Christian Ethics of Permanent Sterilization

(all Bible verses from the NIV)

(this article was previously published by Sight magazine)
One of the most sensitive topics in Christian circles today is the topic of fertility. Although children are widely seen as a blessing from God, the choice to prevent any (or more) children by way of voluntary surgical sterilization is not a topic most people are comfortable discussing over tea. It is seen as a personal choice that does not and should not involve anyone else outside of the marriage.  However, this means that a couple struggling with whether or not to choose this option has very few outlets or sources of information; the Internet is loaded with articles on the health implications of surgical sterilization but is silent for the most part on the spiritual ethics and morality of sterilization.  Hopefully this article will help fill in that gap just a little.

In researching this subject I have been the grateful recipient of many fellow believer’s personal stories and struggles.  They have chosen to be transparent and vulnerable.  I will not be using any names here, but to honor their transparency I will begin with some personal notes of my own.

My husband was born in May of 1974.  His parents had two children and then were informed by the doctors that more children might be too much of a strain to his mother’s health.  They chose to use a new IUD, called the Dalkon Shield.  This IUD was pulled off the market in June of 1974 because it caused many cases of “septic spontaneous abortion”, pelvic inflammatory disease, permanent infertility and in 7 cases, death.  However, my husband was born in May of 1974.  In 1973 his mother suffered an ectopic pregnancy/miscarriage while using the Dalkon Shield and yet the doctors left it in.  Afterwards, his parents used condoms, spermicide and rhythm to help prevent more pregnancies yet just a few months later they conceived my husband.  Four methods of birth control all failed.  My husband was born holding the IUD in his hand like a toy.  A toy!

God’s hand is not just visible in this particular conception however; through the entire 10 plus months of pregnancy (yes, 10) that were riddled with illness and medical malpractice, my husband was kept safe.  After a very difficult birth, he was put into intensive care as it became apparent that he was not only extremely malnourished due to being so overdue, but that he had also somehow suffered severe liver damage while in the womb.  Weeks of illness did not abate until one weekend, all of the area’s churches prayed urgently for his life…and overnight, he was healed.

I love that story, not just because it concerns my beloved but because it shows the awesome power, sovereignty, wisdom and love of God.  In fact, a cursory reading of the Bible will show that God delights in closing wombs only to open them supernaturally; Mary’s virgin conception of Jesus is simply the most awesome.  It should come as no surprise that God also seems to delight in opening wombs that man has tried to shut.  Given an orthodox Christian understanding of God’s almighty power and sovereignty, the choice facing many Christians today over surgical self-sterilization is not just a personal choice.  It is also a spiritual one.  However this does not seem to be the common understanding among Christians today; most respondents to my research did not see it as a spiritual choice, did not have any Bible verses that helped them with their decision and none had ever heard a spiritual leader talk about the issue.

There is a standard protocol within the church that is used when trying to decipher current moral issues.  If the issue is not specifically addressed in Scripture then Scripture is studied to see if there are principles that will help guide the church.  If there are no principles, then the issue is considered a matter of personal choice.  Blue jeans and shoes can be used as examples.  Does the Bible talk about jeans or blue shoes and whether or not a female believer should wear them?  No.  Are there principles that can help us?  Yes, modesty is in Scripture and it is obvious that jeans can be worn modestly or immodestly.  So if a woman wants to wear jeans, she can follow the principle of modesty from the Bible and rest easy in her conscience.  What about the shoes?  Are there any principles that favor blue shoes over, say, pink ones?  No!  So which color shoe you wear is a matter of personal choice.

What about voluntary surgical self-sterilization?  This term refers to vasectomies, tubal ligations (and essures) and hysterectomies (which is really a form of female castration).  The Bible does refer to male castration (eunuch is the term for a castrated man).  In Deuteronomy 23:1 it says “No one who has been emasculated by crushing or cutting may enter the assemby of the LORD.” (all verses NIV)  Thus any man who was physically sterilized was forbidden to worship God in the Temple.  Yet we read later on in Isaiah 56:3-5 “Let no foreigner who has bound himself to the LORD say, “The LORD will surely exclude me from his people.”  And let not any eunuch complain, “I am only a dry tree.”  For this is what the LORD says: “To the eunuchs who keep my Sabbaths, who choose what pleases me and hold fast to my covenant – to them I will give within my temple and its walls a memorial and a name better than sons and daughters; I will give them an everlasting name that will not be cut off. …For my house will be called a house of prayer for all nations.”  Jesus quotes this verse when driving out the money-changers in the Temple.  It is clear that God annuls the Deuteronomy command and says that even eunuchs can worship Him.  Thus we can see that castration or self-sterilization does not affect one’s salvation. The issue before us is whether or not self-sterilization is wise, right and good in God’s eyes.

