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Responsible Parenthood

by Seán Fagan, Does Morality Change? 1997, ch.8.

Published in 1997 by The Liturgical Press Collegeville Minnesota

Reproduced here with the usual permissions

The previous chapter discussed moral discernment in general, on the level of principle, but it may be helpful to take a concrete example to see how it applies in practice. The topic of responsible parenthood is cho­sen for the reason that in the almost thirty years since the publication of Humanae Vitae the majority of Catholics have seldom heard this respon­sibility discussed in its full moral context. For the average Catholic, the encyclical condemns artificial contraception, and Church leaders have been repeating the condemnation ever since, often in the same breath as abortion and divorce. Any debate on the subject quickly moves on to the question of authority and obedience, and acceptance of the teaching is often seen as a test of loyalty to the Church. Sadly, responsible parent­hood itself gets lost in the process. Conscience, moral discernment and responsibility often seem to be by-passed, even in official statements by Church leaders. Humanae Vitae was certainly a watershed for the Church. Some would see the fall-out from the encyclical as a disaster, while others maintain that in spite of the deep suffering it has caused to so many devout Catholics, the overall effect has been positive in helping people towards a more mature understanding of conscience.

The overall context

One paragraph of the encyclical lists what is forbidden, but most of the document is a positive treatment of married love, with insights of lasting value. The opening passages speak of conscience faced with new prob­lems arising from the many changes in the world, and they admit that one question being asked nowadays is: must moral rules change when it is felt that one needs to be heroic in order to observe them, since married couples need love-making to keep their marriage intact? The document is open and realistic in acknowledging changes: the population explo­sion which threatens the world supply of food, the economic and social changes that put new pressures on family life, the costly educational needs of children, and the changing role of women. Pope Paul listed three questions for the Church in the light of these changes:

  1. Do present moral norms for married life need to be changed?
  2. Can the procreative finality of marriage apply to married life as a whole rather than to each individual act?
  3. Can the regulation of births be left to human reason and will rather than to biological rhythms?

The Pope explained that consideration of such questions cannot be limited  to biology, psychology, demography or sociology, but needs to begin with the overall vision of the human person. He presents a very beautiful picture of married love as human, total, faithful, exclusive and fruitful.

This is the ideal that Christian couples aspire to, and it is the context in which they must plan their families. Planning a family is sharing in God’s work. The Vatican II document on The Church in the Modern World (par. 50) says that in this married people are co-operating with the love of God the Creator and are, in a sense, its interpreters. The text invites them to judge matters correctly in a spirit of obedient respect for God, reflecting together, considering their own well-being and the well-being of their children already born or yet to come, reading the signs of the times, assessing their own material and spiritual situation, all in the context of the good of the family, of society and of the Church. It insists that it is the married couple themselves who must in the last analysis make these judgments, and in doing so they must not simply follow their own fancy, but must be ruled by conscience. Fr Gustave Martelet, S.J., a French theologian reported to have been involved in the drafting of Humanae Vitae, said at the time of its publication that an encyclical is not a book of recipes, that many difficulties still remain and it is for every man and man to resolve them in the secrecy of his or her heart. He emphasised that the encyclical cannot be a substitute for individual conscience. The question is: how should couples use their conscience responsibly in this aspect of their married life? Few people will begin their reflection with a study of the encyclical, but many of its insights will naturally be part of their thinking, even if they have problems with its central teaching prohibiting artificial contraception.

When people marry they would love to give free rein to the natural rhythm of spontaneous sexuality to express their love, without having to calculate against the risk of conception. But they know that, however much they would welcome a family as the fruit of their love, there are all kinds of pressures working against this ideal, and they are forced to reg­ulate their family. There are couples who have no difficulties and can gladly accept whatever children God may send them, and thus enjoy the spontaneity of married love, allowing nature to take its course. In the simple context of former times this was quite common, although it was often a question of having no choice. However, for thousands of years people have sought to have some control over their fertility, and tried various forms of contraception. In the complexity and pressure of today’s world there are many situations in which it would be irresponsi­ble, and therefore immoral, just to ‘let a family happen.’ It is an awesome responsibility to bring a child into the world, so it ought to be the out­come of a responsible decision. It takes little effort to produce offspring, but to be a parent means being responsible for its upbringing, health and education. Planning a family means that the couple must first of all put their heads together to decide whether, in their circumstances, it would be wise for them to have children at all, and then to discuss how many and at what intervals. Given the seriousness of what is at stake, their decision must be based on objective criteria and not mere whim. Their discernment must be governed by the precepts already mentioned, that they be attentive to all the facts in the case, that they use their intelligence in trying to understand them, that they reason about what these facts mean, and that they be responsible in making their choice. As Christian believers, they will make their discernment in a context of faith, sensitive to the teaching of Jesus and confident of God’s help when they pray for it. But there is no magic short-cut in this kind of help, because divine grace does not bypass the ordinary human means through which it works.

Initial reflection

To be attentive to all the facts of their situation means that they consider a host of factors. First, the physical, psychological, moral and religious state of both husband and wife, and the welfare of present and possible future children. There can be cases where the physical or psychological health of either partner is so impaired that the couple would be incapable of caring properly for children, or that the illness might be transmitted to their children. A wife whose two pregnancies brought on severe mental disturbance requiring a year or more in a psychiatric hospital each time could very responsibly decide that she should on no account risk anoth­er pregnancy, because of the damage it would bring not only to herself, but to her present children (left without the care of a mother and at the mercy perhaps of an inadequate father), to her husband, and of course to her very marriage, which is the highest value of all to the couple caught in such a situation. A couple who already have two severely handi­capped children and are just barely coping with their situation, but who have been warned that there is a high probability that another child could be handicapped, may decide that their marriage could well break under such a strain and they could not risk such a disaster for themselves and their present children. They would be acting responsibly in deciding against further children and then searching for the most effective protec­tion available. It could happen that no contraceptive apart from sterilisation can provide the security they need.

A couple’s material situation is also an important factor in discerning the number and spacing of children. Lack of housing and employment puts a severe strain on a relationship, and all the more if the relationship is already fragile. Economic problems are a major cause of marital break­down. In some cases the general conditions of the times can be a determining factor in a couple’s decision, for example racialism, perse­cution, famine, or war. During apartheid in South Africa some expatriate couples living there decided that while they could protect themselves from the racialist atmosphere surrounding them, they felt they could never protect their children, so they postponed having any until they left the country.

