch 1.

Procreation is not the only form of “fertility”, “fruitfulness” or “generativity”. Some couples may decide not to have children in order to devote themselves to other worthy endeavours at the service of society and the common good. They do not thereby intend to forfeit the possibility of maintaining sexual intimacy. As Bernard Häring put it:

Love’s fecundity is a reality totally different from biological fertility […]. Conjugal love has a value in itself: Its proper fecundity is in love and for love itself. It enriches not only the spouses but all whom they meet who become sharers of the overflow of their love. Persons who are truly in love become beautiful, intuitive, insightful, attentive, caring, generous and gracious.[37]Bernhard Häring, Free and Faithful in Christ: Moral Theology for Priests and Laity – The Truth Will Set You Free, vol. 2 (Slough: St Paul Publications, 1979), p. 516. Also Cristina Richie, Disrupting the Meaning of Marriage? Childfree, Infertile and Gay Unions in Evangelical and Catholic Theologies of Marriage, Theology & Sexuality 19, no. 2 (2013): 123–42; and Kathryn Lilla Cox, Toward a Theology of Infertility and the Role of Donum Vitae, Horizons 40, no. 01 (2013): 28–52, at 44.

The same criteria used for evaluating whether to have a child apply in evaluating whether to use contraceptives. If a couple determines that in their particular circumstances they should not have a baby, then contraception can be a morally licit choice.

Who Decides on the Morality of Contraceptive Use?

If moral insights, especially on matters considered to be of “natural law”, are in principle open to anybody, then the process for reaching a moral judgment on those matters should be open to anybody. It is not the exclusive prerogative of the clergy or the episcopal hierarchy to propose moral insights. The laity, and particularly experts in the relevant disciplines, have an equal right of participation in the deliberative and decision-making processes to reach a formal statement on those matters.

Furthermore, the principle of subsidiarity discourages higher-level authorities making decisions if a lower-level is efficacious. Subsidiarity demands, on the one hand, that

each decisional level (from the individual upward) has an inalienable responsibility to decide and act within its own operational range and, on the other hand, that only those actions which cannot be achieved by the individual or the smaller group alone, can be appropriately achieved through recourse to the higher level of a structured community. It is essential to observe that the divide between what can be decided autonomously and what should be decided by delegation must be determined by the delegating individual or group and not by the higher levels.[38]Luca Badini Confalonieri, Democracy in the Christian Church: An Historical, Theological and Political Case, Ecclesiological Investigations 16 (London: Continuum, 2012), p. 121, see also pp. 15 and 144.

For it is only the former who has the responsibility to decide on the appropriateness and extent of the delegation.

The most foundational level of decision-making in contraceptive use are the two parties engaged in intercourse. Only they should decide if, when, and how to use contraception. This applies to any couple, whether or not they are Catholic. With regard to Catholic couples specifically, we can expect the Spirit to guide them in this, and other, matter of life by virtue of their baptismal vows: “The parents themselves and no one else should ultimately make this judgment in the sight of God.”[39]NCCB, Responsible Parenthood, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/catholic-teaching/upload/Responsible-Parenthood.pdf

Again, the choice of contraceptive methods too is the exclusive responsibility of the couple concerned, using the generally accepted criteria for making responsible decision (e.g. no harm to others, potential consequences, etc).

The choice of contraceptive methods should be a matter of conscience for the couple involved. New methods are being researched: for instance, concerning both hormonal and non-hormonal contraceptives for men. In that choice, the usual ethical criteria should be used.

The moral discretion of each couple should determine the use of contraception. Many Catholic theologians concur that contraception is often acceptable, and in some cases it borders on an imperative: e.g. to prevent HIV transmission from one spouse to another, to prevent vertical transmission of HIV from mother to child, or to prevent serious medical, financial or other hardships that a pregnancy would entail for the woman, couple, or family.

SECTION 2

Circumstances Where the Use of Contraceptives Can be Morally Required

It is common knowledge that if one spouse is HIV positive, this virus can easily be transmitted to the other spouse through an act of sexual intercourse. The use of a condom would in this case severely lessen that possibility and could provide protection for the spouse who is not infected. Accordingly, in the case of a couple who has decided to have marital intercourse despite one spouse being HIV positive, the use of condoms is morally better than having unprotected sex.

The Principle of the “Double Effect”

James Keenan, S.J., summarizes the principle of the double effect as having four components:

  1. The object of the action must be right or indifferent in itself; it cannot be intrinsically wrong.
  2. The wrong effect, though foreseen, cannot be intended.
  3. The wrong effect cannot be the means to the right effect.
  4. There must be proportionate reason for allowing the wrong effect to occur.[23]

The principle of the double effect can be applied to the use of barrier forms of contraception (condoms, both male and female) to prevent transmission of human immunodeficiency virus [HIV]. We need not assume that condoms would be used by non-married couples, thus simplifying the morally salient features to a matter of life or death for lawfully, sacramentally wedded couples.

James Keenan, S.J., is the most recognizable Catholic writer on the subject of condom use to contain HIV. Along with Jon Fuller, he points out that in the case of HIV serodiscordant couples (i.e. where one partner is infected and the other is not) “the use of a condom can be seen… as a means to prevent the ‘transmission of death’ or ‘potential death to another.’” Using the double effect, condoms lend support to the use of barrier contraception, which also has second and simultaneous effect of preventing conception.[40]Jon Fuller and James Keenan, in Between Poetry and Politics: Essays in Honour of Enda McDonagh, ed. Barbara Fitzgerald and Linda Hogan (Blackrock: Columba, 2003), 158-181, at 176.

The double effect may also be applied to other cases of deadly sexually transmitted disease like human papillomavirus (HPV), which causes cervical cancer[41]Mark Schiffman et al., Human Papillomavirus and Cervical Cancer, The Lancet 370, no. 9590 (2007): 890–907. and Ebola, which has an extremely high fatality rate.[42]Lenny Bernstein and Joel Achenbach, Sex in a Time of Ebola, The Washington Post, October 8, 2014, https://www.washingtonpost.com/news/to-your-health/wp/2014/10/08/sex-in-a-time-of-ebola/.

The Principle of the “Lesser Evil” (Minus Malum)

The use of barrier forms of contraception can also be accepted under the “lesser evil” (minus malum) principle, in the case of an unmarried HIV serodiscordant couple. While it may be considered wrong that the couple is engaged in conjugal activity, it would be even worse to have pre-marital intercourse and not protect the uninfected partner from HIV transmission. Therefore, the “lesser evil” is to use a condom in unmarried sex, rather than have unmarried sex without a condom and risk HIV infection. The same applies to couples where one of the partners has any other sexually transmittable disease.

The Precedent of Anovulant Drugs and Women Missionaries

Women are at risk for rape in all countries and societies. Statistics show 17.6% of US women have been raped at some time in their lifetime.[43]Patricia Tjaden and Nancy Thoennes, Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence Against Women Survey (Washington, DC: US Department of Justice, 2000), pp. 13-14, available at https://www.ncjrs.gov/pdffiles1/nij/183781.pdf. If a woman were to conceive as a result of the rape, the child would not be born within a stable marriage with two parents who are committed to each other.

Conception from rape is even more complicated when the woman is religiously dedicated and will not marry while continuing her vows. While Catholic teaching emphasizes the need to keep the unitive and procreative aspects of sexual intercourse together, there have also been cases where this is subordinate to the need to protect women from pregnancy.

Aline H. Kalbian recorded that during the 1960’s, in the face of an unwanted and unjust pregnancy, Catholic nuns in the Belgian Congo “were given anovulant drugs by doctors on the missions in order to ward off pregnancy which might otherwise result from rape, which was a constant threat in that chaotic episode”.[44]Aline H. Kalbian, Sex, Violence, and Justice: Contraception and the Catholic Church (Georgetown University Press, 2014), 117. In this case, Catholics accepted—and provided—contraception as a necessary medical step to prevent possible pregnancy. The dual suppositions that pregnancy can be harmful and that contraception is a necessary preventive measure are highlighted in this case. We might use casuistry to extend the voluntary use of contraception for any woman at risk for pregnancy due to rape, which is, unfortunately, all women.

The Precedent of Contraception for the Mentally Disabled

In 1986, Lisa Cahill examined several articles on sterilization and mental disability in the journal Theological Studies.[45]Lisa Sowle Cahill, Sexual Ethics, Marriage, and Divorce, Theological Studies 47, no. 1 (1986): 102–17, at 112. She points out that Edward Bayer and Marcellino Zalba

advance the argument that the natural (‘intrinsic’) relation of sexual activity to procreation and to the welfare of the species can be deliberately severed when certain circumstances are present in combination: violence and injury (including danger of pregnancy) to the total personal welfare of a woman.[46]Ibid.

Bayer also focused on sterilization for mentally incompetent women, where a pregnancy and childbirth (or abortion) would constitute an emotionally and physically distressing event for the woman, and where she would be unable to care for the child if born.[47]Edward J. Bayer, Sterilizing the Severely Retarded Woman: Is It Morally Different from Contraceptive Sterilization? Ethics and Medics 10, no. 3 (1985): 3-4. See also a supportive discussion of Bayer’s general position by Thomas J. O’Donnell, ‘Defensive’ Sterilization for the Severely Retarded: Follow-up, Medical-Moral Newsletter 22 (1985): 5-8. And also Bayer’s earlier article, Defensive Sterilization for Severely Retarded Women: A Moral Option? Medical-Moral Newsletter 21 (1984): 5-8.

While involuntary sterilization for mentally disabled persons is hotly debated in bioethics, there are less drastic forms of very effective, less-invasive, temporary contraception, such as intra-uterine devices (IUDs), which would protect a woman from gestating a child that she could not care for.

Maternal Mortality

Contraception is a basic form of preventive medicine that can save women’s lives. According to the World Health Organization (WHO), approximately 800 women die from preventable causes related to pregnancy and childbirth each day and an estimated 80% of all maternal deaths are traced to severe bleeding, infections, high blood pressure during pregnancy and unsafe abortion.[48]The World Health Organization, Maternal Mortality, May 2014, at, http://www.who.int/mediacentre/factsheets/fs348/en/index.html Young women aged 15-19 are at risk for maternal mortality at an average of 52 deaths per 100,000 births. In parts of Sub-Sahara Africa the numbers reach into the hundreds. Furthermore, the United Nations reported that in 2010 there was an average of 210 material deaths per 100,000 live births, with parts of Africa experiencing 500 deaths per 100,000 live births.[49]The United Nations, The Millenniums Development Goals Report (New York: The United Nations, 2013), 33; 28. A woman’s lifetime risk of maternal death is 1 in 3800 in developed countries, compared to 1 in 150 in developing countries (WHO).

Socio-Economic Consequences of the Lack of Access to Artificial Contraceptives

In addition to the increased maternal mortality and morbidity that accompanies lack of access to contraception for spacing purposes in many nations, parental aspirations for children in the contemporary world economy increasingly require longer years of education which is in many nations the responsibility of parents. Larger families divide parental resources into smaller portions, limiting children’s access to education. In addition, since the 1970s worker salaries in most of the world have stagnated or lessened in terms of buying power, requiring more and more married women to work outside the home to support the family, reducing the time and energy that mothers have to expend on children.

SECTION 3 [move to an Appendix?]

The Arguments from Authority: The Appeals to the Bible, to Tradition, and to the Sensus fidelium

As noted earlier, HV contended that its argument was valid on the strength of natural law alone. However, it did also add an argument from authority, asking Catholics to accept the conclusions on the basis of the respect they must show towards of the authority of the pope and the magisterium.

As explained in the methodology section, a decision has been made in this report to focus not on the arguments from authority – which posit that the conclusions must be correct because a so-called Catholic “magisterium”, a constant tradition of teaching, and/or the bible have said so – but rather on the arguments behind those conclusions advanced by any of those sources.

The Evidence from the Bible

It is significant, however, that HV differed notably from the previous papal encyclical on contraception (Casti Connubii) in that it did not adduce any scriptural passage condemning contraception as always and intrinsically evil as another obvious argument from authority in addition to the appeal to the authority of the magisterium.

The reason is that, in the opinion of the majority of exegetes, the bible does not explicitly condemn contraception. Nor does the bible affirm that (conjugal) sex should be for procreation only or – a fortiori – that each sex act should be open to procreation. On the contrary, as we will see, the bible records approvingly several other non-conceptive uses of sexual intercourse.

Traditionally, the main passage that was adduced as condemning contraception is the story of Onan, in Genesis 38:8-10. As it has been noted,

Those who advocate this position usually base their conclusion on two major arguments, one exegetical and one theological.
Exegetically, opponents of the practice of contraception point to the statement that “what he did” (אֲשֶׁר עָשָׂה), not what he possibly intended, was wicked in the Lord’s eyes. Their point is that the only thing the text describes Onan doing is ruining his semen and avoiding conception. To separate motive and relevant circumstances from “what he did,” however, is not exegetically tenable. The general phrase אֲשֶׁר עָשָׂה occurs 191 times in the Old Testament and sometimes assumes a link between the action itself and the motive or circumstance related to it. The same words are used to denote what Ham did in seeing and announcing his father’s nakedness (Gn 9:24), what David did in marrying Bathsheba (2 Sam 11:27), and what Eliashib did in providing lodging for Tobiah (Neh 13:7). The actions themselves, seeing and talking about a naked parent, taking a wife, or showing hospitality to someone, are not morally deficient in themselves, but motives and attendant circumstances in these examples made the actions displeasing to the Lord. And since the motive behind Onan’s actions as well as the deceptive manner of practicing contraception are revealed in the immediate context (verse 9), it is not inappropriate to take this into consideration in defining “what Onan did.”[50]Forrest L. Bivens, Exegetical Brief: Genesis 388-10 – Is the Sin of Onan Applicable to Birth Control in General?, Wisconsins Lutheran Quarterly 98 (2001).

Moreover,

If scripture condemns contraceptives, we would expect a prohibition in passages that speak about sex and sex relations. For example, Lev 20:10-21 presents a list of specific sexual crimes punishable by death under the Mosaic Code. If coitus interruptus is a sexual abuse, one would expect to see it in this list, but neither it nor any other form of birth control appears.[51]Ethics for a Brave New World, 303-304, also Bivens, Exegetical Brief: “we observe that this event concerning Onan is properly viewed as descriptive rather than prescriptive, and to make it normative for marital life in general is inappropriate. One searches in vain for a biblical stipulation forbidding birth control as such. Despite the many sexual regulations in the later Mosaic code, for example, nothing is said on the subject, not even about the practice of what is likely the oldest form of preventing conception, namely withdrawal.”

With regard to the theological point,

those who equate the sin of Onan with contraception in general see the procreation of children as the primary if not the only legitimate purpose of marital intercourse. While motives might vary, therefore, the activity itself would remain unacceptable.[52]Bivens, Exegetical Brief: Genesis 388-10 – Is the Sin of Onan Applicable to Birth Control in General?

The theological argument too, however, clashes with many other passages in the bible which suggest meanings and purposes of sexuality other than procreation:

On the basis on passages like Gn 1:28, 9:1, Ps 127 and 128, […] propagation is very much a part of God’s normal purposes for marriage and that children are distinct blessings from God. We would also maintain, however, that passages like Gn 2:18, 24, Ec 9:9, Sol 4:1-7, 5:10-16, 1 Co 7:1-6, and 1 Pe 3:7 also speak to this issue. Companionship, sexual satisfaction, and mutual helpfulness are also purposes in marriage and are legitimate ends in themselves aside from the production of children.[53]Ibid.

Paul advised the Corinthians thus:

The husband should fulfill his marital duty to his wife, and likewise the wife to her husband. The wife does not have authority over her own body but yields it to her husband. In the same way, the husband does not have authority over his own body but yields it to his wife. Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control.[54]1 Cor 7:3-5.

The other passage which has sometimes been interpreted as referring to the use of chemical contraceptives is Galatians 5:19. In that list of the “works of the flesh”, Paul mentions the word “pharmakeia”. However, that interpretation is not ordinarily regarded as correct by the majority of scholars.[55]REF

It is also important to note that the Bible does not contain a single consistent sexual ethic: some books of the Bible uphold polygamy while others reject it. Some biblical authors condemn premarital or extramarital affairs and others show it as being a part of God’s will.[56]Jennifer Wright Knust, Unprotected Texts: The Bible’s Surprising Contradictions about Sex and Desire (HarperOne, 2011); Michael Coogan, God and Sex: What the Bible Really Says (Twelve, 2010).

