Question 47

Why do they do it, and how can this be changed? 

Female sterilization is the second most frequently used method of family planning among women between the ages of 15-44 in the United States. If you include the use of sterilization of the male partner in the equation, then sterilization becomes the number one method of family planning in the US, even exceeding the use of oral contraception. The pattern of sterilization use among Roman Catholic (RC) women in the US is not much different than the total population of US women. According to the data from the 2002 National Survey of Family Growth (NSFG), the rate of ever use of female sterilization among US women was 15% and among RC-US women 14%, whereas male partner sterilization among US women and US-RC women was about 4%. 

In 2002, researchers form Marquette University analyzed trends in contraception use among RC-US women (using NSFG data) and found that from 1988 to 1995 the ever use of sterilization almost doubled. Marquette researchers recently analyzed the influence of religiosity on the use of contraception among US-RC women based on the data from the latest (2002 – Cycle 6)) NSFG. …. 

What is startling in these findings is that RC women who have frequent church attendance and who view their religion as very important had more frequent (38-69%) “ever use” of female sterilization. The use of sterilization might reflect the completion of the family size, an older population of women, and the decline of female fertility as women reach the age of 35-40. Women in this age range no longer wish to be using hormonal contraception and are probably tired of managing their fertility. Women at this age are also often confused by irregular cycles and are fearful of an unwanted pregnancy in this stage of their life. 

One reason that RC women who have frequent church attendance and believe that their religion is very important had more frequent use of sterilization could be because sterilization is a one-time event. Couples can have the sterilization surgery, confess to a priest, and then be back in the grace of God and the church. The constant use of the pill and/or condoms, on the other hand, requires either frequent confession or a guilty conscience. The sterilization and one-time forgiveness process was first speculated by Leslie Woodcock Tentler in her book Catholics and Contraception; an American History. 

Another reason for the use of sterilization among Catholic couples might be a lack of understanding of the Church’s teaching on family planning and sexual ethics. This reason is somewhat supported by findings showing that the subset of women with orthodox sexual ethics did not have a higher frequency of male (partner) or female sterilization. So too others have pointed out that there is an ignorance of the tenets of the faith system and/or a rejection of the Church teaching on moral issues altogether. Another possible reason is that, although RC couples know the Church’s teachings on contraception and sterilization, they view themselves as “autonomous” adults, and downplay or ignore the role of the church’s official teachings in forming their consciences on the issue of family planning. 

Although there seems to be some influence of religion on the family planning choices of RC women, it is still quite apparent that RC women (and men) have difficulty in either living with or accepting their fertility and that of their spouse. This is evident from the fact that their most frequent ways of dealing with fertility are to either suppress it with hormones or destroy it with surgery. Another implication is that although women and couples view their faith as very important, they may not have a good understanding of the faith and what it teaches, especially in the area of sexuality and contraception. This is further exacerbated by the lack of support from clergy and Catholic health professionals and Catholic health institutions in the area of family planning. Relatively few physicians, professional nurses, nurse midwives, and Catholic health facilities offer and promote the use of NFP. 

The findings of this study are encouraging in that there is a higher use of NFP in women who attend church services frequently and in those who report religion as very important, but discouraging that there is also a frequent use of surgical sterilization among this same group. This would seem to indicate a need for better catechesis, perhaps at a younger age, for Catholic men and women. However, further research would be helpful. In determining whether religious beliefs enter into the decision of women who are choosing a method of family planning at all. 

Another factor that might hold more influence in a woman’s or couple’s contraception decision making is the effects of sterilization on health and/or the marital and conjugal relationship. A recent study showed that women who have been sterilized had a greater likelihood or reporting that stress was interfering with sex and to have seen a physician for sexual problems. The autthors of this study speculated that somehow sterilization is interfering with the emotional bond between the partners. So too there is speculation that sterilization disrupts the woman’s self-esteem and body image, i.e., feeling less feminine and less a woman. Discussing these dynamics with physicians and other health professionals before a woman (or man) is sterilized would be important. In conjunction with discussing the possible effects of sterilization on the marital relationship is a discussion of God’s true design for marriage, the Theology of the Body, and strategies for living with one’s fertility. Hopefully, this would lead more women to reconsider sterilization and develop a newfound interest in living with fertility in accordance with God’s plan. 

(Reprinted with permission from Current Medical Research Summer/Fall 2007, Vol. 20, Nos 3&4, pp. 18-21, DDP/NFP, USCCB, Washington, DC. E-mail: nfp@usccb.org.) 

Cordially yours, 
Fr. Matthew Habiger OSB