Contraceptives have been in use since ancient history. The Talmud discusses three types of contraceptives. The first method is, by drinking a drug that permanently destroys the reproducing ability of the male or female organ. The second method is, by inserting an absorbent cotton that covers the uterus and prevents the sperm from entering. The third method is, by undergoing an operation that permanently prevents the reproductive organs from functioning.

When deciding the pros and cons of using contraceptives there are many factors to take into consideration. First, what contraceptives are halachikly permitted. Second, does the couple have children, do they agree about using contraceptives, and if so which ones. Third, what are the medical pros and cons of each type of contraceptives.

We will first discuss the pros and cons of the Pill from the medical aspect. The components of the Pill treatment are, estrogen the female hormone, and progesterone. The Pill is the most effective contraceptives, however, it sometimes produces side effects that may be crippling or fatal to a very small percentage of potential users. Doctors should not prescribe it for some women.

The Pill can adversely affect the blood pressure, kidneys, liver, gallstones, and cause retention of salt and water, increase the risk of blood clots that result in thrombo-phlebitis, pulmonary ombolism, and strokes. It increases the risk of breast cancer and ovarian cancer. It may cause permanent infertility, so that when the woman will stop taking the Pill she will no longer menstruate or ovulate. The Pill should not be prescribed for a woman with irregular menstruation, or no periods at all, if she has not completed her family.

There is an injectable form of a hormone-based drug that blocks ovulation named Depo-Provero. Unlike the Pill which one must comply with a daily dosing schedule, a Depo-Provero injection is good for three months.

The "Patch" is a preferred alternative to the Injection. It is a thin smooth beige patch of absorbent material that is absorbed with hormones. It delivers a continuous flow of hormones into the skin and from there into the blood stream. These hormones prevent pregnancy by preventing ovulation. It is worn unnoticed under the clothing, and must be positioned in one of four body areas. The buttocks, abdomen, upper torso, upper arm. It is ninety nine percent effective. It is worn in a cycle. Once a week for three weeks the patch is replaced, but the fourth week, no patch is worn. Thereafter the cycle begins again. Unlike the Pill, the side effects of the Patch are minimal. Obesity may be a factor in not prescribing the Patch. It should be dispensed through a gynecologists prescription.

The first halachik issue with these types of contraceptives is, is it safe for this individual to use. Even if the gynecologist willingly writes a prescription, it is advisable to monitor the drug by returning for checkups. The second halachik problem is what are the motivations for taking these drugs. They certainly should not be administered before bearing children without having a valid medical reason. If however they have children and feel that it would be too difficult for them to add to the family, then in theory it would be permitted, but one should first consult with a competent Rav.

The second group of contraceptives are, the diaphragm, cervical cap, spermacides, I.U.D. (inter uterine device), and the condom.

The diaphragm is a thin rubber shield that is held in place against the wall of the vagina by the tension of its springy rim. The cervical cap is a thicker thimble-shaped rubber or plastic cup that fits snugly around the neck of the uterus (cervix), and is kept in place by suction. Both devices are used with spermicidal cream or jelly. The cap can be difficult to insert and remove in some women. But the cap can be left in place for several days as opposed to several hours for the diaphragm.

This group of contraceptives is forbidden by Rabbinical law in general but permitted in certain cases. The prohibition is against destroying sperm either directly as with the sprmacides, or indirectly as with the diaphragm, cervical cap, I.U.D., and condom.

The diaphragm, cervical cap, and spermacides are permitted in cases where pregnancy would endanger either the life of the woman or her embryo, or where pregnancy would cause her severe mental illness or depression, or when a she is in a situation where she fears rape. With these cases it is permitted even if the chance of danger is only a small percent. Although the I.U.D. is effective up to ninety eight percent, the diaphragm, cervical cap, and spermacides are preferred because of the adverse side effects of the I.U.D. If either the Pill or the Patch or the Injection is used with the diaphragm and spermacides, or with the cap and spermacides, or if the diaphragm is used with the cervical cap and spermacides, then these combinations should be more effective than the I.U.D.

The I.U.D. is placed into the uterus and it blocks the sperm from entering the fallopian tubes. It also causes a minor inflammation of the uterine lining that prevents the fertilized egg from implanting in the uterine wall if the sperm succeeds to overcome the I.U.D. and enters into the ovary through the fallopian tube. The danger from the I.U.D. is that the minor infection can result into a major infection that scars and blocks the fallopian tubes and sterilizes the woman, and sometimes leads to a hysterectomy.

