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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0003-REPRODUCTION, (INJAAB/IZDIYAAD) (PART II)

 Background reading material for medicine & fiqh panel discussion at the Kulliyah of Medicine, International Islamic University, Kuantan on 25th March 2000 by Professor Omar Hasan Kasule Sr.

3.0 CONTRACEPTION

HUMAN REPRODUCTION

PURPOSES OF HUMAN REPRODUCTION

The purposes of the human reproductive function can be considered at the individual, family, community, and human levels. Reproduction at an individual level fulfils a deeply-felt human desire for self-perpetuation and a form of immortality. Parents are proud of their children, al tafakhur bi al awlaad (9:55, 9:85) and naturally desire to have many, al takathur bi al awlaad (9:69, 18:39, 19:77, 34:35, 57:20). Children help cement and strengthen the marital bond. As regards the community level, the prophet encouraged Muslims to have as many offspring as possible to give glory to the ummat so that it may be the largest of communities. When righteous people have many children and bring them up to be righteous they will be spreading light and truth in the next generation in a very effective demographic strategy. Reproduction is necessary to ensure survival of the human race

 

Contraception in all its forms runs contrary to the objective of human reproduction mentioned above especially the human survival instinct. Contraception is against basic human nature. There must exist very strong reasons and motivators to make humans limit their reproductive capacity.

 

LOW HUMAN FERTILITY

Human fertility is very low. Conception can occur only in a narrow window of 3-4 days in the menstrual cycle when the ovum is released. Both the ovum and the sperm have a limited life-span. Human conception is of low efficiency. Many ova and sperms are shed but are not utilized. It is possible for one man to be the father of all humans on earth because he produces enough sperms over his life-time. Humans, unlike some animals, do not time their copulation to coincide with the release of the ova. Despite the low fertility humans down the centuries have for various reasons wanted to control conception and birth.

 

HEREDITY

Offspring resembles both parents because they both contribute to the genetic material (KS 574). Quantitatively both parents have equal contributions of genetic material to the offspring. The final appearance of the offspring is not an ‘average’ of the two parents because recessive genes from one parent are overshadowed by dominant ones from the other parent in determining particular traits.

 

LEGAL RULINGS ABOUT REPRODUCTION

Marrying and getting offspring is obligatory, wajib,  for the community otherwise it will weaken and disappear. It is permissible, jubbah, for the individual who can choose to have children or not to have children. It is highly recommended that individuals have children.

 

POPULATION and BIRTH CONTROL

MOTIVATION

Greed not to share wealth. Malthusian theories. Darwinism.

Fear of inability to look after additional children

Freedom to indulge in sexual intercourse without consequences

 

HISTORY

Contraception: Contracpetion was practised by all societies past and present: ancient Egypt, ancient Greece. Modern period: many countries have instituted punitive measures for couples who have more than the set number of children.

 

Abortion: Abortion was used and continues to be used by those who do not want to bear children and find themselves pregnant.

 

Infanticide, wa'ad: The pre-Islamic custom of killing girls, qatl al banaat fi al jaahiliyyat,  for fear of poverty was condemned by the Qur'an (6:137, 6:140, 6:151, 17:31, 60:13). Those innocent children will enter jannat (5:58, KS 575). Pharaonic Egypt instituted a population control policy when the number of Banu Israil increased. Selective infanticide of boys was carried out, qatl al awlaad 'inda al fara'inat (2:49, 7:127, 7:141, 14:6, 28:4, 28:9, 40:23-25).

 

Genocide: Ethnic cleaning

 

GENERAL LEGAL RULINGS ON CONTRACEPTION

We must distinguish between birth control at the societal level as a public policy and birth control as a family decision. There is no evidence of permissibility of the former. There are grounds for permitting the latter is specific circumstances. The specific rulings are discussed under each method of contraception.

