When Permanent Contraception Can Be Licit

Alex and Sarah are Christians who have been married for five years. They have 2 children and would like to have more. However, they feel called to adopt as the route to parenting more children. Their only hesitation is that having another biological child would render adoption largely impossible for them due to financial strains. Sarah has also had uniquely hard pregnancies and they see no reason for her to potentially suffer through another one if there are other paths to parenting more children and so many children who already need parents. Therefore, Sarah and Alex do not wish to conceive again. But they are conflicted. Most forms of contraception still carry the possibility of pregnancy. They also believe that to abstain from sexual intimacy for years on years, “just to be safe,” would be an inappropriate solution for a variety of reasons. So, they consider Alex getting a vasectomy. But they wonder, is that ok? Is permanent contraception an appropriate form of contraception for Christian couples?

You would think such a sensitive and relevant issue would deserve as much airtime as IVF and other bioethical concerns, but you would be wrong. Scour popular Christian websites like The Gospel Coalition, Desiring God, or even here at Mere Orthodoxy, and you’ll find that if you add together all the articles dealing specifically with the issue of the ethics of permanent contraception, you’ll get a grand total of two (and those are from the same website). Is it because it is assumed to be clearly permissible like other forms of contraception? Or is the absence of such a question due to the assumption that the question itself is beyond the pale? Whatever the reason, the silence on the question is troubling as more and more people,^[1] including Christians, opt in to such a procedure–and too often without much thought beyond the cost. So, for the sake of all the Sarahs and Alexes out there, let’s ask the question: is permanent contraception a permissible form of birth control for Christians?

Before proceeding, a note on terminology. Throughout this article, “permanent contraception” refers to what is also called “sterilization”–procedures which, if successful, render men and women incapable of conceiving. Many negative connotations exist with the word “sterilization,” especially as it relates to the history of eugenics.^[2] At the same time, because of the virtual finality of the procedures, further subcategorization beyond “contraception” is necessary. Therefore, this article refers to these procedures–the elective surgeries of vasectomies and tubal ligations–as “permanent contraception.”

Hollinger’s Theological Rationale for Contraception

While there are many defenses of contraception from a Christian worldview, I will specifically review and then utilize the framework for the ethics of contraception made by evangelical ethicist Dennis Hollinger. Hollinger’s argument for the ethics of contraception is based in two theological rationale: 1) human stewardship of creation under God’s providence, and 2) the multiple ends of sex.^[3]

The basis for Hollinger’s first theological rationale is the understanding that the procreative mandate is given in the wider context of the cultural mandate of right stewardship of God’s creation which calls for cultivation of nature for the good of all.^[4] Humanity has been charged to be procreative, to be fruitful and multiply (Gen 1:28). But this is in the context of being told to have dominion over and to care for all of creation (Gen 1:28b, 29; 2:15, 19-20). Hollinger notes that “in all of this there is a clear understanding of human stewardship in relationship to nature, and the cultural and procreative mandates are linked together in the text.”^[5]

While the entrance of sin into creation has not negated this calling, as is shown by God restating the procreative and cultural mandate to Noah (Gen 9:1-7),^[6] the trouble is that, post-Fall, unrestricted procreation may result in harm. It does not take much imagination or historical evidence to wonder how this could be the case. Nor is procreation for procreation’s sake a good the Bible or Christian history upholds. David VanDrunen spends a considerable amount of space on this point. While acknowledging the inherently good gift of procreation, he argues that “it may be possible to be too fruitful and multiply too many times, to the detriment of other obligations. The key principle is that a married couple’s procreative life ought to be carried out thoughtfully and in harmony with the full range of their responsibilities.”^[7]

The realities of various obligations and responsibilities are crucial. If the only obligation humans have is to reproduce, then one would be hard-pressed to find a good reason to intentionally not do so. But this is not the only obligation humans have. For one, they are obligated to those they have already brought into the world. To multiply and multiply could very well hinder one’s ability to care for those who are already in the couple’s care. “Human beings are not bunnies in heat who simply follow their carnal impulses and deal with the consequences later. God made his image bearers morally responsible creatures who must answer for their actions…Each married couple, therefore, ought to be fruitful and multiply only in a way that is consistent with the other good things God has called them to pursue.”^[8]

