Pontifical Council for the Pastoral Care of Migrants and Itinerant People
Pontifical Council for Health Pastoral Care
Pontifical Council for Pastoral Care of Migrants
and Itinerant People
Pontifical Council for the Family
THE REPRODUCTIVE HEALTH
A Note for the Bishops' Conferences
In 1999, the United Nations High Commissariat for Refugees (UNHCR), in collaboration with the World Health Organisation (WHO), the United Nations Fund for Population Activities (UNFPA), and some NGOs, published the Inter-agency Field Manual on Reproductive Health in Refugee Situations; this is a practical book that deals with modalities of assistance to refugees in the area of the so-called ÂReproductive HealthÂ.
The Field Manual is object of several serious concerns for the Church and is the ground for this Note, which has been purposely prepared by three Dicasteries of the Holy See Â The Pontifical Councils: for Health Pastoral Care, for Pastoral Care of Migrants and Itinerant People, and for the Family Â with the goal of emphasising the reservations of the Holy See on some problematic issues of the Manual.
This Interdicasterial Note takes the Field Manual as a pastoral challenge for the Church and calls both pastors and other pastoral workers involved in the areas of family, health care, migrants and Itinerant people, to vigilance, so that the love, respect and protection of refugees and their rights Â among which the inalienable right to life Â may be the underlying and driving motive of their action for the improvement of the conditions of life of millions of displaced persons and refugees, and their enjoyment of the protection of their life and health.
The Field Manual carries anti‑values that offend the dignity of the poorest and most vulnerable populations, with proposals regarding the limitation of births, an idea of irresponsible sexual relations, and even abortion. We find ourselves in front of a current of thought that may be defined as both utilitarian and neo-Malthusian.
The Note in its five parts, offers a horizon of hope different from that expressed in the Field Manual and makes a pastoral proposal ad hoc, which is based on the love for the refugees in full respect of moral truth and the dignity of personal consciences.
Finally, the Note encourages the various authorities responsible for public life, and all men and women of good will to pursue efforts that will ensure to the refugees, a future capable of restoring to each and every one of them a face to the image and likeness of God.
May this Note, help our communities to understand better the problems and difficulties of the refugees, to protect their rights, especially the right to life and health, and to help them in body and spirit, following closely the example of Jesus who himself experienced the condition of a refugee, offering them particular attention and care.
The tragedy of refugees is a Âwound which typifies and reveals the imbalances and conflicts of the modern worldÂ, in which the Church is present with her love and help. For believers in Christ, in the service to their neighbour, what matters is first and foremost the inalienable dignity of the human person created in the image of God (Gen 1:27). In the spirit of the Great Jubilee, the Church rejoices at the co-operation between Âpeoples of every language, race, nationality and religionÂ in facing up to the great challenges of the new millennium, and hopes and wishes that it will lead to the creation of Âa new culture of solidarity and co-operationÂ.
I. The Holy See, the United Nations Organisation, and reproductive health
Among the organisations with which the Holy See co-operates at various levels, the United Nations occupies a special place of importance. Within its structures the United Nations High Commissariat for Refugees (UNHCR) has been concerned for fifty years with protecting the dignity and rights of refugees. There are many examples of fruitful co-operation between the UNHCR and the Catholic Church at both an international level and in those various countries which live the experience of the forced movement of people.
The Holy See, while appreciating the principles which guide the action of the UNHCR, cannot refrain from expressing its own reservations when the ways in which help is given, or even the means employed, could cause grave damage to the dignity of the person and his life, from the first stages of conception until natural death, as is recognised by human reason and expressed by Catholic morality. It is within this context that the meaning of this ÂNoteÂ on the Inter-agency Field Manual on Reproductive Health in Refugee Situations, published in 1999 by the UNHCR, must be understood. Although there are positive aspects to the manual, it is incumbent upon us to point out others which are in contrast with morality. The Catholic organisations that are involved with the UNHCR in the protection, and provision of assistance to, refugees, find themselves in a privileged position to promote the true dignity of refugees as regards sexuality, the family, adolescents, and children. This ÂNoteÂ offers bishops and Catholic pastoral and humanitarian workers a short analysis of the Field Manual as well as certain indications for the protection and the promotion of the dignity and the integral health of refugees.
