Back to Contraception V: Hashchatat Zera & Contraceptives
What is the prohibition of sirus, sterilization? What are its implications for the permissibility of various contraceptive methods? What contraceptives are halachically preferred?
In Brief
What is the prohibition of sterilization (sirus)?
The Torah forbids damaging male reproductive organs. Sefer Ha-chinuch explains that the prohibition assures survival through reproduction, which is essential for the continuity of Creation..
Does the prohibition apply to women?
Though this is debated, many authorities maintain that female sterilization is prohibited rabbinically, and thus can be permitted in very pressing cases.
How do early halachic sources relate to sterilizing treatments?
The Talmud allows women to take sterilizing potions for medicinal purposes and as contraception in cases where childbirth would pose significant pain or danger—at least after pirya ve-rivya has been fulfilled.
How does Halacha view vasectomy and tubal ligation?
Vasectomy is widely considered to violate the Torah prohibition of sirus.
Tubal ligation for contraceptive purposes is widely considered to be rabbinically prohibited, and can be permitted when there is a substantial medical reason and no viable alternative.
Are hormonal contraceptives a halachically permissible method?
Yes, because they do not raise concerns of hashchatat zera, do not damage reproductive organs, and are fully reversible. They are now widely accepted notwithstanding early concerns about side effects and staining (with possible niddah implications).
What about intrauterine devices (IUDs)?
There was early halachic hesitation out of concern they acted abortifacients and because of medical risks in early models. Modern IUDs do not damage reproductive organs, are fully reversible, and do not entail hashchatat zera, so they are widely accepted as well. Some authorities remain concerned about staining and its niddah implications.
What methods are preferred?
When contraception is permissible, many halachic authorities rank commonly accepted reversible methods as follows: Hormonal methods, IUD, spermicide, diaphragm.
Many authorities consider the IUD as no less halachically preferred than hormonal options. As we have seen, some authorities permit the diaphragm only in pressing situations, while a few favor it even over hormonal contraceptives.
However, each couple may have medical, personal, and practical considerations that affect the appropriate halachic ranking for them.
In Depth
Rav Ezra Bick, Ilana Elzufon, and Shayna Goldberg, eds
Sirus
For much of human history, sterilization was one of the few available methods of contraception aside from withdrawal. Halachic discussion of contraception thus often had to weigh the need for sterilization for contraceptive purposes against the severity of the prohibition of sirus.
In the previous parts of this series, we explored when contraception may be used, and the prohibition of hashchatat zera (wasting seed). Here, we discuss the prohibition of sirus (sterilization) and revisit a related Talmudic passage on contraception. We then look at modern methods of contraception for which this prohibition may be relevant, including vasectomy, tubal ligation, hormonal contraceptives, and the IUD. We conclude this piece, and the whole series, with a discussion of choosing between or ranking contraceptive methods.
The Torah lists a few ways in which male genitalia can be damaged, along with a prohibition on inflicting such damage on either humans or animals and on bringing animals so damaged as a sacrifice:
ויקרא כב:כד
וּמָעוּךְ וְכָתוּת וְנָתוּק וְכָרוּת לֹא תַקְרִיבוּ לַה’ וּבְאַרְצְכֶם לֹא תַעֲשׂוּ: וּמִיַּד בֶּן נֵכָר לֹא תַקְרִיבוּ אֶת לֶחֶם אֱלֹקיכֶם מִכָּל אֵלֶּה כִּי מָשְׁחָתָם בָּהֶם מוּם בָּם לֹא יֵרָצוּ לָכֶם:
Vayikra 22:24
And [males whose genitalia are] crushed, or ground, or separated, or cut off, you shall not bring as an offering to God and in your land you shall not do it. And from the hand of a gentile you shall not offer food of your God from any of these, for their ruin is in them [ba–hem], a defect is in them, they will not appease for you.
Sefer Ha-chinuch presents rationales for the prohibition of sterilization that parallel our discussion of hotza’at zera le-vatala:
ספר החינוך פרשת אמור מצוה רצא
משרשי המצוה, לפי שהשם ברוך הוא ברא עולמו בתכלית השלימות, לא חסר ולא יתר בו דבר מכל הראוי להיות בו לשלימותו, והיה מרצונו ובירך בעלי החיים להיותם פרים ורבים, וגם צוה הזכרים ממין האדם על זה, למען יעמודו, שאם לא כן, יהיה המין כלה אחר שהמות מכלה בהם, ועל כן המפסיד כלי הזרע מראה בנפשו כמי שהוא קץ במעשה הבורא ורוצה בהשחתת עולמו הטוב.
Sefer Ha-chinuch Emor 291
Among the roots of the mitzva, since because God created His world with ultimate perfection, He did not leave anything out, or include anything extra, beyond what is fitting to be in it for its perfection, and it derived from His will, and He blessed the animals to be fruitful and multiply, and He also commanded males of the human species in this, in order that they should endure, for otherwise the species would become extinct after death extinguishes them. Therefore, one who destroys male reproductive organs shows himself as one who loathes the work of the Creator and desires the ruin of His good world.
On the one hand, a prohibition of male sterilization is presented as an assurance of species survival through reproduction, and is thus aligned with the Divine will for species to procreate. However, since non-humans are not subject to mitzvot, it cannot easily be defined as merely a corollary to the commandment of pirya ve-rivya. The second, complementary rationale, emphasizes the importance of not damaging reproductive organs because reproduction is essential for the continuity of Creation.
Female Sterilization
As Sefer Ha-chinuch explains it, the prohibition of sirus may cast a negative light on contraception, without ruling out pursuit of contraception by means not subject to the prohibition. This is particularly significant because the Torah specifically mentioned types of destruction that would apply to male genitalia. Indeed, tannaitic authorities debate whether the Torah’s prohibition of sterilization applies to females.
תוספתא מכות, ד:ד
המסרס את האדם ואת הבהמה ואת החיה ואת העוף, בין גדולים בין קטנים, בין זכרים ובין נקבות – הרי זה חייב. רבי יהודה אומר: מסרס את הזכרים – חייב, ואת הנקבות – פטור
Tosefta Makkot 4:4
One who sterilizes a person or a domesticated animal or a wild animal or a fowl, whether mature or young, whether male or female, is liable [for the Torah punishment of lashes]. Rabbi Yehuda says, one who sterilizes males is liable, [one who sterilizes] females is exempt [from Torah punishment].
In the Sifra, Rabbi Yehuda’s position is phrased in even stronger language:
ספרא אמור ז ז: יב
…רבי יהודה אומר: “בהם” אין נקיבות בסירוס.
Sifra Emor 7 7:12
…Rabbi Yehuda says:…”In them” [ba-hem (masculine plural)]—Females are not included in the prohibition of sirus.
The language of “patur”—absent from this excerpt from the Sifra but present in the Tosefta—often means that there is no Torah liability, but there is a rabbinic-level prohibition. This is how Rabbi Yehuda is commonly understood, and this is also the prevalent understanding of Rambam’s position, which draws on the language of the Tosefta.1
רמב”ם הלכות איסורי ביאה טז: יא
והמסרס את הנקבה בין באדם בין בשאר מינים פטור.
Rambam Issurei Bia 16:11
One who sterilizes a female, whether human or another species, is exempt [according to Torah law].
There are, however, dissenting views in both more stringent and more lenient directions. The Vilna Gaon, commenting on a parallel ruling in Shulchan Aruch,2 maintains that female sterilization is a matter of Torah law, in accordance with the first tannaitic view (and against Rabbi Yehuda). On this reading, “patur” refers simply to exemption from the punishment of lashes:
באור הגר”א אה”ע ה:כה
ופ[ירוש] כת”ק [=כתנא קמא] אלא דאין בהם מלקות…
Bei’ur Ha-Gera EH 5:25
The interpretation is like the first tannaitic position [that female sirus is prohibited on a Torah level] but there is no punishment from the Torah of lashes …
On the other extreme, Rashba seems to maintain that only men are subject to any prohibition of sirus.
חדושי הרשב”א שבת קיא.
דבאשה ליכא משום סירוס דסירוס אדם הוא דאסר רחמנא.
Rashba Shabbat 111.
For regarding a woman there is no [halacha] on account of sirus, for sirus of a man is what God prohibited in the Torah.
Taz adds that, although there is no prohibition of sirus for women at all, physically damaging a woman’s reproductive organs to the point that she could not conceive would be prohibited as doing physical harm, similar to the prohibition of causing suffering to animals:
ט”ז אה”ע ה:ו
לשון ‘אין סירוס בנקבות’ מורה על היתר כמו לשון מותר אלא הטעם כיון שמסרס אותה על ידי מעשה כגון הכאה או בעיטה או שאר דברים הגורם סירוס ובא על ידי מעשה שלו אין לומר בו היתר דאפילו בבהמה אסור משום צער בעלי חיים בלא איסור סירוס…
Taz EH 5:6
The phrase [in Sifra] ‘there is no sirus with respect to females’ indicates that it is permissible, like the term ‘permitted’, but the reason [for not using the simpler term] is that since one sterilizes her through an act like hitting or kicking or other things that cause sterilization, and it comes about through his action, one cannot say that it is permissible, for even with an animal it would be prohibited on account of tza’ar ba’alei chayyim [the prohibition of causing suffering to animals] without a prohibition of sirus…
Still, the position that female sterilization is a rabbinic prohibition has been widely accepted under ordinary circumstances—i.e., barring great medical need.
שו”ת אגרות משה אה”ע ד: לד
ובעצם הדין אם יש איסור דאורייתא בסירוס נקבות כהגר”א רבים חולקין עליו…סובר הרמב”ם שאיכא איסור מדרבנן.
Iggerot Moshe EH 4:34
Regarding the fundamental law whether there is a Torah prohibition of sterilizing females, as the Vilna Gaon maintained, many dispute him…Rambam considers there to be a rabbinic prohibition.
It follows that contraception entailing female sterilization, such as tubal ligation, would be prohibited rabbinically. As above, this classification could leave room for the prohibition to be pushed aside in pressing cases of great need.
Sterilizing Potions
Our sages were also familiar with plant-based potions said to permanently sterilize those who imbibed them, called either kos shel ikarin (cup of roots) or sama de-akarta (root potion). A halacha in the Tosefta asserts that neither a man nor a woman may drink this type of potion as a contraceptive:
תוספתא יבמות (ליברמן) ח: ד
…האיש אין רשיי לשתות עיקרין שלא יוליד והאשה אין רשאה לשתות עיקרין שלא תלד…
Tosefta Yevamot (Lieberman) 8:4
…A man is not permitted to drink a sterilizing potion in order that he not father offspring, and a woman is not permitted to drink a sterilizing potion in order that she not give birth…
However, while the Torah’s depiction of sirus entails direct damage to male reproductive organs, these potions would leave the physical anatomy largely intact. Many authorities thus view their use more leniently than other methods of sirus (arguably, even for men),3 notwithstanding the similar reproductive result.
ראב”ד ספרא ז:ז יב
… גרמא כגון על ידי מאכל או על ידי משקה שמצמקת האם שלה ואינה יולדת דבר זה… באשה מותרת שאינה מצווה על פריה ורביה.
Ra’avad, Commentary to Sifra 7:7; 12
Indirect action such as through a food or through a drink that shrivels her reproductive organ so that she is not fertile, this matter…for a woman is permitted, for she is not commanded in pirya ve-rivya.
Along these lines, a talmudic passage suggests that women, but not men, would be permitted to treat jaundice by drinking a medicinal potion with sterilizing side effects:
שבת קי:-קיא.
לירקונא תרין בשיכרא ומיעקר ומי שרי והתניא מניין לסירוס באדם שהוא אסור תלמוד לומר ובארצכם לא תעשו בכם לא תעשו…אלא באשה
Shabbat 110b-111a
For [healing] jaundice: two liquors but it sterilizes [the drinker]. And is that permitted? Has it not been taught in a baraita: Whence do we know that sirus of a man is prohibited? The verse teaches: “And in your land you shall not do it.” To yourselves you shall not do it…Rather, regarding a woman [the drink is suggested].