The Argument from Tradition and Authority

One of the arguments advanced by HV was that

The conclusions at which the [Pontifical Commission on Birth Control] arrived could not, nevertheless, be considered by us as definitive… above all because certain criteria of solutions had emerged which departed from the moral teaching on marriage proposed with constant firmness by the teaching authority of the Church.[9]

This affirms that the evaluation of the morality of contraception needs also to take into account the past moral teaching of “the teaching authority of the Church” when such teaching has remained consistent. It is, in effect, saying that the morality of contraception is to be determined (ultimately? primarily?) via an appeal to (past) authority.

This contrasts with the methodology assumed here, which is that the correctness of a moral teaching – whether contained in the bible or in the church’s tradition – should be evaluated exclusively on the basis of a correct understanding of the relevant facts: here, those to do with the purposes of human sexuality and the biology of human reproduction (see §X.Y).[57]As then theology professor Josef Ratzinger (later to become Pope Benedict XVI) wrote in 1965: “Criticism of papal declarations will be possible and necessary to the degree that they do not correspond with Scripture and the Creed, that is, with the belief of the Church. Where there is neither unanimity in the Church nor clear testimony of the sources, then no binding decision is possible; if one is formally made, then its preconditions are lacking, and therefore the question of its legitimacy must be raised.” This is the more so – and the point is crucial – on something which HV rightly regarded as a matter of “natural law”: namely, as something the determination of whose morality is dependent on a correct grasp of the created evidence. A grasp which, by definition, is accessible to all people – Christians and non-Christians alike – in virtue of their being endowed with reason.

This is not to imply that, for a Christian, scriptural evidence (correctly interpreted) and/or a consistent agreement among Christians in the past cannot provide moral guidance. Rather, it is to say that the moral worth of even scriptural and traditional statements need to be evaluated against whether they were based on a correct understanding of the relevant facts.[58]Bernard Lonergan, [REF needed]. Lonergan’s cognitional and moral theory and epistemology explain in details how “judgments of [moral] value” should be based on attentive experiencing, intelligent understanding, and a rational verification of the relevant facts.

But even on its own merits, HV’s argument from authority does not provide sufficient evidence to support its distinctively Roman Catholic ecclesiological assumptions. While it is not the purpose of this report to address them comprehensively, it is useful to spell them out:

  1. the antiquity of a tradition or teaching is a guarantee (or at least a strong indication) for its correctness;
  2. there has been an uninterrupted “magisterium” in the Catholic Church throughout its history;
  3. whatever has been consistently taught by such a magisterium throughout the centuries is infallible;
  4. the immorality of artificial contraception is an example of just such a teaching which has consistently been taught by an official magisterium throughout church history.

HV provided no proof to support those tacit assumptions. Several pieces of evidence strongly suggest that they are mistaken.

[1] The length of time a given teaching has been upheld by church authorities (or Christians more generally) is only an indication, not a warranty, of whether or not it is correct.[11] One might well point to historical examples of both magisterium and faithful agreeing on some issues that one side later repudiated. The issues of usury, slavery and freedom of conscience come to mind: the history of the change in their moral evaluation can be found in John Thomas Noonan, Jr., A Church that Can and Cannot Change: The Development of Catholic Moral Teaching (Notre Dame IN: University of Notre Dame, 2005).

The arguments supporting any teaching – whether recent or traditional – also need to be examined. In the specific case of contraception, we see that historically the positions forbidding it as morally illicit were based on a mistaken understanding of the biology of human reproduction, or on an evaluation of sexual activity in general as always sinful unless engaged into for the purposes of procreation.[12] [2] The understanding of a hierarchical magisterium comprised of bishops and pope is relatively new in the history of Christianity.[59][REF – the chapter on Magisterium in Dissent in and for the Church] The NT knows of no such institution; what it does witness to are offices such as those of apostles, teachers, prophets, elders, who taught in the community, as well as institutions such as decision-making assemblies (Acts 15), where among other things doctrinal decisions where taken. Without going into details, suffice to say that some Catholic theologians have observed that

The notion of magisterium is rooted in the promise of the Spirit of truth to the company of believers. The basic proposition of the theology of the magisterium is, in Rahner’s words, that “the Church as a whole cannot fall from eschatological grace—hence from truth as grace either—because she is the concrete presence of the definitive self-assertion of God which has occurred in the God-Man.” The promise of truth, then, primarily concerns “the church as a whole.” The Spirit was not promised only to the hierarchical ministry of the Church. “The body of the faithful as a whole, anointed as they are by the holy One, cannot err in matters of belief.” Neither the magisterium nor the Church is simply hierarchical. Neither theologians nor Church officers may claim with any historical accuracy to be, in an exclusive sense, the magisterium.[60]Curran and Hunt, Dissent in and for the Church, notes omitted.

[3] The time since the publication of HV has proved wrong the claim that the “teaching authority of the church” (which the encyclical understood – in a rather reductionist way – as consisting of its episcopal hierarchy) has been consistent throughout history in its condemnation of artificial contraception.

There is no need to delve here into the historical evidence concerning Christians understanding and evaluation of contraception. Most of the historical statements by bishops and theologians have been gathered, and they point to a generally negative view contraceptive practices, based on an erroneous understanding of biology as well as, at times, an Augustinian view of sexuality as something degrading and only to be engaged into in the context of marriage and for the purposes of procreation.[61]Noonan,

What about Christians at large – i.e. the vast majority of the church? After all, both bishops and theologians were ordinarily expected to remain celibate for most of the period under consideration, while it is the laity – and indeed especially laywomen – whose historical discernment and practices on the subject of contraception it would be interesting to recover. This is difficult, given the relative scarcity of the material allowing us to reconstruct the beliefs and practices of common people.

Be that as it may, the question of whether there has been consistency and continuity in belief and teaching on the subject of contraception can be determined without need for delving into the history of clerical statements on the matter.

The Argument from the Sensus Fidelium: Christians Worldwide Are Using Contraceptives

Many Catholic bishops have since the publication of HV spoken out publicly against an absolute ban on contraceptives.[62]List on the Catholics for Choice website. Indeed, even Pope Benedict XVI, in a public interview, admitted – in a somewhat convoluted way – that in some specific circumstances and “in the intention of reducing the risk of [HIV] infection”, the use of a condom can be “a first assumption of responsibility” and “a first step in a movement toward a different way, a more human way, of living sexuality”. This goes against HV’s statement that “sexual intercourse which is deliberately contraceptive [is thereby] intrinsically wrong [Lat. intrinsece inhonestum]” (HV §14) – i.e. always immoral, regardless of the intention or circumstances. The same can be said of many Catholic theologians.[63]In addition to those among the signatories here, you can mention REF This is despite the fact that – with regard to both bishops and especially theologians – the papacy and the Roman Curia have actively discouraged discussion on the topic, and have often acted punitively against theologians and bishops who challenged HV.[64]After Pope John Paul II completed a five-month series of lectures on human sexuality, marriage, and the regulation of births, on November 28, 1984, the Osservatore Romano newspaper printed a front page editorial by Archbishop (later Cardinal) Edouard Gagnon, vice-president of the Pontifical Council for the Family. It stated: “Today … it is no longer possible to have doubts about the authoritative doctrine of the Church [of Humanae vitae] and about the unacceptability of dissent.” Some theologians were “happy to find in a certain popular resistance to the encyclical a good opportunity to propagandize their own ideas on the autonomy of the individual conscience.” But the Pope’s campaign to end doctrinal confusion is “the only way out” of society’s crises, and sustain “with a solid doctrine” the efforts of people fighting “in defence of life and the institution of matrimony.” Addressing a Conference on Natural Family Planning, Pope John Paul II stated: “What is taught by the Church on contraception does not belong to material freely debatable among theologians.” Those who argue otherwise “in open contrast with the law of God, authentically taught by the Church, guide couples down a wrong path.” During the papacies of John Paul II and Benedict XVI candidates to the episcopacy in the RCC were screened for their adherence to HV.[65]Reference to the questionnaire for selecting bishops under JPII and BXVI. Dissenting theologians, on the other hand, risked being formally condemned by the Congregation for the Doctrine of the Faith, losing their jobs, or being silenced.[66]In Anne Patrick’s Liberating Conscience she “contests certain magisterial exercises of authority, like the removal of Charles Curran from his teaching post at the Catholic University of America because of his stand on contraception.” Quoted in Lisa Sowle Cahill, James M. Gustafson and Catholic Theological Ethics, Journal of Moral Theology 1, no. 1 (2012): 92–115, at 111. See Anne E. Patrick, Liberating Conscience: Feminist Explorations in Catholic Moral Theology (London: SCM Press, 1996).

Most significantly, however, it is the understanding and evaluation on the subject of contraception by Christians at large that demonstrates the lack of continuity and consistency in the tradition. Because while it is difficult to reconstruct the beliefs and practices of past generations of Christians, we do have a much better picture of the period since HV thanks to numerous sociological surveys.

Several recent polls have suggested that the majority of the Catholic Church at large disagrees with the conclusions of that encyclical, both in theory and in practice, as Catholics in most Western countries at least – i.e. those for which we have reliable statistical data – make use of several methods of artificial contraception.[67]Rachel K. Jones and Joerg Dreweke, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use (Alan Guttmacher Institute, 2011), http://www.guttmacher.org/pubs/Religion-and-Contraceptive-Use.pdf, showing that an estimated 98% of US Catholic women have used contraception. This is particularly important from an intra-Catholic perspective, because of the belief that “The entire body of the faithful, anointed as they are by the Holy One, cannot err in matters of belief” (LG §12).

Finally, according to ecumenical dialogues, the other Christian churches are part of the sensus fidelium, and they have mostly rejected HV too.

In conclusion, regardless of the continuity of church teaching and belief of the history up to the first half of the twentieth century, sociological evidence shows that for several decades now the majority of Christians does not believe in (or practices) the old ban on contraceptives: “Forty years of non-acceptance that goes into very considerable detail should suffice to consider a revision” of HV’s ban on artificial contraception.[68]Todd A. Salzman and Michael G. Lawler, Experience and Moral Theology, INTAMS Review 14, no. 2 (2008): 156–69, quoting approvingly Dietmar Mieth, Humanae Vitae: A Global Reassessment after Forty Years. Considerations beyond the Birth-Control Controversy, in Concilium – Homosexualities (London: SCM Press, 2008).

Conscientious Objection by Catholics to the HV

The currently accepted official position of the Catholic hierarchy enjoins Catholics to grant papal encyclicals a presumption of truth, a “religious submission of will and of mind.”

However, it is also generally accepted that the presumption of truth does not entail the impossibility of examining the teachings being proposed. Indeed, the traditional teaching concerning the primacy of conscience requires Catholics – just like everybody else – to follow their consciences.[69]Thomas Aquinas, The Collected Works of St. Thomas Aquinas. Summa Theologiae (Charlottesville, Va.: InteLex Corporation, 1993), Ia-IIa, q. 19, art. 5-6. Therefore, if a woman or man were convinced that the morally right action would include limiting procreation by artificial means, they would be obligated to follow their well-formed and informed conscious to take preventative measures.[70]Add references to the similar judgment of episcopal conferences as highlighted by Joseph Selling.

Conclusion: The Ethics of Using Contraceptives

The consensus of contemporary Catholic scholarship is that Christian couples may responsibly use contraceptives.

The moral discretion of each couple should determine the use of contraception. Many Catholic theologians concur that in some cases contraception is acceptable, and in some cases it borders on an imperative [i.e. to prevent HIV transmission from one spouse to another, to prevent the birth of a severely disabled child, to prevent vertical transmission of HIV from mother to child, or to prevent medical or other hardships that a pregnancy would entail for the woman, couple, or family.

RECOMMENDATIONS regarding Revising Papal Teaching on the Ethical Use of Contraceptives
The Wijngaards Institute for Catholic Research – 3rd of August 2017
Note: These recommendations complement an interdisciplinary research report coordinated by the Wijngaards Institute, summarized in the Catholic Scholars’ Statement on the Ethics of Contraception (“the Statement”), signed by more than 160 Catholic academics with expertise in the relevant disciplines, and presented at a side-event to the September 2016 UN General Assembly, co-hosted by UNAIDS, UNFPA, UN Women (as part of the United Nations Inter-Agency Task Force on Religion and Development), the Wijngaards Institute for Catholic Research, the World Council of Churches – Ecumenical Advocacy Alliance, and Islamic Relief USA. See extracts in appendix; full text online at: http://www.wijngaardsinstitute.com/statement-on-contraceptives/.
Contents
EXECUTIVE SUMMARY AND RECOMMENDATIONS 2
NOTES ON THE RECOMMENDATIONS 7
Introduction 7
1. Recommendation. A Clear Magisterial Statement is urgently needed affirming that so-called “barrier methods of birth control” can be used for prophylactic (preventative) purposes. 7
2. Recommendation. The Church should revise the teaching of HV prohibiting “artificial” contraceptives by stating that their responsible use in marriage can be moral and even commendable. 10
2.1 Fidelity to the Truth – Revising HV’s Errors 11
2.1.1 Humanae Vitae misunderstands the Biological Laws of Reproduction 12
2.1.2 Humanae Vitae draws a Moral Obligation directly from the Biological Laws 13
2.1.3 Humanae Vitae Is Contradicted by New Findings from Evolutionary Biology about the Non-Conceptive Purposes of Human Sexuality 14
2.1.4 Humanae Vitae is not supported by the Bible 16
2.1.5 Humanae Vitae contradicts Vatican II 18
2.2. HV contradicts the Common Human Experience 21
3. A Revision of HV Would Preserve Key Elements of Continuity with Traditional Teaching 22
4. Fidelity to the Good – Real Life Impact of Revising HV 25
4.1 Contraceptives save Lives – A Culture of Life Requires an Ethics of Contraceptives 25
4.1.1 Use of Modern Contraceptives Prevents Natural Embryo Loss 31
5. There are no viable alternatives to modern contraceptives for birth control 32
Abstinence is not an effective alternative to the use of modern contraceptives in order to reduce the number of unintended pregnancies and abortions 32
Abstinence-Only Sex Education 32
Fertility Awareness Methods (Natural Family Planning) 33
Are Future Improvements in FAMs’ Typical-Use Effectiveness, Acceptability, Ease of Use, and Cost Likely to Translate into Higher Uptake of Users “Periodic Abstinence” users? 42
Concluding considerations on FAMs. 48
6. Potential Impact of the Catholic Church’s Change of Policy 48
7. A Revision of HV would be received well by the vast majority of Catholics 50
Appendix 1. Can Abstinence-Only Sex Ed be a Solution Instead? 51
[1] Does access to contraception increase risk-taking and promiscuity? 51
Does the Percentage of Unintended Pregnancies and STIs Increase More with Use of Modern Contraceptives than with the use of FAMs? 54

