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The day my fourth child was born was the first time I came face to face with the reality that my ability to bear children is temporary. For one full day, at the age of 30, I was precariously close to needing a hysterectomy, as my postpartum hemorrhage simply didn’t want to subside.
The question of whether hysterectomies are morally permissible is fairly straightforward, since they’re almost always done out of medical necessity to help preserve life or perhaps quality of life. (There is no cure for endometriosis, and the debilitating pain it causes can sometimes be relieved only by hysterectomy.) In these cases, Christians need not debate.
For life-threatening or debilitating medical conditions, then, hysterectomies are licit and, while tragic, can be good: True medicine always seeks to restore the body to its natural function or, when restoration is impossible, preserve it. The procedure renders a woman unable to bear children, but it is not the intended aim. And intention matters.
Like most people, I am not particularly fond of the idea of one of my organs being taken out of my body. The uterus isn’t considered a vital organ like the heart or the lungs since the female body can survive without it. It seems to me that it’s probably there for a reason, though, and perhaps for more reasons than we yet fully understand. The ovaries, for example, are integral to regulating the hormone balances of the entire body, and hormones affect or facilitate many vital bodily functions scientists don’t yet fully appreciate.
On the other hand, sterilization through tubal ligations (or the male counterpart, vasectomies) is more ethically fraught. These types of permanent elective procedures are done not to preserve health but to prevent life. They involve cutting into an otherwise healthy human body and destroying a natural function, a process that in earlier times might have been called “bodily mutilation.” And they are wildly popular. Ninety-nine percent of evangelicals use some form of contraception: most commonly, sterilization and hormonal methods.
There are some seemingly good, perhaps even compassionate reasons to pursue sterilization. The best reason I can think of is to preserve the health of a woman or a future child, such as when a woman is terminally ill or on chemotherapy. And examples like these are not the primary reason I hear from couples who say they want to be sterilized. Usually, it’s from a sense that their families “are complete” or that they don’t think they could handle more children.
I have a strong suspicion, even a conviction, that hormonal methods of birth control, which can cause unintended abortions, and sterilization, which is destructive to the body, are both wrong (though I recognize that position is rather unpopular).
Despite its popularity, sterilization still seems to make people feel, well, weird. I’ve never met a man, for example, who says with unreserved excitement, “Sign me up for a vasectomy!” Other times, it’s joked about, as if in order to handle our deep discomfort with its strangeness, we simply make light of it. I’ve seen many men visibly recoil when the topic comes up. Yet approximately half a million men undergo the procedure each year in the United States alone (and more women than that undergo tubal ligation).
Weirdness—repugnance, “ick” as Gen Z would say—isn’t always meaningful, like when my toddler conveys her disgust for the green stuff on her dinner plate. But other times, when things seem weird, it’s because they are. A sense of unease or even disgust might indicate something beneath the surface worth examination. Weirdness should lead to deeper moral reflection.
Leon Kass, the George W. Bush–appointed chair of the presidential council on bioethics, once wrote that “repugnance is the emotional expression of deep wisdom, beyond reason’s power fully to articulate it.”
In his essay “The Wisdom of Repugnance,” Kass took seriously the public reactions of disgust to the then-novel cloning of Dolly the sheep. We often speak about “knowing something in our gut.” Kass, a Harvard-educated scientist, asked people to pay attention to that. Feeling deep, perhaps even physical unease about something can be a moral guide, a knowing what reason knows not.
So what if we channel Kass and examine this sense of weirdness about sterilization as an invitation to consider its morality?
Let’s start first with the most obvious: It is weird that we use medicine as a tool to incapacitate. The purpose of medicine should be to restore the body’s natural function, to help it flourish as God intended. Sterilization intentionally frustrates God’s design for the human body and for sex, which he created for both unity and procreation. Depending on the type of sterilization, tubes are cut, tied, burned, or blocked.
It’s strange that a practice that harms and permanently alters the human body in order to prevent the potential for new human life is as widely practiced and less widely debated than a similarly permanent, much less consequential practice: tattooing.
Next, consider the strangeness of treating children as if they’re a choice or even superfluous to marriage. Reproductive technologies give us an illusion of choice and control, when in reality all life is a pure gift from God. Having children and avoiding them are frustratingly elusive endeavors. Until quite recently, welcoming children into a marriage was not a choice but a God-ordained norm and a biblical command. It is only modern advances in biotechnology—namely, hormonal birth control, abortion, and sterilization—that have let us think about sex apart from procreation, or even marriage apart from procreation.
Now, our culture sees sex as a right, an inevitability, something we deserve without context and without consequence. And children suffer for it. It’s easier now than ever to treat children like a commodity, just one choice among many, rather than a gift and a natural outflowing of covenantal love.
Scripture talks about focusing on today since it has enough trouble of its own. Yet we worry about the future and take life-altering actions. I have heard families say after undergoing sterilization that they wanted more children and wished they hadn’t acted so rashly. What if God changes your desire for children in a year? Or three? You cannot know what tomorrow holds, how your family or your desires or your financial situation may change.
And finally, though certainly not exhaustively, it’s strange that we opt for such a drastic measure when other means of stewarding family size—means that often also produce virtue and augment health—are available. Fertility awareness-based methods work with the body rather than against it. Fertility is a sign of health that can help some doctors diagnose underlying health conditions, like endometriosis or even cancer.
Instead of shutting down a man or woman’s reproductive capacity, these methods help identify a woman’s small fertile window each month so couples can avoid pregnancy if desired. Contrary to popular belief, chastity and self-control are virtues to be had within marriage in addition to before it. A marriage license is not a license for sex on demand.
Perhaps all matters of sex and bodily function are weird. But God did create us as embodied creatures and took on flesh himself. And that fact alone should substantially raise our consideration of these imperfect, fleshly bodies that will one day die and be remade perfectly by him.
Acknowledging the strangeness of sterilization should prompt us to wonder if it might be wrong, to wonder why we are so deeply uncomfortable with something that is so culturally pervasive. The longer we ignore this sense of weirdness, the more likely we are to be desensitized to it.
Katelyn Walls Shelton is a visiting fellow at the Ethics and Public Policy Center’s Bioethics and American Democracy Program and a women’s health policy consultant.
This article appeared in the May/June 2026 issue of Christianity Today as "Sterilization Is Weird. And That's Okay.".
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