The I.U.D. in theory is subject to the same halachik rules as the diaphragm, cap, and spermacides. Although it also indirectly causes the destruction and abortion of the zygote or embryo, but since it was inserted before the egg was impregnated that is before the embryos life began, we go according to the odds and assume that the sperm will not be able to break through the I.U.D. barricade to enter the fallopian tube and begin pregnancy. Therefore, she would be allowed to insert the I.U.D. for the purpose of blocking the sperm from entering the fallopian tube and not for the purpose of aborting the zygote. Nevertheless, people will draw an inference and say that if the I.U.D. is permitted then the RU 486 morning after abortion pill is permitted. Furthermore, it is not permitted to insert the I.U.D. after the first coitus because it is then a morning-after pill similar to the RU 486 in that we suspect that she may be pregnant from the first coitus. The RU 486 pill is Biblically prohibited because it is taken after intercourse to abort any embryo that may have just come into being, therefore it is forbidden even if she used a contraceptive before intercourse and there is only a small chance that she may be pregnant when she takes the RU 486 pill. The I.U.D. must be removed and inserted after menstruation or when we are confident that she is not pregnant, and before she goes to "mikvah." This way there is no chance that an embryo may be destroyed during the procedure. It is usually left in place for many months before changing.

The condom is Biblically forbidden and may not be used because it is considered masturbation without intercourse since the organ is covered and does not allow any bodily contact with the woman. Even if the condom may have a hole at the tip as long as it will retain some sperm it is prohibited.

The third group of contraceptives permanently sterilizes the husband or the wife through an operation. The method used today is the Pipeline sterilization method where they sever the tubes that carry the sperm into the body, or that allow sperm to enter the ovaries. About one inch of the tube is cut out, cauterized, and tied with a non-absorbable thread. With the female they cut the fallopian tubes. With the male the tube that is cut is called the vas deferens that is attached to the testicles. However, some sperm are left in the part of the tube that is in the body at the time of the operation, so for the next twelve acts of coitus a contraceptive must be used, preferably a combination of two contraceptives as explained before. Most surgeons require that their patients return after four to twelve months and give a semen sample for analysis to check if the vas deferens has joined together again. Patients have some discomfort for two or three days after the vasectomy but there is no hormonal change nor any change in his capacity for sexual relations. Pipeline sterilization is at best only thirty percent reversible through an operation and therefore according to halacha it is treated as if it is permanent until it is reversed and he can have children. If however, they could improve the procedure so that it would be seventy or eighty percent reversible for this individual, then we could be more lenient.

Couples prefer sterilization to the long term use of contraceptives because they fear their failure, and they fear the side effects from the Pill and I.U.D., and have aesthetic objections to remembering to insert contraceptives at an emotionally wrong time.

A vasectomy is prohibited by the Bible and may not be done. Pipeline sterilization of a woman is Rabbinically forbidden and may be permitted under certain conditions.

Although the diaphragm, cap, and spermacides are Rabbinical prohibitions and should have been permitted to be used in a case of illness that is not so severe as described before, it was not because of the severity of the prohibition against wasting sperm. Sterilization was not mentioned in the cases discussed in the Talmud of the three women who may use contraceptives because their problems were temporary and sterilization is permanent and not permitted in these cases. We can consider sterilization in the cases when contraceptives are permitted and it is a long term medical problem to the extent that the husband is considering divorce if his wife will not agree to having intercourse, or because he does not want to put his wife or the embryo at risk. If she can take any combination of two contraceptives as explained before, then this combination would perform about as well as sterilization, and sterilization would then not be permitted. If not, then if the husband does not have any children, but the couple are willing to have children together through IVF with a surrogate mother, then after having at least one child sterilization may be permitted. If not, then sterilization is not permitted because by doing it one actively destroys the husbands chances of performing the commandment of being fruitful and multiply. Likewise, if he has children it may be permitted in this case.

The morning after pill or RU 486 is an abortion drug taken after intercourse. It blocks the action of progesterone, the hormone that allows the fertilized egg to attach itself to the uterine wall and implant itself there. To be sure that the embryo does not succeed, the woman takes prostaglandin two days later which causes the uterus to contract and the cervix to soften and dilate and expel the embryo in ninety seven percent of the cases. This drug is not prescribed for heavy smokers or women thirty five years or older, and only within seven weeks of the first day of a woman's last menstrual period.

As stated before, destroying a fertilized egg or an embryo is a Biblical prohibition and the RU 486 is not permitted.

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