Choice and Accountability

By Dana Haight Cattani

Children are an heritage of the Lord . . .

Happy is the man that hath his quiver full of them.

—Psalms 127:3, 5

My friend Leah1 recently turned 30 and a few weeks later gave birth to her fourth child—an unexpected bundle of joy. Her eldest is six. The children are beautiful, pink-cheeked cherubs, but Leah looks a little wan. Her body is exhausted. Her nerves are frayed. Her mind is scrambled. To hear her tell it, she is done having children. However, her ovaries are just getting warmed up. In all likelihood, they will be in production mode for another 20 years or so, releasing egg after egg like clockwork, as if in the conspiratorial hope of another pregnancy.

Not everyone has such an efficient reproductive system, of course. Infertility is at least as old as Sarah and Abraham, and it is certainly one of the scourges of modern life. Even so, a person can be 30 years old and confident that she is finished having children. In such circumstances, fertility can be more burden than blessing.

Anna Waschke

Abstinence is one possible solution, of course. It is difficult to argue with 100% effectiveness in preventing pregnancy. In the context of marriage, however, abstinence is problematic. The most recent Church guidelines in Handbook 2: Administering the Church 2010 explicitly acknowledge the importance of sexual intimacy “not only for the purpose of procreation, but also as a way of expressing love and strengthening emotional and spiritual bonds between husband and wife.”2 In spite of its perfect potential as a contraceptive, abstinence is a facile and improbable—not to mention unpopular—solution to the nuanced issue of family planning after a family is complete.

Temporary birth control is another alternative. Though an array of options exists, current Church policy discreetly draws a curtain around the marriage bed, asserting that “the decision as to how many children to have and when to have them is extremely intimate and private and should be left between the couple and the Lord. Church members should not judge one another in this matter.”3 In other words, mind your own business, and let other people mind theirs. Implied, but not stated, is the freedom couples have to limit family size using the method of their choice.

Unfortunately, temporary birth control is not infallible. While hormonal methods such as birth control pills and some intrauterine devices can be very effective in preventing pregnancy, barrier methods such as condoms and diaphragms are only moderately effective. Natural family planning is less reliable still. (That hormonal methods offer no protection against sexually transmitted diseases is an important but different topic.) In addition to the basic knowledge any person should have of anatomy and physiology, each method requires extra steps: a physical exam, a prescription, a trip to the pharmacy, possible out-of-pocket expenses, some training, and a willingness to take precautions and plan ahead. Even under ideal conditions, temporary birth control can fail.

A final option is permanent birth control or sterilization, typically tubal ligation or vasectomy. The mere mention can make grown men cringe, and with good reason. Sterilization is, after all, invasive and expensive, although some insurance plans do include it. (It is worth noting, for the cringers among us, that vasectomy is both less invasive and less expensive than tubal ligation—not to mention an investment in a future of sexual activity. Those who have ears to hear, let them hear.) Surgery invariably includes risks as well as a period of recovery. But for those who have finished having children, permanent birth control has some distinct advantages over temporary methods. No paraphernalia. No operator errors. No pregnancies.

An unexpected child can be a great blessing—or a great complication. My friend Lydia was looking forward to re-entering the work force after years as a full-time mother to three children. However, her life took a sharp turn when she discovered in “advanced maternal age”—over 35—that she was pregnant again. She gave birth to a beautiful baby boy with unexpected and serious health problems. His family adores him, but the financial demands of an additional child and the income lost when Lydia could not return to work, coupled with the physical and emotional strain of caring for a special needs infant, have caused some family tensions. Parental attention and resources have been diverted away from the older children just as they begin to face the challenges of adolescence and the expense of college. In a reflective moment, Lydia remarked to me that the perfect number of children is three. Then her youngest came into the room, saw her, and clapped his hands joyfully. She took him in her arms and tenderly stroked his head.

In contrast, I recall the unmitigated delight with which my friend Elizabeth, a busy working mother with two rambunctious middle-grade boys, confided that she was pregnant with a surprise baby girl. Elizabeth had given away the crib and had ceded the house to indoor soccer and Nerf gun wars, but she did not seem to mind the revision to her life that this new baby would require. Months later, when I observed her boisterous boys carrying their baby sister with the utmost care and gentleness, I saw that they were pleased to have someone they could protect from barbarians or enemy fire, should they appear.


In a perfect world, every pregnancy would be a time of joyful anticipation. In fact, reactions to a pregnancy run the gamut from elation to ambivalence to denial to rage and despair. For reasons of mental or physical health, for marital stability, for financial or professional concerns, or for the well-being of existing children or stepchildren, a couple may decide, in the privacy of their own bedroom, that their family is complete. For them, sterilization can be a responsible choice and provident living.

