Sterilization for the Life of the Mother

The newly published preparatory document for the rapidly approaching synod on “Pastoral Challenges of the Family in the Context of Evangelization” observes that “knowledge of conciliar and post-conciliar documents on … the family … seems to be rather wanting.” Church teachings regarding marriage, sexuality, and family “do not seem to have taken a foothold in the faithful’s mentality,” and generally, “many Christians … are found to be unaware of the very existence of” Church teaching on the family.

The documents from the magisterium of Pius XII, Paul VI, and Saint John Paul II that address the gift of human sexuality within marriage seem to have little impact on the majority of the lay faithful. Even less is the awareness of the Church’s clear teaching regarding sterilization for therapeutic purposes—when such procedures are sought in order to secure the health of a woman. The vast majority of Catholics are unaware that the Church has succinctly addressed whether procedures such as a hysterectomy or tubal ligation can be done to secure health.

In 1975 and again in 1993 the Congregation for the Doctrine of the Faith (CDF) responded directly to questions about such medical interventions in two brief documents that were ordered and approved by Pius XII and John Paul II, respectively. The former was a response to questions posed by the Bishops of North America concerning use of such procedures in Catholic hospitals.

Both documents emphasize the difference between direct sterilization and indirect sterilization as articulated by Pius XII and Paul VI. Direct sterilization is a sterilization that “of itself” and “of its own nature and condition, has the sole immediate effect of rendering the generative faculty incapable of procreation.” With direct sterilization, sterility is chosen either as an end (sterility is the goal) or as a means (sterility is sought to bring about another goal, i.e. the health of a woman). Direct sterilization is “absolutely forbidden” in Catholic institutions, because it is not “oriented to the integral good of the person.” Catholics should never choose a sterilization procedure that is “direct.” To do so freely and knowingly is a mortal sin.

Indirect sterilization, on the other hand, is licit because it “has a directly therapeutic character.” Indirect sterilization addresses a present pathological condition in which part of the reproductive system is “seriously injured” and poses an “immediate serious threat to the life or health of the mother.” A typical case, addressed by the CDF, is when the uterus itself is seriously injured. In such a case, a hysterectomy may be chosen even though permanent sterility is a foreseen but undesired consequence. Sterility is tolerated as resulting from a healing act that is directly therapeutic. It is important to note that the woman’s life is not saved as a result of becoming sterile. Sterility is not the aim or solution; rather, it is an indirect and unfortunate consequence of the medical procedure that directly preserves health.

But what if part of the reproductive system does not itself present a risk but rather a future pregnancy poses a significant risk to the health of the mother? Often in such a situation medical practitioners recommend a hysterectomy or tubal ligation. Can a woman follow this recommendation to prevent a future pregnancy and in order to secure her health? The CDF answers plainly, “Negative,” explaining that in this case these procedures would not be “properly therapeutic.” Sterility would be the immediate goal of the procedure itself. Risk to her health is reduced because she is made sterile; therefore, a morally problematic means is chosen to secure a good end. This is a direct sterilization, and therefore, it is immoral. In 1975 the CDF described contrary opinions as “dissent” and in 1993 it said such contrary opinions “cannot be regarded as valid and may not be followed.”

An ethical means of securing the health of the woman must be chosen. For example, the careful practice of periodic abstinence (NFP) may be embraced as an act of love for one’s spouse. This will undoubtedly be experienced as a true test of faith, require great trust in God, and demand sacrificial love for one’s spouse.

It is essential that these teachings be communicated to patients accurately and sensitively in order to ensure a couples’ authentic good. This should happen within what Pope Francis has described as a “culture of encounter” and while always remembering “the ethical good of the person … is the highest good.” A woman should not be arbitrarily deprived of a healing procedure that will also induce sterility if there is an immediate serious threat to her. Conversely, she should not be misled: if the potential threat to her health is posed by a future pregnancy, sterilization may not be chosen. To the extent possible, this challenging, yet essential teaching, ought to be proclaimed within the context of the “Gospel of the Family.”

Arland K. Nichols


Arland K. Nichols is the founding President of the John Paul II Foundation for Life and Family.

  • Michael Paterson-Seymour

    The same reasoning would apply to a medication that produced temporary sterility, such as an anovulant pill fto check dysmenorrhoea. It would be otherwise, if the intention (the aim or purpose, not merely the foreseen consequence) was to prevent conception.

