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'Natural family planning' (NFP) is a term referring to the family planning methods approved by the Roman Catholic Church. In accordance with the requirements for sexual behavior maintained by this church, NFP forbids the use of contraception, as well as all orgasmic acts outside of those achieved through unprotected vaginal intercourse with the user's spouse.
There are only two methods permitted by the Catholic church for avoiding pregnancy. The primary method is periodic abstinence during the fertile period of each menstrual cycle. Methods used to identify the fertile period may rely either on a woman's records of cycle length or observation of fertility signs. These methods may also be used to help achieve pregnancy.
The other method permitted is intentionally extending the natural period of infertility caused by breastfeeding. The Catholic church permits sex during pregnancy, and after the woman goes through menopause.
Prevalence
It is estimated that 2-3% of the world's reproductive age population relies on periodic abstinence to avoid pregnancy.[1] Breastfeeding is believed to reduce the world's fertility rate by 30-45%.[2] However, what portion of this population should be considered NFP users is unclear. Some Catholic sources consider couples that violate the religious restrictions associated with natural family planning to not be NFP users.[3]
There is little data on the worldwide use of natural family planning. In Brazil, NFP is the third most popular family planning method.[4] The "safe period" method of fertility awareness is the most common family planning method used in India, although condoms are used by some.[5]
Use of NFP in developed countries is low, even among Catholics. While Catholics made up 24% of the U.S. population in 2002,[6] only 1.5% of sexually active Americans avoiding pregnancy were using periodic abstinence.[7]
Use of NFP may not be restricted to Catholic couples. In 2002, Sam and Bethany Torode, then a Protestant Christian couple, published a book advocating NFP use.[8] (Five years after authoring the book, the Torodes redacted their advocacy of NFP-only to also support barrier methods as moral. The Torodes converted to Orthodox Christianity.[9])
Methods
There are three main types of NFP. These are the observational methods, the statistical or "calendar" methods, and the lactational amenorrhea method. Observational methods rely on biological signs of fertility, while statistical methods approximate the likelihood of fertility, based on the length of past menstrual cycles.
Observational
Some methods of NFP track biological signs of fertility. When used outside of the Catholic concept of NFP, these methods are often referred to simply as fertility awareness methods rather than NFP. The three primary signs of a woman's fertility are her basal body temperature, her cervical mucus, and her cervical position. Some systems use only cervical mucus to determine fertility. Two well-known mucus-only methods are the Billings ovulation method and the Creighton Model FertilityCare System. If two or more signs are tracked, the method is referred to as a symptothermal method. Two popular symptothermal systems are that taught by the Couple to Couple League, and the Fertility Awareness Method (FAM) taught by Toni Weschler.[10] Some fertility monitoring devices accept and interpret temperature readings, use urinalysis to follow changes in levels of estrogen and luteinizing hormone, or both.
Statistical
These methods make statistical estimates as to when a woman is fertile. They include the Rhythm Method and the Standard Days Method.
Lactational amenorrhea
The lactational amenorrhea method (LAM) is a method of avoiding pregnancies which is based on the natural postpartum infertility that occurs when a woman is amenorrheic and fully breastfeeding. The rules of the method help a women identify and possibly lengthen her infertile period. A strict version of LAM is known as ''ecological breastfeeding''.
Effectiveness
The Rhythm Method, which is sometimes considered NFP,[11] but also not classified as NFP by the United States Conference of Catholic Bishops,[12] has a perfect-use failure rate of 9% per year, while observational and lactational methods of NFP have lower perfect-use failure rates — between 1%-3% per year. The common usage failure rate is up to 25% per year.[13][14]
Theology
Main articles: Christian views on contraception#Roman Catholic Church
Official Catholic
Catholic doctrine holds that God created sexual intercourse to be both unitive and procreative.[15]
The Church considers deliberately altering fertility or the marital act with the intention of preventing procreation to be sinful. Thus, artificial birth control methods and orgasmic acts outside of full marital intercourse are forbidden, while not having sex at all (abstinence) is considered morally acceptable. [16] While deliberate orgasmic acts apart from a culmination in full marital intercourse are forbidden, the Church does not condemn foreplay in the context of sexual relations within marriage. Foreplay is unobjectionable as long as the act culminates with the husband penetrating his wife's vagina with his penis and ejaculating while penetrating. [17] The Catholic Church does not condemn accidental premature ejaculation.
