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Contraception

by Tirzah Meacham (leBeit Yoreh)

One of the major sources dealing with contraception is Tosefta Niddah 2:6: “[T]hree women use a mokh (contraceptive absorbent): a minor, a pregnant woman and a nursing woman. The minor lest she become pregnant and die ... the pregnant woman lest she make her fetus into a compressed fetus [by conceiving a second time causing the second, later conceived, fetus to crush the first, earlier conceived], a nursing woman lest she kill her child [inadvertently by early weaning as a result of the new pregnancy and not being circumspect in providing alternative healthy food] ….” In the continuation of this baraita R. Meir recommends coitus interruptus, an opinion rejected by the sages. The minor was defined as a girl from eleven years and a day to twelve years and a day. Although we now define sexual relations with a minor as child abuse and generally non-procreative, early adolescent pregnancies have the highest mortality rate for both mother and child. In antiquity when cesarean birth, hemorrhage control and antibiotics for infection were unavailable, the mortality rate was extremely high. Superfetation (conceiving again while pregnant) is quite rare but the dangers of a multiple pregnancy both for the mother and the infants are significant. The poskim differ as to whether this baraita should be interpreted as “[S]uch women must use contraception,” in which case other women may also use contraception, or “[S]uch women may use contraception,” thus limiting contraception to those women. The kos shel ikkarin (cup of roots) or sama de-akarta (a drug of sterility or a drug which uproots) referred to in BT Yevamot 65b, etc. is generally considered an oral contraceptive (Riddle).

In addition to prevention of danger to the woman’s life, permission to use contraception is based on the fact that women are not obligated to procreate. The commandment of procreation (periah u-reviah) is based on Genesis 9:1,7, God’s commandment to the sons of Noah. According to Mishnah Yevamot 6:6 (Rambam, Ishut 15:2), the position of R. Yohanan ben Beroka (beginning of the second century c.e.) that both men and women are obligated in procreation was rejected. Procreation was certainly life-threatening in antiquity and remains so to this day. Two other rabbinic commandments are connected to reproduction: habitation (lashevet), i.e. inhabiting the land, based on Isaiah 45:18, and continuing procreation (la’erev), because no one ever knows whether one’s offspring will survive, based on Ecclesiastes 11:6. The latter is limited to men and, according to most poskim, the former is also thus limited (Feldman). Thus women are left with essentially no obligation in procreation. This lack of obligation, although counter-intuitive given conception, nine months of gestation, birth and lactation, is the basis for permissibility and control by women over their reproduction. Cooperation with one’s spouse, who is obligated in all three commandments, is assumed but not enforced. It is likely that the contraceptive knowledge available in antiquity was in the hands of women and practiced without male knowledge or interference. Medieval population quotas demanded some effective form of contraception or safe abortion unless infanticide was practiced.

According to Tosefta Yevamot 8:4, men are prohibited from using oral contraception, undergoing sterilizing surgeries (vasectomies or castration), remaining unmarried or marrying someone who is infertile unless they have already procreated. The same source states that none of these laws apply to women. Barrier methods for men were not specifically prohibited in Talmudic sources because condoms were a much later invention. The refusal of Onan to perform levirate marriage with Tamar by practicing coitus interruptus (Genesis 38) was considered the basis for the prohibition against masturbation (hashhatat zera). This is by no means the simple meaning of the Genesis text, since his refusal to have children with Tamar was based on the fact that the children, “seed,” would be accounted to his brother as his Levirate duty. The interpretation that only ejaculation into the vagina is legitimate has led some yeshiva teachers to suggest that visiting a prostitute is halakhically less problematic than masturbation. In BT Niddah 13ab masturbation was equated with murder, idol worship and adultery. This extremist and ascetic text serves as the prohibition against masturbation which was extended to include use of condoms and, according to some authorities, use of the diaphragm by a woman. Present-day rabbis in the age of fatal sexually transmitted diseases including HIV and certain strains of hepatitis have been reluctant to allow condom use fearing that safer sex would lead to fornication. In fertility examinations, rabbinic authorities tend to prefer post-coital semen testing of women rather than use of a medical condom (which might lead to general condom usage) or masturbation, thereby totally abandoning previously held strictures of modesty for women (Meacham). This is in spite of the fact that any form of sexual relations between a married couple is considered legitimate even if it involves spilling of seed according to the Shulhan Arukh and Tur Even ha-Ezer 25:2 in accordance with Isaac ben Samuel of Dampierre (Ri, d. c. 1185) in Tosafot and Rabbi Joseph ben Ephraim Caro (Beit Yosef, 1488–1575) in the name of Asher ben Jehiel (Rosh, 1250–1327). The Rambam allowed such sexual activity but prohibited ejaculation in the context. The Zohar and later Sefer Hasidim were particularly concerned with spilling seed and prohibited it in the strongest of terms concerned with the demon children created by such acts.