Yet this is the moment when Church policy, as least as articulated in Handbook 2, pulls back the bed curtain and intrudes on the pillow talk:

The Church strongly discourages surgical sterilization as an elective form of birth control. Surgical sterilization should be considered only if (1) medical conditions seriously jeopardize life or health or (2) birth defects or serious trauma have rendered a person mentally incompetent and not responsible for his or her actions. Such conditions must be determined by competent medical judgment and in accordance with law. Even then, the persons responsible for this decision should consult with each other and with their bishop and should receive divine confirmation of their decision through prayer.4


Suddenly, the Handbook language is quite different, as if from another author, edition, or era. While family planning, presumably using temporary birth control, was described as “extremely intimate and private” and a matter that “should be left between the couple and the Lord,” decisions about permanent birth control are apparently not appropriate for couples to make themselves. The Handbook directs couples to meet with their bishop to see if their situation meets this strict criteria of a life-threatening medical condition or incapacitation. These guidelines give the impression that Church leaders are more concerned about the possibility of curtailing fertility than they are about empowering people to use their fertility judiciously and prudently.

Nevertheless, the decision to have a child is, if anything, even less revocable than the decision to end fertility. We cannot change our minds and send a child back or decide that we are not willing to accept this responsibility after all. We cannot renege even if setbacks we had never anticipated—unemployment, single parenting, financial reversals, health problems, a child with a difficult temperament or special needs—sharply constrain our ability to be the parents we had intended to be. Is it better for a couple to have fewer children than they reasonably can raise than to have more children than they possibly can handle? The consequences of a couple having fewer children than they might are hypothetical, but the consequences of having too many children are entirely real and potentially devastating to the parents, the children, and even subsequent generations.

None of us can say for sure what another person or couple can handle. We simply cannot know. Still, we can know when a situation worries, saddens, or disturbs us. I was once a visiting teacher to Miriam, the mother of a toddler. Sometimes Miriam was a dervish of activity. She started projects and made plans. Then, inexplicably, they languished. Since she only wanted to get together when she felt well, it took me a while to figure out that Miriam was bipolar. She was taking medication, but her manic moods were erratic and distressing to her child and husband, who had learned not to count on her. The husband was a creative but meandering student with no visible prospects for a steady job, and the family received both government and church assistance. So I was dismayed to hear Miriam tell me, with great animation, that she was pregnant again. I was much more than dismayed to hear her tell me, after the new baby was born, that she couldn’t wait to have a third.

Similarly, my friend Rebekah came from a large family, and she wanted her own to follow suit. However, she had suffered from an eating disorder from the time she was a young teenager, and she was dangerously underweight. Surprisingly, she had little trouble conceiving. Not surprisingly at all, each pregnancy compounded her physical and mental troubles and exacerbated the stresses on her family. Rebekah’s illness interfered with her best parenting impulses and clouded her judgment. She would not eat enough to sustain herself—much less her unborn child—and sooner or later, she would go into preterm labor. Her doctor would order complete bed rest, which left Rebekah’s older children largely unsupervised while her husband was at work. Well before any due date, Rebekah would bear a low-birth-weight baby. Nurses would whisk the child away to the neo-natal intensive care unit for a substantial stay and assessment of the inevitable long-term health challenges. In a weakened post-partum state, Rebekah would be overwhelmed by the physical and emotional demands of caring for her growing brood. Then, eighteen months later, the cycle would start over.

Both Miriam and Rebekah were following a very Mormon script, and neither seemed inclined—or perhaps even able—to revise that script to reflect the realities of their actual lives. They believed themselves irreproachable in following inspired counsel.

Perhaps Church leaders discourage surgical sterilization because they believe that preserving at least the possibility of fertility is inherently worthwhile and respectful of the commandment in Genesis to “be fruitful, and multiply, and replenish the earth” (Genesis 1:28). Perhaps they discourage it because they know, from sad experience, that people are fickle, that lives evolve and circumstances change. Perhaps they discourage it because it seems modern (though it is not) or selfish or arrogant to try to control a power as mysterious and profound as fertility.

Interestingly, the counsel on permanent birth control is quite different in tone from the counsel on some related contemporary human life issues. These other statements emphasize personal responsibility. Contrasting examples from Handbook 2 include:


In vitro fertilization: “The Church strongly discourages in vitro fertilization using semen from anyone but the husband or an egg from anyone but the wife. However, this is a personal matter that ultimately must be left to the judgment of the husband and wife. Responsibility for the decision rests solely upon them.”5

Artificial insemination: “The Church strongly discourages artificial insemination using semen from anyone but the husband. However, this is a personal matter that ultimately must be left to the judgment of the husband and wife. Responsibility for the decision rests solely upon them.”6

Organ and tissue donations and transplants: “The decision to will or donate one’s own body organs or tissue for medical purposes, or the decision to authorize the transplant of organs or tissue from a deceased family member, is made by the individual or the deceased member’s family. A decision to receive a donated organ should be made after receiving competent medical counsel and confirmation through prayer.”7

Prolonging life: “Members should not feel obligated to extend mortal life by means that are unreasonable. These judgments are best made by family members after receiving wise and competent medical advice and seeking divine guidance through fasting and prayer.”8


In these cases, Church leaders offer general guidance and leave the ultimate decisions to individuals and families, with efforts to garner both medical and divine counsel. However, surgical sterilization seems to be in a different category entirely, something that couples or individuals cannot be trusted to choose wisely and for which they cannot be fully responsible.