What does the New Testament say about it?  In Matthew 19:11-12 “Jesus replied, ‘Not everyone can accept this word, but only those to whom it has been given.  For some are eunuchs because they were born that way; others were made that way by men; and others have renounced marriage because of the kingdom of heaven.  The one who can accept this should accept it.’”  This verse comes in response to the disciples’ dismay that they can’t divorce their wives except for unfaithfulness.  In 1 Corinthians 7:7 Paul says that “I wish that all men were as I am.” He was unmarried and a eunuch for all intents and purposes.  However, he says this after explaining that believers should marry and have sex so as not to open themselves to sexual temptation.  Looking at verse 32 Paul explains “I would like you to be free from concern.  An unmarried man [or woman v 34] is concerned about the LORD’s affairs – how he can please the LORD.”  and in verse 28 “..But those who marry will face many troubles in this life and I want to spare you this.”  Both Jesus in Matthew 19 and Paul in 1 Corinthians 7 explain that choosing singleness for the sake of the gospel is good but it should only be for those who are called to it. In general believers should marry (and the assumption is, have sex and kids) and not get divorced.

These are the verses that deal directly with being a eunuch.  As we have seen, there is not really anything that speaks to voluntary sterilization within a marriage (instead of using any other form of birth control).  Such would have been unheard of in Jewish culture, as barrenness was seen almost as a curse.  Without children, one would be alone in old age, dependent upon charity or the kindness of distant relatives.  In our age of self-reliance, 401K’s and retirement income, it is rare to find children taking care of their parents, or parents expecting their children to help them when they reach the “second childhood.”  Yet recent events have shown graphically that economic downturns can devour a nest egg overnight, leaving the elderly entirely dependent on their children or the state.  In China, where the one-child policy is now showing fruit, there is a serious social problem.  Many couples have 4 elderly parents to care for besides working and raising their own child.  Where do the elderly go?

As Christians, we see that in the Bible it is clear: it is God who opens and closes wombs. No child is a mistake.  What other verses can give us guidelines and principles to help untangle this issue?

Of course the first command that God gave Adam and Eve was “Be fruitful and multiply…” (Gen 1:28).

The body of a Christian is a living temple of the Holy Spirit and we should glorify God with it (1 Cor 6:19).

In a marriage each person’s body belongs not only to themselves but to their spouse as well (1 Cor 7:4).

Children are a blessing from the Lord (Proverbs 127:3), a crown to the aged (Proverbs 17:6) and the bringing up of children is a good deed (1 Timothy 5:10).

In everything we do it should be done for the glory of God (1 Cor 10:31).

Some have mentioned the submission verses for wives, but this doesn’t help one decide whether sterilization is right, it simply puts the onus on the husband to choose.

With this foundation, let us look at why a Christian couple might be looking into voluntary self-sterilization.

Health.  When a couple is told by doctors that having any more children could be detrimental to the health of the wife, who can argue?  It would be considered the height of selfishness for a man in this situation to refuse to use reliable birth control.  Conversely, getting a vasectomy is seen (and done) as an act of love.  However, because surgical self-sterilization is not without health risks, all other methods of birth control should be considered first. (one significant risk is the existence of sperm granulomas and other ways sperm can make it into the blood stream, causing an autoimmune response, that in genetically predisposed men (ie, have psoriasis, etc), may cause a descent into full autoimmune disease, ergo the warning, “Additional research on the effects of vasectomy is obviously necessary, as well as caution in advising this procedure to individuals who may be genetically predisposed to autoimmune disease.”
Immunologic effects of vasectomy in men and experimental animalshttps://www.researchgate.net/publication/16166743_Immunologic_effects_of_vasectomy_in_men_and_experimental_animals [accessed Feb 17 2018].)

Fear.  To be honest, most couples considering this option are looking into it because they do not want any more children.  Fear is really the motivating factor – fear that if they leave it up to God, He will give them more children than they want or can handle.  Many look at other families, who don’t use any birth control, and assume that they would “suffer the same fate.”  In the US, the Duggar family, now on their 19th child, often comes to mind.  This fear is not really logical.  Women’s fertility drops off between the ages of 29-35, then takes a nose dive in the late 30’s – the average woman has only a 65% chance of getting pregnant after 1 year of assiduously trying.  A world survey found that less people are having the number of kids they say they want, which is probably due to many factors like late starting ages, environmental pollution, busy schedules, etc.  While feeling afraid is not sinful in any way, we are told in the Bible not to fear but to trust, and that God’s perfect love drives out fear.  Fear of having more children can also be antithetical to faith in God.  This is when the root issue in the fear is mistrust of God, and can even have as its basis a wrong and sinful view of God as being unloving, unkind and untrustworthy!

Convenience.  This follows closely upon fear, as couples decide that they are “done” yet do not want to spend the next X number of years using some form of birth control.  A couple with this motivation can look into IUD’s before surgical sterilization (notwithstanding my husband’s experience!) as they are long lasting (5-10 years) and immediately reversible. (Of course, IUD’s have their own healthy risks – copper ones may cause more bleeding than normal, and ones using chemicals can be opposed on those terms as well; also there is a significant risk of the IUD becoming imbedded within the uterine wall).