What’s more, in Hollinger’s account, scripture actually teaches that humanity is not at the mercy of creation’s (fallen or not) natural workings but remains steward of it and is now charged with guiding such forces toward fruitful rather than destructive ends.^[9] Thus, “because of the fallenness of our world, we sometimes seek to alter nature to alleviate suffering and pain.”^[10] Rivers are a great example of this. Rivers are good. A gift even. One we cannot do without. And yet, given the proper circumstances post-fall, they can wreak havoc. Thus, we guide and cultivate them with levees and dams and such in order to turn their natural workings toward good rather than ill. So too with procreation.

Stewardship, then, is a response to the providence of God who has given humanity the charge of caring for creation. To allow creation to run its course without any cultivation or, at times, intervention would actually be a form of disobedience. Therefore, humanity must employ technology under God’s providence as a means of mitigating nature’s potentially harmful effects and steering it’s forces toward flourishing as good stewards of post-fall creation.

The conclusion from this first theological rationale: “within this framework of stewardship we can accept contraception, not in order to negate the procreative character of sex, but to steward the gifts and resources God grants to us. We can utilize non-natural means of contraception to work with nature just as we steward many dimensions of natural life through technology and human knowledge.”^[11] Procreation is one of these dimensions of nature that ought to be cultivated under the providence of God through the use of technology for the good of all. This is the case in light of the fact that if the procreative potency of sex is not governed, it may result in a poor stewardship of creation. Contraception, then, is a permissible use of technology to guide procreation toward fruitfulness and away from potentially or inevitably harmful consequences.^[12]

The second theological rationale has to do with the multiple purposes, or ends, of sex. Stated simply, God has intended sex for multiple purposes and these multiple purposes must all be maintained. Procreation is just one of the multiple purposes of sex–the others being consummation of the marriage, display of love between spouses, and physical pleasure.^[13] These “multiple purposes of sex indicate that sexual intercourse embodies more than just procreation but without negating procreation.”^[14] Hollinger argues that the anti-contraception side ends up sacrificing these other ends of sex on the altar of procreation. He presses the point further by stating that a sexually moral act can only occur when all four of these purposes are held together.^[15]

The Bible establishes these other ends of sex as coequally valuable. Song of Songs, whether one takes it on a purely analogous reading or otherwise, is a portrait of mutual love and sexual pleasure without the tethering of children or procreative ends. Pleasure and the expression of love is the telos for the writer. Paul in 1 Corinthians 7:1-9 admonishes singles to become married and married couples to not abstain from sex because of the temptation toward sexual sin. He does so without giving mention to any procreative end. In fact, there exists not a single biblical text that anchors procreation as the divinely intended telos of sex and especially not as the sole telos of sex. The biblical account, of course, recognizes that sexual intercourse leads to conception, but it nowhere insists that it must. This biblical data, and lack of a certain kind, must be considered in reference to what sex is designed for.

Hollinger does respond to the critique that contraception prevents sex from being procreative because it precludes the possibility of conception. While Hollinger acknowledges the procreative nature of sex, he argues that even when contraception is employed sex remains within a “procreative context.” This is a key phrase for his argument. Hollinger agrees with those who are anti-contraception that a married couple can never reject the procreative nature of sex and must be open to procreation anytime they are sexually intimate. But rather than saying it’s on the couple to insure this is the case by not using contraception, his point is that sex is inherently procreative because of its context.^[16]

Oliver O’Donovan raises a similar point in an aside in his Resurrection and Moral Order. He, as always, is worth quoting at length:

The point at issue, for those who believe, as the majority of Christians still seem to, that openness to procreation is a significant aspect of the virtue of chastity in marriage, is whether that disposition of openness is constituted only by a repeated sequence of “open” sexual acts, each of them open to procreation in its own right, or whether it is comprehensible as a virtue of the married life in its totality, regardless of whether contraceptive measures are taken during some phases of it.^[17]

