Monday, March 26, 2012

Artificial Contraception, Why Not? NFP, Why? A Guest Post from Bear


Thank you, Bear, for this guest post! Bear has been a semi-frequent semi-anonymous commenter of this blog from its beginning who is:
-Byzantine Catholic
- a Philosopher with interests in logic and analytic philosophy
- interested in early music, opera, film, swimming and riding
- owned by a bossy cat

"Reading this other US based blogs, there seems to be a bit of contention among Catholics in the US about the use of NFP and whether it is equivalent to using artificial contraception, and whether it permissible to use. There is a lot of discussion about the Ends - the procreative and unitative  aspects of marriage and the "marriage debt". While such a discussion is often helpful and illuminating, it obviously does not answer the entire question: a more rigourous person could argue that when engaged in sex, the couple should actively intend both ends.

I think that it could be useful to consider why the Church considers Artificial Contraception wrong.
What is the problem with Artificial Contraception?
The difference between NFP and other fertility control is that NFP does not disrupt the natural function of the body or the act. Other fertility control methods either engage in post facto acts of violence (abortion and IUDs) or inhibit the act (condoms and some forms of the pill).

In a Thomist context to remove or to disrupt a natural and good function or ability is disordered: it equivalent to mutilation, such as amputation: one does not cut off a finger for cosmetic reasons, but if it has gangrene then one cuts it off to save the person. This is also the reason why intoxication, whether from alcohol, cannabis, cocaine, crack, heroin &c., is also wrong - because it inhibits the faculty of reason, and often has other side effects.

While this does not mean disordered acts are automatically prohibited and can not be done, there are a couple of consequences. This act can not be the primary reason. That is, it can not be done on its own or be the actual end of an action. There needs to be a good reason for the act. If there is a greater good - for example, saving the life of someone with gangrene - then this mutilation is permissible for that greater good. This is the principle of "Double Effect".

What does this mean for artificial contraception? It means that things like the pill can not be used for contraception, but can be therapeutic reasons to assist a women. Consider, a women is under significant stress and she has menses every two weeks and is becoming anaemic. She is can take medicine to control her menses to ensure that she stays healthy.

My mother used to say about the pill "You don't give medicine to healthy people" - especially if it is to stop their natural functions.

Thus, given that NFP does not alter any natural function and is in the context of marriage, there is nothing disordered with the means. So any objections to NFP will be in the intent of NFP.
Intent
Intent is the purpose of the action (or inaction). Knowledge, while intrinsically good, it a double edged sword. We can use knowledge for good or evil. So while the action of something may not be intrinsically morally disordered, the context and the purposes maybe. For example, genetic sequencing of a virus.

Good if the intent is to find a treatment and a possible immunisation for the virus.
Evil if the intent to determine the best way to genetically engineer the virus so that no one will have immunity then to weaponise this pathogen. The action in each case is the same - sequencing a virus. But the intent is vastly different.

Similarly, NFP uses a body of knowledge about human physiology that allow a couple to know when they are fertile. How the couple use this knowledge is really up to them, and one will have to judge on their intent. 

The most common object to the intent of NFP seems to be that its use is rejecting God's providence, and not showing trust in Him. This is a rather narrow view of God's providence. It also ignores that God has given us reason, and the desire for knowledge and the ability to understand our world. God's providence means that we use our abilities and talents cooperating with the Almighty's plans - the parable of the Talents certainly emphasises that. There are a number of stories and jokes about Gods providence, such as rescuing a man from flood or winning the lottery. There are two points made with these stories. We are expected to exercise our natural reason and talents. It is not a passive acceptance of the divine will and that angels will do our work for us.

God may work in ways we do not expect or understand. Consider a couple who decide that they will trust in God's providence and not work or actively seek a means of living to support their family. We would not consider that an appropriate view of God's providence. We would certainly not think this is an example worth emulating and promoting: and telling couples who are working that they wrong because they are not trusting in God's providence.

This is a rather old problem - the Apostle Paul had this difficulty in some of his own converts, who refused work to trust in God's providence. As the Apostle wrote in 2 Thessalonians 3:10-13. While we were with you, we gave this order: “If anyone doesn't want to work, he shouldn't eat.” We hear that some of you are living in idleness. You are not busy working you are busy interfering in other people's lives! We order and encourage such people by the Lord Jesus, the Messiah, to do their work quietly and to earn their own living. Brothers, do not get tired of doing what is right. So if one wants to say that NFP is not trusting in God's providence, one will have to argue that using the knowledge of human physiology and fertility is somehow disordered.

