The Pastoral of the Church has always availed itself of the contribution of laymen, even more so after Council Vatican II. Today the contribution of laymen to the Pastoral is even more necessary given the decrease of sacerdotal and religious vocations.

In particular, the Pastoral of the Church in the world of Health needs laymen in order to accomplish Christ's mandate: to announce the Gospel and to heal the sick. Healing the sick is not something to be added as an afterthought, but it is almost an integral part of evangelization, it is that which makes it believable. Jesus himself characterized his announcement "healing the sick".

It is for this reason that in the course of the centuries the church developed deaconries, hostels for pilgrims, monastic infirmaries, religious orders devoted to the assistance of the ill. It is for this reason that the church invented the very concept of Hospital and largely contributed to develop those features we nowadays know. Even when the modern states, after the French Revolution, began to be interested in health, in order to maintain the ideal of sanitary assistance high, the church favoured the founding of catholic sanitary institutions all over the world. From the prestigious great hospitals and faculties of medicine of Catholic Universities to the dispensaries in the mission countries. As of today, the church still is the major single non governmental health provider in the world.

This enormous effort was not/is not aimed only at making up for the fact that governments did not show any concern for some forms of poverty and marginalization; the effort was and is a witness to the fact that attention directed to the human person is not true unless the whole of man is involved, even when he is frail, weak, decayed, and all men are involved, even when they have been abandoned, and their social weight and their importance in the society of productivity and commodities are no longer significant.

It is for this reason that we can say with pride that the effort of the church in the world of health greatly contributed to the development of human civilization, favouring all over the world the growth of a culture of mercy and of compassion, of rights and of the respect of man in all situations of life and in all phases of existence.

But the presence of the church in the world of health was and is dictated by the awareness that it is precisely when man expresses the need to be healthy that he is led to question himself on the fundamental questions of life, the meaning of birth, of suffering, of dying. The church is aware that a correct answer to these questions can also condition the answer to other questions on which the religious consciousness of man is founded. Who am I? Where am I going? What meaning does my life have? The need to regain health can lead to asking for salvation (salus).

It is for these reasons that, even in non-catholic hospitals, the church always favours the presence of chaplains, of sisters of nursing orders, of doctors and nurses with catholic training and faith, of volunteers inspired by the model of the Good Samaritan.

In this sense the specialist doctor in Obstetrics-Gynaecology and the obstetric nurse share the responsibility of every catholic health worker for the church health pastoral.

Today, however, their role has become much more important and their responsibility is bigger. Up to a few decades ago in fact doctors' morality and catholic morality were rarely in contrast and the catholic doctor had no difficulties in making available to his patients all that medical science offered, without for this reason suffering from conflicts of conscience. It is true, there have always existed doctors and midwives who performed abortions, but they did so outside the common moral recognized by the profession and in a hidden manner because they would be blamed. When I studied medicine, the forensic medicine textbook distinguished only four types of abortion: spontaneous, therapeutic (only to save the mother's life), eugenetic and criminal. On the latter two types the professional blame was extremely clear.

Things have deeply changed in the past decades. The availability of methods of pharmacological contraception, the feminist movement, the introduction of abortions in a great number of legislations, the growing possibilities offered by genetics of discovering illnesses before birth, the development of techniques of in vitro fertilization, the consequent production of embryos with the objective of curing sterility, their availability to scientific research, the discovery of the potential of embryonic cells for the development of useful tissues for transplantation for the cure of degenerative illnesses, the hypothesis of total or partial cloning already realized in the animal kingdom, all this has radically changed the scene.

Pregnacy and childbirth are no longer seen as acts which are, most of the times, physiologic; they are instead often lived as a disgrace and an illness which the doctor must take upon himself to cure. A son is no longer seen as a gift, but as an object of desire, to be made only if one wants, when one wants, and to be accepted only if the gift is well packed and is not damaged.

Medicine no longer has as its objective the defense of life, it is more worried about the quality of life.
International organizations gave up the fight so that the fundamental health rights be ensured to all populations and social strata; they only worry about reducing the request of such rights, favouring a fall in the birth rate all over the world.

The ambiguous term of "reproductive health" has been created behind which, together with the prevention and control of gynaecological illnesses, contraception, abortion, sterilization, fall in birth rate, are publicized, offered and imposed to governments and health workers, while we still worry too little about maternal mortality, still too high in some countries in the world and in some social strata even in developed countries.

The catholic obstetrician gynaecologist and the midwife are naturally in the middle of these tensions and changes. The catholic obstetrician gynaecologist has always been the doctor of women, and he feels upon himself the pressure of a social ideology that would like to make of him an instrument so that the reproductive health we mentioned might be realized in a safe and efficient way, and so that the new reproductive technologies are developed. While this pressure is exerted upon his conscience, he also feels responsible for being the doctor of the youngest and weakest among men, the defender of those who have no voice, who express no vote, who have no economic nor social weight.

