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Islamic Medicine
Staff member
A crucial difference between abortion and contraception is that in the latter there is no killing of an already existing fetus. All Quranic references forbidding the killing of children for any reason including poverty, present or anticipated, or the female infanticide practiced by pre-Islamic (Jahiliya) Arabs therefoie do not apply. The great majority of old and contemporary jurists therefore had liberal views on contraception, as long as it does not negate altogether the procreative function of marriage. It is not acceptable therefore that a marriage should be contracted with the preset condition or intention to make it a childless marriage.

The evidence that contraception is not religiously prohibited derives from various reports since the time of the prophet peace be upon him. In the esteemed compendia of Al-Bukhari and of Muslim, both very reliable sources on the prophet's traditions, a companion of the prophet with the name of Jabir reports: "We practised contraception by withdrawal (coitus interruptus) at the time of the prophet peace be upon him, at the time the Quran kept being revealed to him, and when he knew he did not forbid us".

Responding to a question from a man whether it was alright to practise coitus interruptus with a woman he owned, the prophet said:

"If you so wish you may. And if God willed for her something (pregnancy), she will have it." (Muslim)

This reference to the possibility of failure of the contraceptive method that was known at that time, became relevant as the man later went to the prophet to tell him that the woman had become pregnant, to which the prophet remarked:
"I have already said it to you. Whatever is willed for her will come to her. " (Muslim)

The practice is also sanctioned with one's wife, except that it must be by mutual consent, as decreed by the prophet:

"A man must not practise withdrawal with his wife unless she freely consents." (Abu Dawood)

The objectives of contraception have been many and varied. At one time the search for a reliable acceptable contraception was spurred (and actually funded) by advocates of the women's liberation movement, believing that as man can enjoy sexual liberty without the threat of bearing an undesired pregnancy, then woman should be freed from that fear and enabled to enjoy sex without such anxiety. At the beginning contraception was a prescription for the married woman. But times changed and with them the accepted social norms, and contraception is now universally available for married and unmarried. On the medical side, the hazards of high parity have become identified and the terms 'grand multiparity' and 'the dangerous multipara' were coined, and contraception was promoted by doctors to obviate these hazards. These are mainly anaemia" calcium deficiency that might lead to soft bones and secondary contraction of a previously adequate pelvis, diabetes mellitus, haemorrhages and malpresentations associated with pregnancy, worsening of existing medical diseases and age related maternal illness or fetal anomaly.

The economic factor on a global scale has been widely publicized, projecting that population explosion will soon outstrip resources that are already available or that can be added, and publications relating to this give quite convincing statistics and projections. But probably the most effective single motivating factor is the socio-economic factor at the level of the individual family. As the number of children ceased to be a financial asset, the emphasis is mainly on the quality of life the parents want for their children, and that the required standards of raising up the children and of catering for the whole family might be incompatible with a large number of chilren.

Iman Al-Ghazali wrote that contraception was permitted and innumerated a wide range of indications to practise it, beginning with health reasons that would make pregnancy a health hazard to the woman, through socio-economic factors and going as far as the mere wish of the woman to preseve the beauty of her physique.

The instruction of the prophet to Muslims to 'marry, procreate, and abound in number, for I will pride myself with you amongst the nations on the day of reckoning" (Abu-Dawood) is sometimes quoted as evidence against the permissibility of contraception. But it is obvious that numbers alone are no reason for pride unless the quality was also good. In another tradition the prophet-as if reading clearly through many centuries said:

"There will come a time when other nations fall upon you like greedy eaters upon a bowl of food. And God will take off from the hearts of your enemies any heed for you, and put in your hearts fear of them. And throw feebleness into you. "When asked: Apostle of God, will that be because we are small in number? He said: No. You will then be too many but rather like the foam floating over water. The Quran rebukes the wrongdoers saying:

"It is not your wealth nor your children that will bring you nearer to Us in degree." (34:37)

The distinction between quality and quantity is adequately illustrated in the following verse:

"How oft by God's will has a small force vanquished a large one. God is with those who steadfastly persevere." (2:249)

The Islamic look at contraception, however, does not stop at a statement of its permissibility. Several states have adopted a population policy aiming at curbing the preproductive rate, and it is the consensus of Muslim scholars that no population policy should be enforced on the people, for such will be in conflict with a basic Islamic human right. Public education and cultural maturity have proved to be the most effective measure in this respect, but then the matter should be left for each individual family to meet their circumstances by their own free choice. It has been the constant observation that with widespread education of women and active participation in the affairs of their community the family size had tended to be smaller, an this and not the economic factor is the primary motivating factor toward family limitation. The ethnic and cultural variability is great and in our opinion should be acknowledged and respected. It is not uncommon in practices serving a mixed community, like ours in Kuwait, to receive the woman seeking to stop pregnancy after one or two children, and the mother of six children who is quite anxious because over the past two years she has not become pregnant yet.

