The Case Against Vasectomies

Questions of babies—and plans regarding babies—casually pervade many a conversation.

Whether it’s a play date, women’s get-together, playground hang, chats during pregnancy or after birth, it’s what parents are bound to talk about at some point. During the time I was on Instagram, questions of plans regarding children made appearances often in Q&A’s, photo captions, or newsletters of prominent evangelical women writers, podcasters, Bible teachers, ministry ladies. The topic comes up quite frequently in person and online.

I have also noticed sterilization is alluded to or outright talked about as a logical, sensible matter of course in all these instances.

We may have read lots of books and heard lots of teaching on various aspects of sexuality. We hear about lust, same sex attraction, purity culture, sex outside marriage. We hear about the bonding delights of married sex and the vague goodness of children. But when push comes to shove, many of us were left to our own devices to navigate sex and fertility together. We often weren’t guided to consider—in any robust way at least—how they relate, how to steward them together over the course of our marriage.

Unfortunately, the topic is compartmentalized into questions such as “how many do you want?” and internalized as such. In lieu of proper teaching and discipleship, even our most popular marriage books talk about sex as if fertility were hardly even a matter of consideration to navigate. If conversations online and in person are any indication, there is a lot of confusion and lack of guidance on these two as a package deal.

These discussions are completely intertwined with (and revealing of) everything else related to our view of sex and children, body literacy and women’s health, our married relationships and the life of faith as a Christian. Because of these concerns, I’ve had one foot in the Catholic world for a few years now, learning and gleaning quite a bit. Evangelical engagement with the topic is anemic by comparison, lacking a commonly understood vocabulary. Developing one would help our marital discernment as we honestly wade through what more-and-less morally valid reasons there might be to avoid a child within marriage, and licit means of doing so—aided by some semblance of a theology of the body.

Those topics need their own deep dives. But as someone who now can now speak a bit of both languages in this department, I’d like to share some overarching, amateur observations. Apparently they’ve been helpful to others. Let’s begin with some low hanging fruit.

Vasectomies abound in Protestant and broadly evangelical spaces. I’m sorry to be so frank, but it’s true. (My husband and I have also come across quite the handful of Catholics who aren’t shy about saying so, either, oddly enough).

They are, for the most part, de-stigmatized. Matthew Lee Anderson estimates—and this sounds about right, based on observations and interactions—that 40-50% of men 38 and over in evangelical spaces have had the procedure done. Why is this? And why might it still be “deeply immoral”?

The Default Evangelical Approach

First: Deny that there is any moral issue in view at all. Second, justify it by appealing to care for one's wife, who endures childbearing. Third, don't ask, don't tell. Or fourth: Because deep down we know we're coping with the inherent weirdness, joke about it.

This has served no one. It’s gotten us where we are today. And you shouldn’t feel the need to swim the Tiber if you care about these things.

Okay, let’s unpack some categories for consideration. Why should we care about rampant vasectomies?

Rampant vasectomies distort the ends of medicine.

I borrowed this phrasing from Matthew Lee Anderson’s shrewd essay on the subject.

Medicine and health care generally is, by normal definitions, for the purpose of healing or aiming toward health. Fertility is a sign of health in both men and women. Consider all the medical interventions that tamp out and suppress our fertile bodies with a sledgehammer!

As I ask elsewhere, “Where do medical techniques, procedures, and approaches go beyond assisting toward health, wholeness, and dignity? When do they cross into the realm of creating new narratives—about the givenness of life? The reality of human nature? The meaning and purpose of our physical bodies?”

Anderson describes how “medical interventions that damage the body are justified not on grounds of “avoiding harm” but healing the body. There is room within such a framework for preemptive interventions, to be sure: we can anticipate disease and dysfunction. But interventions that damage in order to preserve the body’s proper functioning are categorically different than interventions that damage when no disruption or dysfunction threatens.”

They infantilize adults.

“I’m on a pastoral staff… and the others look at me like I have three heads any time this topic comes up. I rarely get more than “So what we just have as many kids as we can??” from them or anyone else.” 

These are the kinds of anecdotes that pop up everywhere. They’re puzzling! We’re adults with agency.

We neuter animals because they cannot control themselves or act with the agency of human beings. They have no relational stakes in the game of reproduction to contend with, because they are not made in the image of God. I would hope our ways of relating to our bodies and our spouses look different than the animals—or children, for that matter. Such infantilization is degrading.

They asks little (in fact, nothing) of men in the way of understanding and working with the nature of his wife’s design

How is our knowledge of a woman’s anatomy and reproductive system? The basic changes it goes through monthly? Do we know what ovulation is, at the very least? These are good places to start in understanding what God has made. After all, we’ve been given a default pattern to work with, quite literally built into the female body.