Only when the couple have decided, in the light of all these factors, and when possible and necessary with the help of advisers (doctor, social worker, spiritual adviser, family or friends) to plan their family, can the question of birth control arise, and it is only at this point that they need to consider possible methods. The various methods cannot be morally eval­uated apart from the wider discussion of the couple’s total situation. The primary value in the whole discernment process is the good of the marriage as a whole, namely the welfare of the couple as a couple. In a sense the wel­fare of the children is secondary because their well-being depends so much on the marriage relationship between the parents. As the primary value, the welfare of the marriage itself takes precedence over so-called ‘nature’ or the natural biological rhythms of reproduction, and it is tradi­tional Catholic morality that in a conflict of values the secondary must be sacrificed in favour of the primary. The right to life of a starving person takes precedence over the right to private property of the person whose food he takes without permission and seems to ‘steal.’

Essential factors in discernment

After the initial discussion of the couple’s overall situation there are five factors that need to be examined before it is possible to reach a responsi­ble decision. These are:

  1. the state of the marriage;
  2. motives;
  3. methods;
  4. consequences;
  5. circumstances

Only when all of these factors have been considered together can a deci­sion be reached. If the decision is responsible, it will be morally good, if irresponsible it will be morally bad. Without this kind of discernment, taking account of all the factors involved, it is difficult to see how a responsible decision can be arrived at. Unfortunately, large numbers of Catholics see Church teaching on responsible parenthood simply and solely as condemning artificial contraception, which is labelled as intrin­sically evil, never allowed.

Responsible parenthood, like responsible medicine, is morally con­cerned with motives and values, and only secondarily concerned with techniques or methods, namely: what is the best way to achieve the val­ues we cherish (life, marriage, children) with a minimum of harm done? When values clash, as they do in all areas of life, we have to find a respon­sible compromise. There are situations in which it is not possible to ensure that all values will be equally promoted: survival of the marriage, the physical or emotional health of the partners, the welfare of the chil­dren both present and future, and respect for the natural rhythm of reproduction, and in these cases the couple themselves have to decide togeth­er what is the best way of preserving the values in question, in keeping with their importance and the degree to which they are threatened. There can be no pre-packaged, slot-machine solutions to such intimate and personal problems. Each of the following five factors needs to be careful­ly examined.

  1. The state of the particular marriage. The marriage itself is the primary value to be protected and promoted, but marriages vary in their concrete reality, and it is their own individual marriage that is the concern of the couple, not some abstract notion of an ideal beyond their personal expe­rience. A particular marriage can be close, warm, solid, healthy and enduring, or doubtful, fragile, threatened, on the verge of breakdown. A decision valid for one marriage could be disastrous for another, and to ignore this is to act irresponsibly. A close, dedicated and highly motivat­ed couple might find that one of the natural methods of family planning suits them and even binds them closer together in their commitment, whereas the same method could wreck a fragile marriage because one or other partner could not bear the strain.
  1. The motives for avoiding or spacing children. There can be a variety of motives. They can be selfish or unselfish, serious, light or even down­right frivolous. It is not unknown that couples for whom the natural methods of family planning work easily and effectively use them with­out scruple for purely selfish motives, justifying their behaviour on the grounds that the method is ‘allowed’ by the Church, while condemning another couple whose circumstances require that they avoid conception at all costs, but for whom the natural methods simply do not work. All of the factors listed above under initial reflection could be motives or reasons for a couple to decide on some form of family planning. Responsible par­enthood requires that they evaluate the seriousness of their reasons. Although Pope Pius XII in 1951 spoke of the Christian duty to procreate, he recognised that there could be serious motives (medical, eugenic, economic and social) to justify a couple in avoiding a family for a long time, even for the entire duration of the marriage (although he had only periodic continence in mind as a means). In practice, a serious motive means a proportionate reason.
  1. The methods. Many methods are available and they need to be eval­uated from the point of view of effectiveness and It is necessary to know what they involve, how they work, and what probable or possible side-effects they have, not only immediate but also long-term. A couple for whom it is absolutely imperative that they avoid a family needs to find the most effective method of contraception possible, whereas a cou­ple whose reason for avoiding children is less serious might responsibly choose a less effective method. In the latter case an unplanned pregnan­cy might be harmful for the couple, but not a tragedy that would seriously damage their marriage or the children they already have. Where a particular method has dangerous side-effects, the couple needs to check whether the risk is certain, probable or just a possibility, and then to weigh the risk from the method against the risk of pregnancy and the seriousness of the harm feared from the pregnancy in their situation. Artificial contraceptives have side-effects that can be a serious risk to health, but in some cases natural family planning can involve risks, for example the strain on an already fragile marriage. Human life has never been without risk, and even commonly-used medicines can have unwanted side-effects. It is a question of weighing the risks against the benefits. Risk-taking is a normal part of everyday life. Moral responsibil­ity requires that the risks be evaluated, and that they be justified only by a proportionate reason.
  1.  The consequences, insofar as they can be foreseen: of the methods, of the decision, for the couple and for present or future children. We are respon­sible not only for our decisions and actions, but for the consequences that flow from them to the extent that we foresee them. To plead ignorance of them does not lessen responsibility if we could and should have foreseen them. For example, it is not enough to say that natural family planning is more in keeping with nature, or that it is favoured by Church teaching. It must be asked: what will it do to this particular marriage? and: are both partners committed to it and ready to accept all that it involves?
  1. The circumstances of the couple, for example, their age and their phys­ical and emotional health, and the many other factors mentioned above under initial reflection. Some of these may be quite serious and enter into the determining motives for family planning, whereas others may be simply circumstances needing to be kept in mind in the discernment. A couple who are both at critical points in their career might decide to post­pone a family. But if they put off their first baby until the wife is in her early forties they should know that having a first baby at that age can give rise to complications for both mother and child that could be seri­ous. Besides, if they wait a considerable number of years they may grow accustomed to such a level of social life that it would be difficult to adjust to the restrictions that the arrival of a baby can bring, or they may feel more like grandparents when the child becomes a teenager and they will find it difficult to cope. These may not be determining factors in their decision, but they need to be taken into account for a balanced judgment, a responsible decision.

Church teaching

It may seem surprising that Humanae Vitae is not listed among the five essential factors that need to be considered in a moral discernment about birth regulation. This is not because Church teaching does not matter or is only of secondary importance, but rather because it is presumed that Christians who take this matter seriously and wish to make a responsible decision will be influenced by their faith at every step of their discern­ment. Their Christian faith will give them a particular sensitivity to, and appreciation of, the basic values of life, married love, family and children.