Current rabbinic objections to masturbation and other non-coital sexual acts are based on the extremist positions in BT Niddah 13ab and mystical notions, the norms of exceptionally early marriage including child marriage and pro-natal ideas rather than the reality of prolonged adolescence, higher education, economic realities reflecting career choices, the position of women in society and a tendency to delayed marriage.

The vast majority of modern responsa on contraception are deeply influenced by the murder of six million Jews in the Holocaust. Rabbinic authorities have taken a quantitative approach to procreation with very little relationship to its impact on women, their health, their ability to parent effectively, their career aspirations and economic realities. This is partially due to a desire to maintain what is considered to be the status quo of women as mothers without outside careers (unrealistic as that might be). It has taken on theological and political ramifications in Israel in an effort to out-reproduce secular Israelis and the Arab population, while in the Diaspora it is seen as a mode of stemming the tide of assimilation. There is strong pressure for women to consult rabbinic authorities for permission to use contraception even for spacing of children, maternal health issues and dangers of congenital malformation and offspring. There are, however, a number of leniencies permitting contraceptive use which have been derived from various (often oral) rulings by halakhic authorities and which have become common practice among women without specific rabbinic consultation, e.g. one to two years after the birth of each live child for child spacing, use of contraception for several years after cesarean births (including permanent use after three cesarean births), extended contraception for major risk to the mother’s health, exhaustion due to repeated pregnancies, postpartum depression, mental anguish of the mother, birth of a handicapped child requiring special care, constant inappropriate behavior of children, repeated births of handicapped or defective children or instability of the mother leading to child abuse and even severe economic difficulties. The pro-natal stance of Israel can be seen by the fact that Jerusalem has the highest rate of Downs Syndrome births in the world (mainly due to advanced maternal birthing ages) and that Israel has the highest proportion of fertility clinics per capita in the world. Ecological concerns about overpopulation in Israel and in the world in general and the lack of sustainability have not yet permeated mainstream Orthodox rabbinic thinking on contraception.

After the principle of ovulation was discovered, some orthodox women delayed ritual immersion after menstruation and the seven clean days so that ovulation would occur prior to resumption of sexual relations. This mode of contraception resembles the Catholic rhythm method with similar failure rates and reduction of the couple’s sexual expression. It became the preferred Orthodox mode of contraception despite the reduction of sexual contact and the resulting reduction in the fulfillment of the biblical commandment of onah, meeting the wife’s sexual needs.

When contraception is allowed by rabbinic authorities, the order of preference is for what is universally considered the most risky forms of birth control: intrauterine device (IUD) (potential complications include heavy or prolonged uterine bleeding, infection, piercing of the uterine wall, etc.), oral contraceptives or hormonal implants (potential complications include higher incidence of the formation of blood clots with an increased likelihood of stroke, heart attack, breast and uterine cancer, and prolonged infertility after usage has ceased), spermicides (potential allergic reactions), and barrier methods such as a diaphragm often in combination with spermicides. These methods disrupt the path of the sperm only after the sexual act, thereby allowing vaginal ejaculation by the man. The most common recommendation by physicians for safe contraception is for condoms combined with a spermicide, which is categorically forbidden by poskim (Tendler). Jewish women are instructed by rabbis to use less safe methods, if they are allowed contraception at all. As with the issue of abortion, the more public the debate about contraception became, the more some rabbinic authorities attempted to usurp women’s control over their bodies.