One person offered this: “I think a big part as to why many Christian men don't have that understanding in their wives is that there isn't much discussion around family planning leading up to marriage. In the time leading up to my wedding and now newly wed, this [discussion thread] and Life Considered has been the only place where I've seen anyone around me discuss this kind of thing.”

He’s not alone. I’ve received numerous such stories and comments from all sorts of people. It’s safe to say we’ve all been failed in some way on the basics here. But when we know better, we can do better. I hope that’s true for individuals, pastors doing premarital, and marriages. This is foundational “Live with your wife in an understanding way” kinda stuff.

Permanently sterilizing one’s body abdicates all necessity of needing to attend to this part of your wife—and therefore this part of your shared life. But marriage includes a partnership in navigating the cyclical nature of fertility. It is a shared endeavor. “Set it and forget it” techniques and attitudes put high priority on avoiding the inconvenience of attending to one another, as I heard someone put it.

In this spirit, “taking one for your wife” seems vastly overrated. If you’re going to “take one for your wife” in avoiding pregnancy, perhaps do so by remaining cognizant of your shared fertility and remain a partner in navigating it throughout the fertile years God gives you. That seems more manly than abdicating any ongoing responsibility and participation.

They deny the givenness of and reverence due the body.

We don’t even have to use the word sacramental here. Christ’s own incarnation confirms the body we’ve been given deserves respect. It holds glory.

Anderson says he has “little patience for hasty dismissals that evangelicals are ‘gnostics’ because they speak about heaven or think communion is only (though never merely) a symbol. But the uncritical accommodation of a superficially innocuous practice like vasectomies comes from somewhere, and until evangelicals face up to our deep entanglement in the spirit of the age our witness to the truth will remain impotent.”

Deliberate alteration or suppression of the body’s healthy functions for the sole purpose of having sex seems profoundly disturbing. Attempting to physiologically stamp fertility out of the body for the purposes of not having to “deal with it” on a monthly basis seems like a rejection of our embodied selves. It’s the ideology of machines.

The logic inherent in physiologically erasing fertility through hormonal contraceptives and IUDs continues on in sterilization. Harmful alteration of our proper functions is degrading to the person, whether male or female. “In the past, doctors would describe such interventions as ‘mutilation’—a term that has fallen out of favor, but which I think the Christian still has a stake in.”

They prematurely close off opportunities to routinely communicate in marriage.

Going back to number 3, we ought to attend to the other. The dance is physical, but also relational.

When procreation is on the table each month for this season of your marriage, you are faced with communicating about it in some way. You have to talk about it—your family life, fears, desires, finances, physical health, support structures, challenges, hopes, what God might be asking of you together in marriage. Here are some questions to consider together when it comes to welcoming children.

This discernment surrounding pregnancy, as Emily Stimpson Chapman explains, is “not a decision we have to make anew every month, but it is a decision we have the opportunity to reaffirm or revisit every month.”

Voluntarily shutting down a foundational part of married life, never needing to be discussed again, is a loss. What does that do to a relationship? These matters are shared and intimate. We ought to be close enough to have those conversations, and reaffirm any intentions together. If not, perhaps this vulnerable communication is something to work on in marriage.

They prematurely close off opportunities to remain in conversation with God.

Does our relationship with the Lord include matters of sex, fertility, and childbearing? If not, why not?

Chapman again: “This is one of the gifts of… not artificially manipulating our fertility with surgery, pills, or devices. It gives us the freedom to not make permanent decisions about our family size in the face of temporary problems and invites us to remain in conversation with God about His will for our family.”

They are often done on the heels of grief, in a spirit of fear, or during the throes of temporary challenges.

Anderson describes how “these accommodations have made their way into Protestant moral theology by way of the logic of ‘exceptions.’ …evangelicals need “grave and serious reasons” to move forward, to only employ these means with “prayerful discernment.” As one moral theologian once quipped about this approach to abortion, the net effect among the mainline churches has been abortion on demand with tears... There is almost a pathological intellectual heroism at work in the mentality that we can affirm ‘exceptional’ practices without allowing them to become pervasive in our communities.”

This one comes after years of observation and hearing many stories. There are resounding themes when it comes to making permanent decisions or definitive declarations, and these seem to be common ones.

Miscarriage and pregnancy loss are earth-shaking, often traumatizing. Pregnancy fears and physical challenges are very real. Parenting demands much of us, and is exhausting and overwhelming at times—particularly when all the children are quite young. We need a hopeful imagination to see beyond the most intense years, and move forward with faith in the God who is with us, and for us.

What if you change your mind in a year or two? We absolutely have “freedom to not make permanent decisions about our family size in the face of temporary problems.”

They normalize the pressure put on couples to decide once and for all to be "done."

The option—and now its universal acceptance—has created some unnatural pressures all around. Feel free to resist this definitive, black and white thinking about childbearing as the default course. Though universally accepted, we don’t need to medically finalize such things that belong to an intimately shared life.