In a more narrative Talmudic passage (which we saw earlier in this series), Yehudit, wife of Rabbi Chiyya and mother of two sets of twins—two boys and two girls—makes the decision to drink a sterilizing potion to avoid the pain she has experienced with childbirth:
יבמות סה:-סו.
יהודה וחזקיה תאומים היו אחד נגמרה צורתו לסוף תשעה ואחד נגמרה צורתו לתחלת שבעה יהודית דביתהו דר’ חייא הוה לה צער לידה שנאי מנא ואתיא לקמיה דר’ חייא אמרה אתתא מפקדא אפריה ורביה אמר לה לא אזלא אשתיא סמא דעקרתא לסוף איגלאי מילתא אמר לה איכו ילדת לי חדא כרסא אחריתא דאמר מר יהודה וחזקיה אחי פזי וטוי אחוותא
Yevamot 65b-66a
Yehuda and Chizkiya were twins, one finished developing at the end of nine [months] and one finished developing at the beginning of the seventh [month]. Yehudit, Rabbi Chiyya’s wife, had pain at childbirth. She changed her clothes [to disguise herself] and came before Rabbi Chiyya. She said: Is a woman commanded in pirya ve-rivya? He said to her: No. She went and drank a root potion. In the end, the matter was revealed. He [Rabbi Chiyya] said to her: Would that you had given birth to one more wombful for me. For master said: Yehuda and Chizkiya were brothers, Pazi and Tavi were [their twin] sisters.
According to this account, Yehudit took her exemption as a woman from the mitzva of procreation as halachic grounds for drinking the potion, without her husband’s knowledge. Tosafot note that, since she and Rabbi Chiyya had already fulfilled pirya ve-rivya, her halachic concern must actually have been with fulfilling the mitzva of la-erev, to continue having children after pirya ve-rivya was fulfilled.
תוספות שבת קי: ד”ה והתניא מניין לסירוס שהוא אסור
משמע בסוף הבא על יבמתו (יבמות סה:) גבי דביתהו דר’ חייא דאי הוה מיפקדה אפריה ורביה לא הוה שתיא סמא דעקרתא אף על גב דהוי לה שתי נקבות ושני זכרים משום בבקר זרע [את] זרעך ולערב אל תנח ידך (קהלת יא) ובאשה לא שייך סירוס
Tosafot Shabbat 110b s.v. ve-hatanya minayin le-sirus she-hu asur
It is understood [from the passage] at the end of “Ha-ba al yevimto” (Yevamot 65b) regarding Rabbi Chiyya’s wife, that if she had been obligated in pirya ve-rivrya, she would not have drunk the root potion, even though she had two girls and two boys, on account of: “In the morning sow your zera, and in the evening, don’t rest your hands” (Kohelet 11:6). And for a woman, sirus is not relevant.
Rabbi Chiyya’s response is especially significant. His wish for more children is couched as a personal desire, and not as a halachic criticism of his wife’s decision. By responding in this way, he implicitly acknowledges the halachic permissibility of her actions.
Previously, we looked at details of what factors allow for drinking a kos shel ikarin. Though the precise definition of “tza’ar leida” is not clear from this passage, it is clear that, at the very least, there are some cases of medical need which would have made this form of sterilization permissible, and preferable to long-term abstinence or divorce.
Let’s turn now to practical implications of what we’ve learned for assessing the halachic permissibility of current methods of contraception.
Vasectomy and Tubal Ligation
Vasectomy and tubal ligation are extremely reliable modes of contraception, 99.5%-99.85% effective.4 Both entail permanent damage to reproductive organs, and are thus considered classic acts of sirus. Therefore, in line with what we’ve learned about sirus, when they are performed for contraceptive purposes, vasectomy is typically considered a Torah-level prohibition,5 while tubal ligation is widely considered a rabbinic prohibition.
One element of the halachic definition of sirus is its permanence, so that irreversible acts of sterilization are usually treated with greater stringency than fully reversible methods. While both vasectomy and tubal ligation may be reversed, reversal requires additional surgery and its success is not assured.6 . In a responsum from 1979, Rav Eliezer Waldenberg raises the possibility that if tubal ligation were to become more easily and reliably reversible, then it would not be considered sirus at all:
שו”ת ציץ אליעזר יד: צו
קשירת החצוצרות … בהיות והעיקור נעשה בצורה כזאת שבזמן מן הזמנים אפשר לתקנו ולהחזיר לאשה כושר הלידה…ואמנם בספרי שם טענתי בנוגע לזה שי”ל [=שיש לומר] שזה לא נקרא אפ”ה [אפילו הכי] עיקור זמני בהיות והפעולה הזאת אם תשאר כמו שהיא עיקור תמידי הוא, ורק אפשר ע”י [=על ידי] פעולה מחודשת לבטל את זאת הפעולה, אבל כתבתי זאת בנוגע ללתת עדיפות ליתר הדרכים מונעי העיבור מפעולה זאת כדיעו”ש [=כדיעויין שם], אבל באין אפשרות לדרכים אחרים כבנידוננו שפיר הדבר הזה קל מיהת ביותר מעיקור תמידי בהיות וישנו מיהת אפשרות להחזיר לה עוד כושר הלידה, [ואילו יכלנו לקבוע שזה כן נקרא זמני בהיות ויש מציאות להחזיר כושר הלידה, אזי היה מקום לומר שבכלל עיקור כזה איננו בגדר סירוס שאסרה תורה…[
Tzitz Eliezer 14:96
Tubal ligation…given that the sterilization is done in a manner that at some point in time it will be possible to repair it and restore the woman’s ability to bear children…And indeed in my book there [earlier] I argued with regard to this that even so it should not be called a temporary sterilization since this action, if it remains as is, is permanent sterilization, and it is only possible to nullify this procedure through a new action. But I wrote this regarding giving preference to other contraceptive methods, as can be seen there. But with no possibility for other methods, as in our situation, it is nevertheless better than permanent sterilization since there is nevertheless a possibility to restore her ability to bear children [and if we could establish that this is indeed called temporary because there is a possibility of restoring the ability to bear children, then there would be room to say that this type of sterilization isn’t in the category of sirus that the Torah prohibited at all…]
When sterilization is a side effect of other, critical medical procedures, it is permitted. Likewise, in cases when pregnancy or childbirth would pose a special risk to life, and other methods of contraception cannot be used, tubal ligation would be permitted. Rav Moshe Feinstein presents the reasoning in a late 1978 responsum:
שו”ת אגרות משה אה”ע ד: לד
בענין סירוס אשה שסכנה לה להתעבר ואינה יכולה למנוע העיבור באופן אחר…ששיטת הגר”א היא שיטה גדולה דרב גובריה, יש עכ”פ [=על כל פנים] לסמוך על רבותינו הראשונים שהם ודאי גם רבותיו של רבינו הגר”א והם גם רבים לפ”מ [=לפי מה] שידוע לנו בשעת הדחק כזה שהוא מעין עיגון והתורה מעידה שהוא צער גדול מאד אף לפי שעה, וגם צער הבעל גדול מאד שגירושין הוא דבר היותר רעה לאדם…ומצד שאיכא גם איסורין דרבנן שאסרו אף במקום צער גדול בסתמא אין לנו לומר זה אלא כשמפורש כן, וכ”ש [=וכל שכן] איסור זה שאיכא הרשב”א שסובר שליכא שום איסור….וזה שהחמרתי בתשובתי [אה”ע א:סג] הוא משום שלפניה היה עצה להשתמש במוך כמפורש שם.
Iggerot Moshe EH 4:34
In the matter of sirus of a woman for whom it is dangerous to get pregnant and who cannot prevent pregnancy in another way…For the position of the Gera [Vilna Gaon] is a great position for great was his power; nevertheless, one can rely on our early halachic authorities, who certainly were also the rabbis of the Gera, and they are many. According to what is known to us, in a pressing situation like this, which is like igun [marriage with no possibility of relations] and the Torah bears witness that it is a very great distress even temporarily, and also the husband’s distress is very great, for divorce is very bad for a person…And from the perspective that there are also rabbinic prohibitions that they prohibited even in a place of great distress, without specific explication we should not say that, except when it is explicitly so, and how much more so this prohibition where there is Rashba who reasons that there is no prohibition at all [for women]…and I was stringent in my [earlier] responsum [EH 1:63] because she had the possibility of using a moch [instead], as is explained there.
In a late 1977 responsum, Rav Betzalel Stern suggests that this would even be permissible when a woman has a clear basis for concern that she would conceive a child with an intellectual disability.
שו”ת בצל החכמה ד סו:ג
לדעת רובם המכריע של הפוסקים אין בסירוס אשה איסורא דאורייתא (אות א – ד ז’ י”ב). – ד) להסוברים סירוס אשה דאורייתא ע”כ [=על כרחך] גם המסתרסת בכלל איסור, וה”ה [=והוא הדין] דבזכרים גם המסתרס בכלל אזהרת לאו (אות ח – י). – ה) באשה שיש חשש מבוסס שאם תלד יהי[ה] הולד מפגר, מותרת לעבור נתוח שלא תוכל להתעבר עוד, אם לא כשיש לה אפשרות לכך ע”י [=על ידי] תרופות (ו – ח, י”א – י”ג) ומכש”כ [=ומכל שכן] כשהרופא המנתח הוא עכו”ם [=לא יהודי] (אות ח’).
Responsa Be-tzel Ha-chochma 4 66:3
3. In the view of the decisive majority of halachic authorities, sirus of a woman entails no Torah prohibition. 4. For those who maintain that sirus of a woman is on a Torah level, perforce also the woman undergoing sirus is included in the prohibition, and this is also the case for males, that the man who undergoes sirus is included in the prohibition. 5. Regarding a woman where there is a well-founded concern that if she gives birth the child will have an intellectual disability, she is permitted to undergo surgery so that she will no longer be able to become pregnant, if she has no other possibility through medicines, and all the more so if the surgeon is not Jewish.
In recent years, Puah Institute submitted questions on tubal ligation to a range of modern halachic authorities. One of the institute’s rabbanim, Rav Aryeh Katz, summarized the responses in an article:7
רב אריה כ”ץ, על דרך האמצע, אמונת עתיך 118, תשע”ח
מטעם מכון פוע”ה נשלחו בעבר שתי שאלות עקרוניות לפוסקים בנושא קשירת חצוצרות; השאלה הראשונה עסקה באישה חוזרת בתשובה שיש לה תשעה ילדים, והיא מרגישה שהבית עומד להתפרק עקב הקושי החינוכי והקושי בגידול הילדים. השאלה השנייה עסקה באישה שיש לה בעיות נפשיות וגופניות להיכנס להיריון, והיא אינה מעוניינת באמצעים אחרים למניעת היריון עקב חששות שונים. הפוסקים נקטו כמה גישות במענה לשאלות אלו: הרב אפרים גרינבלט והרב אביגדור נבנצל נטו להקל כשמדובר במקום צער גדול. לעומת זאת הרב מרדכי אליהו, הרב יצחק זילברשטיין, הרב יקותיאל פרקש והרב מנשה קליין שללו קשירת חצוצרות בכל מקום שאינו מוגדר כפיקוח נפש. הרב אריאל נקט בדרך אמצעית – במענה לשאלה הראשונה אסר קשירת חצוצרות והציע פתרונות אחרים. מנגד, בשאלה השנייה, שבה היו גם חששות נפשיים, כתב שאם יש חשש ממשי לפגיעה נפשית (ולא סתם ללחץ), יש מקום להתיר את הקשירה.
Rav Aryeh Katz, The Middle Way, Emunat Itecha 118, 5778
On behalf of Puah Institute, two foundational questions were sent out in the past to halachic authorities regarding tubal ligation; the first question dealt with a woman who was a ba’alat teshuva with nine children, who felt that her home was on the verge of falling apart because of the educational difficulty and the difficulty of raising the children. The second question dealt with a woman who has mental health and physical problems with becoming pregnant and is not interested in other contraceptive methods due to various concerns. The halachic authorities took a few approaches to responding to these questions: Rav Ephraim Greenblatt and Rav Avigdor Nebenzahl leaned toward leniency when speaking of a situation of great distress. In contrast Rav Mordechai Eliyahu, Rav Yitzchak Zilberstein, Rav Yekutiel Farkash, and Rav Menashe Klein ruled out tubal ligation in any case not defined as lifesaving. Rav [Yaakov] Ariel took a middle position—in response to the first question he prohibited tubal ligation and suggested alternate solutions. In contrast, in the second question in which there were also mental health concerns, he wrote that if the concern is enough to create mental harm (and not just stress), there is room to permit the ligation.
