Maternal Age as a serious reason to avoid pregnancy

[Xantippe]

Hoosier Daddy quoted this:

“At a country level, India (19% or 56,000) and Nigeria (14% or 40,000) accounted for roughly one third of the maternal deaths in 2010. Democratic Republic of the Congo, Pakistan, Sudan, Indonesia, Ethiopia, United Republic of Tanzania, Bangladesh and Afghanistan comprised between 3 to 5 percent of maternal deaths each. [17] These ten countries combined accounted for 60% of all the maternal deaths in 2010 according to the United Nations Population Fund report. Countries with the lowest maternal deaths were Estonia, Greece and Singapore [18].”

As I understand, the historical norm for maternal deaths is something like 1 maternal death for every 100 births.

You’ll notice that there’s a rough relationship between the amount of childbearing the average woman does in a country and the risk of maternal death. I’ll note done the average number of births per woman in each country you named:

Here are the high-mortality countries and the average number of births per woman:

India: 2.59
Nigeria: 5.49
Congo: 4.5
Pakistan: 3.34
Sudan: 4.32
Indonesia 2.09
Ethiopia 4.04
Tanzania 5.53
Bangladesh: 2.2
Afghanistan: 6.16

Here are the low-mortality countries and the average number of births per woman:

Estonia: 1.52
Greece: 1.42
Singapore: 1.2

As I said, it’s a rough correlation, and the casaulity is probably very complicated, but there’s a strong correlation between a super low birth rate and a high level of safety for mothers.

 

[Xantippe]

Rau said:

“I assume the reasoning from your husband would say it is OK to marry and use NFP in these circumstances?”

Yes!

PaulinVA said:

“Since the Church has not provided a list of serious reasons, you can not state that maternal agealone is not a serous reason. It cuts both ways.”

Right.

Rico S said:

“No. We are saying that it CAN be serious enough reason…not that it always is for every couple. The other camp in this thread is saying that mother’s age CANNOT be serious enough reason alone to avoid for ANY couple.”

Right.

Rau said:

“Age is bound up,with medical, eugenic, social and perhaps economic factors.”

Exactly.

 

[bitterhope]

Just to let you know, most hospitals now treat pregnant patients with breast cancer during pregnancy with no ill effects for the baby. My cousin just had her daughter and is also now in remission. Both mom and baby are doing well.

 

[Galbin]

Just to let you know, most hospitals now treat pregnant patients with breast cancer during pregnancy with no ill effects for the baby. My cousin just had her daughter and is also now in remission. Both mom and baby are doing well.

Did she have breast cancer while pregnant? God love her if she did! I am however very glad to read that she is doing well. It must have been very traumatic for her though.

 

[Vico]

Age is bound up,with medical, eugenic, social and perhaps economic factors.

Age itself is not one of the indications that has been approved. Time may bring any of the other indications.

 

[bitterhope]

Did she have breast cancer while pregnant? God love her if she did! I am however very glad to read that she is doing well. It must have been very traumatic for her though.

Yes. She was diagnosed at age 33 at her first prenatal appt. she was shocked and devastated, but once the dr. confirmed diagnosis and told her that the standard treatment was ok during pregnancy she did well. It seems many drs have noticed the outcome tends to be better when started during pregnancy and mom is calmer as well. Babies tend to do well with treatment too. She is the first person in the family to have breast cancer so no one ever thought it possible, especially when she was do young. I guess we never know what life has planned for us.

She is disappointed that she can’t nurse, but we are just so happy she is with us.

 

[Xantippe]

bitterhope said:

“Just to let you know, most hospitals now treat pregnant patients with breast cancer during pregnancy with no ill effects for the baby. My cousin just had her daughter and is also now in remission. Both mom and baby are doing well.”

Very good!

I was just reading that the first trimester continues to be problematic, but there are fewer worries about the second and third.

In any case, not an ideal situation.

Vico said:

“Age itself is not one of the indications that has been approved. Time may bring any of the other indications.”

Bear in mind that the list is preceded by “such as.”

Here’s the quote again:

“Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called “indications,” may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life.”

Medical, eugenic, economic and social are huge and very elastic categories.

Also, the use of “such as” to precede the list indicates that “medical, eugenic, economic and social” reasons are not the only possible serious motives the pope envisioned.