Our reservations with regard to the Field Manual form part of the concern of the Church about the moral and intellectual confusion that in recent years has taken root in public opinion, among various political leaders, in international institutions, and in the practice of medicine itself. More precisely, one is dealing with the way of answering the question: what is man? The answer implied, and at times explicitly expressed, in the Field Manual reflects a philosophical approach that, in its attempt to promote individual freedom, neglects corresponding individual and social duties. It runs the risk of offending the very dignity of the poorest and most vulnerable populations with proposals regarding the limitation of births, an idea of sexual relations where responsibility is not involved, and even abortion. In addition, there is a lack of sufficient attention to knowledge of the culture and the religion of refugees. At its base are to be found many traces of a current of thought that could be defined as utilitarian or neo-Malthusian.
The Field Manual reflects the discussions on Âreproductive healthÂ that were held during the ÂConference on Population and DevelopmentÂ which took place in Cairo in 1994. This kind of Âreproductive healthÂ is promoted today by certain organisations of the United Nations such as the World Health Organisation (WHO), and the United Nations Fund for Population Activities (UNPFA). At the concluding session of the Cairo conference, the Holy See issued a declaration in which it expressed the reservations held by the Church regarding the ideology of Âreproductive healthÂ. The same reservations apply to the Field Manual.
II. The Church's love for refugees
Within the context of her universal missionary mandate, the Church, paying special attention to the signs of the times, perceives with increasing awareness the existence of the phenomenon of millions of displaced persons and refugees. She intends to co‑operate so that these people can improve their conditions of life and enjoy protection for their lives and health.
In his message on the subject of emigrants Â a message especially relevant for refugees Â Pope Paul VI said: ÂWe look in a particular way at what emigrants suffer in such movements: they suffer a spiritual and moral trauma which disturbs every inner judgement, and while in their spirits there enter aspirations of every kind, among which one is good and worthy, that of a better condition of life, an easy confusion of ideas is produced, in which are shaken the principles on which are based the honesty, the normality, and the humanity of their psychology. How many emigrants thus lose every religious practice...and how many are upset in their own family affections by the sadness of the conditions in which they find themselves and by the rise of disordered passions? Emigration provokes such serious and widespread moral and religious crises and takes place with such suffering and such painful consequences that the pastoral ministry of the Church cannot be unconcerned about it; and during these years the more the phenomenon of emigration intensifies and grows worse, the more the concern and care of the diocesan clergy, of religious, and of the Catholic laity must intervene and demonstrate a speedy and multiple capacity to bring comfort and help to emigrants which is up to the level of their need, which today has grown and is urgentÂ.
The Church, called upon by these inhuman situations, takes them upon herself in her apostolic care and concern, and is convinced that Âthe proclamation of Christ and the kingdom of God must become the means for restoring the human dignity of these peopleÂ.
III. Worrying points in the ÂField ManualÂ
Before engaging in a specific analysis of the most worrying points of the Field Manual, it should be remembered that we are dealing here with a basic difference between the utilitarian conception of human sexuality, connected with the concept of reproductive health, and the perspective offered by the Church in her respect for the dignity of man and his sexuality. The sexual anthropology based upon divine revelation asserts that Âman and woman have been created, which is to say, willed by God: on the one hand, in perfect equality as human persons; on the other, in their respective beings as man and womanÂ. God Âcreated them to be a communion of persons, in which each can be ÂhelpmateÂ to the other, for they are equal as persons (Âbone of my bones...') and complementary as masculine and feminineÂ. Their conjugal life is destined to be fertile and to fulfill itself in the common work of watching over the creation, in conformity with the generosity appropriate to responsible fatherhood-motherhood according to the objective criteria of morality. One should, therefore, respect the dual meaning of the mutual giving of the man and the woman, open to life, in marriage, which the contraception promoted by so-called Âreproductive healthÂ contradicts.