To summarize, vasectomy is prohibited for contraceptive purposes. Rulings on tubal ligation vary, but in general it is permitted only when there is a very compelling medical reason and no other method is suitable. When such procedures are necessary, they would ideally be performed by a non-Jew, who is not subject to these prohibitions.
Hormonal Contraceptives
Though there has been talk for years of male hormonal contraceptives in development, none has yet reached the market.8 Current hormonal methods of contraception work to prevent ovulation, so that a woman cannot conceive.
Combined estrogen-progesterone contraceptives, about 93% effective with typical use, and even higher with perfect use,9 come in daily pills, a weekly patch, and a monthly vaginal ring.10 Progesterone-only methods also change the composition of a woman’s cervical mucus in a way that prevents conception. They include daily pills (efficacy comparable to combined pills),11 shots every three weeks (96% effective), and implants that last for three years (99.9% effective). We discuss intrauterine systems that secrete progesterone in our next section.
The morning-after pill is used on an emergency basis after relations; its efficacy depends on timing and formulation. When taken prior to ovulation, it simply prevents ovulation within the sperm’s fertile window. When taken later, it can prevent implantation.12
The first combined hormonal contraceptive pill was approved in the US in 1960, and some halachic authorities raised concerns. Rav Moshe Feinstein expressed misgivings about the permissibility of hormonal contraceptives because they can lead to irregular staining or breakthrough bleeding, which can sometimes make a woman nidda. For a contraceptive to make a woman nidda, so that relations are impossible, would defeat its purpose. For example, in a 1979 responsum he writes:
שו”ת אגרות משה אה”ע ד: לד
…אפשר לה לשמש בגלולות (פילן) שיש שמונעין ג”כ [=גם כן] מלהתעבר אבל מה שלא הזכרתי עצה זו אף שלדין זה דמניעה מהריון היא עדיפא דהרי אינו סותם את הרחם משום דגורם להרבה נשים שרואות משהו דם וקשה להן ליטהר לבעלה אף שהגלולות מעצרין ריבוי הדם אף מזמן הוסת ולהרבה נשים מועיל גם שלא יראו כלל מ”מ [=מכל מקום] איכא נשים שגורם להם לראות באיזה יום אף שלא בשעת וסת, וגם לפי הרבה רופאים יש לחוש שיגרום זה איזה מחלה מסוכנת ואף שלא מצוי כל כך יש למיחש.
Iggerot Moshe EH 4:34
It is possible for her to use the pills that also prevent pregnancy, but I did not mention this possibility—even though regarding this law of contraceptives it is preferable, for it does not block the uterus—because it causes many women to have some bleeding, and it is difficult for them to become tehorot with regard to their husbands, even though the pills prevent heavy bleeding even during menstruation, and for many women cause them not to bleed at all, nevertheless, there are woman for whom the pill causes bleeding on some day that is not her time of menstruation. And also, according to many doctors one should be concerned that this [pill] will cause some dangerous illness, and even though it is not so common, one should be concerned.
Rav Moshe also expressed concern that hormonal contraceptives could have potentially dangerous side effects. While medical safety is a major halachic value, halacha typically relies on the consensus of medical experts to assess the safety of a given regimen. These concerns have been significantly allayed in the intervening decades, as hormone doses of pills have been decreased.
Hormonal methods of contraception raise no concern of hashchatat zera. With respect to sirus, while they do make a woman temporarily infertile, hormonal contraceptives do not damage a woman’s reproductive anatomy. They thus might be most closely likened to a kos shel ikarin, but with the great advantage of being temporary with fully reversible effects. For these reasons, they are widely regarded as halachically permissible contraceptives. In a 1966 responsum, Rav Eliezer Waldenberg enumerated their halachic advantages:
שו”ת ציץ אליעזר חלק ט סימן נא – קונ’ רפואה במשפחה שער ב
וכשהרצאתי הדבר לפני הרופאים….אמרו שכעת פחתו בהרבה החששות. אבל זה עוד לא מספיק עד שידעו בבירור שאין כל חשש בלקיחתם….שהכדורים פועלים לעקרות זמנית. ואם אמנם יבורר שישופרו עד שלא מזיקים כבר כלל, הרי הדרך הזאת למניעת הריון היא המובחרת ביותר, דאין כאן שום השחתת זרע וגם העקרות של האשה זמנית היא בלבד, ועוד זאת דאין כאן פעולת עקרות בידים. ויש לציין דאודות קיחת אמצעי לכך דרך הפה כבר נזכר גם בשו”ת מהר”ם בריסק ח”א סימן צ”ז. ובהגהת המו”ל [=המוציא לאור] מעיר שם דשתיית מעצצין [מעדעצין] או איניקטיאן [איניעקטיאן] הוי כעין כוס של עיקרין וכו’ ולכן הכא עדיף דלא נתעקרה רק שאינה מתעברת מתשמיש זה עיין שם.
Responsa Tzitz Eliezer 9 51 Treatise on Medicine and Family 2
When I raised the matter before physicians [that hormonal contraceptives could cause dangerous illness] …they said that the concerns have now been much reduced. But this is still not enough until they know clearly that there is no concern with taking them….For the pills act to temporarily render infertile. And if indeed it becomes clear that they improve to the point that they are no longer at all harmful, this method of contraception is the most preferred, for there is no hashchatat zera here whatsoever, and also the woman’s infertility is merely temporary, and furthermore there is no direct sterilizing act. And it should be noted that taking pills orally for this purpose is already mentioned in Responsa Maharam Brisk [1930s] (1:97). And in the publisher’s notes there he comments that drinking a medicine or [receiving] an injection is like a kos shel ikarin. And therefore, here it is preferable, for she does not become infertile, she just will not conceive from this act of relations, see there.
For many women, hormonal contraceptives are the preferred contraceptive choice, especially because of the reduced bleeding and the control they can provide over the menstrual cycle.
Still, to this day, while many women on hormonal contraceptives may not become nidda at all, others have chronic staining,13 which can limit opportunities for intercourse. Halachic authorities may still take this into account when assessing which contraceptives are preferred.14 Some women experience other negative side effects, such as vaginal dryness or decreased libido, and some cannot take hormones for medical reasons or are simply reluctant to do so.
Intrauterine Devices
Intrauterine devices seem to prevent conception primarily by making the uterus and fallopian terms less hospitable to sperm. They come in two main varieties, copper and progesterone-secreting, both of which are over 99% effective. The copper IUD can remain in place for up to ten years. The hormonal varieties can remain in place for up to eight years and also change the composition of a woman’s cervical mucus, like other progesterone contraceptives.15
Initially, there was much halachic concern about the IUD, both because it was thought to work primarily as an abortifacient and because there was a health crisis with one specific type of IUD in the 1970s.16 Largely for these reasons, we will see that some halachic authorities prefer hormonal contraceptives to IUDs.
In recent years, as the safety of IUDs has been more widely established, they are often likened halachically to hormonal contraceptives, not raising concerns of hashchatat zera and, in their reversibility, being considered more lenient than kos shel ikarin. As with hormonal contraceptives, there is some halachic concern for staining on the IUD.
שו”ת ציץ אליעזר חלק י סימן כה פרק י
…שכהכדורים כן גם שימת הטבעת [IUD], אינה גורמת להפסדת זרע לא של הבעל ולא של האשה… באופן שאין חשש כלל לפן ואולי גורמים להשחתת הזרע של הבעל או של האשה.
Tzitz Eliezer 10 25:10
For like the pills, so is placing the IUD, it does not cause destruction of zera neither of the husband nor of the wife …In a way that there is no concern at all for the aspect of perhaps causing hashchatat zera of the husband or of the wife.
Choosing a Method
In this piece and the previous one, we have discussed the permissibility of various contraceptive methods available today. Now, we turn to the question of which methods are halachically preferred.
A discussion of the relative preference of various contraceptive methods takes concerns regarding sirus and hashchatat zera into account. All other factors being equal, many halachic authorities would rank contraceptives as follows:
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
דעת רוב הפוסקים, שהגלולה היא הדרך העדיפה ביותר, בתנאי שיש היתר הלכתי עקרוני להשתמש באמצעי מניעה, ובתנאי שאין השימוש בגלולה גורם סכנה לאשה, ובתנאי שאין הגלולה גורמת לה דימום בין ווסתי. אם אי אפשר להשתמש בגלולה, דנו הפוסקים ביחסים שונים בין אמצעים אחרים: כיפה וקוטלי זרע – רוב הפוסקים סבורים, שקוטלי הזרע עדיפים; ויש הסבורים, שהכיפה עדיפה. יש מי שקבע את סדר העדיפויות הבא – גלולה, התקן תוך-רחמי, כיפה, עיקור האשה, כובעון באיש.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
…The opinion of most halachic authorities, that the pill is the most preferred method, on condition that there is a basic halachic permission to use contraceptives, and on condition that the use of a pill does not pose danger to the woman, and on condition that the pill does not cause her breakthrough bleeding. If it is not possible to use a pill, halachic authorities discussed different relationships between other methods: [between] a diaphragm and spermicide, most halachic authorities maintain that spermicide [alone] is better; there are those who maintain that the diaphragm is better. There are those who set up the following order of preference: pill, IUD, diaphragm, female sterilization [e.g., tubal ligation], a male condom.
As Dr. Steinberg notes, halachic authorities vary in their approaches. Though he lists the pill first above,17 because it is so widely accepted, he himself points out that, when contraceptive use is permitted, the IUD is widely understood as not violating any transgression:
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
התקן תוך-רחמי – לאור העובדה, שאמצעי מניעה זה איננו גורם להשחתת זרע במובן ההלכתי; הוא איננו מפריע כלל בקיום יחסי אישות ובהנאת הביאה, ועקב כך אינו מפריע לקיום מצות עונה; והוא זמני והפיך, ועקב כך אין בו איסור סירוס – אין מעיקר הדין איסור על האשה להשתמש בתכשיר זה.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
…The IUD, in light of the fact that this contraceptive method does not cause hashchatat zera in a halachic sense; it does not interfere at all with relations or with pleasure from them, and therefore does not interfere with fulfilling the mitzva of ona; and it is temporary and reversible, and therefore entails no prohibition of sirus—the fundamental halacha is that there is no prohibition on a woman’s using this device.
Some halachic authorities present other, albeit less widely accepted, orders of preference. For example, Rav Nahum Rabinovitch expresses his preference for the diaphragm, because he had particular concerns about hormone use:
שו”ת שיח נחום צה, שימוש בגלולות למניעת הריון
לפענ”ד [=לפי עניות דעתי] יש מגרעת לגלולות לעומת הדיאפרגמה, והיא זו: הדיאפרגמה אינה מפריעה כלל לתהליכים הטבעיים של הגוף, הואיל והיא בעצם סותמת מבחוץ את פתח הרחם ומונעת כניסת הזרע, וממילא אין לה שום השפעה על המתרחש במערכת ההורמונלית של גוף האשה. לא כן הגלולות, פעולתן היא לשנות את המאזן ההורמונלי, ולכך ישנן תופעות לוואי…אמצעי המניעה המועדף הוא דיאפרגמה (- או אמצעים הדומים לה), אלא אם כן נדרש אמצעי אחר מחמת צורך רפואי או צורך נפשי מיוחד.
Responsa Siach Nahum 95, Use of Pills to Prevent Pregnancy
In my humble opinion, there is a disadvantage to pills as opposed to the diaphragm, and that is: The diaphragm does not interfere at all with the body’s natural processes, since it basically seals the cervix from the outside and prevents sperm from entering, and naturally it has no effect at all on what happens in the hormonal systems of a woman’s body. Not so the pills; their action is to change the hormonal balance and thus there are side effects…The preferred contraceptive is the diaphragm (or similar methods), unless a different method is needed due to medical need or a special emotional need.