 

[bitterhope]

Yes, I agree it is not ideal and I wouldn’t wish it on anyone, but I don’t think it is best to worry about things so much. I pray you never need to go through cancer, especially with little ones or pregnant (or both!) but if anyone here finds themselves in a situation like that, I hope they find peace in knowing their little one will most likely be alright.

 

[Rau]

Age itself is not one of the indications that has been approved. Time may bring any of the other indications.

I think you misunderstand. No indications have been approved - a number of classes have been named which are very broad, within which some reasons will be just for some parents. The set of classes is not exclusive.

This notion of “age alone” as though that could be isolated quite apart from all the factors that come with age, is just silly. I don’t think anyone intends to isolate “age” from other factors such as:

• maternal risk
• child risk
• parental weariness
• parental health

When people talk of “age” they implicitly factor in something(s) else. Age is no more a factor in isolation than is altitude. To interpret the question as though it is, is to misrepresent the question.

 

[Xantippe]

To continue Rau’s point.

-economics, too

I’ve noticed that a lot of parents of families only really get in gear with regard to saving for retirement or straightening out their finances once their kids are raised and gotten through college. I think in the US it’s really more the rule than the exception (I’ve known a number of them), and that factors into parents’ desire not to keep having children through their 40s. If a couple like that has a child at 45, the kid starts college when the parents are 63 and then the parents will be funding college until they are 67. To start retirement savings at 67 is not that great.

Ideally, couples would be able to start saving for retirement earlier, but over and over again, I’ve seen the pattern that parents find it difficult to save when raising children (particularly during the college years) and are only able to start making serious financial progress once they are empty nesters.

 

[Vico]

I think you misunderstand. No indications have been approved - a number of classes have been named which are very broad, within which some reasons will be just for some parents. The set of classes is not exclusive.

This notion of “age alone” as though that could be isolated quite apart from all the factors that come with age, is just silly. I don’t think anyone intends to isolate “age” from other factors such as:

• maternal risk
• child risk
• parental weariness
• parental health

When people talk of “age” they implicitly factor in something(s) else. Age is no more a factor in isolation than is altitude. To interpret the question as though it is, is to misrepresent the question.

I have to disagree. To say the justifying reason is age and not say that it is a medical, eugenic, social, or economic factor is misleading because not every factor associated with age would be morally justifiable. What Pope Pius XI and Pope Pius XII actually said is clear. As an example this statement was made:
The Medical indication [for NFP] is a serious danger to the health or the life of the mother, diagnosed by a doctor, qualified either from a scientific point of view or from a moral point of view. In such a case the obligation “of providing for the preservation of mankind” (621) ceases, because a woman is not obliged, by the matrimonial contract, to expose herself to dangers or injury which are not ordinarily part of maternity (Courier de Rome, June 1991, p.2). (Reference: No. 621 in Papal Teaching: Matrimony. Selected and arranged by the Benedictine Monks of Solesmes, trans. Michael J. Byrnes. Boston: St. Paul Books, 1963.)

See: catholicapologetics.info/morality/family/natural.htm

 

[Rau]

I have to disagree. To say the justifying reason is age and not say that it is a medical, eugenic, social, or economic factor is misleading because not every factor associated with age would be morally justifiable. What Pope Pius XI and Pope Pius XII actually said is clear. As an example this statement was made:
The Medical indication [for NFP] is a serious danger to the health or the life of the mother, diagnosed by a doctor, qualified either from a scientific point of view or from a moral point of view. In such a case the obligation “of providing for the preservation of mankind” (621) ceases, because a woman is not obliged, by the matrimonial contract, to expose herself to dangers or injury which are not ordinarily part of maternity (Courier de Rome, June 1991, p.2). (Reference: No. 621 in Papal Teaching: Matrimony. Selected and arranged by the Benedictine Monks of Solesmes, trans. Michael J. Byrnes. Boston: St. Paul Books, 1963.)

See: catholicapologetics.info/morality/family/natural.htm

That statement does not appear to be in conflict with mine. No one has said that any factor associated with age would be a just reason for every person. But a person citing “age” has in mind some accompanying factor which may be a just reason for them.