Bibliography

Dorff, Elliott. Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Part 2: Moral Issues at the Beginning of Life, chapter 5. Philadelphia: 1998, 116–133.

Dorff is a Conservative rabbi whose halakhic decisions are often accepted and published by the Committee for Standards and Law on reproductive issues. He considers it a demographic imperative on the part of Jews to produce three to four children per family in order to guarantee Jewish survival. He begins this chapter on contraception and abortion by relating to masturbation. He rejects earlier opinions concerning the medical repercussions of masturbation. Dorff relates to the later age of marriage and the preference for masturbation over non-marital relations. He relates to the three-pronged obligation (procreation, inhabiting the land, continuing to reproduce) as based on the high occurrence of spontaneous abortion and high death rates for the neonatal and early childhood periods. Dorff holds that men (who are obligated in procreation) may use contraception if they have already procreated. He does not view condoms as an efficient mode of contraception but considers them absolutely necessary in situations where safer sex is a consideration (e.g. possible exposure to HIV, sexually transmitted diseases). He considers sexual abstinence an obligation for HIV carriers, holding that preservation of life takes precedence over sexuality. His preferred mode of contraception is the diaphragm, followed by oral contraceptives. In situations where male sterilization is dictated because of life/health threatening conditions, Dorff distinguishes between physical castration, which would be biblically prohibited, and vasectomy. In the case where the wife’s health and safety are threatened by an additional pregnancy, he considers vasectomy which is an outpatient procedure preferable to tubal ligation for the woman, which requires anesthesia. He urges less delay in procreation while still taking into account the desire for professional training and career establishment.

Feldman, David M. Birth Control and Jewish Law: Marital Relations, Contraception, and Abortion as set forth in the classic texts of Jewish Law. New York: 1968 (republished in 1995 with an epilogue, with 28 pages relating to new reproductive technology and summarizing some of the author’s ideas in light of the intervening discussion on the topics). There is an extensive bibliography and helpful index.

This is the most comprehensive book on contraception and abortion and Jewish ideas of procreation and sexuality. It relates to the sources of Jewish law, the codes and responsa on the topics and has ongoing comparisons to Canon law. Feldman presents the material clearly and has long chapters on the baraita of the three women and the relation to it throughout the generations, and what constitutes a mokh and “cup of roots.” The book is dated but the discussions on the classical texts remain significant. Feldman presents situations in which contraception would be required and when it would be permitted, generally along the lines of preference for the pill, diaphragm and IUD. He is clearly pro-natal as a result of the Holocaust and low Jewish birthrates.

Jacob, Walter. “Be Fruitful and Multiply.” In The Fetus and Fertility in Jewish Law: Essays and Responsa, edited by Walter Jacob and Moshe Zemer, 224. Pittsburgh: 1995.

The 1927 responsum of Rabbi Jacob Zallel Lauterbach (1873–1942) permitted birth control. Jacob urges limitation of contraception because of the Jewish population crisis. Increasing Jewish numbers would have a negligible effect on world population. He believes that women should be included in the commandment to procreate but does not approve of their exclusion from education and professional careers. Jacob suggests a redirection of community and charitable funds in order to encourage larger families by supporting the education of the children even through college. He emphasizes the necessity for the stability of family life.

Meacham (leBeit Yoreh), Tirzah. “Seminal Issues.” In Jewish Legal Writings by Women, Volume 2, (Micah D. Halpern and Chana Safrai, eds.) forthcoming.