Even where a general order of preference can be established, other factors also have halachic weight in determining what is permissible.
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
העקרונות ההלכתיים לקביעת העדיפות בבחירת אמצעי מניעה במקום שהדבר מותר הם: השיטה חייבת להיות בטוחה ככל האפשר מסיכונים וסיבוכים רפואיים, ומתופעות לוואי, ובעיקר דימומים בין-ווסתיים. השיטה חייבת להיות יעילה ככל האפשר למניעת הריון…האמצעי צריך להיות רחוק ככל האפשר מהפרעה בקיום יחסי אישות טבעיים ורגילים, וצריך שלא יפריע בהנאת הביאה, כדי לקיים את מצות עונה כראוי…האמצעי צריך להיות רחוק ככל האפשר מהשחתה ישירה ופעילה של תאי הזרע, כדי למנוע איסור השחתת זרע. האמצעי צריך להיות זמני והפיך…כדי למנוע איסור סירוס.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
The halachic fundamentals in setting preferences in choosing a contraceptive method when the matter [contraception] is permissible are: The method must be as safe as possible from risks and medical complications, and from side effects, mainly from intermenstrual bleeding. The method must be as effective as possible as contraception…The method needs to be as far as possible from interference with having natural and regular marital relations, and must not interfere with the pleasure of intercourse, in order to fulfill the mitzva of ona [pleasurable relations at regular intervals] as is fitting….The method must be as far as possible from direct and active haschata of the sperm cells, in order to avoid hashchatat zera. The method must be temporary and reversible…in order to avoid the prohibition of sirus…
The individual concerns of each woman and couple must also be taken into account. For example, a given contraceptive might be medically contraindicated for a specific woman, either because of some health effects of the contraceptive itself or because the case requires a higher level of efficacy than some contraceptives can provide. Additionally, some contraceptives are appropriate or available for long-term use and less appropriate for use in the very short term.
Furthermore, for some couples, the process of using a particular method might be challenging. For example, some women struggle to keep track of taking a daily pill, while others might be uncomfortable inserting a contraceptive vaginally. Both availability and pricing of different methods differ widely based on location and on health coverage. Finally, some contraceptive methods also raise halachic questions that aren’t directly related to the question of permissibility, such as whether insertion of an intrauterine device, or the staining common with some hormonal contraceptives, make a woman nidda.18
While not losing sight of all of these factors, couples should be familiar with the halachic discourse relevant to common contraceptives, and take it into account along with considerations more specific to their situation and contraceptive needs. In a recent publication, Yoetzet Halacha Rabbanit Tirza Kelman summarizes this dynamic well:19
רבנית תרצה קלמן, תכנון משפחה ואמצעי מניעה, עמ’ 17, 23
…עקרונות היסוד של הפסיקה בנוגע לאמצעים השונים אינן נוגעות למקרה ספציפי דווקא. קיימות שיטות הלכתיות שונות ביחס לסדר העדיפות ההלכתי בין האמצעים השונים, וטוב יעשה זוג שיש להם סמכות הלכתית קבועה שהם מתייעצים איתה, אם יברר מהי שיטתה בעניין. בנוסף, חשוב לדעת שאף על פי שהעקרונות ההלכתיים כלליים וקבועים, מצב נקודתי של זוג מסוים עשוי לגרום לכך שביחס אליהם סדר העדיפויות יהיה שונה…אחרי שההכרעה ההלכתית הרפואית הזוגית והאישית היא שיש צורך במניעת הריון כרגע, יש לגשת לבירור מעשי על האפשרויות השונות ולבחור אמצעי מניעה מתאים. חשוב להבין שלכל אחד מהאמצעים יש יתרונות ויש חסרונות. אף אחד מהאמצעים אינו מושלם.
Rabbanit Tirza Kelman, Family Planning and Contraceptives, pp. 17, 23
…The fundamental principles of halachic rulings regarding the various methods [of contraception] don’t relate specifically to a particular case. There are different halachic approaches regarding the halachic order of preference, and a couple who have a halachic authority with whom they consistently consult will do well to clarify with them their position in this matter. Additionally, it is important to know that even though the halachic principles are fixed and generally applicable, a particular couple’s specific situation could cause the order of preference to be different for them…After the halachic, medical, couple’s, and personal determination is made that there is a need for contraception at the moment, one should enter into a practical clarification of the different possibilities and choose an appropriate contraceptive method. It is important to understand that every method has advantages and disadvantages. No method is perfect.
How can Halacha determine what contraceptive method to use, when this such a personal decision?
Navigating contraceptive choice is often difficult, as a couple must consider and contemplate a range of relevant factors. This is true for all couples, not only halachically observant Jews. For example:20
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
“How to Pick the Birth Control Method that’s Right for You.” Cleveland Clinic, February 10, 2022
In deciding what birth control method is right for you, ask yourself questions like: Do you think you want to have children someday? How soon? How effective is the birth control method you’re considering? How important is it that the method be very effective? How significant would an unplanned pregnancy be? Will you be able to use the birth control method correctly every time? Are there factors that might impact that ability? What are the potential side effects of the methods you’re considering? How would you feel if these side effects happened to you? What are your periods like, and are you looking for a method to help make them lighter or more regular? Is your partner willing to participate in preventing pregnancy by using condoms or considering a vasectomy (permanent contraception for men)? How often do you have sex, and how many partners do you have? How will you protect yourself from sexually transmitted infections? Do you have any health conditions that would impact the safety of certain forms of birth control? How much control do you prefer over your birth control method?
A halachically observant couple has an overlapping but somewhat different list of questions to consider. This becomes apparent when comparing the above list to the passage by Rabbi Dr. Avraham Steinberg (cited above) about choosing a method:
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
העקרונות ההלכתיים לקביעת העדיפות בבחירת אמצעי מניעה במקום שהדבר מותר הם: השיטה חייבת להיות בטוחה ככל האפשר מסיכונים וסיבוכים רפואיים, ומתופעות לוואי, ובעיקר דימומים בין-ווסתיים. השיטה חייבת להיות יעילה ככל האפשר למניעת הריון…האמצעי צריך להיות רחוק ככל האפשר מהפרעה בקיום יחסי אישות טבעיים ורגילים, וצריך שלא יפריע בהנאת הביאה, כדי לקיים את מצות עונה כראוי…האמצעי צריך להיות רחוק ככל האפשר מהשחתה ישירה ופעילה של תאי הזרע, כדי למנוע איסור השחתת זרע. האמצעי צריך להיות זמני והפיך…כדי למנוע איסור סירוס.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
The halachic fundamentals in setting preferences in choosing a contraceptive method when the matter [contraception] is permissible are: The method must be as safe as possible from risks and medical complications, and from side effects, mainly from intermenstrual bleeding. The method must be as effective as possible as contraception…The method needs to be as far as possible from interference with having natural and regular marital relations, and must not interfere with the pleasure of intercourse, in order to fulfill the mitzva of ona [pleasurable relations at regular intervals] as is fitting….The method must be as far as possible from direct and active hashchata of the sperm cells, in order to avoid hashchatat zera. The method must be temporary and reversible…in order to avoid the prohibition of sirus…
As represented here, both the medical establishment and the halachic tradition prioritize contraceptive safety and efficacy and a careful consideration of side effects.
Some of the differences between the lists simply reflect different cultural norms. For example, items on the first list—especially those oriented to multiple sexual partners, sexually transmitted infections, and questions about having a family at all—are typically less relevant to halachically observant women considering contraception, who are predominantly married (or about to be) and interested in having families with children.
A couple of the differences, however, are more significant: limiting use of specific contraceptive methods and prioritizing Halacha over personal preference.
Halacha limits the choice of some contraceptive methods. A halachically observant couple are unlikely to consider vasectomy as a contraceptive option, since it is considered a clear violation of the prohibition of sirus. Condoms are also usually not seen as an option, since they are only rarely halachically permitted, due to the prohibition of hashchatat zera. Halachic perspectives on hashchatat zera and use of a diaphragm vary widely, and whether a couple even considers it may depend on the view that they follow.
Tubal ligation raises halachic concerns of sirus, albeit to a lesser degree than vasectomy. While many halachic authorities permit tubal ligation when other contraceptives cannot meet a couple’s medical and psychological needs, this still pushes couples who might otherwise prefer tubal ligation to turn to other methods.
A study from 2020 that compares the use of varying contraceptive methods among Charedi and secular Israeli women exemplifies how this may work out in practice,:21
Yehuda Sabiner, MD, Misgav Rottenstreich, MD, Sorina Grisaru-Granovsky, MD PhD, Daniel S. Seidman, MD, “Use of Contraception among Ultra-Orthodox Jews: A Matched Case-Control Study” Fertility and Sterility, 2020, Vol, 114, issue 3.
Of the ultra-Orthodox women, 57.5% reported ever using birth control compared to 86.0% of the secular women (p<0.001). The majority, 83.1%, of ultra-Orthodox women reported requesting religious guidance before using contraception. Among ultra-Orthodox women, reporting previous contraceptive use, the most common birth control methods were oral contraceptive pills by 81.5%, IUDs by 27.1% and spermicides by 36.9% versus 78.2%, 15.9% and 2.8%, respectively, among matched secular women.
Much of the variance between the communities seems to correlate with the halachic preferences that we’ve discussed. Charedim reported higher levels of IUD use, and dramatically higher levels of spermicide use. Even so, among contraceptive users from both populations under study, levels of use of oral contraceptives were quite similar and oral contraceptives and IUD’s were the most popular contraceptive choices.
In other words, Halacha favors two of the long-term contraceptive methods that secular women in Israel seem to favor as well. The tension between Halacha and personal contraceptive choice may thus be most keenly felt in the long term by couples who would, left to their own devices, prefer a method that Halacha does not favor, which brings us to the second major difference between the lists.
The medical list puts more weight than Rabbi Dr. Steinberg’s on individual habits or preferences. In contrast, the halachic presentation assumes that a personal preference unrooted in medical concerns will be considered only after halachic permissibility has been taken into account. This assumption is typical of halachic discourse, though it may seem more jarring in this highly personal context.
Additional recent research may help put this into some perspective:22
Preethy D’Souza, Julia V. Bailey, Judith Stephenson and Sandy Oliver “Factors influencing contraception choice and use globally: a synthesis of systematic reviews” (2022), The European Journal of Contraception & Reproductive Health Care
Factors affecting contraception use are remarkably similar among women in very different cultures and settings globally. Use of contraception is influenced by the perceived likelihood and appeal of pregnancy, and relationship status. It is influenced by women’s knowledge, beliefs, and perceptions of side effects and health risks. Male partners have a strong influence, as do peers’ views and experiences, and families’ expectations. Lack of education and poverty is linked with low contraception use, and social and cultural norms influence contraception and expectations of family size and timing. Contraception use also depends upon their availability, the accessibility, confidentiality and costs of health services, and attitudes, behaviour and skills of health practitioners…. There are links between religion and contraception use globally, which vary by religious background, affiliation or denomination of men or women, and of health care providers; personal beliefs and strength of belief or strictness of doctrine; degree of involvement in religious events; and the influence of religious leaders.
In and out of the Jewish community, it seems to be the case that a variety of personal, societal, and religious factors often limit a couple’s real contraceptive choices.
With the awareness that religious leaders play an important role in shaping these factors within our communities, and that more limited choices and autonomy can be challenging, Rabbanit Tirza Kelman addresses the importance of ensuring that our communal discourse be well informed:
הרבנית תרצה קלמן, תכנון משפחה ומניעת הריון, עמ’ 12-11
הנושא של מבנה המשפחה ומניעת הריון משפיע מאד על חייהן של נשים בגיל הפוריות אך השיח הציבורי לגביו מצומצם. הזמן המוגבל שיש לרופאות הנשים במפגש עם נשים, וחוסר היכרות עם מרחב האפשרויות מצמצמים מאד את השליטה שיש לנשים על התהליך ועל הבנת משמעות ההחלטות שלהן…והמידע [הרפואי וההלכתי] עשוי לתרום תרומה משמעותית לקבלת החלטה שתתבסס על הבנת המצב ההלכתי והפיזיולוגי באופן רחב יותר.