Regarding the Pope’s statement, it does appear to be quite unlike the typical Church teaching on moral matters. I note it is limited to the Medical class, and only in respect of the Mother. It refers to indefinite consequences such as “serious danger to health”, and “dangers and injury not ordinarily part of maternity” - I’m sure some will argue that serious health risks are a normal part and parcel of maternity!!

This hasn’t occurred to me before, but I wonder how this prescription is derived from moral principles? At the same time it seems to be both imprecise and too specific!! Perhaps a sign of overreach? Current day expression of the rules on NFP seem to be far more circumspect, and somewhat more tuned toward parental discernment. I could well believe that’s no accident, but a development of the teaching.

The reference to “providing for the preservation of mankind” is also curious. If that is the obligation that ordinarily weighs against use of NFP, then how do we interpret circumstances when, due to a healthy birth rate in the world or in a country, mankind’s preservation is well in hand?

 

[Vico]

That statement does not appear to be in conflict with mine. No one has said that any factor associated with age would be a just reason for every person. But a person citing “age” has in mind some accompanying factor which may be a just reason for them.

Regarding the Pope’s statement, it does appear to be quite unlike the typical Church teaching on moral matters. I note it is limited to the Medical class, and only in respect of the Mother. It refers to indefinite consequences such as “serious danger to health”, and “dangers and injury not ordinarily part of maternity” - I’m sure some will argue that serious health risks are a normal part and parcel of maternity!!

This hasn’t occurred to me before, but I wonder how this prescription is derived from moral principles? At the same time it seems to be both imprecise and too specific!! Perhaps a sign of overreach? Current day expression of the rules on NFP seem to be far more circumspect, and somewhat more tuned toward parental discernment. I could well believe that’s no accident, but a development of the teaching.

The reference to “providing for the preservation of mankind” is also curious. If that is the obligation that ordinarily weighs against use of NFP, then how do we interpret circumstances when, due to a healthy birth rate in the world or in a country, mankind’s preservation is well in hand?

Pope Pius XII explains here, in Address to Midwives:
The reason is that marriage obliges the partners to a state of life, which even as it confers certain rights so it also imposes the accomplishment of a positive work concerning the state itself. In such a case, the general principle may be applied that a positive action may be omitted if grave motives, independent of the good will of those who are obliged to perform it, show that its performance is inopportune, or prove that it may not be claimed with equal right by the petitioner—in this case, mankind.
The matrimonial contract, which confers on the married couple the right to satisfy the inclination of nature, constitutes them in a state of life, namely, the matrimonial state. Now, on married couples, who make use of the specific act of their state, nature and the Creator impose the function of providing for the preservation of mankind. This is the characteristic service which gives rise to the peculiar value of their state, the bonum prolis. The individual and society, the people and the State, the Church itself, depend for their existence, in the order established by God, on fruitful marriages. Therefore, to embrace the matrimonial state, to use continually the faculty proper to such a state and lawful only therein, and, at the same time, to avoid its primary duty without a grave reason, would be a sin against the very nature of married life.
Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called “indications,” may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life. From this it follows that the observance of the natural sterile periods may be lawful, from the moral viewpoint: and it is lawful in the conditions mentioned. If, however, according to a reasonable and equitable judgment, there are no such grave reasons either personal or deriving from exterior circumstances, the will to avoid the fecundity of their union, while continuing to satisfy to the full their sensuality, can only be the result of a false appreciation of life and of motives foreign to sound ethical principles.
~ Address to Midwives, Given by His Holiness Pope Pius XII, 29 October 1951

 

[Rau]

Pope Pius XII explains here, in Address to Midwives:
The reason is that marriage obliges the partners to a state of life, which even as it confers certain rights so it also imposes the accomplishment of a positive work concerning the state itself. In such a case, the general principle may be applied that a positive action may be omitted if grave motives, independent of the good will of those who are obliged to perform it, show that its performance is inopportune, or prove that it may not be claimed with equal right by the petitioner—in this case, mankind.
The matrimonial contract, which confers on the married couple the right to satisfy the inclination of nature, constitutes them in a state of life, namely, the matrimonial state. Now, on married couples, who make use of the specific act of their state, nature and the Creator impose the function of providing for the preservation of mankind. This is the characteristic service which gives rise to the peculiar value of their state, the bonum prolis. The individual and society, the people and the State, the Church itself, depend for their existence, in the order established by God, on fruitful marriages. Therefore, to embrace the matrimonial state, to use continually the faculty proper to such a state and lawful only therein, and, at the same time, to avoid its primary duty without a grave reason, would be a sin against the very nature of married life.
Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called “indications,” may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life. From this it follows that the observance of the natural sterile periods may be lawful, from the moral viewpoint: and it is lawful in the conditions mentioned. If, however, according to a reasonable and equitable judgment, there are no such grave reasons either personal or deriving from exterior circumstances, the will to avoid the fecundity of their union, while continuing to satisfy to the full their sensuality, can only be the result of a false appreciation of life and of motives foreign to sound ethical principles.
~ Address to Midwives, Given by His Holiness Pope Pius XII, 29 October 1951

