The use of contraceptives – the deliberate interference with the natural process of fertility in order to prevent conception

-  is widespread across the global community. Hormonal contraceptives are considered convenient and effective
methods of spacing children – or even not having children at all. Meanwhile, barrier methods of contraception are hailed
as the answer to international problems such as AIDS and other Sexually Transmitted Infections (STIs). Together, both
methods allow individuals to exert full control over their reproductive lives. However, the effects of widespread
contraceptive usage are perhaps not as clear as they first seem. Hormonal contraceptives come with their own health
risks – some of which will remain unknown. They also raise a host of medical questions concerning their mechanism of
action (how the contraceptive actually works) and whether or not contraceptives have an abortifacient effect (a drug
which allows conception to occur yet renders the woman’s womb hostile to implantation – effectively, working as an
early abortion). This is particularly problematic for Judeo-Christian or Islamic tradition where life begins at conception.
Yet, the ethical questions arising from contraception are by no means confined to questions of health. The increased
usage of contraception has contributed to a new understanding of the role of sexual intercourse, the family and the
notion of responsible parenthood – all of which bear intimately on the functioning of society as a whole.

Introduction to the contraception debate

The arguments about contraception fall into several groups:

 philosophical arguments such as the "natural law" argument

 arguments based on different ideas of marriage, sex and the family

 human rights arguments such as

 'procreative liberty'

 a woman's right to control her own body

 human rights arguments about mass birth control programmes

 arguments based on the good or bad consequences of birth control (consequentialism)

 arguments about the environmental and resource problems caused by over-population

 religious arguments
Summary of the arguments against contraception

Those who say contraception is morally wrong do so for a variety of reasons.

Contraception is inherently wrong

 Contraception is unnatural

 Contraception is anti-life

 Contraception is a form of abortion

 Contraception separates sex from reproduction

Contraception brings bad consequences

These are consequentialist arguments against contraception.

 Contraception carries health risks

 The "contraceptive culture" is dangerous

 Contraception prevents potential human beings being conceived

 Contraception prevents people who might benefit humanity from being born

 Contraception can be used as a eugenic tool

 Contraception is often misused in mass population control programmes in a racist way

 Mass population control programmes can be a form of cultural imperialism or a misuse

of power

 Contraception may lead to depopulation

 This sounds odd to an age concerned about overpopulation but for substantial parts of the
1800s and 1900s this was a real fear.

Contraception leads to "immoral behaviour"

 Contraception makes it easier for people to have sex outside marriage

 Contraception leads to widespread sexual immorality

 Contraception allows people (even married people) to have sex purely for enjoyment

Arguments based on life and the natural order

Contraception is unnatural

Holders of this view argue something like this

 the natural consequence of having sexual intercourse is conceiving a child

 it is wrong to interfere with this

 therefore birth-control is intrinsically wrong

This argument depends on two other ideas:

 there is some purpose to the processes of the universe

 Opponents say this is a religious idea rather than a secular one - most scientists regard the
idea that there is a purpose to the universe as nonsense

 it is wrong to interfere with the natural order of the universe

 Opponents say that human beings interfere with the natural order of the universe all the
time (for example when doctors cure illnesses) - sometimes the results are good and sometimes bad

 Therefore birth control is only a wrong interference with the natural order of the universe if it
produces a bad result

 so it's necessary to look at the consequences of contraception to assess whether it is good or

bad

 that is a different argument, which has nothing to do with the natural order of the universe

Contraception is anti-life

This argument is based on the premise that life is a good thing. Holders of this view argue that
contraception is morally wrong because:
 life is a fundamental good - it is a good thing

 those who use contraception are engaged in an intentionally "anti-life" act

 because they intend to prevent a new life coming into being

 they therefore have a bad intention

 it is always morally wrong to do something with a bad intention

Contraception is a form of abortion

Some birth control techniques can operate by preventing the implantation and development of a
fertilised egg.

Those opposed to such methods say that this amounts to an abortion, and that if abortion is
wrong then those forms of contraception must also be wrong.

The forms of contraception included in this objection are:

 some birth control pills

 most modern birth control pills can prevent implantation of a fertilised egg, even though this is
not the main way they work

 there is no way for the user to know after any act of intercourse whether the pill prevented
implantation (or worked in some other way)

 therefore using such pills always runs the risk of causing an abortion

 it is wrong to run the risk of causing an abortion

 the "morning-after" pill

 this is also capable of operating by preventing implantation of a fertilised egg

 the IUD

 this can operate by preventing implantation of a fertilised egg

 Arguments based on sexual behaviour and health

 The danger of the "contraceptive culture"
 Some people are concerned that "the availability of contraceptives leads to promiscuity
which then leads to abortion".

Contraception carries health risks

Contraception may damage the health of the individual using it in two ways; either through side
effects of the contraceptive or because using contraception allows people to have more sexual
partners and thus increases the possibility of catching a sexually transmitted disease.

Side effects

Some forms of contraception do have side effects that damage health while others have not been
shown to have health risks.