In some situations the conflict between social pressure and the responsibility of conscience can become unbearable. It can lead on the one hand to giving up the profession so as not to subordinate conscience; on the other hand, to compromise and conformity so as not to give up the profession.

This conflict takes place every time the young doctor is asked to apply abortive intravenuous infusions during the period of rotating internship, when he is asked about his independence from "religious prejudices" before he can have access to the programs of specialization; when during the period of training for specialization he is forced to take part in turns of activity, foreseen in the curriculum of his studies, that require the performance of abortions or the taking part in IVF techniques; when, after specialization, he is refused jobs because reserved to personnel who will guaranteee all the activities advertised by the service, abortions included; when some carreer possibilities are closed to him because he does not have experience in all the professional fields that the managing role requires; when even the agencies of the United Nations or of other financing centres refuse the requests of NGOs which do not include, in their projects of international health cooperation, abortion and sterilization among the methods for ensuring family planning in developing countries.

If to this we add the fact that in any case the catholic obstetrician gynaecologist faithful to the Magysterium of the Church is seen as a retro character, one cannot be surprised if, everywhere, catholic obstetricians-gynaecologists are diminishing and in some situations they risk to disappear completely.

Yet this continuous, progressive decrease of catholic obstetricians gynaecologists seems to have taken place without provoking excessive alarm in the church.

While, rightly, abortion has continued to be condemned, natural methods of planning have been proposed, the dangers for the future of human civilizations implied in embryo manipulation, both for scientific scopes and for the cure of sterility with IVF, and for the selection of carriers of genetic illnesses and finally for the production of staminal cells, have been denounced, perhaps we did not sufficiently realize that the defense against these ills became ever weaker as catholic obstetricians gynaecologists disappeared and the remaining ones ended up almost feeling guilty of their own convictions.

To whom in fact does a woman address herself in order to obtain information on how to control her fertility? To whom does she ask for advice in order to solve difficulties in her sexual life as a couple? To whom does she wish to talk when an undesired pregnancy turns upside down hers and her family's plans? To whom does she ask to be helped to overcome the ever more frequent cases of sterility?

The woman first of all seeks the help of the specialist doctor in obstetrics or gynaecologist, the doctor of women. He is in fact also their confidant, the keeper of their innermost secrets, perhaps even more so than the confessor.

A medical doctor who is respectful of the needs of morality and who is convinced of the Magysterium of the Church can help her live her doubts and difficulties in the light of faith. Only an obstetrician who is convinced of his own responsibilities as a cousellor and guide of the Christian woman can contribute to the strengthening of the family, to the culture of welcoming the newborn, who represents a gift. Only a catholic obstetrician-gynecologist can suggest the use of natural methods, can make her reflect upon the consequences of abortion, can advise her to adopt a baby rather than undergo IVF. Only a catholic doctor specialized in obstetrics can provide a valuable contribution to the sexual education of young women, and to the preparatory courses to marriage.

Only an obstetrician-gynecologist can contribute to the education of future medical doctors and of future midwifes in the respect of life. Only a medical doctor who loves life can promote research that is respectful of mankind.

It is for these reasons that the catholic obstetrician-gynecologist medical doctor must not disappear.

We must be alert so as not to make this happen, so that the right to be trained and to exercise the profession according to conscience be respected, we must object every time this right is violated, we must help those who suffered discrimination for having been witnesses of their faith to the teachings of the church.

It is the call of the Pope E.V.74.
"To refuse to take part in committing an injustice in not only a moral duty; it is also a basic human right. Were this not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the true and the good, would be radically compromised. What is at stake therefore is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities. Those who have recourse to conscientious objection must be protected not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane."

We must make this call ours and we must actively undertake works and initiatives that may render it effective. Some actions seem to be particularly necessary.

Local Churches have to keep attention focussed on the medical profession, proposing the ideal of a profession respectful of life, standing by those health workers who are respectful of the right to life, particularly obstetricians-gynaecologists, favouring their getting together and cultural expression.

The denouncing of cases of violation of the right to be trained and practice according to one's own moral convictions must be coordinated and systematic; it must reach the desks of the media, of professional associations, of national and international organizations for the defense of human rights.

Catholic Universities and Hospitals must fully respect the indications of the Magysterium, both with regards to research involving embryos and in all the instances of obstetric-gynaecologic practice, while Bishops should feel responsible for vigilating in order to prevent misconducts that, despite everything, continue to take place.

The same Institutions should provide a qualified and internationally recognized teaching network, to permit at least to offer possibilities of specialization in obstetrics and gynaecology to those physicians who suffer discrimination or unacceptable pressures on their moral beliefs.