They will have experience of these values in their own lives and have seen them reflected in the life of the Christian community which is God’s family. They can discover some beautiful insight-full passages in the encyclical about married love, but they will have known these already from their own experience of the faith, enriched by Catholic writings on the subject and by some of the documents of the Second Vatican Council. They know that Pope Paul’s encyclical is an important, authoritative statement of Catholic teaching on marriage and they will respect it and do their best to integrate it into their decision-making. Some may feel that they have to obey it when it condemns artificial contraception. But most adults know that obedience is the response to an order, a command, not to teaching. The respectful response to teaching is docility, openness, the willingness to learn and to be convinced. To act in serious matters with­out understanding and conviction is irresponsible and can be immoral.

But large numbers of married Catholics find that the teaching of the encyclical on contraception does not make sense in the light of their experience, and that its reasoning fails to convince them. In all good con­science they confess that no amount of good will or mental gymnastics can force them to see it as God’s will. If it is true, they believe that it ought to shine by its own light. Truth cannot simply be decreed, but only pre­sented and explained. The encyclical is described as teaching, but no teaching takes place until somebody learns. Those who have had the opportunity to study the encyclical know that the assertion that artificial contraception is intrinsically evil, wrong of its very nature and therefore never allowable in any circumstance, is based on a particular theory of natural law. If natural law is valid for the whole human race, it seems strange that only a tiny minority of Catholics can see it. When Church leaders claim that the Pope receives a special help from the Holy Spirit to understand natural law more fully than others, it seems even more strange, indeed a great pity, even tragic, that the Holy Spirit cannot give the extra bit of help to the Holy Father that would enable him to convince others of this deeper meaning of natural law. A later section of this chap­ter will return to the encyclical.

Natural methods

Birth control methods can be described as either natural or artificial. Nat­ural family planning is so called because it does not interfere physically with the reproductive system or the act of intercourse. It involves periodic abstinence from intercourse, during the fertile periods of the menstrual cycle. It is based on the fact that conception is possible only on certain days during the cycle. Avoiding intercourse during these days ensures that no conception will take place. Pinpointing ovulation, when the ovum is released from the ovary, is the key factor in determining the fertile period, but allowance has to be made for the fact that the ovum can  only be fertilised during the first few hours after its release, and the further fact that the male sperm is capable of fertilising the ovum for up to three days after intercourse, although some studies show cases in which the sperm retains its power to fertilise for up five or seven days. If the fertile period in each cycle can be calculated, conception can be avoided by abstaining from intercourse.

The first method used to identify the fertile and infertile days was the calendar method, based on the fact that ovulation occurs twelve to sixteen days before the beginning of the next menstrual period. By keeping a record of the varying length of the individual menstrual cycles over a certain length of time, for example six to twelve months, it is possible to estimate the date of ovulation and calculate the beginning and end of the fertile period. Because of the variations in the cycle, the formula cannot provide a mathematical certainty, so an element of risk is present.

Another method, the Basal Body Temperature method (BBT), is based on the fact that there is a noticeable rise in a woman’s basal body tempera­ture at the time of ovulation, which is maintained until the beginning of the next period. Allowing for the life-span of ovum and sperm, it is cal­culated that the time from the third consecutive day of the higher temperature until the onset of the next menstruation is infertile and therefore ‘safe’ for intercourse. It is claimed that if intercourse is restrict­ed to this post-ovulatory phase of the cycle (about ten days), the risk of conception is about 1 per cent, which is equivalent to the success rate of many oral contraceptives and much higher than that of condom or diaphragm. But couples wishing to avail also of the pre-ovulatory phase, determined by the calendar method, would have an increased risk of pregnancy.

A further advance in natural methods came from the work of Drs John and Evelyn Billings, based on the changes that take place in the cervical mucus during the menstrual cycle, making it possible to recognise the infertile days in the first, pre-ovulatory, part of the cycle, as well as those in the second part. This is known as the ovulation method. Its advantage is that it enables couples to make use of both first and second infertile parts of the cycle, although use of the first part is less reliable.

The most recent development in the area of natural family planning is a high-technology variation on the rhythm method, providing computer-guided advice on when to abstain from sex. It involves a hand- held monitor in conjunction with disposable urine-test sticks. A green light on the monitor indicates safe sex for the following twenty-four hours, a red light signifies that it is unsafe, and on eight days of the month yellow light signals the need for a urine test to measure the level of hormones associated with ovulation. Initial trials have shown very positive acceptance by women, and it seems that its reliability level is between at of condoms, which the World Health Organisation says is 88per cent, and that of some pills, 98 per cent.

It is difficult to get absolutely reliable figures for the effectiveness of the various methods of family planning, but Dr John Marshall, emeritus professor of neurology in the University of London, claims that the oral contraceptive is the most effective, reversible method of avoiding pregnancy, followed closely by the BBT method when intercourse is restricted the second, or post-ovulatory, infertile phase of the cycle. The Ovulation method may be equally successful when only the second phase is ed. The barrier methods of the condom and diaphragm come next in effectiveness, whereas the most risky methods are the BBT and Ovulation method when both the first (less reliable) and the second infertile phases of the cycle are used. Sterilisation and total abstinence seem to be the only infallible means to avoid a pregnancy; all others are less than ally reliable. In the case of natural family planning, a really successful ovulation indicator must be capable of indicating accurately the bounds of the fertile period, and to be of real service it must also be simple, cheap, painless, rapid, specific and reliable, and the phenomenon being measured must be recognisable in most women.

Artificial contraception

Artificial methods involve interfering with either the reproductive sys­tem or the reproductive act to prevent conception taking place. This may be done by:

1. Changing the reproductive system, either by surgical sterilisation (male or female), or drug sterilisation (anovulant pills which inhibit ovula­tion).
2. Interfering with the reproductive act by any of the following means: withdrawal by the husband before insemination; condom or sheath (used by husband to contain semen and prevent insemination); diaphragm or cap (used by the wife to close entrance to the womb); coil, spring or other intra-uterine device (IUD, generally thought to prevent implantation of the fertilised ovum, in which case it is aborti- facient); spermicidal creams, jellies, pastes, suppositories and foaming tablets, aerosols (all intended to kill sperms or to prevent them from reaching the ovum); douche (washing out after inter­course, practically useless, since a sperm may be in the cervix within ninety seconds of insemination).

