بسم الله الرحمن الرحيم
Question:
Assalamu Alaikum Wa Rahmatullah Wa Barakatuhu
Our respected Sheikh, I have a medical question that is in need of a very urgent reply, I am a doctor working in a Gynecology Obstetrics Hospital in which Cesarean section operations are performed if it is necessary for the woman, as well as if the life of the fetus or her life were at risk.
There are some pregnant women who suffer from illnesses that make pregnancy difficult for them, and experience a very difficult circumstances, compelling them to not to get pregnant or to space between childbearing periods of at least 3-4 years, so she is forced to use contraception methods. But for some women, the contraception methods do not work with them for the required spacing, which threatens her life because she is exposed to performing many closely-spaced Cesarean sections. Some women suffer from cartilage in the vertebrae, and others incur severe hemorrhage, hence doctors resort to sealing the fallopian tubes permanently so that she no longer bear children if she already has children, so it has become common that women come to the hospital and ask for their fallopian tubes to be sealed claiming that she cannot become pregnant and that she cannot use contraception methods, asking for the closing of her fallopian tubes permanently while her age does not exceed 36 years of age, and others are 32 years of age. So she insists on the doctor to perform for her a Cesarean Section to tie (ligate) her fallopian tubes permanently.
Question: What is the Sharí rule upon this doctor who is following the case of a woman during her pregnancy stages, and sees that pregnancy is difficult for her and that it is necessary for her to perform the operation of permanently sealing her fallopian tubes? And what is the ruling upon the doctor who only follows the woman's statements without further investigation whether her statements are precise?
Answer:
Wa Alaikum Assalam Wa Rahmatullahi Wa Barakatuhu,
Temporary contraception is allowed according to the well-known evidences related to Al-Ázl (Coitus Interruptus/withdrawal)...
As for permanent contraception and the causing of infertility, it is Haram. Using medications to permanently prevent pregnancy and cut off offspring, as well as performing surgeries that prevent pregnancy permanently and cut off offspring is Haram. It is not allowed to perform them, because the ruling of castration applies to it, it falls under it and takes its ruling, because these usages cut off offspring, as castration ends it, and explicit prohibition has been stated regarding castration. It was narrated by Sa'd bin Abi Waqqas (raa) that:
«رَدَّ رسولُ اللهِ صلى الله عليه وسلم على عُثمانَ بنِ مظعونَ التَّبَتُّلَ، ولو أذنَ له لاخْتَصَيْنا» "Allah's Apostle forbade `Uthman bin Maz'un to abstain from marrying (and other pleasures) and if he had allowed him, we would have gotten ourselves castrated." Agreed upon, Úthman bin Mathóon had had come to the Prophet (saw) and said:
«يا رسولَ اللهِ إني رجلٌ يَشُقُّ عليَّ العُزوبَةُ فأذَنْ لي بالاخْتِصاءِ، قال: لا، ولكنْ عَلَيكَ بالصِّيامِ» "O Messenger of Allah, I'm a man who is finding single-life difficult, so allow me to castrate myself, he said: No, but perform fasting" and in another narration he said:
«يا رسولَ اللهِ، أتأذَنُ لي في الاخْتِصاءِ؟ قال: إن اللهَ أَبْدَلَنا بالرَّهْبانِيَّةِ الحَنيفيَّةَ السَّمْحَةَ» "O Messenger of Allah, do you allow me to castrate myself? He said: Allah (swt) replaced us with the monastic Hanifi tolerant (religion)." And it was narrated by Anas (ra) who said the Prophet (saw) used to command us to marry, and prohibited us from celibacy completely, and would say:
«كانَ النبيُّ صلى الله عليه وسلم يَأْمُرنا بالباءَةِ، ويَنْهى عنِ التَّبَتُّلِ نَهْيَاً شديداً، ويقولُ: تَزَوَّجوا الوَدودَ الوَلودَ فإني مُكاثِرٌ بِكُمُ الأُمَمَ يومَ القيامَةِ»
"Marry the child-bearing, for I shall outnumber the other nations with your numbers of the Day of Judgment." (Extracted by Ahmad)
Also, cutting off offspring is contradictory to what the Legislator made the purpose of marriage being for offspring and child bearing, thus Allah (swt) said in presenting the blessings bestowed upon the people:
[وَاللَّهُ جَعَلَ لَكُمْ مِنْ أَنْفُسِكُمْ أَزْوَاجًا وَجَعَلَ لَكُمْ مِنْ أَزْوَاجِكُمْ بَنِينَ وَحَفَدَةً]
"And Allah has made for you mates (and companions) of your own nature, and made for you, out of them, sons and daughters and grandchildren"
Therefore, permanent sterility operations are Haram for both men and women.
However, if a woman became pregnant, and the proficient trustworthy doctors decided that keeping the fetus in the mother's womb threatens the mother's life by death, and the death of the fetus with her, then in this situation, it is permissible (Mubah) to abort the fetus, and save the mother's life. Saving life is something that Islam called for...
As for a woman's saying that she is ill and fears for her life from pregnancy, it is something far from reality, how many women became pregnant while being ill, and continued their pregnancy, giving birth to a full-term and healthy baby... And Allah (swt) granted her good health... However, as we said previously if she becomes pregnant and the continuation of her pregnancy will threaten the mother's life with death and the death of the fetus with her, decided by proficient and trustworthy doctors, then it is permissible to abort the baby.
Accordingly, sterility is Haram. Treating the woman throughout her pregnancy is required, and maintaining her life throughout her pregnancy is also required if this pregnancy threatens her life with death, and the death of the fetus with her by the decision of proficient and trustworthy doctors, then aborting the pregnancy is permissible. As for treating her by making her permanently sterile based on the woman's request, then that is Haram.
Doctors should not disparage this matter, they should exert their effort in diagnosing the pregnancy and the illness... for it is a trust, and the doctor should adhere to that, and should not sell his Akhira with an offer of the Dunya, regardless of the amount.
[فَمَا مَتَاعُ الْحَيَاةِ الدُّنْيَا فِي الْآخِرَةِ إِلَّا قَلِيلٌ]
"But little is the comfort of this life, as compared with the Hereafter." [At-Tauba: 38]
In conclusion, I advice husbands and wives to increase their offspring, and to pledge to them a righteous upbringing, because as the number increases the Prophet (saw) will "boast" of them on the Day of Judgment.
Al-Bayhaqi also narrated on the authority of Abu Umamah that the Prophet (peace and blessings be upon him) said: «تَزَوَّجُوا فَإِنِّي مُكَاثِرٌ بِكُمُ الْأُمَمَ يَوْمَ الْقِيَامَةِ... » "Marry one another, for I will be boast of your great numbers in front of other nations (on the Day of Judgment)". Al-Hakim in Al-Mustadrak also reported like this Hadith according to the two Sahih, narrated by Ma'qal Bin Yasar (ra), and al-Bazar in his Musnad narrated by Anas bin Malik (ra), and others.
Allah Almighty looks after the righteous men and women.
The link to the answer from the Ameer's page on Facebook.