In other words, does the procreative nature of sex require that each and every sexual act be “open” to conception? He, along with the vast majority of Protestants, seems to think the answer is no. Rather,

a married couple do not know each other in isolated moments or one-night stands. Their moments of sexual union are points of focus for a physical relationship which must properly be predicated of the whole extent of their life together. Thus the virtue of chastity as openness to procreation cannot be accounted for in terms of a repeated sequence of chaste acts each of which is open to procreation. The chastity of a couple is more than the chastity of their acts, though it is not irrespective of it either.^[18]

Each sexual act needs to be open in the same way to retain the vitrture of chastity within marriage or its procreative nature because of the necessarily procreative context of marriage.

Sex within marriage is always procreative because of the context in which it occurs where the couple has assumed the risks of sex and the responsibility of children which could occur were the contraception to fail.^[19] Just because the likelihood of a child is lessened does not mean sex has lost its procreative nature. As O’Donovan said, it is not each sexual act but “the married life in its totality” that renders the context of those sexual acts procreative. And so, “sex’s very nature points symbolically and realistically beyond the relationship to the generation of new life. But within this context, the multiple purposes of sex allow for the possibility of stewarding this dimension of physical intimacy. Contraceptives can be allowed because there are multiple purposes of sex, but the multiple purposes of sex can never be isolated from each other.”^[20] It is the context of a fruitful and flourishing marriage that renders sexual acts procreative, not their imminent openness to conception. Thus, the procreative purpose of sex can be maintained even when contraception is used.

Taken together then, Hollingers two-fold theological rationale combine to form the framework that because “God has ordained sex for more than procreation means the possibility of working within the natural world to steward it, rather than allowing nature itself to become the only determinant of what happens in the fruitfulness of our sexual acts. But the procreative nature of sex means we must be open to its fruitfulness should that occur.”^[21]

Having laid out Hollinger’s theological rationale for contraceptive use, we now turn to the question of permanent contraception specifically. Does permanent contraception fit into Hollinger’s framework thus making it a permissible form of contraception for Christians?

Evaluating Permanent-Contraception in Light of Hollinger’s Theological Rationale

Hollinger’s twofold theological rationale for an ethic of contraception is 1) human stewardship of nature under the providence of God for the good of all and 2) the multiple ends of sex. This framework will help determine whether or not permanent contraception is an appropriate form of contraception for Christians.

In light of Hollinger’s framework, the first question to be asked is, “Is permanent contraception a right stewardship of nature under the providence of God for the good of all?” I believe the answer is yes. Part of Hollinger’s argument is that contraception is a viable option for Christians precisely because to allow nature to run its course in any and every situation even when to do so would result in harm would be the opposite of good stewardship.^[22] To say it another way, Gilbert Meilaender puts it, “it cannot be right to rule out all human intervention in the procreative process–as if we were only finite beings who ought never seek to transcend and control what is naturally given.”^[23] Permanent contraception can be such an intervention.

This is so because permanent contraception can prevent a family from conceiving more children when that would cause harm. There are a variety of reasons this could be the case. There are cases such as Alex and Sarah, where couples wish to adopt but fear the possibility of getting pregnant at the same time. For many families, conceiving another child while in the process of adopting would be unwise. In these cases, permanent contraception serves to virtually terminate the risk of conception making adoption a viable option. Permanent contraception, then, enables a variant kind of fruitfulness, an alternate form of procreation.

There is also the already mentioned reality of prior obligations to the children we have previously brought into the world. Parents are obligated to the children they have already conceived over and above some idealistic “obligation” to procreation. Therefore, “to procreate responsibly means to do so with an honest appraisal of our capability to discipline children and raise them in the fear of the Lord.”^[24] Every family is limited in the number of children they are able to wisely and responsibly raise and disciple–the number of which will vary from family to family for a host of reasons specific to each family. To continue to conceive without considering the means of one’s family or the impact on the children already borne into it, is to neglect the obligation we have to those we have already conceived. When a couple reaches the cap of their capability, permanent contraception can be a means of ensuring they do not break previous obligations to their children.