3.The morning after pill, which attacks the already fertilised ovum or pre­vents its implantation in the womb. This is abortion rather than contraception.

In the sexually liberated 1960s the various anovulant pills were hailed as a miracle of science that would solve the birth control problem. But in recent years more and more evidence shows that many of the pills on the market have quite serious side-effects, especially when taken continu­ously over a period of years. They are far from simple, and it is not easy to discover the less harmful ones among the variety of types available. As chemical agents, spermicides have the same problem. Few are free of dangerous consequences. A mother in the US who sued the manufactur­er of a spermicidal jelly with the claim that her use of it was responsible for her child’s birth defects, was awarded $4.7 million in damages. More suits like this could mean that it would no longer be profitable for manu­facturers to produce such chemicals. Some US companies produce injectable contraceptives that prevent pregnancy for three months or up to five years which are sold in many countries around the world, but are not approved by the Food and Drug Administration. Many British mem­bers of parliament have asked the government to ban one of these, Norplant, because of its dangerous side-effects.

But producers learn from their mistakes and research continues to provide safer and more effective pills. Not all chemical contraceptives are so dangerous as to render their use automatically irresponsible. In 1973 it was reported that 36 per cent of married women preferred the pill to all other birth control methods, yet its use dropped by almost half in the following years. A medical survey recently showed that many con­traceptive pills do not increase the chance of breast cancer, even in high-risk groups, but very many women are still wary, perhaps rightly so.

An interesting development in the area of intra-uterine devices is that in early years products were removed from the market because they were inferior, but nowadays production of superior products has dropped because of the high cost of insurance for the manufacturers. It is claimed that the IUD has a failure rate of only 5 per cent in the first year of use, in contrast to 19 per cent for the diaphragm, 17-24 per cent for sponges, 18 per cent for spermicidal foams and jellies and 10 per cent for condoms, but on the other hand, not only are infections from IUDS quite numerous, but they have given rise to crippling lawsuits. One US com­pany spent $1.5 million in legal fees to defend itself in four cases, which they won, but another manufacturer spent $490 million on 9,450 lawsuits and had 6,000 further legal claims. Whatever is said about the effective­ness of this form of contraceptive device, it seems to have quite serious side-effects. Where IUDs are abortifacient, they cannot be considered as lawful means of birth control in the context of responsible parenthood.

Sterilisation

It is reported that at present in the US the most popular form of birth con­trol is sterilisation. It is claimed that one-third of sexually active women are either sterilised or have partners who are. It does not seem to have major side-effects, and for those who have serious reasons for sacrificing their reproductive capacity it could be the most satisfactory solution. An example of a not infrequent case is the mother of two with a blood disor­der which made any pregnancy and birth a serious risk to her life. She used natural family planning for years, but without much success, resulting in two children and ten miscarriages. Added to the strain of observing the method was the major fear for her health and future each time she became pregnant. She had a loving, caring husband, but this recurring fear, lasting for the duration of each pregnancy until it ended in miscarriage, left both partners so tense that their marriage was seriously affected. Doctors assured her that she would continue to conceive for another twenty years but would never bear a live baby. Sterilisation solved her problem and the couple have had a totally new experience of marriage ever since. The wife, understandably, gets quite angry when she hears some clerics criticise her decision, accusing her of mutilation and of interfering with nature. Sterilisation removed her capacity to con­ceive, but the doctors told her that it was nature itself which deprived her of the ability to produce a live child. She prefers realities to philosophical abstractions.

Unpublicised consequences

Many people choose natural family planning in preference to artificial contraceptive devices because it seems more natural, has less dangerous side-effects and has a high rate of reliability when used faithfully. For Catholics it also has the approval of the Church, thus relieving them of the risk of a guilty conscience in not following Church teaching. They know that it involves considerable sacrifice on their part, but some cou­ples see this as a challenge to their love and find that it can deepen their commitment to each other. The experience of such couples has to be accepted and respected, but some supporters of natural family planning present that experience as the norm, suggesting that, with effort and good will, it could become the experience of every couple using the nat­ural methods.

Very many couples and some pastors and marriage counsellors know another side of the reality, but unfortunately they seldom speak of it pub­licly. The question arises: do theologians and Church leaders realise just how serious the other side of the picture really is? The negative conse­quences of natural family planning are not simply the unfortunate result of human weakness or ignorance on the part of the occasional couple. They are of sufficient importance to warn us against absolutising any one method of family planning to the level of God’s plan for all people, espe­cially as God has said nothing about the matter. The question may be asked: can it be God’s will that people have to suffer so much in such an intimate area of their lives in order to be loyal, not to the Church as the community of God’s holy people, but to an item of teaching that has nothing to do with divine revelation, and is not convincing to the vast majority of Catholics, including some cardinals, bishops, priests and reli­gious, and most of all, to those married Christians who alone have personal experience of the reality in question? To speak openly of the dif­ficulties of the natural methods does not mean that they should not be used, that they are not reliable, or that they are in some way inferior. On the contrary, natural family planning has very positive values and can certainly be recommended, and in some ways it is better than artificial contraception. But for a responsible decision, people need to know all the facts of a situation in order to evaluate what is involved. Decisions about family planning are difficult enough for most couples, but they should not be made more complicated by hiding significant facts.

It would be easy to quote some case histories from personal experi­ence, but they could be dismissed as general impressions from a few exceptional couples. Fortunately, we have the testimony of an impecca­ble witness, a dedicated Catholic of unquestioned integrity and love of the Church, who has done a major service to the Church in publishing a short book called Love One Another, Psychological Aspects of Natural Family Planning. (1) It is a fascinating book. The author, Dr John Marshall, is emeritus professor of neurology in the University of London, and was a member of the original commission of six people established in 1963 by Pope John XXIII to study the question of birth control. He has the added qualification of forty years of teaching natural family planning by corre­spondence and has had the written and oral confidences of over ten thousand couples who shared their experience with him. Summarising that vast amount of human experience, he says that for some, it was lib­erating and fruitful, but for others it was destructive of their relationship and the cause of much suffering and sorrow. Dr Marshall maintains that this unique archive of human experience should be made available to those who teach natural family planning and to those who practise it. But it should also be studied by Church leaders and all those who debate the subject, especially to those who speak too glibly about ‘natural law.’

