"Natural family planning." No, it's not the old
calendar "rhythm" method just being peddled under a new name.
It ordinarily does not require long periods of sexual abstinence.
And it's not "Vatican Roulette," the nickname cynics often gave
rhythm because in their minds it came closer to gambling than
to any real science!
The generation of Catholics who relied on calendar
rhythm for their family planning method in the 50's and 60's often
experienced extreme frustrationand a good number of "rhythm
babies"! The introduction of the Pill, many thought, would eliminate
all the frustrations. The Pill seemed to offer everything denied
by calendar rhythmeffectiveness, freedom from fear of pregnancy,
spontaneous sex. But it brought its own set of problems, questions,
dilemmas: Was it moral? What of harmful side effects? Did its
use promote promiscuity?
With the 70's the "new" methods of natural family
planning (NFP) appeared on the scene. Among those adopting the
natural methods were young couples of different religious persuasions,
feminists, health advocates. The ever-growing group extolled the
virtues of natural family planning. They found it effective, free
from side effects and beneficial to their marital and sexual relationship.
Why then has NFP not been even more widely embraced?
Unfortunately, calendar rhythm produced a generation of skeptics
among couples, doctors and priests who had become bitterly aware
of the limitations of the rhythm method. Yet when rhythm came
into use in the 1930's it was a great advance in understanding
and controlling fertility. For centuries there had been the mistaken
idea that ovulation coincided with menstruation. Then, however,
Dr. Kyusaku Ogino in Japan and Hermann Knaus in Austria both correctly
identified ovulation as occurring about two weeks before
menstruation, to which it was related. The mistake or scientific
error was in assuming that ovulation always occurs at a regular
time in the cycle.
Although NFP today is founded on sound scientific
principles, it is still linked in the eyes of manyunfairlywith
the ineffective rhythm method. The purpose of this Catholic
Update is to explain the methods and benefits of natural planning
and to explore the values on which it is based.
What is natural family planning?
What is natural family planning? In the broadest
sense, natural family planning refers to methods of avoiding (or
achieving) pregnancy that cooperate with a couple's fertility
rather than suppress it through the use of drugs or contraceptive
devices. These methods involve determining the woman's fertile
period and abstaining from intercourse during that time to avoid
pregnancy, or having intercourse then to achieve pregnancy. Properly
applied, these natural methods are in full accord with the teachings
of Pope Paul VI and John Paul II on the subject of family planning.
Because they take advantage of the body's natural rhythms of fertility
and infertility and place no positive obstacles to the transmission
of life, they do not fall under the Catholic Church's official
ban against artificial contraception. The assumption is, of course,
that even when couples are using natural methods, they are not
using them to avoid conception for selfish motives but for sound
reasons like physical or emotional health or economic circumstances.
But let's take a closer look at how the natural
family planning methods work. Where the rhythm method simply used
mathematical calendar calculations to predict ovulation, natural
family planning carefully observes the signs and symptoms of fertile
and infertile periods.
Each month several eggs (ova) begin to ripen in
the ovary. As this occurs, the hormone estrogen is released. Among
other effects, estrogen stimulates the secretion of a certain
type of mucus from the cervix, which joins the uterus to the vagina.
Usually the vagina is dry and hostile to sperm, which cannot survive
more than a few hours in that environment or pass through the
cervix into the uterus. When this mucus flows (wet mucus days)
it protects the sperm cells and facilitates their movement. It
nourishes them in the cervical crypts and provides channels for
them to swim up through the uterus to the fallopian tube to fertilize
the egg that has reached maturity. In a regular cycle, this mucus
flows for about three to five days and, as ovulation approaches,
its consistency becomes like that of raw egg white and can be
stretched between finger and thumb.
Once the egg is released, the corpus luteum
or yellow body, which encased the ripening egg, begins to release
another hormone, progesterone. Progesterone not only inhibits
any further ovulation but also changes the character of the mucus
so that it no longer protects or provides channels for the sperm.