Rabbanit Tirza Kelman, Family Planning and Contraception, pp. 11-12
The topic of family structure and contraception greatly affects the lives of women in their fertile years, but communal discussion of it is limited. The limited time that gynecologists have to meet with a woman, and a lack of familiarity with the range of possibilities, really narrow women’s control over the process and over understanding the significance of their decisions…[Medical and halachic] knowledge should contribute significantly to making a decision that will be based on understanding the halachic and physiological situation more comprehensively.
Halachic guidance, when provided well, can sometimes expand a couple’s awareness of contraceptive options–or perhaps even expand what options are available. For example, diaphragms and healthcare professionals qualified to fit them are currently easier to find in Israel than in many areas in the United States. It is likely that demand from religious couples plays a role. (Religious populations, especially Catholics, have also contributed to the development of the Fertility Awareness Method.)
Regardless of the specific community to which they belong, a couple should be able to learn about the full range of contraceptive methods and halachic perspectives on them. Even when a contraceptive decision will be shaped through consultation with a halachic authority, going into a consultation with more knowledge can facilitate a couple maximizing their choices and exercise of autonomy within the framework of Halacha.
Concluding Thought
We’ve seen that strategies for preventing pregnancy are recorded as early as the book of Bereishit. But safe, effective, reversible contraceptive methods that do not violate the prohibition of hashchatat zera or sirus are a much more recent development. The introduction of hormonal birth control and the IUD have changed women’s health and family structure in important ways over the course of the past century.
Halacha’s response to these innovations has been cautious and gradual. As the world changes swiftly around us, it is important to hold on to the mitzvot of procreation and to the essential connection between marriage and creating a family. Furthermore, when a new method of contraception is introduced, it can take time to determine that it is indeed safe for long-term use over large populations.
Still, Halacha is a living system, responsive to human needs and to new medical realities. Halachic sources from the Talmud and onwards accept contraceptive use as an essential tool in situations where pregnancy and childbirth could have severe consequences for a woman’s health. Today, methods that present few halachic difficulties in themselves create more room to permit contraception for reasons of physical or mental health, and to preserve the well-being of marriages and families, without losing sight of the joy, meaning, and mitzva in raising children.
Further Reading
- Ellinson, Rabbi Elyakim Getsel, Tichnun Ha-mishpacha U-mniyat Herayon (Moreshet 1976).
- Rav Gavriel Goldman and Rav Menachem Burstein, Sefer Puah III: Herayon Ve-leida, 2nd Edition (Machon Puah, 2021).
- Rav Yehuda H. Henkin, Responsa Benei Banim 1:30. Available here.
- Rav Dr Avraham Steinberg, “Meni’at Herayon.” Encyclopedia Refuit Hilchatit, (new edition 5766). Available here. Nishmat HaBayit vol. I: Contemporary Questions on Women’s Reproductive Health (Maggid Books, 2021).
- Rabbanit Tirza Kelman, Tichnun Mishpacha Ve-emtza’ei Meniya (Nishmat HaBayit Research Institute, 2020). Available here.
Notes
מגיד משנה הלכות איסורי ביאה טז: יא
רבי יהודה אומר אין הנקבות בסרוס וכן מבואר בפרק שמנה שרצים ופירש רבינו חיובא הוא דליכא אבל איסורא איכא מדלא תני מותר לסרס הנקבות ולזה כתב רבינו פטור:
Maggid Mishneh Issurei Bi’a 16:11
Rabbi Yehuda says females are not included in sirus, and so is explained in chapter Shemoneh Sheratzim (Shabbat ch. 14), and Rambam explained that there is no [Torah] liability, but there is a [rabbinic] prohibition since the Tosefta doesn’t teach “it is permitted to do sirus on females,” and for this reason Rambam wrote patur.
שולחן ערוך אה”ע ה:יא
והמסרס את הנקבה, בין באדם בין בשאר מינים, פטור אבל אסור.
Shulchan Aruch EH 5:11
One who sterilizes a female, whether human or another species, is exempt [from the Torah] but violates [a rabbinic] prohibition.
3. Some authorities even maintain that this type of sterilization is prohibited only rabbinically for males:
ספר יראים שמב [דפוס ישן – שפא]
ונראה הדבר שעיקור סם מדרבנן
Yere’im 342 (formerly 381)
It seems correct that sterilization through a drug is prohibited rabbinically
ראב”ד ספרא ז:ז: יב
ובזכר בין סרוס דבידים בין דממילא אסור
Ra’avad, Commentary to Sifra 7 7:12
With a male, whether direct sterilization or indirect sterilization [as with a potion], it is prohibited.
5. Damage to the testicles (petzu’a daka) can render a man ineligible to marry (Devarim 23:2). However, Chazon Ish establishes that a procedure such as a modern vasectomy, which is performed internally and not on the external male genitalia, does not fall into this category. Available here.
חזון אי”ש, אה”ע הלכות פו”ר י”ב
…ומדלא הוזכרו בגמ[רא] ובפוסקים משמע דבמקום שהשבילין בפנים אינם בכלל פצוע דכא ואינו נפסל אלא אם נפצע ונדך בגיד וביצים וחוטין שבהם, אבל לא החוטין הפנימים שבתוך הגוף, ואף אם מסתרס על ידי כריתת השבילים בתוך הגוף מ”מ [=מכל מקום] אינו נאסר בקהל ודינו כשאר עקר…
Chazon Ish EH Pirya Ve-rivya 12
…Since they were not mentioned in the Talmud and in the works of halachic authorities, the inference is that where the tubes are internal they are not included in petzu’a daka and he is not rendered unfit unless he is injured or crushed in the penis or testicles and the sinews between them, but not the internal sinews that are inside the body, and even if he is sterilized through cutting the tubes within the body, in any case he is not prohibited to marry and his halachic status is like any other infertile man…
10. The ring is not considered an impediment to intercourse. It does not fill the vaginal canal and sperm can freely move through it into the uterus.
הרב יעקב אריאל, שו”ת פועה מניעת הריון עמ’ 120
נראה לעניות דעתי שמכיוון שהיא אינה מונעת את הכנסת הזרע לרחם, אלא רק מפרישה הורמונים המונעים ביוץ או הפריה, אין לדמותה למשמשת במוך, שתוארה כמי שמשמש על עצים ואבנים, אלא דינה כמו הגלולה שאין בה השחתה…
Rav Ya’akov Ariel, Responsa Puah, Contraception, p. 120
It seems in my humble opinion that since it does not prevent the entry of zera into the uterus, but just secretes hormones that prevent ovulation or conception, one should not compare it to having intercourse with a moch, which is described as someone who has intercourse onto wood or trees, but rather its law is like the [contraceptive] pill, which does not entail hashchata…
Sources
Sirus
ויקרא כב:כד
וּמָעוּךְ וְכָתוּת וְנָתוּק וְכָרוּת לֹא תַקְרִיבוּ לַה’ וּבְאַרְצְכֶם לֹא תַעֲשׂוּ: וּמִיַּד בֶּן נֵכָר לֹא תַקְרִיבוּ אֶת לֶחֶם אֱלֹקיכֶם מִכָּל אֵלֶּה כִּי מָשְׁחָתָם בָּהֶם מוּם בָּם לֹא יֵרָצוּ לָכֶם:
Vayikra 22:24
And [males whose genitalia are] crushed, or ground, or separated, or cut off, you shall not bring as an offering to God and in your land you shall not do it. And from the hand of a gentile you shall not offer food of your God from any of these, for their ruin is in them [ba–hem], a defect is in them, they will not appease for you.
ספר החינוך פרשת אמור מצוה רצא
משרשי המצוה, לפי שהשם ברוך הוא ברא עולמו בתכלית השלימות, לא חסר ולא יתר בו דבר מכל הראוי להיות בו לשלימותו, והיה מרצונו ובירך בעלי החיים להיותם פרים ורבים, וגם צוה הזכרים ממין האדם על זה, למען יעמודו, שאם לא כן, יהיה המין כלה אחר שהמות מכלה בהם, ועל כן המפסיד כלי הזרע מראה בנפשו כמי שהוא קץ במעשה הבורא ורוצה בהשחתת עולמו הטוב.
Sefer Ha-chinuch Emor 291
Among the roots of the mitzva, since because God created His world with ultimate perfection, He did not leave anything out, or include anything extra, beyond what is fitting to be in it for its perfection, and it derived from His will, and He blessed the animals to be fruitful and multiply, and He also commanded males of the human species in this, in order that they should endure, for otherwise the species would become extinct after death extinguishes them. Therefore, one who destroys male reproductive organs shows himself as one who loathes the work of the Creator and desires the ruin of His good world.
תוספתא מכות, ד:ד
המסרס את האדם ואת הבהמה ואת החיה ואת העוף, בין גדולים בין קטנים, בין זכרים ובין נקבות – הרי זה חייב. רבי יהודה אומר: מסרס את הזכרים – חייב, ואת הנקבות – פטור
Tosefta Makkot 4:4
One who sterilizes a person or a domesticated animal or a wild animal or a fowl, whether mature or young, whether male or female, is liable [for the Torah punishment of lashes]. Rabbi Yehuda says, one who sterilizes males is liable, [one who sterilizes] females is exempt [from Torah punishment].
ספרא אמור ז ז: יב
…רבי יהודה אומר: “בהם” אין נקיבות בסירוס.
Sifra Emor 7 7:12
…Rabbi Yehuda says:…”In them” [ba-hem (masculine plural)]—Females are not included in the prohibition of sirus.
רמב”ם הלכות איסורי ביאה טז: יא
והמסרס את הנקבה בין באדם בין בשאר מינים פטור.
Rambam Issurei Bia 16:11
One who sterilizes a female, whether human or another species, is exempt [according to Torah law].
באור הגר”א אה”ע ה:כה
ופ[ירוש] כת”ק [=כתנא קמא] אלא דאין בהם מלקות…
Bei’ur Ha-Gera EH 5:25
The interpretation is like the first tannaitic position [that female sirus is prohibited on a Torah level] but there is no punishment from the Torah of lashes …
חדושי הרשב”א שבת קיא.
דבאשה ליכא משום סירוס דסירוס אדם הוא דאסר רחמנא.
Rashba Shabbat 111.
For regarding a woman there is no [halacha] on account of sirus, for sirus of a man is what God prohibited in the Torah.
ט”ז אה”ע ה:ו
לשון ‘אין סירוס בנקבות’ מורה על היתר כמו לשון מותר אלא הטעם כיון שמסרס אותה על ידי מעשה כגון הכאה או בעיטה או שאר דברים הגורם סירוס ובא על ידי מעשה שלו אין לומר בו היתר דאפילו בבהמה אסור משום צער בעלי חיים בלא איסור סירוס…
Taz EH 5:6
The phrase [in Sifra] ‘there is no sirus with respect to females’ indicates that it is permissible, like the term ‘permitted’, but the reason [for not using the simpler term] is that since one sterilizes her through an act like hitting or kicking or other things that cause sterilization, and it comes about through his action, one cannot say that it is permissible, for even with an animal it would be prohibited on account of tza’ar ba’alei chayyim [the prohibition of causing suffering to animals] without a prohibition of sirus…
שו”ת אגרות משה אה”ע ד: לד
ובעצם הדין אם יש איסור דאורייתא בסירוס נקבות כהגר”א רבים חולקין עליו…סובר הרמב”ם שאיכא איסור מדרבנן.
Iggerot Moshe EH 4:34
Regarding the fundamental law whether there is a Torah prohibition of sterilizing females, as the Vilna Gaon maintained, many dispute him…Rambam considers there to be a rabbinic prohibition.
Sterilizing Potions
תוספתא יבמות (ליברמן) ח: ד
…האיש אין רשיי לשתות עיקרין שלא יוליד והאשה אין רשאה לשתות עיקרין שלא תלד…
Tosefta Yevamot (Lieberman) 8:4
…A man is not permitted to drink a sterilizing potion in order that he not father offspring, and a woman is not permitted to drink a sterilizing potion in order that she not give birth…
ראב”ד ספרא ז:ז יב
… גרמא כגון על ידי מאכל או על ידי משקה שמצמקת האם שלה ואינה יולדת דבר זה… באשה מותרת שאינה מצווה על פריה ורביה.
