Ellen Painter Dollar
As I cradled my third newborn in his first hours of life, I was seized by a single, overwhelming thought: Never again. I could not possibly have another baby. My “never again” was more than a wearily satisfied observation that our family now felt complete. My “never again” was a desperate plea, tinged with panic, stoked by fear.
Panic is what sets in after you’ve had a c-section with an epidural that didn’t quite work, and you consider how it would feel to be pregnant again, inching closer to the day when once again the doctors would put a needle in your spine and take a scalpel to your flesh, and you would hope (but not know) that the medicine would work. Fear is what overwhelms you when you think about how this last pregnancy messed with your already-compromised skeleton in ways that your first two pregnancies didn’t, and you imagine the implications of temporary health setbacks becoming permanent obstacles to your ability to care for your children.
Wanting to avoid another pregnancy with as much certainty as possible, I got an IUD inserted when my son was three months old. More than 99 percent effective at preventing pregnancy, an IUD gave me the assurance I craved, without my having to do anything more than have the device checked at my annual exam and replaced after five years. The IUD also meant I would no longer menstruate regularly. Given my history of irregular, heavy, painful periods, this side effect cured a condition that had plagued me since puberty.
Couples make decisions about family size and pregnancy timing based on our circumstances and limits. As Christians, we consider additional factors, from faith-based moral standards to how we perceive God’s call in our lives. For me and my husband, medical limits loomed most large, though constraints on our finances and parental energy, our sense that our family was indeed complete and my growing itch to return to my writing career also figured in our decision to use hormonal contraception. Whatever our circumstances, reliable contraception can contribute to a family’s health by helping us flourish within the limits of our bodies, minds, money, and other resources.
Why did we choose a hormonal contraceptive over other options, some of which Christians perceive as ethically preferable? For example, Natural Family Planning (NFP) is a method, used to both attempt and avoid pregnancy, that shuns hormonal, barrier, and surgical contraceptive methods in favor of tracking a woman’s fertility via analysis of her menstrual cycles, temperature, and/or cervical mucus. Couples practicing NFP avoid intercourse on a woman’s fertile days if they wish to avoid pregnancy, and attempt intercourse if they hope for a pregnancy.
NFP requires no “drugs, devices, or surgical procedures,” and advocates claim that it makes use of “the physical means that God has built into human nature” to achieve or avoid pregnancy. NFP is, in other words, aligned with what is “natural,” implying that contraceptive methods are “unnatural.” This natural vs. unnatural dichotomy crops up in many of our fervent cultural debates, around vaccines and GMOs in food for example, with the “natural” positioned as obviously good and the “unnatural” as problematic. But the division between “natural” and “unnatural,” and our desire to judge one as better than the other, is not nearly as clear as our cultural discourse makes it sound.
As Eula Biss writes in her book On Immunity,
[The word natural] implies a medicine untroubled by human limitations, contrived wholly by nature or God or perhaps intelligent design. What natural has come to mean to us in the context of medicine is pure and safe and benign. But our use of natural as a synonym for good is almost certainly a product of our profound alienation from the natural world.
That “profound alienation” is, perhaps, precisely what tempts us to downplay the potential damage to bodies, souls, and marriages when an unexpected pregnancy poses problems—medical, financial, psychological, marital—far more significant than having to replace the baby supplies you gave away when you thought you were done having children.
While the language around NFP is appealing—the method is meant to foster “openness” to the possibility of life and avoid putting up “barriers” to that possibility—our decision was influenced both by practical concerns and a sense that an open, barrier-free approach to sex and procreation can thrive with other family planning methods as well. Given how another pregnancy could wreak havoc on my fragile body, I would have been terrified to have another potential pregnancy held at bay only by our attempts, made in the chaotic milieu of life with young children, to measure, track, predict, and manage the not entirely predictable interplay of sexual desire and procreation. The potential for us to get something wrong or my body to do something unexpected was too great. For me to remain psychologically and physically open to my children and my marriage, I needed to count on something other than my subjective tracking of my body’s wonky cycles.
