From our point of view, we believe that the medical risk/benefit balance does not support the preventive use of contraceptives in celibate women, such as the nuns.
A lively debate on this subject has been recently published in the Los Angeles Times, following an opinion piece authored by Malcolm Potts1, professor of Obstetrics and Gynaecology at Berkeley University in California (U.S.) (published 30-I-2014) and a group of readers who responded to his comments in the same newspaper a few days later (6-II-2014).
In the article, Potts openly criticised the opposition shown by a group of nuns from the state of Colorado (U.S.) to comply with President Obama’s governmental precept referring to the mandatory funding of contraceptive methods by companies for their employees.
Potts maintains that it is advisable for the nuns themselves (who for conscientious reasons object to encouraging the use of these methods among contracted staff) to use it as a way of reducing the risk of certain types of reproductive cancers.
The author states that, in populations of women who have had few or no pregnancies, on having had more ovulatory menstrual cycles (he says that women who have had several children with long periods of breastfeeding may have had no more than 40 ovulatory cycles in their fertile lifetime, compared to the 400 that may have occurred in childless women), the risk of suffering ovarian or uterine cancer is significantly increased.
Potts is an advocate for the right to abortion, and was the first health director of the influential American Planned Parenthood Federation, which provides family planning services.
The author began by presenting scientific information (biased, as we will now explain) to then move on to a crushing moral evaluation of the Magisterium of the Church on contraceptive methods and human sexuality.
Nevertheless, we must ask ourselves if Potts’ statements are true with respect to the indisputable benefits of oral contraceptives in childless women to reduce their risk of cancer.
In a reply to the article author2, Dr. Rebecca Peck, professor at Daytona Beach University in Florida (U.S.), countered that the statements made by Potts were true, but only in part. According to Peck, ovarian and uterine cancers are much less common than breast cancer. Uterine cancer has an estimated prevalence of 1 in 19 women throughout their lifetime, and 1 in 72 women in the case of ovarian cancer. However, breast cancer appears in 1 in 8 women.
To back up his statement, Potts cited the National Cancer Institute, the leading U.S. agency for cancer research. However, what he did not consider is that the same agency reported that, unlike the case of uterine and ovarian cancers, the risk of breast, cervical and liver cancer is increased with the use of oral contraceptives3,4. Breast cancer is more common in women who started using oral contraceptives in adolescence.
In women with no children and who therefore have not breastfed, the prevalence of breast cancer is higher than in mothers who have breastfed. Thus, the use of oral contraceptives in this case, as in the case of the nuns, would increase this risk even further.
It should also be taken into consideration that oral contraceptives can predispose women to thromboembolic problems. In this respect, we have recently published a paper in the journal American Journal of Obstetrics and Gynecology5 on this topic, and there are related reports in the document archives of the Bioethics Observatory website.
From our point of view, we believe that the medical risk/benefit balance does not support the preventive use of contraceptives in celibate women, such as the nuns referred to in this article, to reduce the risk of uterine and ovarian cancer. In the end of course, this must be subject to the will of potential users, provided that they have been medically well-advised.
What seems clearer is that, if they are certainly not going to have sex, morally there is no major issue for them to take oral contraceptives for medical purposes, as long as the drugs used are virtually one hundred percent contraceptive.
4 Burkman R, Schlesselman JJ, Zieman M. Safety concerns and health benefits associated with oral contraception. American Journal of Obstetrics and Gynecology 2004; 190(4 Suppl):S5–22
5 Aznar J, Cerdá G. Factor V Leiden carriers taking oral contraceptives have an increased risk of thrombosis. American Journal of Obstetrics and Gynecology. 2013;209(2):156
Justo Aznar and Julio Tudela
Summary: It has sometimes been proposed that it would be advisable for nuns to use contraceptives to reduce the risk of certain types of reproductive cancers. This report states that this is not easy to sustain for medical reasons, although there are no ethical drawbacks if the drugs used act by a virtually contraceptive mechanism.
Description:Use of contraceptives in nuns to prevent reproductive cancers