Catholic Culture News
Catholic Culture News

Solving The Puzzle Of Natural Family Planning

by Charlotte Hayes


A primer and resource guide for couples getting started in natural family planning, this article traces the history and development of the various methods of NFP. A list of "must-reads" and helpful organizations for NFP follows the article.

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Publisher & Date

The Morley Institute, Inc., Washington, D.C., December 2001

Mary Drake was in a dilemma. The now 34-year-old Catholic from rural Minnesota wanted to follow what many, both inside and outside the Faith, regard as a difficult teaching of the Church: the ban against the use of contraception. Unfortunately, she had to convince Tim, her deeply skeptical, non-Catholic fiancé. "I guess you'd have to say I was pro-contraception," Tim recalls.

"We did have a few arguments over it," he chuckles. For one thing, Tim had never heard of natural family planning (NFP), an alternative to artificial contraception that the Church considers acceptable when used properly. For another, he had no idea why the Catholic Church teaches that contraception is wrong. "What convinced me then," he says, "was that she didn't want to use anything that could harm her body or her fertility, as the Pill often does."

Though not entirely convinced, Tim couldn't argue with that, and so he reluctantly agreed to go along with Mary on the matter. The couple began learning about NFP as part of their marriage preparation in 1989. Tim and Mary opted for the Billings Ovulation Method, which happened to be offered in Mary's diocese. This method relies on charting the presence of cervical mucus, which accompanies ovulation, to determine a woman's fertile times. Mary remembers Tim asking, "Are you sure this works? No doctor I know has ever brought it up."

Most doctors won't bring it up, and many Catholics remain ignorant of the theological and biological aspects of NFP. Only about 3 to 4 percent of women in their reproductive years in the United States use any form of NFP.

"You can probably guess-timate that 2 or 3 percent of Catholic women use it," says Theresa Notare, assistant director of the Diocesan Development Program for NFP and secretariat for pro-life activities for the United States Conference of Catholic Bishops (USCCB). But for those who know about NFP, the rewards are often immense.

An enthusiastic convert to NFP (and subsequently to the Catholic Church, which he entered in 1995), Tim Drake says that the big surprise for him was that NFP actually enhanced the couple's sexual relations. "Most people roll their eyes and think that the periods of abstinence will be difficult," he says, "but we've found it's wonderful because it almost creates the honeymoon over and over again." Says Mary, "Intercourse is more natural — you're like Adam and Eve in the garden." She adds that when couples use NFP, "You're dialoguing not just with each other but with God."

Not Just Catholics

But if NFP is so beneficial, why do so few Catholics practice it? "Lack of information and ignorance," says Notare, citing the small number of people certified to teach NFP. There's also the intensely secular nature of contemporary culture: "You aren't going to read about the Ovulation Method or the Sympto-Thermal Method in women's magazines," Notare says. All Catholic dioceses in the United States have at least one NFP coordinator, or contact person, who is in touch with NFP teachers. Even in those dioceses that do not have a structured NFP ministry, there is at least one NFP teacher.

While many regard the Church's ban on artificial contraception as narrow-minded and harsh, Notare has described the Church's "vision of human sexuality" as "scripturally based, sacramentally real, morally honest, and spiritually rich."

Catholic teaching on marriage treats sexual intercourse as "an awesome treasure given to married couples," Notare has noted. She continued, "There is no other human act through which two human beings reach out to one another and say, 'I love you enough to want to be one with you,' and at the same time touch God's hand and create another human being with Him. Because sexual intercourse possesses these profound human and divine dimensions, the Church treats it with reverence, never trivializing or separating it from its real meaning."

Fertility, in this view, is "oriented to the future." A Catholic couple who wants to limit the number of children they have could practice abstinence — but only for good reasons. Early confessors' manuals, for example, stated that a couple could use abstinence because of "pauperism." Contraception, though widely practiced in the pagan world, has been banned throughout Church history. A Christian document from the first century, the Didache (The Teaching of the Apostles), banned the use of chemicals, a popular form of contraception in the ancient world: "You shall not use magic. You shall not use drugs."

The late theologian, Rev. John Hardon, S.J., commenting on this early stricture against contraception, noted: "Records from the practices of these times tell us that the people would first try some magical rites or resort to sorcery to avoid contraception. If this failed, they would use one or another of the medical contraceptives . . . If, notwithstanding, a woman became pregnant, she would try to abort. And, if even this failed, there was always the Roman law that permitted infanticide."

The Catholic Church wasn't alone in prohibiting contraception for much of history. Protestant churches continued the stricture long after the Reformation, and even religious leaders who were not Christian regarded contraception as wrong. Gandhi, for example, in 1925, urged advocates of artificial contraception to consider the consequences. "Any large use of the methods is likely to result in the dissolution of the marriage and in free love," Gandhi argued prophetically.

Too Many People?

A subtle challenge to the almost universal prohibition of contraception came in 1798, when Thomas Malthus, an economist and the "small planet" proponent of his day, predicted that the world would one day suffer from drastic overpopulation. His famous treatise, An Essay on the Principle of Population, is the first population scare book. An Anglican clergyman, Malthus advocated "population control" but only by means of late marriage and, once the family had attained the size decreed by the parents, abstinence.

Less than half a century later, technology found an easy method of artificial contraception: the modern condom. After Thomas Goodyear discovered in 1839 how to vulcanize rubber, the thin rubber condom replaced cruder condoms that had once been fashioned from animal skins. Despite the teachings of the Catholic Church and Protestant faiths, people began to promote this method of contraception.

Hard as it is to believe now, contraception was once actually illegal. When Margaret Sanger, the founder of Planned Parenthood, created a periodical devoted to contraception, The Woman Rebel, in 1914, the U.S. Postal Service refused to send it through the mail. Sanger was arrested three times for her repeated attempts to mail the magazine. Sanger, who learned about diaphragms in Europe and promoted their use in the United States, was originally attracted to birth control because she thought it was beneficial to women. Later, however, she became a zealous advocate of population control and set up Planned Parenthood.

Christian churches, however, remained steadfast in their opposition to contraception . . . for a while. The first break from tradition came in 1930, when the bishops of the Church of England, who as a body had affirmed the traditional view of marriage and upheld the ban on contraception as recently as 1920, voted at the Lambeth Conference, the governing body of Anglicanism, that contraception was morally acceptable. