For years, the sexual and reproductive health of women with intellectual and developmental disability or disabilities has been insufficiently addressed by institutions and family members due to a lack of information, training, and, sometimes, religious issues. In this context, contraceptive digital pills can enhance the sexual and reproductive control of this population group. Digital pills could help to improve adherence to treatments aimed to prevent unwanted pregnancies, as well as allowing women and their caregivers to exert better drug intake control. (...) However, there are some ethical risks to consider that may outweigh these benefits. This study sets out to explore the ethical considerations that should be taken into account in the case of a potential roll‐out of contraceptive digital pills as a way of improving the sexual and reproductive health of these women. (shrink)

Emergency contraceptives may sometimes prevent implantation, thereby causing the death of the embryo. According to some positions contrary to abortion, because the embryo is a human animal, there are usually decisive moral reasons not to use them. In this article, I will show that objecting to the use of emergency contraceptives on those grounds is unjustified. If organisms are real existents, then according to the most plausible conception of what is required for a group of cells to compose one, the (...) embryo cannot qualify as a single organism. On the other hand, if organisms are virtual objects, then whether or not the embryo qualifies as one is morally irrelevant. I conclude that even if those positions are right about the morality of abortion, they are not entitled to oppose the use of emergency contraceptives. (shrink)

Don Marquis’ future-like-ours account argues that abortion is seriously immoral because itdeprives the embryo or fetus of a valuable future much like our own. Marquis was mindful ofcontraception being reductio ad absurdum of his reasoning, and argued that prior tofertilisation, there is not an identifiable subject of harm. Contra Marquis, Tomer Chaffercontends that the ovum is a plausible subject of harm, and therefore contraception deprives theovum of a future-like-ours. In response, I argue that being an identifiable subject of harm (...) is notsufficient for Marquis’ argument to succeed. In addition, we must also share our identity withan ovum. I show that on the account of personal identity utilised by Marquis’ defenders, weare not identical with an ovum. As a result, Chaffer’s reductio fails. (shrink)

The Islamic government of Iran recently passed and announced a new law titled “Rejuvenation of the Population and Protection of the Family.” This legislation is a noteworthy example of biopolitics‐influenced biolaw. In terms of abortion, contraception, prenatal screening, and population control, this law clearly contrasts with women's fundamental rights and freedoms and has significant health‐related consequences for different sectors of the population. A historical review of the population policies of the Islamic Republic of Iran shows the occurrence of multiple (...) abrupt and radical changes in such policies over the past four decades. This new law, promoted by religious biopolitics, is the most recent example, and places stringent limits on abortion. According to it, all decisions concerning abortion must be made in courts rather than in health clinics. Such courts are typically presided over by male religious scholars. This law also limits prenatal screening to the degree that will increase the rate of genetic defects, especially in the population's lower socioeconomic strata. By strictly limiting access to contraception, this law will increase the rate of unwanted pregnancies and sexually transmitted diseases. This paper argues that such an influence of biopolitics on biolaw contrasts with the principles of bioethics. Still, Iran's current institution of bioethics cannot address it effectively. Therefore, a new model of interaction between bioethics, biopolitics, and biolaw is needed to prevent the detrimental consequences of such pieces of legislation. Such a paradigm shift is demanded by the current “Woman, Life, Freedom” movement of the Iranian people. (shrink)

In the essay I argue that the routine use of contraception is morally tantamount to early-term abortion because it produces the same result: namely, it prevents the creation of a human life that would have otherwise probably taken place. Because it can be shown that contraception is ethically acceptable, it follows that early-term abortion is as well.

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the (...) right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case (...) at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)

This is a response to James Dubois’ “Is anesthesia intrinsically wrong?” I do not address many of the claims in this article but only DuBois’ use of the moral evaluation of the medical use of anesthesia as a counter example to two lines of reasoning developed to defend the traditional Catholic prohibition of contraception. Elizabeth Anscombe's dialectical defense of this teaching does not imply that such a defense must logically apply to the use of anesthesia. John Finnis’ defense of (...) this teaching on the basis of a natural law argument does not imply that consciousness is a basic human good. (shrink)

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active (...) pills (16%), only 9% took correct action. Multivariate analyses revealed that women's education and their husbands' support helped protect against taking incorrect action with a missed pill. The fieldworker's contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands' support is essential to improve the pill-taking behaviour of Bangladeshi women. (shrink)

