American Catholics are an unruly bunch. They do things like occupy churches that were supposed to be closed and sold, they pursue and investigate abusive priests, and generally act like the democratic process can be taken into church.

Early on, American Catholics in large numbers decided to make their own decisions about birth control. To become a parent is such a life-changing event that few couples are willing to ‘have as many children as God sends’ with no consideration for their capacity or desire to care for a large family. The Church’s permission to use periodic abstinence inspired research in the fine science of making it work, and theologians constructed beautiful explanations of why that form of contraception is moral but condoms are a sin. Catholics in the developed world had to make their peace with the contradictions between the Church’s teaching and the reality of their lives.

For the most part, they did. The crisis happens at the margins.

It happens when a rape victim seeks treatment at a Catholic hospital and is not offered emergency contraception. It happens when a nun is excommunicated for allowing an abortion to save a woman’s life. It happens in countries where the Church uses its political influence to limit women’s access to reproductive care, and where the status of women is low. It happens where a wife has no power to protect her own health when her husband is infected with HIV. It happens when the parish priest tells her that she must submit and trust God.

As of now, the Pope is not saying that a woman may require her husband to use a condom– that doing so is an act of responsibility and respect for her as a human being.

As of now, the Pope is exploring the ethics of harm reduction and human regard for oneself and one’s sexual partners using the example of a male prostitute who wants to protect himself and others. From the New York Times …

In the new book, “Light of the World,” to be published Tuesday, Benedict said condoms were not “a real or moral solution” to the AIDS epidemic, adding that that “can really lie only in a humanization of sexuality.”

But he added that “there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility.”

AIDS activists were thrilled. “This is a significant and positive step forward taken by the Vatican,” the executive director of the Joint United Nations Program on H.I.V./AIDS, Michel Sidibé, said in a statement. “This move recognizes that responsible sexual behavior and the use of condoms have important roles in H.I.V. prevention.”

This is a breach in a wall of dogma, behind which is the suffering of the world’s poor– who bear the burden of HIV, maternal and child mortality, and disempowerment. If a teenage boy forced to sell his body has a right to use a condom, how can you say a married woman does not? How can you say she has no right to protect herself from a pregnancy that threatens her life, her health, her ability to support her children? This wall is going to crumble like the Berlin Wall, despite efforts to patch it up…

Richard Dujardin in the Providence Journal reports that the advocates and providers who work in HIV prevention are taking the Pope’s statements as supporting condom use for protection from a deadly disease. Local theologians are rushing to block the obvious conclusion– that couples may have a vital need to protect themselves from unwanted pregnancy. They are also reminding us in the strongest terms that the Church considers birth control to be a sin and the Church uses its power to limit access to birth control and discourage people from using it.

Paul Gondreau, who teaches the theology of the body at Providence College, said that he sees it as ironic that Benedict’s comments were part of an attempt to defend remarks he made on a plane trip to Africa last year, in which he said use of condoms would not help the AIDS crisis there but make it worse.

Gondreau said that he saw nothing in the pope’s new remarks that would suggest that he or the Church would be ready to approve the use of condoms by a married couple if one of the partners has AIDS.

David O’Connell, president of Catholics for Life, said, as he sees Benedict’s remarks, his focus is not so much on not spreading AIDS, but on the prostitutes’ recognizing that the “person with whom he or she will be engaging in this intimate act is someone more than one who will give me money.”

“It speaks nothing about marriage or contraception but the beginning of caring for another human being.”

As for a married couple, one of whom has AIDS, O’Connell said he does not believe that the only choice facing such a couple is condoms or abstinence.

“As I understand it, God may still have a desire to create a new human being in a relationship blessed by God even if one may have a disease. I’m sure the church teaching will not change.”

Early in the AIDS epidemic, health care providers were debating the options for people infected with HIV who wanted to have children. These people were going to have children despite the risk, but were open to measures to decrease the chance of passing HIV to the baby. The prospects of a healthy birth are very good now, but only because of effective drugs and the strong advocacy of patients and providers, who gave urgent attention to this question. It doesn’t hurt to say a prayer, but lives are saved by the work of doctors, nurses and others in the material world who dedicate themselves to protect mothers and babies.

Katha Politt, at The Nation reminds us that conception and birth are never risk-free and can be catastrophic for some women– especially the poor women of the world…

It hasn’t mattered that a woman who got pregnant could be beaten or thrown out of her home, that she could lose her job, or that the sex might be rape by a partner or a stranger. Well, actually, in the 1960s, nuns in Congo were permitted to use birth control pills to protect themselves from impregnation by rapist soldiers. Ordinary women, even in wartime, are out of luck.

Nor has it mattered that a woman might be injured or die if she conceives. After all, like AIDS, pregnancy and childbirth can be dangerous. In the developing world maternal mortality rates are themselves an epidemic: according to the World Health Organization, about 350,000 girls and women die in pregnancy or childbirth annually, and this does not take into account birth injuries like fistula or the long-term toll on the body of having many babies too close together. The church has been adamant that women have no right to protect themselves from conception except by periodic abstinence, which requires a cooperative partner and has a real-life failure rate of 25 percent.

At the margins, where the Church has more power and women have much less, the impact of the Pope’s words are strongest. And that is where the injustice of denying women the right to protect themselves from disease and unwanted pregnancy is most deeply felt. I don’t think the Church will be able to close this breach– too much pent-up force is behind it.

Theologians are constructing lovely circular arguments to explain why it’s in God’s will that children lose their mothers to AIDS and women and infants die for lack of the power to control conception– but the Pope said that people have a right to protect themselves and that doing so can be an act of respect for themselves and others. You can’t take that back.

MORE: The Pope, in his example of a male prostitute using condoms for disease prevention– to protect his own life and others until he is able to find a better life– is using a classic example of the harm reduction philosophy. More on that here…

Pope Considers Harm Reduction