Today's forms of scientific knowledge allow us to affirm that human life begins at the moment of fertilisation. Reason is thus called upon to accept, in philosophical and ethical terms, the pre-eminent human value of individual life from that moment, and its defence and protection is a requirement of natural law. The Church also affirms, on the basis of reason as well as of Revelation, the obligation to respect and to protect the right to life of every human embryo and rejects as immoral every action which brings about its abortion or manipulation.
The Field Manual (in particular in chapter IV) proposes, without reservations, after forced sexual relations, the use of so-called Âemergency contraceptionÂ, previously also called the Âmorning-after-pillÂ, and presents it as a ÂcontraceptiveÂ. But the reality is that it is not solely contraceptive because in the case of effective fertilisation a chemical abortion would be carried out during the first days of pregnancy. The World Health Organisation relativises the biological status of the embryo during the first days by calling it a Âpre-embryoÂ, that is, a bunch of cells. Here we encounter a sophism because such a denomination does not have a precise biological basis. Natural morality cannot accept the use of this Âemergency contraceptionÂ.
In the same way, the means of birth control promoted by the Field Manual are unacceptable, because of their well-known abortive effect as well (chapter VI). Here we are dealing with a contraceptive pill based on progestagens (the Âmini-pillÂ), injectable contraceptives (Depoprovera) or implants placed under the skin (Norplant), and the coil (IUD).
It should be observed that the Field Manual presents sterilisation as simple ÂcontraceptionÂ. It is instead a radical suppression of the procreative function, which is often carried out in poor countries without the victim of this procedure always being correctly informed.
In addition, the separation between sexuality and procreation promoted by the Field Manual through the promotion of a Ânon-judgemental approachÂ regarding extra‑marital relations as well as homosexual relations cannot be accepted. For this reason, pastors must be very careful about the information programmes on reproductive health proposed by the Field Manual for adolescent refugees (chapter VIII). Rather than being educated for real love, within the prospect of marriage and a future family, these boys and girls are introduced into the world of individualistic and irresponsible sexual pleasure, which increases the risk of extending the HIVAIDS epidemic. The Field Manual, rather than promoting the education of young people for responsible procreation, as a true prevention for this disease, limits itself to offering the condom, as has already happened in the past in schools and places of war with the diffusion of contraceptive material and printed matter. The Field Manual envisages the ubiquity of the condom in massive quantities, although the not insignificant percentage rate of failure of this ÂprotectionÂ is more than demonstrated today. The Field Manual is not the most suitable instrument for education in mature sexual responsibility.
Natural methods are morally legitimate when there are good reasons for employing them, and they are therefore suitable to responsible procreation, in refugee camps as well, because they do not cost anything, respect the body and the relationship of the couple, and foster dialogue and a responsible approach by the spouses.
There is a last rather worrying point presented by the Field Manual: the presence in the milieu of refugees, in the form of post-abortion medical care, of equipment which allows the carrying out of abortions (suction with MVAs or Âmanual vacuum aspiratorsÂ). This is equipment that will be put into the hands of health care workers who have varying kinds of qualifications although it should be used only by medical doctors. It will be very difficult, in such conditions, to control the present-day use of this equipment and to verify whether the declaration inserted in the request expressed by the Holy See in chapter VI of the Field Manual (Âin no cases should abortion be promoted as a method of family planningÂ) is effectively respected.
IV. The pastoral approach
The distribution of the Field Manual among refugee populations or to other displaced people must not be taken lightly by the pastors of souls who care for them both in camps and elsewhere. The diffusion of the Field Manual is another appeal to the Church to ensure a more incisive pastoral presence, and not only a presence involving the provision of aid, in these situations. Thus the Christian community, with gospel-based morality, will provide its specific support, working with all refugees and the organisations dedicated to serving them.