Feminist scholars have identified how race and gender discourses influence the creation and implementation of school-based sexual health education and the provision of health care, yet there are few studies that examine how race and gender work in sexual health promotion as it occurs through community-based public health efforts. Drawing on three years of ethnographic research in a low-income Puerto Rican community, this article demonstrates how a gendered racial project of essentializing Latinx culture surrounding young women’s sexuality and reproduction works (...) to both obscure and reinforce race and racism in sexual health promotion. Professional stakeholders mobilize culture as an explanation for high birth rates among young Latinas in the city and reproduce a “Latino culture narrative” in which Latina gender and sexuality is understood as deterministic and homogenous. Simultaneously, an ideology of colorblindness enables the uncritical promotion of long-acting reversible contraception and obscures the history of reproductive oppression experienced by women of color. I consider how colorblindness and culture narratives allow stakeholders to abdicate responsibility for gendered racial inequality and conclude by advocating for the incorporation of racial and reproductive justice frameworks in sexual health promotion. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will (...) exist in the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)

Combined oral contraceptives have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and (...) class='Hi'>contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. (shrink)

Pharmacists with religious or ethical objections to prescribing emergency contraception won the latest round in the fight over conscience clauses in a case that could have broader implications for attempts to restrict access to contraception. In Stormans, Inc. v. Selecky, a federal District Court in Washington State granted an injunction to block the enforcement of regulations that would have forbidden pharmacists to refuse to dispense emergency contraception on the grounds of religious or ethical objections. In its decision, (...) the court applied Supreme Court abortion precedent without explicitly ruling whether emergency contraception should be legally categorized as a form of abortion or as contraception. However, the legal status of emergency contraception affects the strength of the defendants’ claims that the law was justified on the grounds of preventing sex discrimination. In neglecting to rule one way or the other, the court not only failed to adequately consider the sex discrimination claim but also may have opened the door to more restrictive regulation on contraceptives generally. (shrink)

The author discusses the effects of contraception, which have borne out the predictions of Pope Paul VI's encyclical Humanae Vitae: the explosion of out-of-wedlock births, lack of respect for women, STD's, HIV/AIDS, etc. The overpopulation claims that fed the acceptance and promotion of contraception have been discredited by demographers; now the social costs of underpopulation are increasingly apparent. Acceptance of contraception has now also led to an embracing of morally objectionable technologies like cloning. This is the latest (...) consequence of the separation of sex and reproduction signaled by the acceptance of contraception. (shrink)

Contraception works by preventing fertilization of an egg or preventing implantation of a fertilized embryo. For those who believe pregnancy begins at implantation, contraceptives preventing implantation are not abortifacient. However, for those who assert that pregnancy begins at fertilization, any agent causing the intentional loss of an embryo, even prior to implantation, is abortifacient, both morally and for lack of a different term to describe the postfertilization, preimplantation loss. In the debate on this topic, much of the discourse on (...) both sides wrongly focuses on the opposing side's perceived ignorance in denying scientifically proven definitions rather than on the substance of the conflict. Indeed, both sides accuse the other of prioritizing its “subjective” views over “objective” facts. In this essay, we unpack the scientific, cultural, and religious factors that underlie this debate. We argue that the only way to move forward is to clarify our terminology and engage with the substance of the argument, rather than merely the rhetoric. (shrink)

In El Salvador from 1978 to 1988, contraceptive use among married women 15–44 years of age increased from 34% to 47%, and the total fertility rate declined from 6·3 to 4·6 children per woman. Most of this change took place from 1978 to 1985. Sterilization is the most prevalent method used, but nearly one-half of the women who are sterilized did not use any contraception before their operation. Few young couples use reversible methods of contraception to space births (...) or delay the start of childbearing. On average, women wait 8 years after marriage and have nearly three children before they use contraception. (shrink)

This article builds on existing feminist literature on obstetric violence in the context of childbirth to argue that there is a continuum of obstetric violence that also includes that perpetuated in relation to pregnancy prevention and termination, as well as antenatal healthcare and birth. This structural violence is highlighted in relation to conscientious objection, the reporting of people suspected of illegal abortions by their healthcare providers, and contraceptive coercion. Recognizing the limitations of criminal and human rights approaches to obstetric violence, (...) this article takes Martha Fineman’s vulnerability theory as the foundation for the transformative structural change of healthcare institutions. (shrink)