This is a gender analysis of R. Eliezer Waldenberg’s position on semen procurement for fertility testing. The article demonstrates the rabbinic preference for halakhic stringencies for men that are played out on women’s bodies. Issues of modesty, comfort and even physical safety of women are set aside in order to allow men to hold the most stringent positions in reference to masturbation. The critical passage in BT Yevamot 76a deals with the necessity of examining a man while having an ejaculation in order to determine that his penile injury has healed and will not reopen during ejaculation. This is in order to allow him to marry a Jewish-born woman. The two modes mentioned in the Talmud to stimulate the man to ejaculation are showing him women’s colored garments and application of heat to the anal area. Many have interpreted this to mean that only indirect modes of stimulation are allowed, rather than understanding direct masturbation as an obstruction to the necessary visual examination of the penis during ejaculation. R. Ouziel has interpreted this passage to mean that in any situation in which there is a need for ejaculation without coitus, any mode of achieving ejaculation is allowed. The narrow interpretation of R. Waldenberg and others is partially based on a desire to emphasize in every manner possible that masturbation is forbidden based on the extreme statements in mystical texts and in BT Niddah. An easy mode to obtain semen, i.e. non-coital stimulation by the woman, is not mentioned by the poskim possibly because of their agenda to limit sexual expression only to coitus (lest fornication in other situations result) and not to engage in a discussion of sexuality. R. Ouziel’s position could be applied to an infertile couple were there a rabbinic will to do so.

Riddle, John M. Contraception and Abortion from the Ancient World to the Renaissance. Cambridge, MA: 1992.

This well-annotated book gives an excellent survey of sources from antiquity to the Renaissance which describe the preparation and/or use of contraceptives and abortifacients. The author surveys sources from a variety of cultures: Egyptian, Jewish, Greek, Roman and Islamic, including the translation of some of the classical medical texts during the Renaissance. Riddle concludes that not only was there a fairly widespread knowledge and use of contraceptives (barrier and oral) and abortifacients, but they were relatively effective. He also surmises that women may have been the main source of this wisdom, although some recipes and instructions entered the male textual world. He classifies the sama de-akarta mentioned in the Talmud as a contraceptive but does not include the definition “to uproot” in his semantic range. Had he entertained this definition, he might also have classified sama de-akarta as an abortifacient. He also deals with ensoulment, connecting the idea to Jewish, Christian, pagan, Roman and Hellenistic positions. Riddle addresses the modern scholars who cast doubt on the efficacy of ancient contraceptives and abortifacients, demonstrating their possible effectiveness through scientific studies on the composition of ingredients. He puts the entire issue of abortion and contraception into historical perspective.

Rosner, Fred. Biomedical Ethics and Jewish Law. Hoboken, NJ: 2001.

Although the publisher claims that this book reworks previous articles and has many additions, the chapters on contraception, artificial insemination, in vitro fertilization, abortion, and multifetal pregnancy reduction are exactly the same as they are in Rosner’s book, Modern Medicine and Jewish Ethics (second edition), 1991.

The latest work on contraception cited in this work is from 1983. The article is not as offensive as Rosner’s 1971 Tradition article republished in Jewish Bioethics but Rosner does state, “The Jewish attitude toward contraception by any method is a non-permissive one when no medical or psychiatric threat to the mother or child exists.” He urges couples to seek competent rabbinic opinion (i.e. the stringent Orthodox consensus tending to prohibit contraception).

Rosner, Fred. “Contraception and Jewish Law.” Reprinted from Tradition (Fall 1971).

