Abstract: When contraception is halachically permitted, the choice of a method needs to be made on a case by case basis based on medical and halachic considerations. Halachic concerns with preventing the progression of sperm to the uterus prohibit the use of condoms and make the use of the diaphragm a matter of debate. Most authorities prefer the use of hormonal contraception unless it is medically contraindicated or has led to an unmanageable amount of unanticipated bleeding. The IUDis permitted by most authorities but some still hesitate to allow it.
Discussion: Once delaying pregnancy has been permitted in a given situation, the question of selecting a method is addressed. Observant couples may consult with a rabbi about which methods are permissible for them. Halachic rulings will vary based on the couple's individual circumstances and on the rabbi's particular approach. This article outlines the basic principles taken into account when issuing a halachic ruling.
First of all, the method should be reversible. Sterilization is never permitted for men and only rarely for women.
The next concern is hotza'at zera levatalah, translated as wasting seed. Priority is given to the method that least interferes with the normal course of marital relations and with progression of the semen through the vaginal canal to the cervix. Once contraception is permitted, natural methods such as the lactational amenorrhea method (LAM) or fertility awareness method (FAM) raise no issues of hotza'at zera levatalah. Among those methods that involve external intervention, hormonal methods are generally the first choice. Second choice is usually the IUD, and third choice is the diaphragm. The ranking of spermicide alone (which has limited efficacy ) is a matter of rabbinic debate. Condoms, whether male or female, are a clear violation of the prohibition of wasting seed and would only be permitted in very rare circumstances.
The articles in this section review halachic evaluations of particular methods. The less halachically controversial a given method, the wider the range of cases in which rabbis will permit it. The more controversial the method, the more important the role of specific medical indications for its use. These evaluations are provided to assist the physician in understanding the concerns of his or her patients.
Couples seeking contraception will also be concerned with the amount of spotting and bleeding that might be caused by the method. (Please see Introduction to the Laws of Niddah for a discussion of the implications of spotting and bleeding.) A method that leads to significant or frequent staining will limit or prevent marital relations to an unacceptable degree.
Implications for Patient Care: Halachic as well as medical considerations need to be taken into account in deciding the optimal method of contraception for the halacha observant couple who requires pregnancy prevention.
The physician should ensure that the couple is fully aware of any medical issues involved in the choice of contraceptive method for a particular woman. Sometimes, direct discussion with the couple's rabbi or a written summary may be of assistance.
 Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011
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