Having sex at an infertile time in a woman's life (such as pregnancy or post-menopause) is also considered acceptable, since the infertile condition is considered to be created by God, rather than as an act by the couple.[18] Similarly, under Catholic theology, it may be morally acceptable to abstain during the fertile part of the woman's menstrual cycle.[19]
Increasing the postpartum infertile period through particular breastfeeding practices — the lactational amenorrhea method — is also considered a natural and morally unobjectionable way to space a family's children.[20]
The Catholic Church acknowledges a potential benefit of spacing children[21]
and use of NFP for this reason is encouraged. ''Humanae Vitae'' cites "physical, economic, psychological and social conditions" as possibly compelling reasons to avoid pregnancy.[22]
Couples are warned, however, against using NFP for selfish, immoral, or insincere reasons.21
Many Catholic sources extol the benefits children bring to their parents, their siblings, and society in general, and couples are encouraged to have as many children as their circumstances make practical.[23]
In the 1950s and 1960s, Jesuit Fathers John C. Ford and Gerald Kelly argued that "even with absolutely no excusing cause based on health, economics, etc., no married couple is bound by the law of God to have more children than is necessary for the general conservation and gradual increase of the human race." They stated in a 1964 publication that "today in the United States a family of four children would be sufficient to satisfy the duty." Frs. Ford and Kelly wrote that a majority of theologians at a 1952 meeting of the Catholic Theological Society of America agreed with this position.[24] In 2006, Catholic theologian Thomas Stork argued that, while four children may not necessarily be the correct number, "the general approach of these authors and of the pre-conciliar moralists was correct."[25]
Dissident and other opposing
Many Catholics have voiced significant disagreement with the Church's stance on contraception.[26] The Canadian Conference of Catholic Bishops issued probably the most heavily dissenting document, the Winnipeg Statement. In it, the bishops argued that many Catholics found it very difficult, if not sometimes impossible, to obey ''Humanae Vitae''. Additionally, they reasserted the Catholic principle of primacy of conscience.[27] Former Catholics such as Fr. Charles Curran have also criticized the stance of ''Vitae'' on artificial birth control.[28]
Theological opposition has additionally come from Protestant Christianity. John Piper's ''Desiring God'' ministry states of NFP, ''"There is no reason to conclude that natural family planning is appropriate but that "artificial" means are not."''[29] Sam and Bethany Torode, former advocates of NFP-only, have redacted their position to include barrier methods and explain their current theology this way:
:''We also see honest congruity with the language of the body by saying "no" to conception with our bodies (via barrier methods or sensual massage) when our minds and hearts are also saying "no" to conception. We don’t believe this angers God, nor that it leads to the slippery slope of relativism or divorce. We strongly disagree with the idea that this is a mortal sin.... it’s a theological attack on women to always require that abstinence during the time of the wife’s peak sexual desire (ovulation) for the entire duration of her fertile life, except for the handful of times when she conceives.''9
Potential advantages
Fertility awareness methods of NFP can be used to track reproductive health in general, and aid in the diagnosis of gynecological health and/or fertility problems. Particularly with the Sympto-Thermal Method, which is based on a scientific method of self-observation, temperature, external and internal mucus, and cervical observations are all recorded daily on a calendar. Any observation of irregularities may prove helpful, providing a doctor or gynecolotist with important diagnostic information with dates and a personal history of any abnormalities.[30] The fertility knowledge gained from NFP methods may also be used to help achieve pregnancy.[31]
Since NFP methods do not interfere with natural female hormone cycles, NFP is not proven to have any physical side effects. Relatedly, intercourse may be spontaneous, as compared to the use of condoms.[32] However, intercourse is not spontaneous during the days where sex is forbidden.
NFP can be free or very low-cost.31 Some methods encourage the use of a thermometer and/or photocopied charts, which can be obtained relatively inexpensively. Some couples choose to use software or to use other devices such as a string of beads for counting the days.
