Contraceptives and Catholics: "Sex and Drugs" goes to Divinity School for a Day

To understand some of the Catholic Church's recent stances on condoms (See my previous post )and abortion of a nine-year old incest survivor in Brazil (Source: Huffingtonpost), I thought it would be useful to review a key document that informs some of the Pope's recent decisions and statements. I'm no expert in religion and it shows- I just have more questions!

Documentation that Guides Catholic Church

Decisions

While the Old and New Testament address adultery and divorce, there is no Bible-based guidance to Christians on use of contraceptives, which came later. The reference most commonly used in Catholicism is the Humanae Vitae- a document attributed to Pope Paul VI in 1968. (Source: Wikipedia)

The Humane Vitae was written in response to the oral contraception becoming available in 1960 and a Catholic Church Commission Report in 1966 which proposed that, "that artificial birth control was not intrinsically evil and that Catholic couples should be allowed to decide for themselves about the methods to be employed", and a minority report which held that contraception was instrisically evil. (Source: Wikipedia)

The Humanae Vitae prohibits use of artificial contraception, but does not label it as evil and overall is a complicated document which is supposed to reaffirm previous Church positions and embody some of the conflict within the church on contraceptives. (Source: Wikipedia)

Three Catholic Cheers for Sex!

The Humanae Vitae does take a tremendous step and call, "sexual activity, in which husband and wife are intimately and chastely united with one another, through which human life is transmitted, is...noble and worthy.''

Hurrah for the Catholic Church's appreciation of sex!

Asserting an Inseparable Connection and then Severing it?

The Vatican's Humanae Vitae "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" yet "the Church teaches that married people may then take advantage of the natural cycles immanent in the reproductive system and engage in marital intercourse only during those times that are infertile, thus controlling birth in a way which does not in the least offend the moral principles."

Now this point confuses me. The overall point of this document is to say that the benefit the couples gets from sex relating to couple unity and intimacy should never be separate from the other benefit of sex- procreation. Yet then the document goes on to say that it is allowable for couples to time when they have sex to reduce the potential that the sex act will result in a pregnancy.

All is supposed to be "cleared up" when the documents says that "neither the Church nor her doctrine is inconsistent when she considers it lawful for married people to take advantage of the infertile period but condemns as always unlawful the use of means which directly prevent conception".

Oh thanks- all clear now.

My biggest issue with the Humane Vitae is that it states "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. "

This is in conflict with my limited understanding of the Catholic interpretation of the power of God. As I understand, God is all powerful and miracles are possible. Couples who were previously thought to be infertile have been able to conceive and this miracle is attributed to God's will. How can we be so arrogant to belive that these small steps could override God's will?

As the religious right has brought up many times, there is no contraception that is 100%- not condoms, oral contraceptives, even sterilization. "In the United States, most studies of breakage caused by fault in the condom itself have shown breakage rate is less than 2 condoms out of every 100 condoms. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time." Avert.Org Condom Effectiveness If condoms work only 87-97% of the time, there is room for divine action.

The % chance for divine intervention for condoms is not too far off with perfect practice of contraception by following natural cycles. Chances of pregnancy in a typical ovulation calendar varies by day from 0-20%.

Why must a fertile 20-something be held to a higher standard of self-discipline than an infertile peer or the post menopausal generation? Chances of conceiving post menopause are extremely low per "Ask Our Expert" at drspock.com. Why do the baby boomers get to have all of the fun?

Limiting contraception to "infertile methods" puts the moral burden unevenly on the most fertile part of the population. If we were to truly hold ourselves to not separating the procreative and couple-intimacy benefits, wouldn't those populations who were less fertile be expected to abstain from sex full stop?

Understanding Why the Church Accepts Natural Cycle Contraception, but Not Artificial Contraception- Unpacking the Concept

Why is natural cycle contraception considered ok while artificial contraception (oral contraception, injectables, condoms, etc.) is not? I'll paraphrase the HV's section on this using two couple examples- Couple A live within the church rules of maintaining intimacy while avoiding a pregnancy while Couple B are avoiding a pregnancy using artificial birth control.