The usual approach is to argue that NFP intrinsically promotes a "contraceptive mentality". Unfortunately, this is a very vague accusation and since it usually comes as an assertion without arguments, it is difficult to know what it actually means. While, yes, it can be used for contraception, the couple could also abstain altogether, or have a "Josephite Marriage" for contraceptive reasons. I rarely find those opposed to NFP also opposed to "Josephite" marriages.

NFP is also used to assist couples to conceive - again this knowledge is good. If one is opposed NFP for birth spacing, is one also opposed to it for this reason? If so, why? The problem is that the knowledge is there and it is up to the couple how they use that knowledge. To attack NFP is to fundamentally question the motives and virtue of those involved without providing an argument stronger then "I don't like it". This is not really a good argument.
Final Thoughts
When Jesus, our Divine Master, was teaching, he criticised the Pharisees for placing heavy burdens upon people and not lifting a finger to help them. I think He was also speaking directly to us: warning us that we should not lay burdens upon people without considering how it will affect them or providing them with the means to carry the burden. We should also take the Apostle's instruction seriously in getting on with our own lives and work and not interfere with other people's lives.

So unless there is a solid argument that using NFP is disordered, we should not place another burden upon families. Yes, we should trust in the providence of God, but God gave us reason, knowledge and intelligence. These are the highest faculties given in creation, and these are to be used to cooperate with God's providence."

27 comments:

  1. You might find this interesting also. From the Holy Father, Pope Pius XII's address to Midwives:

    "Today, besides, another grave problem has arisen, namely, if and how far the obligation of being ready for the service of maternity is reconcilable with the ever more general recourse to the periods of natural sterility the so-called "agenesic" periods in woman, which seems a clear expression of a will contrary to that precept.

    "You are expected to be well informed, from the medical point of view, in regard to this new theory and the progress which may still be made on this subject, and it is also expected that your advice and assistance shall not be based upon mere popular publications, but upon objective science and on the authoritative judgment of conscientious specialists in medicine and biology. It is your function, not the priest's, to instruct the married couple through private consultation or serious publications on the biological and technical aspect of the theory, without however allowing yourselves to be drawn into an unjust and unbecoming propaganda. But in this field also your apostolate demands of you, as women and as Christians, that you know and defend the moral law, to which the application of the theory is subordinated. In this the Church is competent."

    - continued -

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    1. "It is necessary first of all to consider two hypotheses. If the application of that theory implies that husband and wife may use their matrimonial right even during the days of natural sterility no objection can be made. In this case they do not hinder or jeopardize in any way the consummation of the natural act and its ulterior natural consequences. It is exactly in this that the application of the theory, of which We are speaking, differs essentially from the abuse already mentioned, which consists in the perversion of the act itself. If, instead, husband and wife go further, that is, limiting the conjugal act exclusively to those periods, then their conduct must be examined more closely.

      "Here again we are faced with two hypotheses. If, one of the parties contracted marriage with the intention of limiting the matrimonial right itself to the periods of sterility, and not only its use, in such a manner that during the other days the other party would not even have the right to ask for the debt, than this would imply an essential defect in the marriage consent, which would result in the marriage being invalid, because the right deriving from the marriage contract is a permanent, uninterrupted and continuous right of husband and wife with respect to each other."

      - continued -

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    2. "However if the limitation of the act to the periods of natural sterility does not refer to the right itself but only to the use of the right, the validity of the marriage does not come up for discussion. Nonetheless, the moral lawfulness of such conduct of husband and wife should be affirmed or denied according as their intention to observe constantly those periods is or is not based on sufficiently morally sure motives. The mere fact that husband and wife do not offend the nature of the act and are even ready to accept and bring up the child, who, notwithstanding their precautions, might be born, would not be itself sufficient to guarantee the rectitude of their intention and the unobjectionable morality of their motives.

      "The reason is that marriage obliges the partners to a state of life, which even as it confers certain rights so it also imposes the accomplishment of a positive work concerning the state itself. In such a case, the general principle may be applied that a positive action may be omitted if grave motives, independent of the good will of those who are obliged to perform it, show that its performance is inopportune, or prove that it may not be claimed with equal right by the petitioner—in this case, mankind."