EXECUTIVE SUMMARY AND RECOMMENDATIONS
1. With regard to the use of barrier methods of birth control (e.g. condom) for prophylactic purposes (e.g. to minimise the probabilities of spreading AIDS and other STIs), the following points should be noted:
1.1. Humanae Vitae (HV) §15had already admitted the possibility of therapeutic interventions necessary to heal, even though they have a contraceptive effect.
1.2. In 2006 the Pontifical Council for Health Care Workers (now subsumed by the new Dicastery for Promoting Integral Human Development)commissioned an official research report collating the opinion of some moral theologians on the subject. Its conclusion was that barrier methods can be responsibly chosen when used for prophylactic purposes.
1.3. Since then, there have been several magisterial pronouncements which permit the prophylactic use of barrier methods such as condoms.
1.4. More recently still, in February 2016,in response to a question from a journalist about using “artificial” contraceptives to avoid getting pregnant during the Zika virus epidemic, Pope Francis stated: “Avoiding pregnancy is not an absolute evil”.
Hence the Statement, §14 offered the following Recommendation #1
With regard to the use of modern contraceptives as prophylactic.
In view of the magnitude of the HIV/AIDS epidemic, the fact that Catholic-run health care centers and schools constitute approximately 25% of the total worldwide, and that the topic has already been extensively researched, we recommend to the competent authorities in the Catholic Church that the following two steps be implemented as a matter of urgency:
The 2006 document by the Pontifical Council for the Pastoral Assistance to Health Care Workers which suggested that barrier methods of contraception can be morally legitimate when used by married Catholic couples for prophylactic purposes should be made public.
An official magisterial document should be published affirming that the use of non-abortifacient modern contraceptives for prophylactic purposes can be morally legitimate and even morally obligatory.
The statement could include an explicit provision allowing for the distribution of such modern contraceptives for prophylactic purposes by Catholic-run health care facilities, with the provision of adequate guidance.
2. With regard to the use of modern non-abortifacient contraceptives, the following points should be noted:
2.1 HV’s total ban on “artificial” contraceptives is groundless and mistaken. The biological grounds adduced for it are non-existent, the inferences it draws from supposed biological facts are mistaken, and the encyclical even contradicts itself on a key point (see “Notes on the Recommendations”, below).
Significantly, no other justification for a prohibition against “artificial” contraceptives has been found since HV, whether in the theological reflection or in official magisterial documents.
2.2 HV directly contradicts the Second Vatican Council’s Gaudium et Spes (GS). Some of HV’s key affirmations had been explicitly rejected as erroneous by the commission charged with examining the proposed amendments to the final draft of the relevant paragraphs of GS on responsible parenthood.
2.3 HV directly contradicts the 1966 Final Report of the Pontifical Commission on Birth Control. Such Final Report offered helpful suggestions on how to revise recent papal teaching prohibiting contraceptives, in light of the duty towards “responsible parenthood” (GS §48-51) and new understanding of the non-conceptive purposes of sexual intercourse in marriage. Many of those suggestions can still prove helpful in revising HV.
2.4 HV is not supported by the bible. The template texts on human sexuality – Gen 1:28, 2:18, 24, as well as the Song of Songs – affirms that the primary raison d’être, meaning and purpose of human sexuality is the fellowship and relationship between male and female, their union/communion of life and love (“one flesh”). In other words, the primary purpose or finality is affective or unitive one.
Notably, procreation is not included in the core statements describing the raison d’être of sexuality (Gen. 2:18, 24). Instead, it is described separately and, significantly, as a blessing rather than a command.
The relevant passages of Genesis 1-2 describe human sexuality as good independently from the existence of a procreative finality in each and every act of sexual intercourse.
2.5 HV is revisable. This was explicitly stated in the official presentation of the encyclical to the press on 29 July 1968, the morning after its publication, by Mons. Ferdinando Lambruschini, who repeated twice that the encyclical was not infallible, and that its conclusions may be revised on the basis of new evidence.
2.6 The insistence that each and every act of sex must preserve a procreative finality is a profound misunderstanding of the meanings and purposes of human sexuality.
2.7 Given how central sexuality is to human nature, this mistake fundamentally weakens both the authority of the hierarchy in the eyes of Catholics and non-Catholic Christians, and the authority/appeal of Catholicism and Christianity in general in the eyes of non-Christians. It is a scandal to both ad intra (pastoral) and ad extra (evangelising) work, as well as to ecumenism.
2.8 HV’s central prohibition has been rejected by the church. The majority of Catholics reject it (the sensus fidelium). The same applies to non-Catholic Christians and, last but not least, the majority of people worldwide: this final fact is particularly relevant because the prohibition purports to be a norm of natural law, which applies universally and to all times, and whose reasonableness can be accessed to, and evaluated by, Christians and non-Christians alike.
2.9 There is no indication this de facto rejection is going to change in the foreseeable future, i.e. that people worldwide will stop using modern contraceptives and start using instead Fertility Awareness Methods (FAMs) based exclusively on periodic abstinence. There are several reasons for that, listed below.
2.10 First, the ongoing development of increasingly effective, affordable, and easy-to-use contraceptives (including Long-Acting Reversible Contraceptives, or LARCs) is accelerating the trend towards universal global coverage and uptake of modern contraceptives. As the late Cardinal Martini said in 2012, “In matters concerning life and love, there is no way we can wait so long” (i.e. centuries) before correcting a mistaken papal teaching.
2.11 Secondly, the two alternatives to “artificial” contraceptives that the Catholic Church proposes to “artificial” contraceptives have been found to be inefficient in typical use. They are 1) “abstinence-only sex education,” to teach people to abstain from sex till marriage; and 2) FAMs using “periodic abstinence” during the fertile window within marriage.
2.12 FAMs are only used by an estimated 3% of people worldwide. Their purpose is to track the monthly fertility window in order to know when to have protected intercourse or indeed to abstain. Only the latter option is regarded as moral by HV and current papal teaching.
2.13 Worldwide, FAMs using exclusively abstinence rather than contraceptives during the fertile window have a very high population level typical-use failure rate (estimated to be approximately 25%). In other words, one woman in four using periodic abstinence to avoid a pregnancy will fall pregnant within a year.
2.14 FAMs are generally used to know when to use contraceptives (generally condoms) rather than in order to know when to abstain.
2.15 Abstinence (including “periodic abstinence” methods) is not a viable alternative, as the evidence strongly suggests. Note that abstinence is the only alternative means of birth control and family planning to modern contraceptives, and therefore the only one accepted by HV and current papal teaching. Note also that the abstinence required by current papal teaching must be absolute before marriage, and “periodic” during marriage: specifically, for a duration between one-third to half the time of each monthly cycle. However, extensive evidence (primarily but not exclusively from the USA) shows that abstinence-only sex education is either ineffectual (no difference on key indicators in comparison to control groups which have not received any sex education), or only marginally effective, to a much lower degree than so-called “comprehensive” sex education, which includes information on the use of modern contraceptive.
2.16 Periodic abstinence-based FAMs are likewise not a viable alternative to modern contraceptives. 1. Their population level typical use failure rate (for those FAMs for which it is available) is relatively high, approximately 25%. That is, one in four women who want to avoid a pregnancy and use a “periodic abstinence” will still become pregnant within a year (compare this with the almost non-existent failure rate of the most effective modern contraceptives – e.g. the Long Acting Reversible Contraceptives – at <1%). 2. They require abstinence between one third and half the length of the monthly cycle. 3. FAMs are often marketed and used as fertility trackers, in order to know when to have protected sex, rather than when to abstain. 4. Hence, worldwide they are only used by an estimated 3% of women who want to avoid a pregnancy.
2.17 The papal ban on using “artificial” contraceptives applies to about one fourth of health care facilities worldwide, which are Catholic. For this reason, the papal ban results in vast numbers of unintended pregnancies worldwide, primarily in the developing world, about half of which end up in abortion. A culture of life requires an ethics of contraceptives!
2.18 It is possible to revise HV while highlighting both the element of continuity (valid concerns and insights) with HV itself, and the elements of continuity with Tradition, not the least with GS §§48-51 and Amoris Laetitia.
In summary: the relevant evidence supports the conclusion that using modern contraceptives for family planning can be moral and commendable.
As noted, Mons. Ferdinando Lambruschini, when officially presenting HV on behalf of Paul VI shortly after its publication, explicitly said that a revision of its conclusions was possible if new findings came to light.
The argument can be made that those findings from evolutionary biology were not as well known in the sixties as they are now. The same can be said with regard to findings from the bible (see the “Notes on the Recommendations” below), social studies on the consequences of contraceptive use, etc., which shed much more light on the “natural” significance and finality of human sexuality. They can be presented as one of the basis for the revision.
Hence the Statement offered the following Recommendation #2:
An official independent commission should be urgently established by the competent ecclesiastical authority in order to re-examine the teaching of HV. 
NOTES ON THE RECOMMENDATIONS
Introduction
In 2007, the late Cardinal Carlo Maria Martini said:
I am firmly convinced that the Church leadership can show us a better way than Humanae Vitae has managed to do. The Church will regain credibility and competence. Consider how John Paul II brought new life to the relationship between the Church and Judaism, and similarly between Church and science because he spoke the unforgettable words acknowledging wrong, words that have an effect today, centuries after the unjust judgments on Galileo or Darwin. In matters concerning life and love, there is no way we can wait so long. It is a sign of greatness and self-confidence if someone can acknowledge the mistakes and limited vision of their past.
In the same book-interview he also said: “Even if condoms were allowed for HIV-infected couples as a ‘lesser evil,’ that is probably not enough.”
1. Recommendation. A Clear Magisterial Statement is urgently needed affirming that so-called “barrier methods of birth control” can be used for prophylactic (preventative) purposes.
“[I]n mature HIV epidemics about 50% of HIV infections occur within marriage.”
Before addressing the broader problem concerning the absolute prohibition against “artificial” contraceptives for family planning, it would make sense for the magisterium to first address the “easier” issue of the use of so-called “barrier methods” for prophylactic (as distinct from contraceptive) purposes.
This would arguably facilitate the reception of the conclusion of a future independent commission set up to examine the ethics of using modern contraceptives for family planning, and minimise possible worries from the conservative minority who would opposed any suggestion for change in that area.
Now, with regard to the issue of the use of barrier methods for prophylactic purposes, it is urgent to put out a clear magisterial statement unambiguously stating that such a use can be responsible and morally legitimate.
1) HV had already admitted the possibility of therapeutic interventions necessary to heal, even though they have a contraceptive effect:
“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” (HV §15).
2) More recently, in 2006 the Pontifical Council for Health Care Workers (now subsumed by the new Dicastery for Promoting Integral Human Development) commissioned moral theologians to develop a lengthy report, which Cardinal Javier Barragán said at the time was more than 200 pages long. Its conclusion was, apparently, that barrier methods can be responsibly chosen when used for prophylactic purposes.
3) Since then, there have been several magisterial pronouncements which permit the prophylactic use of barrier methods such as condoms. First, in 2010 Pope Benedict XVI said so in his book interview Light of the World (the first ever papal pronouncement in favour of such use). This was officially clarified and confirmed as consonant with Catholic tradition by the CDF in its “Note on the Banalization of Sexuality”:
“Those who know themselves to be infected with HIV and who therefore run the risk of infecting others, apart from committing a sin against the sixth commandment are also committing a sin against the fifth commandment – because they are consciously putting the lives of others at risk through behaviour which has repercussions on public health. […] In this context […] it cannot be denied that anyone who uses a condom in order to diminish the risk posed to another person is intending to reduce the evil connected with his or her immoral activity.
[T]hose involved in prostitution who are HIV positive and who seek to diminish the risk of contagion by the use of a condom may be taking the first step in respecting the life of another […]. This understanding is in full conformity with the moral theological tradition of the Church”
4) More recently still, in February 2016, in response to a question from a journalist about using “artificial” contraceptives to avoid getting pregnant during the Zika virus epidemic, Pope Francis stated: “Avoiding pregnancy is not an absolute evil,” and he went on to say: “In certain cases, as in this one, such as the one I mentioned of Blessed Paul VI [of Catholic nuns in Congo using the anovulant pill to avoid becoming pregnant in case of rape], it was clear”. Fr. Lombardi, the Pope’s spokesman at the time, confirmed to Vatican Radio that Pope Francis was indeed arguing for “the possibility of taking recourse to contraception or condoms in cases of emergency or special situations”.
Those latest affirmations by Pope Francis (and the clarification by Fr. Lombardi) are ground-breaking. They mean:
1) the pill and condoms can be used with the direct intention of avoiding conception. The point of attention is that this is different from, and broader than, the strictly “prophylactic” use of barrier methods in order to avoid a disease (such as would be the case with HIV/AIDS, as in Pope Benedict XVI’s condom remarks, above). The nuns in Congo were using “artificial” contraceptives not in order to avoid a disease, but rather with the direct intention of avoiding a pregnancy. Similarly, people in areas affected by the Zika epidemic who decide to use “artificial” contraceptives do so directly intending to avoid pregnancy (i.e. with a directly contraceptive intention), and not simply to avoid a disease;
2) Using the pill and condoms to avoid a pregnancy (as distinct from avoiding a disease, i.e. the prophylactic purpose!) could apply to other “cases of emergency or special situations” (Fr. Lombardi).
The above affirmations contradict HV: that encyclical famously affirms that any action which aims at hindering the procreative finality of sexual intercourse for the purpose of avoiding procreation is an “intrinsic evil,” i.e. immoral always and everywhere, regardless of the intention of the agent(s), the circumstances of the situation, and the consequences of the action (HV §14).
What is more significant, however, is that those affirmations did not have any influence in terms of changing the official policy within the Catholic institutions concerned: with few exceptions, Catholic charities, health clinics, hospitals, and schools worldwide, and especially in the developing world, continue their previous policy not to provide condoms or other barrier methods of birth control for prophylactic (as distinct from family planning) purposes. The Knights of Malta have been one of the latest victims of the lack of clear guidelines in that regard, with accusations that their efforts to distribute condoms to high-risk populations such as sex workers in Myanmar were against papal teaching.
Therefore, the teaching on the use of condoms as prophylactic expressed in the authoritative interventions mentioned above (and especially in the CDF own “Note on the Banalization of Sexuality”) needs now to be re-affirmed more clearly and unambiguously. A strong re-affirmation of the morality of using condoms or other barriers for prophylactic purposes in official magisterial documents (encyclicals, etc.) is urgent.
Can this can be done by working with other Vatican departments – i.e. the one on the Integral Human Development – to resurrect the 2006 report, and release appropriate guidelines for Catholic individuals and health care facilities?
The evidence of the considerable potential impact of such a clear policy is already there. In part, it is simply the general evidence of the contribution that condom use can make, together with abstinence and fidelity, to reducing HIV/AIDS transmission rates.
More specifically, the evidence is there thanks to the initiative of the late Boniface Lele, Catholic archbishop of Mombasa in Kenya, who – in an extraordinary breach with the then current papal and curial views – in 2005 allowed serodiscordant Catholic couples in his archdiocese to use condoms. This resulted in a statistically significant increase in condom use among the target audience only (serodiscordant Catholic couples), and a corresponding decrease of HIV/AIDS infections.
Hence the Statement recommends:
§14.2. An official magisterial document should be published affirming that the use of non-abortifacient modern contraceptives for prophylactic purposes can be morally legitimate and even morally obligatory.
The statement could include an explicit provision allowing for the distribution of such modern contraceptives for prophylactic purposes by Catholic-run health care facilities, with the provision of adequate guidance.
2. Recommendation. The Church should revise the teaching of HV prohibiting “artificial” contraceptives by stating that their responsible use in marriage can be moral and even commendable.
We can now move to the more delicate issue concerning the revision of the prohibition of using “artificial” contraceptives for family planning.
A revision is needed for several reasons:
a) because HV’s argument is mistaken. A revision is thus required by fidelity to the truth (orthodoxy). These are the doctrinal reasons for a revision. They are explained concisely in the Statement §§1-6, and complemented by the section “Fidelity to the Truth” below.
b) because it causes negative consequences in the lives of millions of people, including unintended pregnancies and abortions. A revision is thus required by fidelity to the good (orthopraxis). These are the ethical reasons for a revision. They are explained concisely in the Statement §10, and complemented by the section “Fidelity to the Good” below, and by Appendix 2.
c) because the vast majority of Catholics has rejected that teaching in their lives. The magisterium is here in a situation of schism from the body of the church. Healing that schism will strengthen the unity of the church. The majority of non-Catholics Christians have also rejected such a norm, which is therefore a scandal to ecumenism. Finally, that norm is supposed to be of natural law, and as such it should be capable of being understood and evaluated by all human beings regardless of their culture or religion, both now and throughout history. But the vast majority of people do not abide by that norm. That strongly signals that such a norm is mistaken.
A revision is therefore recommended as a step towards fidelity to the truth, as a step towards fidelity to the good, and as a step to strengthen communion and unity within the Catholic Church, and between the Catholic Church and other Christian churches.
2.1 Fidelity to the Truth – Revising HV’s Errors
One of HV’s mistakes that has been the most apparent, not only to experts but also to laypeople, was its famous contradiction between the following statements:
1) “sexual intercourse which is deliberately contraceptive [is] intrinsically wrong”; and intrinsically wrong is also “any action which either in preparation of, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation—whether as an end or as a means” (HV §14, emphasis added).
2) it is morally legitimate to use the rhythm method to have sexual intercourse with “the intention to avoid children and [the] wish to make sure that none will result” (HV §16).
The rhythm method limits sexual intercourse to the sterile periods in a woman’s monthly cycle with the intention of avoiding procreation. This is tantamount to act “in preparation of” sexual intercourse with the intention of deliberately preventing procreation. If doing the latter is always wrong, as HV §14 asserts, then rhythm or other FAM are always morally illegitimate when used to avoid procreation.
Conversely if, as HV §16 affirms, it is indeed morally legitimate to have sexual intercourse with a contraceptive intention (when using the rhythm method), then it cannot be correct to affirm:
a) that “sexual intercourse which is deliberately contraceptive [is] intrinsically wrong”;
b) that each and every act of sexual intercourse must always have a procreative finality and significance (HV §12).
Point b) is the famous “inseparability principle” at the heart of HV: it is among the statements contradicted by HV §16, which allows sexual intercourse with a contraceptive intention (when used within the context of the rhythm method). Using the rhythm method to have sexual intercourse with a contraceptive intention of avoiding children means deliberately choosing to separate the two “finalities” of sexual intercourse – i.e. union and procreation – which, according to HV §12, should never be separated.
Furthermore, HV affirms that “Sexual activity […] does not, moreover, cease to be legitimate even when, for reasons independent of their will, it is foreseen to be infertile.” (HV §11). The sentence appears to suggest that sexual activity ceases to be morally legitimate if wilfully timed so as to be infertile, e.g. when using any FAM.
In contrast, as noted, HV §16 also affirms that couples can of their own free will choose to have sexual intercourse when they can foresee it will be infertile. To choose to time sexual intercourse precisely to coincide with the period foreseen to be infertile is to do so wilfully:
couples who deliberately abstain from love-making during fertile periods but who make love at other times, do appear to be practicing contraception by another name. This is because not having sex at certain times is not just not doing anything, and so not doing anything wrong. As Gareth Moore points out, “They do not just not have intercourse; they actively avoid intercourse, as part of their plan to avoid children” (2001, p. 165). Their intentions are clear.
Not only is HV contradictory with regard to its central “inseparability principle”: but the latter is also based on a mistaken understanding of biology.
2.1.1. Humanae Vitae misunderstands the Biological Laws of Reproduction
HV’s argument is that because the biological “laws of conception” reveal that sexual intercourse has a “capacity to transmit life” (HV §13), each and every act of sexual intercourse has a “procreative significance” (HV §12) and “finality” (HV §3), and an “intrinsic relationship” (Lat. per se destinatus) to procreation (HV §11).
This misinterprets the biological evidence. The causal relationship between insemination and, on the other hand, fertilization, implantation, and ultimately procreation, is statistical, not necessary. No act of sexual intercourse has “per se” (i.e. in itself, by nature) an independent biological capacity for procreation. (If it were not so, every act of insemination would result in a conception). Rather, such a biological capacity is relative, i.e. dependent on the fulfilment of numerous other conditions. This fulfilment is statistical, not necessary.
Because no act of sexual intercourse has an independent capacity for procreation, it is erroneous to affirm – as HV does – that each and every act of sexual intercourse has, by nature, a procreative purpose or “finality.”
It is worthy of note that, as befits an argument which, as HV itself admitted, belongs to the (non-revealed) natural moral law, such an appeal to the biological facts of the created order of nature is the only argument supporting the papal doctrine prohibiting “artificial” contraceptives. Significantly, no other official justifications of HV’s prohibition has been provided in the years since 1968.
2.1.2. Humanae Vitae draws a Moral Obligation directly from the Biological Laws
From the above mentioned mistaken biological “fact” that each and every act of sexual intercourse has a procreative “finality” and “significance”, HV derived the moral obligation for human beings to never hinder them.
However, it is mistaken to derive a moral norm directly from biological laws. This is because our behavior, as rational agents, is not entirely determined by biology. Rather, biological laws are subsumed and controlled by our rationality and responsibility.