Ra’avad, Commentary to Sifra 7:7; 12
Indirect action such as through a food or through a drink that shrivels her reproductive organ so that she is not fertile, this matter…for a woman is permitted, for she is not commanded in pirya ve-rivya.
שבת קי:-קיא.
לירקונא תרין בשיכרא ומיעקר ומי שרי והתניא מניין לסירוס באדם שהוא אסור תלמוד לומר ובארצכם לא תעשו בכם לא תעשו…אלא באשה
Shabbat 110b-111a
For [healing] jaundice: two liquors but it sterilizes [the drinker]. And is that permitted? Has it not been taught in a baraita: Whence do we know that sirus of a man is prohibited? The verse teaches: “And in your land you shall not do it.” To yourselves you shall not do it…Rather, regarding a woman [the drink is suggested].
יבמות סה:-סו.
יהודה וחזקיה תאומים היו אחד נגמרה צורתו לסוף תשעה ואחד נגמרה צורתו לתחלת שבעה יהודית דביתהו דר’ חייא הוה לה צער לידה שנאי מנא ואתיא לקמיה דר’ חייא אמרה אתתא מפקדא אפריה ורביה אמר לה לא אזלא אשתיא סמא דעקרתא לסוף איגלאי מילתא אמר לה איכו ילדת לי חדא כרסא אחריתא דאמר מר יהודה וחזקיה אחי פזי וטוי אחוותא
Yevamot 65b-66a
Yehuda and Chizkiya were twins, one finished developing at the end of nine [months] and one finished developing at the beginning of the seventh [month]. Yehudit, Rabbi Chiyya’s wife, had pain at childbirth. She changed her clothes [to disguise herself] and came before Rabbi Chiyya. She said: Is a woman commanded in pirya ve-rivya? He said to her: No. She went and drank a root potion. In the end, the matter was revealed. He [Rabbi Chiyya] said to her: Would that you had given birth to one more wombful for me. For master said: Yehuda and Chizkiya were brothers, Pazi and Tavi were [their twin] sisters.
תוספות שבת קי: ד”ה והתניא מניין לסירוס שהוא אסור
משמע בסוף הבא על יבמתו (יבמות סה:) גבי דביתהו דר’ חייא דאי הוה מיפקדה אפריה ורביה לא הוה שתיא סמא דעקרתא אף על גב דהוי לה שתי נקבות ושני זכרים משום בבקר זרע [את] זרעך ולערב אל תנח ידך (קהלת יא) ובאשה לא שייך סירוס
Tosafot Shabbat 110b s.v. ve-hatanya minayin le-sirus she-hu asur
It is understood [from the passage] at the end of “Ha-ba al yevimto” (Yevamot 65b) regarding Rabbi Chiyya’s wife, that if she had been obligated in pirya ve-rivrya, she would not have drunk the root potion, even though she had two girls and two boys, on account of: “In the morning sow your zera, and in the evening, don’t rest your hands” (Kohelet 11:6). And for a woman, sirus is not relevant.
Vasectomy and Tubal Ligation
שו”ת ציץ אליעזר יד: צו
קשירת החצוצרות … בהיות והעיקור נעשה בצורה כזאת שבזמן מן הזמנים אפשר לתקנו ולהחזיר לאשה כושר הלידה…ואמנם בספרי שם טענתי בנוגע לזה שי”ל [=שיש לומר] שזה לא נקרא אפ”ה [אפילו הכי] עיקור זמני בהיות והפעולה הזאת אם תשאר כמו שהיא עיקור תמידי הוא, ורק אפשר ע”י [=על ידי] פעולה מחודשת לבטל את זאת הפעולה, אבל כתבתי זאת בנוגע ללתת עדיפות ליתר הדרכים מונעי העיבור מפעולה זאת כדיעו”ש [=כדיעויין שם], אבל באין אפשרות לדרכים אחרים כבנידוננו שפיר הדבר הזה קל מיהת ביותר מעיקור תמידי בהיות וישנו מיהת אפשרות להחזיר לה עוד כושר הלידה, [ואילו יכלנו לקבוע שזה כן נקרא זמני בהיות ויש מציאות להחזיר כושר הלידה, אזי היה מקום לומר שבכלל עיקור כזה איננו בגדר סירוס שאסרה תורה…[
Tzitz Eliezer 14:96
Tubal ligation…given that the sterilization is done in a manner that at some point in time it will be possible to repair it and restore the woman’s ability to bear children…And indeed in my book there [earlier] I argued with regard to this that even so it should not be called a temporary sterilization since this action, if it remains as is, is permanent sterilization, and it is only possible to nullify this procedure through a new action. But I wrote this regarding giving preference to other contraceptive methods, as can be seen there. But with no possibility for other methods, as in our situation, it is nevertheless better than permanent sterilization since there is nevertheless a possibility to restore her ability to bear children [and if we could establish that this is indeed called temporary because there is a possibility of restoring the ability to bear children, then there would be room to say that this type of sterilization isn’t in the category of sirus that the Torah prohibited at all…]
שו”ת אגרות משה אה”ע ד: לד
בענין סירוס אשה שסכנה לה להתעבר ואינה יכולה למנוע העיבור באופן אחר…ששיטת הגר”א היא שיטה גדולה דרב גובריה, יש עכ”פ [=על כל פנים] לסמוך על רבותינו הראשונים שהם ודאי גם רבותיו של רבינו הגר”א והם גם רבים לפ”מ [=לפי מה] שידוע לנו בשעת הדחק כזה שהוא מעין עיגון והתורה מעידה שהוא צער גדול מאד אף לפי שעה, וגם צער הבעל גדול מאד שגירושין הוא דבר היותר רעה לאדם…ומצד שאיכא גם איסורין דרבנן שאסרו אף במקום צער גדול בסתמא אין לנו לומר זה אלא כשמפורש כן, וכ”ש [=וכל שכן] איסור זה שאיכא הרשב”א שסובר שליכא שום איסור….וזה שהחמרתי בתשובתי [אה”ע א:סג] הוא משום שלפניה היה עצה להשתמש במוך כמפורש שם.
Iggerot Moshe EH 4:34
In the matter of sirus of a woman for whom it is dangerous to get pregnant and who cannot prevent pregnancy in another way…For the position of the Gera [Vilna Gaon] is a great position for great was his power; nevertheless, one can rely on our early halachic authorities, who certainly were also the rabbis of the Gera, and they are many. According to what is known to us, in a pressing situation like this, which is like igun [marriage with no possibility of relations] and the Torah bears witness that it is a very great distress even temporarily, and also the husband’s distress is very great, for divorce is very bad for a person…And from the perspective that there are also rabbinic prohibitions that they prohibited even in a place of great distress, without specific explication we should not say that, except when it is explicitly so, and how much more so this prohibition where there is Rashba who reasons that there is no prohibition at all [for women]…and I was stringent in my [earlier] responsum [EH 1:63] because she had the possibility of using a moch [instead], as is explained there.
שו”ת בצל החכמה ד סו:ג
לדעת רובם המכריע של הפוסקים אין בסירוס אשה איסורא דאורייתא (אות א – ד ז’ י”ב). – ד) להסוברים סירוס אשה דאורייתא ע”כ [=על כרחך] גם המסתרסת בכלל איסור, וה”ה [=והוא הדין] דבזכרים גם המסתרס בכלל אזהרת לאו (אות ח – י). – ה) באשה שיש חשש מבוסס שאם תלד יהי[ה] הולד מפגר, מותרת לעבור נתוח שלא תוכל להתעבר עוד, אם לא כשיש לה אפשרות לכך ע”י [=על ידי] תרופות (ו – ח, י”א – י”ג) ומכש”כ [=ומכל שכן] כשהרופא המנתח הוא עכו”ם [=לא יהודי] (אות ח’).
Responsa Be-tzel Ha-chochma 4 66:3
3. In the view of the decisive majority of halachic authorities, sirus of a woman entails no Torah prohibition. 4. For those who maintain that sirus of a woman is on a Torah level, perforce also the woman undergoing sirus is included in the prohibition, and this is also the case for males, that the man who undergoes sirus is included in the prohibition. 5. Regarding a woman where there is a well-founded concern that if she gives birth the child will have an intellectual disability, she is permitted to undergo surgery so that she will no longer be able to become pregnant, if she has no other possibility through medicines, and all the more so if the surgeon is not Jewish.
רב אריה כ”ץ, על דרך האמצע, אמונת עתיך 118, תשע”ח
מטעם מכון פוע”ה נשלחו בעבר שתי שאלות עקרוניות לפוסקים בנושא קשירת חצוצרות; השאלה הראשונה עסקה באישה חוזרת בתשובה שיש לה תשעה ילדים, והיא מרגישה שהבית עומד להתפרק עקב הקושי החינוכי והקושי בגידול הילדים. השאלה השנייה עסקה באישה שיש לה בעיות נפשיות וגופניות להיכנס להיריון, והיא אינה מעוניינת באמצעים אחרים למניעת היריון עקב חששות שונים. הפוסקים נקטו כמה גישות במענה לשאלות אלו: הרב אפרים גרינבלט והרב אביגדור נבנצל נטו להקל כשמדובר במקום צער גדול. לעומת זאת הרב מרדכי אליהו, הרב יצחק זילברשטיין, הרב יקותיאל פרקש והרב מנשה קליין שללו קשירת חצוצרות בכל מקום שאינו מוגדר כפיקוח נפש. הרב אריאל נקט בדרך אמצעית – במענה לשאלה הראשונה אסר קשירת חצוצרות והציע פתרונות אחרים. מנגד, בשאלה השנייה, שבה היו גם חששות נפשיים, כתב שאם יש חשש ממשי לפגיעה נפשית (ולא סתם ללחץ), יש מקום להתיר את הקשירה.
Rav Aryeh Katz, The Middle Way, Emunat Itecha 118, 5778
On behalf of Puah Institute, two foundational questions were sent out in the past to halachic authorities regarding tubal ligation; the first question dealt with a woman who was a ba’alat teshuva with nine children, who felt that her home was on the verge of falling apart because of the educational difficulty and the difficulty of raising the children. The second question dealt with a woman who has mental health and physical problems with becoming pregnant and is not interested in other contraceptive methods due to various concerns. The halachic authorities took a few approaches to responding to these questions: Rav Ephraim Greenblatt and Rav Avigdor Nebenzahl leaned toward leniency when speaking of a situation of great distress. In contrast Rav Mordechai Eliyahu, Rav Yitzchak Zilberstein, Rav Yekutiel Farkash, and Rav Menashe Klein ruled out tubal ligation in any case not defined as lifesaving. Rav [Yaakov] Ariel took a middle position—in response to the first question he prohibited tubal ligation and suggested alternate solutions. In contrast, in the second question in which there were also mental health concerns, he wrote that if the concern is enough to create mental harm (and not just stress), there is room to permit the ligation.
Hormonal Contraceptives
שו”ת אגרות משה אה”ע ד: לד
…אפשר לה לשמש בגלולות (פילן) שיש שמונעין ג”כ [=גם כן] מלהתעבר אבל מה שלא הזכרתי עצה זו אף שלדין זה דמניעה מהריון היא עדיפא דהרי אינו סותם את הרחם משום דגורם להרבה נשים שרואות משהו דם וקשה להן ליטהר לבעלה אף שהגלולות מעצרין ריבוי הדם אף מזמן הוסת ולהרבה נשים מועיל גם שלא יראו כלל מ”מ [=מכל מקום] איכא נשים שגורם להם לראות באיזה יום אף שלא בשעת וסת, וגם לפי הרבה רופאים יש לחוש שיגרום זה איזה מחלה מסוכנת ואף שלא מצוי כל כך יש למיחש.
