Berkley Center

Meet three Catholic women living in the Democratic Republic of the Congo (DRC): 

Felicity

Felicity is one of a team of women who teach fertility awareness-based family planning to couples in her district. The average Congolese woman will bear five or six children in her lifetime. “Couples want to plan their families these days,” Felicity says. “If they know when the woman is fertile they can avoid sex at those times, or use a condom during sex. Spacing children is healthier for the mother and better for the child. And it makes the couple cooperate.”

Sr. Immaculata

Sr. Immaculata works as a midwife at Holy Family Catholic Hospital. “We try to make child-birth safer,” she says. “In 2013, 21,000 women died in pregnancy or child-birth in DRC. That is 21,000 too many. One of the problems is that women have too many children too quickly. They are worn out, and their children suffer. We advise them to go slow. But some find it difficult to tell their husbands ‘No more children. Not yet.’ Not all men listen. Some get angry with their wives. Others turn their attentions elsewhere.” Along with the other religious sisters of child-bearing age in her convent, Sr. Immaculata is on the pill. She takes this to prevent pregnancy in the event that she becomes a victim of the sexual and gender based violence that is rife in DRC. 

Dr. Agatha

Dr. Agatha was born in Europe and works as a physician at Holy Family Hospital. When asked about how the hospital supports women who have been raped, Dr. Dorothea explains, “All victims of sexual assault are given compassionate care, offered an HIV test, and referred to a rape counsellor. Those who present at the hospital immediately after being raped are offered emergency contraception.” 

Dr. Agatha is HIV-positive. She became infected twelve years ago, as a result of a needle stick injury while working in a clinic. She and her husband use condoms when they have sex. Speaking about their decision, Dr. Agatha says, “We initially tried abstinence. I was petrified that I might infect my husband. He helped me to let go, and to trust him. Abstinence would have meant that the virus had won, that it had a permanent hold over us. Gradually, we realized that our love for one another would pull us through.”

Discussion 

DRC is a post-conflict country with high levels of poverty. Life expectancy is 50 years.[1] Nine out of every ten people with HIV in DRC do not receive treatment.[2] Forty-seven percent (31m) of DRC’s population is Roman Catholic.[3] In February 2014, Univision’s survey of Catholic opinion found that 49 percent of DRC Catholics opposed the use of contraceptives; 44 percent supported their use.[4] Contraceptive prevalence is low throughout DRC, especially in rural areas.[5] Periodic abstinence is the most widely used method of family planning, and is the only means of birth regulation permitted by the Catholic Church. The fertility awareness techniques taught by Felicity can improve the effectiveness of this method of family planning. As with the use of condoms, periodic abstinence requires the cooperation of the male partner. According to Sr. Immaculata, not all husbands will agree to periods of sexual abstinence, and this can eventually take its toll on wives and children. Her observation that periodic or complete sexual abstinence can strain relationships and trigger infidelity was a point recognized by the Catholic Church at the Second Vatican Council.[6]

Rape remains part of the violent history of the Congo. During the post-independence conflict (1960-1964), Vatican theologians agreed that religious sisters at risk of sexual attack would be justified in taking anovulant contraceptives to prevent any unwanted pregnancy resulting from rape. The same precaution—regarded as a legitimate defense against an unjust act of violence—can be used by religious sisters in war-torn parts of the world today. Sr. Immaculata is neither defying nor being permitted an exception to Catholic teaching on contraception. That teaching only concerns consensual love-making in marriage, which does not apply to rape. 

Holy Family Hospital is following Catholic guidelines when it offers emergency contraception to women immediately following rape. Many Catholic hospitals across the globe have such protocols. However, in order to avoid destroying fertilized ova, the use of abortifacient contraceptives is not permitted.[7] In the years before hormonal contraceptives were available, douches were considered licit in such cases. 

When a Catholic spouse is infected with HIV, the Church counsels the couple to abstain from sexual intercourse for the remainder of the marriage. For Dr. Agatha and her husband, abstinence seemed the wrong way to tackle the challenges HIV brought to their relationship. They have access to condoms and know how to use them correctly. They are willing to accept the low risk of HIV transmission that careful condom use involves in order to preserve their sexual relationship. By so acting, do Agatha and her husband contravene Catholic teaching on contraception? 

This remains the subject of intense and highly technical theological debate, and opinion is divided. Pope Paul VI’s Humanae Vitae (1968), the key text, rules out “sexual intercourse which is deliberately contraceptive.” Is it “deliberately contraceptive” for a married couple to use condoms to protect a spouse from HIV infection? Some contend the key issue involves the couple’s intentions. If the purpose is to prevent infection (rather than to prevent conception), the couple’s behavior is not deliberately contraceptive. Others focus on the contraceptive character of condom use. Their concern is with the nature and meaning of the sex act and in how, by using condoms, the couple blocks its openness to procreation and, some would argue, subverts its unitive character. 

This case has brought to light differences of opinion between supporters of Humanae Vitae, who are currently divided about whether and on what basis the prophylactic use of condoms by a married couple (i.e., to protect a spouse against HIV infection) should count as contraception. This remains an open question on which the Catholic Church has not passed judgement. In other words, at the present time, there exists within the Catholic Church some uncertainty and confusion concerning the type of behavior prohibited by the teaching of Humanae Vitae. 

In the face of the Church’s silence at an official level, it is individual bishops and cardinals who have attempted to offer pastoral guidance on HIV-related questions. In 2010, for instance, Austrian bishop and physician Klaus Küng stated:

If for instance a husband who has AIDS refuses to be reasonable and if it looks as though he would use force if refused, then his wife would be justified in demanding that he use a condom as that would lessen the danger of infection. In my view, that would not contradict Humanae Vitae. The purpose of using a condom in such a case is not contraception but protection from disease.[8]

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[1] The World Bank, Democratic Republic of the Congo, World Development Indicators, 2014 
[2] Joint United Nations Programme on HIV/AIDS, UNAIDS Report on the Global AIDS Epidemic 2013, Geneva: UNAIDS, 2013, p. 57 
[3] The Pew Research Center, "The Global Catholic Population," Washington, DC, February 13, 2013 
[4] Univision, Voice of the People Catholic Survey, February 2014, p. 6 
[5] The World Bank,"Reproductive Health at a Glance: Democratic Republic of Congo," April 2011. Cf. World Health Organization, "Global Health Observatory Data Repository: Democratic Republic of Congo Statistics Summary 2002-present," Geneva: WHO, 2013 
[6]Second Vatican Council, Gaudium et Spes (The Pastoral Constitution on the Church in the Modern World), 1965, n. 51 
[7] Hormonal contraceptives operate in different ways. Some keep the egg and sperm apart. Some (anovulants) stop egg production. Some (abortifacients) make it difficult for a fertilized egg to implant in the uterus. Some contraceptives function via a combination of these mechanisms. 
[8] Cf. Christa Pongratz-Lippitt, "Urgent need for sexual morality encyclical," The Tablet, December 4, 2010, p. 27 

This posting is part of a collection addressing the nexus of women, religion, and the family. The views and opinions expressed in this article are those of the authors and do not reflect the official policy or position of the Berkley Center or WFDD. The goal of the entire collection is to generate discussion around these important topics.