Trained women advise on medical/halachic matters

Medical issues comprise a significant chunk of Jewish law (halacha) – and when they concern gynecology, fertility, obstetrics, family purity and other intimate matters, many observant women feel uncomfortable consulting with Orthodox male rabbis. To overcome such reticence, which could even lead to ignoring Jewish practices because women are too shy to ask questions, the profession of female halacha consultants (yoatzot halacha) was established a decade ago.

While Orthodox rabbis supervise on halachic issues, they remain pretty much in the background of the service. A total of 75 highly trained women have each undergone 1,000 hours of intensive learning in Jewish law, medicine, psychology and other specialties. They field queries through a hotline (02-640-4343 and at 1-877-YOETZET in the US) and a increasingly popular website (www.yoatzot.org) and manage a database of stored information.

One such embarrassing question was from a cancer patient undergoing radiotherapy. In order for doctors to know the exact spot for radiation, they had to mark the point on her body. But since such a “blemish” could prevent her from going to the ritual bath for purification before having physical contact with her husband, she called the Nishmat hotline. The halacha adviser consulted a rabbi affiliated with Nishmat and told her she could go to the ritual bath despite the spot. The caller said she was so embarrassed by the thought of asking a rabbi that she would otherwise have just avoided going for ritual immersion.

The service is provided free by Nishmat – the Jerusalem Center for Advanced Study for Women – which was founded by Rabbanit Chana Henkin and is located at 26 Berl Locker Street at the Pat junction. Her husband Rabbi Yehuda Henkin is the rabbinical supervisor of the project.

So far, the hotline has fielded some 150,000 queries from women and a small number of men. As e-mail is increasingly more convenient than live hotlines (this one works weekdays from 6 p.m. to midnight, after Shabbat till midnight and on Friday mornings), information on scores of subjects has accumulated, along with a collection of some 4,000 anonymous questions and answers.

Through the website one can also reach a Hebrew site, which was launched five years ago and is managed by halacha consultant Tirza Kelman, while an additional English site for physicians that provides more technical information can be found at www.jewishwomenshealth.org.

Dr. Deena Zimmerman, a veteran pediatrician, halacha consultant and the site’s medical adviser was one of the first graduates of Nishmat’s Keren Ariel Institute to be certified as a halacha consultant, and has authored many of the articles on the website. A mother of five who works for Terem – the private urgent care center at the western entrance to Jerusalem – Zimmerman just finished a 400-page volume, published by Ktav and two years in the making, called Genetics and Genetic Diseases: Jewish Legal and Ethical Perspectives.

“About two-thirds of the halachic questions posed to us come with a medical component. There are many haredi and even modern Orthodox women who are not exposed to biology in their education and [are] unaware of matters that others take for granted,” said Zimmerman in an interview with The Jerusalem Post.

“They hear about our unique service mostly by word of mouth. We do not do significant advertising.”

But Zimmerman said it was a good idea to approach the four health funds, which could promote awareness of the the hotline and websites.

The organization promises women answers to their queries within 72 hours of posting, but usually they arrive earlier. If there is only a medical aspect, Zimmerman has the final say, but if there is also a halachic aspect, the rabbi comments before it’s distributed. The language is modern and straightforward. Some of the questions posed in English have been translated for the Hebrew site.

AN EXAMINATION of questions and answers provides a very varied scope – from permitted birth control to hormonal medications such as for treatment of acne, the halachic obligation to have more than a boy and a girl or two children and how to deal with psychiatric problems.

There even are queries about going to the mikveh (ritual bath) with dreadlocks (which are almost impossible to comb before immersion) or with navel or eyebrow rings that can’t easily be removed. Others deal with queries from women after breast-cancer surgery who are ashamed about their bodies being seen by mikveh attendants, as well as similar embarrassment in women with physical disabilities or who have a permanent colostomy after colon surgery.

All the responses are prefaced by the statement that the written advice “does not preclude, override or replace the ruling of any rabbinical authority. It is the responsibility of the questioner to inform us of any previous consultation or ruling. As even slight variation in circumstances may have halachic consequences, views expressed concerning one case may not be applied to other, seemingly similar cases.”

For example, one woman sent in this query: “I have a question which has been bothering me for some time, in regard to asking a rabbi about using birth control. From past experience, it is not a simple thing to get rabbinical permission to put off having more children for longer than a year, sometimes two. Personally, we have reached the point where we don’t even ask. I am not prepared to go through pregnancy and birth again right now. We have daughters and a son, and we are going through serious financial difficulties. It is not the right time, and we hope that time will come soon.

“I once heard that the commandment of having children was given to the man, not the woman, because childbirth does, in fact, put the woman in danger, and the Torah cannot command one to put oneself in danger. If the couple already have a boy and a girl, and a woman says that she needs a rest, how can a rabbi possibly not give her permission to practice birth control, especially since most of the physical work concerning the young ones is on her shoulders?” The response was that “once the couple have a boy and a girl, they have fulfilled the biblical command.

