Humanae vitae: Pastoral Aspects

Julia Cataudella, MD, CCFP,

NFPMC, FCP
14 January 2009
St. Augustine’s Seminary
Outline

 Moral Context
 Family planning
– Contraception
– Natural Family Planning
 Infertility
– Artificial reproductive technologies
– Natural procreative technology
 Pastoral Issues
Marriage is a sign of God’s love
 Married love particularly reveals its true
nature and nobility when we realize that it
takes its origin from God, who "is love"…
husband and wife, through that mutual gift
of themselves, which is specific and
exclusive to them alone, develop that union
of two persons in which they perfect one
another, cooperating with God in the
generation and rearing of new lives.

Humanae vitae, 8
Marital love

Free
Total
Faithful
Fruitful

Humanae vitae, 9
Marital love

 Inseparable connection of the marital act

Union + Procreation

Humanae vitae, 14
Language of the Body

 “Likewords bodily actions have

meaning… unless we intend those
meanings with our actions we should
not perform them any more than we
should speak words we do not mean.
In both cases, lies are spoken…”
Counterfeit Love

 Contraception, Sterilization
 Sexual activity outside of marriage
 Masturbation
 Pornography
 Homosexual activity
 Artificial Reproductive Technologies
John Paul II

 “Such a violation of the inner order of

conjugal communion, a communion that
plunges its roots into the very order of the
person, constitutes the essential evil of the
contraceptive act.”

Theology of the Body, 123:7

 Fruits of Love:
TRUE versus COUNTERFEIT

 Supports human dignity  Hurts human dignity

 Allows love to grow  Treats person as thing

 Leads to happiness  Leads to emptiness

 God’s love welcome  God’s love rejected

 Unity  Disunity

 Good Fruits: new life,  Bad Fruits: bickering,

harmony, trust, jealousy, mistrust,
fidelity, respect, etc. adultery, disease, etc.
Outline
 Family planning
– Contraception
 Union without procreation
– Natural Family Planning
 Union with procreation
 Infertility
– Artificial reproductive technologies
 Procreation without union
– Natural procreative technology
 Procreation with union
Outline

 Family planning
– Contraception
– Natural Family Planning
 Infertility
– Artificial reproductive technologies
– Natural procreative technology
Humanae Vitae

 To be condemned… is direct
sterilization… permanent or temporary
 Similarly excluded is any action which either
before, at the moment of, or after sexual
intercourse, is specifically intended to
prevent procreation—whether as an end or
as a means

Humanae vitae, 14
Contraception: Types

 Hormonal -Pill, Patch (BCP), Injection

 Mechanical -Intrauterine device
 Barriers -Condom, Diaphragm,
Spermicides
 Sterilization -Tubal ligation, Vasectomy
 Practices -Coitus Interruptus (withdrawl)
Contraception

 Inseparable connection of the marital act

Union + Procreation

Humanae vitae, 14
Hormonal methods

1. Prevent ovulation
2. Prevent conception
3. Prevent implantation
Prevent ovulation

Estrogen
Progesterone
 Prevent ovulation

Very high
dose of
artificial
estrogen
shuts down
ovulation
 Prevent implantation

Human
person Thins lining of the uterus

OVARY IMPLANTATION
DAY 5-10

Larimore WL, Stanford JB. Arch Fam Med 2000;9:126-133.

Intra-uterine device (IUD)

Inflammation
and scarring of
uterine lining
prevents
implantation of
human person
Barrier methods

Sterilization

Diaphragm

Condoms Spermicides
Withdrawal (Coitus interruptus)

 Does not prevent pregnancy

– Pre-ejaculatory fluid
– Fertile mucus
 “Onan went in unto his brother’s wife, he
spilled his seed on the ground, lest he should
give seed to his brother and the thing which he
did displeased the Lord; wherefore he slew him
also.”

Genesis 38:9-10
Medical consequences of
artificial birth control

Biological
Psychological
Social
Medical consequences of
artificial birth control

Biological
Psychological
Social
Pregnancy rates

Method 12 month pregnancy rates

Birth control pill 8.7%
Diaphragm 12.0%
Depo-provera 6.7%
Condom 16.4%
Withdrawal 18.4%
Sterilization 0.04%
Kost, K et al. Contraception 2008;77:10-21
Trussell J, Contraception 2004;70:89-96
 Biological

 Unintended pregnancy (49%)

 Abortion (54% of unintended pregnancies)
 Blood clots (veins, lungs, brain, eyes)
 Strokes, Heart attacks
 Breast Cancer (24-40% increase)
 Sexually Transmitted Diseases
 Cervical Cancer
 Reduced fertility
 Diabetes, high cholesterol, blood pressure
 Migraines on OCP, increase stroke risk more
 Osteoporosis
Cancer protection?

 Endometrial cancer
– smoking >35 cigarettes/d also protective!

The Cancer and Steroid Hormone Study of the CDC N Engl J Med 1987;316:650-655.
Viswanathan AN Int J Cancer 2005 May 10;114(6):996-1001.
Cancer protection?

 Ovarian cancer
– Protection only after > 5 years of BCP use
– Less than the protection after the birth of 1 child!