This is also evident in the area of human sexuality (please see section below, on the findings from evolutionary biology), so that it is impossible to derive the morality of means of family planning simply on the biology of the sexual intercourse. This was acknowledged by the famous par. 51 of Gaudium et Spes (GS) on family planning, by the 1966 Final Report of the Pontifical Commission on Birth Control, and by many of the leading moral theologians before and after HV itself.
HV further justified the inference of a moral obligation from a supposed biological “fact” on the basis that it is God who established the biological laws expressing the procreative finality and significance of each and every act of sexual intercourse, and therefore to thwart them would be tantamount to go against God’s will.
This is deeply mistaken from the point of view of fundamental theology. According to mainstream Christian theology, unless one can prove an explicitly revealed absolute divine command never to interfere with the biological laws of the generative process – and scriptural exegesis has excluded the existence of such a divine command – one must assume no exceptions exist to the rule according to which human beings are understood as enjoying both the mandate and the responsibility to steward creation, “interfering” with it for theirs and creation’s mutual flourishing.
In this, the position of mainstream Christian theology coincides with the philosophical position which maintains the impossibility of deriving a moral obligation directly from a factual description, i.e. a judgment of value (about what morally ought to be) directly from a judgment of fact (about what is).
Therefore, the Statement notes:
§3.3. The affirmation that human beings may not interfere with the biological laws regulating human reproduction because they have been established by God is in contradiction with observational evidence on how human beings interact with the created order.
As agents of reason, human beings have a unique capacity to intentionally alter the schedule of probabilities inherent in the physical, chemical and biological laws of nature. This is a reality of daily life: for instance, any sort of medical intervention, from something as insignificant as taking pain-killers to something as consequential as performing cardiovascular surgery, affects probabilities – of healing, survival, death, etc.
Furthermore, the decision not to intervene in natural processes also affects those probabilities, just as choosing to intervene does.
The moral question is not whether to alter the schedule of probabilities within natural processes, but rather whether, when, and how doing so is conducive to human flourishing and the flourishing of all creation.
From the above perspective, Fertility Awareness Methods are also “unnatural” and “artificial,” as the Doctrinal Commission of Gaudium et spes noted in one of its reply to a proposed amendment (see section 2.1.5 below). In effect, people who use them time sexual intercourse outside the fertile window, in order to avoid procreation – an intentional, artificial separation of the “procreative” meaning which should be supposedly inseparable from the unitive meaning of each and every act of sexual intercourse.
FAMs are also “unnatural” in a second way: namely, in subjecting conjugal love to biological determinants. Since with FAMs sexual intercourse can take place only during days determined by the female cycle, it deprives a couple of the freedom in love-making. A spouse can come home after a long absence and the couple may be forced to abstain for days because they returned “at the wrong time” (more on this in section 5.3 below).
2.1.3. Humanae Vitae Is Contradicted by New Findings from Evolutionary Biology about the Non-Conceptive Purposes of Human Sexuality
The reason why moral norm with regard to contraception cannot be drawn directly from biology can be easily understood by looking at the evolutionary biology of human sexuality.
For most mammals, sexual intercourse is limited by biology to fulfil the function of genotype transmission or reproduction. Sexual activity is determined biologically by the reproductive hormones, which regulate its exercise and generally limit it to the female oestrus, a regularly occurring period of sexual receptivity and fertility in most female mammals (excluding humans).
It is distinctive of the evolutionary development of highly intelligent animal species that sexual intercourse moved away from an almost exclusive reproductive finality and related biological determinism on the reproductive hormones and the female oestrus. In particular, “Humans have the distinction of being comparatively free of hormonal determinism in our reproductive activities. Female fertility does not depend on limited periods of oestrus, and male sexual arousal does not require the perception of hormonal cues.”
Rather, female sexual receptivity broke free of the hormonal determinism of the oestrus, and sexual intercourse acquired other meanings and ends than the mere transmission of the genotype, or reproduction: namely, sexual pleasure, pair-bonding, and many other purposes influencing socialization. This is particularly evident in the evolutionary development of primate sexuality: already in the great apes, and even more clearly in humans.
The advantages of retaining sexual receptivity at all times, including those when conception is not a physiological option, is obvious. Such a strategy clearly helps to maintain long-term relationships. It is an evolutionary device to maximize parental care of the young and provide sexual pleasure and comfort for the highly sexed human being.
The evolution of primate sexuality, and particularly the sexuality of human beings, shows a shift away from an exclusively reproductive function and related biological dependence on the reproductive hormones and the female oestrus, towards a sexuality more subsumed under the control of the brain and, consequently, responsive to rational agency.
In other words, “nature” itself shows that the sexuality of humans, differently from that of most other animals, is not simply determined biologically, i.e. regulated by the reproductive hormones. Rather, human sexuality and sexual intercourse are subsumed under the control of rational intentionality.
Such an integration of the reproductive hormones under the control of rational intentionality is precisely the distinctive “nature” of human sexuality in comparison with most non-human animals.
In this sense, what is “natural” for the sexual intercourse of human beings is what is in agreement with their rational faculties, rather than what follows blindly the patterns of the biological laws regulating reproduction. HV is accordingly mistaken to derive a moral obligation always to respect the supposedly natural procreative finality of each and every act of sexual intercourse.
Any appeal to the “nature” of sexual activity, the “natural finality” or telos of human sexuality cannot ignore the findings concerning the varied non-conceptive meanings and purposes of human sexuality, as highlighted by both evolutionary biology and sociological surveys. Those findings make it impossible to regard procreation as intrinsic to each and every act of sexual intercourse. Hence the Statement notes:
§8. The Bible identifies a variety of morally worthy non-conceptive motives for engaging in sexual intercourse. This is confirmed by evolutionary biology and modern sociological surveys, among other disciplines.
Those non-conceptive motives for sexual intercourse include pleasure, love, comfort, celebration and companionship. They are morally worthy even without the concurrent occurrence of either a “procreative significance” of the biological “laws of conception,” or the agents’ procreative intention.
The use of modern contraceptives can facilitate one or more of sexual intercourse’s non-conceptive meanings, as well as have additional morally worthy purposes – e.g. family planning, following the requirements of responsible parenthood (HV §10).
Therefore, the decision to use modern contraceptives can be taken for a variety of morally worthy motives, and so it can be ethical.
In summary: HV is reductionist and mistaken in deriving a moral obligation with regard to human sexual behaviour from the biology of human reproduction (which in any case it misunderstands at the factual level itself). Doing so ignores that the very distinctiveness of human sexuality and sexual intercourse is that they have “broken free” of the biological and hormonal determinism controlling the sexual behaviour of most other animals. It reduces human sexuality to a mere functionalist and utilitarian understanding, whereby each and every use of it must aim to biological reproduction. Instead, in human beings, because they are “rational” animals, the biological and hormonal “laws” have been subsumed under the higher control of human rationality and responsibility, which can and does routinely direct them for ends other than biological reproduction alone, such as affectivity, communion, commitment, and love.
C: The Duty/Responsibility towards “Responsible Parenthood” requires a corresponding Right of Freedom from Excess Fertility.
2.1.4. Humanae Vitae is not supported by the Bible
HV affirms that each and every time people engage in sexual intercourse, they must preserve the procreative significance and finality which is said to be intrinsic to sexual intercourse itself.
However, this is contradicted by the seminal biblical texts directly addressing the meaning and purpose of sexuality: namely, Gen 2:18 and 24 (“It is not good for the man to be alone” and “That is why a man leaves his father and mother and is united to his wife, and they become one flesh”) and the Song of Songs.
Those two passages of Genesis highlight the “unitive” function (i.e. fellowship, relationship, affective union/communion in love) as the only raison d’être distinctive of human sexuality. In contrast, procreation is introduced only separately (Gen 1:28: “God blessed them and said to them [i.e. to man and woman], “Be fruitful and increase in number…”), and described merely as a blessing, rather than a command, and a blessing which is not distinctive of human beings but rather is given to all animals. Thus Richard M. Davidson, one of the foremost experts on sexuality in the Old Testament, on Genesis 1:26-28 and 2:18, 24:
[S]exuality cannot be wholly subordinated to the intent to propagate children. Sexual differentiation has meaning apart from the procreative purpose. The procreative blessing is also pronounced upon the birds and fish on the fifth day (v. 22), but only humankind is made in the image of God. Genesis 1 emphasizes that the sexual distinction in humankind is created by God particularly for fellowship, for relationship, between male and female.
The complete absence of any reference to the propagation of children in Gen 2 highlights the significance of the unitive purpose of sexuality. This omission is not to deny the importance of procreation (as becomes apparent in later chapters of Scripture). But by the “full-stop” after “one flesh” in v. 24, sexuality is given independent meaning and value. It does not need to be justified only as a means to a superior end, that is, procreation. The interpretation given by some that husband and wife become one flesh in the flesh of their children is not warranted by the text.
Sexual love in the creation pattern is valued for its own sake. When viewed against parallel ANE [Ancient Near Eastern] creation stories, this biblical view of marriage also seems to be a polemical corrective to the prevailing ANE perspective represented, for example, by the Atrahasis Epic, which “links marriage and procreation closely as if to suggest that the primary function of marriage is procreation.” For the biblical narrator, by contrast, “the communitarian, affective function of marriage takes precedence over the procreative function of marriage.”
Commenting on Davidson, David Instone-Brewer added:
The concept of “one flesh” implies a sexual unification separate from any connotation of childbearing, and linked with the “clinging” it implies a permanence in the relationship.
“Sexual differentiation has meaning apart from the procreative purpose […] [S]exuality is given independent meaning and value. […] Sexual love in the creation pattern is valued for its own sake.”
Interestingly, such an understanding was seemingly ground-breaking and counter-cultural for the times: other Ancient Near Eastern cultures regarded marriage in a much more reductionist and utilitarian way, i.e. as first and foremost for procreation. Ironically, by affirming that each and every act of sexual intercourse must always preserve the goal of reproduction, HV contradicts such a groundbreaking insight of the bible, and reverts to the same reductionist and utilitarian view of sexuality common among other Ancient Near Eastern cultures.
In summary: Genesis 1-2 affirms that the primary raison d’être, meaning and purpose of human sexuality is the affective or unitive one, i.e. the fellowship and relationship between male and female, the union/communion of love, affectivity, etc.
In contrast, procreation is not included in the core statements describing the raison d’être of sexuality (Gen. 2:18, 24). Instead, it is described separately, and as a blessing (rather than a command), a blessing moreover which is not exclusive or distinctive of humans, but is rather repeated to all other animals.
Accordingly, Genesis 1-2 does not regard procreation as a finality which needs to be present always, in each and every act of sexual intercourse. Genesis 1-2 describe human sexuality as good independently from the existence of a procreative finality in each and every act of sexual intercourse. Therefore, Genesis 1-2 contradicts what is in fact the central claim of HV.
Finally, it may be worth recalling that nowhere in the NT does Jesus or anybody else mention, never mind condemn, contraception, despite it being a well-known and widespread practice in the ancient world.
2.1.5. Humanae Vitae contradicts Vatican II
HV explicitly states that its treatment of the question was done “keeping foremost in Our Minds what was taught about this matter with the highest authority in Gaudium et Spes (GS), the pastoral constitution recently issued by the Second Vatican Council” (HV §7).
Despite that claim, HV’s key affirmation, namely the so-called “inseparability principle” that each and every act of sexual intercourse has by nature a “procreative significance and finality,” is in direct contradiction with what the so-called Mixed Commission said in explaining the meaning of GS §§48-51, on responsible parenthood.
Specifically, the commission rejected as erroneous several “modi” (or proposed “amendments”) to GS §§48-51, amendments that were later affirmed by HV, in contradiction with the commission. Here they are:
1) The commission denied that each and every act of sexual intercourse is “per se apt [per se apti] for the generation of offspring.” The commission rejected this, stating “Not all acts tend to generation [ad generationem tendunt] (cf. sterility and the sterile times)” (modus 56 to par. 49).
In contrast, while HV §11 did acknowledge that “new life is not the result of each and every act of sexual intercourse,” it still concluded that each and every act of sexual intercourse is “in itself oriented towards procreation” (“ad vitam humanam procreandam per se destinatus”), and has by nature a procreative “finality”. This is an explicit contradiction of what the commission said – as well as of the biological reality.
2) The commission agreed that sexual intercourse among spouses is not just a biological act but a “human act” (as affirmed by GS §48), in the sense that it is consensual, and that “conjugal life [and sexual intercourse] is integrally human and not merely biological” (“vita coniugalis […] integre humana et non tantum biologica [est]”). This is important for the following crucial point:
3) The commission refused to say that “the generative faculty” is one of the “objective criteria” for determining the morality of the different means of birth control. It chose instead the words “taken from the nature of the person and his acts,” explaining the rejection of the amendment as follows: “by these words it is asserted that the acts are not to be judged according to a merely biological aspect, but as they relate to the human person integrally and adequately considered” (modus 104).
Yet, as noted, HV bases its central moral norm – the so called “inseparability principle” that each and every act of sexual intercourse must have a procreative finality (in addition to a “unitive” finality) – on precisely the “generative faculty” (“facultati vitae propagandae” HV §13) of the biological act.
HV §16 further insists that it is only interference with such a “generative faculty” that makes it possible to say that “artificial” contraceptives are prohibited (as they “obstruct the natural development of the generative process”), while the method of periodic continence is not.
4) The commission refused to explicitly condemn “onanism” and “contraceptive arts” [artes anticonceptionales]. That condemnation was in an amendment strongly proposed, twice, by Pope Paul VI, on 23rd and 26th November 1964, two weeks before the close of Vatican II, when the final draft of GS §48-51 had already been discussed and no amendments asking for a change of the substance of the text should have been accepted anymore.
The commission rejected it. The reason, it noted, is that the expression “contraceptive arts” would include “the method of periodic continence, which often requires technical computations”. In other words, the commission said that the method of periodic continence would fall within the category of “contraceptive art” – HV §16 would use synonymous expressions – so that any condemnation of the latter would have to include the method of periodic abstinence.
On this point too, HV contradicted the commission: as is well known, the encyclical famously yet erroneously distinguished between the method of periodic continence, which it regarded as “natural” and morally licit, and “artificial” contraceptives which it prohibited (see HV §§7, 16, and 17).
5) The commission refused to say that “conjugal love, independently from the procreative intention, does not justify conjugal acts.” Rather, it sharply replied: “this affirmation is not consonant with received doctrine.”
In contrast, HV’s core affirmations are the following:
a) each and every act of sexual intercourse need to have not just a “unitive” but also a “procreative” finality and significance (HV §12);
b) each and every act of sexual intercourse needs to maintain its intrinsic finality to procreation (HV §11);
c) “sexual intercourse which is deliberately contraceptive [is] intrinsically wrong” (HV §14, contradicted by HV §16 on the method of periodic abstinence which can be moral even when used with a contraceptive intention).
Together, those three affirmations make clear that people engaging in sexual intercourse must never intentionally contracept and must always intentionally preserve the procreative finality intrinsic to sexual intercourse.
In other words, HV condemns sexual intercourse which is independent from the procreative intention. It thereby contradicts the conciliar commission. Although, as noted, HV later contradicts itself by allowing sexual intercourse with a contraceptive intention but only when using the method of periodic continence, and not when using “artificial” contraceptives.
HV’s contradictions of Gaudium et Spes as explained by the conciliar commission can usefully be acknowledged as requiring and justifying a change of that encyclical.
2.2. HV contradicts the Common Human Experience
Historically, the reasons people have sex have been assumed to be few in number and simple in nature–to reproduce, to experience pleasure, or to relieve sexual tension. [However,] motives for engaging in sexual intercourse may be larger in number and psychologically complex in nature.
Surveys have identified the following, among others: love and commitment, spiritual transcendence, kindness, stress reduction and relaxation, duty, conformity, experience seeking, self-esteem and self-confidence, social status, money, revenge, and so on.
Procreation is but one of the meanings and finalities of sexual intercourse. Biologically, in the human species the vast majority of acts of sexual intercourse does not have a procreative capacity, and therefore does not have a procreative finality. And there are no other grounds – whether in the bible, or indeed in the experience of people – to affirm that procreation need to be present as one of the finalities each and every time people engage in sexual intercourse.
I also quote an extract from the forthcoming interdisciplinary research report on which the Statement is based:
Not all motives [for sexual intercourse] will be always morally worthy. However, those which are indeed morally worthy can be affirmed and celebrated within marriage. Contraception can facilitate the other meanings of sexual activity, such as love, spousal bonding, play, comfort, celebration and companionship among others.
3. A Revision of HV Would Preserve Key Elements of Continuity with Traditional Teaching
Such a revision can be made better understood by highlighting both the ongoing validity of some of HV’s insights and concerns, and the continuity of the new conclusion with key elements of the Catholic tradition on marriage and sexuality.
Good suggestions in this regard were already made in the 1966 Final Report of the Pontifical Commission on Birth Control. Most retain their validity to this day. Other elements of continuity:
– The call to “Responsible parenthood” (GS §51, HV §10);
– The acceptance that sexual intercourse can be undertaken with a contraceptive intention (HV §16 on the method of periodic abstinence, and several earlier pronouncements by Pius XII). As the 1966 Final Report of the Pontifical Commission on Birth Control noted:
“The notion of responsible parenthood which is implied in the notion of a prudent and generous regulation of conception, advanced in Vatican Council II, had already been prepared by Pius XII. The acceptance of a lawful application of the calculated sterile periods of the woman—that the application is legitimate presupposes right motives—makes a separation between the sexual act which is explicitly intended and its reproductive effect which is intentionally excluded.
The tradition has always rejected seeking this separation with a contraceptive intention for motives spoiled by egoism and hedonism, and such seeking can never be admitted. The true opposition is not to be sought between some material conformity to the physiological processes of nature and some artificial intervention. For it is natural to man to use his skill in order to put under human control what is given by physical nature. The opposition is really to be sought between one way of acting which is contraceptive and opposed to a prudent and generous fruitfulness, and another way which is, in an ordered relationship to responsible fruitfulness and which has a concern for education and all the essential, human and Christian values.
In such a conception the substance of tradition stands in continuity and is respected. The new elements which today are discerned in tradition under the influence of new knowledge and facts were found in it before; they were undifferentiated but not denied; so that the problem in today’s terms is new and has not been proposed before in this way. In light of the new data these elements are being explained and made more precise. The moral obligation of following fundamental norms and fostering all the essential values in a balanced fashion is strengthened and not weakened.”
– Opposition to the “Contraceptive mentality”: as already the 1966 Final Report noted,
“a willingness to raise a family with full acceptance of the various human and Christian responsibilities is altogether distinguished from a mentality and way of married life which in its totality is egotistically and irrationally opposed to fruitfulness. This truly “contraceptive” mentality and practice has been condemned by the traditional doctrine of the church and will always be condemned as gravely sinful”;
– The rejection by GS §51 of two key affirmations later repeated in HV, namely that each and every act of sexual intercourse is in itself apt to procreate, and that the morality of sexual intercourse can be judged on the basis of the merely biological dimension.
– Continuity with Amoris Laetitia’s affirmation that “procreation and adoption are not the only ways of experiencing the fruitfulness of love”. This refers to what is sometimes called “generativity” which, as is now accepted in Catholic theology, is more than mere biological reproduction. Family planning via modern contraceptives can facilitate non-biological “generativity”/“procreativity.” Women (and men) can and do decide to limit their families in order to devote themselves to other forms of service, thus expressing their “generativity” in a way which is non-biological but not necessarily less morally worthy. In this connection, there is evidence that women planning their families tend to have improved access to both educational and work opportunities, and contribute in many ways to the common good.
– Continuity with Amoris Laetitia’s subtle revision of HV, according to which natural methods are no longer compulsory, but merely “to be promoted” (AL §222). That, and the emphasis on the fact that a couple must make decisions concerning family planning in conscience, suggests that using “artificial” contraceptives is no longer viewed as an “intrinsic evil.”
– New exegetical studies on the meaning and purpose of sexuality in the bible. The template texts, Gen 2:18 and 24 (“It is not good for the man to be alone” and “That is why a man leaves his father and mother and is united to his wife, and they become one flesh”) and the Song of Songs, highlights the “unitive” function (i.e. affective union/communion in love) as the only raison d’être truly distinctive of human sexuality. In contrast, procreation is introduced only separately (Gen 1:28), and described merely as a blessing, rather than a command, and a blessing which is not exclusive or distinctive of human beings but rather is given to all animals. See Davidson, Flame of Yahweh: Sexuality in the Old Testament, 2008, pp. 49-50.
– The legitimacy of using barrier methods for prophylactic purposes (HV §15, CDF, “Note on the Banalization of Sexuality,” 2010).

