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Is sterilization permitted when pregnancy would be dangerous?

17 December, 2023

Question:

My husband and I have been blessed with three healthy children, in the past three years. We have two boys and a girl.

Unfortunately, the pregnancies and deliveries have not been so trivial for me. I have had three c–sections. On the most recent one, my uterus nearly ruptured so the doctor advised me not to have any more children, as pregnancy would be very dangerous for my body.

I went on birth control, but it has very negative effects on me, making me feel terrible and putting me in negative moods all the time. This has had a severely negative impact on my relationship with my husband. I want to stop the birth control but I cannot risk another pregnancy that could, God forbid, have dire effects on my health.

I’m wondering if there is a way my husband would be permitted to get a vasectomy. I know that usually that is not the preferred method of birth control but I am hoping that due to the unique and extenuating circumstances, it would be allowed. Thank you!


Answer:

We appreciate the sensitive nature of this question.

We assume from your question that using an IUD or diaphragm with spermicide would be medically ruled out. If they are not, either one would be a halachically preferred course of action.

We would also recommend discussing with your physician the side effects you are experiencing with hormonal contraception. Symptoms often improve after a few months of use. If they don’t, changing to a different form of hormonal contraceptive can sometimes make a difference. If you’re using progesterone-only contraception, you can discuss with your physician whether and when it might be possible to switch to combined hormonal contraception. Combined hormones can affect milk supply, so this would depend on whether you’re breastfeeding, how well breastfeeding is established, and the age of your baby.

Even among similar types of hormonal contraceptives, a different formulation or delivery method could make a difference in side effects. For example, among combined hormonal contraceptives, the NuvaRing’s hormonal effects tend to be more localized, and thus it might provide you with the contraception that you seek without the negative side effects.

Please see here for further discussion of mood-related side effects of hormonal contraception.

If no other contraceptive options are suitable, then in situations like yours in which pregnancy would be life-threatening, a tubal ligation may be permitted after individual rabbinic consultation. Within the methods of surgically blocking the tubes, there may be some preference to the use of rings or clips, which at least in theory, can be reversed, over actual destruction of the tubes, as in their ligation. Ordinarily, long-term sterilization is prohibited. But the prohibition for men is on a Biblical level and for women it is rabbinic, so a tubal ligation would be permitted before a vasectomy.

Please be in touch to follow up and to let us know if we can be of further assistance.


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