The 2012 contraception mandate issued by the US Department of Health and Human Services has intensified the debate over a health care practitioner’s right to conscientiously object to providing contraception. This paper approaches the debate over conscientious objection to contraception from a pharmacist’s standpoint. It shows that contraception is the cause of or a contributing factor to observed psychosocial suffering and is not “preventive health care” as labeled. It argues not only that a pharmacist should have (...) the right to conscientiously object to dispensing contraception but also that, given the mission of the pharmacist as a health care practitioner, a pharmacist is obligated to refuse to dispense contraception. The paper argues that the obligation to refuse to dispense contraception applies to all who are involved in the provision of health care. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 675–696. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extramarital Contraception in the Catholic Faith:A Call to Action from a Physician and EthicistCara BuskmillerIntroductionDefinitionsBefore proceeding to a discussion of extramarital contraception, it is relevant to lay a foundation of definitions and limitations of this essay. Here, "sex" and "sexual act" will refer to acts of penile–vaginal intercourse and acts meant to lead to such intercourse, respectively. Other acts which are rightly called "sexual" are not relevant (...) to this essay, as the focus here is on encounters that could result in fertilization.The traditional natural law theory with its analysis of object, intention, and circumstances is at play in this essay, with a hylomorphic understanding of nature and ethics. In this understanding of ethics, the names of many acts include not only an object but an intention and circumstances (e.g., murder specifies an illegal type of killing with premeditation). Likewise, "contraception" here refers to the use of any drug or device which temporarily lowers fertility (object), to prevent fertilization (intention) due to presumed-fertile sex (circumstance). Such drugs or devices are called "contraceptives" in this essay. In this essay, "contraception" is not committed solely by intending to avoid fertilization, so acts such as trying to avoid fertilization by timing sex during infertile parts of a menstrual cycle are not contraception, and the pastoral term "contraceptive mindset" does not apply. "Contraception" is also not solely defined by the use of particular medical products, since the intention to avoid fertilization is part of the definition in this essay. Thus, [End Page 1245] prescribing or taking a birth control pill for polycystic ovarian syndrome, in the words of Pope St. Paul VI in his 1968 landmark encyclical Humanae Vitae (HV), is not at all illicit, here because such treatment is not contraception, and the problems of contraception do not apply (§15)."Marriage" in this essay refers principally to sacramental matrimony, made by the consent of a baptized man and a baptized woman.1 Civil marriage, cohabitation, long-term affairs, sex in dating, short-term hookups, prostitution, and sexual assault represent a spectrum of falling away from matrimony. This essay assumes that matrimony is God's one true plan for sex, fertilization, and childrearing. This essay also makes heavy use of the Scholastic-personalist perspective of HV on the unitive and procreative dimensions of sex. As sexual relationships "fall away" from matrimony, they lose resemblance to these dimensions."Consent" is here defined as a free act in which a person agrees to do, accept, or reject something.2 Consent is an act of the will, and it may be partial or total. Only when consent is total is a person held fully responsible for his or her actions; for example, only when consent is total can a person commit a mortal sin. Consent is different from assent, which is not of the will, but of the mind.3 In this paper, sex without consent is termed "sexual assault"—the status of the act as an assault is solely determined by consent. These definitions allow for a sexual assault in which a victim withholds consent and yet does not resist an attack,4 which is different from past legal and colloquial definitions.5 This definition also allows for assault victims that have positive emotional responses to or physical arousal from an attack. These responses from a victim do not make the assault consensual or desired, [End Page 1246] and in fact make post-traumatic recovery more difficult.6 Simply put, consent is of the will, and this is not diminished by whether the body follows suit; this differs from some legal definitions of consent in canon law, where the will of the person agreeing to a contract is signified by externals, even if there was no intention to fulfill the duties of the contract.7 Consent will be central to this essay, since it helps make the spectrum of relationships that "fall away" from marriage intelligible in two sets: one with consent, and one without."Intellectual disability" in medical and ethical literature refers to a large spectrum of differences in mental and behavioral performance, but this essay is only considering intellectually disabled persons who would be unable to... (shrink)

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active (...) pills (16%), only 9% took correct action. Multivariate analyses revealed that women support helped protect against taking incorrect action with a missed pill. The fieldworker support is essential to improve the pill-taking behaviour of Bangladeshi women. (shrink)

L’article se propose de voir comment ont été promus par les gouvernements de la Ve République la contraception et l’avortement en Guadeloupe et Martinique entre 1964 et 1975. La volonté de différencier la métropole (politique nataliste) des Antilles (politique néo-malthusienne) a été battue en brèche par le refus de l’Église et de certains partis politiques antillais. Les féministes ont dénoncé ces différences de politique. La contraception a été par ailleurs encouragée par des associations et des médecins soucieux d’améliorer (...) la vie des femmes en limitant les grossesses à répétition. En fin de compte, ce sont les femmes elles-mêmes qui ont décidé (ou non) de limiter les naissances. (shrink)

This work appeared in 1964. That it remains a significant contribution to this fast-moving controversy of our times is an index of its value; for not many defences of the natural law prohibition of contraception have survived the documents of the Second Vatican Council and John T Noonan’s magisterial history of contraception.