Moreover, I see little practical or moral difference between limiting our openness to another baby using graph paper, thermometers, and review of mucosal consistency vs. using an intrauterine device, a daily pill, or a surgical severing of the vas deferens. NFP advocates say that in the first case, we work with the body’s natural systems, rather than manipulating them. But we use external means to manipulate our bodies in the name of better health all the time. Vaccines, for example, fool the body into thinking it is being invaded by an infectious agent. We use meditation or anti-anxiety medication to moderate our bodies’ natural and necessary stress response when it becomes too vigilant. Our bodies’ pain response is vital to our survival, but that doesn’t stop us from medicating it away so that we can function.
For us, the detailed attention required for NFP to be effective loomed as a far greater practical barrier to marital intimacy than a contraceptive that is 99 percent effective with little effort or attention required. And isn’t it contrary to the innate bodily processes and wisdom that NFP supposedly trusts that couples wishing to avoid a pregnancy must avoid intercourse at the very time when a woman is most likely to desire it (when she’s ovulating)?
I am, of course, oversimplifying. Whether or not a couple has intercourse on a particular night is less important than whether they have an overall healthy intimacy, sexually and otherwise. Sexual intimacy doesn’t require intercourse. I know couples for whom NFP has been both effective and relatively straightforward. But arguments touting NFP as morally superior because of its openness, lack of barriers, and respect for natural bodily processes fall flat when we consider the practical concerns of couples who need reliable, easy-to-use contraception to maintain a healthy sex life while avoiding an unwanted pregnancy—and the ways in which hormonal contraceptives can also foster openness and respect for our bodies’ capabilities and limits.
Being clear about our needs can be looked down upon in Christian circles. God knows what we need, not us, right? Certainly we can be swayed by everything from advertising to addiction to believe that we desperately need something unnecessary or detrimental. But God has entrusted to us an awful lot of responsibility for ourselves, one another, and the planet, inviting us to see and respond to myriad needs, including our own, equipped with God’s grace and love. Surely, if we are making decisions within marriages and communities seeking God’s guidance and wisdom, we can trust our own brains and hearts to help us know what we need to truly flourish. I think of the people whom Jesus healed who didn’t hesitate to tell him that they needed a particular sort of healing, sometimes—as with the bleeding woman or the paralyzed man who had his friends lower him through the ceiling—expressing their physical needs in desperate actions whose meaning was clear.
After a lifetime with an impaired body, I know what I need to function well. I know that I need to avoid more pregnancies and more babies. I need to avoid worry about potential pregnancy that would haunt me, and interfere with marital intimacy, if I were counting on ovulation charts and timing rather than a device with a 99 percent effectiveness rate that works without my having to do anything.
What’s truly open to the movement of God’s spirit is for couples to figure out what we need to nurture a healthy marriage and family life within whatever limits we have—physical, financial, psychological. What married people most need is grace within which to explore what makes each marriage flourish, not instruction about the one and only way to embody married love.
Author’s Note: This post was written as a contribution to Amy Julia Becker’s series on contraception at her Christianity Today blog. The series included posts on contraception as a global health issue, an overview of hormonal contraceptive methods, a history of contraception in the U.S., and personal essays from Christians about their experiences with Natural Family Planning and vasectomy. My post was intended to join the other personal essays as an account from a Christian who uses hormonal contraception. In the aftermath of Rachel Stone’s post on contraception as a global health issue blowing up, however, Christianity Today editorial staff, knowing that hormonal contraception in general and IUDs in particular are controversial for evangelicals, asked Amy Julia not to publish any personal essays about those forms of contraception. Weary of watching her intentions for a challenging conversation being overshadowed by contentious comments, Amy Julia agreed to pull my post, with my blessing.
To briefly address the negative image many Christians have of IUDs: Today’s devices are much different than the original IUDs, which were plagued with problems, including high infection rates. Contrary to a popular impression, IUDs do not primarily work by preventing the implantation of a fertilized egg. Rather, the presence of the device itself along with the hormones with which the device is implanted most likely work by lowering the likelihood of ovulation and/or fertilization (by, for example, affecting sperm). As with some other hormonal methods of contraception, the exact mechanisms by which IUDs work are not precisely known.
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