SECTION 2
4. Fidelity to the Good – Real Life Impact of Revising HV
As noted, while HV does contain some sound teachings – e.g. its argument that birth control is required by “responsible parenthood” – its key argument and conclusion are deeply flawed. Therefore, their revision is required firstly by fidelity to the truth.
But a revision is also required by fidelity to the good. This section is an attempt at quantifying the negative consequences that the current papal prohibition against “artificial” contraceptives is causing to millions of people, especially in the developing world.
Two points in this regard:
1) Worldwide, non-use of modern contraceptives have a disproportionate effect on the number of unintended pregnancies, about half of which end up in abortions. Allowing modern contraceptives for family planning would save lives. As a well known Catholic medical doctor once said, “A culture of life requires an ethics of contraceptives.”
2) Allowing modern contraceptives would heal the schism between magisterial teaching and Catholics’ belief and practice on this issue, thereby increasing the unity of the church.
What follows will expand on both affirmations. It must be reiterated, however, that the papal prohibition to use “artificial” contraceptives rests entirely on the validity of the “natural law” arguments above.
If using modern contraceptives for family planning does not go against nature and the created order, then it cannot be regarded as “intrinsically evil” (i.e. immoral regardless of the intention of the agents, the circumstances of their situation, and the consequences of that action).
Yet the worldwide papal ban on using contraceptives is not only erroneous (and so against the truth): it also causes many concrete negative consequences, first and foremost unintended pregnancies, approximately half of which end up in abortions.
What follows has put together the most relevant scientific evidence on some of the negative consequences of the current papal prohibition.
4.1 Contraceptives save Lives – A Culture of Life Requires an Ethics of Contraceptives
Methodological preface: The effectiveness of a contraceptive method is evaluated not just in its “perfect use” efficacy, but also in its “typical use” effectiveness. It is particularly important that “typical use” be assessed at population level, because only then you reach an insight into real-world effectiveness of a given contraceptive method.
Summary:
The stakes are high: an ineffective family planning method – such as those based exclusively on “periodic abstinence” (the only ones approved by HV and current papal teaching) – increase recourse to abortion:
1. An estimated 50% of unintended pregnancies worldwide end up in abortion, or approximately 85 million out of 215 million each year.
2. “Periodic abstinence” methods – the only ones allowed by current papal teaching – have a significantly higher population level typical use failure rate (approximately 25%) than the most effective modern contraceptives. That is, one in four women trying to avoid pregnancy using periodic abstinence will still fall pregnant within a year.
2. As a consequence, users of “periodic abstinence” methods
a) account for a disproportionately high percentage of the unintended pregnancies worldwide
b) account for a disproportionately high percentage of abortions following contraceptive failure
The more a contraceptive method is effective (as well as affordable, acceptable and easy-to-use), the more it prevents unintended pregnancies and abortions.
Conversely, the more a contraceptive method is ineffective – and “periodic abstinence” methods have among the worst population level typical-use effectiveness rate – the more it results in unintended pregnancies and, as a consequence, it increases recourse to abortion.
A culture of life urgently requires an ethics of contraceptives.
Evidence:
• “Approximately 40 percent of [the 213 million] pregnancies worldwide, or 85 million pregnancies, were unintended in 2012”.
• Approximately 818 million sexually active reproductive-age women in the developing world are seeking to avoid a pregnancy as of 2008.
• Of those 818 million women in the developing world who want to avoid a pregnancy, approximately one in four – i.e. an estimated 215 million, or 26% – are not using modern contraceptives.
• Of those 215 million, approximately 75 million only use traditional methods (the remaining do not use any contraceptive at all). Traditional methods include those based on “periodic abstinence” (PA, the only category of methods allowed by current papal teaching), withdrawal, breastfeeding, lactational amenorrhea method or LAM, douching, and various folk methods).
• Most significantly for present purposes, in the developing world the relatively small minority of women using either traditional methods of contraception exclusively, or no contraceptives at all (around 26%, or 215 million women) accounts for the vast majority (82%) of unintended pregnancies: a disproportionate share of the total. That is, the 26% of women who do not use modern contraceptives account for an estimated 60 million out of a total of 72.6 million unintended pregnancies in the developing world.
• Traditional methods of contraception – including those based on PA – have lower typical-use (as distinct from “perfect-use”) effectiveness rates than the most effective modern contraceptive methods.
With regard to PA methods specifically, their failure rate in typical (as distinct from perfect) use is estimated to be approximately 25% worldwide. A 2004 study of 15 low- and middle-income countries focusing specifically on those methods confirmed earlier estimates of approximately 25%, largely based on US data, by reporting a median typical-use failure rate of 23.6%. That means that, in typical use, almost one in four women using PA methods to avoid conception becomes pregnant within a year.
• It was noted above that an estimated 40% of pregnancies worldwide are unintended as of 2012. Of these, a staggering 50% end up in abortion.
• As a consequence, PA users a) account for a disproportionately high percentage of the unintended pregnancies worldwide; and b) account for a disproportionately high percentage of abortions following contraceptive failure. Specifically, the above mentioned 2004 study of 15 low- and middle-income countries found that, while the median value of women using PA in those countries was only 3.3% (compare the estimated global average of 2.6%), the relatively high typical-use failure rate of 23.6% (median value) meant that “PA failures accounted for 28% of all contraceptive failures”, as well as “one-sixth [or 16.7%] of all abortions (or miscarriages) following contraceptive failure.” In other words, despite PA users being a relatively small percentage, they account for a disproportionate share of unintended pregnancies and abortions.
In summary: “despite the fact that [PA] is a relatively rarely used method [i]ts contribution to mistimed and unwanted births is […] considerable”.
Therefore “an ineffective family planning method may increase recourse to abortion.”
Conversely, using the most effective modern contraceptives is one of the factors to reduce the number of unintended pregnancies and, as a consequence, abortions.
The more a contraceptive method is effective, acceptable, affordable and easy-to-use, the greater its effect in preventing unintended pregnancies and, as a consequence, abortions.
Use of modern contraceptive methods with high typical-use effectiveness reduces unintended pregnancies and therefore abortions, i.e. it saves lives. In contrast, use of methods with lower typical-use effectiveness – such as those involving “periodic abstinence” – increase both the number of unintended pregnancies and the consequent recourse to abortions, thus causing a loss of life.
Therefore, a culture of life therefore requires an ethics of using contraceptives.
• Improving modern contraceptive uptake can result in a considerable lowering of unintended pregnancies and abortion rates. Estimates are that if all 200 million women in the developing world who do not use a modern method of contraception were to do so, 54 million unintended pregnancies would be prevented (or almost two-thirds of the total). By the same token, an additional 21 million unplanned births and 26 million abortions (14 million of which would be unsafe), 6 million miscarriages, 70,000 maternal deaths and 500,000 infant deaths would be averted.
• In evaluating those numbers, it is important to recall that non-use of modern contraceptives is not caused solely or even primarily by lack of access. Rather, the main motivations women worldwide have given for non-use of modern methods of contraception include “constraints on women’s decisionmaking abilities [and] provider bias”. The former include opposition to contraception because of cultural or religious norms and beliefs, whether of the woman herself, her partner, or other close person (e.g. relatives). The latter includes the prohibition on the part of many Catholic educational and health care facilities to inform about or make available modern contraceptive methods for family planning. A revision of HV would help the Catholic Church contribute powerfully to overcome all those issues.
The evidence provided above demonstrates that users of less efficient contraceptive methods based on “periodic abstinence” experience a disproportionate number of unintended pregnancies in comparison with users of more effective modern contraceptives, and that in turn a very high percentage (close to 50%) of those unintended pregnancies end up in abortion.
The numbers involved are in the millions. Those statistics are robust and cannot be ignored any longer. The data speak for themselves, and the defence of life itself demands an urgent change of policy from the Catholic Church.
The evidence provided above demonstrates the following direct causal relationships:
High Typical-Use Failure Rate of a Contraceptive Method => High Percentage of Unintended Pregnancies => High Percentage of Abortions
It also demonstrates that the population level typical use effectiveness of periodic abstinence methods is much lower than that of the most effective “artificial” contraceptives. As a consequence, users of periodic abstinence methods account for a disproportionate share not just of unwanted pregnancies but also of abortions.
Given the above, even those subscribing to the condemnation as morally wrong of the use of “artificial” contraceptives for family planning can accept the need to allow their usage if and when it lowers the number of abortions, on the basis of the principle of the lesser evil.
4.1.1 Use of Modern Contraceptives Prevents Natural Embryo Loss
There is another way in which modern contraceptives save lives: namely, by preventing natural early embryo loss.
“[H]umans are unique in the very high frequency of chromosome abnormalities and consequent early embryo wastage”: In the human species, even after insemination and conception, a very high percentage (approximately 50%) of zygotes are naturally discarded either before, during, or shortly after the process of implantation.
It has been estimated that this results in approximately 200 million early embryo losses worldwide a year.
Such a high percentage of “natural selection” occurs due to genetic abnormalities in the gametes, resulting in chromosomally unbalanced conceptions which fail to develop properly.
In addition, “the endometrium has the ability to recognize, respond to and eliminate implanting compromised embryos,” and therefore endometrial dysfunctions – such as “impaired differentiation of endometrial stromal cells into specialized decidual cells” – account for most of the non-chromosomal early embryo loss, i.e. the elimination of genetically viable embryos. Hence, “the natural in utero selection process […] eliminates 95% of chromosomally unbalanced conceptions”.
The extent to which modern contraceptives prevent such a relatively high natural embryo loss depend on their effectiveness in preventing ovulation and/or fertilization. The more effective the method, the higher the prevention of natural early embryo loss.
Population-level typical-use effectiveness of the most effective modern contraceptives can be compared both 1) to non-use of any contraceptive, and 2) to population-level typical-use estimates (if available) of those Fertility Awareness Methods (FAMs) which are based exclusively on periodic abstinence, and thus exclude any use of “artificial” contraceptives during the fertile window.
1) In the first case, consider that modern contraceptives (especially LARCs) have a very high population level typical-use effectiveness because of their very high effectiveness in blocking ovulation and fertilization.
In contrast, “periodic abstinence” methods have a failure rate of approximately 25%. That number refers to verified clinical pregnancies (i.e. post-implantation): but if we were to include into the percentage of failures also the number of successful fertilizations, the number would be arguably higher.
In other words, typical use of “periodic abstinence” methods would result in a successful fertilization in a much higher number of cases than if using most modern contraceptives, especially LARCs.
This means that using “periodic abstinence” methods may contribute to natural early embryo loss to a much higher degree than using most modern contraceptives, especially LARCs.
FAMs may also increase the proportion of pregnancies occurring with “ageing” gametes and therefore may increase the rate of births with congenital malformations.
[WICR academics are in the process of examining current statistical estimates on the subject; an updated comparison of the natural embryo loss percentages using modern contraceptives and “periodic abstinence” methods will be sent to the Pontifical Academy for Life as soon as it is ready] 5. There are no viable alternatives to modern contraceptives for birth control
5.1. Abstinence is not an effective alternative to the use of modern contraceptives in order to reduce the number of unintended pregnancies and abortions
There are currently no alternatives to modern contraceptives in order to reduce the number of unintended pregnancies and consequent abortions.
The only alternative current papal teaching proposes is abstinence: to by achieved via 1) “abstinence-only sex education” before marriage, and 2) by using exclusively “periodic abstinence” methods of family planning within marriage.
Both policies have been proved largely ineffective. What follows summarises some of the key findings in that regard.
5.2. Abstinence-Only Sex Education
[1] No program of abstinence-only sex education is as effective in reducing unintended pregnancies and abortions as the so called “comprehensive” sex education programs, which do on the whole emphasise abstinence, but also provide guidance on the use of contraceptives for both family planning and prophylactic purposes.
This is the more so when there is access to affordable, effective, and easy-to-use modern contraceptives. In fact, the extensive evidence available on the vast majority of abstinence-only programs show little to no effect in delaying sexual debut, pregnancies, or STIs.
In contrast, “comprehensive” sex education, which complements an emphasis on abstinence and fidelity with information about how to use modern contraceptives for both family planning and prophylactic purposes, has been proved to lower STIs, unintended pregnancies, and abortions, not only in comparison with people who received no sex education whatsoever but also, more to the point, in comparison to people who had received abstinence-only sex education.
5.3. Fertility Awareness Methods (Natural Family Planning)
[2] Fertility Awareness Methods likewise present several major problems.
1) The most relevant for present purposes is that they are largely marketed and used simply as fertility trackers to more accurately target the use of barrier methods (generally condoms), rather than to abstain, during the fertile window.
This is not likely to change even were all the other considerable current drawbacks of NFP methods to be resolved in the future. Among such current drawbacks, one can mention:
• low typical-use effectiveness,
• unsuitability to women with irregular cycles (the relatively recent Standard Days Method is unsuitable for up to 50% of women!),
• low acceptability and continuation rates (this could be due to a mixture of low acceptability [the requirement to abstain to close to half the time each cycle is very demanding, particularly for young couples], low effectiveness, low ease of use, and relatively long training required);
• low current uptake worldwide – arguably a result of the previous points, i.e. low acceptability, effectiveness, ease of use, and continuation rates.
The following points will expand on those drawbacks.
1) Fertility Awareness Methods of family planning (FAMs) based on “periodic abstinence” alone have a relatively low population-level typical-use effectiveness, that is they display a relatively high population level typical-use failure rate, approximately 25% for “periodic abstinence” based FAMs. In other words, one in four women using them who is trying to avoid a pregnancy will become pregnant within one year.
Low effectiveness is particularly important because “Of all the reasons why women choose particular contraceptives, method effectiveness ranks among the most important”.
One of the most comprehensive recent comparative studies of the effectiveness of the various contraceptive methods found that
modern contraceptive methods with the least room for user error generated the lowest median failure rates and the lowest variability in these rates. […] Withdrawal and periodic abstinence had the highest failure rates.
Indeed, “Implant users were 9 times less likely to report contraceptive failure than women using contraceptive pills and 23 times less likely than women using periodic abstinence.”
One of the things that renders more difficult an accurate assessment of typical-use effectiveness is that fact that FAMs are often used in conjunction with another contraceptive method (usually the male condom), rather than abstinence, during the fertile period. This point is discussed below.
On the other hand, the population level typical-use effectiveness – which is a key requirement for their universal viability – is still unproven.
Newer FAMs include the Standard Days Method (SDM), the Symptothermal Method (STM), and the Marquette Method (this latter using a hormonal fertility monitor, ClearBlue™).
Some of those newer FAMs – e.g. the SDM and STM– have observed a high typical-use efficacy (88% and 98% respectively) but – and this is the point of attention – only in intervention studies: no rigorous randomized controlled trial has been carried out on them. Consequently, there is no evidence that their high efficacy in intervention studies will translate into high typical-use effectiveness at population level.
In addition, even those newer FAMs suffer from very considerable drawbacks, as highlighted below.
2) Most FAMs (including one as relatively recent as the Standard Days Method/CycleBeads™) require a relatively long period of abstinence, i.e. almost half the monthly cycle. (Of course, this applies only when abstinence rather than protected intercourse is chosen during the fertile period).
Thus, for the calendar methods “The duration of abstinence is 14 days, or about half of the cycle”; even newer FAMs fare only slightly better:“12 days of abstinence are required” by the SDM/CycleBeads™ developed in 1999. Worse still, use of the TwoDay Method implies “some women will find only 12 safe days per cycle,” i.e. abstinence is required for the majority of days. The STM (double-check) “only” requires 7-10 days of abstinence per cycle, i.e. about a third of the monthly cycle: nevertheless, “[d]ouble checking provides more security in determining the fertile phase and may demand less, but sometimes more abstinence than earlier rules based on temperature alone.”
Requiring abstinence at a minimum of one third, and more commonly half of the time every month, means requiring a very significant change in sexual behaviour, especially for young couples.
This largely defeats the main morally commendable goal of modern contraceptives, namely that of facilitating the spontaneous expression of marital love. As it has been noted, “Modern contraceptive methods were invented so couples could act on natural impulses and desires with diminished risks of pregnancy. […] In this regard, modern methods must enable couples to have sexual intercourse at any mutually-desired time.”
Abstinence FAMs by and large do not allow this for significant numbers of couples. Recent research from 55 countries (n=245,732 women) strongly suggests that use of FAMs decreases coital frequency, while use of modern contraceptives is associated with higher coital frequency. In not a single country out of the 55 surveyed women who did not use contraception were having more sex than those who did.
Yet it is also well-known that a healthy sex life contributes to a healthy relationship and marriage. Modern contraceptives better allow a healthy sex life than methods requiring sexual abstinence for approximately half the time each cycle. As the lead authors of that recent study commented:
“Modern contraception presents an opportunity to reduce the risk of pregnancy without having to reduce sexual frequency, [Suzanne] Bell adds. Healthy sex lives are good for relationships but we often leave that out of conversations about the benefits of family planning,” she says. Adds [David] Bishai, the senior author: “For too long development specialists told policymakers that investing in family planning would create prosperity for the next generation. Now it’s time for a message focused on this generation. More family planning means more sex for married couples now.”
That is arguably the reason why HV acknowledged that received papal teachings on contraception “can be observed only with the gravest difficulty, sometimes only by heroic effort” (HV §3).
It is arguably also the reason why FAMs (including the SDM/CycleBeads™ and the STM) are generally marketed as fertility tracker to know when to avoid unprotected intercourse, rather than to simply know when to abstain. This is indeed the way that many FAMs practitioners use them, namely to pinpoint when to use contraceptives (generally condoms).
Noteworthy in this regard is the fact that the two seminal studies about the efficacy of the STM and the SDM respectively include not only users abstaining during the fertile period, but also those using barrier methods. Indeed, the reference article with regard to the effectiveness of the STM, based on a 22-years European longitudinal study, found that the majority (509 out of 900 couples, or 56.5%) of participating couples had protected intercourse (i.e. used a barrier method) during the fertile window, with only 35.7% (322 out of 900) abstaining. That category cannot be considered users of “Natural Family Planning” as required by the Catholic Church: rather, they can be described as “periodic users of condoms.”
This despite the majority of participants in that longitudinal study being likely more motivated than average to use that method, as admitted by the lead investigator, himself a Catholic and a promoter of the STM.
3) Generally speaking, FAMs are not suitable for women who have an irregular monthly cycle. This is the case with all the recent methods mentioned above: the SDM, the STM, Marquette, TwoDays Method, and so on.
The STM, for example, was tested on women with a “Normal cycle lengths between 22 and 35 days”, with the warning that “20% of cycle lengths could be outside this range.”
The SDM has an even worse eligibility pool: “At any given time, only 50–60 percent of women will meet the [SDM] requirements of cycle regularity and length”. When its other limitations are considered, it means that the SDM meets the “need of only a minority of women of reproductive age”.
Calendar methods other than the SDM fare even worse, in that they “should not be used if all cycles are shorter than 27 days”.
4) Even newer FAMs are still relatively inaccurate in tracking the fertile window of women who have a regular cycle.
To accurately track the fertile window, it is necessary to be able to determine the time of ovulation approximately a week before it occurs. This is not easy to achieve. All FAMs rely on observation of the indirect, secondary effects of ovulation, such as changes in basal body temperature, cervical mucus, and/or the levels of estrogen and LH hormones.
Predicting the time of ovulation approximately a week before it occurs has an inherent margin of error. In order to be on the safe side, all FAMs tend to overestimate the duration of the biological fertile window. As a consequence, they require sexual abstinence for a longer period – almost half the time each cycle – than what would be required by the biological fertile window.
For example, “using the cervical mucus method over estimates the actual fertile phase by 5–6 days, and that is a very conservative estimate. [C]ervical-mucus monitoring is not as easy and maybe not as accurate as we had assumed.” More in general, Fehring admitted that
all of the current indicators of fertility utilized in methods of NFP are imperfect. All of them produce information in menstrual cycles that is hard to interpret. Most of these indicators overestimate the actual fertile phase.
Because of the inherent uncertainty of predicting the ovulation time about a week in advance, it is unlikely that advances in fertility tracking (e.g. by using fertility monitors, as Fehring is advocating) will be able to significantly lessen the require to abstain for at least 10 days per monthly cycle (i.e. approximately one-third of the time).
And such a significant requirement will make it unlikely that FAMs will be used primarily to know when to abstain rather than simply as fertility trackers, to more accurately target contraceptive usage during the fertile window (please see also section 5.4 below).
5) Acceptability and continuation rates appear to be low. “NFP methods are not all that easy to provide or to use,” as even Dr Richard Fehring, a long-time researcher of NFP and the developer of the Marquette Method, recently observed.
With regard to the SDM/CycleBeads, for instance, “only 91 of 1,181 (7%) women admitted within the introduction studies and followed with quarterly interviews were still using the method on completion of year 3.” Given that as well as the above mentioned fact that “At any given time, only 50–60 percent of women will meet the [SDM] requirements of cycle regularity and length,” the Standard Days Method meets the “need of only a minority of women of reproductive age.”
Another prominent researcher of FAMs observed that in developing countries “cost of teaching is an issue and […] continuation has a higher priority than efficacy”.
Among other issues hindering adoption of FAMs is the fact that “partner cooperation in the use of periodic abstinence can be difficult to garner consistently […] where gender inequalities are pronounced.” This is the more so because, as noted above, even the newer FAMs method, including the STD and STM, require abstinence for more than half the monthly cycle. Even a recent qualitative study sympathetic to FAMs reported that one African woman “found SDM harder to use than the injectables she had switched away from, because it required ‘a lot of self control on his side’.”
6) Low current uptake: “Worldwide FAB [Fertility Awareness Based] methods and withdrawal are used, respectively, by about 3.6% and 2.9% of all couples of reproductive age.” Specifically, in the USA, “[O]nly 0.2 percent of all U.S. women and 0.4 percent of all U.S. Catholic women between the ages of 15–44” use FAMs or, according to a more optimistic measure, “Only 1 to 3 percent of U.S. women use NFP for birth control”.
In addition, “health professionals are reluctant to provide NFP services due to their inefficiency and poor efficacy. Only about 6–10 percent of physicians in the U.S. and Europe would consider prescribing them for birth-control purposes.”
The relatively low uptake may be linked to those methods being relatively complex to use (i.e. they have low acceptability and continuation rates), requiring a relatively long period of abstinence (close to have the monthly cycle), and to them being only appropriate to women with regular cycle lengths (e.g. with regard to the relatively recent Standard Days Method “only 50–60 percent of women will meet the requirements of cycle regularity and length […]. Furthermore the method cannot be reliably used in the transition from LAM to resumption of regular cycles, a critical time for child spacing.”
In summary, “The complexity and diligence required by many NFP methods make them unrealistic and untenable for many persons.”
5.4. Are Future Improvements in FAMs’ Typical-Use Effectiveness, Acceptability, Ease of Use, and Cost Likely to Translate into Higher Uptake of Users “Periodic Abstinence” users?
Let us assume that in the future FAMs – perhaps complemented with hormonal fertility monitors linked to smartphones “apps”– will be capable of pinpointing the start and end of the fertile window with a very high degree of accuracy (despite the inherent difficulty of accurately predicting the time of ovulation approximately a week in advance).
Let us also posit that they may be able to do so for all women, including the many women who have an irregular hormonal profile and an irregular cycle, and who so far cannot effectively use many FAMs methods.
Let us further posit that pinpointing the time of ovulation a full week in advance of it happening will be much easier than is currently the case, where it generally requires a combination of regular calendar readings, temperature measurements, and cervical mucus assessments for maximum accuracy. Let us posit, for instance, that it could be done uniquely via a hand-held hormonal fertility monitor somehow capable of anticipating the time of ovulation by a full week with 100% accuracy.
Let us posit, finally, that such fertility monitors will overcome another considerable hurdle, namely affordability (the ClearBlue™ monitor used by the Marquette Method currently retails for $109.99USD, excluding the test sticks, at $39.20USD for 30), and that it will be able to be subsidised and accessible to everyone on the planet, including the poorest.
1) Still, even were FAMs and fertility monitors to become highly accurate, easy-to-use, and universally accessible for free, it is highly unlikely they will be used to know when to abstain from sex, rather than when to use barrier methods.
This is already the case: the most effective FAMs (i.e. the SDM and the STM) have been tested and marketed simply as methods for tracking the fertility cycle, and not as requiring periodic abstinence. Users are told to avoid unprotected sexual intercourse during the fertile period, either by abstaining or by using modern contraceptives (often condoms).
Indeed, even the Georgetown University-based Standard Days Method (CycleBeads™), available through UNFPA to international NGOs, markets it for “women who keep track of their cycle days and do not have unprotected intercourse on Days 8 through 19 of their cycles” (emphasis added). On the official website of SDM/CycleBeads™, it is explained that
If a woman wants to prevent pregnancy using this family planning method, then she should avoid intercourse or use a back-up birth control method such as condoms during her fertile days (days 8-19).
Similarly, the two seminal studies about the efficacy of the STM and the SDM respectively include not only users abstaining during the fertile period, but also those using barrier methods. Indeed, the reference article with regard to the effectiveness of the Symptothermal Method, based on a 22-years European longitudinal study, found that the majority (509 out of 900 couples, or 56.5%) of participating couples had protected intercourse (i.e. used a barrier method) during the fertile window, with only 35.7% (322 out of 900) abstaining. Only “in more than a third [of the cycles analysed] the STM was used with abstinence during the fertile time.” This despite the majority of participants in that longitudinal study being likely more motivated than average to use that method, as observed by the lead investigator, himself a Catholic and a promoter of the STM.
2) One of the main reasons why it is highly unlikely FAMs will be used to know when to abstain from sex, rather than when to use barrier methods, is that to abstain every month during the fertile window requires a significant change in sexual behaviour. The evidence is that such a change is rejected in the vast majority of cases.
Interventions to change sexual behaviour have consisted in providing adequate sex education. A considerable amount of evidence from the USA suggests that “abstinence-only” sex education curricula are not effective in changing sexual behaviour. Significantly, the vast majority of such programs has not been effective in changing sexual behaviour in comparison to “comprehensive” sex education, where often an emphasis on abstinence is complemented with information on modern contraceptives. Specifically, a meta-analysis of 98 interventions (51,240 participants) from 67 studies concluded that
interventions were successful at reducing the frequency of sexual behavior when (1) they were implemented with adolescents who were institutionalized, (2) had no focus on abstinence as a goal, (3) had greater numbers of intervention sessions, and (4) had control conditions with non-HIV content (eg, general health promotion); the latter predictor narrowly missed conventional statistical significance. On average, interventions did not succeed when the intervention focused on abstinence….
The same results have been found again and again elsewhere in the world. More evidence is provided in Appendix 2.
In light of that evidence, even were FAMs requiring periodic abstinence to be promoted worldwide and coupled with an abstinence-only sex-education course of suitable length, they would be highly unlikely to bring to a widespread change of sexual behaviour.
Quite simply, the reason why such a change in sexual behaviour is unlikely is that it would run against the experiences and insights of the vast majority of people all over the world, namely:
• that sexual intercourse has many more meanings and purposes than reproduction alone, and that each and every act of sexual intercourse need not be open to procreation;
• that “responsible parenthood” is a moral duty, and it requires family planning (in this, people agree with the Catholic position);
• that family planning via modern contraceptives is no more “artificial” (and no less “natural”) than contraceptive methods based on periodic abstinence during the fertile window;
• that both categories of technical means for family planning, when used with the same intention of avoiding procreation – and with all other things being equal – are morally equivalent.
It is arguably for those reasons that the vast majority of people across the world do not perceive using modern contraceptives to be always immoral when used for family planning. As a consequence, regardless of how accurate, easy-to-use, and affordable FAMs will become, it is highly unlikely that people will ever be convinced of the need “periodically abstain” rather than using modern contraceptives during the fertile window simply because of a supposed moral duty to always preserve procreation as the intrinsic finality of each and every act of sexual intercourse, and because modern contraceptives would be supposedly “artificial” and “against nature”, while Fertility Awareness Methods would not.
Finally, in this connection, it should be recalled that FAMs are also “unnatural” or “artificial” in two ways. First, because they artificially time sexual intercourse so as to intentionally avoid procreation. As mentioned earlier, that was the very reason why the Doctrinal Commission rejected an amendment to explicitly condemn the “contraceptive arts” because such an expression would include “the method of periodic continence, which often requires technical computations,” and which previous popes had already accepted.
Secondly, FAMs are artificial and unnatural because they submit the supremely human act of conjugal love to biological determinants. Since with NFP intercourse can take place only during days determined by the female cycle, it deprives a couple of the freedom in love-making. A couple can be reunited after a long absence and yet they may be forced to abstain for two weeks because they were reunited “at the wrong time”. As recent research shows, use of FAMs decreases coital frequency, while use of modern contraceptives is associated with higher coital frequency. Hence modern contraceptives better allow the “natural” expression sexual love than methods which artificially and unnaturally constrain such an expression to the biological determinism of the female menstrual cycle and so require sexual abstinence for approximately half the time each cycle.
6) The ongoing development and increased worldwide availability of more effective, easy-to-use, and affordable contraceptives is another factor that will hamper usage of Fertility Awareness Methods to abstain, rather than have protected intercourse, during the fertile window.
Among the recent developments, noteworthy is the rapid rise of Long-Acting Reversible Contraceptives (LARCs, which include injections, intrauterine devices [IUDs] and subdermal hormonal implants). LARCs are the most effective reversible methods of contraception because they do not depend on patient compliance. So their “typical use” failure rates, at less than 1% per year, are about the same as “perfect use” failure rates.
Another significant change is the ongoing development of new male contraceptives, both hormonal and mechanical (the latter represented for instance by Vasalgel/RISUG [“Reversible Inhibition of Sperm Under Guidance”]).
In the strategy to reduce unintended pregnancies and abortions, the current recommendation – shared by USAID and UNFPA – is to “use more effective contraceptive methods, without increasing total contraceptive prevalence rate,” by encouraging the following changes:
• All traditional method users switch to a short-term modern method.
• Women using contraception for birth spacing switch to a short-term modern method, and women using contraception for limiting births switch to a long-acting modern method.
• All non-long-acting and permanent method users switch to a reversible long-acting method of contraception.
• All spacers [i.e. women who want to delay a new pregnancy, in order to space their children] switch to a long-acting method, while all limiters [i.e. women who do not want to have any more children] switch to a permanent method.
As it has been observed, modern contraceptives are there to allow the free expression of sexual love whenever mutually desired. The above strategies would allow doing so in a much better way than periodic abstinence.
In summary, it is certainly useful to increase knowledge of the monthly fertility cycle across the world. FAMs are ways of tracking the monthly fertility cycle. Their use should therefore be encouraged. However, it is highly likely that the increased knowledge of the monthly fertility window will be used in order to more accurately target the use of barrier methods of contraceptives, rather than to abstain, for the reasons highlighted earlier.
5.5. Some concluding considerations on FAMs.
To many non-Catholics and indeed Catholics, FAMs appear to be a paradigmatic example of disobeying the spirit of the law, while attempting to stick to the letter (despite the impossibility of doing so).
HV affirms that sexual intercourse is for reproduction, and therefore every time you have sexual intercourse children should be at least a possibility. It is always immoral to hinder the procreative finality which is natural and intrinsic to every act of sex, according to that encyclical.
If that were truly to be the case, then using “natural” means of contraception with the specific intention of not reproducing would contradict HV’s general principle above and, by the same token, it would contradict both its spirit and its letter.
As HV §16 affirms, both “artificial” and “natural” methods of family planning are undertaken with the identical intention of avoiding procreation. Therefore they are, all other things being equal, morally equivalent.
The only difference is – as the evidence gathered here shows – that FAMs are harder to abide by, and so result in considerable less sexual activity between spouses.
That conveys the wrong message: you are allowed to “break” the inseparable bond between the unitive and procreative meanings of sexual intercourse by avoiding conception, but only if you trade that off for a sufficient amount of “ascesis,” in the form of sexual abstinence (see HV’s observation that its message requires heroism and ascesis at HV §§3 and 21).
6. Potential Impact of the Catholic Church’s Change of Policy
Of the women in developing countries who do not use modern contraceptives, close to one in four say that they do not use modern contraceptives because they or others close to them oppose them. That is generally due to cultural or religious objections against them. The evidence suggests that the role of the Catholic Church in this regard is not insignificant.
Because of the extent of the Catholic Church’s health provision, those negative consequences have a worldwide impact:
– Approximately one-fourth of health care facilities worldwide are Catholic and therefore cannot, by statute, offer even non-abortifacient contraceptives for the purpose of family planning.
In the developing world they are often the only providers of health care for large sections of the population. Anybody relying on them cannot ordinarily access other reproductive health services.
– What Catholic Church officials say on the issue significantly influences the sexual behavior and reproductive choices of many Catholics in the developing world.
This is both because of the trust and authority they enjoy as spiritual leaders, and because of their power to shape the concrete policies of Catholic health care facilities.
Catholic hospitals and individuals cannot in theory provide contraceptives for family planning. Some still do, but have to do so secretly.
As a consequence, millions of poor people are denied access to modern non-abortifacient family planning services because of the current official stance of the Catholic Church.
A case in point is the very public “condom scandal” that rocked the Knights of Malta. Their charity arm, Malteser International, was forced to change its policy of distributing condoms to sex workers in some developing countries because management felt it was against current papal teaching and Vatican directives.
The same happens regularly at the individual level. A case in point is the charity work by Fr. Heinz Kulüke, since 2012 superior general of the SVD missionaries. Fr. Kulüke had been helping the poor in and around Cebu since 1986 and, on an almost nightly basis he distributed condoms to women and girls involved in prostitution in the Barangay Kamagayan, a red light slum area of Cebu City. But he had to do so without any institutional support from the Catholic Church. Quite the contrary in fact: in 2010, charges were brought against him to the local bishop alleging that he was distributing condoms, and that that was against church teaching. He survived the attack, and went on to be elected Superior General of the SVD order.
The point of attention of those two well known cases is that unless the Catholic prohibition on using contraceptives for both prophylactic and family planning purposes is officially abandoned, Catholic individuals and institutions will continue being hampered in what they can do publicly, with very severe consequences for millions of people.
7. A Revision of HV would be received well by the vast majority of Catholics
It would boost, rather than damage, the moral authority of the magisterium in the eyes of the vast majority of people, whether Catholics, non-Catholic Christians, and non-Christians in general.
Only a small minority of Catholics would be upset, namely very conservative Catholics who accept and practice HV’s conclusions (recall the worldwide usage of periodic abstinence methods is less than 3%, and it is unknown which percentage of that figure are Catholic users who use FAMs to obey HV).
To attempt and preserve the status quo, for fear of the conservative minority, is the “safer” option only apparently: in reality it will continue the alienation of Catholics from the Church, and will not stop the issue from resurfacing in the media regularly. The magisterium’s authority will continue to suffer from it, especially with regard to what it says about sexual morality.
To minimise the shock to the conservative minority, a few things can be done.
First, act with regard to the prophylactic use of condoms. That will in itself get rid of the perceived absoluteness of HV’s prohibition, and prepare the ground for further advances.
Second, set up an independent study commission, to show that any conclusion has the backing of the relevant experts (including the experience of laypeople).
It is important that the selection of the commission members be impartial, based exclusively on their relevant expertise.
Third, emphasise the positive effects of using contraceptives. They were ignored by HV §17, which only focused on presumed negative effects (sexual promiscuity, mistreatment of women, etc.).
Fourth, liaise with the wider theological community worldwide to present any future revision to the media, and to help explain it to them. The Wijngaards Institute is happy to offer its support in that regard.


