Humanae Vitae and Global Health
While many women in the Global North and large parts of Latin America continue to use contraception despite Humanae Vitae, in developing countries—especially where the Catholic hierarchy holds sway over government family planning policies—the impact of this ban has been deadly. The Catholic hierarchy’s insistence that Humanae Vitae guide the health policies of governments, and often foreign assistance for these policies, has led to a persistent unmet need for modern family planning in developing countries. This gap has set back development progress, led to increased abortion, death and disability for women denied the ability to limit pregnancies and hurt efforts to stem the spread of HIV&AIDS.
The Catholic hierarchy is a vociferous opponent of modern contraception on the African continent, which has the world’s lowest rate of contraceptive use.
Today, an estimated 214 million women globally have an unmet need for modern contraception, which contributes to high rates of maternal mortality.[i] A wide-scale study found that contraceptive use reduced maternal mortality by almost 44 percent. Increasing the contraception prevalence rate in low-performing developing countries would not only avert some 27 deaths per 100,000 women, but would “reduce the burden on [the] maternal health system for serving more women effectively and efficiently.”[ii]
Despite this evidence, the Catholic hierarchy is a vociferous opponent of modern contraception on the African continent, which has the world’s lowest rate of contraceptive use. Pope John Paul II called the promotion of contraceptives in developing countries attacks on the family and part of a “culture of death.”[iii] Bishops routinely make false charges that modern contraception is harmful to women’s health, that the increased use of contraception leads to increased levels of abortion and that international family planning programs are western plots to destroy African society.[iv] This is especially concerning because Catholicism is growing fastest in Africa—the Catholic population on the continent has increased by 238 percent since 1980 and Catholics are predicted to account for nearly 25 percent of the population by 2040.[v]
Catholic bishops have been especially influential in promoting these views in countries with large Catholic populations, such as Angola, Congo, Gabon, Kenya, Nigeria, Rwanda and Uganda, which have persistently high rates of unmet need for contraception.[vi] In Nigeria, Catholic bishops refuse to acknowledge the role that modern contraceptives play in reducing maternal mortality.[vii] In 2015, the Nigerian bishops charged that international family planning programs were part of a “culture of death” designed to promote a “radical” program of abortion and contraception pushed by “wealthy philanthropists, donor nations and international organizations” that would result in the “hyper-sexualization of our youth.”[viii] In 2016, the Catholic bishops in Uganda instructed all Catholic facilities, which include 115 health centers and nine hospitals, to stop dispensing contraceptives, citing Humanae Vitae as the reason and calling contraceptives immoral.[ix]
As a result, support for contraceptive use among African Catholics is persistently lower than in other parts of the world. The same 2014 survey that found that 78 percent of Catholics worldwide support contraceptives, found that only 44 percent of Catholics in Congo and 43 percent in Uganda back modern methods of contraception.[x] A 2014 Pew survey found some of the lowest levels of support for contraceptives in the world in Nigeria and Ghana, where 54 and 52 percent of the population respectively say using contraceptives is “morally unacceptable.”[xi] A survey of women’s reasons for not using family planning found that women in Africa were more likely than women in other developing regions to cite personal or family opposition to contraceptives. It found that “opposition to contraception is somewhat more frequently cited as a reason for nonuse than in earlier years,” which could be due to a growing tide of cultural conservatism or fears about the health effects of contraceptives.[xii] Fully 38 percent of women in Nigeria and 28 percent of those in Congo not using contraceptives cited such opposition as the reason.[xiii]
Nevertheless, some developing countries have been able to overcome battles with the Catholic hierarchy and meet women’s needs for contraception. Kenya, for instance, has successfully promoted the use of modern contraceptives, despite its influential bishops’ conference. The Ministry of Health partnered with international NGOs to meet its goal of 52 percent of married women using contraceptives by 2015 and by 2014 it already had 53 percent usage rates, resulting in a global Excellence in Leadership for Family Planning Award. Kenya is on target to expand family planning access to nearly 60 percent of married women by 2018, two years ahead of target.[xiv]
Yet these efforts have come under attack from the Kenyan bishops’ conference, which has painted the program as a western attack on African culture and society. “The drive by foreign agencies … to target millions of girls and women in Africa for the artificial family planning … is unimaginable, dangerous and could lead to the destruction of human society,” said the bishops’ statement when Kenya’s government first announced its family planning campaign in 2012.[xv] Calling contraceptives “unholy,” Kisumu Archbishop Zacchaeus Okoth announced an anticontraceptive initiative in December 2017 to “educate couples on natural family planning” and oppose the use of popular modern methods such as Norplant, a contraceptive implant, which Okoth falsely charged is causing harm to women.[xvi]
In the Philippines, Catholics voice strong support for contraceptives but have been limited in accessing them by the hierarchy. According to the 2014 poll of Catholics worldwide, 68 percent of Catholics in the Philippines support contraceptive use.[xvii] The country had a successful government-backed family planning program in the 1990s, providing free and reduced-cost contraceptives to its large low-income population. But when Gloria Macapagal-Arroyo became president in 2001, she paid back the Catholic bishops for supporting her candidacy by ending the program and making natural family planning the country’s official method of birth control. As a result, the country’s rate of unmet need for modern contraceptives shot up to 38 percent by 2012.[xviii] Its high rate of poverty grew even higher, as the number of poor people increased by 4 million between 2003 and 2006.[xix] The decline in the country’s maternal mortality rate, which had decreased at two percent per year between 1990 and 2000 also reversed.[xx]
Several reproductive health bills were introduced throughout the 2000s to restore the country’s family planning program, but were successfully blocked by the politically influential Catholic bishops. They falsely charged that these bills would legalize abortion and threatened to excommunicate legislators who voted for them. But grassroots support from Catholics finally overwhelmed the bishops. In 2012, the Reproductive Health law passed that guaranteed all women access to modern contraceptives and instituted a program of sex education for schools.