    It is an application of the classic principle of double-effect, “where an action is chosen for a good cause, even though a bad but unintended effect may result. For example, a soldier may remain at his post even though he knows he will be killed, or a man may licitly jump to his death from a tall burning building in order to avoid the flames.” (S Alphonsus Liguori, Theologia moralis, lib. III, tractatus IV, cap. I, 367)

  • Vincent

    Mr. Nichols, You are correct in your writing but the bigger problem is the Catholic Hospitals themselves as well as the parish priests and Bishops. This is the era of omission, no one denies what you say they just don’t say it and it doesn’t become part of the culture. I’ve worked in Catholic Hospitals for 15 years, I have never, ever, ever, seen any religious figure (Sister, brother, or priest) lift a finger to explain these teachings to medical students, doctors, or even patients in any manner save perhaps that ‘Catholic hospitals don’t allow for that’ and you have to go the other hospital to get your tubes tied.

    • AcceptingReality

      For that matter very, very little with regard to the moral teachings of the Church is ever said by clergy from the pulpits, much less the hospitals. The emphasis is on hospitality, inclusiveness and just plain being nice. Never, ever say anything that would challenge the faithful.

  • donna

    since all goes to issue of intention, and I agree it should, why in heaven’s name does it matter what is chosen to prevent fertilization ? this is irrational. How it is any more or less morally licit to choose to prevent it by any method such as NFP. This is a means. So one may abstain but I fail to see where that is any more of a moral choice in context of marriage according to church, or the means are and should not be relevant. If there is a prevailing objective reason which supersedes the commandment it would seem the best possible and safest way should be utilized. This does not, of course, permit the use of abortifacient birth control methods which are subsequent to fertilization although the Orthodox jewish community allows it as well as abortion in face of direct threat to health of living mother. We are guilty of mortal sin when we violate the commandments of God in spite of how we do it. we can kill someone with either a knife or gun the weapon is not complicit nor does the use of one or the other change our fault.

    • ColdStanding
      • donna

        i appreciate it very much but no matter how much some twisted use of language claiming that NFP is not contraceptive it is if intention in use is prevention of fertilization and implantation.. Same for rhythm. If justae causae exists it is IRRELEVANT what method is used unless abortifacient. This is all part of the “new theological movement” (of course, NEW) rationalizing which is being used in Church to find some grounds or rapprochement with 95%+ of “catholics” directly disobeying Magisterium. I believe it used to be understood if married this issue should be actively discussed with one’s confessor (as my parents did) before undertaking its use. Back to my gun and knife analogy if you murder someone does it matter what the weapon. Of course not Nor does it matter here if one is on firm theological grounds for justifying contraception what imaginable difference can it possibly make to use one tool or another. There was nothing in this article more than rhetorical flourishes and lack of any use of logic or reason. But I thank for taking time to forward.

        • JP

          NFP can only be used if authorized by the couple’s priest. In certain, narrow circumstances it is permitted. However, it is by no means supposed to be used as “Catholic Birth Control”. A priest, after meeting with a couple can determine if NFP is called for. There is also the remedy of abstinence in cases of health or financial reasons. I think some Catholic couples, by the way they write or talk about NFP, abuse NFP.

          • Joe

            “NFP can only be used if authorized by the couple’s priest. ”
            Where did you hear that?

            • jonnybeeski

              Agreed. JP, cite your authority, if you would. Otherwise, I propose that HV itself establishes that the couple is the one to discern whether or not they are being called to have another child or to postpone.

        • Guest

          Avoiding conception is not the issue. How you avoid it is the issue.

        • Guest 2

          How can abstaining from sex be contraceptive? So, if a nun or priests abstains because s/he doesn’t want children, is that okay? NFP works to avoid pregnancy when the couple chooses to abstain from relations.

          • HenryBowers

            “Not wanting” is different than “opposing.”

    • Guest

      The intention and the means always matter. NFP is always a moral means. It is never illicit. The intention can be illicit though.

      • HenryBowers

        “NFP is always a moral means.” But that’s only because the intention to protect existing goods, as opposed to the intention to oppose conception, has been adopted. In what other human-bodily enterprise do we say: “Moving the foot such-and-such is always a moral means.” Not if it’s triggering an explosion of TNT!

    • HigherCalling

      Differing means have differing consequences. The negative consequences surrounding artificial contraception are legion, contributing significantly (even directly) to the Culture of Death. NFP has no such negative consequences, contributing fully to a Culture of Life.