Although this book was republished in 2000, many of the articles are recycled from earlier publications. The opinions reflect stringent Orthodox positions. Rosner, a physician, assumes that the mitzvah of procreation is ongoing though he derives it from Genesis 1:28 whereas poskim derive the commandment from the Noah story (Genesis 9:27). He makes rather extreme and offensive statements concerning contraception, for example, the economic argument for using contraception in large families “may be no more morally justified than robbery by parents to provide for the needs of the children.” Such a position may be justified for Dr. Rosner but less privileged people suffer from malnutrition, neglect and the entire spectrum of poverty- related maladies. He speaks strongly against those who “masquerade behind a medical indication, particularly psychiatric illness,” for whom in his opinion contraception is certainly immoral. The desire of the wife to continue working or have a profession is considered by Rosner to be convenience and is, therefore, certainly immoral. Like many other Orthodox writers, he cites the Catholic position concerning contraception (that it is prohibited in all forms except the rhythm method of abstinence during the fertile period). Rosner brings some sources which give a positive view about sexuality but does not relate to a woman’s anxiety concerning conception and the impact of this on her sexual experience. He relates to the male perspective only. Rosner considers the rhythm method unreliable even though it is probably one of the most common contraceptive methods in the ultra-Orthodox world where a woman can simply delay going to the mikveh. He considers this method to be mentioned in BT Niddah 31b when the time at which conception is most likely is disputed. He does describe other methods of birth control mentioned in the sources, for example, violent motions after intercourse to uproot the semen (BT Ketubbot 37a) used by “promiscuous women,” “cup of roots” as a sterilizing potion which was considered permanent, and the baraita on the three women who can use a mokh. Rosner claims that biblical law would require sexual intercourse even if the wife is too young to bear children, without relating to aspects of child abuse and the fact that all Western countries and Israel prohibit marriage of such girls. He does mention both the permissive and non-permissive opinions on the use of mokh. The “cup of roots” is considered by Rosner to be the source which would allow the contraceptive pill and is even an improvement because it causes temporary sterility. Both Rambam and the Shulhan Arukh permit the use of the “cup of roots” but later poskim require medical indications to permit contraception. Contraception should not be used prior to the fulfillment of the minimum mitzvah of procreation (one boy and one girl) and only if there are medical concerns. The least objectionable mode is the pill. Rosner absolutely condemns the use of condom, coitus interruptus and abstinence as contraceptive methods. He advises competent rabbinic opinions based on expert medical testimony for issues of contraception. Like nearly all other orthodox writers, he makes a logical leap and maintains that the obligation to procreate is constant, thereby eliminating possibilities for family planning.

Rosner, Fred and J. David Bleich (eds.). Jewish Bioethics. Hoboken, NJ: 1979, 2000.

Rosner, Fred, and Moshe Tendler, eds. “Procreation and Sexuality.” In Practical Medical Halacha (third edition). Hoboken, NJ: 1990.

Contraception is permitted if there is a serious threat to the mother, for example, rheumatic heart disease or severe renal distress. The posek may take into account psychological factors. When permission is given, oral contraceptives, chemical spermicides, diaphragms or cervical cups are the preferred method whereas condoms and coitus interruptus are forbidden. Intermenstrual spotting is a deterrent for the use of the IUD. As IUDs have been responsible for uterine perforation, the commandment “guard yourselves” to avoid health risks would also prohibit IUD use.

Steinberg, Avraham (tr. Fred Rosner). Encyclopedia of Jewish Medical Ethics. Volume 1, “Contraception.” Jerusalem and New York: 2003.

Avraham Steinberg is an (ultra-) orthodox physician. He gives a short description of modes of contraception both ancient and modern including their advantages and disadvantages concerning efficacy, safety, sexuality, expense and reversibility. Steinberg considers full-time nursing an exceptionally efficient mode of contraception. It should be noted that many women have become pregnant while nursing full-time because ovulation precedes menstruation after birth, so it may be less effective than Steinberg notes. The contraceptive efficacy of nursing depends on twenty–four-hour access, no supplements or disruptions due to illness, etc. Steinberg outlines the modes of contraception mentioned in classical Jewish sources and gives their modern parallel. He gives an overview of the general principles which include: 1) emitting semen in vain, 2) castration, 3) the obligation of procreation and inhabiting the world and 4) the sexual rights of wives. Steinberg discusses contraceptive methods from the halakhic point of view, i.e. whether there are 1) biblical or rabbinic prohibitions, 2) no prohibitions per se but the contraceptive has side effects (danger to the woman or inter-menstrual bleeding) and 3) prohibited methods in and of themselves (e.g. coitus interruptus, condoms and for some poskim, the diaphragm). As summarizer of the halakhic opinions, he makes no critical examination of the prohibitions, e.g. the Er and Onan story as the basis forbidding coitus interruptus in general, while the story relates to refusal to perform Levirate marriage. He apparently takes the position that non-coital sexual relations are forbidden and only intercourse is allowed. Steinberg brings tables showing the decreasing birthrate for various Jewish populations worldwide and especially in Israel to demonstrate the demographic imperative for Jews to reproduce. He disregards concerns for overpopulation, believing that technology will provide adequate food, despite questions of lack of sustainability, freshwater shortages throughout the world and the long-term health concerns about genetically modified food.

