Should nuns be given the pill for health reasons?

Like any other women who do not have children (nulliparous women), Catholic nuns find themselves with an increased risk of dying from breast, ovarian, and uterine cancer compared with women who bear children. A Comment published Online First by the Lancet suggests that, since the contraceptive pill reduces overall mortality and mortality due to ovarian and uterine cancer, Catholic nuns should be given the pill for health, rather than contraceptive, reasons. The Comment is by Dr Kara Britt, Monash University, Melbourne, Australia, and Professor Roger Short, University of Melbourne, Australia.

Nulliparous women have more ovulatory menstrual cycles than women who have children, due to the absence of pregnancy and lactation. This increased number of cycles increases cancer risk. Other factors increasing the overall number of cycles, regardless of having children or not, also increase cancer risk, such as going through puberty earlier or menopause later. Women who have children further decrease their risk of these cancers if they have their first child at a young age, bear more children, and breastfeed.

The authors say studies have shown that overall mortality in women using the contraceptive pill is 12% lower than in never-users. The risk of developing ovarian and endometrial cancers falls by 50-60% in pill users compared with never-users, protection that persists for 20 years, showing a clear long-term benefit. Of course, as with any medication, the pill is not risk-free. For example, the combined oestrogen/progestogen pill can increase the risk of blood clots (venous thromboembolism), and as such the woman's medical history should always be considered.

The authors conclude: "The Catholic church condemns all forms of contraception, as outlined by Pope Paul VI in Humanae Vitae in 1968. Although Humanae Vitae never mentions nuns, they should be free the use the contraceptive pill to protect against the hazards of nulliparity since the document states that 'the Church in no way regards as unlawful therapeutic means considered necessary to cure organic diseases, even though they also have a contraceptive effect'. If the Catholic church could make the contraceptive pill freely available to all its nuns, it would reduce the risk of those accursed pests, cancer of the ovary and uterus, and give nuns' plight the recognition it deserves."