Survey

Dr Marshall reports on a survey carried out from the headquarters of the Catholic Marriage Advisory Centre in London in 1965-67 involving over five hundred couples following the BBT method. Statistics were com­piled of the success/failure rate of the method, distinguishing between couples who used only the post-ovulatory infertile phase of the cycle (most reliable), and those who used both pre- and post-ovulatory infer­tile phases, and taking account of those who kept the rules strictly and those who did not. Among those who used only the second phase and kept the rules strictly there were only 1.2 accidental pregnancies per 100 women per year, and 4.2 for those who were less strict in keeping the rules. For those who used both phases, and therefore took a greater risk of conception, the numbers were 5 pregnancies per 100 women per year for those who kept the rules and 13.3 among those who were careless. In terms of effectiveness, the figure of 1.2 for those who were able to accept a longer period of abstinence and were faithful to the timetable is a sig­nificantly high success rate of the method.

This survey was followed up by a further investigation involving a questionnaire sent separately (to preserve anonymity) to the wives and husbands who had taken part in the field-trial. The response was an unusually high 82 per cent. When asked whether they experienced anxi­ety about a possible pregnancy when using the method, three-quarters of the women answered ‘Yes,’ but once the learning period was over just over 40 per cent of both men and women responded that they still wor­ried. Asked about the difficulty of abstinence, over half the men said it was often difficult and a slightly higher percentage of women said they sometimes found it difficult. Only 1 per cent of men and 8 per cent of women replied that they never had difficulty with abstinence. When asked whether the method had any effect on their relationship, almost 70 per cent of both men and women said it had no effect, but a quarter of both men and women reported that it had a bad effect. A high proportion of both sexes said that they were more conscious of sex during the peri­ods of abstinence. When asked if they engaged in forms of love-making short of intercourse during periods of abstinence, almost 90 per cent of both men and women said ‘Yes,’ and over 40 per cent admitted that this sometimes led to orgasm, even though orgasm was not sought, but even resisted.

A common criticism of natural family planning is that it removes spontaneity in love-making and intercourse, but more than half of the men and women in this survey said that this was not true in their experi­ence. About a third felt that spontaneity was indeed impaired and they felt they could not express their love adequately during periods of absti­nence. Over 60 per cent of men and women felt that their appreciation of intercourse was greater after abstinence. Overall the survey showed a very positive judgment of the BBT method, with 66 per cent of men and 75 per cent of women asserting that they found it satisfactory, whereas less than a quarter found it unsatisfactory. Three-quarters of both men and women in the group said that the method had helped their marriage, whereas less than one in ten found it a hindrance. This is indeed high praise for the method, which is often criticised unfairly. Many of the people who use it are enabled to regulate the size of their family in accor­dance with their needs, and in many cases its use improves the marriage relationship.

Facts behind the figures

The above statistics give a fairly positive picture of the effectiveness of the BBT method, but they do not speak of the price to be paid for this effec­tiveness. One has to read the letters behind the figures to get some grasp of the strain and heart-break caused by the high degree of abstinence required. While some couples express satisfaction with their experience of the method as a whole, a large number recount sad stories of disap­pointment, frustration and anger at not being able to comfort their partners as they would wish in moments of serious need. One couple found the method quite effective in spacing out their three children, but the efforts required over several decades left them emotionally crippled to the point where in the freedom of the post-menopause years they had become incapable of even the simplest physical expressions of affection. A particular hardship was experienced by those cases in which the hus­band’s job required that he be away from home for a week or more at a time, but more than six months could pass before his home visits would coincide with his wife’s ‘safe’ period. Is it not a serious misuse of lan­guage to describe this as ‘natural’ when the couple concerned felt it was totally unnatural?

This couple and others like them could well feel that although they were obeying the laws of the Church by using the safe period, they were being unfaithful to the vows they took before God on the day they were married. Fidelity to this so-called ‘natural law’ proclaimed by the Church prevented them from experiencing their marriage as the ongoing sacra­ment that it is meant to be, a powerful sacrament of affirmation, healing and growth. Some of the couples had such a negative experience of nat­ural planning that they changed to the pill to save their marriage. One mother described how she felt a hypocrite going to the sacraments as a ‘good Catholic’ because she was using the natural methods, but felt guilty knowing how un-Christian her home life was with all the bicker­ing and tension. She and her husband decided that the family came first, so they changed to the pill, and they are convinced that they are now fol­lowing God’s will in good conscience.

Authority of the facts

It is tempting to continue the list of cases, but the reader should study Dr Marshall’s unique collection of these very special human experiences. One is saddened by the fact that all of this valuable experience seems to have had no influence whatsoever on the writing of Humanae Vitae. With so much emphasis on authority in the debate, it is incredible that the most important authority of all, the authority of the facts, was totally ignored, and almost thirty years later is still seldom recognised. In fact, the papal commission that preceded Humanae Vitae was provided with first-hand accounts of the experience of married people. One of the three married couples invited to be part of the commission, Patrick Crowley and his wife Patty, the lead couple responsible for the phenomenal growth of the Christian Family Movement in the US and throughout the world, pre­pared for their task by collecting three thousand letters from Catholic married couples from eighteen countries, describing their experience. They were from devout members of the Christian Family Movement, dedicated Catholics active in their parishes who met regularly to share their faith. Just recently Patty asked author Robert McClory to write her experience, the inside story of the papal commission (Turning Point). (2) It complements and reinforces Dr Marshall’s book.

Patty says that she and her husband were shocked by what they learned from the experience of those they contacted. They could not believe the hardships people were going through to be faithful to Church teaching in the matter of birth control. She was even more shocked at the reactions of the few minority group theologians on the commission who seemed to have their minds made up and did not want to be confused by facts. Their glib response was that ‘hard cases make bad laws.’ A humor­ous note was the fact that the three married couples were obliged to celibacy while in Rome, since the husbands and other male members of the commission were housed in the Spanish college while the wives were lodged in a convent a mile away. The books of Marshall and McClory are essential reading for an understanding of the genesis and context of Humanae Vitae. They provide material seldom acknowledged by Church leaders and they show how Catholics fully committed to Catholic teach­ing and supportive of the Church came to change their convictions about its teaching on birth control.