      - continued -

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    3. "The matrimonial contract, which confers on the married couple the right to satisfy the inclination of nature, constitutes them in a state of life, namely, the matrimonial state. Now, on married couples, who make use of the specific act of their state, nature and the Creator impose the function of providing for the preservation of mankind. This is the characteristic service which gives rise to the peculiar value of their state, the bonum prolis. The individual and society, the people and the State, the Church itself, depend for their existence, in the order established by God, on fruitful marriages. Therefore, to embrace the matrimonial state, to use continually the faculty proper to such a state and lawful only therein, and, at the same time, to avoid its primary duty without a grave reason, would be a sin against the very nature of married life.

      "Serious motives, such as those which not rarely arise from medical, eugenic, economic and social so-called "indications," may exempt husband and wife from the obligatory, positive debt for a long period or even for the entire period of matrimonial life. From this it follows that the observance of the natural sterile periods may be lawful, from the moral viewpoint: and it is lawful in the conditions mentioned. If, however, according to a reasonable and equitable judgment, there are no such grave reasons either personal or deriving from exterior circumstances, the will to avoid the fecundity of their union, while continuing to satisfy to tile full their sensuality, can only be the result of a false appreciation of life and of motives foreign to sound ethical principles."

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  2. Thank you for contributing Nicole

    There is so much to study

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  3. Wonderful post, Bear! There is a lot of judging and mis-reading going around and it's nice to read such a clear, concise explanation of Church teaching. Great job!
    -F

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  4. Two things I learned yesterday about childbearing from two solid sources, Father Brian Mullady, O.P. at a mission who made the observation that Our Blessed Mother was the midwife of St. Elizabeth and therefore she was the first person John the Baptist saw when he was born. Then the second source is my daughter in law who said...regarding the same two Holy Women, that she was going to find out what sex her baby was because both of them knew the sexes and names of their "boys". Interesting...she said she thought it was a part of our nature that we lost at The Fall. These are things I will always ponder with wonder.

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  5. St. Elizabeth Anne Seton didn't know the sex of her children. That's why I'm not finding out the sex of my child.

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  6. --------------
    "The usual approach is to argue that NFP intrinsically promotes a "contraceptive mentality". Unfortunately, this is a very vague accusation and since it usually comes as an assertion without arguments, it is difficult to know what it actually means. While, yes, it can be used for contraception, the couple could also abstain altogether, or have a "Josephite Marriage" for contraceptive reasons. I rarely find those opposed to NFP also opposed to "Josephite" marriages."
    --------------

    In regards to this portion of the blog I must say, first of all, a continent marriage or "Josephite" marriage is usually observed for two possible purposes: 1) to imitate the greatest marriage of humanity - that of the Theotokos and St. Joseph, or 2) to simply avoid the conception of children. The first reason, is of course the greater of the two reasons. However, the second reason is not evil or wrong or impure AND it is most definitely NOT comparable to the use of NFP to avoid conceiving. The reason it is not comparable is because a married couple's decision to have intercourse during the time period when a woman is naturally infertile during her cycle is a decision where the couple actively choose to indulge in fleshly pleasures while intentionally seeking to not participate in procreation, which is the ultimate goal of intercourse. However, in practicing a "Josephite" marriage to avoid conception, the couple does NOT indulge in fleshly pleasure of intercourse while intentionally divorcing it from the procreative act. So to compare the two is absolutely incongruent.

    One must understand that a "contraceptive mentality" does not simply mean a mentality where one wants to avoid having children, but rather a mentality where one wants to avoid having children WHILE STILL INDULGING IN THE FLESHLY PLEASURE OF INTERCOURSE.

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  7. SC- I'm not really clear about where you are going here

    First about the Josephite marriage for non-spiritual reasons- I suppose if a marriage is always continent because they went into the marriage knowing there was an extremely dire medical condition that only total abstinence would protect

    NFP to space children is for those couples who still desire the unitive aspect of the marital act even when they are most likely (but not guaranteed)infertile, but the act is still procreative because they have not done anything unnatural to avoid another pregnancy.