Also, body temperature rises, signaling the decline of the fertile
period and providing an "incubator" for a fertilized egg. Chances
of conception decrease rapidly in the three days after ovulation.
If the egg is not fertilized, the lining of the uterus built up
by estrogen and progesterone as nourishment for new life is shed
in menstruation (menses) about two weeks later (normal range is
10 to 16 days).
Sometimes ovulation is delayed by stress or illness.
or some other disturbance. The egg begins to ripen, the mucus
begins to flow, then stops. As conditions once again become favorable,
the process of ovulation resumes. When this happens a woman experiences
an irregular cycle. But as long as one carefully watches and analyzes
the mucus, the state of fertility can be accurately monitored.
Natural family planning consists of observing the
key signs that mark the fertile phase: the mucus (and the opening
of the cervical os [mouth] for those women who wish to observe
that sign) at the beginning of the fertile phase. The "absolutely
infertile" phase at the end of the cycle is signaled by the rise
in temperature together with the change in the character of the
mucus and the closing of the cervical os. Monitoring the mucus
sign alone is called the ovulation method, and many women rely
solely on it, and successfully so. When the temperature and other
signs (symptoms) are watched in addition, this combined approach
is called the sympto-thermal method. The methods should be learned
from a competent teacher.
How effective is NFP?
Skeptics will ask: "How easily can a woman observe
the mucus?" "How accurately does it reflect the fertile phase?"
and "How effective is NFP as a family planning method?" As early
as 1978, a five-country study of the ovulation method by the World
Health Organization found that 97 percent of the women could identify
the mucus after three cycles of observation. Most studies, including
those of the 1990's, have rated the method 98 to 99 percent effective
in avoiding pregnancy when couples are well taught and follow
the rules. Hormonal tests can be taken that correlate the women's
observations with levels of estrogen in the urine and thus confirm
that their observations are correct.
These modern methods of natural family planning,
unlike the rhythm method, do not depend on regular cycle lengths
for effectiveness. They can be used from the first days of marriage
through breast-feeding to menopause. They can also be used to
help couples achieve pregnancy since the quality and consistency
of the mucus reveals the day(s) in the cycle when conception is
most likely to occur.
Even before marriage adolescents and singles can
benefit from knowledge of their fertility. A single career woman
told me that this knowledge not only freed her from the fear that
stems from ignorance of normal body processes (many mistakenly
assume that the mucus discharge is pathological or the result
of sexual fantasies) but also gave her a feeling of awe at how
it all works. She has woven fertility awareness into her concept
of sexuality and daily experience of living. "It is so tied in
with you as a sexual woman. You're fertile or infertile." This
woman could rejoice in being sexually alive even when "not using
her fertility." A college student told me that charting her fertility
brought knowledge of reproduction to a personal level. "This is
what I need to know. It helps me know about my moods and why I
feel like being close to someone." Her boyfriend, too, is interested
in the idea.
And that's another appealing aspect of natural
family planning, namely, the enthusiasm of the men who understand
it. It is stressed that without the man's cooperation the woman
alone will have difficulty practicing natural family planning.
Knowing this, most NFP programs encourage the husband's attendance.
I know of many husbands who have gone from passive acceptance
to active promotion. A Canadian, who had previously decided to
get sterilized when "we completed our family," told me: "I shall
never do that now. My fertility is a gift to Therese, and hers
to me. I'm proud of the fact that I can bring it to her in a responsible
How couples grow using NFP
At the heart of marriage is the sexual relationship.
Natural family planning, which challenges the couple to live in
tune with the fertile and infertile phases of the cycle, makes
radical demands on the relationship. It takes time for most couples
to adjust to these demands. Those who do report increased intimacy,
greater communication, an improved sexual relationship, a spiritual
awakening or deepening of an already active spiritual sense. Studies
in Canada, England, the United States and other countries show
couples find the same rewards in NFP no matter what their cultural
or religious background. Only 50 percent of the couples interviewed
for my book, Challenge to Love, other than the NFP teachers,
were Catholic. The rest belonged to other religious faiths or
had no religious affiliation.
