Contraception II: Family Planning

A Note of Introduction

We began our exploration of childbearing with a look at the mitzva of procreation. Then we introduced major overarching halachic and hashkafic considerations relevant to decisions on contraception and discussed health needs as a basis for permitting contraception. Now, let’s turn to the questions of spacing children and using contraception after fulfilling pirya ve-rivya.

In future pieces, we address other factors recognized by Halacha in making contraceptive decisions, a Rabbi’s role in these decisions, and contraception at the beginning of marriage.

The phrase “family planning” is often used as a euphemism for practicing contraception. Dr. Chana Katan offers a religious reframing that reflects a holistic approach to building a family, including periodic pauses as needed.¹

Indeed, it is common for couples to feel that they would benefit from a delay between births as they build their families, whatever their ideal size. In the words of Yoetzet Halacha Goldie Katz Samson:

In practice, a specific health concern for the mother might mean that it is halachically permissible to use contraception, as might already having a boy and a girl (the case to which Yoetzet Katz Samson refers, and which we discuss later on). However, there are also special considerations related specifically to postpartum health and to baby care that have halachic implications for contraceptive use.

Postpartum Recovery

It can take a while for a woman to recover her health postpartum—or after a pregnancy loss. The delayed postpartum phase, during which a woman’s muscles and tissues recover from pregnancy and childbirth, typically continues for about six months postpartum.²

In the Talmud, the first two years postpartum are considered to be a time of recovery for the mother, at very least with respect to the menstrual cycle:³

Additionally, medical research has found that a break of at least six months between childbirth and the following pregnancy benefits both a woman and her children. After a cesarean section, a break of at least eighteen months is recommended to reduce risk of uterine rupture when a woman plans to attempt vaginal delivery.⁴

Professor Michael Schimmel, head of the neonatal intensive care unit at Shaarei Zedek Medical Center, conducted research using Israeli Ministry of Health statistics on over 440,000 pregnancies between 2000-2005 (excluding first births and multiples). He found that there were clear medical advantages to waiting at least a year between pregnancies, i.e., not getting pregnant within twelve months postpartum.⁵

There are also more minor medical advantages for women following vaginal deliveries to waiting eighteen months prior to beginning the next pregnancy. Conversely, there are medical benefits when the interval between pregnancies is less than five years.⁶

The Nursing Period

A Talmudic passage that we saw in our previous piece cites a nursing mother as one of the women who might have special reason to prevent pregnancy. In her case, the concern is for the health of her infant.

This passage makes clear that nursing (nowadays, we would add pumping) can provide added grounds for permitting contraception postpartum. Modern medicine and contemporary Halacha continue to recognize the unique value of a mother providing breastmilk, even when alternatives are available. Rav Yaakov Ariel summarizes a broad halachic sensibility that views the nursing period as a time with more grounds for contraceptive use:

For many halachic authorities, the nursing relationship is a meaningful consideration in allowing for delay of a woman’s subsequent pregnancy. (Perhaps most strongly, Rav Yehuda Henkin, quoted below.) In practice, though, nursing or pumping for an infant is only one of a constellation of factors in permitting contraception postpartum, and the factor most commonly emphasized in halachic discourse is concern for a woman’s health.

Health

We have seen that physical and mental health considerations can provide a basis for contraceptive use. There is a range of halachic approaches to permitting postpartum contraception for health reasons, and to whether an individual ruling is needed. (We discuss a rabbi’s role in these decisions in a future piece.)

Specific Medical Conditions Many authorities permit contraception postpartum when a woman has a specific health difficulty, but only short-term, though a couple could always return for another ruling.⁷

In some cases, as with Sarah, who was interviewed for a study on fertility management among Orthodox women,⁸ a longer break may sometimes be medically—and thus halachically—necessary:

Sarah’s story highlights the importance of both halachic and medical education. If a woman does not know that closely-spaced pregnancies can be dangerous, or that contraception is sometimes permissible, she is likely not to use contraception even when it might be halachically permitted or mandated.

Cesarean Section One special case is when there are concerns regarding uterine rupture, as after a C-section. Rav Moshe Feinstein rules that women following childbirth via cesarean section should practice contraception until it is safe to become pregnant again, according to the most strict medical opinion. Though a person’s knowledge of their own medical condition ordinarily bears halachic weight in decision-making about conception and contraception, it does not leave room for leniency to attempt pregnancy sooner in a case such as this, where a woman does not have a firm basis to judge the condition of her uterus.