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  8. Bear- I haven't really commented on your post -but the most important aspect I believe is the final thought where we cannot judge a married couple for why they use NFP- that puts a burden on the couple that the Church doesn't put. Simcha Fisher wrote a great post "Why doesn't the Church make a List?"- that is along the same lines as your last thought.

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  9. priest's wife -

    "NFP to space children is for those couples who still desire the unitive aspect of the marital act even when they are most likely (but not guaranteed)infertile, but the act is still procreative because they have not done anything unnatural to avoid another pregnancy."

    In response to that comment I must say, an act is procreative only when it is COMPLETELY open to conception. When a couple knows that the chances of them conceiving are slim to none, and they still engage in the marital act, it isn't exactly a procreative act. The natural-ness of the method does not by any means deem it any more procreative and an unnatural method. In fact, people promoting NFP, as well as studies, discuss how it is 99% effective, whereas condoms are only about 70% effective. By this logic, a condom would be more open to life than NFP.

    Going back to what I was saying, if a couple doesn't keep track of the woman's cycles and just engages in the marital act without knowing if she is fertile or infertile, they are truly engaging in a unitive AND procreative act. Also, if a couple charts the cycles and abstains completely during the infertile periods, then too they are being unitive and procreative when they have intercourse only during the woman's fertile periods. Simply because the act is unitive doesn't make it ok to perform, unless it is procreative as well. It's not an either-or situation, but instead an "and" situation. The act ought to be unitive AND procreative. And knowingly having intercourse between the woman's fertile periods with the intention of not conceiving is NOT procreative.

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    1. SC - I'm confused, probably because I'm so used to seeing arguments against NFP in the opposite direction. You object to NFP because of its contraceptive nature? I think you may be mistaking Theology of the Body for a Quiverful manifesto. God created us perfectly. If He had intended us to always be actively fertile and open to pregnancy, He would have designed us so. He does nothing by accident - He is always intentional. Because He gave us days of fertility and days of infertility, and by designing our bodies in a way so that we can read the signs of fertility - because of this we can see the beauty of His workmanship, and of His plan.

      As someone told me, improbable is not impossible - God can work miracles. NFP allows Him to do that.

      And, I have a question for you:
      Shortly before our marriage, we discovered that I have PCOS, and that I do not always ovulate. In fact, sometimes months go by where I do not ovulate at all. Because of this syndrome, it's entirely possible that I may be infertile. The Church teaches that our marriage is no less blessed, and that our sex is no less unitive - even if it may not be possible for us to procreate.

      So, by your logic, my husband and I shouldn't engage in sex because I might never be fertile?
      If you think so, I think you drastically misunderstand the purposes of marriage and sex.

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    2. Kate - Thanks for taking the time to comment- I have a feeling that SC would say it is ok for you (maybe infertile) to have relations because you are never thinking "I hope I don't conceive this cycle"- except maybe sometimes you do- like when you are doing the math and think- hmmm- if I get pg this cycle, I can do nothing at Disneyland when we go

      But the point is- we are in the minority of people who aren't using unnatural means to delay pregnancy- I think we rock

      are one of the two bloggers that is starting the "I use NFP" blog?

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    3. :-) No, I wish I was! That's Katie of NFPandMe (I know, too many Kates & Katies) and Kayla of the Alluring World.

      I still think their argument is invalid, as they seem to be implying that any sex in which you're unlikely to conceive is sinful.

      But, then again, the argument is murky at best, so that might not be what they're saying at all.

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  10. Just to clarify a statement I made above:

    "When a couple knows that the chances of them conceiving are slim to none, and they still engage in the marital act, it isn't exactly a procreative act."

    What I mean is: When a couple knows that the chances of the conceiving are slime to none, and they still engage in the marital act WITH THE INTENTION OF NOT CONCEIVING, it isn't exactly a procreative act.

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    1. So the marital act post-menopause is wrong because it is not procreative?

      Bear

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  11. SC- so I understand from your comments that a married couple cannot have intercourse during knowingly infertile times if they seek to be both unitive and procreative? Because if a woman has 'normal' thirty day cycles, she doesn't really need to be charting to realize when she is most likely infertile

    For me and I believe the theology of the Catholic Church- we need to go back to bear's final paragraph about not putting an undue burden on married couples who are not using artificial birth control

    SC- your final comment I think is half right- but is a couple 'allowed' to engage in marital relations when they know they probably won't conceive? I think you would say yes because the couple is not putting a barrier to life.