Appendix 1. Can Abstinence-Only Sex Ed be a Solution Instead?
Public statements by popes and bishops in the past twenty years or so show a significant shift in the arguments used to justify the prohibition against “artificial” contraceptives. HV was clear that “artificial” contraceptives are “intrinsically evil” because they go against nature.
Now, however, this argument is largely passed under silence; instead, the argument which is often repeated is the following:
1) access to contraception increases risk-taking and promiscuity by “enabl[ing] sexual encounters and relationships that would not have happened without it”;
2) Modern contraceptives can fail: their failure rate in the real world, due to incorrect or inconsistent use, is significant;
3) The sexual promiscuity enabled by modern contraceptives, and their real failure rate, is what causes both unintended pregnancies and STIs (e.g. HIV, Zika, etc);
4) The only solution is abstinence: complete abstinence before marriage, and periodic abstinence within marriage.
In summary: modern contraceptives increase a risky sexual behaviour, can fail, and so they increase both the number of unintended pregnancies and the spread of STIs.
In other words, there has been a shift in the arguments used by the hierarchy, and particularly the last two popes, to defend the absolute prohibition of “artificial” contraceptives. Nowadays, in public speeches and interviews, references to the affirmation that “artificial” contraceptives are “intrinsically evil” because against nature are generally avoided. Instead, that prohibition is now supported mostly by arguing that 1) modern contraceptives enable riskier sexual behaviour than would otherwise be possible without them, 2) that they have a relatively high failure rate, and, as a consequence of those two points, 3) that they increase transmission of STIs, unwanted pregnancies, abortions etc.; and the conclusion is drawn that the only solution is abstinence.
These arguments are unfounded and deserved a detailed reply.
[1] Does access to contraception increase risk-taking and promiscuity?
The evidence does not support this hypothesis. The USA provide an ideal testing ground for the first hypothesis, because for decades it has run extensively two types of sex education curricula — so-called “comprehensive” programs that promote abstinence but also teach about contraceptives (also known as “Risk Reduction” programs), and programs that promote only abstinence, many of which cast contraceptive use in a negative light, if it is included at all (also known as “Risk Avoidance” programs).
The amount of evidence available is impressive. A number of large studies have shown that the programs which are proven to positively change teen behaviour belong to the “Risk Reduction” comprehensive category – a positive change which results in a significantly lower percentage of both unintended pregnancies and abortions. In contrast, the vast majority of risk-avoidance, “abstinence only” programs have not been shown to lower unintended pregnancies or abortions in comparison to control groups which were not taught any sex education at all. Below are some of the key studies:
Teaching about contraception [is] not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.
In fact,
Study results [a meta analysis of “56 studies that assessed the impact of such [sex ed] curricula (8 that evaluated 9 abstinence programs and 48 that evaluated comprehensive programs) on adolescents’ sexual behaviour”] indicated that most abstinence programs did not delay initiation of sex and only 3 of 9 had any significant positive effects on any sexual behavior. In contrast, about two thirds of comprehensive programs showed strong evidence that they positively affected young people’s sexual behavior, including both delaying initiation of sex and increasing condom and contraceptive use among important groups of youth. Based on this review, abstinence programs have little evidence to warrant their widespread replication; conversely, strong evidence suggests that some comprehensive programs should be disseminated widely.
Again, there is no evidence that availability of Emergency Contraception results in an increased sexual risk behaviour. “[A] substantial body of research demonstrates that there is no relationship between availability of EC [Emergency Contraception] and increased sexual risk behaviour.”
A meta-analysis of 98 interventions (51,240 participants) from 67 studies concluded that
interventions were successful at reducing the frequency of sexual behavior when (1) they were implemented with adolescents who were institutionalized, (2) had no focus on abstinence as a goal, (3) had greater numbers of intervention sessions, and (4) had control conditions with non-HIV content (eg, general health promotion); the latter predictor narrowly missed conventional statistical significance. On average, interventions did not succeed when the intervention focused on abstinence and when control groups included HIV-related content (eg, in diluted form).
The same results have been found again and again elsewhere in the world.
[S]tudy after study dispute the effectiveness of abstinence-only education for reducing teen pregnancy, delaying the onset of sexual activity, and promoting safer sex practices among youth (March & Fields, 2014). Opponents of abstinence education argue that the rights of young people are violated in respect to reliable sexual health information and resources, free of coercion. […] Earlier, Santelli et al. (2006) conducted a review of abstinence and abstinence-only education showing that it was ineffective in delaying sexual activity. In addition, these programs can have a negative impact on the knowledge and well-being of young people, particularly LGBTIQ and other marginalized youth. Schalet (2011) argues for the recognition of diversity and for comprehensive sexuality education.
Does the Percentage of Unintended Pregnancies and STIs Increase More with Use of Modern Contraceptives than with the use of FAMs?
Where free modern contraceptives are available, unwanted pregnancies and abortions have gone consistently down.
A 2003 landmark study, “Relationships Between Contraception and Abortion: A Review of the Evidence,” found that:
After fertility levels stabilized in several of the countries that had shown simultaneous rises in contraception and abortion, contraceptive use continued to increase and abortion rates fell. […] Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly.
Those findings have been confirmed in several regions of the world. In the USA, for example,
A study [of 9,256 women and adolescents in the St. Louis area between 2007 and 2011] by investigators at Washington University [School of Medicine in St. Louis] reports that providing birth control to women at no cost substantially reduces unplanned pregnancies and cuts abortion rates by a range of 62 to 78 percent compared to the national rate [in the USA].
Modern contraceptives can fail, but the best methods (e.g. IUD, etc) are almost 100% effective, and the current global trend is towards long-acting, reversible, contraceptives (LARCs) which are highly effective, with a <1% failure rate over 5 years of use. They are the most effective reversible methods of contraception because they do not depend on patient compliance. So their typical use failure rates are about the same as perfect use failure rates.
In contrast, FAMs require a very high users’ compliance – a compliance HV itself described as “heroic” and as requiring “ascesis” (HV §§3 and 21) – have a population level typical-use failure rate (estimated 25%) much higher than said LARCs, as well as other best-in-class modern contraceptives. Worldwide, that means that approximately one in four women using traditional methods will conceive in any given year despite trying to avoid a new pregnancy.
• It has been estimated that approximately 40 percent of pregnancies worldwide are unintended – the result of non-use of contraception, ineffective contraceptive use or method failure.
• “Accidental pregnancies are mostly among users of traditional methods; substituting traditional method use with modern contraception could therefore reduce contraceptive failures by over 40%. Also, where less-effective family planning methods are commonly used, unplanned pregnancies and, consequently, abortions are likely to occur”;
• “An increase in contraceptive prevalence and in the use of effective contraceptive methods reduces the incidence of abortion. This is empirically supported by data from developed countries.”
• “Abortion prevalence is higher where the unmet need for family planning is high, contraceptive prevalence is low, and less-effective contraceptive methods prevail.”
• “a study of 12 developing countries show[s] that in those countries the shift to modern method use could reduce induced abortion levels by some 30% on average; and a shift from using traditional to modern methods can, on average, reduce abortion by over 20%. This suggests that the best option for reducing numbers of abortions is expanded family planning counselling and services to encourage use of modern contraceptive methods.”
The evidence is that by far the most effective way to lower unintended pregnancies and abortions is by providing access to effective modern contraceptives.