General Allowances Many of the challenges of the postpartum period are more universal, so some halachic authorities have taken a more general approach, suggesting timeframes during which it would be permissible for a couple postpartum to use contraception, without an individual ruling. The couple could consult a halachic authority at any point during that timeframe, and would at minimum revisit the halachic question of contraception at the end of it, in light of their specific circumstances, such as the wife’s health.

I. Up to One Year Chazon Ish reportedly ruled that it is permissible for any woman, whether before or after pirya ve-rivya has been fulfilled, to use contraception for up to a year postpartum to facilitate regaining her health:

This ruling, allowing any woman to wait a year between childbirth and conceiving again, has been widely accepted. Women who follow it will also be past the high point of medical concern raised by Professor Schimmel.

Dr. Elchanan Bar-On and Rabbi Yoel and Dr. Chana Katan argue for the possibility of relying on this ruling after miscarriage as well:

Whether after miscarriage or a live birth, a couple relying on this ruling who still have health concerns after a year has passed would look to the general principles about health and contraception that we discussed in part one of this series.

II. Up to Two Years In the early nineteenth century, Rav Avraham David Wahrman of Buchach suggests that the mitzva of pirya ve-rivya might not even be applicable during the twenty-four month nursing period, based on nursing’s contraceptive effects:

Rav Wahrman is uncertain how the exemption he suggests could take into account the fact that some women conceive easily after only a year of nursing. This question may be stronger today, when it is very common for women not using contraception to conceive within two years postpartum.

Still, it was once rumored that standard practice in pre-war Lithuania was to permit contraception for up to two years to space out births, perhaps based on the Talmudic passage about a woman not returning to herself for two years after childbirth. Rav Moshe Feinstein rejects this rumor as unfounded and writes that he rules on a case-by-case basis:

At the same time, some halachic authorities argue that concern for health allows for a longer timeframe for using contraception in general. Rav Nahum Rabinovitch centers health and the Talmudic mention of a woman not returning to herself for two years as a basis for permitting contraception as needed for two years following childbirth:

Rav Rabinovitch seems to leave this to the couple’s discretion and suggests that they ask a halachic question only if they wish to wait longer than two years.

III. Up to Five Years Rav Yehuda Henkin attests that his renowned grandfather, Rav Yosef Eliyahu Henkin, permitted contraception for two and even up to four or five years after childbirth when a woman’s central concern is to allow her to care for the child, whether by staying at home or by nursing, even when pirya ve-rivya has not yet been fulfilled.

Rav Yehuda Henkin suggests that his grandfather’s limit of four to five years likely derives from the halacha that allows a woman to nurse for up to four or five years, when necessary, notwithstanding possible contraceptive effects.

This ruling suggests a much broader conceptual understanding of the mitzva of pirya ve-rivya. Pirya ve-rivya here is defined not just as a matter of conceiving or having children, but also as encompassing their earliest care and well-being. From this perspective, family planning that prioritizes the well-being of one’s existing offspring is not in conflict with pirya ve-rivya, but rather fulfills the values it represents. Like Rav Ariel, Rav Henkin leaves room for a couple to assess for themselves whether these grounds for permitting contraception apply to them, though he attests to responding to questions of this sort.

We’ve now seen broad consensus to permit relatively short-term contraception for purposes of spacing children, including where the basic mitzva of pirya ve-rivya—the birth of at least one girl and one boy—has not yet been fulfilled. Once a family has a boy and a girl, what are the halachic considerations in using contraception?

Previously, we learned in our discussion of procreation that even after a man has satisfied his obligation of pirya ve-rivya, he should not desist from continuing to have children into old age, la-erev (lit., in the evening).

Having more children than a boy and a girl is a religious value, whether for Rabbi Yehoshua’s rationale of not knowing which of one’s children will survive and what each child will become and accomplish, or to contribute toward humanity’s purpose of shevet, settling the world.

Even if one were to argue, in light of the world’s current population, that shevet has been largely achieved, Tosafot suggest another, more particularistic concern, to preserve the Jewish people by reproducing above replacement level:

This type of argument has taken on even greater weight following the devastation of the Holocaust. The Lubavitcher Rebbe, was a leading example of postwar advocacy for Jews having as many children as possible, notwithstanding growing general concerns about overpopulation:⁹

As in this passage, it is especially hard to distinguish hashkafic perspectives from halachic discourse on contraception after pirya ve-rivya has been fulfilled, since the halachic weight of la-erev is subject to debate.

