On this 50th anniversary of Pope Paul VI’s historic encyclical, Humanae Vitae, Religion Dispatches reaches into the archive to bring you the surprising story of its controversial conclusions on birth control, originally published in 2014. 

Years later, when the remembrance of so many other things had faded, the memory still remained crisp in her mind. She saw herself lying in the hospital bed, bleeding, writhing in agony. She remembered clawing at the curtain surrounding the bed, trying get help, certain she was going to die. Finally she managed to cry out, “God dammit, I can’t die. I have five children.”

Her cries roused her roommate, who summoned a doctor. The doctor managed to staunch the bleeding from the hematoma that had resulted from the birth of her fifth child. It was not an unexpected complication. She had hemorrhaged after giving birth to her fourth child. The doctors had warned her against any more pregnancies, but she was a devout Catholic and the church said that using birth control was a sin. So another pregnancy had followed quickly on the heels of the last, and a little over a year later she was again in danger of dying and leaving her children motherless. As she lay helpless on her bed, Jane Furlong-Cahill made a decision.”I decided that the pope can have all the kids he wanted. I was through,” she said.

After that she used the Pill, which had only just become available, and eventually she got a tubal ligation to permanently end her childbearing ability. It was a controversial choice for a Catholic woman in 1964, but especially so for Cahill, who was one of the first women formally trained in Roman Catholic theology and knew that the church made no exception to its teaching that Catholics could never use artificial methods of contraception. The only acceptable form of birth control for Catholics, both then and now, is natural family planning, which relies on calculating a women’s infertile period during her menstrual cycle and only having sex on those days. The “rhythm method,” as natural family planning was called in the early 1960s, was notoriously unreliable, however, which made it a poor option for women like Cahill who really, really didn’t want another child.

The Catholic Church’s absolute ban on modern methods of contraception is inextricably linked to its views on sex and marriage. The church fathers who laid out the founding doctrine of the religion were always squeamish about the idea of sexual intercourse; they considered chastity a holier state. But at the same time, they recognized that it was neither possible nor practical to suggest that most people abstain from sex. Corralling sex within marriage was better than unbridled fornication. Hence, it was “better to marry than to burn with passion,” according to the apostle Paul.

But even within marriage, the Christian fathers’ acceptance of sex was grudging. Influenced by the Stoics, they looked to nature to determine the purpose and moral limits of bodily functions like sex. Therefore, sex within marriage was only moral if it was used for its “natural” purpose of procreation. They taught that Christians were not to have sex for pleasure or when pregnancy was impossible, such as when a woman was already pregnant. The belief that procreation sanctified sex automatically excluded the possibility of using withdrawal, contraceptive potions, or crude devices—all of which were common and widely used in the early Christian world to frustrate conception.

The first formal theological condemnation of contraception was made by St. Augustine in the early 400s, when he declared that it is “a procreative purpose which makes good an act in which lust is present,” and that married people who contracept “are not married.” It was a proclamation that would guide Catholic thinking about contraception for the next 1,500 years as the Augustinian doctrine was gradually codified by the church.

In 590, Pope Gregory the Great decreed that married couples who mixed pleasure with procreation in sexual intercourse “transgressed the law.” The first church legislation forbidding contraception appeared in the 600s in a canon that specified a penance of ten years for any woman who took “steps so that she may not conceive.” The church’s reaction to the distinctly non-procreative ethic of courtly love in medieval Europe and Catharism, a Christian sect that rejected the Catholic sacraments, including marriage, further hardened its insistence on the procreative purpose of sex. By 1400, Augustine’s doctrine on contraception was the rule within the church.

Despite its longevity, Cahill wasn’t the only Catholic woman questioning the teaching on birth control. In 1964, another budding theologian named Rosemary Radford Ruether published an article entitled “A Catholic Mother Tells: Why I Believe in Birth Control” in the Saturday Evening Post, bringing the issue straight into the living rooms of Main Street America.

Ruether took the church to task for failing to acknowledge that in modern marriages couples didn’t have sex just for the purpose of having children. She also revealed what many Catholic couples were saying privately: the rhythm method not only didn’t work, but put extraordinary strain on otherwise happy marriages. “A man and a wife may follow all the current methods for predicting the time of ovulation, they may be armed with an arsenal of slide rules, thermometers, glucose tests, they may abstain for the proscribed period with dogged perseverance, and they may still find that the method has failed. The rhythm method keeps couples in a constant state of tension and insecurity,” she wrote.

Ruether, who was just embarking on a promising career as a theologian and already had three young children, wrote of her own failure with the method and the desperation of other women who found themselves pregnant when they didn’t want to be, including a friend who was in despair after finding herself pregnant for the sixth time in seven years. Like many women of her day, Ruether realized that controlling her fertility with a fairly high degree of certainty was essential to her ability to steer her own life. “I see very clearly that I cannot entrust my destiny just to biological chance. As a woman who is trying to create a happy balance of work and family, I know effective family planning is essential. A woman who cannot control her own fertility, who must remain vulnerable to chance conception, is a woman who cannot hope to be much more than a baby-machine,” she wrote.