A final example, and one that mirrors much of humanity’s use of technology to cultivate and at times intervene in creation, is that of the health of the mother. Perhaps a woman has had severe Hyperemesis Gravidarum in her past pregnancies and the toll on her and her family is simply too much to risk her becoming pregnant again. Permanent contraception would be a compassionate decision to avoid further harm to the mother where other forms of birth control are not as reliable and the risk of pregnancy is just too great.

These few examples, and many others could be given, show that there are a host of contexts where permanent contraception can be utilized ethically. It can be a preventative means of avoiding harm or an enabling means for pursuing a holy activity the Lord is calling a couple to.

Hollinger’s second theological rationale is the multiple purposes of sex. Permanent contraception does not thwart any of these purposes of sex. In fact, permanent contraception only makes sense if a couple desires to maintain the multiple purposes of sex while avoiding conception and in some situations would be the wisest and most compassionate means to enable them to do so.

To give one example, take a gut-wrenching situation where a woman has had several miscarriages. It becomes clear that she is unable to carry a child to full term. And yet, she is clearly able to conceive. What is the couple to do? Clearly not abstain from sex given this second theological rationale. So, are there to continue being sexually intimate knowing they could concieve only to lose another child? If contraception is on the table, why not go with the safest and seemingly most compassionate option: permanent contraception? Permanent contraception would be one avenue of stewarding these harsh realities of our fallen world while allowing the couple to maintain the multiple ends of sex with peace of mind and a clear conscience, knowing they have chosen the most sure form of contraception.

When considered against Hollinger’s two theological rational for contraception in general, permanent contraception allows the couple to remain sexually intimate within in a procreative context without the risk of conception if that would be unwise or harmful for their family given the specifics of their situation. It is a right use of technology to steer creation away from harm and toward fruitful ends, even if not the one we typically assume, while not sacrificing any of the multiple purposes of the sexual act.

Here, though, the question can and should be explicitly raised as to whether or not permanent contraception causes sex to cease to be procreative because of its permanent nature and places it in a class of its own apart from other types of contraception. At first this may seem to be the case. Permanent contraception, if successful, renders conception virtually impossible. But this is just the question for any form of contraception. If one uses a condom, or the pill, or an IUD, or even Natural Family Planning, is she causing sex to be nonprocreative? No, because the sexual act is an inherently procreative act occurring in a procreative context (marriage) as discussed above. This remains true of permanent contraception. Like with other forms of birth control, it arises from a decision to not conceive and yet remains within the procreative confines of the marriage relationship. Couples using Natural Family Planning or condoms or IUDs are making the same decision as those opting for permanent contraception–to intentionally avoid conceiving children. Yet none of them avoid the procreative nature of sex, and we (unless you are against all forms of birth control) don’t think they do. It is the context that matters, not the explicit openness of each act. If that were not the case, no form of contraception would be permissible.

Furthermore, no form of contraception is a guarantee, including permanent contraception. Immediately following the procedure, conception is still possible and even likely and it could take months of the couple having sex to “test” whether or not the procedure was successful. So, like with other forms of contraception, the couple, must be open to the possibility that their sexual intimacy may result in a child whether they mean for it to or not. If the couple accepts this then they are not usurping the procreative nature of sex. As discussed above, it is impossible to do so because of the procreative context married sexual acts occur within. They, like couples using other forms of birth control, will in all likelihood avoid conception, but not the procreative nature of sex.

