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A little background on Numbers 5:11-31 is in order, because this is a rather unusual passage. It is a situation in which a husband suspects his wife is an adulterer but has no evidence. He could then bring her before a religious tribunal, and she would drink a concoction that would either prove or disprove the charge of adultery. There are no other such trial/ordeals in the Old Testament. While there is the occasional drawing of lots to determine guilt, this is the only time that someone must undergo some kind of trial where the results are believed to reveal the truth.
Such practices were more common among non-Jews in the ancient Middle East. Many scholars think that this practice was adopted to prevent women from becoming victims of jealous husbands and misogynist judges. We need to remember that ancient Judaism had a deep distrust of human judgment and human justice. In situations where the ancient Jews felt a judgment must be rendered and it did not have sufficient “checks and balances” on human prejudices, they would turn to ways of perceiving divine judgment.
To condemn someone for adultery, there had to be two witnesses, and the perpetrators had to have been warned in advance. But situations in which a husband was “sure” that his wife had committed adultery but could not prove it created such a strain on the marriage and the local community that they felt something had to be done to bring closure and resolution to the matter. Given the Jewish distrust of human notions of judgment and justice, having a group of men make the judgment probably seemed like a bad idea to them. It appears that they adopted, in this one instance, a sort of ordeal/test for the wife to go through if she insisted on her innocence.
Given that it’s generally assumed that the concoction is not actually a threat to health, the only way a bad reaction would occur would be because of psychological reaction due to a guilty conscience.
As strange as this matter is in the Old Testament, it also has no real attestation from the biblical period. It’s never mentioned again in the Bible, and it’s mentioned by only a few historical figures and writings—but always as something that they have heard about, never about an actual case they witnessed. Some of the recollections of the procedure also differ from the biblical method. And the Mishnah states the practice was stopped. So there is some question of whether this was ever actually used.
But it is in the Bible, so what would happen if she was guilty? Well, that depends on your translation. Some translations state that if she is guilty her “uterus will fail” or “shrink,” which would mean that she would become infertile. A few translations do translate that if guilty she will “miscarry,” but this is a distinct minority of translations.
It is important to note that the “reward” for innocence is that she will be able to conceive children, which seems to imply that even if she was infertile she would no longer be. This would also seem to imply that miscarriage is not what is being referred to as divine punishment but rather infertility.