Reproductive Health: What the Birth Control Movement Contributed and How Catholic Moral Theology Can Expand the Clinical Conversation
Kirsten Dempsey, PhD Student, Saint Louis University
In 2018, the United States Census Bureau recorded that there were over 166 million women in the U.S., with 126 million of them at or above the age of puberty (10-12 years old). This means millions of women in the U.S. receive gynecologic care from a gynecologist, obstetric gynecologist, or primary care physician. Among the gynecologic medical concerns, two of the most common goals for women who are sexually active are how to avoid pregnancy and how to achieve pregnancy. These goals pose fascinating questions about what options - pharmacologic, surgical, and otherwise - are offered to women to attain these goals. I will examine these contemporary clinical realities in light of the historical context of the birth control movement, its successes and failures. I will argue that there are resources within Catholic moral theology capable of enhancing the clinical conversation of goals, values, and options; and ultimately that fertility awareness programs deserve a place in this conversation.
The history of gynecologic medicine in the U.S. is inextricably intertwined with the history of the birth control movement, which arose with laudable ideals, like improving women's ability to enter the workforce and offering control over reproduction amid high infant and maternal mortality rates. Other ideals were questionable, like Margaret Sanger's eugenic interests, encouraging reproduction among the “superior race” and discouraging reproduction among the poor and working class.
The medical options that were developed reflect attempts to correct issues but those corrections came with limitations. For women avoiding pregnancy, options like intrauterine devices or contraceptive medications are fairly successful but pose certain risks and harms. For women attempting to achieve pregnancy, options like in vitro fertilization can be successful but pose many risks and are costly. Presenting these as primary solutions in gynecology is problematic because they do not work for many patients. Some women cannot use hormonal contraception for medical reasons while others seek non-pharmaceutical or non-invasive methods for value-based reasons. There is also the cultural trend toward “organic” products and non-genetically modified foods, evidenced by numerous organic feminine products in today’s market. Women with these values may want non-pharmaceutical reproductive options. By focusing on solutions that alter the functioning of reproductive cycles instead of working with them, the birth control movement offers an incomplete presentation of gynecologic options for women today.
The tradition of Catholic moral theology offers alternatives to these common medical options. These include natural family planning (also called fertility awareness) methods to avoid or achieve pregnancy, and medical evidence for their success has grown in recent decades. Furthermore, the theology behind these methods offers positive, holistic resources for clinicians to better discuss reproductive goals and values with women and couples. Among these resources are an emphasis on communication through a personalistic framework and the cultivation of virtues, instead of just compliance with taking a pill or inserting a device. I am offering a corrective by suggesting that clinicians who address gynecologic concerns with patients should present fertility awareness methods alongside the current medical options.
The history of gynecologic medicine in the U.S. is inextricably intertwined with the history of the birth control movement, which arose with laudable ideals, like improving women's ability to enter the workforce and offering control over reproduction amid high infant and maternal mortality rates. Other ideals were questionable, like Margaret Sanger's eugenic interests, encouraging reproduction among the “superior race” and discouraging reproduction among the poor and working class.
The medical options that were developed reflect attempts to correct issues but those corrections came with limitations. For women avoiding pregnancy, options like intrauterine devices or contraceptive medications are fairly successful but pose certain risks and harms. For women attempting to achieve pregnancy, options like in vitro fertilization can be successful but pose many risks and are costly. Presenting these as primary solutions in gynecology is problematic because they do not work for many patients. Some women cannot use hormonal contraception for medical reasons while others seek non-pharmaceutical or non-invasive methods for value-based reasons. There is also the cultural trend toward “organic” products and non-genetically modified foods, evidenced by numerous organic feminine products in today’s market. Women with these values may want non-pharmaceutical reproductive options. By focusing on solutions that alter the functioning of reproductive cycles instead of working with them, the birth control movement offers an incomplete presentation of gynecologic options for women today.
The tradition of Catholic moral theology offers alternatives to these common medical options. These include natural family planning (also called fertility awareness) methods to avoid or achieve pregnancy, and medical evidence for their success has grown in recent decades. Furthermore, the theology behind these methods offers positive, holistic resources for clinicians to better discuss reproductive goals and values with women and couples. Among these resources are an emphasis on communication through a personalistic framework and the cultivation of virtues, instead of just compliance with taking a pill or inserting a device. I am offering a corrective by suggesting that clinicians who address gynecologic concerns with patients should present fertility awareness methods alongside the current medical options.