Appendix

Women’s Fertility – A Perspective over the Life-Span

Biologically, a woman’s fertile periods are limited. Women are fertile from first menarche to menopause. Most women begin menstruating between the ages of 11-15, with a mean of 13 years old [Tarhane, Sonal, and Arti Kasulkar, “Awareness of adolescent girls regarding menstruation and practices during menstrual cycle,” Panacea Journal of Medical Sciences 5, no. 1 (2015): 29-32.] Menopause has three gradual phases: premenopause, perimenopause, and postmenopause. Although it varies from woman to woman, one study placed women ages 30 and 48 in the premenopausal category, women ages 48 to 59 inclusive as perimenopausal, and woman 60 and older as postmenopausal. (Slemenda, Charles, Christopher Longcope, Munro Peacock, Siu Hui, and C. Conrad Johnston, “Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women,” Journal of Clinical Investigation 97, no. 1 (1996): 14-21, at 14). Female fertility begins to decline in the 20’s, and sees drops until full menopause. Women rarely become pregnant after 50 and even women 35 and older are considered at lower risk for conception.
Between first menses and menopause women are physically fertile and can potentially become pregnant. However, “during the average woman’s menstrual cycle there are six days when intercourse can result in pregnancy; this ‘fertile window’ comprises the five days before ovulation and the day of ovulation itself.” The average menstrual cycle is 28 days long. (Wilcox, Allen J., David Dunson, and Donna Day Baird, “The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study,” BMJ 321, no. 7271 (2000): 1259-1262, at 1259.)
Women are also unable to conceive during pregnancy and lactation, although rare exceptions occur (World Health Organization, “Infertility Definitions and Terminology,” 2013).
Therefore we see that women have the potential to conceive for approximately 6 out of 28 days, over a period of less than 50 years [in reality, closer to 25 years], minus any time that they are pregnant or lactating.
Statistically, therefore conception is the exception and not the rule for intercourse, given that women are infertile for 22 days a month; before menstruation and after menopause; and while pregnant or lactating.