I want to make this point unmistakably clear, if the intention to not conceive is the issue with permanent contraception, then all forms of contraception are off the table. Even natural forms that intentionally avoid sex during the window of the month when a woman can become pregnant would be morally amiss on this ground because they avoid sex for a reason other than the one Paul gives in 1 Corinthians 7 and are they are intentionally rendering the marriage bed unprocreative. Permanent contraception does not diverge from other forms in its intention, only in its guarantee. But surely this alone cannot be the reason it should be off the table for Christian couples. Or to say it the other way around, surely the greater risk of a “suprise” cannot be why some forms of contraception are permissible and permanent contraception is not.

Finally, there is the issue of the reversibility of permanent contraception procedures. In a very real sense, “permanent contraception” is a misnomer. The procedures, in a large majority of cases (see below), are actually not permanent. Just ask Michael Scott who, in a fit of anger, describes having a vasectomy, getting it reversed, and then having it done again because of the changing whims of his girlfriend–”Snip snap, snip snap, snip snap!”. Like the implantation of an IUD or the taking of birth control pills which alter hormones, in the vast majority of cases permanent contraception just isn’t permanent and can be reversed.

Permanent contraception serves the same purpose as other forms of contraception. It prevents conception as a means of steering creation away from harm and toward fruitfulness under while enabling the multiple ends of sex to be kept.

Returning to the hypothetical case of Alex and Sarah, pursuing permanent contraception allows their family to be in a position to adopt while avoiding undue suffering for Sarah and financial burden their family could not sustain. They are still being fruitful and multiplying through foster care and adoption–not that these are the only worthy avenues to fulfill such commands. They remain able to fulfil the multiple purposes of sex within the procreative context of marriage. But rather than letting it be determinative, they are guiding nature toward a fruitful end given the realities of their situational context.

Two Common and Fair Concerns

I want to briefly address two concerns with permanent contraception that, in all honesty, deserve an article in themselves but a few paragraphs here will have to suffice. The concerns are 1) that we are harming the body to avoid harm and 2) if this alteration is allowed, then where does it stop? I will deal with the second, first.

A common question lodged at permanent contraception is, “if we allow this kind of tweaking of the human body for a certain end then where do we draw the line?” On the one hand, I see this concern as not much different from the concern those who are against any form of contraception would ask about non-abortive contraception in general. Contraception just does interfere with and alter the body’s natural functions. That’s the entire point. So, in large part, I see this as a question pro-contraception Christians need to and have answered.

On the other hand, the question does seem to have a unique relevance for permanent contraception as the procedures physically alter the body where, it seems, other forms of birth control do not. A straight to the point way to pose this question with specifics would be to ask, “if a major point for the permissibility of permanent contraception is to avoid harm, why shouldn’t we allow sex reassignment surguries so those who are plagued by Gender Dysphoria can avoid the harm their perceived wrongly sexed bodies cause them?” That is a very good question. One that I feel the weight of very much. But, again, and not to entirely avoid it, I do wonder if this is a question specifically for permanent contraception or for any form of contraception that alters the body.

To ask it outright, is permanent contraception that different from female hormone-based forms of contraception such as “the pill” or IUD? With those, a change to the woman’s body is brought about, it just happens to be at the level of hormones. The entire point of these contraceptive measures is to ensure the female body does not operate as usual. If the point is raised, “Yes, but it is not a permanent change,” I would answer this in three ways. The first is to say that in actuality neither is permanent contraception given the high success rates of reversal procedures (see below). Second, is that the criteria? Is the issue that the body is altered or that the body is altered permanently? If it is wrong at all, it seems it would be in principle not in duration. The third is to say, “well it depends on the kind of hormonal birth control being used.” Recent studies have shown that “using any IUD more than doubled (2.6 times) the risk of tubal infertility compared with not using an IUD.”^[25] My point in raising these points is to demonstrate that the “altering the body” charge is not one that lies only at the feet of permanent contraception. And I raise it because it is a concern posed by those who would defend forms of non-abortive contraception that also alter the body. And I genuinely think there is some hypocrisy there.