Refugees and displaced people often have nothing at all and require, according to their effective needs, greater love, care, concern, and active solidarity from Christians and pastors who live side by side with them. Organising the pastoral care of these people, ensuring their spiritual well-being, their access to the Word of God, to sacramental forgiveness, to the Eucharist, and to the other sacraments forms a part of the response that Christians must give to the commandment of Christ to love his brethren.
Naturally, the local Church as well as the Universal Church is committed to material, psychological and medical help for refugees. Catholic agencies that are involved in providing refugees with help and relief are generally under the guidance of a bishops' conference. The bishops' conferences themselves, in countries where there are refugees, are in contact with them through these agencies and also through their own instruments of humanitarian aid. In the co-operation of these institutions of the Church in providing assistance, under the guidance of the bishops' conferences, these institutions, in their loyalty to Christ, should have special respect for the person of the refugees and for their rights, whatever their conditions of life or their religion may be. The pastors of souls who draw near to refugees to help them at a spiritual level also take on the duty to promote amongst them a feeling of dignity, self‑respect, and mutual respect, and to spread, through their own example, care and respect amongst those people who help refugees and those who occupy positions of importance in the provision of such help.
V. Specific pastoral problems
The distribution of the Field Manual on Reproductive Health, it should also be observed, raises specific problems at a pastoral and moral level. The pastoral care of the faithful requires from every bishops' conference that their physical health is also taken into account. Amongst the faithful there are those who make up the refugee population. They are generally under-fed and often in precarious conditions of health. The Field Manual promotes so-called reproductive health from a more than narrow perspective. Given that the Church, with her charitable bodies, with the help of her consecrated members, and with her Catholic health care workers and medical doctors, is generally very present at an executive level in such situations involving refugees, pastors must be very vigilant to ensure that practices proposed by the Field Manual and considered to be immoral do not gain a foothold.
First of all, pastors have the duty to ensure respect for refugees as persons and for their rights. This involves knowing the refugees and the health care workers who are looking after them, winning their trust, listening to their appeals, and paying attention to everything said in confidence.
Education is a duty of pastoral workers and Christian laity who are involved in the service of refugees. This is not a matter of merely providing health care information but also of making an appeal to ethics based upon the Word of the Gospel, with all its force and with its on-going call to holiness, whatever the conditions of existence of a Christian may be. By such an initiative, the Christian vision of life and human sexuality and its requirements will be presented, as well as the teaching of the Magisterium regarding the immorality of co-operating in abortion, sterilisation and contraception. Above all else, efforts will be made to give time and attention to refugee children and adolescents, organising, where possible, meetings with them to prepare them for real love and for the prospect of their future engagement and marriage. AIDS, too, should be spoken about, as well as its prevention through respect for the dignity of one's own body.
Lastly, pastors of souls will try, to the extent that this is possible, to offer the health care personnel caring for refugees a specific spiritual help. Health care workers and medical doctors who work in this area are often foreigners, volunteers, marked by devotion and warm hearts, who find themselves frequently placed in a distinct condition of need because of the difficult circumstances in which they have to operate, at times with few resources with which to perform their task. All of this can lead them to neglect the requirements of moral truth. As a result, they can be led to apply to refugees the means which appear to them to be the simplest and the speediest, with little information being offered to the person treated, especially when there are problems of communication. It is therefore important to establish good human relationships with the health care workers, medical doctors, and helpers, encouraging them, appreciating their service, and reminding them of the Word of God. Those of them who are Catholics should receive special catechetical and spiritual assistance, and clear information about the teaching of the Church in moral matters regarding the family and sexuality.