The contraceptive armamentarium has become very much developed over the past few decades, and yet it is true to say that search for the ideal contraceptive still continues. The Islamic rule of 'No harm and no harming', should be meticulously observed, and unless the safety of a contraceptive method is proven, it should not be dispensed. Every time and again the medical literature carries the news about side effects and complications some serious following the use of one or the other contraceptive, and this arouses much anxiety if it finds its way to the public press. Since the marketing of contraceptive pills in the fifties and their widespread use, qualitative and quantitative modifications in their formula have never stopped, casting an air of suspicion about their alledged safety. Although much has been known about the pill after thirty years of use, especially pertaining to situations where the pill should not be given, reservations are sometimes voiced concerning more subtle biological changes that would take several generations to express themselves and claiming that interference with normal physiology for long periods of time cannot occur at no price.

Another ethical reservation in the field of contraception is the observation that some governments have put a ban on certain contraceptives for their own people, while sanctioning their production by their own firms in their own country but only for export. This covers also a wide variety of medicines and chemicals, banned for local use but produced to be sold to other countries. It has also been observed that some new drugs (an example is the contraceptive pill itself) or technologies devised by medical scientists, are not granted endorsement for national use until they have been extensively tried outside the borders, on other nations, and their safety or unsafety properly established. In other words other nations are used as human guineapigs to know if the drug is safe for the masters. It is regrettable to see scientific (!) bodies mediating in the process, under the guise of funding medical research and fostering academic collaboration. Despite the excuse, the ugly fact remains that states and medical bodies operate on the basis of a double standard in evaluating human life, and that human beings are not equal or as George Orwell put it they are all equal, but some are more equal than the others.

A contraceptive method should not act by agression against an established pregnancy. The operation of menstrual regulation' which inspite of the innocent name is a very early induced abortion, or the use of prostaglandins for the medical induction thereof (this might be the future method for wholesale early abortion) cannot be sanctioned by Islam. The intrauterine contraceptive device has caused much debate, whether it is a contraceptive or an abortifacient. In its early days it was assumed that as a foreign body it sensitized the genital tract so that the' unfertilized ovum would be hurried along without being fertilized, in a manner likened to diarrhoea. Other theories suggested alterations in the endometrium making it unsuitable for nidation, or even inducing an abortion of the nidated embryo. Perhaps this question can be answered by diagnosing recent pregnancy in two groups of normal fertile normally menstruating women: the one fitted with the device and the other for control. A rosette inhibition test is reported to be able to diagnose pregnancy only hours after fertilization. If the incidence of pregnancy in the contraceptive device bearers is statistically higher than the general background incidence of unnoticed , miscarriages in the general population represented by the control group (unknown but estimated as more than twenty per cent), it might be concluded that the device is abortifacient. The newer generations of intrauterine contraceptive devices, however, incorporate contraceptive means. Copper containing devices emanate copper ions which are known to be spermicidal. Progesterone containing devices would alter the physico-chemical properties of the cervical mucus rendering it too thick to be penetrated by spermatozoa.

Two more aspects of contraception deserve further comment. The warning cry about shortage of resources in the face of population growth seems to focus solely on population limitation as the only solution. It is felt that other complementary solutions should also be highlighted and implemented. Redistribution of wealth should also be considered, not only nationally but also internationally. While some societies suffer from the sequelae of overnourishment others are in the grip of famine or undernutrition. Some countries burn the surplus of some crops so as to maintain prices, while others are in dire need of it. Basic food items are used as a political weapon and poverty of whole nations is exploited by purposes of conversion: political or religious. The international monetary system based on usury has transformed loans given to poor countries from a blessing to an expanding curse, and economics of poor nations are depleted in a desperate attempt to pay interest rates, let alone the debts. The selfish game of politics keeps igniting military conflict here and there so that nations' resources are spent on buying arms from the developed industrialized countries, instead of giving priority to building up their economy. On the other hand , military expenditure by major powers is tremendous, and the search for more deadly weapons continues at astronomical cost. If only part of the military budgets were diverted to the development of known resources and the discovery of fresh ones then perhaps the picture would not have been as gloomy. There is a crisis of human compassion and a lack of trust between nations that is at the root of much of the contemporary human suffering. Unless people of all nations realize that they are one big family and act accordingly at all levels, the mere curbing of population growth will never be the answer. Unless politics and economics acknowledge and heed moral considerations, the future of humanity remains bleak. It is amazing and unfortunate that the great political figures of our times continue to abide by the traditional rules of politics based on prejudice, deceipt and selfishness. Intelligent statesmanship should not fail to see the abyss humanity is heading to, and the long chain of aetiology that leads to an international climate of bitterness and despair in which the value of man and the values of humanity entirely lose their worth.

The remaining aspect of contraception has lately come under the light and achieved public awareness. One type of human conflict is manifested by what may rightly be called the demographic warfare. In certain locations long term plans have been drawn to change the population composition, so that with time minorities would grow to be majorities and majorities would shrink to be minorities. Family limitation is strongly preached in certain quarters while it is strongly banned upon others.

A people might react by a higher reproductive rate in the face of national disasters or in the aftermath of war. Palestinians are known to be very pronatal, but when a people have lost everything except their sheer numbers then it would be folly to sacrifice this as well. Israeli sources have repeatedly expressed anxiety at the higher reproductive rate of the Arab population compared with the Israeli population in Israel. A doctor or a reformer preaching the hazards of high parity or the population explosion to Palestinian Arabs would be none but a voice lost in the wilderness. It would seem the more that the balancing of people and resources takes more than contraception to achieve
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