In the past months there has been a substantial increase in efforts by the Roman Catholic hierarchy, and by organizations strongly linked to the Roman Catholic Church, to curtail sharply access to and use of all contraceptives other than "natural" family planning methods approved by the Roman Catholic Church. These efforts include public comments by Pope John Paul II both from the Vatican and during his travels in Third World countries; statements and lobbying by the United States Catholic Conference aimed at eliminating U.S. financial assistance for international family planning programs if abortion is one of a number of legal options available, even if offered on a voluntary, non-U.S. supported basis; and finally efforts by domestic "natural" family planning groups to overturn Agency for International Development procedures requiring grantees fully and fairly to inform potential contraceptors of the risks and benefits of all methods.
Many Catholics oppose these efforts by the leaders of their church because they severely limit the free exercise of conscience by Catholics and non-Catholics alike. Their opposition is strongly rooted in medicine, ethics and theology.
First, to assume that any single method of contraception is medically indicated or appropriate for all women is at best naive. "Natural" methods are frequently contraindicated for women in developing countries. They involve careful scrutiny of changes in cervical mucus to determine fertility, and are most reliable in healthy women in clean, stable environments. Malnutrition and infection, frequent side effects of poverty, will alter mucosity, making determination of fertility less reliable.
In addition, "natural" famly planning requires a high degree of motivation and cooperation between partners, including abstinence from vaginal intercourse for almost half a woman's menstrual cycle. The subordinate status of women in many cultures makes this cooperation highly improbable. To describe such methods to Third World couples as medically "as reliable as artificial contraception," a claim frequently made by natural family planning advocates in the Catholic Church, is to perpetrate a cruel hoax on couples seriously committed to controlling their fertility.
Second, both medical and social ethics in the Catholic tradition support universal application of the principles of informed consent. "Ethical Guidelines for Catholic Health Care Institutions," a widely used and respected set of norms developed by Catholic theologians, ethicists and health care personnel, includes the following statement: "The patient is the primary decision maker in all choices regarding health and treatment. This means that he or she is the first decision maker, the one who is presumed to make initial choices, based on his or her beliefs and values." While no health care agency or individual should be forced to provide services that violate his conscience, it is accepted practice in the medical field that clients should be referred for those services to others whose conscience is not so bound.
No health care provider who does not fully inform a client of the advantages and disadvantages of a method of contraception under consideration or of the full range of options can be said to operate in an ethical manner. Public policy decisions that permit agencies to circumvent these principles are themselves ethically flawed.
Third, contrary to the conventional wisdom, the morality of artificial contraception is by no means a closed subject within the Catholic Church. It is a matter of continuing and lively discussion within the hierarchy, among theologians and by lay Catholics. The encyclical "Humanae Vitae," which proscribes the use of artificial contraception by Catholics, was described by the Vatican as "not infallible" teaching. While Catholics need to take this teaching quite seriously, there is room for legitimate dissent.
Current Catholic theology places strong emphasis on respect for the conscience of individuals as moral agents, as well as respect for the freedom and beliefs of other faith groups. It also makes a clear distinction between the moral teachings of the Catholic Church and the right of legislators to use "prudential judgment" in developing public policy.
Finally, surveys by the National Opinion Research Center of the University of Chicago show that only 29 percent of U.S. Catholic priests agree with the church's prohibition and that there is almost universal acceptance of artificial contraception by laity. In addition, in a 1984 study conducted by the Gallup organization, 79 percent of Catholics polled agreed that health-service providers in developing countries should include family planning in their services. Only 26.8 percent of Catholics believed that the U.S. government should not provide family planning assistance in countries where abortion is legal, while 61 percent believed that the United States should support family planning in these countries.
Father Bryan Hehir, a high-ranking official of the United States Catholic Conference, noted in 1974 that the church could "regard contraceptive practice as an issue of private morality that the church continues to teach for its members but not an issue of public morality on which it seeks to affect public policy" (emphasis mine).
Current efforts by the hierarchy and others within the Catholic community to limit international family planning options both exceed the need of the church to teach and to protect its members and violate many medical, ethical and public policy principles generally accepted in the Catholic community.