Users considering a particular form of birth control should:

 make sure they are aware of its risks

 compare those risks to the risks of other forms of contraception

 compare those risks to the risks that go with having a baby

 take an informed decision based on that information

This is probably not an ethical objection to contraception itself, although it does involve the ethical
issue of informed consent to medical treatment.

STDs

The second interpretation of this objection is that contraception increases health risks because it
makes it more likely that people will have multiple sexual partners.

This increases the risk of individuals catching sexually transmitted diseases, and increases the
opportunities for such diseases to spread in the population.

Contraception makes it easier for people to have sex outside marriage

This is certainly true, since sexual intercourse without contraception carries a significant risk of
conceiving a child, which most of those having sex outside marriage would regard as a deterrent.

People think separating sex from marriage is wrong because:

 it makes immoral behaviour less risky

 it undermines public morality by making it more likely that people will have sex outside
marriage

 it weakens the family

Contraception is not wrong

Condoms

The moral case for contraception is largely based on the absence - in the eyes of supporters - of
any good reason for considering birth control morally wrong.

But there are many positive reasons why people believe that it is right to allow people to practice
birth control.

Human rights benefits

 it's essential for "procreative liberty"

 if people are not allowed a choice over whether or not to have children, their autonomy and
freedom to control their lives is seriously restricted

Health benefits
 it prevents the conception of unwanted children

 and so reduces the number of possible abortions

 it enables women whose health would be at risk if they conceived, to continue to have sex

 the use of condoms helps prevent sexually transmitted diseases and HIV
Family benefits

 it prevents the conception of children that a family cannot support

 it enables people to avoid having more children than they want

 it improves marriage because

 it enables couples to enjoy the unitive function of sexual activity without being anxious about
conceiving a child

 it enables couples to have fewer children and thus spend more time together and with the
children they do have

 it reduces the cost of marriage (children are expensive)

Benefits for women

 it promotes gender equality and the autonomy of women:

 pregnancy and child-rearing affect women much more than men

 women should have the right to choose or avoid these activities

 any restriction of birth control is therefore sexual discrimination

 it promotes gender equality and the autonomy of women:

 it enables women to enjoy sexual activity on the same basis as men

 any restriction of birth control is therefore a denial of women's right to sexual autonomy

 it promotes gender equality and the autonomy of women:

 without contraception a woman may find herself having regular pregnancies

 this leads her to remain economically dependant on her partner

 it enables women whose health would be at risk if they conceived, to continue to have sex
Demographic benefits

 it enables world population to be controlled and thus protects the environment and reduces
poverty

 many people think this is a dubious benefit, and point out that fairer use of the world's
resources would be a better way of reducing poverty and more environmentally friendly behaviour would
be a better way of protecting the environment

Is there ever a duty to use contraception?

Some proponents of virtue ethics suggest that if a person knows that they would not be a good
parent, they have an obligation to avoid becoming a parent.

A person who agrees with this and knows that they would be a bad parent should therefore:
 abstain from sex,

 use effective contraception

 or be willing to have an abortion if contraception doesn't work.

Medical ethics and contraception

What ethical issues do doctors or other medical professionals face when giving contraceptive
advice?

Their primary concern should always be the welfare of the patient concerned.

This goes hand in hand with respecting the autonomy of the patient: the doctor must respect the
patient's right to make their own decisions, which means the doctor should provide the method the
patient prefers unless there is a medical reason not to do so.

The doctor should make sure the patient gets the information and advice they need to be able to
choose wisely.

It's important to realise that the doctor has rights too. Organisations such as the British Medical
Association recognise that a doctor has the right to claim a conscientious objection to prescribing
contraception and emergency contraception. However in such a case the doctor should refer the
patient to another source of treatment and advice.

Methods

The principle of informed consent requires a doctor to make sure that the patient is aware of, and
has genuinely understood the hazards and benefits of various methods of contraception.

For each method of birth control the patient needs to know:

 Reliability of the method

 Ease of use of the method

 Potential side-effects

 Health risks
Doctors should explain the methods available, and help patients weigh the advantages and
disadvantages of the methods so as to make the best choice for their situation.

Doctors must make sure that that patients are able to use the chosen method properly and can
recognise and cope with side effects.

Doctors provide continuing support for their patients' birth control needs.

Doctors should outline the emergency contraception options that are available if there is a problem.

Where the method is sterilisation the doctor must ensure that the patient is aware that it is unlikely
to be reversible.

Personal views
Where the doctor has strong ethical or religious views on birth control they have two choices:

 Make the patient aware of their views and give the patient an opportunity to consult
someone else

 Disregard their own views and give unbiased medical advice

It is unethical for a practitioner to give medical advice influenced by a non-medical factor without
disclosing this to the patient.

This poses problems not just for doctors who disapprove of contraception itself, but also for doctors
who while willing to provide birth control to married couples, believe it is wrong to help unmarried
people avoid the consequences of sexual immorality.

An additional moral issue for doctors is whether or not they need to warn patients seeking
contraception outside marriage (or at least a settled relationship) of the dangers of sexually
transmitted diseases.

Confidentiality

Doctors have an obligation to maintain patient confidentiality.

This has come under pressure in cases where teenagers seek help with contraception from a doctor
and make it clear that they do not wish their parents to know about it.