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  12. This is Simcha's post that I think is pretty eloquent about this issue:

    http://simchafisher.wordpress.com/2011/03/23/why-doesnt-the-church-just-make-a-list/

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  13. Some ideas- Sex is marriage needs to unitive and procreative.

    http://www.vatican.va/archive/ccc_css/archive/catechism/p3s2c2a6.htm

    http://www.ewtn.com/library/MARRIAGE/PROCUNIT.TXT

    Unitive means that it is a means to become one body- an act that unifies the married couple- an act that they can only perform together, etc. It is a "mutual gift of self" to the other

    Procreative means that there cannot be unnatural acts or barriers/artificial birth control to the possibility for procreation

    Does the marital act have to be 100% unitive and 100% procreative to be a perfect act?

    What if the act is not perfectly unitive in that it was not a perfectly unified mutual gift of self in that one spouse was a bit sick and not completely giving during the marital act?
    Or perhaps one spouse was feeling resentful about a past hurt from the other spouse and thus that hurt spouse was not perfectly emotionally open to the gift of self- that act was not perfectly unitive

    What if the act was not perfectly procreative in that they knew that most likely ovulation had occurred- but they did nothing to 'guarantee' a pregnancy-free cycle?

    My point is- we need to look to the Church and not be 'more Catholic than the Pope'

    The Church provides what is lacking in our imperfect nature- the marital act is unitive and procreative is the couple is married sacramentally and have done nothing to unnaturally bar life.

    Yes, this means that couples who know they will 99.999999999999% not conceive a child are 'allowed' to have marital relations. Splitting hairs and accusing couples who are spacing children with NFP (basically just a knowledge of the cycle God gave women- you would have to be actively ignoring the cycle to not be aware of what is going on each month)

    Scrupulosity is a dangerous game to play- because if you go down this road then a married couple can only have marital relations about a week a month or they might have a 'contraceptive mentality' because they MIGHT be having relations with the hope that God don't send them life this month.

    I can tell you- many faithful couples with a house full of lovely children might want to space for many reasons (maybe simply a mom needing more than 2 hours of sleep-mental health IS a serious reason!- I say- give them a break- the Church says they can abstain from fertile periods to avoid pregnancy that cycle as long as nothing unnatural is done.

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  14. SC - Please don't make our burdens heavier.

    Me and my wife have 4 wonderful boys; ages 8, 6, 3, and 17 months. Every one of them is a amazing gift. My wife delivered all of them via cesarean section. Two were emergencies. One of the emergencies was because of a uterine rupture. She also had a miscarriage 8 weeks ago.

    We are using NFP on the recommendation of a good and holy priest.

    If the Lord gave a child today, we would welcome it and love it, but we are not at a point where we could actively try to conceive another child.

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  15. Mad Cow- I am so sorry for your loss.

    Luckily, SC and me and you are 'just' Catholics with opinions and we have much higher sources from which to study what is good. Let's start with papal documents. Using NFP to space children is a way for married couples to benefit from the unitive and procreative goods of the marital act (I say any marital act with no artificial birth control is procreative- there's a PhD dissertation in that for anyone with is interested...)

    Mad Cow- your assignment....Hug your wife, Hug your kids, cry (if you can), and in a while have your wife go to a homeopathic doctor to help prepare her if she gets pregnant again. NOT to give her a guilt trip!!! So- maybe don't suggest this for a year or so. I say she is a rock star already- having 4 c-sections. Stinging nettle and red raspberry leaf tea will be good. But this is a time when you can really help her- don't drive her crazy, but make sure she is getting enough sleep (a 17 month old makes this not so easy) and watch for signs of depression- even if she isn't really the type to become depressed, her hormones have been through a lot.
    Madcow, your wife and you are doing what most in the world refuse to do- trust God's plan for your family by watching the fertility signs He created and abstaining during apparently fertile times- a sacrifice of love to give your family some breathing space and also time for your wife to heal. Nothing unnatural- just some time to sacrifice

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  16. The thing about practicing NFP to avoid pregnancy, is that the couple avoids intercourse during the time that they most want sex. So they sacrifice something significant in order to avoid. I think this dynamic provides a kind of natural checks-and-balances that protects against using NFP for purely selfish motives. In my own experience having the example of my husband practicing self mastery over something so powerful as his sexual drive for my benefit and the good of our marriage has been incredibly healing for me. It has communicated his respect for me as few things could. And also gaining self mastery myself has been liberating. Due to pregnancy and breastfeeding, my husband and I have had long periods of time where we did not abstain monthly and honestly sex became more routine and at times I felt taken for granted. I think the periods of abstinence in using NFP to avoid pregnancy has increased the unitive aspect of intercourse during the times we are able. Also, when we have used NFP in order to achieve pregnancy, having the knowledge that it is this time God might use to create a new life adds an additional dimension to the act.