I don’t know to which point in my prior post you direct the above quote? But I continue to find this reasoning “stretched”. Clearly, married folks have the burden of “preserving mankind”, but there is a leap to conclude that this implies that only a “grave” issue ought to influence a couple against another child (given they maintain a sexual relationship)! *The Pope’s reasoning however does well support the Church position against entering into marriages with a view to avoiding children entirely. *

While one can say (referencing the Pope’s expression) that mankind “petitions” that marriages be fruitful, it only wishes them to be sufficiently fruitful, not more. It is not clear that it requires each couple to continue to act in favour of “fruitful” until a “grave” reason causes them to do otherwise.

One last point - the Pope expresses concern at those would seek to “avoid the fecundity of their union, **while continuing to satisfy to the full **their sensuality”. This hardly seems a likely possibility if one is using NFP to avoid [just ask anyone using it!], but certainly it does describe the ABC user!

It would be interesting to know the average number of children born to parents who limit themselves to NFP as a means to avoid vs. those who accept no such limitation. This might reveal something rather ironic about the focus of the debate!

 

[Xantippe]

Rau said:

“It refers to indefinite consequences such as “serious danger to health”, and “dangers and injury not ordinarily part of maternity” - I’m sure some will argue that serious health risks are a normal part and parcel of maternity!!”

Certain discomforts and mildly annoying but temporary ailments are part of a normal pregnancy (mild morning sickness, heartburn, hemorrhoids), but I think there’s a fairly bright line between the normal stuff vs. the more dangerous stuff. I think you can definitely tell the difference when talking to a doctor, for instance, what they regard as normal and what they regard as worrisome. As I’ve mentioned previously, “Advanced Maternal Age” is in fact an obstetrical category that triggers all sorts of special treatment.

When I read “serious danger to the health or the life of the mother, diagnosed by a doctor, qualified either from a scientific point of view or from a moral point of view” what I’m hearing is openness to medical opinion and expertise. I think that the obstetrical community’s treatment of “Advanced Maternal Age” as a risk factor demonstrates that age alone is in fact an acceptable reason for older women to avoid. To respect that medical judgment is quite in the spirit of that particular papal statement. It doesn’t need to be read in a rigoristic way.

Aside from that, Humanae Vitae has a higher level of authority and it is definitely much less specific.

 

[Xantippe]

One more thing–there are vast areas of the world where access to a real medical doctor is close to impossible, while at the same time it might be fairly obvious that a life threatening condition was present due to previous difficult obstetrical history.

So, I don’t think that that quote about the doctor was meant to be as restrictive as it is being treated. Presumably, there is good reason why that restrictive language did not find its way into Humanae Vitae.

 

[Xantippe]

Rau,

My suspicion is that in the “Address to Midwives,” the pope is primarily concerned with intentionally childless couples. It sounds like he’s primarily talking about the intentionally childless, rather than those with small families.

I also agree that the language about avoiding “the fecundity of their union, while continuing to satisfy to the full their sensuality” doesn’t really sound like he’s talking about NFP. We’ve in a previous thread talked about the issue that conservative NFP might only provide 10 days per cycle.

I also strongly suspect that a major part of the difficulty here is caused by the fact that at the time the pope was writing (1951?), calendar rhythm had only been available at all as a family planning method for about two decades.

en.wikipedia.org/wiki/Calendar-based_contraceptive_methods

At the time of the “Address to Midwives” there simply hadn’t been enough pastoral experience of Calendar Rhythm yet for the theology of it to be very well-formed. I think that explains a great deal–by the time of Humanae Vitae (1968), there had been substantially more pastoral experience, and it had become quite clear that 1) Calendar Rhythm would only space births for the average woman (rather than avoid conception entirely) and she’d probably wind up with a fair-sized family and 2) a truly effective natural family method is going to require a lot of abstinence.