Social scientist Dr. Thomasina Borkman, associate
professor of sociology, George Mason University, and I decided
to analyze systematically the responses of the 50 couples interviewed
in depth for my book to learn more about their reactions to NFP.
For the most part, these couples were satisfied NFP users. But
we had to deal first of all with a paradox. Couples said, on the
one hand, that abstinence was difficult and yet, on the other,
that it was rewarding and benefited their relationship.
TV ads constantly equate the virtue of their product
with how easy it is to use. Did you ever hear a salesperson say
his or her product requires effort to enjoy? Even how-to books
and educational texts are continually designed to make learning
easy. By contrast, few couples told me abstinence was easy. Yet
most were so satisfied with NFP that they had become promoters
of the method. Dr. Borkman concluded that when the rewards of
periodic abstinence outweigh the disadvantages, the difficulty
of abstinence becomes a challenge rather than a privation. She
noted that training for a swim meet or a basketball tournament
can also be difficult but rewarding.
We also discovered that couples grow in two stages
while using NFR The first stage can be called the physical
because it has to do with a new approach to the body. The second
stage is the psychological/relational because it affects
the relationship more deeply.
The physical stage
When a woman learns what is happening in her body
and sees, for example, the signs of her fertility in mucus and
temperature, she gets excited and exclaims: "I didn't know this.
It's absolutely fantastic." Husbands also need to be attuned to
the physical process and teachers encourage them to keep the chart
(the daily record of fertility symptoms, e.g., mucus, temperature,
etc.). Discussing the physical signs can become a very important
vehicle for couples to explore the more intimate aspects of their
lives and provides them a language for communicating in the sensitive
area of sex.
Although couples need to abstain from intercourse
during the fertile period if they wish to avoid pregnancy, they
do not need to abstain from loving. Most couples findsome
with more difficulty than othersthat there are many ways
to say, "I love you," from cooking a favorite meal to bringing
home a bouquet of flowers. There can be much joy in holding one
another. As one wife told me: "I don't need the whole thing. He
can put his arms around me. When he cuddles me I feel enveloped."
This stage, particularly, is the beginning of sexual
mastery. While the woman more often than not appreciates the caressing
without climaxing in intercourse, the man can find it difficult.
One husband told me that because he is easily excited, he finds
it difficult to restrict their love activity to touching and caressing.
His wife, therefore, tends not to initiate it and leaves that
up to him. He has to decide when it becomes too difficult.
This learning how to caress not only is a boon during
the abstinence period but also helps the sexual relationship generally.
Sex therapists prescribe it to help couples with problems of sexual
response. For example, sometimes while using natural methods,
a woman will feel the greatest sexual desire about the time of
ovulation, her time of greatest fertility, and less desire in
the infertile period. This is triggered by the hormones. Since,
as sex experts advise, caressing on the part of a tender husband
can be more effective than hormones in arousing his wife's desire,
he should be more prepared to help her at this time. For many
couples, simply going without intercourse for 10 days or so is
enough of a stimulant for both husband and wife.
A deeper stage
The second stage concerns the psychological or relational
aspects. For example, couples speak about being in tune with one
another and with the world. A husband reports that he is more
sensitive to his wife as a person and wants her to "become everything
she is capable of, reaching all of her potential as a woman."
Communication goes beyond charting to discussion of sexual feelings
and interpersonal awareness. A husband says: "Our sexual relationship
has been getting much better. We've been forced to talk to one
another about what's going on. We have increased sexual activity,
a sense of awareness of one another."
Couples who came to natural methods out of a sense
of obedience to the Church's teaching have spoken about a new
personal relationship with God. Even a couple who were not affiliated
with a formal religion were able to see their relationship in
spiritual terms after using natural methods: "When you start seeing
that your relationship to others extends way beyond what you're
used to, you are led to trust more and more in the way the universe
works. It becomes like a calling."