I do believe the question about sex change surgeries to aleviate psychological harm is a fair one. But I also believe we are dealing with very different things when, in one case, we tie or snip tubes or are altering hormonal activity, and in another we are lopping off breasts and penises, sowing vaginas closed, or constructing the full range of these. I think our gut level intuition and our moral reasoning tells us these are very, very different actions. I don’t think we take a plunge down that slope by permitting permanent contraception. But maybe I’m wearing rose colored glasses.

Then there is the concern about “harming”^[26] the body to avoid harm to the body. My above response already answers this to some degree. Permanent contraception just isn’t substantively different from other forms of non-abortive birth control on this point–particularly not the most popular ones: “the pill” and IUDs. They all prevent the body from doing what it otherwise would and therefore, from this perspective, harm the body.

But I would also point out that we regularly allow medical interventions on the human body which cause “harm” or alter the body’s natural functions, if that harm or alteration avoids greater or further harm. This is the case with hysterectomies, a relevant example as it has to do with the reproductive system. Women routinely have these procedures for a number of reasons, but most typically to avoid harm. Women may also have one or both of their ovaries removed in order to stop from having chronic ovarian cysts. We could go on. There is no shortage of cases where we regularly and without any hesitation alter the body in order to avoid harm. Yes, we even at times render parts of the body incapable of doing what they otherwise would (the examples above fall into this category) if in doing so we discern that greater harm would be avoided. We only do this with the utmost caution, but we do it nonetheless.

Those who see permanent contraception as impermissible for Christians on the grounds of its “harming” of the body, must reckon with the fact that further and further procreation can do the same. The few examples given above demonstrate this clearly enough. Yes, permanent contraception alters the body. The question should be asked whether alteration equates harm in the first place. But let’s say it does, the question still remains: aren’t some types of medical “harm” to the body permissible if they avoid greater or further harm? Of course they are. Therefore, if procreation at any cost is not a biblically backed mantra, then permanent contraception, like its sister types, can be a permissible medical altering of the body to avoid harm as a right stewardship of creation.

Reasons for Hesitation

I want to make sure I am clear about my argument “for” permanent contraception. My argument is that permanent contraception can be a permissible form of contraception given the specific circumstances of a couple and/or family that would necessitate it. I wholeheartedly do not believe that most couples should pursue permanent contraception. I do not believe that over a million people a year should be having these procedures. I believe that it is a form of birth control that should only be used in situations like the ones described above, where it avoids undue harm and/or enables an alternate kind of fruitfulness that conception would impede.

Permanent contraception, while permissible, should only be used with the utmost hesitation and thoughtfulness. It should be rare, not normative, within the church and Christians should only pursue it with the highest degree of caution. Given that, what should their considerations be?

The most obvious is the permanent nature of this form of contraception. Unlike other forms which can be paused, this form of contraception is one that carries a sense of finality. I say, “a sense” because the procedures are, in fact, reversible. However, there is no guarantee that a reversal will be successful. John Hopkins states that tubal ligation can be reversed through another procedure and that afterward anywhere 50%-80% of women are able to conceive.^[27] The odds for men are better with upwards of 90% of men being able to conceive following a vasectomy reversal.^[28] But the point remains, there is no guarantee. A couple must be as certain as possible that they do not desire to conceive children and are at peace with this possibility. If a couple might desire to conceive children in the future, that couple would be acting recklessly to pursue permanent contraception.

John Piper, while accepting the permissibility of permanent contraception, points to another issue for Christian couples to consider: what if one’s spouse dies unexpectedly?^[29] Can a Christian truly be sure they will never again want biological children? Suppose Alex and Sarah decide Alex ought to have a vasectomy. Tragically, Sarah passes away the next year. A few years pass and Alex remarries. He and his wife decide they would like to have biological children. Alex has his vasectomy reversed. Unfortunately, the procedure is not successful, and they cannot conceive.

Couples must consider this sort of grim possibility before pursuing permanent contraception. One simply cannot know what life holds; therefore, if a Christian pursues permanent contraception, they must be willing to never again conceive children, even in a future marriage. An added component of this is that it increases the need for both parties to be absolutely sure that this is the path they wish to take. This cannot be a “well, honey, whatever you think” kind of decision. It is far too weighty and given the uncertainty of life, could have unforeseen consequences a couple cannot in the present imagine. A couple simply cannot know exactly what they are signing up for, as the hypothetical scenario above demonstrates, and for and must come to terms with that aspect of this form of contraception.