Cahill and Ruether were not alone in concluding that the church’s dictum on contraception was an anachronism. Catholic theologians and bishops were also suggesting it was time to revisit the teaching. Two developments spurred their willingness to question the ban. One was a change in how the church viewed the purpose of marital sex. The church had held since Augustine’s time that the primary purpose of sex within marriage was procreation. But gradually a more positive view of sex crept in that allowed that pleasure and the expression of conjugal love could be part of the equation. In 1951, Pope Pius XII formally admitted that it was okay for married couples to enjoy sex: “In seeking and enjoying this pleasure, therefore, couples do nothing wrong.”

The church’s view of marriage was evolving in tandem. Increasingly it viewed marriage as having two ends: procreation and the “ontological completion of the person” within the union of marriage. This meant that many of the old prohibitions against “sterile” sex within marriage—that is, sex that could not produce offspring—such as sex during pregnancy, no longer held. If some limited forms of non-procreative sex within marriage were now considered licit and sex was acknowledged to have more than one purpose in marriage, this raised the question of whether in general each and every act of intercourse within marriage necessarily had to be procreative.

The second reason many theologians believed that the church could approve modern contraceptives was because it had already approved the idea of family planning when it approved the rhythm method. As Ruether noted in her Saturday Evening Post article, the church’s distinction between “natural” family planning and contraceptives was “theologically meaningless.”

The church’s incongruence on the issue of family planning dated back to 1930 and the papal encyclical Casti Connubi (On Christian Marriage), which was written to address the growing acceptance of birth control throughout the Western world. The tipping point was reached in 1930, when the Anglican Church officially approved the use of birth control by married couples. Other Protestant denominations soon followed, signaling that contraceptives had gained moral and social legitimacy. The Catholic Church had to respond. On the very last day of 1930, Pope Pius XI issued Casti connubii, in which he firmly restated the absolute Augustinian prohibition on contraception and denounced the idea that the primary purpose of marriage was anything other than producing and raising children. He condemned contraception as “base and intrinsically indecent” and said that it “violates the law of God and nature, and those who do such a thing are stained by a grave and mortal flaw.”

The encyclical was read to ban all known forms of contraception: withdrawal, the use of condoms or diaphragms, douching after intercourse, and folk contraceptive potions. However, the pope appeared to give approval to a birth control method that had been rattling around since the ancient Greeks but had seen a spike in interest since the discovery of female ovulation in the mid-1800s: timing sexual intercourse to coincide with a woman’s naturally occurring sterile period. The method had limited practical application at the time because science had yet to figure out exactly when during the menstrual cycle women ovulated.

But all that changed in the early 1930s when scientists finally determined when ovulation typically occurred, allowing for the development of the rhythm method. It was far from perfect, but it did offer a way to at least slow the growth of a family without resorting to contraceptives. The Vatican earlier had indicated preliminary acceptance of rhythm, but growing interest in the method elevated the question of whether it was acceptable under Catholic doctrine to a pressing theological concern.

The question was not definitively answered until 1951 by Pope Pius XI’s successor, Pius XII. In an address to the Italian Catholic Society of Midwives, he declared that the “observance of the sterile period can be licit” if done for serious reasons. He said, however, that serious indications for limiting births included “medical, eugenic, economic, and social” reasons, which went far beyond the reasons traditionally accepted by even the most liberal of Catholic theologians for refraining from sex to limit family size: extreme poverty or a serious threat to the woman’s health. In doing so he gave the Catholic Church’s stamp of approval to the idea of couples purposely manipulating the size of their family for the sake of the family’s overall well-being.

So by 1960 the church had made three key admissions: that sexual intercourse within marriage played a role that was not limited to procreation; that it was acceptable to limit family size for a number of reasons; and that it was licit to use the naturally occurring sterile period to do so. Enter Catholic physician John Rock. By designing a contraceptive that used hormones already present in a woman’s body to mimic the natural infertility of a pregnant woman, he hoped the Vatican would find a theological basis to approve the method.

In 1958, when the Pill was already being tested on human populations, Pius XII said its use would be acceptable “as a necessary remedy because of a disease of the uterus or the organism” even if it had the secondary effect of causing sterility. This meant women could use the Pill to treat painful periods or excessive bleeding, which became a popular early theological work-around for Catholic women who wanted to use it.

Theologians also speculated that the Pill could be used to regulate irregular menstrual periods to make the rhythm method work more effectively. Of course, that raised the question why not just permit the use of the Pill?