Most of the theologians on the commission were deeply impressed by the dossier of information and felt that it was relevant to the business of the commission. But the traditionalists held to their narrow philosophi­cal view that the meaning of human intercourse in the context of married love could be defined unmistakably, infallibly, without reference to the experience of committed married Catholics. A sad but humorous note was introduced during a debate by the impatient outburst of the Spanish theologian, Fr Zalba: ‘What becomes of the millions we have sent to hell if this teaching is not valid?’ Courteously Patty Crowley asked him: ‘Father Zalba, do you really believe God has carried out all your orders?’ But she was up against a Church convinced that it had all the answers, even before hearing the questions or looking at the facts. A perfect exam­ple of this attitude was the visit of Mgr George Kelly, a member of the expanded commission, well known for his marriage apostolate, who flew in to Rome to read a document on the evil of contraception, and returned to New York the following day without any dialogue with the commission that had been discussing the matter for months. He made no secret of the fact that he objected to people like the Crowleys, Dr Marshall and even experts in a variety of human sciences being members of the commission, since he claimed that birth control was a moral matter, to be decided solely by the teaching authority of the Church.

Laity ignored

When the Second Vatican Council discussed marriage, Pope Paul VI removed the question of birth control from the agenda and reserved it to himself, because, he explained, he wanted to hear the results of the spe­cial papal commission that had been set up in 1963 to study it. The original group of six were convinced that the Church would not change its traditional teaching, and they saw rhythm as the Catholic solution. The commission was expanded to fifteen members the following year and most of these believed that the pill could not be approved. In 1965 there were fifty-eight members, and for the final session in 1966 there were seventy-two. It included fifteen cardinals and bishops, as well as priests, lay men and women, including three married couples, people whose expertise covered a wide area of philosophy, theology, scripture, law, history, medicine, biology, psychology, sociology and economics. Many were involved in teaching natural family planning, and the major­ity at the start supported traditional Church teaching, but they changed their stand totally in the course of the discussions. In the 1965 sessions the commission came to understand how the Church had changed over the centuries in its approach to sex, marriage and procreation. The following year the theologians voted that Casti Connubii could be reformed, and everyone began to question the benefits of the rhythm method. In the end, the vast majority agreed that contraception was not intrinsically evil, and that the Council should remove the ban on contraception. Car­dinal Doepfner, one of the most outspoken members, declared that Casti Connubii (1931) was not infallible, but was subject to doctrinal develop­ment, just as the Council accepted religious freedom in spite of the Church’s very different record in the past.

The voting was practically unanimous. Even the four theologians who favoured holding on to the traditional position had to admit that they had no arguments to prove the majority wrong, except that to change the teaching would damage the authority of the Church, which cannot admit that it ever made mistakes. This seems to have been the fear that prevented Pope Paul VI from making any change in the teaching when he wrote Humanae Vitae. The media at the time spoke of majority and minority reports from the commission, but there was never any minority report. There was simply a private letter to the Pope, after the commission was disbanded, signed by the four priests who repudiated the official report of the commission; it was an unauthorised alternative report to the one presented officially to the Holy Father as the almost unanimous view of the cardinals, bishops, priests and laity who formed the commission. The traditionalists kept up private pressure on the Pope long after the commission had finished its work. One of these is reported to have boasted to friends that Pope Paul was open to change and was almost convinced by the report of the commission, but he would give in to the traditionalists eventually, and this seems to be what happened. In fact, the many draft texts used by the Pope to help him write Humanae Vitae were mostly the work of representatives of the minority opinion which repudiated the report of the papal commission. Members of the commission were disturbed at the rumours they heard of their report being ignored. Bishop Reuss begged the Pope to publish the documents of the commission, but this was refused. Cardinal Suenens warned the Pope that if the Vatican continued along the line it seemed to be taking, the Church would have not only a credibility gap, but a credibility chasm.

One can sympathise with Pope Paul, so deeply conscious of his responsibility for the unity of the Church and his duty to safeguard its teaching. He later admitted that the years leading up to his final decision in 1968 were the most agonising of his life, causing him great spiritual suffering. He said that he had written the encyclical with a feeling of love and pastoral sensitivity for married couples. Could he have foreseen the earthquake which Humanae Vitae provoked in the Church? It brought about perhaps one of the greatest crises of conscience that the Church has ever experienced. Although it was not an infallible pronouncement, Pope Paul asked that the teaching be accepted with respect. But no teach­ing takes place unless someone is taught. The question should be asked: what can the Church learn from the experience of this encyclical and its aftermath? Bishop Christopher Butler, one of the most respected partici­pants in the Second Vatican Council, asserted that the fact that the encyclical was not ‘received’ by the Church could be seen as ‘invalidat­ing’ its teaching.

Teaching rejected

In the conclusion of his encyclical, Pope Paul invited bishops to uphold this teaching of the Church, exhorted priests to give an example of obe­dience by preaching it, assured married couples that the grace of the sacrament would help them to follow it in spite of its difficulty, and he appealed to doctors and scientists to show that there can be no contra­diction between God’s law concerning human reproduction and the fostering of married love. The factual position in today’s Church makes one wonder if all of these appeals fell on deaf ears. Many episcopal conferences (surely a recognised part of the teaching Church) issued pas­toral statements to help people understand the encyclical and they considerably softened the declaration of paragraph 14 condemning all artificial means of contraception. It is an open secret that many cardinals and bishops today (like most of those on the papal commission) are not convinced of the teaching on this point, but out of loyalty to the Church or fear of offending the present Holy Father, will not admit this publicly. Cardinal König, the retired archbishop of Vienna, is an exception. In a debate with Cardinal Ratzinger in 1992 he dismissed the ‘irritating dis­tinction between artificial and natural contraception’ and declared that on the question of birth control we have ended up with a bottleneck mostly because of this distinction, almost as if the morally important thing is the ‘trick’ of cheating nature.

A large majority of the world’s foremost theologians no longer accept that artificial contraception is intrinsically evil, but are forced to be cir­cumspect about their views lest they lose their teaching posts. Shortly after the encyclical was published, over 600 US theologians and other academics, some of the most outstanding in the country, signed a docu­ment saying that ‘spouses may responsibly decide according to their conscience that artificial contraception in some circumstances is permis­sible, and indeed even necessary, to preserve and foster the value and sacredness of their marriage.’ Soon afterwards a group of equally emi­nent European theologians with world reputations, signed a similar declaration. Had some not signed it, it is highly probable that they would be bishops today. When in 1987 Pope John Paul II declared that the Church’s teaching on contraception is not open to free discussion among theologians, there was a formal protest by 163 theologians from Ger­many, Austria, the Netherlands and Switzerland (The Cologne Declaration), and this was endorsed by 130 French theologians, sixty Spanish theologians, sixty-three Italian theologians and 431 members of the Catholic Theological Society of America. In many countries up to 80 per cent of married Catholics do not accept the teaching. Confessors report that while formerly contraception was an agonising concern in the confessions of Catholics, it is seldom even mentioned as a scruple nowa­days. This situation ought to be a cause for concern in a Church which claims to be a sacrament of Christ, the Way, the Truth and the Life, a Church committed to radiating joy and hope, confident in the belief that perfect love casts out fear.