The Catholic Church cannot but listen to the cry of the poorest, of the weakest, of those who cannot intervene in the decisions that are taken about them. The Church welcomes them, supports them, and takes up their defence against every authoritative or manipulative measure which harms them. Her relationship with the UNHCR is lived out in this perspective: with her knowledge of human nature and her ethical vision, the Church can effectively encourage the UNHCR in its mission to protect the human dignity of refugees, as well as suitably lead it back, when the need arises, to a more integral respect for moral truth and the dignity of personal consciences. In this sense, the relationship between the Catholic Church and the UNHCR, in assisting refugees, can be increasingly closer and more fruitful. In this spirit of co-operation we thus present these indications regarding the Field Manual on Reproductive Health in Refugee Situations.
Vatican City, 14 September 2001, Feast of the Exaltation of the Holy Cross.
Pontifical Council for Health Pastoral Care
Javier Lozano Barragán,President
José Luis Redrado Marchite, O.H., Secretary
Pontifical Council for Pastoral Care of Migrants and Itinerant People
Stephen Fumio Hamao, President
Rev. Fr. Michael A. Blume, S.V.D., Undersecretary
Pontifical Council for the Family
Alfonsocard. López Trujillo,President
Francisco Gil Hellín, Secretary
 John Paul II,Encyclical Letter Sollicitudo Rei Socialis, 30 December 1987, n. 24. The pastoral solicitude of the present Note regards refugees, asylum-seekers, exiles, displaced persons, and every person who experiences forced migration. In dealing with the concept of ÂrefugeeÂ as used by the Holy See, it is to be hoped that the same protection and the same rights prescribed by international law in the defence of refugees will also be accorded to those who live the experience of forced migration within their own countries. See Pontificio Consiglio della Pastorale per i Migranti e gli Itineranti, I Rifugiati: Una Sfida alla Solidarietà (Libreria Editrice Vaticana, 1992), nn. 3-4.
 John Paul II, Incarnationis Mysterium,Bull of Indiction of the Great Jubilee of the Year 2000, n. 12; cf. John Paul II, Message for the Celebration of the World Day of Peace, 1 January 2001, n. 17.
 This manual is the outcome of the co-operation of various agencies of the United Nations Organisation, principally the WHO, the UNPFA and the UNHCR, and certain NGOs. A draft of this manual was published in 1996. The publication of 1999 takes up the text of 1996 but has some changes.
 Cf. Second Vatican Ecumenical Council, Pastoral Constitution Gaudium et Spes, n. 12.
 Cf. Santa Sede (S.E.R. Mons.Martino R.), ÂConsenso parziale e con riserveÂ, L'Osservatore Romano, Friday 16 September 1994, p. 4.
 Paul VI, ÂMessaggio per la Giornata dell'Emigrazione, 24 novembre 1963Â, in Insegnamenti di Paolo VI, vol. 1, 1963, p. 347.The original context was that of emigration in general, of which the experience of refugees is a particularly dramatic example.
 John Paul II, Encyclical Letter Redemptoris Missio, 7 December 1990, n. 37.
 Cf. Pontificio Consiglio per la Famiglia, Sessualità umana: verità e significato.Orientamenti educativi in famiglia (8 December 1995), nn. 8-15.
 Catechism of the Catholic Church, 369; see Jn 2:7-22.
 Ibid., 372.
 Cf. Ibid., 1604.
 Cf. Ibid., 2368.
 Cf. John Paul II, Encyclical Letter Evangelium Vitae, 25 March 1995, n. 60.
 Pontificia Accademia per la Vita, « Sulla messa in vendita in Italia della cosiddetta Âpillola del giorno dopoÂ », L'Osservatore Romano, 1 November 2000, p. 4.
 Cf. Paul VI, Encyclical Letter Humanae Vitae, 25 July 1968, n. 14.
 On the anti-values implicit in the contraceptive mentality (very different from the responsible practice of fatherhood and motherhood which takes place in the full truth of the conjugal act), see John Paul II, Encyclical Letter Evangelium Vitae, n. 13.