A British Medical Association report recommended in December 2003

 that children of under 16 must be entitled to expect that both the existence and the content
of a consultation in connection with pregnancy or contraception will normally remain secret

 that in the case of any departure from this rule doctors should be liable to justify their
action.
In such cases:

 Doctors are advised to encourage young people to inform parents of the consultation and
explore the reasons if the patient is unwilling to do so

 Doctors should take into account whether the patient is likely to have sexual intercourse
without contraception

 Doctors should assess whether the patient's physical or mental health or both are likely to
suffer if the patient does not receive contraceptive advice or supplies

 Doctors should consider whether the patient's best interests would require the provision of
contraceptive advice or methods or both without parental consent

 If the doctor believes that colluding with the child in deceiving the parent would be unethical
then the only moral course of action is to be open with the child, and if necessary to refer them
to a clinic where confidentiality is a feature of the service offered. It would be unethical to
promise confidentiality and then break it.
Guidelines from British medical and family planning organisations state:
 The duty of confidentiality owed to a person under 16 is as great as that owed to any other
person.

 Regardless of whether or not the requested treatment is given, the confidentiality of the
consultation should still be respected, unless there are convincing reasons to the contrary.

 Any competent young person, regardless of age, can independently seek medical advice and
give valid consent to medical treatment.

 Competency is understood in terms of the patient's ability to understand the choices and their
consequences, including the nature, purpose and possible risk of any treatment (or non-treatment).

 Parental consent to that treatment is not necessary.

 It is obviously preferable for young people to have their parents' support for important and
potentially life-changing decisions. Often, however, young patients do not wish parents to be
informed of a medical consultation or its outcome and the doctor should not override the
patient's views.

 Establishing a trusting relationship between the patient and doctor at this stage will do more
to promote health than if doctors refuse to see young patients without involving parents.
Can doctors ever break confidentiality over contraception?

Yes they can, but only in very limited circumstances.

In the UK all the following conditions must be met:

 the patient does not have sufficient understanding to appreciate what the advice or
treatment being sought may involve

 the patient cannot be persuaded to involve an appropriate person in the consultation

 the doctor believes breaking confidentiality is essential to the best medical interests of the
patient
There is one other situation in which confidentiality can be breached in this context, and this is
where the health, safety or welfare of someone other than the patient would otherwise be at
serious risk.

This is likely to arise in cases where the doctor suspects, with good reason, that the patient and
other people may be suffering from sexual abuse or exploitation.

A doctor who does breach confidentiality must be prepared to justify his or her decision before the
General Medical Council.
Christian ideas about contraception come from church teachings rather than scripture, as the
Bible has little to say about the subject. As a result, their teachings on birth control are often based
on different Christian interpretations of the meaning of marriage, sex and the family.

Christian acceptance of contraception is relatively new; all churches disapproved of artificial

contraception until the start of the 20th century.

In modern times different Christian churches hold different views about the rightness and
wrongness of using birth control.

Liberal Protestant churches often teach that it is acceptable to use birth control, as long as it is not
used to encourage or permit promiscuous behaviour.

Less liberal churches only approve the use of contraception for people who are married to each
other.

Since these churches regard sex outside marriage as morally wrong (or if not wrong, as less than
good), they believe that abstaining from sex would be morally better than having sex and using
birth control.

More conservative churches suggest that contraception should be limited to married couples who
are using it to regulate the size and spacing of their family. They often teach that using
contraception to prevent children altogether is not desirable.

The Roman Catholic Church only allows 'natural' birth control, by which it means only having sex
during the infertile period of a woman's monthly cycle. Artificial methods of contraception are
banned.

Thus the only way for a Catholic couple to be faithful to the Church's teachings on human sexuality
and to avoid having children is to use 'natural' family planning. Many Catholics have decided to
disobey church teaching in this part of their lives, causing a substantial breach between laity and
the Church establishment.

The Bible on contraception

Two parts of the Bible are often quoted to show God's disapproval of birth control:

 First, God commanded his people to "Be fruitful and multiply," and contraception is seen as
specifically flouting this instruction.

 Second, Onan was killed by God for "spilling his seed," which is often taken as divine
condemnation of coitus interruptus.
The first of these examples is normally rebutted by demonstrating that contraception has not
prevented human beings from being fruitful and multiplying.

There are at least two interpretations of the second example:

 God may have been angry with Onan for having sex for a purpose other than having
children

 this interpretation supports the idea that contraception is morally wrong

 it also supports the idea that there is only one kind of morally good sexual act: sex between a
man and a woman who are married and who are having sex to produce children

 God may not have been angry with Onan for preventing conception but for failing to honour
a commandment to produce a child with his dead brother's wife

 but this interpretation has no application to modern cultures or morality

 the act that Jewish law required Onan to perform would nowadays be regarded as rape, since
the widow's consent was not required - and this makes the story a very dubious foundation for moral
argument

Scripture in favour of contraception

The Bible never explicitly approves of contraception. However, there are a number of passages
where the Bible appears to accept that sex should be enjoyed for other reasons than the
production of children, and some people argue that this implies that no wrong is done if a couple
have sex with the intention of not having children.