On April 8th Vatican released the long awaited publication by Pope Francis “Amoris Laetitia” (The Joy of Love). This very lengthy and comprehensive document deals with the many issues facing the family. There are many beautiful passages in it about a large number of issues. Many catholics around the world will be pleased to read about the Pope’s (Church’s) much more open and progressive views of such issues as divorce and homosexuality amongst many other issues. But in fact nothing has changed.

In this document the Pope reaffirms the position of the Roman Catholic Church regarding the use of artificial methods of contraception. This statement is certainly very disappointing to many catholics and to catholic medical care givers.

Only natural methods of family planning, the so called “fertility awareness methods” are condoned by the Catholic Church. That is just fine for motivated and somewhat educated couples, with some access to medical care and teaching; also this approach works best if the women has regular menstrual cycles. Medical advances have made these methods more sophisticated and precise than the original method, based on just counting the days of the menstrual cycle and abstaining from intercourse on the so called fertile days. Under ideal circumstances these natural methods have a high success and low failure rate, equal or better than some artificial methods. And many couples who use it are very satisfied with it, even though they still require a considerable amount of effort.

Under less than ideal circumstances however, these natural methods have a high and unacceptable failure rate. This is true in our own country but especially in developing countries and areas (like refugee camps) where people live in squalor, lack food and most basic living needs, have no or inadequate medical care, and women often have very irregular or absent menstrual cycles, so that the natural methods of family planning become utterly impractical. Yet the Catholic Church insists that only these natural methods are acceptable.

During his return last year from a visit to the Philippines, Pope Francis made the somewhat unexpected statement that catholic families would do well to limit their families to a manageable size. A most welcome recommendation indeed! However, during the same interview Pope Francis again reaffirmed the opposition by the Church to any form of artificial birth control. How then are the people living under less than ideal circumstances as I described above, supposed to adhere to the Pope’s recommendations to limit the seize of their family? The natural methods have a high failure rate under these conditions. It seems to me that the Pope (and the Catholic Church) can not have it both ways and place these people before a very unfair dilemma. Either adhere to the Church’s teaching and attempt to use the natural methods of family planning that are allowed, but in doing so risk an unwanted pregnancy, or ignore the teaching and use the many artificial methods available and in doing so be marginalized by the Church to which they belong. A very large number of professed catholics world-wide are choosing the latter option, and that includes me.

Some of the catholic priests, with whom I have discussed this issue will tell me to ignore the Church’s teaching, follow my conscience, and continue with my practice of prescribing artificial methods of contraception and carrying out permanent sterilization procedures. (I am a gynecologist). That is of course just fine for me, but in the overall picture of things, it makes no sense. If rules, regulation, and laws are such that a vast majority of people, including those in position of authority are ignoring them, is it then not time for the leadership to seriously review and hopefully modify the rules? That, to me and to many of my catholic colleagues and patients, seems only logical. In that sense the recent publication by Pope Francis is certainly most disappointing.

William J. LeMaire MD
Emeritus Professor
Department of Obstetrics and Gynecology
University of Miami Miller School of Medicine

Authored By DR William LeMaire on Thursday 19th May 2016