A 26 year old woman presented to a general gynaecology clinic requesting sterilisation. She worked as the manager of a large legal practice in London. She had never been pregnant. She was five years married and her husband used condoms for contraception. At the age of 17 she had discovered that she had a serious congenital heart defect. Neither she nor her husband had any desire to have children, and they had spoken about this at some length. The reasons she gave for requesting sterilisation were that she had no desire to have children and did not have faith in other forms of contraception (and did not wish to change her lifestyle or threaten her financial status; she saw children as a financial burden; felt that children would prohibit many important life choices, including the opportunity to travel; thought the world was already burdened with enough people; and had serious anxieties about the risk of medical complications during a pregnancy as her cardiologist had told her that pregnancy would be risky). The gynaecologist suggested alternative and reversible methods of contraception, including the intrauterine progestogen system. He also asked whether her partner would consider vasectomy. He explained the risks of laparoscopic sterilisation, which include a small risk of death and a risk of about 1 in 300 of requiring an emergency laparotomy to repair damage done to internal organs. The patient declined the intrauterine system and refused to ask her husband to have a vasectomy as he was only 25. She explained that, should she die prematurely, her husband might meet a new partner who wanted to have children.
1) Is her request for sterilisation permissible (Islamically, whether she is Muslim or not)?
2) Is the doctor allowed to carry out this procedure? (muslimah doctor)
3) Would the ruling change if her main reason for requesting a sterilisation was not that she did not want children, but that it might be risky with her given congenital heart condition (medical reason)? I.e. does her intention matter, whether she doesn’t want a child (against God’s will?) or whether she wished to preserve her own health (conforming to God’s will for medical reasons?)
4) If sterilisation is permissible in any of the cases, is the husband’s permission required? (E.g. in ‘azl, it is generally with mutual consent… can sterilisation be viewed Islamically as permanent ‘azl?)
5) Hypothetically, if there was a 100% fool-proof method of contraception that was temporary (i.e. not sterilisation, so no defacing or altering the creation of Allah (swt), then would this form of contraception be allowed given that possibility of conceiving with the contraceptive is absolutely zero?
Under normal circumstances, female sterilization is considered to be absolutely and decidedly prohibited (haram) in Shari’ah. The irreversible nature associated with both the male and female sterilizations clearly contradicts one of the primary purposes (maqasid) of marriage which is to have children, as mentioned by Imam Abu Hamid al-Ghazali in his Ihya’ Ulum al-Din.
Furthermore, sterilization is a form of mutilation of one’s body (muthla), which has been clearly forbidden in the Shari’ah. Allah Most High mentions in al-Nisa’ the words of Satan, when he said:
“I will mislead them, and I will create in them false desires; I will order them to slit the ears of cattle and to deface the (fair) nature created by Allah.”
However, in cases of absolute necessity, sterilization does become permitted. The well-known principle of Islamic jurisprudence based on the guidelines of the Qur’an and Sunna states: “Necessities make prohibitions lawful.” (Ibn Nujaym, Al-Ashbah wa al-Naza’ir 85)
Cases of absolute necessity include a woman’s life or her permanent health being severely threatened by pregnancy, or her facing the risk of losing her life with additional births after having gone through Caesarean operations on previous occasions. As such, if unbiased and professional medical advice is taken, and one comes to the conclusion that the life or permanent health of a woman would be seriously affected by pregnancy and that there is no other cure for her illness, only then would female sterilization be permitted.
You state that the woman in question has a serious congenital heart condition and as such her becoming pregnant might be risky. In light of the above explanation, she will need to obtain professional medical advice ideally from an experienced and upright Muslim doctor (who knows the severity of the prohibition of sterilization in Islam) and then act accordingly. If the medical expert feels that pregnancy is a severe risk to her life or permanent health, then she may undergo sterilization.
The other reasons outlined in your question do not justify sterilization. In fact, some – such as seeing children as a financial burden thus fearing poverty and thinking that the world was already burdened with enough people – are in direct conflict with the teachings of Islam. Even reversible contraception is not permitted due to “such” reasons and intentions in mind.
As for the doctor and medical practitioner, if sterilization is justified (in light of the above-mentioned explanation), then it is permitted to carry out the operation on the patient. If, however, it is not Islamically justified, such as when there is no absolute necessity, or when alternatives are available, then it is not permitted for the Muslim doctor to perform the operation, since this would be held as assisting another in a sinful act.
I hope the above answers all your questions.
And Allah knows best
[Mufti] Muhammad ibn Adam
Leicester , UK