Iggerot Moshe EH 4:34
It is possible for her to use the pills that also prevent pregnancy, but I did not mention this possibility—even though regarding this law of contraceptives it is preferable, for it does not block the uterus—because it causes many women to have some bleeding, and it is difficult for them to become tehorot with regard to their husbands, even though the pills prevent heavy bleeding even during menstruation, and for many women cause them not to bleed at all, nevertheless, there are woman for whom the pill causes bleeding on some day that is not her time of menstruation. And also, according to many doctors one should be concerned that this [pill] will cause some dangerous illness, and even though it is not so common, one should be concerned.
שו”ת ציץ אליעזר חלק ט סימן נא – קונ’ רפואה במשפחה שער ב
וכשהרצאתי הדבר לפני הרופאים….אמרו שכעת פחתו בהרבה החששות. אבל זה עוד לא מספיק עד שידעו בבירור שאין כל חשש בלקיחתם….שהכדורים פועלים לעקרות זמנית. ואם אמנם יבורר שישופרו עד שלא מזיקים כבר כלל, הרי הדרך הזאת למניעת הריון היא המובחרת ביותר, דאין כאן שום השחתת זרע וגם העקרות של האשה זמנית היא בלבד, ועוד זאת דאין כאן פעולת עקרות בידים. ויש לציין דאודות קיחת אמצעי לכך דרך הפה כבר נזכר גם בשו”ת מהר”ם בריסק ח”א סימן צ”ז. ובהגהת המו”ל [=המוציא לאור] מעיר שם דשתיית מעצצין [מעדעצין] או איניקטיאן [איניעקטיאן] הוי כעין כוס של עיקרין וכו’ ולכן הכא עדיף דלא נתעקרה רק שאינה מתעברת מתשמיש זה עיין שם.
Responsa Tzitz Eliezer 9 51 Treatise on Medicine and Family 2
When I raised the matter before physicians [that hormonal contraceptives could cause dangerous illness] …they said that the concerns have now been much reduced. But this is still not enough until they know clearly that there is no concern with taking them….For the pills act to temporarily render infertile. And if indeed it becomes clear that they improve to the point that they are no longer at all harmful, this method of contraception is the most preferred, for there is no hashchatat zera here whatsoever, and also the woman’s infertility is merely temporary, and furthermore there is no direct sterilizing act. And it should be noted that taking pills orally for this purpose is already mentioned in Responsa Maharam Brisk [1930s] (1:97). And in the publisher’s notes there he comments that drinking a medicine or [receiving] an injection is like a kos shel ikarin. And therefore, here it is preferable, for she does not become infertile, she just will not conceive from this act of relations, see there.
Intrauterine Devices
שו”ת ציץ אליעזר חלק י סימן כה פרק י
…שכהכדורים כן גם שימת הטבעת [IUD], אינה גורמת להפסדת זרע לא של הבעל ולא של האשה… באופן שאין חשש כלל לפן ואולי גורמים להשחתת הזרע של הבעל או של האשה.
Tzitz Eliezer 10 25:10
For like the pills, so is placing the IUD, it does not cause destruction of zera neither of the husband nor of the wife …In a way that there is no concern at all for the aspect of perhaps causing hashchatat zera of the husband or of the wife.
Choosing a Method
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
דעת רוב הפוסקים, שהגלולה היא הדרך העדיפה ביותר, בתנאי שיש היתר הלכתי עקרוני להשתמש באמצעי מניעה, ובתנאי שאין השימוש בגלולה גורם סכנה לאשה, ובתנאי שאין הגלולה גורמת לה דימום בין ווסתי. אם אי אפשר להשתמש בגלולה, דנו הפוסקים ביחסים שונים בין אמצעים אחרים: כיפה וקוטלי זרע – רוב הפוסקים סבורים, שקוטלי הזרע עדיפים; ויש הסבורים, שהכיפה עדיפה. יש מי שקבע את סדר העדיפויות הבא – גלולה, התקן תוך-רחמי, כיפה, עיקור האשה, כובעון באיש.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
…The opinion of most halachic authorities, that the pill is the most preferred method, on condition that there is a basic halachic permission to use contraceptives, and on condition that the use of a pill does not pose danger to the woman, and on condition that the pill does not cause her breakthrough bleeding. If it is not possible to use a pill, halachic authorities discussed different relationships between other methods: [between] a diaphragm and spermicide, most halachic authorities maintain that spermicide [alone] is better; there are those who maintain that the diaphragm is better. There are those who set up the following order of preference: pill, IUD, diaphragm, female sterilization [e.g., tubal ligation], a male condom.
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
התקן תוך-רחמי – לאור העובדה, שאמצעי מניעה זה איננו גורם להשחתת זרע במובן ההלכתי; הוא איננו מפריע כלל בקיום יחסי אישות ובהנאת הביאה, ועקב כך אינו מפריע לקיום מצות עונה; והוא זמני והפיך, ועקב כך אין בו איסור סירוס – אין מעיקר הדין איסור על האשה להשתמש בתכשיר זה.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
…The IUD, in light of the fact that this contraceptive method does not cause hashchatat zera in a halachic sense; it does not interfere at all with relations or with pleasure from them, and therefore does not interfere with fulfilling the mitzva of ona; and it is temporary and reversible, and therefore entails no prohibition of sirus—the fundamental halacha is that there is no prohibition on a woman’s using this device.
שו”ת שיח נחום צה, שימוש בגלולות למניעת הריון
לפענ”ד [=לפי עניות דעתי] יש מגרעת לגלולות לעומת הדיאפרגמה, והיא זו: הדיאפרגמה אינה מפריעה כלל לתהליכים הטבעיים של הגוף, הואיל והיא בעצם סותמת מבחוץ את פתח הרחם ומונעת כניסת הזרע, וממילא אין לה שום השפעה על המתרחש במערכת ההורמונלית של גוף האשה. לא כן הגלולות, פעולתן היא לשנות את המאזן ההורמונלי, ולכך ישנן תופעות לוואי…אמצעי המניעה המועדף הוא דיאפרגמה (- או אמצעים הדומים לה), אלא אם כן נדרש אמצעי אחר מחמת צורך רפואי או צורך נפשי מיוחד.
Responsa Siach Nahum 95, Use of Pills to Prevent Pregnancy
In my humble opinion, there is a disadvantage to pills as opposed to the diaphragm, and that is: The diaphragm does not interfere at all with the body’s natural processes, since it basically seals the cervix from the outside and prevents sperm from entering, and naturally it has no effect at all on what happens in the hormonal systems of a woman’s body. Not so the pills; their action is to change the hormonal balance and thus there are side effects…The preferred contraceptive is the diaphragm (or similar methods), unless a different method is needed due to medical need or a special emotional need.
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
העקרונות ההלכתיים לקביעת העדיפות בבחירת אמצעי מניעה במקום שהדבר מותר הם: השיטה חייבת להיות בטוחה ככל האפשר מסיכונים וסיבוכים רפואיים, ומתופעות לוואי, ובעיקר דימומים בין-ווסתיים. השיטה חייבת להיות יעילה ככל האפשר למניעת הריון…האמצעי צריך להיות רחוק ככל האפשר מהפרעה בקיום יחסי אישות טבעיים ורגילים, וצריך שלא יפריע בהנאת הביאה, כדי לקיים את מצות עונה כראוי…האמצעי צריך להיות רחוק ככל האפשר מהשחתה ישירה ופעילה של תאי הזרע, כדי למנוע איסור השחתת זרע. האמצעי צריך להיות זמני והפיך…כדי למנוע איסור סירוס.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
The halachic fundamentals in setting preferences in choosing a contraceptive method when the matter [contraception] is permissible are: The method must be as safe as possible from risks and medical complications, and from side effects, mainly from intermenstrual bleeding. The method must be as effective as possible as contraception…The method needs to be as far as possible from interference with having natural and regular marital relations, and must not interfere with the pleasure of intercourse, in order to fulfill the mitzva of ona [pleasurable relations at regular intervals] as is fitting….The method must be as far as possible from direct and active haschata of the sperm cells, in order to avoid hashchatat zera. The method must be temporary and reversible…in order to avoid the prohibition of sirus…
רבנית תרצה קלמן, תכנון משפחה ואמצעי מניעה, עמ’ 17, 23
…עקרונות היסוד של הפסיקה בנוגע לאמצעים השונים אינן נוגעות למקרה ספציפי דווקא. קיימות שיטות הלכתיות שונות ביחס לסדר העדיפות ההלכתי בין האמצעים השונים, וטוב יעשה זוג שיש להם סמכות הלכתית קבועה שהם מתייעצים איתה, אם יברר מהי שיטתה בעניין. בנוסף, חשוב לדעת שאף על פי שהעקרונות ההלכתיים כלליים וקבועים, מצב נקודתי של זוג מסוים עשוי לגרום לכך שביחס אליהם סדר העדיפויות יהיה שונה…אחרי שההכרעה ההלכתית הרפואית הזוגית והאישית היא שיש צורך במניעת הריון כרגע, יש לגשת לבירור מעשי על האפשרויות השונות ולבחור אמצעי מניעה מתאים. חשוב להבין שלכל אחד מהאמצעים יש יתרונות ויש חסרונות. אף אחד מהאמצעים אינו מושלם.
Rabbanit Tirza Kelman, Family Planning and Contraceptives, pp. 17, 23
…The fundamental principles of halachic rulings regarding the various methods [of contraception] don’t relate specifically to a particular case. There are different halachic approaches regarding the halachic order of preference, and a couple who have a halachic authority with whom they consistently consult will do well to clarify with them their position in this matter. Additionally, it is important to know that even though the halachic principles are fixed and generally applicable, a particular couple’s specific situation could cause the order of preference to be different for them…After the halachic, medical, couple’s, and personal determination is made that there is a need for contraception at the moment, one should enter into a practical clarification of the different possibilities and choose an appropriate contraceptive method. It is important to understand that every method has advantages and disadvantages. No method is perfect.
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
“How to Pick the Birth Control Method that’s Right for You.” Cleveland Clinic, February 10, 2022
In deciding what birth control method is right for you, ask yourself questions like: Do you think you want to have children someday? How soon? How effective is the birth control method you’re considering? How important is it that the method be very effective? How significant would an unplanned pregnancy be? Will you be able to use the birth control method correctly every time? Are there factors that might impact that ability? What are the potential side effects of the methods you’re considering? How would you feel if these side effects happened to you? What are your periods like, and are you looking for a method to help make them lighter or more regular? Is your partner willing to participate in preventing pregnancy by using condoms or considering a vasectomy (permanent contraception for men)? How often do you have sex, and how many partners do you have? How will you protect yourself from sexually transmitted infections? Do you have any health conditions that would impact the safety of certain forms of birth control? How much control do you prefer over your birth control method?
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
העקרונות ההלכתיים לקביעת העדיפות בבחירת אמצעי מניעה במקום שהדבר מותר הם: השיטה חייבת להיות בטוחה ככל האפשר מסיכונים וסיבוכים רפואיים, ומתופעות לוואי, ובעיקר דימומים בין-ווסתיים. השיטה חייבת להיות יעילה ככל האפשר למניעת הריון…האמצעי צריך להיות רחוק ככל האפשר מהפרעה בקיום יחסי אישות טבעיים ורגילים, וצריך שלא יפריע בהנאת הביאה, כדי לקיים את מצות עונה כראוי…האמצעי צריך להיות רחוק ככל האפשר מהשחתה ישירה ופעילה של תאי הזרע, כדי למנוע איסור השחתת זרע. האמצעי צריך להיות זמני והפיך…כדי למנוע איסור סירוס.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
The halachic fundamentals in setting preferences in choosing a contraceptive method when the matter [contraception] is permissible are: The method must be as safe as possible from risks and medical complications, and from side effects, mainly from intermenstrual bleeding. The method must be as effective as possible as contraception…The method needs to be as far as possible from interference with having natural and regular marital relations, and must not interfere with the pleasure of intercourse, in order to fulfill the mitzva of ona [pleasurable relations at regular intervals] as is fitting….The method must be as far as possible from direct and active hashchata of the sperm cells, in order to avoid hashchatat zera. The method must be temporary and reversible…in order to avoid the prohibition of sirus…
Yehuda Sabiner, MD, Misgav Rottenstreich, MD, Sorina Grisaru-Granovsky, MD PhD, Daniel S. Seidman, MD, “Use of Contraception among Ultra-Orthodox Jews: A Matched Case-Control Study” Fertility and Sterility, 2020, Vol, 114, issue 3.
