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The How and Why of Natural Family Planning

by Mary Shivanandan

"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 frustration—and 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 rhythm—effectiveness, 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 many—unfairly—with 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 way."

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 find—some with more difficulty than others—that 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.

Achieving pregnancy

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 planning—the 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 fertility.

Hopeful signs

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 coordinator.

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 of love."'

Mary Shivanandan, M.A., S. T.L., S. TD., is a professor at the John Paul Institute for Studies on Marriage and Family, Washington, D.C. Dr. Shivanandan has been engaged in the study of marriage, family and natural family planning for the past 20 years both in the United States and abroad. She is the author of Challenge to Love (formerly Natural Sex) as well as numerous articles in professional and popular journals. She is a board member of Women Affirming Life, a pro-life organization.

Published with ecclesiastical approval.

 

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