It has been remarked that the continued repetition in the strongest terms of the condemnation of artificial contraception is reminiscent of the marginal directive once found in a preacher’s sermon notes: ‘Argu­ment weak here, shout like mad!’ In spite of Pope Paul’s appeal for more study and research to strengthen his teaching, the past three decades have not produced a single argument to move it a step forward or to make it more convincing. Indeed, the sad fact is that in all these years people seldom heard a worthwhile explanation of the Vatican II teaching on marriage and what responsible parenthood in the full sense really means. The fear and lack of openness surrounding the subject have not lessened over the years. The one-metre high pile of documentation from the papal commission that preceded Humanae Vitae has unfortunately never been published, so the facts assembled by all those experts and especially the rich contribution of so many dedicated married Catholics are omitted from discussions of the subject. It is not clear that Pope Paul would have had time to study it all in detail. At the 1980 Synod of Bish­ops on the subject of the family, Cardinal Basil Hume insisted that married couples, who have experience of marriage, are an authentic the­ological source to be listened to in any discussion on family life. He pointed out that their problem was not frailty or weakness of will, but the fact that they simply were not convinced that the use of artificial contra­ceptives is in all cases intrinsically disordered. He suggested that if the synod would listen to all the different points of view it would find a solution.

At the same synod Archbishop John Quinn of San Francisco declared that many couples of good will did not accept the intrinsic evil of each and every use of contraception, and he said that the same conviction is to be found among theologians and pastors whose learning, faith, discre­tion and dedication to the Church are beyond doubt. Sadly, these two prophetic voices, so much in tune with what the Church ought to be, either were not heard or were deliberately excluded, and there was no ‘listening to all the different points of view.’ In fact, the synod was so orchestrated that no real dialogue was possible. The traditionalists were still in control in the Vatican. The encyclical produced after the synod shows no sign of any influence from the laity, or any reference to their married experience. Indeed, some commentators claim that it could have been written in the same terms even if the synod had never taken place. The teaching Church will continue to lose credibility until it gives more convincing evidence that it is also a listening, learning Church. How can it be asserted that Church leaders are listening to the gospel and to the Holy Spirit if they cannot listen to their lay brothers and sisters who make up the vast majority of Church members and are uniquely qualified to speak of their experience as people who live the sacrament of matrimony?

Disillusion

According to Robert McClory’s study, the members of the papal com­mission were not only surprised, but shattered that their three years of hard work seemed to count for nothing. It seems that the Vatican never even thanked them for it. McClory says that many of them have become more and more disillusioned since then, because instead of trying to develop the teaching of Humanae Vitae with supporting arguments, the Church seems to discourage and even suppress any real discussion of it. Apart from the difficulties people experience with the so-called natural methods of family planning, with their psychological, marital and aes­thetic ill-effects, there are inconsistencies and contradictions in the encyclical itself. Pope Paul said that he could not accept the conclusions of the papal commission because it put forward criteria for resolving the birth control question that departed from the Church’s teaching. But he never said what these were, nor have they ever been made public by the Church since then, so the question cannot be debated.

After condemning absolutely any action before, during or after inter­course which would prevent conception, the encyclical in the next paragraph says that therapeutic actions which produce the same effect are quite lawful provided this effect is not directly willed. In other words, it is lawful to take contraceptive pills as therapy, for example to regu­larise the female cycle. A Vatican spokesman said that, on this principle, religious sisters in danger of rape in a war situation could take contra­ceptive pills as preventive therapy. But contraceptive pills act according to nature in its chemical and physiological laws to inhibit ovulation in these cases just as they do when taken as contraceptives. If contraception is ‘intrinsically evil’ then there can be no exceptions. But if the good intention of therapy makes it less evil, then the good intention of saving a marriage, protecting the mother’s health, or safeguarding the upbring­ing of children should also qualify as justifying reasons for the pill as a method of family planning. As explained in an earlier chapter, the phrase ‘intrinsically evil’ is rejected by most theologians today as misleading and unfounded. An action cannot be described as morally evil of its very nature, in all circumstances, without reference to its human meaning, therefore to the intention, context and consequences. Why should the reproductive system be more sacred than a person’s life? Human life is sacred, but tradition has accepted that in some situations it may be sacrificed. Life is a near-absolute value, but this does not give rise to an absolute moral norm. The papal commission that spent three years studying the matter came to the conclusion that, with the exception of abortion, no method of birth control can be called intrinsically bad or good. Its moral value depends on how and why it is chosen as a means in die exercise of responsible parenthood.

What is natural?

Chapter 5 should warn against a too facile, indeed a mistaken, recourse to natural law to justify natural family planning and condemn artificial methods. To label something immoral, and intrinsically evil, because it is artificial, a frustration of a natural process, seems arbitrary when most of human activity in today’s world involves artificial materials and tech­niques, and modern medicine is continually interfering with nature to improve the total nature and overall good of human persons. Moreover, we are more aware nowadays that many things which in the past were labelled ‘natural’ were simply chosen on the basis of the prevailing cul­ture and then labelled as natural. Classical moralists preached that our behaviour should conform to ‘what nature teaches all animals,’ but in fact nature teaches nobody anything; it is an abstraction. For centuries it was taken for granted that certain sexual activities like male and female homosexual behaviour and masturbation were aberrations introduced by human free will, but not found in nature, among animals. We now know that all kinds of sexual behaviour are to be found among animals. Those who quote nature as God’s will should be reminded that there is a species of chimpanzee which avoids all aggressive behaviour by having immediate recourse to sexual activity (both heterosexual and homo­sexual, male and female) whenever a conflict flares up, which results in one of the most peaceful examples of communal life in the animal king­dom. In what sense can ‘nature’ be a guide to morally good behaviour for humans?