Divorce rate
Proponents of NFP say it increases marital satisfaction and helps lower divorce rates. Anecdotal evidence and small studies are put forth in support of this view.[33]
One study involving 505 women using NFP found a correlation between lower divorce rates and the use of NFP.[34]
Claims regarding communication
Fertility awareness forms of NFP (which require daily charting of fertility signs) can result in couples communicating more about their bodies and sexuality; this is said to improve communication skills throughout the entire marriage. One idea, called a "courtship and honeymoon effect",[35] is that the scheduled abstinence encourages couples to express love in non-genital ways, and to have a greater appreciation for intercourse when it does happen.[36]
Potential disadvantages
Abstinence requirement
★ The fertility awareness and statistical forms of NFP require periodic abstinence, known as continence, most commonly 8-10 days of each menstrual cycle. It is common for the woman's sexual desire to be highest on those fertile days, and low in other parts of the cycle.[37] That the couple must abstain from sex during the woman's periods of peak sexual desire may be deeply frustrating for both partners, and lead to feelings of isolation.[38]
★ Some methods of NFP require up to six months of research and observation (and abstinence) in order to collect baseline data, so these methods cannot be immediately implemented by a new user. [39]
★ Couples seeking the lowest risk of pregnancy (less than 1% per year) may be required to abstain for more than half of each menstrual cycle.
★ For women in certain situations - breastfeeding, perimenopause, or with hormonal diseases such as PCOS - abstinence may be required for months at a time.9
★ When taught in the context of Catholicism, the Church teaches that orgasmic acts outside of intercourse, such as consummated masturbation and oral sex, are morally incompatible with the correct practice of NFP. Some couples are not comfortable with this restriction. Periodic abstinence also limits spontaneous sex.[40]
Method limitations
★ Some fertility awareness forms of NFP require observation or touching of cervical mucus, an activity with which some women are not comfortable. Some practitioners prefer to use the term "cervical fluid" to refer to cervical mucus, in an attempt to make the subject more palatable to these women. Some drugs, such as decongestants, can change cervical mucus. Women may not be able to rely on these forms of NFP while taking these drugs.[41]
★ Some fertility awareness forms require tracking of basal body temperatures. Because irregular sleep can interfere with the accuracy of basal body temperatures, shift workers and those with very young children, for example, might not be able to rely on those methods.41
★ The NFP methods that encourage breastfeeding infertility can only be used until the woman's first post-partum menstruation. Even the most strict form results in average return of menses at 14 months post-partum,[42][43] and menstruation can return as early as 6 weeks post-partum.[44] Many women breastfeeding newborns sometimes experience a return of mensturation much earlier then the typical range despite exclusive breastfeeding - some as early as 8 weeks post-partum. Without this early return of the menses occurring, the phenomena of "Irish Twins" (children born within 12 months of each other), or that of mothers with a first pregnancy in their early 20's birthing 12 or more children in their lifetime, would obviously not be physically possible.
★ NFP does not protect against sexually transmitted disease.40
Implantation failure and miscarriage
★ It has been speculated by some that unprotected intercourse in the infertile periods of the menstrual cycle may still result in conceptions, but create embryos incapable of implanting.[45]
It has also been suggested that pregnancies resulting from method failures of NFP are at increased risk of miscarriage and birth defects due to aged gametes at the time of conception.[46]
The most recent research, however, suggests timing of conception has no effect on miscarriage rates,[47] low birth weight, or preterm delivery.[48]
See also
★ Theology of the Body
★ New feminism
Notes
1. Periodic abstinence in developing countries: an assessment of failure rates and consequences, Che Y, Cleland J, Ali M, , , Contraception, 2004
2. The Art of Natural Family Planning, , John, Kippley, The Couple to Couple League, 1996, ISBN 0-926412-13-2
3. Kippley (1996), p. 13
Question #8
4. Traditional beliefs part of people's lives, Keller S, , , Network, 1996
5.
6. Largest Religious Groups in the United States of America
7. Fertility, Family Planning, and Reproductive Health of U.S. Women: Data From the 2002 National Survey of Family Growth, , A, Chandra, Vital Health Stat, 2005 See Table 56.
8. Open Embrace: A Protestant Couple Rethinks Contraception, Sam Torode, Bethany Torode, J. Budziszewski, , , Wm. B. Eerdmans Publishing Company, March 2002,
9. AN UPDATE FROM BETHANY
10. Unlike the organizations associated with other popular observational systems, Toni Weschler has no connection to the Roman Catholic Church.