The bishops refused to relent, and in 2013, the country’s supreme court blocked implementation of the Reproductive Health law after sustained lobbying from the bishops, who claimed it violated freedom of religion. In 2014, the court allowed partial implementation of the law. Finally, in 2017, President Rodrigo Duterte issued an executive order that allowed for the full implementation of the Reproductive Health law. Nevertheless, the Catholic bishops were successful in blocking distribution of condoms in schools, signaling that they will continue to try and impose Humanae Vitae on a population that has disregarded the teaching.[xxi]
[i] Guttmacher Institute, “Adding It Up: Investing in Contraception and Maternal and Newborn Health,” December 2017. https://www.guttmacher.org/sites/default/files/factsheet/adding-it-up-contraception-mnh-2017.pdf
[ii] S. Ahmed, Q. Li, L. Liu and A. Tsui, “Maternal deaths averted by contraceptive use: an analysis of 172 countries,” The Lancet, July 14, 2012, pp. 111-125.
[iii] Pope John Paul II, Evengelium Vitae, March 25, 1995, http://w2.vatican.va/content/john-paul-ii/en/encyclicals/documents/hf_jp-ii_enc_25031995_evangelium-vitae.html
[iv] Father Peter West, “Fight the Culture of Contraception in Uganda,” Human Life International, https://www.hli.org/2012/12/fighting-the-culture-of-contraception-in-uganda/.
[v] Mark Pattison, “Africa’s Catholic Population Has Grown by 238 Percent Since 1980,” Catholic Herald, June 3, 2015, http://www.catholicherald.co.uk/news/2015/06/03/africas-catholic-population-has-grown-by-238-per-cent-since-1980/.
[vi] S. Bradley, T. Croft, J. Fishel, and C. Westoff, Revising Unmet Need for Family Planning, DHS Analytical Studies No. 25, Calverton, MD, ICF International, 2012.
[vii] “Catholic Church Restates Opposition to Use of Condom, Family Planning,” Premium Times, December 18, 2012. https://www.premiumtimesng.com/news/111658-catholic-church-restates-opposition-to-use-of-condom-family-planning.html
[viii] “Nigerians Speak Out Against Abortion and Contraception Promoted by International Organizations,” Aleteia, April 24, 2015, https://aleteia.org/2015/04/24/nigerians-speak-out-against-abortion-and-contraception-promoted-by-international-organizations/.
[ix] Emmanuel Ntirenganya,“Catholic Church changes stance on ‘artificial’ family planning methods,” The New Times, Sept. 4, 2016, http://www.newtimes.co.rw/section/article/2016-09-04/203226/.
[x] Bendixen & Amandi for Univision, “The Voice of the People,” February 2014, conducted December 2013-January 2014.
[xi] Michael Lipka, “Africans Among the Most Morally Opposed to Contraception,” Pew Research Center, April 16, 2014. http://www.pewresearch.org/fact-tank/2014/04/16/africans-among-the-most-morally-opposed-to-contraception/
[xii] G. Sedgh, L.S. Ashford and R. Hussain, “Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method,” New York: Guttmacher Institute, 2016.
[xiv] Gatonye Gathura, “Catholic Bishop Reawakens Fight on Contraceptives,” The Standard, January 13, 2018, https://www.standardmedia.co.ke/health/article/2001265788/catholic-bishop-renews-fight-on-contraceptives.
[xv] Fredrick Nzwili, “Kenyan Roman Catholic Bishops Oppose Push for Birth Control,” https://www.pcusa.org/news/2012/8/2/kenyan-roman-catholic-bishops-oppose-push-birth-co/.
[xvi] Mactilda Mbenywe, “Church to Establish Anti-Contraceptive Movement,” The Standard, (Kenya) Dec. 27, 2017, https://www.standardmedia.co.ke/article/2001264213/church-to-establish-anti-contraceptive-movement.
[xvii] Bendixen & Amandi for Univision, “The Voice of the People,” February 2014, conducted December 2013-January 2014.
[xviii] S. Bradley, T. Croft, J. Fishel, and C. Westoff, Revising Unmet Need for Family Planning, DHS Analytical Studies No. 25, Calverton, MD, ICF International, 2012.
[xix] Chino Leyco, “Philippines Trails in Poverty Reduction, Says U.N. Report,” Manila Times, April 3, 2008.
[xx] Maternal mortality in 1990-2015: Philippines, WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division Maternal Mortality Estimation Inter-Agency Group, 2015. http://www.who.int/gho/maternal_health/countries/phl.pdf
[xxi] Erik De Castro, “Inside the Philippines’ Long Journey Towards Reproductive Health,” The Conversation, May 9, 2017. https://theconversation.com/inside-the-philippines-long-journey-towards-reproductive-health-72737