To recap, we saw that some halachic authorities treat la-erev as a rabbinic-level mitzva—even an especially weighty one, while others consider la-erev as more subject to individual judgment. In either case, a few authorities say la-erev is fully satisfied by having a second pair of male and female children, which makes halachic discussion of contraception from that point onward merely a matter of method. Others suggest it entails having as many children as possible, and still others that it simply means not deciding to stop having children altogether, even if there are long breaks in childbearing. (See here for further discussion.)

Let’s revisit Rambam’s rulings on la-erev to illustrate how challenging this can be to parse and how this foundational debate leads to different modern halachic rulings. Rambam calls la-erev a rabbinic mitzva, but he also says that fulfilling it depends on a man’s ko’ach, what is in his power. This might mean physical ability to procreate,¹⁰ but it might also mean something much more subjective, like having energy for raising children.¹¹

Rambam presumably does not mention the woman’s ko’ach because this halacha is addressed to men, who are directly obligated in pirya ve-rivya. In a separate halacha, Rambam permits a woman whose husband has fulfilled pirya ve-rivya to waive her right to sexual relations at set intervals. He also permits a man who has fulfilled pirya ve-rivya to marry a woman who cannot bear children:

If Rambam views la-erev as a rabbinic obligation, how can he permit a woman to waive her right to relations or a man to marry an infertile woman, given that these choices preclude conception? Possible responses depend on how we understand the nature of la-erev: Is it an absolute imperative, or subject to personal considerations?

I. Absolute Imperative Maggid Mishneh suggests Rambam might grant such permission only on a Torah level, but not rabbinically:

According to this school of thought, since la-erev is a rabbinic imperative, actions that would result in preventing conception would be rabbinically constrained.

Many modern halachic authorities follow this line of thought with la-erev. We saw Rav Wosner, above, ruling that a couple should continue to bear children even after they had eight, and wished to stop. Puah Institute, in a compendium of halachic rulings on contraception, presents this approach to la-erev:

According to this view, a couple is permitted to practice contraception after fulfilling pirya ve-rivya only if they have a reason recognized as valid. (We discuss a few possible reasons in a future piece.) This tends to place the burden of proof on the couple.¹²

II. Subject to Personal Considerations Alternatively, perhaps la-erev is more flexible, allowing for personal considerations. Chida reads Rambam in this way, permitting long, even indefinite, intervals between episodes of intercourse, which inevitably would impact childbearing.

Rav Dr. Avraham S. Avraham in his Nishmat Avraham explains Chida’s position as follows:

Halachic sources until the mid-20th century sometimes permit what might be called “passive contraception,” delaying mikveh night or some other limited abstinence. With the advent of newer contraceptive methods like the pill that raise fewer halachic questions (as we discuss in subsequent installments of this series), we can sometimes infer that new methods would be permitted in cases when an earlier source permits “passive contraception.” Thus, such methods would seem to be permissible for Birkei Yosef for long-term use after fulfilling pirya ve-rivya, at a couple’s discretion, without need for rabbinic consultation.

We saw previously that Rav Moshe Feinstein understood la-erev as leaving room for contraceptive measures. Here is more of that responsum, where he suggests a very open-ended list of reasons—based on either spouse—to permit a couple to abstain from relations during their fertile window, once pirya ve-rivya has been fulfilled.

Rav Moshe even indicates that he might countenance the result of abstinence at fertile times being that they have no further children at all. Even in the responsum we excerpted earlier, permitting use of contraceptive pills when a woman has general weakness, Rav Moshe permits their use even more widely to a couple once pirya ve-rivya has been fulfilled:

However, in another responsum, Rav Moshe suggests a time limit for this of three years.¹³

Rav Yaakov Ariel, in a responsum we excerpted in our last piece, summarizes this more flexible view of la-erev, with an emphasis on the woman’s assessment of what she can handle:

Although Rav Ariel seems to reject convenience as a factor, he acknowledges that a range of possible considerations could influence a decision about contraception once pirya ve-rivya has been fulfilled.

Concluding Thought

We began this piece with Dr. Chana Katan’s conception of ‘positive family planning.’ Building a family is simultaneously wondrous and challenging. Pauses can serve as a healthy, halachically-sanctioned element of building a family, helping it flourish.

In our next piece, we’ll discuss additional factors that affect halachic decisions on contraception. Then we’ll move on to discussing a Rabbi’s role in these decisions and whether a couple can practice contraception at the beginning of marriage.