Stewardship.  Many cite the Bible’s verses on being good stewards of their God-given assets as a reason for not having more children (and thus choosing sterilization).  The assets include time, money, and energy.  This is certainly a good point!  Let’s look at our other verses to see if they will help us understand how stewardship fits into this issue.  Married couples should have sex, children are a blessing and God commanded the human race to be fruitful and multiply.  Also, there are many verses that speak of God as a loving father who gives good gifts to His children (one of which is children) and as He is the one who creates them, He can certainly also give the time, money and energy to us to raise them.  Personally, I think God has too high of an estimation of me sometimes – I don’t think I have enough of any of the above to even think about adding more kids!  But as each Christian prays to God about this issue, stewardship can certainly be a valid consideration.  As it has been said, prayer is submitting our will to God’s and prayerfully seeking God’s will in this matter will reveal it.

Adoption.  Quite a few Christian couples expressed the thought to me that if God wanted them to have any more children, they could always adopt.  One couple is even in the process of adopting.  Adoption is absolutely a wonderful Christian calling and ministry.  But if that is a reason for self-sterilization, let us search ourselves very closely to make sure that it is not just an excuse, covering over fear or convenience.  The couple I mentioned is using an IUD to prevent natural children while they are in the process of adoption, and anyone looking into adoption can also look into using an IUD in the meantime – possibly adopting in the future does not necessitate voluntary sterilization now.

Cost.  Vasectomies and tubal ligations are usually covered by health insurance, while other methods of birth control can be expensive.  Over the long term, cost can be a factor.  It is interesting that in countries like Canada, where the population is decreasing and there is great fear of future economic repercussions, a surgical sterilization is paid for by the government but a reversal is not covered.  Considering that the costs are not really that much different (approximately $100 difference to the doctors), you would think that a country wanting more population growth would “put their money where their mouth is!”  Cost is the most common factor in couples choosing not to reverse the sterilization after some time has passed and their feelings/convictions have changed.  Dr. James H. Bledsoe, MD, FACS had a 16 year ministry doing vasectomy reversals for Christian couples.  He says “The main reason couples wanted a reversal was that they wanted more children, having realized what a mistake it was in having sterilization. However, many wanted to be obedient in turning this aspect of their lives over to God.  Even though there are not documented health issues with long term vasectomies, I feel that there well could be health issues found in the future.”

There are not too many Christians who espouse the idea that mankind is evil and the less children, the better, but if there are consider the following: Chuck Colson, in an article about a new movement to self-sterilize to save the earth, said “Societies that view children as a burden find themselves facing extinction. That, in turn, leaves the future of our civilization, and of life itself, in the hands of the fruitful, those who believe that man, created in God’s image, is the crown of creation, not the curse.” (http://www.breakpoint.org/2007/12/fruitless-folly/ )

On the other side, one reason many people cite for NOT getting themselves sterilized is trust in God, and/or unwillingness to “play God” and decide themselves how many children they will have (versus letting God decide).  The “Quiverfull” movement is a group of people within the Christian community who don’t use any birth control (except perhaps natural family planning).  Rick and Jan Hess in their book, A Full Quiver: Family Planning and the Lordship of Christ say “”Behold, children are a gift of the Lord.” (Psa. 127:3) Do we really believe that? If children are a gift from God, let’s for the sake of argument ask ourselves what other gift or blessing from God we would reject. Money? Would we reject great wealth if God gave it? Not likely! How about good health? Many would say that a man’s health is his most treasured possession. But children? Even children given by God? “That’s different!” some will plead! All right, is it different? God states right here in no-nonsense language that children are gifts. Do we believe His Word to be true?”

Given the wide variety of choices for birth control now available, it is not necessary to be a full quiver Christian if you want to trust God to choose the number of your children, just as it is also not necessary to use surgical sterilization if you believe that you should choose the number of children.

What now should we do?  If you are considering a surgical self-sterilization and are a Christian, look hard at your motives.  If after doing this you feel that they are honoring to God, look at the verses mentioned above, and any others that God brings to mind.  If, after doing this you are convinced that self-sterilization is for you, you can be guided by the verse “Whatever you do.. do it all for the glory of God.”  This is assuming both partners in the marriage are in agreement.  It is profoundly unwise, if not sinful, for one partner to self-sterilize without the agreement of the other (1 Cor 7:4).

If however after struggling through this issue together you find no peace, then wait – most recommend 2 years after the birth of your youngest child anyways.  Even pro-vasectomy websites and doctors will urge anyone considering self-sterilization to view it as permanent, and to be 100% sure before committing (not surprisingly, vasectomies are the number 1 surgery patients don’t show up for).  Since your body and your spouse’s body are temples of the living God, it is wise and good to be at peace with Him and each other before arranging to cut your body.  I will close with the words of the Teacher: “The end of the matter; all has been heard. Fear God and keep his commandments, for this is the whole duty of man. For God will bring every deed into judgment, with every secret thing, whether good or evil.” (Ecclesiastes 12:14 ESV)

Update 2/17/18: There is a vasectomy alternative called Vasalgel that looks like it will be coming into human trials this year, and to the market in general after that. This alternative involves, basically, injecting a gel into the vas deferens instead of cutting it. Early research from India (where this was developed under the name of RISUG) seems to indicate fewer health issues than a standard vasectomy. Also, and most pertinent for the purposes of this article, this method would be immediately reversible – a simple solution injected into the vas deferens dissolves the gel.