Pope Francis, contraception, and Zika: why epidemiology can never trump tradition

Share

MosquitoThe Zika virus is fuelling an international effort to limit Brazil’s fertility. Writing from a Roman Catholic perspective, Dr Gerard M Nadal here analyses Pope Francis’s recent in-flight pronouncements on the matter.


Even the dimmest wit in the Society of Jesus can make his thoughts plainly understood. So it must be that Pope Francis knew what he was saying when he broke with 2,000 years of sacred Tradition and magisterial teaching this week when he alluded to Paul VI permitting nuns being raped in Africa to use contraception to avoid pregnancy, and used that as the moral grounds on which to permit the use of contraception in the midst of the Zika virus outbreak. In his own words, as reported by the Associated Press:

Abortion is an evil in and of itself, but it is not a religious evil at its root, no? It’s a human evil. On the other hand, avoiding pregnancy is not an absolute evil. In certain cases, as in this one (Zika), such as the one I mentioned of Blessed Paul VI, it was clear.

So, avoiding pregnancy amidst the Zika outbreak is not an absolute evil? Enter proportionalism.

To be clear, he linked the use of contraceptives then to the situation he is addressing now.

Before proceeding with the moral nightmare this introduces, it is best to consider some infectious disease epidemiology and how Francis’ proportionalism betrays not only his duty to uphold all that his predecessors have taught, but also betrays a stunning ignorance of infectious diseases compounded by hemispheric blinders.

It has been reported that only 4% of Brazil’s current microcephaly cases are attributable to Zika. 17 out of 404 as of last week. And for that a Pope is willing to flush Humanae Vitae. Pia de Solenni did a masterful job at outlining the epidemiology of this outbreak, and the reader is advised to get it all here.

With Zika affecting the hemisphere from which this pope comes, and with which he has exclusively focussed his priestly life, Francis is missing some more pressing global numbers in maternal infectious disease and resulting rates of infant mobidity and mortality. There is so much more fertile ground for justifying contraception. Consider HIV/AIDS and some statistics from WHO.

Globally there are 36.9 million people living with HIV/AIDS. Of these, 2.6 million are children who contracted the virus from their mothers in utero, or through breastfeeding. Without any treatment, roughly 30-40% of pregnancies result in vertical transmission (mother to child) of HIV. With antiretroviral monotherapy, these rates can be cut in half. With combination antiretroviral therapy, the rates are cut to 2%.

So consider if 10 million women with HIV all get pregnant, and if they all have access to combination antiretroviral therapy, there would still be 200,000 babies born with HIV. Is the new teaching from the First Class Chair of Peter aboard the papal plane sufficiently broad to suggest a duty by HIV positive women to not reproduce?

Then there is the even broader health concern of global malaria. Roughly 50% of the world’s population are exposed to malaria, especially in Africa. According to WHO:

Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. Malaria-associated maternal illness and low birth weight is mostly the result of Plasmodium falciparum infection and occurs predominantly in Africa.

And in the WHO 2015 Fact Sheet on malaria:

According to the latest estimates from WHO, there were 214 million new cases of malaria worldwide in 2015 (range 149–303 million). The African Region accounted for most global cases of malaria (88%), followed by the South-East Asia Region (10%) and the Eastern Mediterranean Region (2%).

In 2015, there were an estimated 438 000 malaria deaths (range 236 000–635 000) worldwide. Most of these deaths occurred in the African Region (90%), followed by the South-East Asia Region (7%) and the Eastern Mediterranean Region (2%) …

Children under five are particularly susceptible to malaria illness, infection and death. In 2015, malaria killed an estimated 306 000 under-fives globally, including 292 000 children in the African Region. Between 2000 and 2015, the mortality rate among children under five fell by 65% worldwide and by 71% in Africa.

In the document, WHO goes on to discuss treatment and the issues of malaria in pregnancy:

Artemisinin-based combination therapies (ACTs) are highly effective against P. falciparum, the most prevalent and lethal malaria parasite affecting humans. Globally, the number of ACT treatment courses procured from manufacturers increased from 11 million in 2005 to 337 million in 2014. The African Region accounted for most (98%) manufacturer deliveries of ACTs in 2014.

Malaria infection during pregnancy carries substantial risks for the mother, her fetus and the newborn child. In Africa, the proportion of women who receive intermittent preventive treatment in pregnancy (IPTp) for malaria has been increasing over time, but levels remain below national targets. In 2014, an estimated 15 million of the 28 million pregnant women at risk of malaria did not receive a single dose of IPTp.

To their credit, and unlike Francis, there is no mention of preventing the transmission of life as a solution to endemic disease.

Were time to permit, one could detail all of the tropical diseases, among others, and the effects on fetuses and neonates. 1/3 of the world’s population is infected with TB. Cholera strikes millions, etc …

Is the prevention of life itself in a disease outbreak with 4% infant morbidity really the best Pope Francis can do? Where is his exhortation for governments to come to grips with the fact that all of Rachel Carson’s Silent Spring hysteria about DDT has been disproven by science over the past 50 years? Where is the exhortation to curb the mosquito populations spreading so many horrendous diseases? Where is the voice of a pope to his environmentalist friends to meet him half way and abandon their anti-human life agenda?

For all of his stated love of the poor, Francis has invited International Planned Parenthood and Marie Stopes to a blood meal on the very poor whose dignity he portends to uphold. By invoking Paul VI and the Congo episode with artificial contraception, he ignored NFP and the volumes written by his predecessors.

To permit artificial contraception for Zika is to have sold the family farm, to permit it for all developing nations where endemic disease is present.

Public health doesn’t involve nonexistence. Public health concerns itself with preventing and curing disease. It is clear that the Holy Father doesn’t grasp this essential truth that I learned in training as a medical microbiologist. Public Health officers cannot morally and ethically resort to killing patients or preventing human reproduction as a legitimate means of addressing crises.

The same holds true for popes.

Francis should stick to matters concerning his Holy Office, and in all humility allow himself to be guided by the unchanging wisdom of 2,000 years of magisterial teaching.

He. Is. Peter.

He should start behaving as such.


This article first appeared here.

Leave a Reply

Your email address will not be published. Required fields are marked *

*