<

Collaborative Group on Epidemiological Studies of Ovarian Cancer Lancet 2008;371:303

Gordon, B New Engl J Med 2001;345:235-240
Irregular menstrual bleeding?

 Cover up underlying cause

 Can delay proper diagnosis
 Common side effect of:
– Injectable birth control
– BCP
Medical consequences of
artificial birth control

Biological
Psychological
Social
Psychological

 Depression
 Anxiety
 Sexual dysfunction
 Loss of libido

- can be irreversible
 Psychology of attraction
and mating disordered
– pheromones
Sigmund Freud

“This is actually the criterion

by which we judge whether a
sexual activity is perverse - if
it departs from reproduction
in its aims and pursues the
attainment of gratification
independently."
Introductory Lectures on
Psychoanalysis
Medical consequences of
artificial birth control

Biological
Psychological
Social
Societal consequences

1. Marital infidelity
2. Lowering of moral standards
3. Men will forget the reverence due to women
– disregarding her physical and emotional equilibrium
– reduce her to being a mere instrument
4. “Dangerous weapon…in the hands of public
authorities”

Humanae vitae, 17
Social

 Abortion
 Increased Unwanted Pregnancies (nearly 50%)
 Increased Single Parenthood
 Increased Divorce (50%, 80% after cohabitation)
 Insult and violence to women, and children
 Bodies used as machines, people as objects
(casual sex, fertility, ART)
 Depopulation
 Older age at first pregnancy, Infertility
Cohabitation

 50% of marriages are preceded by

cohabitation in Canada
 57% of teens who expected to marry also
expected to cohabit

2006 Census Statistics Canada

Manning, WD Journal of Marriage and Family, 2007
Cohabitation

 Marriages preceded by cohabitation:

– 46% higher rate of divorce
– Increased risk of:
 domestic violence for women
 physical and sexual abuse for children

– Decreased marital quality and stability

Vanier Institute for the Family, 2005 www.vifamily.ca

Responsible parenthood

 To know and respect the biological laws of

creation
 To have power by reason and will over
instinct and passion
 To consider personal situation
 To fully recognize duties towards:

God - themselves - the family - society

Pope Paul VI, Humanae vitae,
10
Spacing births
 Iftherefore there are well-grounded reasons for
spacing births, arising from the physical or
psychological condition… or from external
circumstances,
 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
Humanae vitae, 16
NFP vs. Contraception
Outline

 Family planning
– Contraception
– Natural Family Planning
 Infertility
– Artificial reproductive technologies
– Natural procreative technology
NFP

 IS NOT
– Rhythm method
– Calendar day method
– Catholic Roulette
Natural Family Planning

 Observable signs of fertility:

– Change in mucus discharge
– Change in body temperature
– Change in cervix
Cervical mucous

Prof Erik Odeblad Drs. John and Evelyn Billings

Swedish Bio-physicist Developers of the Billings Ovulation Method
Dr. Thomas Hilgers

Presentation of NaProTECHNOLOGY textbook to Pope J ohn Paul II, by Thomas

Ovary Estrogen

Ovulation

Progesterone
Uterus

Estrogen Progesterone
Menses Lining matures
Lining grows

Follicles Ovulation
Ovulation Corpus Luteum
Phases of the menstrual cycle

Ovulation
Cervical mucus

Estrogen Progesterone

Mucus Dry
Days Days
 Normal menstrual profile

Estrogen Progesterone

The relationship of serum levels of estradiol-17β      
Effectiveness

 Avoiding pregnancy
– 97-99% among motivated users
 Achieving pregnancy
– 98% within 6 cycles if normal fertility
– 20-40% if infertility, and
– Up to 80% with NaProTechnology

Hilgers & Stanford, 1998

Howard & Stanford, 1999
European Natural Family Planning Study Groups, 1999
Trussel et al, 1990
Tough cases?

 Breastfeeding
 Irregular
cycles
 Continuous mucous
 Peri-menopause
Outline

 Family planning
– Contraception
– Natural Family Planning
 Infertility
– Artificial reproductive technologies
– Natural procreative technology
Donum Vitae 1987

 The right of every person to be conceived

and to be born within marriage and from
marriage (I, 6)
 Human procreation must be the fruit and the
sign of the mutual self-giving of the
spouses, of their love and of their fidelity =
conjugal act.
Donum Vitae 1987

 If a technical means facilitates the conjugal

act or helps it to reach its natural objectives,
it is morally acceptable.
 If, on the other hand, the procedure were to
replace the conjugal act, it is morally illicit.
(II, 6)
ART

 Inseparable connection of the marital act

Union + Procreation

Humanae vitae, 14
Intra-uterine insemination (IUI)

 Sperm obtained
through masturbation
 Bypass cervical
mucous filter

Washed
Sperm
Zavos PM Fertil Steril 1989;51(1):190-3.
Velde ER New Engl J Med 1999;340:224-226
Intra-uterine insemination (IUI)

 Sperm
obtained
through masturbation
 Replaces the conjugal act
 Bypass cervical
mucous filter