I also think that the normal definition for papal infallibility is being stretched pretty hard in this discussion.

en.wikipedia.org/wiki/Papal_infallibility

 

[Rau]

Rau,

My suspicion is that in the “Address to Midwives,” the pope is primarily concerned with intentionally childless couples. It sounds like he’s primarily talking about the intentionally childless, rather than those with small families.

I also agree that the language about avoiding “the fecundity of their union, while continuing to satisfy to the full their sensuality” doesn’t really sound like he’s talking about NFP. We’ve in a previous thread talked about the issue that conservative NFP might only provide 10 days per cycle.

I also strongly suspect that a major part of the difficulty here is caused by the fact that at the time the pope was writing (1951?), calendar rhythm had only been available at all as a family planning method for about two decades.

en.wikipedia.org/wiki/Calendar-based_contraceptive_methods

At the time of the “Address to Midwives” there simply hadn’t been enough pastoral experience of Calendar Rhythm yet for the theology of it to be very well-formed. I think that explains a great deal–by the time of Humanae Vitae (1968), there had been substantially more pastoral experience, and it had become quite clear that 1) Calendar Rhythm would only space births for the average woman (rather than avoid conception entirely) and she’d probably wind up with a fair-sized family and 2) a truly effective natural family method is going to require a lot of abstinence.

I also think that the normal definition for papal infallibility is being stretched pretty hard in this discussion.

en.wikipedia.org/wiki/Papal_infallibility

I agree with the context you give for this address. Papal infallibility is not relevant to this address, hence I have no qualms challenging its reasoning and the interpretations some are putting on it.

 

[Rau]

One more thing–there are vast areas of the world where access to a real medical doctor is close to impossible, while at the same time it might be fairly obvious that a life threatening condition was present due to previous difficult obstetrical history.

So, I don’t think that that quote about the doctor was meant to be as restrictive as it is being treated. Presumably, there is good reason why that restrictive language did not find its way into Humanae Vitae.

There is a considerable evolution from this point (Pius XII) to the current day teaching, in particular, the elimination of specifics on what is “serious” (which, as we’ve seen, becomes unworkable if you try to define it), and the emphasis on the parents making the judgement (which is a consequence of the last point).

 

[Vico]

Here is the statement from 1880 defining Natural Family Planning (the term today) with my translation.
*"De uso exclusivo temporum agenneseos:

“Qu.:An licita in se sit praxis coniugum, qui, cum ob iustas et graves causas prolem honesto modo evitare malint, ex mutuo consensu et motivo honesto a matrimonio utendo abstinent praeterquam diebus, quibus secundum quorundam recentiorum theoremata ob rationes naturales conceptio haberi non potest?”
“Resp.: Provisum est per Resp. S. Paenitentiariae, 16. Iun. 1880.”*
On the exclusive use of the agenesic (sterile) period:

Query: Whether licit in itself is the practice by which for just and grave causes, wishing to avoid offspring in a honorable way, from the matrimonial use abstain, by mutual consent and with honorable motives, except on those days which, according to certain recent theories, that for natural reasons conception is not possible.

Response: The Response provided per the Sacred Penitentiary, 16 June 1880.

Commentary:
The Apostolic Penitentiary defined our Natural Family Planning: “except on those days which, according to certain recent theories, that for natural reasons conception is not possible.”

It was made public in 1881, to not disturb couples that used the agenesic periods to avoid onanism:"Qu:. An licitus sit usus matrimonii illis tantum diebus, quibus difficilior est conceptio?

“Resp.: Coniuges praedicto modo utentes inquietandos non esse, posseque confessarium sententiam de qua agitur, illis coniugibus, caute tamen, insinuare, quos alia ratione a detestabili onanismi crimine abducere frustra tentaverit”

(DS 3148). Published in:

• Nouvelle Revue Théologique, vol. 13 (1881), pp. 459-460,
• Analecta Iuris Pontificii, vol. 22 (1883), p. 249.