 

MALE CONTRACEPTIVE METHODS

MALE REVERSIBLE METHODS

The reversible methods for males are the condom, coitus saxanicus, coitus reservatus, and coitus interruptus. Coitus interruptus is allowed, tarkhiss al 'azal (KS 154 KS 154-155: Bukhari K67 B96; Bukhari K82 B4; Bukhari K77 B18; Muslim K77 H15-H28; Abu Daud K12 B46; Tirmidhi K9 B39; Nisai K26 B55; Ibn Majah K9 B30; Darimi K71 B36; Muwatta K29 H95-H97, H99, H100; Ahmad 3:22, 26, 33, 47, 49, 51, 53, 57, 59, 63, 68, 71, 72, 82, 88, 92, 93, 140, 309, 312, 313, 377, 380, 386, 388, 450; Ahmad 6:361; Tayalisi H 1244, 1697, 2175, 2177, 2193, 2207). Although permitted,  coitus interruptus is considered offensive, karahiyat al 'azal (KS 155: Muslim K1 H31,;Tirmidhi  K9 B40; Ibn Majah K9 B61; Muwatta K29 H98;  Hakim?Ahmad 1:380, 397, 439; Hakim?Ahmad 6:361, 434; Tayalisi H 396. It is forbidden if the wife does not give permission, al nahyu 'an al 'azal illa bi idhniha (KS 155 Hakim?Ahmad 31). 

 

MALE IRREVERSIBLE METHODS

Vasectomy is the only available irreversible contraceptive method for males. It has some side effects.

 

FEMALE CONTRACEPTIVE METHODS

FEMALE REVERSIBLE METHODS

Reversible methods for females are either mechanical or chemical. The mechanical barriers are: the diaphragm, the cervical cap, the vaginal sponge, and the IUD. Often neglected and not mentioned are the traditional non-invasive methods of sexual abstinence and using the natural rhythm of menstruation to avoid coitus during the fertile days of the menstrual cycle. Each of these methods has advantages and side effects that are either physical or psycho-social.

 

Spermicides: Spermicides kill sperms. Each has its own specific method operating either before or after conception.

 

Intra-uterine device: The IUD prevents implantation of a fertilized ovum. The safest and perhaps the least effective is the rhythm method.

 

The oral contraceptive pill suppresses ovulation. The OC has revolutionised contraceptive practice since its development in the 1960s. It is largely responsible for the excesses of the sex revolution in which people saved from fear of pregnancy engaged in sex on an unprecedented scale. The sequential progesterone-estrogen pill's mechanism of action involves: inhibition of ovulation by suppressing FSH and LH, alteration of cervical mucosa and inhibiting sperm transport, interference with ovum transport, inhibition of implantation by suppressing normal endometrial development. Besides its contraceptive actions, the pill is useful in menstrual regulation. Among its adverse effects are: circulatory disorders such as MI, venous thrombosis, CVA, and HT; abnormal uterine bleeding, carbohydrate intolerance, neoplasia, and gall bladder disease.

 

FEMALE IRREVERSIBLE METHODS

There are two main irreversible methods for females: tubal ligation and hysterectomy. Tubal ligation is a simple surgical procedure that is reversible with much difficulty. Hysterectomy is not done deliberately for purposes of contraception. It is carried out for some other purpose and it serves the additional purpose of contraception.

 

SOCIAL IMPLICATIONS OF CONTRACEPTION

SEXUAL PROMISCUITY

Availability of safe contraception removes the fear of pregnancy and encourages more people to engage in illegal extra-marital sexual activity

 

POPULATION IMBALANCES

Population imbalances resulting from severe birth control

 

PRELUDE TO GENOCIDE

Wide-spread practice of birth control makes it easier to accept and practice genocide.

 

4.0 PREGNANCY, haml

A. DIAGNOSIS OF PREGNANCY

The Qur’an mentioned pregnancy, haml (3:6, 3:35, 7:189, 13:8, 16:78, 19:22, 22:2, 22:5, 23:14, 31:14, 31:34, 39:6, 46:15, 53:32, 65:4, 65:6).

 

The traditional diagnosis of pregnancy was based on amenorrhoea, signs and symptoms of pregnancy, and abdominal enlargement in the late stages. Earlier diagnosis of pregnancy based on hormonal and radiological procedures is now available. This earlier diagnosis can not lead us to shortening the post-divorce period of waiting, iddat al talaaq. We know that the material reason, illat, for waiting three months is to ensure that the wife is not pregnant. We however do not know the wisdom, hikmat, behind the ordaining of iddat.

 

Legal situations may arise in which the diagnosis of pregnancy is disputed. Pregnancy is not possible below a certain minimum age. It is however possible to get pregnant even before menarche.