Washed
Sperm
Zavos PM Fertil Steril 1989;51(1):190-3.
Velde ER New Engl J Med 1999;340:224-226
In-vitro fertilitzation (IVF)
In-vitro fertilitzation (IVF)

 Replaces the conjugal act

Risks of ART
 Multiplebirths
 Congenital abnormalities
 Obstetrical complications
 Perinatal complications
 Embryo loss
– Transfer, freezing - thawing
– Selective reduction abortions
– Embryonic stem cell research
Guzick DS New Engl J Med 1999;340:177-183
BMJ 1990 May 12;300(6734):1229-33
Hansen M Hum Repro 2005;20(2):328-338
Jackson RA Obstet Gynecol 2004;103(3):551-63
Financial cost of ART

 Semen analysis $350

 IVF treatment cycle $5500
 ICSI $1200
 Blood work/treatment cycle $300 $7850
 Embryo freezing and 1yr storage $500
 Thaw and transfer of embryos $600
 Embryo freezing storage/year $200
 Intrauterine insemination $300
 Donor sperm $700/cycle

http://www.mtsinai.on.ca/reproductivebiology/fees/default.htm
ART pregnancy rates/cycle

No pregnancy 64.9%
Ectopic pregnancy 0.7%
Single fetus 20.3%
32.3%
Multiple-fetus 12.0%
Unknown fetal # 2.1%
26.5%
Birth rate
Centre for Disease Control and Prevention, Division of Reproductive
Health. 2007 Assisted Reproductive Technology (ART) Report
The suffering of infertility

 Whatever its cause or prognosis, sterility is

certainly a difficult trial.
 The community of believers is called to
support the suffering of those who are
unable to fulfill their legitimate aspirations to
motherhood and fatherhood.
(Donum Vitae II, 8)
Outline

 Family planning
– Contraception
– Natural Family Planning
 Infertility
– Artificial reproductive technologies
– Natural procreative technology
Natural Procreative Technology

 Applicationof medical knowledge to

cooperatively restore a woman’s cycle
Medical applications
Timed hormonal profile
Ovulation induction
Ovulation induction

 Facilitates the conjugal act

Infertility
 Luteal phase defect
 Recurrent miscarriage
 Limited cervical mucous
 Polycystic ovarian syndrome
 Endometriosis
 Low sperm count
 Medical and Surgical correction
Other medical applications of NPT

 Irregularmenstrual cycles
 Hormonal problems
 Pre-menstrual syndrome
 Ovarian cysts
 Unusual bleeding
 Effects of stress
 Prevent miscarriage and prematurity
Pastoral Issues

Formation
Confession
Formation of Conscience

 "Afflicted with doubts about alternatives to

contraceptive technology, we abandoned you
to your confused and lonely consciences with
a lame excuse: 'follow what your conscience
tells you.' How little we realized that it was
our consciences that needed to be formed
first."

Philippine Bishops Conference, 1990

Formation in love

 more important task for the man than

adapting himself to the biological cycle of the
woman is the creation of a favourable
psychological climate for their relationship
without which the successful application of
natural methods is out of the question

Love and Responsibility, 283

Confession and conjugal life
 Four basic principles for confessors in
dealing with penitents on matters of
responsible procreation:
– The example of a merciful Christ
– A "prudent reserve" in inquiring into these sins
– Help and encouragement toward repentance
– Advice that leads penitents gradually to "embrace
the path of holiness"
Vade Mecum [Guidebook] for Confessors Concerning Some Aspects of
the Morality of Conjugal Life, March 1, 1997, Pontifical Council for the
Family
Moral principles
 … " it is never lawful, even for the gravest reasons, to do
evil that good may come of it (18) - in other words, to
intend directly something which of its very nature
contradicts the moral order, and which must therefore be
judged unworthy of man, even though the intention is to
protect or promote the welfare of an individual, of a family
or of society in general.

Humanae vitae, 14
Moral principles
 Neither is it valid to argue, as a justification for
sexual intercourse which is deliberately
contraceptive, that a lesser evil is to be preferred to a
greater one, or that such intercourse would merge
with procreative acts of past and future to form a
single entity, and so be qualified by exactly the same
moral goodness as these.

Humanae vitae, 14
NFP methods
 Symptom-thermal Method
– www.serena.ca
– basic cervical mucous assessment and temperature to determine
fertile time
 Billings Ovulation Method
– www.naturalfamilyplanning.ca
– Sensation and observations of cervical mucus
 Creighton Model System Fertility Care
– www.fertilitycare.ca
– Sensation and observations of cervical mucus
NPT resources

 Donum Vitae
– Congregation for the Doctrine of the Faith, 1987
 Pope Paul VI Institute
– www.popepaulvi.org
 Marguerite Bourgeous Centre
– www.fertilitycare.ca
– 416-465-2878
Abortion resources
 Second Chance Ministries
– Angelina Steenstra
– asteenstra@sympatico.ca
– 905-430-7990
 Sisters of Life
– http://sistersoflife.org
– (416) 261-7207 (St. Augustine’s Seminary)
 Silent No More
– http://www.silentnomoreawareness.org
 Priests for Life
– http://www.priestsforlifecanada.com
– www.priestsforlife.org