At that point, it is very common, though not universal, for rabbis to give a heter [permission] for the couple to practice birth control for up to two years. Since the mitzva is not just to bear children, but to raise them, emotional and economic factors must be taken into account.

Many rabbis will extend a heter beyond two years in light of these factors.

“A rabbi should still be consulted, even after there is a boy and girl, because of the rabbinic admonishment to continue to procreate even after fulfilling the biblical quota.... Although the exact definition and parameters of the rabbinic obligation are the subject of much discussion and debate among the prominent halachic authorities, most agree that one may not decide to cease and desist from procreating forever. Our site’s rabbinic supervisor, Rabbi Yehuda Henkin, has argued that a couple has fulfilled even the rabbinic command once they have two boys and two girls.”

The reply continues: “The question remains: what happens when a couple seeking a heter to use birth control after having both a boy and a girl are turned down? The classic rabbinic approach was only to permit contraceptive use when a woman’s life was at stake. Since the classic rabbinic literature on this topic precedes the availability of the contraceptive pill, we are left with a quandary: how much of the rabbinic reluctance was based on the methods historically available and how much was based on timeless Torah principles....

“Ultimately, what is most important is that a couple be familiar with a rabbi’s approach to these issues before seeking his counsel. A couple should seek out the counsel only of a rabbi whom they respect enough to be prepared to honor his evaluation of the issue. The rabbi, in turn, must learn enough about the couple’s situation to apply his approach appropriately and to explain the factors involved in a way the couple can understand and accept. In this way, it is less likely that a couple would receive a ruling that they could not deal with. If they could not deal with it, communication would be strong enough that they could contact the rabbi again with their concerns. A rabbi takes the urgency of a questioner’s concerns very much into account.”

Another woman wrote: “As a teenager, I was diagnosed with bipolar disorder and suffered from clinical depression until I started taking lithium to balance my moods. I have continued the medication, and I married this year. We have a wonderful marriage and are now considering starting a family. Prior to our marriage, we consulted with our rabbi and received a six-month heter for birth control. Six months later, I have a lot of stress at my job (which I can’t leave) and feel torn between work and home... in other words, I feel that I have a lot on my head, and I cry about it often. Although I tried once to go off the pill, I quickly realized with my crying spells, that this was not the time to go off the lithium.”

Her own rabbi reluctantly gave permission to continue with birth control, but she was worried that he didn’t understand the psychiatric issues, especially the risks involved with going off lithium or conceiving while on the drug. She felt frustrated at being unable to communicate with him about this important decision.

The website response was that her rabbi should be given a letter of evaluation from her doctor or psychiatrist, outlining the relevance of her condition to family planning and stating that it would not be wise to embark on a pregnancy in her current condition and circumstances, or that alternatively she could sign a release to enable her psychiatrist to speak with her rabbi directly.

“At the moment it sounds like you have permission for the next number of months to continue to use birth control in any case. If you still want a different opinion, you may speak to another rabbi on condition that you informed the second that you already asked one before. You might want to spend the current break that you have been given working on the issues that are stressing you, either alone or with professional help. Investigate with your physicians the possibility of using other medications that have less teratogenic risk or to further evaluate the risks of pregnancy while on lithium.”

Yet another question, common among observant brides-to-be, is about taking hormones several months before the wedding so she and her husband will not be forbidden to have physical contact immediately after because her menstrual period had begun.

“Some of my friends have long engagements whereby they cannot choose a wedding date based on their cycle. So they go on those birth control pills beforehand.... Two of my friends have not been able to conceive since they got married – one for many years now. Can these girls go on the pill for a short time before their wedding and really expect that their fertility will not be compromised in the process?” The response was: “It is unlikely that short-term use of birth control pills would cause long term effects on fertility. If a couple have difficulty conceiving after one year of trying, they should go for evaluation and treatment.”

Zimmerman personally discourages the automatic use of birth-control pills to regulate one’s cycle before marriage, saying that women who are “regular” usually don’t have to be concerned about it.

ZIMMERMAN NOTED that secular physicians may know very little about the halachic needs of observant women. They also find the website written in “medicalese” more suitable and can relate to it better, she continued.

The Nishmat project also offers an on-line, English-only course – Kalla Companion – for religious soon-tobe brides who are not familiar enough about with their bodies and relevant halacha, as well as another for already-married women of any age that is called The Marriage Companion.

“Premarital courses for brides and bridegrooms are very common in Israel for the observant, but in the Diaspora, far away from the main Jewish centers, they are unavailable. So our online courses are a big help,” she said. The organization also has a special website translated into Spanish, a project started by an immigrant from Chile who suggested it.

Issues are always less frightening to people if they have reliable information.

The Yoetzot Halacha service makes women more informed women and alleviates their concerns.