A couple’s motives matter too. If one accepts that permanent contraception is a permissible form of contraception, the question still remains whether or not a specific couple should pursue this form of contraception. For Christians to rightly pursue permanent contraception they must first evaluate their motives as best as possible to ensure they would not be doing so for less than moral reasons.^[30]

How might a Christian know if their motives for permanent contraception are valid? Again, the couple’s reasoning would need to be able to line up with an appropriate ethic of contraception in general. In their context, is it a right stewardship of God’s allotted resources for the good of all under God’s providence? Are the multiple purposes of marriage being regarded rather than tossed aside?^[31] Spitzer and Saylor also add helpful guardrails by stating that “the Bible does not expressly prohibit contraception but it does set forth certain principles such as the sanctity of life, the command to multiply, and the mutual obligation of the husband and wife to satisfy each other’s sexual needs.”^[32] These biblical principles must be considered in the couple’s immediate context as well.

The couple would also need to consider if their motives have seeds of sin planted deep within them. Does the couple see children as a “nuisance” rather than a gift? Are they wanting to avoid children for selfish reasons? Is the reason for permanent contraception as the desired form of contraception valid or a matter of convenience? Have they actually brought the matter before the Lord and weighed it in Christian community or are they running heedlessly after their own desires?

Much prayerful discernment must be had before embarking on the use of permanent contraception. The grim possibilities that could follow the procedure must be stared in the face and considered. It will render a couple sterile with no guarantee of reversal. While this is what they want now, are they sure it is what they want for the rest of their lives or in possible future marriages? Therefore, rather than being normative, it should only be pursued when the specifics of the couple’s context deems it wise and necessary and when their motives are virtuous. Permanent contraception should be entered at the slowest of paces. And yet, given all that, a couple is free to do so.

Conclusion: Careful and Thoughtful Acceptance

So, how ought the church to think about the ethics of permanent contraception? I humbly suggest that because permanent contraception follows Hollinger’s twofold theological rationale for contraception, Christians are free to consider it. However, it is my belief that while permanent contraception can be considered, it ought to only be pursued when a family’s context deems it a wise choice to avoid genuine harm (financial, physical, or otherwise) or to enable alternate forms of fruitfulness and flourishing (e.g. foster care, adoption, missions to regions unsuitable for children) other than conceiving of biological children–the further bearing of which would render these alternate activities unwise. So long as a family remains faithful stewards of their God-given resources under his providence while maintaining the multiple purposes of sex within a procreative context, I argue that permanent contraception is permissible contraception.

On the defensive side of things, I would contend that there is much less difference than is typically assumed between permanent contraception and other readily accepted forms that also alter the body. All non-natural forms of contraception prevent the body from doing what it otherwise would: conceive; some, like permanent contraception, alter the body to ensure this is the case. The only difference I can see is that permanent contraception offers a greater guarantee of procreation without conception. To those who defend other forms of contraception that also alter the body while not being abortive, I would ask, again, is the greater risk of a “surprise” really the dividing line? If not, what is? I see VanDrunen’s conclusion on permanent contraception as unavoidable, “if…there is no theoretical difference between so-called natural and artificial methods [of contraception], then there seems to be no theoretical moral problem with sterilization either. The moral questions here are again practical rather than theoretical.”^[33]

Hollinger ends his case for the ethics of contraception by saying that “thinking shaped by an understanding of stewardship in relation to nature, and by a commitment to the multiple purposes of sex in which they are held together, allows us to employ contraceptives, not as a means of autonomous control, but as a stewardship for God’s glory, the building-up of the church and service to the human race.”^[34] I humbly contend that permanent contraception fits this bill. Because procreation is not our only obligation, nor the governor of our other ones, permanent contraception, given the appropriate context and considerations, can be a right use of technology for the stewardship of creation toward fruitfulness and flourishing that is holistic and not simply numerical.