Some people believe that having children is a manifestation of their faith and obedience. Yet everywhere around the world, the more educated, affluent, and accustomed to regular medical care that people are, the more likely they are to limit their family size. Within the Church, the same general trends hold. People with knowledge and resources—and even faith—do what they think is best for themselves and their children.

The converse—that people with less access to education, money, and health care are less likely to limit their family size—also holds true in the Church. This group often includes people from impoverished households, communities, or nations. In many traditional societies, a large family is a mark of status and good fortune, and extended families live in close proximity where they can care for each other. When a family moves away or immigrates, it trades that support network for the hope of better opportunities for the parents and certainly the children. Yet the more children a family has, the greater the strain on finances, supervision, and other finite household resources, and the greater the odds that those children will flounder in the new environment, perhaps in ways the parents never could have imagined. Limiting family size can be the key to a successful transition to a new, often more expensive, and sometimes callous place. It would be helpful if Church leaders could encourage—or at least not discourage—couples as they plan their families in ways that support their complex needs and goals and as they honor their existing parental obligations.

Ruth, an immigrant member of a ward I attended, had come with her large family from a poor country to an expensive metropolitan area in the United States. After their arrival, she became pregnant with twins. Following their delivery, her doctor suggested that while she was still in the hospital, he could perform a tubal ligation so that she would not have any more children. Ruth’s husband was angry that she would consider interfering with God’s plan for their family, but Ruth decided that tubal ligation might help them. Inauspiciously, a pre-surgery blood draw indicated that she was slightly anemic. Ruth believed that this information was a divine warning not to have the surgery, so she cancelled it. Subsequently, as the family became mired in financial problems and the older children fell into truancy and delinquency, Ruth had another baby.

Likewise, I will never forget a newly-married couple who moved into a ward where I lived a number of years ago. From previous marriages, the wife brought five children and the husband brought three. When I visited the wife, Abigail, one evening, she told me of their struggles to find a landlord willing to rent a three-bedroom apartment they could afford to their blended family of ten. A few minutes later, Abigail mentioned that she hoped to have another baby. She felt that a child with her new husband would strengthen their commitment to each other and be a living promise of their hopes for this marriage. From the adjacent room, a rumbling din suddenly crescendoed into an audible argument. Over the voices of quarreling teenagers—living promises of the hopes of former marriages—Abigail told me how much she loved babies.


In the Garden of Eden, God gave contradictory commandments to Adam and Eve. Be fruitful and multiply. Do not partake of the fruit of the tree of knowledge of good and evil. We believe that Adam and Eve had to work out their own plan for reconciling these two commandments and that they were wise and far-sighted to do so. We have modern-day paradoxes, too, and the same issues continue to vex us. On one hand, we are instructed that the commandment to be fruitful and multiply is still in effect and that we should not postpone marriage or childbearing. On the other hand, we are counseled to acquire all the education we can and to live within our means. Unless we have access to a trust fund and a nanny, these instructions are frequently incompatible in the short term. We must devise our own unique plans for reconciling them in the long term.

The policies outlined in Handbook 2 provide guidance and promote consistency across the various outposts of the Church. However, individuals and circumstances vary, and one-size-fits-all guidelines ignore thorny realities. The current official counsel on surgical sterilization may impede, or at least give pause to, conscientious couples by tainting this valuable tool in family planning with institutional disapproval. Additionally, bishops, Relief Society presidents, visiting teachers, and other first responders who want to fulfill their stewardships appropriately may feel hampered from speaking favorably about sterilization, even when it seems to be the most sensible and provident course of action. While family planning is a private matter, sometimes tacit or even active encouragement regarding more reliable or more permanent birth control from a trusted and close source can be appropriate, helpful, and compassionate.


An ancient Sufi story tells of a man who left his camel outside a mosque while he went inside to offer his thanks to Allah. When the man emerged from the mosque, his camel was gone. Angrily, the man railed against Allah for allowing this misfortune. After listening to the man’s tirade, a passerby observed drily, “Listen, trust Allah, but—you know—tie your camel.”

First tie, then trust. Sequence matters. Personal responsibility matters. Due diligence matters. We can trust God to help us plan wise and appropriate families, but we may need to tie our, uh, camels as part of the process.

My friend Leah, the mother of four children under age six, commented obliquely to me that “steps would be taken” to ensure that this new baby would be her last. Even her deft use of passive voice could not gloss over the unmistakable truth that she and her husband were grappling with deep, difficult questions about bodies, spirits, and families. After a moment of sustained eye contact, I smiled, and nodded as if to say: Trust God. And trust yourself.



1.  Names and details have been altered throughout the article.

2.  Section 21.4.4, Handbook 2: Administering the Church (Salt Lake City: The Church of Jesus Christ of Latter-day Saints, 2010), (accessed 25 February 2012).

3.  Ibid.

4.  Ibid., 21.4.15.

5.  Ibid., 21.4.7.

6.  Ibid., 21.4.3.

7.  Ibid., 21.3.7.

8.  Ibid., 21.3.8.