 

References   [ + ]

1. “The official teaching rests on the view that the innate purpose of the sexual faculty is twofold: procreation and love union. Every sexual act must be open to procreation, and must be expressive of love. This is the church’s basis for condemning masturbation, contraception, sterilization and homosexual acts. It is also the ground for condemning artificial insemination, even with the husband’s semen (AIH). Contraception is wrong, in the hierarchical magisterium’s view, because it prevents procreation. AIH is wrong because the act of insemination is not the natural act which, by its very nature, is expressive of love.” Charles Curran, Roman Catholic Sexual Ethics: A Dissenting View, Christian Century, December 16, 1987, pp. 1139-1142.
2. Josef Fuchs, Christian Morality: The Word Becomes Flesh, trans. Brian McNeil (Dublin: Gill and Macmillan, 1987), p. 115, quoted in Mark Graham, Josef Fuchs on Natural Law (Washington, D.C.: Georgetown University Press, 2002), p. 163, but consult also pp. 162–6 and 183–5.
3. Pontifical Commission on Birth Control, Draft of a Document Concerning Responsible Parenthood (Schema Documenti de Responsabili Paternitate), 1966.
4. Peter B. Gray and Justin R. Garcia, Evolution and Human Sexual Behavior (Cambridge, MA: Harvard University Press, 2013).
5. Irina Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, in Bioscience Ethics (Cambridge, Mass.: Cambridge University Press, 2009), 90–105, at 93. As Pollard noted, at the biological level, this occurred via a “transfer of the physiological control of libido from the female sex hormones (estrogens and progesterone) involved in ovulation and pregnancy, to another set of hormones, in this case the androgens testosterone and androstenedione. A woman’s complement of androgens derived from her ovaries and adrenal glands keep her sexual drive active throughout the menstrual cycle”. Ibid. This was something unknown to Catholic natural law on sexuality, which was for the most part in place by the end of the Middle Ages. Therefore for most if not all of its history the Catholic natural law tradition on sexuality could not even “attempt to understand the significant of this change away from sex oriented exclusively to procreation” Christine E. Gudorf, Body, Sex, and Pleasure: Reconstructing Christian Sexual Ethics (Cleveland, OH: The Pilgrim Press, 1994), 64-65.
6. Giuseppe Benagiano and Maurizio Mori, The Origins of Human Sexuality: Procreation or Recreation?, Reproductive Biomedicine Online 18 Suppl 1 (2009): 50–59, at 52.
7, 29, 46, 53. Ibid.
8. Melissa Emery Thompson and Martin N Muller, Comparative Perspectives on Human Reproductive Behavior, Current Opinion in Psychology 7 (February 2016): 61–66.
9. Irina Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, in Bioscience Ethics (Cambridge, MA: Cambridge University Press, 2009), 90–105.
10. Paul R. Abramson and Steven D. Pinkerton, With Pleasure: Thoughts on the Nature of Human Sexuality (Oxford University Press, 2002).
11. Giuseppe Benagiano and Maurizio Mori, The Origins of Human Sexuality: Procreation or Recreation?, Reproductive Biomedicine Online 18 (2009): 50–59, at 50.
12. Irina Pollard, Pollard’s Response To Leavitt’s Commentary, Eubios Journal of Asian and International Bioethics 7, no. 5 (1997): 134–35.
13. Ibid. Indeed, “we know that humans have tried to practise contraception ever since they began to leave written records. According to Potts and Campbell (2002), modalities to avoid conception after intercourse are described in Egyptian papyri (Ebers, 1550 BC; Petre, 1500 BC), the Greek writings of Soranus (Gynecology, c.AD 100) and in the Latin works of Pliny the Elder (AD 23–79) and Dioscorides (De Materia Medica, c.AD 58–64).” Benagiano and Mori, The Origins of Human Sexuality, 2009. p. 53.
14. Peter B. Gray and Justin R. Garcia, Evolution and Human Sexual Behavior (Cambridge, MA: Harvard University Press, 2013), p. 112.
15. HV §§11-12
16. “Clinically recognized pregnancy loss [i.e. after a successful embryo implantation], is usually quoted as 15-20%. It is this clinical fraction of failed pregnancies that has been extensively studied cytogenetically and in which a chromosome abnormality rate of at least 50% has been established. This contrasts markedly with a 5% chromosome abnormality rate found in stillbirths, illustrating clearly the natural in utero selection process that eliminates 95% of chromosomally unbalanced conceptions. [I]t can be seen that 50-60% of developmental anomalies at birth are of unknown etiology while known causes can be assorted into chromosomal aberrations, mutant genes and environmental factors. Of the known categories, 20-25% are multifactorial inheritances.”
17. Pollard, Pollard’s Response to Leavitt’s Commentary.
18. Pollard, Fertility Awareness: The Ovulatory Method of Birth Control, Ageing Gametes and Congenital Malformation in Children, 2009.
19. As Bernard Lonergan noted, “So there arises the question whether this statistical relationship of insemination to conception is sacrosanct and inviolable. Is it such that no matter what the circumstances, the motives, the needs, any deliberate modification of the statistical relationship must always be prohibited? If one answers affirmatively, he is condemning the rhythm method. If negatively, he permits contraceptives in some cases. Like the diaphragm and the pill, the menstrual chart and the thermometer directly intend to modify the statistical relationship nature places between insemination and conception. [M]arital intercourse of itself, per se, is an expression and sustainer of love with only a statistical relationship to conception.” REF.
20. Charles E. Curran and Robert E. Hunt, Dissent in and for the Church: Theologians and Humanae Vitae (Sheed & Ward, 1970), p. 165.
21. See the classic explanation by Richard Feynman, that “what we are proposing […] is that there is probability all the way back: that in the fundamental laws of physics there are odds.” Probability and Uncertainty: The Quantum Mechanical View of Nature, in The Character of Physical Law (Cambridge, Mass.: The M.I.T. Press, 1965), 127–48 (emphasis added).
22. Cynthia SW Crysdale, Revisioning Natural Law: From the Classicist Paradigm to Emergent Probability, Theological Studies 56, no. 3 (1995): 464–84, at 476 and 477.
23. Ibid. at 477-478.
24. Ibid. at 476.
25. Ibid. at 483.
26. Ibid. at 478.
27. Ibid. at 479.
28. Ibid. at 484.
30. Margaret A. Farley, Just Love: A Framework for Christian Sexual Ethics (New York ; London: Continuum, 2006); Gudorf, Body, Sex, and Pleasure; Shaji George Kochuthara, The Concept of Sexual Pleasure in the Catholic Moral Tradition, vol. 152 (Gregorian Biblical BookShop, 2007).
31. § 1.2.2.2.
32. Margaret A. Farley, Same-Sex Relationships and Issues of Moral Obligation, Anglican Theological Review 90, no. 3 (2008): 541–47. A similar position is adopted by Marvin M. Ellison, Making Love Just: Sexual Ethics for Perplexing Times (Fortress Press, 2012).
33. GS §50, see also HV §10.
34. Majority Report of the Birth Control Commission, 1966: part 1 ch. III.
35, 36. Majority Report of the Birth Control Commission, 1966: part II ch 1.
37. Bernhard Häring, Free and Faithful in Christ: Moral Theology for Priests and Laity – The Truth Will Set You Free, vol. 2 (Slough: St Paul Publications, 1979), p. 516. Also Cristina Richie, Disrupting the Meaning of Marriage? Childfree, Infertile and Gay Unions in Evangelical and Catholic Theologies of Marriage, Theology & Sexuality 19, no. 2 (2013): 123–42; and Kathryn Lilla Cox, Toward a Theology of Infertility and the Role of Donum Vitae, Horizons 40, no. 01 (2013): 28–52, at 44.
38. Luca Badini Confalonieri, Democracy in the Christian Church: An Historical, Theological and Political Case, Ecclesiological Investigations 16 (London: Continuum, 2012), p. 121, see also pp. 15 and 144.
39. NCCB, Responsible Parenthood, http://www.usccb.org/issues-and-action/marriage-and-family/natural-family-planning/catholic-teaching/upload/Responsible-Parenthood.pdf
40. Jon Fuller and James Keenan, in Between Poetry and Politics: Essays in Honour of Enda McDonagh, ed. Barbara Fitzgerald and Linda Hogan (Blackrock: Columba, 2003), 158-181, at 176.
41. Mark Schiffman et al., Human Papillomavirus and Cervical Cancer, The Lancet 370, no. 9590 (2007): 890–907.
42. Lenny Bernstein and Joel Achenbach, Sex in a Time of Ebola, The Washington Post, October 8, 2014, https://www.washingtonpost.com/news/to-your-health/wp/2014/10/08/sex-in-a-time-of-ebola/.
43. Patricia Tjaden and Nancy Thoennes, Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence Against Women Survey (Washington, DC: US Department of Justice, 2000), pp. 13-14, available at https://www.ncjrs.gov/pdffiles1/nij/183781.pdf.
44. Aline H. Kalbian, Sex, Violence, and Justice: Contraception and the Catholic Church (Georgetown University Press, 2014), 117.
45. Lisa Sowle Cahill, Sexual Ethics, Marriage, and Divorce, Theological Studies 47, no. 1 (1986): 102–17, at 112.
47. Edward J. Bayer, Sterilizing the Severely Retarded Woman: Is It Morally Different from Contraceptive Sterilization? Ethics and Medics 10, no. 3 (1985): 3-4. See also a supportive discussion of Bayer’s general position by Thomas J. O’Donnell, ‘Defensive’ Sterilization for the Severely Retarded: Follow-up, Medical-Moral Newsletter 22 (1985): 5-8. And also Bayer’s earlier article, Defensive Sterilization for Severely Retarded Women: A Moral Option? Medical-Moral Newsletter 21 (1984): 5-8.
48. The World Health Organization, Maternal Mortality, May 2014, at, http://www.who.int/mediacentre/factsheets/fs348/en/index.html
49. The United Nations, The Millenniums Development Goals Report (New York: The United Nations, 2013), 33; 28.
50. Forrest L. Bivens, Exegetical Brief: Genesis 388-10 – Is the Sin of Onan Applicable to Birth Control in General?, Wisconsins Lutheran Quarterly 98 (2001).
51. Ethics for a Brave New World, 303-304, also Bivens, Exegetical Brief: “we observe that this event concerning Onan is properly viewed as descriptive rather than prescriptive, and to make it normative for marital life in general is inappropriate. One searches in vain for a biblical stipulation forbidding birth control as such. Despite the many sexual regulations in the later Mosaic code, for example, nothing is said on the subject, not even about the practice of what is likely the oldest form of preventing conception, namely withdrawal.”
52. Bivens, Exegetical Brief: Genesis 388-10 – Is the Sin of Onan Applicable to Birth Control in General?
54. 1 Cor 7:3-5.
55. REF
56. Jennifer Wright Knust, Unprotected Texts: The Bible’s Surprising Contradictions about Sex and Desire (HarperOne, 2011); Michael Coogan, God and Sex: What the Bible Really Says (Twelve, 2010).
57. As then theology professor Josef Ratzinger (later to become Pope Benedict XVI) wrote in 1965: “Criticism of papal declarations will be possible and necessary to the degree that they do not correspond with Scripture and the Creed, that is, with the belief of the Church. Where there is neither unanimity in the Church nor clear testimony of the sources, then no binding decision is possible; if one is formally made, then its preconditions are lacking, and therefore the question of its legitimacy must be raised.”
58. Bernard Lonergan, [REF needed]. Lonergan’s cognitional and moral theory and epistemology explain in details how “judgments of [moral] value” should be based on attentive experiencing, intelligent understanding, and a rational verification of the relevant facts.
59. [REF – the chapter on Magisterium in Dissent in and for the Church]
60. Curran and Hunt, Dissent in and for the Church, notes omitted.
61. Noonan,
62. List on the Catholics for Choice website. Indeed, even Pope Benedict XVI, in a public interview, admitted – in a somewhat convoluted way – that in some specific circumstances and “in the intention of reducing the risk of [HIV] infection”, the use of a condom can be “a first assumption of responsibility” and “a first step in a movement toward a different way, a more human way, of living sexuality”. This goes against HV’s statement that “sexual intercourse which is deliberately contraceptive [is thereby] intrinsically wrong [Lat. intrinsece inhonestum]” (HV §14) – i.e. always immoral, regardless of the intention or circumstances.
63. In addition to those among the signatories here, you can mention REF
64. After Pope John Paul II completed a five-month series of lectures on human sexuality, marriage, and the regulation of births, on November 28, 1984, the Osservatore Romano newspaper printed a front page editorial by Archbishop (later Cardinal) Edouard Gagnon, vice-president of the Pontifical Council for the Family. It stated: “Today … it is no longer possible to have doubts about the authoritative doctrine of the Church [of Humanae vitae] and about the unacceptability of dissent.” Some theologians were “happy to find in a certain popular resistance to the encyclical a good opportunity to propagandize their own ideas on the autonomy of the individual conscience.” But the Pope’s campaign to end doctrinal confusion is “the only way out” of society’s crises, and sustain “with a solid doctrine” the efforts of people fighting “in defence of life and the institution of matrimony.” Addressing a Conference on Natural Family Planning, Pope John Paul II stated: “What is taught by the Church on contraception does not belong to material freely debatable among theologians.” Those who argue otherwise “in open contrast with the law of God, authentically taught by the Church, guide couples down a wrong path.”
65. Reference to the questionnaire for selecting bishops under JPII and BXVI.
66. In Anne Patrick’s Liberating Conscience she “contests certain magisterial exercises of authority, like the removal of Charles Curran from his teaching post at the Catholic University of America because of his stand on contraception.” Quoted in Lisa Sowle Cahill, James M. Gustafson and Catholic Theological Ethics, Journal of Moral Theology 1, no. 1 (2012): 92–115, at 111. See Anne E. Patrick, Liberating Conscience: Feminist Explorations in Catholic Moral Theology (London: SCM Press, 1996).
67. Rachel K. Jones and Joerg Dreweke, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use (Alan Guttmacher Institute, 2011), http://www.guttmacher.org/pubs/Religion-and-Contraceptive-Use.pdf, showing that an estimated 98% of US Catholic women have used contraception.
68. Todd A. Salzman and Michael G. Lawler, Experience and Moral Theology, INTAMS Review 14, no. 2 (2008): 156–69, quoting approvingly Dietmar Mieth, Humanae Vitae: A Global Reassessment after Forty Years. Considerations beyond the Birth-Control Controversy, in Concilium – Homosexualities (London: SCM Press, 2008).
69. Thomas Aquinas, The Collected Works of St. Thomas Aquinas. Summa Theologiae (Charlottesville, Va.: InteLex Corporation, 1993), Ia-IIa, q. 19, art. 5-6.
70. Add references to the similar judgment of episcopal conferences as highlighted by Joseph Selling.