Footnotes

1. Five hundred thousand men and seven hundred thousand woman a year receive these precedures. https://theconversation.com/500k-american-men-get-vasectomies-every-year-a-specialist-explains-the-easy-and-reversible-procedure-186984; https://www.webmd.com/sex/birth-control/pregnancy-after-tubal-ligation. ↑
2. However, as this PBS article shows, the issue of forced sterilization and eugenics is not a historical issue in the United States with forced sterilization occurring in California prisons as recently as 2010: Lisa Ko, “Unwanted Sterilization and Eugenics Programs in The United States,” PBS.com, January 26, 2016, http://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/. ↑
3. Hollinger’s case for contraception using these two rationales is found primarily in his article, “The Ethics of Contraception,” Journal of the Evangelical Theological Society 56, no. 4 (2013): 683-696 . He also includes a modified treatment in his book, The Meaning of Sex (Grand Rapids, MI: Baker Academic, 2009), 164-166. ↑
4. Hollinger, “The Ethics of Contraception,” 690. ↑
5. Ibid., 691. ↑
6. Hollinger, “The Ethics of Contraception,” 691. ↑
7. David VanDrunen, Bioethics and the Christian Life (Wheaton, IL: Crossway, 2009), 107. ↑
8. Ibid. ↑
9. Ibid., 692. ↑
10. Hollinger, Meaning of Sex, 165. ↑
11. Hollinger, “The Ethics of Contraception,” 692. ↑
12. Hollinger, Meaning of Sex, 165. ↑
13. Hollinger, “The Ethics of Contraception,” 693-695. ↑
14. Ibid., 693. ↑
15. Ibid. ↑
16. Hollinger, “The Ethics of Contraception,” 694-695. ↑
17. Oliver O’Donovan, Resurrection and Moral Order: An Outline for Evangelical Ethics (Grand Rapids: William B. Eerdmans, 2001), 210. ↑
18. Ibid. Italics added. ↑
19. Hollinger, “The Ethics of Contraception,”, 696 ↑
20. Ibid. ↑
21. Ibid., 694. ↑
22. Hollinger, “The Ethics of Contraception,” 692. ↑
23. Gilbert Meilaender, Bioethics: A Primer for Christians (Grand Rapids, MI: Eerdmans, 2013), 17. ↑
24. VanDrunen, Bioethics and the Christian Life, 109. ↑
25. National Library of Medicine, “New studies link IUDs, infertility; say copper devices safer”
    https://pubmed.ncbi.nlm.nih.gov/12313655/. ↑
26. I for one would not call alterations at the level of tubal ligation and vasectomies “harmful.” But because these procedures cause the body to not do what it naturally would, many would consider them to be “harmful” by definition and so I am using their verbage to answer their concern. ↑
27. “What is Tubal Ligation?,” HopkinsMedicine.org, accessed December 9, 2019, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation. ↑
28. Mayo Clinic Staff, “Vasectomy Reversal,” MayoClinic.org, July 11, 2019, https://www.mayoclinic.org/tests-procedures/vasectomy-reversal/about/pac-20384537. ↑
29. John Piper, “Is Permanent Contraception a Sin?,” Desiring God, March 13, 2015, https://www.desiringgod.org/interviews/is-permanent-birth-control-a-sin. ↑
30. Hollinger provides some clarity to avoid unethical use of contraception in “The Ethics of Contraception,” 693. ↑
31. Hollinger, “The Ethics of Contraception,” 696. ↑
32. Walter Spitzer and Carlyle Saylor, eds., Birth Control and the Christian: A Protestant Symposium on the Control of Human Reproduction (Wheaton: Tyndale, 1969) xxiv-xxv. ↑
33. VanDrunen, Bioethics and the Christian Life, 117. ↑
34. Hollinger, “The Ethics of Contraception,” 696. ↑