    It seems to me if God intended every act of intercourse to result in pregnancy He could have a) made women fertile all the time, like men, or b)made humans like many animals that only desire sex when they are fertile. But God has given me seasons. Seasons of fertility and seasons of infertility, and if a particular act of intercourse is not fertile, it is not me who has rendered it so, it is God. There are so many ways that I feel NFP has blessed my marriage and has given me a profound reverence to the way God has created women.

    If couples are in the financial, emotional,and physical condition to not use NFP and accept all children that may come, great. But many people are not in this position and it seems rather unkind to say that sexual union in marriage can only be the privilege of people who are financially, emotionally, and physically stable enough to do so.

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  17. My Feminine Mind- Thanks for taking the time to comment

    "Seasons of fertility and seasons of infertility, and if a particular act of intercourse is not fertile, it is not me who has rendered it so, it is God." Ok- I think this sentence especially is perfect for the discussion- and yes, this too- "It seems to me if God intended every act of intercourse to result in pregnancy He could have a) made women fertile all the time, like men, or b)made humans like many animals that only desire sex when they are fertile." YES!

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  18. I am saddened that someone would accuse NFP-practicing Catholics of being closed to life for using the signs God gave us to understand our cycles and make responsible decisions for our families. I don't want to repeat what others have said already, all of which I agree with, but would just like to point out that the marital act is always procreative when no unnatural barriers are put in place. NFP is completely natural and allows couples to participate fully in the marital act while being completely unitive AND procreative. And, nothing is impossible with God; if He wants a child to be conceived He can allow that to happen.

    The logic that a couple having sex during known infertile times is having a contraceptive mentality means that the Church would expect a couple to be completely abstinent from the time of menopause on or a couple may have to be completely abstinent from the time a baby is born until the woman's fertility returns, which could be as short as 4-6 months or as long as 15 months or more depending on what level of breastfeeding is taking place, etc. That is a lot of burden to put on couples and completely unrealistic. This is why NFP is a gift.

    I would also like to point to an article on this very subject that I think is very insightful: NFP: 5 Truths Everyone Should Know

    From my own personal experience, my husband and I learned NFP prior to marriage so that we had that knowledge if we should ever need it. And we have. But in addition, we have experienced many long periods of infertility that were very painful and difficult emotionally. To require abstinence from us during those times would have put great strain on our marriage. The Church would NEVER ask such a thing from us. We have also experienced two miscarriages and a stillbirth. Again, having that knowledge of my cycles was helpful when we needed to avoid conceiving for a period of time for my mental and emotional health. Currently we have twin boys that are 10 months old, we are open to having more children, but we need to wait a bit for a variety of reasons, which I will not go into because they are between my husband and I.

    SC: I hope this helps you see the flaws in your logic. Having knowledge of NFP does not mean we need to keep our marital relations to only fertile periods and no other time. From someone who has incredibly long cycles, that would mean my husband and I would only get a week or so every 3-4 months. Is that really what God wants for my marriage? I don't think so.

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  19. I've heard that there are women whose cycles are predictable enough that they can be confident in their stage of the cycle at any day.

    I've never met any of those women!

    Also : THANK YOU to Bear for reminding us that using birth control pills for legitimate medical reasons, not for contraception, is not bad in and of itself. I took the pill throughout high school and college because my body could not regulate its hormones & I was in very severe medical trouble. I won't go into graphic details, but it was physically necessary, and I had exhausted all other options (through the help of various doctors). I eventually was able to stop using it, but I am grateful that I could find a solution to a debilitating and serious problem.

    MadCow : I am so, so, so sorry. My mother had both myself and my brother by emergency cesareans, and I know how difficult her recovery was with my brother. I hope you are all able to sleep soon.

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thanks for commenting! (comments on old posts are moderated)