      • donna

        i did not touch upon that issue but i am entirely conversant for over 25 years with negative consequences of artificial BC and have counseled many women to discontinue prior to breaking reports of seminal nurses meta analysis. My comments were not on topic only that if there is justae causae device for contraception, if NOT ABORTIFACIENT or medically dangerous, should be irrelevant. This eliminates the pill as it now is acknowledged that it may in fact be abortive and certainly IUD. Couples are conflating the two. Issue here is first and foremost whether there is sufficient cause to allow dispensation from magisterium and I frankly do not know why this is such a difficult thing for readers of this article to comprehend. But then again there are very few priests who are really willing to explain these facts to laity. My position is that if cause exists device is of secondary consideration with exceptions stated above. This is not what the Church requires; i consider it hair splitting. When my mother and her friends wished to prevent more conceptions the person with whom this decision was made was their confessor. Today decision in most instances not to be open to conception is independently taken and couples assume just because they are using the Church approved methods they are on solid theological ground. Certainly orthodox Jews always have this mediated by their rabbi. Once they are given permission they are free to choose how to proceed. I knows many Orthodox women who take the pill.

    • HenryBowers

      Donna, could the issue be clarified if we say “preventing” fertilization isn’t always bad, but “opposing” fertilization is intrinsically unreasonable?

  • Joe

    In many ways, this article only “stirs the pot” as it seems to be a “hard case”. How often would this ever really occur, where a subsequent pregnancy, or even a current one, would threaten the life of the mother to the extent to justify sterilization or some other procedure which caused termination? Sourcing HLI, even Alan Guttmacher admitted ” it is possible for almostn any patient to be brought through pregnancy alive”.

    • Joe

      Further, if out of good and reasonable intentions a married couple chose this route, would we rejoice in their eternal condemnation, or remind them of God’s mercy? Being faced with this rare threat would be akin to Abraham sacrificing Issac. If God can forgive any sin, surely we would hope He can forgive a mother seeking to preserve her earthly life for the good of her remaining children.

      • Guest

        The idea though is not that one can commit a sin thinking they can confess it afterwards. That seems like presumption.

    • Guest

      It is a common issue. Many women have problems where a uterine ablation is performed and a tubal ligation is done to prevent pregnancy. It is not licit.

      • Guest 2

        Why is the ablation being performed in the first place? Heavy menses due to aging? Well, there are often nutritional ways around that (I should know, I’ve got that problem.) I’ve strongly considered the procedure, but so far haven’t gone that route since a proper diet and exercise keeps things under control and, frankly, are much cheaper, healthier ways to go about things. (I grant, proper diet and exercise seems to be complicated concept for many people.) Ablation is not illicit, but the ligation afterwards would be.

        • Guest

          I agree with your last sentence at that was my point.

          • Joe

            I don’t disagree with Church teaching on this, but If the elephant in the room is medically unecessary uterine ablations being a “back door” into justifying sterilization, then deal with that specifically in a pastoral and direct way- and of course, the CDF could never allow that. I stand by my initial question- how frequently would a case occur where a woman’s uterus would be damanged from delivery, but left in place? What is the criteria for deciding whether or not it is a “grave enough” condition to remove it? If a damaged uterus is left in place, only to never allow a woman to conceive without putting her life in danger, then she is effectively rendered childless from that point forward, as her husband would certainly never put her life in jeopardy. The CDF doesn’t first require a doctor to leave a damaged uterus in place, close the woman up, only to see if a woman can first live with it as such. They allow for it to be removed. And if a healthy uterus suddenly begins hemoraging, then the CDF also does not establish a requirement for other procedures to be done first- except if she were pregnant, then you would want to try to preserve both the mother and child’s lives if possible.
            I still think cases where a married couple would have to accept prepetual abstinence in order to preserve the life of the mother would be exceedingly rare, and framing this issue in an article like this really only exemplifies why the faithful blatantly disregard the magisterium on this matter. Church teaching is difficult to accept far less frequently than articles like this make it out to be. People are given the perception that it is unreasonable, when it’s really not.
            I’d love to hear stories from married couples that were forced to accept prepetual abstinence and what the effect on their marriage was. Maybe more stories like that would encourage more faithful to be more open to church teaching and accept difficult situtations with trust in God.

            • Joe

              Q1 states…”in order to counter an immediate serious threat to the life or health of the
              mother,”. “Life” and “Health” are two distinct things, and the CDF seems to allow for consideration of “health” even if the woman’s “life” is not in immediate danger.

            • Lizzy

              I’d love to hear stories from married couples that were forced to accept prepetual abstinence and what the effect on their marriage was. Maybe more stories like that would encourage more faithful to be more open to church teaching and accept difficult situtations with trust in God….
              Good luck finding any couples in that situation who would extol the benefits of following Church teaching in their married life!!! Its hard enough to find couples who are happy with NFP and “periodic” abstinence.

  • Guest

    Good article and yes most have no idea about moral theology and this issue.