11. i.e. [1], [2], [3]
12. Basic Information on Natural Family Planning
13. Facts in Brief: Contraceptive Use
14. Effectiveness and acceptability of the sympto-thermal method of natural family planning in Germany, Frank-Herrmann P, Freundl G, Baur S, et al, , , American journal of obstetrics and gynecology, December 1991
European Natural Family Planning Study Groups. Prospective European multi-center study of natural family planning (1989-1992): interim results, , , , Advances in Contraception, December 1993
Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study, Frank-Herrmann P, Freundl G, Gnoth C, et al, , , Advances in Contraception, June-September 1997
15. #2363
16. CCC #2351-2359
17. Good News about Sex and Marriage: Answers to Your Honest Questions about Catholic Teaching, Christopher West, , , Servant Publications, 2000,
18. Casti Connubii
19. CCC #2370
20. NFP - Two basic forms
21. CCC #2368
22. Humane Vitae
23. Humanae Vitae Section I.9
The Blessings of Children
In Praise of Big Families
Principles of the Couple to Couple League
24. , which cites:
: Contemporary Moral Theology: Vol.2 (II), Marriage Questions, , John C., Ford, Newman Press, ,
25. Storck (2006)
26. A summary and restatement of the debate is available in Roderick Hindery. "The Evolution of Freedom as Catholicity in Catholic Ethics." ''Anxiety, Guilt, and Freedom''. Eds. Benjamin Hubbard and Brad Starr, UPA, 1990.
27. Canadian Bishops' Statement on the Encyclical "Humanae Vitae"
28. Loyal Dissent: Memoir of a Catholic Theologian (Moral Traditions), Charles E. Curran,, , , Georgetown University Press, , ISBN 1-58901-087-6
29. Does the Bible permit birth control? Desiring God Staff
30. Fertility Awareness for Reproductive Health
31. Basic Information on Natural Family Planning
32. Condoms and HIV Prevention
33. Marital Duration and Natural Family Planning. Accessed October 2005.
34. Divorce Rate Comparisons Between Couples Using Natural Family Planning & Artificial Birth Control
35. Kippley (1996), p. 246
Taking Charge of Your Fertility, , Toni, Weschler, HarperCollins, 2002, ISBN 0-06-093764-5
36. NFP & the Couple's Relationship
37. Women's sexual experience during the menstrual cycle: identification of the sexual phase by noninvasive measurement of luteinizing hormone, Susan B. Bullivant, Sarah A. Sellergren, Kathleen Stern, et al, , , Journal of Sex Research, February 2004
38. http://www.openembrace.com/
39. Safer Sex and Contraception - Natural Family Planning
40. Natural family planning
41. How to Observe and Record Your Fertility Signs
42. The relation between breastfeeding and amenorrhea, Sheila K. and John F. Kippley, , , Journal of obstetric, gynecologic, and neonatal nursing, November-December 1972
43. Breastfeeding survey results similar to 1971 study, Sheila Kippley, , , The CCL News, November-December 1986 and 13:4 (January-February 1987) 5.
44. Postpartum Visit Checklist
45. The rhythm method and embryonic death, Luc Bovens, , , Journal of Medical Ethics, 2006
46. Aged gametes, adverse pregnancy outcomes and natural family planning. An epidemiologic review, Gray, RH, , , Contraception, October 1984
47. Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning, Gray RH, Simpson JL, Kambic RT, , , American Journal of Obstetrics and Gynecology, May 1995
48. Effects of timing of conception on birth weight and preterm delivery of natural family planning users, Barbato M, Bitto A, Gray RH, et al, , , Advances in Contraception, June-September 1997
External links
Press
★ ''New Life for Family Planning'', Michael P. Harris, ''Time'', September 19, 1988
★ The Orgasmatron Finally Shows Up: High Tech Rhythm ''New York Observer'', June 27, 2004
NFP information
★ Billings Ovulation Method
★ Creighton Model System
★ The Couple to Couple League
★ openembrace.com - An update from Sam & Bethany Torode, authors of the NFP-only advocacy book ''Open Embrace'', detailing how the couple has moved away from an NFP-only stance since authoring the book.
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