Cooperation is essential
Some women choose natural methods because such methods
require that both the man and the woman must take equal responsibility
for family planning. The egg or ovum lives only 12 to 24 hours
after ovulation unless it is fertilized. Sperm may survive about
three to five days in the woman's reproductive tract when the
cervical mucus is present. So it is the life of the sperm and
the ovum together that determines a couple's fertility. NFP teachers,
therefore, stress the joint fertility of the couple. Just as they
need to cooperate to achieve pregnancy while using natural methods,
so also they must cooperate to avoid pregnancy.
This joint responsibility is one of the major differences
between NFP and contraception. Contraception, which makes sexual
intercourse available anytime, caters to the male pattern of continuous
fertility and ignores the cyclic fertility of the woman. By making
sex available all the time, contraception can lead couples to
experience a loss of specialness.
A conscious choice to have a child together marks
a high point for many couples. It is not unusual for a couple
who at first have decided that their family is complete to change
their minds when they come in touch with their fertility and know
the most likely time to conceive. "We loved that child into life,"
said one. It was a "high, exciting feeling," said another. It
becomes a "very special act of intercourse." Husbands who have
shared this decision become involved in the pregnancy from the
moment of conception and often say: "We are pregnant." Indeed,
natural family planning leads couples to the beauty of the Church's
teaching on responsible and generous parenthood.
An unplanned pregnancy can also be a crisis for
couples. While natural family planning is 98 to 99 percent effective,
in practice many couples are ambivalent about having another child
and break the rules for avoiding pregnancy. In such cases, many
grow to accept the child with joy. Others, however, drop out of
natural family planning, especially as our society does not currently
encourage childbearing. This is where the Christian community
needs to offer support and counseling.
So far I have discussed from a positive point of
view the basic elements of natural family planningthe challenge
of abstinence, the husband's cooperation, more communication,
mental and spiritual enrichment, Church guidance, even unplanned
pregnancies. As you can well imagine, it is possible for a given
marriage partner to respond negatively or resentfully to any of
these points. Natural methods, therefore, demand a great deal
of a couple. They mean taking full responsibility for fertility
and for the marriage itself.
Breast-feeding is an integral part of natural methods.
Breast-feeding not only provides nutritional benefits to the baby
and protection from infections, but also strengthens the bond
between mother and child. Furthermore, when the mother breast-feeds
without giving any supplements fertility is suppressed. It has
been estimated by experts worldwide that there is only a two percent
chance of pregnancy in the first five to six months after birth
if the mother is breast-feeding the infant "on demand." For many
breast-feeding mothers the period of infertility lasts much longer.
By observing her mucus the woman can monitor the return of her
Advances in natural family planning have made this
method reliable and helpful for an increasing number of people
today. More and more couples around the world are choosing natural
methods of family planning, and it has been shown that higher
education, or even literacy, is not necessary to practice NFR
In this country efforts to make natural family planning more available
have grown. As of 1995, under the Diocesan Development Program
for NFP, about half the dioceses have appointed a special NFP
Pope John Paul II often speaks about the challenges
and rewards of natural family planning: "The Church does not claim
that responsible parenthood is easy, but the grace of the Sacrament
of Marriage gives Christian couples a readiness and a capacity
to live out their commitments with fidelity and joy. At the same
time, the use of the natural methods gives a couple an openness
to life, which is truly a splendid gift of God's good.ness. It
also helps them deepen their conjugal communication and draw closer
to one another..." ("The Family and Fertility", June 1, 1984).
In his "Letter to Families" (February 2, 1994)
Pope John Paul II urges that "in the conjugal act, husband and
wife are called to confirm in a responsible way the mutual gift
of self which they have made to each other in the marriage covenant.
The logic of the total gift of self to the other involves a potential
openness to procreation: In this way the marriage is called to
an even greater fulfillment as a family....The question of responsible
fatherhood and motherhood is an integral part of the 'civilization
Published with ecclesiastical approval.