Steinberg states that if pregnancy is dangerous the options of refraining from cohabitation, relying on heavenly intervention and, for some rabbis, divorce, are all unacceptable, leaving the possibility of contraception. He then summarizes the position of various poskim and under what circumstances contraception is allowed. The clearest of these is danger to the woman’s life. Other opinions include a possible danger to the woman’s life, great suffering, temporary or permanently dangerous situations. In each situation he classifies the methods (pre-coital and post-coital), makes distinctions between the various methods and states whether biblical or rabbinic prohibitions or no prohibitions are involved. He cites many rabbinic opinions reflecting a range of positions in the orthodox and ultra-orthodox world. Only a few of the positions legitimize family planning policies and the leniencies have come about as a result of physical dangers to the health of the mother (e.g. after cesarean sections, etc.), mental illness (postpartum depression, nervousness), the potential to abuse children as a result of stress, blindness, lower extremity venous thrombosis, severe weakness and nervousness. Despite the fact that a nursing woman is specifically mentioned as one who uses a mokh, that opinion was not discussed by poskim, possibly because historically contraception was in the hands of the women. This necessitated a specific permissive response by relatively modern poskim.

Nearly all English publications on contraception take very stringent positions. Because Steinberg published originally in Hebrew, there is a far wider spectrum of opinions offered than in most English publications. For example, Steinberg refers to permission to use contraception for one year after a cesarean section, for several years (or permanently if there is danger) after three cesarean sections, for postpartum depression until recovery, for stress causing child abuse, severe weakness and nervousness, or if pregnancy would result in blindness or, for some poskim, if there is potential danger, especially if the contraceptive method is not prohibited as a method (e.g. the pill). Permission to use contraception is given by some if the man has fulfilled his obligation (one boy and one girl) or if several children of the same sex are born and the wife is weak or exhausted, or for one to two years or more after each live birth for child spacing, especially if a handicapped child is born, for mental anguish of the mother, constant inappropriate behavior of the children, or repeated births of handicapped or defective children. Permission for contraception has been granted for severe economic difficulties, especially if more children would cause marital strife. Women prone to miscarriage who cannot maintain a pregnancy have also been allowed to use contraception. He refers to the historical permission for contraception during the Nazi era. When contraception is allowed, the choice of methods is based on freedom from medical complications (especially intermenstrual bleeding), efficacy, non- interference with coitus or pleasure, non-active destruction of sperm and that it is temporary.

Tendler, Moses D. Chapter 8: “Population Control—The Jewish View.” Reprinted from Tradition (Fall, 1966).

Rabbi Tendler is an Orthodox rabbi associated with Yeshiva University. This is chiefly an article denying that there is a population crisis. Food distribution difficulties and adequate food production can be solved through technology, according to Tendler. For him, poverty is a relative term because of consumerism. He considers the IUD and post-coital contraceptive pills to be abortifacients and therefore prohibited. The Holocaust, together with low Jewish birthrates, created a Jewish population crisis. If contraceptive methods are allowed at all, they must be acceptable, e.g. the pill or spermicide. Permission for contraception is “non-transferable” and “non-expendable,” meaning that each case must be brought to an orthodox rabbi for consideration. The motivation for contraception, whether the mitzvah to procreate has been fulfilled, the contraceptive methods, the medical and psychological status of the couple and financial status are all elements that must be considered in family planning. According to Tendler’s summary, family planning is a Jewish possibility.

How to cite this page

Meacham (leBeit Yoreh), Tirzah. "Contraception." Jewish Women: A Comprehensive Historical Encyclopedia. 1 March 2009. Jewish Women's Archive. (Viewed on October 23, 2014) <http://jwa.org/encyclopedia/article/contraception>.

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