Multifactorial analyses of data from representative British and German national contraception surveys were used to examine the principal demographic determinants of contraceptive use by women. Contraceptive use appeared to be determined mainly by reference to ‘reproductive status’. Women who were postponing pregnancies were using oral contraceptives, whereas those who wanted no more children relied more on intrauterine devices or sterilisation. Differences between the countries suggested that the choice of contraceptive method was influenced by health care policy, the organisation of (...) the relevant services and differential provider preferences. The contraceptive method used was also related to having occasional rather than steady sexual partners, lower educational level and frequent church attendance. Contraception decisions appeared to follow a fixed pattern, based more on a couple's demographic situation than on the characteristics of the contraceptive methods. This resulted in an unnecessarily restricted choice of methods. (shrink)

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of (...) rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

In the 1960s, before the promulgation of Humanae Vitae, the Catholic philosophers Elizabeth Anscombe and Herbert McCabe OP debated whether there are convincing natural law arguments for the claim that contraception violates an exceptionless moral norm. This article revisits those arguments and critiques McCabe’s approach to natural law, concerned primarily with ‘social sin’ and not simply violations of ‘right reason,’ as one particularly ill-suited to addressing questions in sexual ethics and unable both to distinguish properly between certain forms of (...) sexual wrongdoing and more obviously social sins such as theft, and also to distinguish between ‘natural’ and ‘unnatural’ sexual acts. Anscombe’s views, I argue, are closer to those of Thomas Aquinas and provide reasons for making the distinctions McCabe does not. An argument concerning the nature of the institution of marriage and the effects of non-marital acts on that institution is proposed as a way of strengthening Anscombe’s argument that contraception violates an exceptionless moral norm. (shrink)

Marquis’s account of the ethics of abortion is unsatisfactory but not as Christensen implies baseless. It requires to be amended rather than abandoned. It is true, as Marquis asserts that murder and abortion both might deprive people of something of value to them, in particular, the life of a sort that might have been to them worth living. However, it is mistaken to conclude, as Marquis does, that murder and abortion are thereby morally equivalent. Not all deprivation is wrongful. Not (...) all that is wrongful is wrongful because it deprives someone of something. Contrary to what Christensen asserts, and Marquis seems to accept, it is not solely those discernible people who currently exist who might be deprived by our current actions. It is not only towards and concerning such living discernible people that we can have moral duties. It is not only such living discernible people who can be the beneficiaries of our generosity. Hence, contraception and the emission of greenhouse gases are, like abortion, issues that raise significant moral questions; however, they might each be properly answered. Nonetheless, it does not follow that is morally equivalent to each other far less than they are all morally equivalent to murder. If and when they are morally wrong, they can be different wrongs. (shrink)

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons (...) and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

Medical history has so far paid hardly any attention to the longue durée, a history in which, according to Braudel, 'all change is slow'. It is therefore one of the challenges of the emerging field of the social history of medicine to work audaciously across time as well as across space. An interesting subject, for example, is the history of contraception. Throughout history, there has been almost nothing people have worried about more than having sex without fear of consequence. (...) At first sight, the story of contraception seems to be one of progress, from the Ancient Egyptian crocodile-dung pessary to the modern-day condom and contraceptive pill. A closer look, however, shows a pattern of remarkable continuities in the reproductive behaviour of men and women over the last two thousand years. In this paper, I shall attempt to show why traditional male-dominated contraceptive methods still linger on despite the sexual revolution brought about by the invention of the 'pill' in the late 1950s. (shrink)

There are three stages at which procreative outcomes can be prevented or altered: (1) prior to conception (2) during pregnancy and (3) after birth. Daniel Engster (Soc Theory Pract 36(2):233–262, 2010) has ably argued that plans to prevent or alter procreative outcomes at stages (2) and (3)—through abortion and adoption—introduce financial, physical, and emotional hardships to which women are disproportionately vulnerable. In this paper, I argue that plans to prevent or alter undesirable procreative outcomes at stage (1)—through contraception use—similarly (...) disadvantage women. I suggest that accounts proposing moral responsibilities to delay or permanently avoid procreation are insufficiently attentive to the methods through which undesirable procreative outcomes might be prevented and how such methods unfairly burden women. In conclusion, I propose several ways that men and women might more equitably share contraceptive responsibility. (shrink)