 

B. PERIOD OF GESTATION

Legal situations arise in which the court must reach a decision based on knowledge of the minimum and maximum periods of gestation. Bleeding or spotting in early pregnancy (KS 207: Darimi K1 B97, Muwatta K2 H101) that is thought to be an abortion or a menstruation can be the cause of the confusion in computing the period of gestation. The early jurists using medical knowledge available in their times had reached conclusions about the minimum and maximum durations of gestation. These need to be revised in view of modern medical knowledge and the availability of sophisticated diagnostic procedures.

 

C. ACTIVITIES IN PREGNANCY

PHYSICAL ACTS OF IBADAT

Salat: Standing up, qiyaam; bowing, rukuu; prostration, sujuud, and sitting down in salat may be difficult for a woman in advanced pregnancy. It may also be difficult for her to put her hands on her abdomen.

 

Siyaam: A pregnant woman may be excused from fasting. If the excuse is based on fear of nutritional deficiency in the mother or in both the mother and the fetus, the missed fasting must be made up. If the exemption is based on fear of harm to the fetus alone, expiation is by feeding the poor. 

 

Hajj: the hustles of movement in hajj may be too strenuous for a pregnant woman

 

COITUS

Sexual intercourse is physically cumbersome in advanced pregnancy. It may also introduce infections in the birth canal. In the rare instance of placenta previa it may provoke potentially fatal bleeding.

 

PUNISHMENTS

Legal punishments, huduud, can not be carried out in pregnancy until after delivery and suckling of the baby

 

BREAST FEEDING

There is no ruling against breast feeding in pregnancy. It is a medical necessity since breast milk is the best food for a baby.

 

STRENOUS PHYSICAL WORK IN PREGNANCY

A woman in advanced pregnancy has limited ability to do physical work, at home or outside the home, and has to be excused

 

DIVORCE

A pregnant woman can be divorced but can not be forced out of her house until after delivery

 

D. POST-PARTUM BLEEDING, nifaas

MINIMUM and MAXIMUM PERIODS

 

PHYSICAL IBADAT

Salat:

Siyaam:

Hajj:

Qur'an: touching the Qur;an is forbidden

 

COITUS

Sexual intercourse is forbidden

 

DIVORCE

Divorce of a woman in the post-partum period is prohibited

 

E. THE NEW-BORN

BIRTH IN THE QUR’AN

The Qur’an mentioned child birth, wilaadat (3:36, 11:72, 19:15, 19:33, 22:3, 35:11, 41:47, 46:15, 58:2, 65:4, 65:6, 71:27, 90:3)

 

THE PHYSIOLOGY OF PARTURITION

Studies in sheep have shown that the mature fetus provides the initial stimulus for parturition by secreting cortisol which acts on the placenta to decrease progesterone secretion, increase estrogen and prostaglandin secretion. This causes cervical ripening and results into parturition. These findings have not been confirmed in humans.

 

CRYING OF THE NEWBORN

The books of sunnat have given reasons for the crying of the baby at birth (KS 575: Bukhari K65 S3 B2; Muslim K43 H148; Ahmad 2:233, 368). Every new born is touched by the shaitan, mass al shaitan 'inda al wilaadat (KS 575: Bukhari K60 B44; Bukhari K65 S3 B2; Muslim  K43 H146-147; Hakim?Ahmad 2:233, 274, 288, 292, 319, 368, 523).

 

RIGHTS OF THE FETUS

Right to life

Right of inheritance

 

RIGHTS OF THE NEW BORN

 

RIGHTS OF THE MOTHER

 

WHAT IS DONE FOR THE NEWBORN

Adhan and iqamat at birth

Naming, tasmiyat: choice of a good name

Circumcision, khitaan

Shaving the hair, halq al sha’r

'Aqiiqah:

 

5.0 BREAST-FEEDING, ridha’a

A. CONTROL OF LACTATION

Onset, continuation, and end of lactation are under endocrine & neural control, neuro-humoral. It can be affected by the psychological state of the mother. Drugs can also affect lactation so care must be taken in any prescriptions for the mother. Some drugs suppress lactation as a side effect. Some drugs may be taken with the deliberate purpose of suppressing lactation. Drugs given to the mother can be excreted in breast milk and can affect the baby.