A further misunderstanding was that all laws of nature follow a physical one-to-one, cause-and-effect pattern, whereas in human repro­duction nature’s pattern of coition and conception is a matter of statistical probabilities, so that the vast majority of acts of intercourse do not lead to conception. Interfering with these probabilities (or taking advantage of them), which is what the various natural methods do, is as artificial as taking the pill to alter nature. If it is wrong to set up a barrier against conception, what moral difference is there between a physical or chemical barrier (artificial) and a temporal or time barrier (natural methods)?

Most people would prefer to enjoy the spontaneity of love-making in their marriage, but the pressures of modern life make this almost impos­sible. Their concern with birth regulation is not necessarily the result of selfishness, but mostly because of economic necessity, and of more com­plex changes in society, like their desire for equality, their need for sexual fulfilment, and the emancipation of women. People who, through no fault of their own, but out of responsibility for their marriage and family, are forced to practise some form of birth control are understandably angry when Humanae Vitae assures them that, ‘as all honest men know’ the use of artificial methods leads to infidelity and a decay of morals, and tempts husbands to treat their wives as mere sex objects. This is not the experience of responsible parents. They may well ask: if the Holy Spirit can be so wrong about the psychological effects of birth control, how can we trust that same Spirit on the more difficult subject of natural law?

The Holy Spirit

The Humanae Vitae experience caused an earthquake in the Church. It was a shattering experience for the dedicated members of the papal birth control commission to see all their hard work totally rejected. The married Catholics for whom it was an agonising problem of conscience were left with a heavier burden and an even more acute dilemma. It was a major blow to the many world-class theologians who had studied the subject for years and had become convinced that the traditional teaching had no convincing arguments. For many of these it was not just an intel­lectual setback but a test of their love of the Church, and some were so deeply affected that it had repercussions on their health. Time has soft­ened the pain so that it is now possible to see that in spite of the suffering, it has benefited the Church. It has helped people to relativise some of their false absolutes and encouraged them to experience more deeply the meaning of personal conscience.

Those who defend the encyclical emphasise it as ‘the teaching of the Church,’ but teaching is not limited to words. The way in which the prob­lem was treated and the document was written is also Church teaching, giving rise to the question: where was the Holy Spirit in all of this? It is difficult to accept that the Holy Spirit should ignore the world gathering of bishops in the Second Vatican Council, pay no attention to the special papal commission set up to study the question, allow the many volumes of testimony from committed married Catholics from all over the world to sink into oblivion, and work exclusively through a tiny intransigent group convinced that the Church should never change, a group which worked in almost total secrecy and who finally got their way by playing on the fears of Pope Paul VI. In spite of, or perhaps because of, agonising for years over the gap between ‘Church teaching’ and the demands of responsible parenthood, many Catholics are now experiencing a special presence of the Spirit in the joy and peace of a good conscience.

Our changing Church

Responsible parenthood was studied in this chapter as a concrete exam­ple of moral discernment, but it can also serve as an example of ‘changing morality.’ Sacred scripture has absolutely nothing to say about contraception, but the history of the Church shows that the topic was always a moral problem for its members. John T. Noonan’s master­ly study, Contraception: A History of its Treatment by the Catholic Church,3 makes it clear that it is difficult to speak of a ‘constant teaching of the Church’ on the matter. Even when the teaching seemed to be the same, there were radical changes of emphases and a whole variety of reasons given for condemning different practices. Cultural conditioning and simple ignorance are clear in the more bizarre formulations of the teach­ing. The teaching was always a mixture. Aquinas could lyrically write that ‘there is something miraculous in a man finding in one woman a pleasingness which he can never find in another,’ and at the same time maintain that the sole reason why God created women was for child­bearing, because in all other things a man finds a better help-mate for himself in another man than in a woman. He went on to condemn as immoral any position in intercourse other than the ‘natural’ one of the man on top. The Vatican II understanding of married love cannot be called the ‘constant teaching of the Church,’ since it was only officially accepted, against opposition, at the Council itself. Moreover, contracep­tion as we know it nowadays was unknown in the past. In 1930 Pius XI in Casti Connubii condemned all forms of contraception without excep­tion, whereas twenty years later Pius XII allowed the rhythm method for serious reasons, and in time this came to be proclaimed as God’s will for all marriages.

Not only did the teaching change over centuries, but Catholic experi­ence also changed considerably in the present century. Large numbers of married Catholics during the first fifty years lived in scrupulosity and fear, and many women abstained from Holy Communion for most of their reproductive years because they could not make a sincere purpose of amendment in confession knowing that they had no choice but to con­tinue acting against Church teaching to save their marriage. Even when Pope Paul VI in Humanae Vitae encouraged them not to lose heart but to come to confession frequently, they still held back as they felt that this would mean treating the sacrament as a mere guilt-shedding process without any genuine purpose of amendment. There may be some people who are still troubled in conscience, but today most couples simply decide on the contraceptive method that in their circumstances suits them best in their efforts to live good married lives, and in all good con­science they feel no need to confess it as a sin. This is a major change in the life of the Church and there are no indications that it can be reversed.

Those who believe in the Vatican II images of the Church as the people of God, a communion of brothers and sisters, all equal in the Lord, a pil­grim people seeking the Truth and trying to be faithful to the Way, find it hard to accept as God’s will a teaching that is so much at variance with their daily experience and their God-given intelligence. They know that truth cannot be decreed, but only discovered, shared and explained, whether it be called divine truth or human truth. In the area of revealed truth, the Church, in the person of Pope or Council, can only define what is already the faith of the Church, of the believing community. That is why such definitions need time, to mature and to become clear. In the area of morals the Church should be a little more humble in claiming to know God’s will. Its teaching might be all the more forceful and convinc­ing if it were presented a little more tentatively and humbly, remembering the many terrible things that in the past were presented as ‘the teaching of the Church.’

One of the better consequences of the crisis provoked by Humanae Vitae is that it has encouraged people to take more seriously the question of personal conscience. The really sad effect is that in the three decades since its publication so much time and energy have been wasted on the subject of contraceptive methods that the good news about human sexual­ity, Christian married love and family life is seldom heard. We can easily forget that God’s love becomes incarnate in people who touch our lives with love, and that the sacrament of husbands and wives, parents and children is a place in which this is experienced in a totally unique way.

Notes

  1. John Marshall Love One Another, Psychological Aspects of Natural Family Planning  Sheed & Ward  London,1996.
  2. Robert McClory Turning Point, Crossroad Publishing Company New York,1995
  3. John T. Noonan, Contraception, A History of its Treatment by the Catholic Church, Harvard University Press,1965.