There seem to be two major arguments:

(1) Couple A's abstinence during the most fertile times of the ovulation cycle is self control that demonstrates their true love for each other, so they may have sex during infertile times with the intention of avoiding pregnancy within the rules of the church. Couple B is not practicing a method that is time-restrictive and are therefore not sacrificing anything to demonstrate their true love.

(2) Couple A is taking advantage, "of the natural cycles immanent in the reproductive system and engage in marital intercourse only during those times that are infertile, thus controlling birth in a way which does not in the least offend the moral principles", while Couple B obstructs, "the natural development of the generative process".

Is this the Catholic Church's Feminist Manifesto? If So Can I Get an Upgrade?

This document also asserts that that "a man who grows accustomed to the use of contraceptive methods may forget the reverence due to a woman, and, disregarding her physical and emotional equilibrium, reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her as his partner whom he should surround with care and affection."

It is odd to me that the same document which praises self-discipline could expect such a severe swing to depravity with the simple use of contraceptives. Cases of men's lack of reverence of women, unfortunately, predates contraceptive devices. Regulating use of contraceptives will not change this- though perhaps if men were able to become pregnant this would change. The HV is supposed to be a statement with the Church's, "new understanding of the dignity of woman and her place in society"- but to me, limiting a woman's access to birth control seems to impair her ability to have her dignity.

Picture via Flickr

Does Congress have its Economics Twisted?

The House recently cut a provision in its economic stimulus package that would include family planning services for low income populations via Medicaid. This decision House Speaker Nancy Pelosi(D-CA) had argued for including the contraception provision because it will "reduce costs to the states and to the federal government" resulting from unplanned pregnancies. (CBS)

Contraception and Economics

In addition to conservative ire, Pelosi's argument seems to stir up a heady mix of Malthusian theory, issues regarding birth spacing, and the aging population. Thomas Malthus argued that there is the potential for rapid population growth that would create demand that exceeds the existing resources (in his example, food supply). Malthus believed that in addition to natural causes, misery, and vice; moral restraint (such as marrying at a later age) could check population growth. Malthus would have loved modern contraception. In the case addressed in Congress, the limited resource is governmental funds for social programs to assist low income populations. The population in need is growing (more people find themselves in the Medicaid-eligible group due to lost jobs) while the available resource has decreased. The cost of regular birth control for one couple is much lower than the cost of a child born to a couple.

If a couple makes a set income, it follows that they could afford to better meet the needs of their family if they have one child than if they had two. Having the choice to limit unwanted pregnancies through contraception becomes particularly important for low income populations who may not be able to afford the resources needed for that additional child. Can you afford the average $11,000 it takes for the first year of a child's life?

Birth spacing is a concept that takes family planning further, using contraception to ensure a minimum number of years between each child. Studies have shown that having 3-5 years between births increases survival rates and health outcomes for the born child, the older child, and the mother. In addition to the devasting impact a lost child or mother has to a family, it is possible that a family, especially one without health insurance, could never recover financially from the burden of medical and funeral costs.

Freakonomics readers will recall an argument by Donohue and Levitt that attributes the decline in crime to the legalization of abortion. While this argument has been criticized for many angles, it does bring up possible social consequences resulting from changes in access to family planning services and products.

And then there is the elephant in the room- the baby boomer population who is rapidly becoming the retirement age. A young, working population is needed to help the government and employers meet financial obligations to baby boomer retirees on pensions and Medicare. Economists have also pushed that population growth is a source of economic growth (the larger the population, the more purchasers demanding products).

So we must ask ourselves, does the government want us to have babies or to not have babies?

What does the government incentivize: more babies or fewer?

Since it is tax season, a look at the 1040 form list of exemptions gives us a better idea of what the US government has wanted us to do. We get exemptions for the number of dependents (such as children) we have. The exemption does not cover all of the expenses related to raising a child, but it does ease the burden in the balance between demand and resources for families.

We can also look at what health insurance companies cover and not cover. For many, contraception is NOT covered by their insurance carrier, yet the same carrier will cover prescriptions for Viagra. While birth spacing is a PROVEN way families can maintain good health of mothers and children, most families do not have access to the contraception that helps couples better time births. Meanwhile, older men can continue to have an active sex life and perhaps, if their female partners are using fertility treatments or are younger, they can also have children. Governmental bodies have the option of regulating change in what insurance companies cover, yet it does not seem to be a priority. As birth spacing is linked with better health, it is likely in the financial interst of insurance companies to include contraception as part of their preventitive health package. A little governmental kick in the rear here could go a long way.