 

B. PERIOD OF BREAST-FEEDING

The Qur'an set the statutory period of breast-feeding as 2 full years, muddat al ridha'a (2:233, 31:14, 46:15). No maximum period was set.

 

C. PAYMENT FOR BREAST FEEDING

The father has to give financial compensation to a divorced wife who is breast-feeding his child (65:6)

 

FOSTER BREAST FEEDING

Breast feeding of a child not issued from the mother automatically creates a legal relation that in the regard of the Law is no different from that that of a son or a daughter. The relation encompasses the wet nurse, the children of the wet nurse,  and the husband of the wet nurse. The conditions set by the Law for this relation to hold are: the wet nurse must be a female at least 9 years of age, the baby suckled must be less than 2 years old, and at least 5 separate breast feeding sessions must be held. The legal relationship thus established leads to marital restrictions between foster brothers and foster sisters (4:23).

 

E. ACITIVITIES DURING BREAST FEEDING

PHYSICAL ACTS OF IBADAT

Salat: a nursing mother is allowed to combine 2 prayers

 

Siyaam:

Suckling while pregnant:

Intercourse with suckling woman:  (al ghayla)

Milk banks:  purpose - how used - advantages - disadvantages - fiqh issues - how to resolve fiqh issues

Work and maternity leave for lactating woman

 

DISCUSSIONS

MENSTRUATION

Marriage before menarche

Medical complications of coitus in menstruation

Hysterectomy before menarche

Ovariectomy before menarche

Teaching Qur’an while in menstruation

Physiological distress of menstruation

Psychological distress of menstruation

Reason for making up salat and not saum if missed during menstruation

Hormonal menstrual regulation

 Criteria for decision that menstruation has stopped in order to bathe and pray

 Physiological explanation of the manifestations of the pre-menstrual syndrome

 Pre-menstrual syndrome and marital disputes

 Pre-menstrual syndrome as legal defence in criminal acts

 Salat with pre-menstrual syndrome

 Saum with pre-menstrual syndrome

 Menopausal mood and mental changes causing marital discord

 Menopausal or post menopausal syndrome as legal defence in criminal cases

 Artificial menopause, surgical or medical

 Pros and cons of using estrogen replacement therapy

 Legal rulings on menorrhaghia

 Legal rulings on metrorrhaghia

 Legal rulings on dysmenorrhoea

 

HUMAN SEXUALITY

 Gender identity

 Gender awareness

 Legal rulings on trans-sexuality

 Legal rulings on sexual abstinence, rahbaniyyat

 Sexual attraction: visual, chemical, aural

 Use of cosmetics to hide natural defects

 Use of defects to enhance appearance

 Rulings on the use of perfumes

Rulings on cosmetic surgery

Rulings on male circumcision

Rulings on female circumcision

Problems due to discord between biological and mental maturity

Teenage sexual abstinence

Penalty for non-coital adultery

Definition of female shyness in relation to sexual hygiene

Definition and rulings on awrat

Rulings on khalwat in the car, the office, by telephone, by internet

Rulings on mixing, ikhtilaat, at the work-place, public transportation, hospital, class-room

Rulings on what constitutes tabarruj

Rulings on spouse withholding sexual priviledges

Rulings on maharim

 

CONTRACEPTION

Population control as national policy

Permissible contraception

Haram contraception

Rulings on male methods of contraception

Rulings on female methods of contraception

Disagreement between husband and wife on contraception

 

PREGNANCY

Legal rulings on the minimum and maximum durations of pregnancy

Determination of date of conception in disputes about parenthood

Determination of the date of conception in disputes about zina accusations

Salat and saum in first trimester pregnancy complications

Saum in early pregnancy

Hajj in late pregnancy

Salat and saum in post abortal period

Rights of the fetus to property and inheritance

Rights of the mother

Rulings about naming a newborn

Rulings about aqiiqat for the new born

 

BREAST FEEDING

Rulings on the period of lactation/breast feeding

Is refusal to breast feed a form of child abuse?

Rulings on payment for breast feeding

Salat for nursing mother

Saum for nursing mother

 

Professor Omar Hasan Kasule Sr. March 2000