The debate over contraception emerged as the major issue facing the Catholic Church. Popular publications wrote about the “Catholic Revolution” and the “Growing Unrest in the Catholic Church” as the controversy became the subject of widespread discussion. In 1963, Pope John XXIII, who had succeeded Pius XII, appointed a commission that would eventually comprise fifty-five members, including five married Catholic women, theologians, priests, and physicians, to study the question of whether the church’s teaching on artificial contraception should be changed. There is some indication that he created the commission as a way to isolate the incendiary issue of birth control from the Vatican II proceedings, which were already dealing with a number of controversial doctrinal issues, and had no real intention of changing the policy on birth control.

Originally there were no lay members on the commission, but when they were added they were all married Catholic couples drawn from conservative Catholic family organizations who could be expected to mirror the hierarchy’s position on contraception. The commission studied Catholic teachings on contraception and marriage and heard from its lay members on the realities of using the rhythm method. Contrary to the assertions of the hierarchy that the rhythm method, with its continual obsession with fertile periods and the timing of sexual intercourse, was a way to bring couples closer together and strengthen marriages, they heard that it stressed marriages and drove couples apart.

They also heard from the women on the commission about the importance of sex in marriage beyond procreation and the burdens of repeated or poorly timed pregnancies. After a series of hearings, the commission voted overwhelmingly to recommend that the ban against artificial means of birth control be lifted. After all, the church had accepted the idea of birth control, so why not give couples a better way to practice it if it would strengthen marriages and families?

Unhappy with the direction of the commission, the Vatican packed the last commission meetings with fifteen bishops to formulate the final recommendation to the pope. But even the bishops voted nine to three (three abstained from voting) to change the teaching, concluding that the popes’ previous teaching on birth control were not infallible and that the traditional theological basis for the prohibition of contraception was invalid. They declared that responsible parenthood was an essential part of modern marriage and that the morality of sexual acts between married couples was not dependent “upon the direct fecundity of each and every particular act” but must be viewed within the totality of the marriage relationship.

Despite the commission’s years of work and theologically unassailable conclusion that the church’s teaching on birth control was neither infallible nor irreversible, Pope Paul VI stunned the world on July 29, 1968, when he reaffirmed the church’s ban on modern contraceptives in Humanae Vitae (Of Human Life). He declared that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life.”

The pope had deferred to a dissenting minority report prepared by four conservative theologian priests on the commission that maintained contraception was a “sin against nature” and a “shameful and intrinsically vicious act.” These theologians said that church could not change its teaching on birth control because admitting the church had been wrong about the issue for centuries would raise questions about the moral authority of the pope, especially on matters of sexuality, and the belief that the Holy Spirit guided his pronouncements. “The Church cannot change her answer because this answer is true because the Catholic Church, instituted by Christ could not have so wrongly erred during all those centuries of its history,” they wrote.

As one of the conservative theologians famously asked one of the female members of the commission, what would happen to “the millions we have sent to hell” for using contraception if the teaching were suddenly changed?

But another reason lurked behind the official explanation about why the teaching could not be changed: maintaining the link between sex and procreation was essential to the maintenance of the traditional, subordinate role of women. Maintaining the traditional family, in which men were leaders in the world outside the home and women were confined to the domestic realm by the demands of young children and repeated pregnancies, was a key concern of the Catholic Church. In the mid-1950s the Catholic bishops made headlines when they condemned married working mothers for deserting their children and helping to destroy the home. Allowing women to regulate their fertility was dangerous to what the church considered the natural order of things: women as receptors of God’s will as expressed through the acceptance of pregnancy.

Stanislas De Lestapis, a Jesuit sociologist who was one of the four authors of the minority report, first warned against what he termed the “contraceptive mentality” a couple of years earlier in his 1961 book, Family Planning. He said allowing women the freedom to regulate when they got pregnant would lead to a decline in women’s maternal instinct and a hostility toward children, increased female promiscuity, and “confusion between the sexes.”

Humanae Vitae came as a shock to Catholics, who had seen other aspects of the church—like the Latin mass and the teaching that Catholicism was the only road to salvation—change as a result of Vatican II and widely expected the contraception ban to be lifted. It seemed that the church was perfectly willing to evolve doctrine—except when it affected women.

The day following the encyclical’s release, eighty-seven leading Catholic theologians released a statement condemning it, saying it relied on outmoded conceptions of papal authority and natural law. They said the encyclical was not infallible and, because it was “common teaching in the Church that Catholics may dissent from authoritative teachings of the magisterium when sufficient reasons for doing so exist,” Catholics couples may “reasonably decide according to their conscience that artificial contraception in some circumstances is permissible.”

The outcry over Humanae Vitae only further reinforced the belief of Catholic feminists that the church’s teaching regarding sexuality had little to do with theology. To Ruether and Cahill it was just one more piece of evidence that nothing would change in the church unless women made their voices heard. Eventually these pioneering women would bring their work to bear in an area that no one in the church was talking about: abortion.