Ethics

Nancy Pelosi has since taken on criticism based on the group the contraception provision was intended to benefit: low income women. Some have said who is to say that the pregnancies that this provision would prevent would not develop into highly productive children. While they make a good point, offering contraception as an option does not mean that it is mandatory. The answer should be to offer all women access to more affordable birth control. Women who are not Medicaid eligible are still in need of the choice of birth spacing.


Ways the government could better stimulate the economy in both the short term and long term

It made sense that contraception was kicked out of the economic stimulus package. Yet there is a need for some change sooner or later.

1. Just as we provide tax exemptions for dependent children, educator expenses, and student loans provide an exemption for out-of-pocket birth control costs.

2. Act legislatively to get health insurance companies to include birth control in their standard coverage package.

3. Work with pharmaceutical companies to negotiate the price down for birth control options.

4. If having a younger, working population is needed to balance the baby boom retiree population, modify immigration laws to allow more of the young, professional population to immigrate to the US.

Introduction to Sex, Drugs, and Behavior Change

Note: This blog seeks to find ways to better understand complicated issues of behavior change related to sexual and drug-risk related behavior. Some of the issues brought up in this blog are of a sexual nature or relate to drug use and may include notes that are (intended to be) humorous. If you think any of this may offend you, please do not read.
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Sex. We talk about it, we joke about it, we dish about it, we brag about it. Sex has many faces, it can be (re)productive, playful, or risky in more ways than one. We like it because it feels good or, in some cases (as John Mellencamp says) it "hurts so good." Yet why do some not use condoms when they know they should?

Hurts so Good by John Mellencamp

Sex is the perfect example of learning about behavior, why we do what we do, and why it changes. There are hundreds of professionals who have spent their careers working on how to change sexual behavior and yet we all still have a lot to learn.

What have we learned from more than 30 years of behavior change activites? Actually, a good amount. We just need to pay attention to what we already "know" and try to figure out what's left.

As an example, reducing sexual risk requires a focus first on condom use and talking to partners. Avoiding or downplaying condoms only hurts us in the end.

Let's think about the abstinence-focused curriculum promoted by well-intentioned but almost willfully ignorant policy makers and misled parents. The resulting change from this strategy in youth sexual behavior has been largely contrary to goals. While some young people are delaying their sexual debut (i.e. when they first have sex), they are NOT waiting until marriage, and many are not using condoms.

We have also learned that education and awareness-building alone do not change everyone's behavior.

Drug (licit and illicit) use also gives us a great example.

In 1950, Richard Doll and A. Bradford Hill conducted a case control study that first gave the world the idea that smoking and lung cancer were linked*. From 1951-2001, Doll, Hill, et al ran a prospective cohort study that followed up doctors over fifty years to see if those who were smokers had higher rates of cancer than those who were non-smokers**. Starting in 1954, articles were published on their findings to date which showed a strong causal relationship between smoking and cancer.**

In the US, an American study with similar results was described in the Reader's Digest article "Cancer by the Carton" in 1952. While there was a decline in smoking after the buzz from this article, many continued smoke and non-users continued to initiate.

While awareness of the dangers of smoking did spur some to quit, other factors were at play. There is, of course, addiction, but that is not the whole story. But what of the numbers who initiated? Cigarette advertising a la "Mad Men" could explain some of this. We live in the era where increasing cigarette taxes and city-wide smoking bans are increasingly used and have seen a measureable decrease in smoking as a result, so that must be part of the answer. As before, the answer is composed of multiple factors, some which we know, some we guess, and others we have yet to find out.

Welcome to Sex, Drugs, and Behavior Change


* Doll R Hill AB "Smoking and Carcinoma of the Lung" British Medical Journal 1950 (2) 739-748
** Doll R, Hill AB "The Mortality of Doctors in Relation to their Smoking Habits" British Medical Journal 1954 (1) 1451-1455
** Doll R, Peto R Boreham J Sutherland I "Mortality in Relation to Smoking: 50 Years' Observation on Male British Doctors" British Medical Journal 2004 328 (7455) 1519