Of the ultra-Orthodox women, 57.5% reported ever using birth control compared to 86.0% of the secular women (p<0.001). The majority, 83.1%, of ultra-Orthodox women reported requesting religious guidance before using contraception. Among ultra-Orthodox women, reporting previous contraceptive use, the most common birth control methods were oral contraceptive pills by 81.5%, IUDs by 27.1% and spermicides by 36.9% versus 78.2%, 15.9% and 2.8%, respectively, among matched secular women.
Preethy D’Souza, Julia V. Bailey, Judith Stephenson and Sandy Oliver “Factors influencing contraception choice and use globally: a synthesis of systematic reviews” (2022), The European Journal of Contraception & Reproductive Health Care
Factors affecting contraception use are remarkably similar among women in very different cultures and settings globally. Use of contraception is influenced by the perceived likelihood and appeal of pregnancy, and relationship status. It is influenced by women’s knowledge, beliefs, and perceptions of side effects and health risks. Male partners have a strong influence, as do peers’ views and experiences, and families’ expectations. Lack of education and poverty is linked with low contraception use, and social and cultural norms influence contraception and expectations of family size and timing. Contraception use also depends upon their availability, the accessibility, confidentiality and costs of health services, and attitudes, behaviour and skills of health practitioners…. There are links between religion and contraception use globally, which vary by religious background, affiliation or denomination of men or women, and of health care providers; personal beliefs and strength of belief or strictness of doctrine; degree of involvement in religious events; and the influence of religious leaders.
הרבנית תרצה קלמן, תכנון משפחה ומניעת הריון, עמ’ 12-11
הנושא של מבנה המשפחה ומניעת הריון משפיע מאד על חייהן של נשים בגיל הפוריות אך השיח הציבורי לגביו מצומצם. הזמן המוגבל שיש לרופאות הנשים במפגש עם נשים, וחוסר היכרות עם מרחב האפשרויות מצמצמים מאד את השליטה שיש לנשים על התהליך ועל הבנת משמעות ההחלטות שלהן…והמידע [הרפואי וההלכתי] עשוי לתרום תרומה משמעותית לקבלת החלטה שתתבסס על הבנת המצב ההלכתי והפיזיולוגי באופן רחב יותר.
Rabbanit Tirza Kelman, Family Planning and Contraception, pp. 11-12
The topic of family structure and contraception greatly affects the lives of women in their fertile years, but communal discussion of it is limited. The limited time that gynecologists have to meet with a woman, and a lack of familiarity with the range of possibilities, really narrow women’s control over the process and over understanding the significance of their decisions…[Medical and halachic] knowledge should contribute significantly to making a decision that will be based on understanding the halachic and physiological situation more comprehensively.
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Hashkafic Q&A
How can Halacha determine what contraceptive method to use, when this such a personal decision?
Navigating contraceptive choice is often difficult, as a couple must consider and contemplate a range of relevant factors. This is true for all couples, not only halachically observant Jews. For example:20
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
“How to Pick the Birth Control Method that’s Right for You.” Cleveland Clinic, February 10, 2022
In deciding what birth control method is right for you, ask yourself questions like: Do you think you want to have children someday? How soon? How effective is the birth control method you’re considering? How important is it that the method be very effective? How significant would an unplanned pregnancy be? Will you be able to use the birth control method correctly every time? Are there factors that might impact that ability? What are the potential side effects of the methods you’re considering? How would you feel if these side effects happened to you? What are your periods like, and are you looking for a method to help make them lighter or more regular? Is your partner willing to participate in preventing pregnancy by using condoms or considering a vasectomy (permanent contraception for men)? How often do you have sex, and how many partners do you have? How will you protect yourself from sexually transmitted infections? Do you have any health conditions that would impact the safety of certain forms of birth control? How much control do you prefer over your birth control method?
A halachically observant couple has an overlapping but somewhat different list of questions to consider. This becomes apparent when comparing the above list to the passage by Rabbi Dr. Avraham Steinberg (cited above) about choosing a method:
רב ד”ר אברהם שטינברג, מניעת הריון, אנציקלופדיה רפואית הלכתית ד, תשס”ו
העקרונות ההלכתיים לקביעת העדיפות בבחירת אמצעי מניעה במקום שהדבר מותר הם: השיטה חייבת להיות בטוחה ככל האפשר מסיכונים וסיבוכים רפואיים, ומתופעות לוואי, ובעיקר דימומים בין-ווסתיים. השיטה חייבת להיות יעילה ככל האפשר למניעת הריון…האמצעי צריך להיות רחוק ככל האפשר מהפרעה בקיום יחסי אישות טבעיים ורגילים, וצריך שלא יפריע בהנאת הביאה, כדי לקיים את מצות עונה כראוי…האמצעי צריך להיות רחוק ככל האפשר מהשחתה ישירה ופעילה של תאי הזרע, כדי למנוע איסור השחתת זרע. האמצעי צריך להיות זמני והפיך…כדי למנוע איסור סירוס.
Rav Dr. Avraham Steinberg, Contraception, Encyclopedia of Medical Halacha, 2006
The halachic fundamentals in setting preferences in choosing a contraceptive method when the matter [contraception] is permissible are: The method must be as safe as possible from risks and medical complications, and from side effects, mainly from intermenstrual bleeding. The method must be as effective as possible as contraception…The method needs to be as far as possible from interference with having natural and regular marital relations, and must not interfere with the pleasure of intercourse, in order to fulfill the mitzva of ona [pleasurable relations at regular intervals] as is fitting….The method must be as far as possible from direct and active hashchata of the sperm cells, in order to avoid hashchatat zera. The method must be temporary and reversible…in order to avoid the prohibition of sirus…
As represented here, both the medical establishment and the halachic tradition prioritize contraceptive safety and efficacy and a careful consideration of side effects.
Some of the differences between the lists simply reflect different cultural norms. For example, items on the first list—especially those oriented to multiple sexual partners, sexually transmitted infections, and questions about having a family at all—are typically less relevant to halachically observant women considering contraception, who are predominantly married (or about to be) and interested in having families with children.
A couple of the differences, however, are more significant: limiting use of specific contraceptive methods and prioritizing Halacha over personal preference.
Halacha limits the choice of some contraceptive methods. A halachically observant couple are unlikely to consider vasectomy as a contraceptive option, since it is considered a clear violation of the prohibition of sirus. Condoms are also usually not seen as an option, since they are only rarely halachically permitted, due to the prohibition of hashchatat zera. Halachic perspectives on hashchatat zera and use of a diaphragm vary widely, and whether a couple even considers it may depend on the view that they follow.
Tubal ligation raises halachic concerns of sirus, albeit to a lesser degree than vasectomy. While many halachic authorities permit tubal ligation when other contraceptives cannot meet a couple’s medical and psychological needs, this still pushes couples who might otherwise prefer tubal ligation to turn to other methods.
A study from 2020 that compares the use of varying contraceptive methods among Charedi and secular Israeli women exemplifies how this may work out in practice,:21
Yehuda Sabiner, MD, Misgav Rottenstreich, MD, Sorina Grisaru-Granovsky, MD PhD, Daniel S. Seidman, MD, “Use of Contraception among Ultra-Orthodox Jews: A Matched Case-Control Study” Fertility and Sterility, 2020, Vol, 114, issue 3.
Of the ultra-Orthodox women, 57.5% reported ever using birth control compared to 86.0% of the secular women (p<0.001). The majority, 83.1%, of ultra-Orthodox women reported requesting religious guidance before using contraception. Among ultra-Orthodox women, reporting previous contraceptive use, the most common birth control methods were oral contraceptive pills by 81.5%, IUDs by 27.1% and spermicides by 36.9% versus 78.2%, 15.9% and 2.8%, respectively, among matched secular women.
Much of the variance between the communities seems to correlate with the halachic preferences that we’ve discussed. Charedim reported higher levels of IUD use, and dramatically higher levels of spermicide use. Even so, among contraceptive users from both populations under study, levels of use of oral contraceptives were quite similar and oral contraceptives and IUD’s were the most popular contraceptive choices.
In other words, Halacha favors two of the long-term contraceptive methods that secular women in Israel seem to favor as well. The tension between Halacha and personal contraceptive choice may thus be most keenly felt in the long term by couples who would, left to their own devices, prefer a method that Halacha does not favor, which brings us to the second major difference between the lists.
The medical list puts more weight than Rabbi Dr. Steinberg’s on individual habits or preferences. In contrast, the halachic presentation assumes that a personal preference unrooted in medical concerns will be considered only after halachic permissibility has been taken into account. This assumption is typical of halachic discourse, though it may seem more jarring in this highly personal context.
Additional recent research may help put this into some perspective:22
Preethy D’Souza, Julia V. Bailey, Judith Stephenson and Sandy Oliver “Factors influencing contraception choice and use globally: a synthesis of systematic reviews” (2022), The European Journal of Contraception & Reproductive Health Care
Factors affecting contraception use are remarkably similar among women in very different cultures and settings globally. Use of contraception is influenced by the perceived likelihood and appeal of pregnancy, and relationship status. It is influenced by women’s knowledge, beliefs, and perceptions of side effects and health risks. Male partners have a strong influence, as do peers’ views and experiences, and families’ expectations. Lack of education and poverty is linked with low contraception use, and social and cultural norms influence contraception and expectations of family size and timing. Contraception use also depends upon their availability, the accessibility, confidentiality and costs of health services, and attitudes, behaviour and skills of health practitioners…. There are links between religion and contraception use globally, which vary by religious background, affiliation or denomination of men or women, and of health care providers; personal beliefs and strength of belief or strictness of doctrine; degree of involvement in religious events; and the influence of religious leaders.
In and out of the Jewish community, it seems to be the case that a variety of personal, societal, and religious factors often limit a couple’s real contraceptive choices.
With the awareness that religious leaders play an important role in shaping these factors within our communities, and that more limited choices and autonomy can be challenging, Rabbanit Tirza Kelman addresses the importance of ensuring that our communal discourse be well informed:
הרבנית תרצה קלמן, תכנון משפחה ומניעת הריון, עמ’ 12-11
הנושא של מבנה המשפחה ומניעת הריון משפיע מאד על חייהן של נשים בגיל הפוריות אך השיח הציבורי לגביו מצומצם. הזמן המוגבל שיש לרופאות הנשים במפגש עם נשים, וחוסר היכרות עם מרחב האפשרויות מצמצמים מאד את השליטה שיש לנשים על התהליך ועל הבנת משמעות ההחלטות שלהן…והמידע [הרפואי וההלכתי] עשוי לתרום תרומה משמעותית לקבלת החלטה שתתבסס על הבנת המצב ההלכתי והפיזיולוגי באופן רחב יותר.
Rabbanit Tirza Kelman, Family Planning and Contraception, pp. 11-12
The topic of family structure and contraception greatly affects the lives of women in their fertile years, but communal discussion of it is limited. The limited time that gynecologists have to meet with a woman, and a lack of familiarity with the range of possibilities, really narrow women’s control over the process and over understanding the significance of their decisions…[Medical and halachic] knowledge should contribute significantly to making a decision that will be based on understanding the halachic and physiological situation more comprehensively.
Halachic guidance, when provided well, can sometimes expand a couple’s awareness of contraceptive options–or perhaps even expand what options are available. For example, diaphragms and healthcare professionals qualified to fit them are currently easier to find in Israel than in many areas in the United States. It is likely that demand from religious couples plays a role. (Religious populations, especially Catholics, have also contributed to the development of the Fertility Awareness Method.)
Regardless of the specific community to which they belong, a couple should be able to learn about the full range of contraceptive methods and halachic perspectives on them. Even when a contraceptive decision will be shaped through consultation with a halachic authority, going into a consultation with more knowledge can facilitate a couple maximizing their choices and exercise of autonomy within the framework of Halacha.
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