The amount of anguish I hear from those who acted rashly—and now regret or mourn that decision—is gutting. Perhaps we were never meant to hold the weight of such pressure to permanently decide.

They even more starkly reveal our preferred tradeoffs, choosing certain things over the blessing of children.

Every choice in life is a tradeoff. We’re always choosing one thing over another thing. But as Wendell Berry puts it in his novel Jayber Crow, “To love anything good at any cost is a bargain.”

Anderson posits that “In turning away from God, we have lost confidence in life… we’ve lost the ability to look at life and say that it’s good, that it’s a blessing, that it’s worth having. And I think that that has happened largely because we have embraced Mammon. We’ve embraced the comforts, the material comforts of upper-middle-class aspirations. And the deadening effects of money have crowded out fertility.”

Perhaps we are all wrapped up in some way with the spirit of the age and resistant to the blessing of children, for reasons we won’t readily admit. Perhaps there are quite personal, physical, or practical reasons to consider. They are worth discussing with our spouse and praying through in order to discern the best way forward. To that end, here’s a list of questions that could be of use.

Sterilization remains an overtly aggressive means of rejecting of the gift of children. Its very nature is violent, and it sends a message.

They are often done with an attitude of being owed deterministic control over childbearing.

There is a difference between agency and absolute, air-tight control over our very nature. The difference seems to be humility, an openness to living within certain limits.

Perhaps we need some creaturely humility with our prudence. And humility has a generous spirit. Such humble generosity will answer differently to the questions “How many do you want?” or “So, are you done?”

As Kelly Garrison reflected on the unknowns and loss in being willing to receive the gift of children, “Before I was married, I thought this meant being “open” to a dozen mischievous children a la the Old Woman Who Lived in a Shoe. And it does mean that for some. For others it means fewer children. For some of us, it means loss. For some of us, tragically, it means no children at all.”

They communicate in a quite jarring way how much we idolize unfettered, unencumbered sex.

It should be incredibly strange to think that there could not possibly be any other way to avoid pregnancy. Objectively, there are other methods (just stating facts, see point 14 as I’m not writing a book here) which don’t do damage to one another’s bodies—while also inviting or requiring being cognizant of the cyclical nature of shared fertility. If a person cannot be bothered even with those, I’m concerned about what that communicates.

What kind of people are we forming?

I wonder how much our attitudes and actions reveal us as people formed in virtue and the fruit of the Spirit. I also wonder how much our handling of sex and procreation is back-fitted to a culture pervaded by the pornographic lust in the air we breathe. That air is, by nature, sterile and self-serving.

It’s instructive to observe the lengths we’ll go to, the medical interventions we’ll subject our bodies to, in order to have pleasure without the possibility of children in sight. “…we know our idols by the violence we are willing to countenance. What begins with the worship of sex ends with the glorified scissors of the operating table.”

What about the possible death of a spouse or children?

More children aren’t a replacement for lost children, or a spouse who passes away. But shutting down the opportunity to procreate has real implications for situations of tragedy and remarriage, which do happen.

The Christian Witness

There’s some things we should retrieve as part of the whole Christian heritage. A cohesive sexual and reproductive ethic—one that speaks something distinct about the goodness of our created selves—is desperately needed today. 

Do we handle our bodies, sex, the welcome of children differently than the secular world? If not, why not?

In a succinct reminder to live set apart in our embodied selves, Anderson states, “Our calling as Christians is to conform our bodies to the death of Jesus, carrying in our bodies the dying of Jesus so that the life of Christ may be manifested through them to the world—whether that is as we age and die, or whether that is as we wrestle with fertility and infertility, or whether that is while we live our ordinary, quotidian lives… through the possession of our vessels of honor.”

My hope is for us to think more robustly of our lives in this world beyond transactional accounts of merely what we can do that “isn’t technically forbidden because the Bible doesn’t speak to it directly.” That is a low bar for the Christian, and frankly a boring way to think.

Vasectomies are the lowest hanging fruit we can address before turning to more complex issues, such as Augustine's (and many other patristic theologians!) views on sex, desire, and procreation.

Plot twist?

We haven’t even touched on interpretations of, and weight given to, the story of Onan, natural law, or Christian tradition… marriage as sacrament in Catholicism… female desire… theologies of suffering… apparently Aquinas and Aristotle… “each and every act”…implications of God the Father eternally begetting the Son… openness toward the blessing of children themselves… discerning a “clearly felt moral obligation” (Anglican) or “just cause” (Catholic) to space or avoid pregnancy... whether one is Full Humanae Vitae NFP or Humanae Vitae Adjacent, etc... among many other fun things!

Alas, I am a mere laylady.

(originally published at Life Considered)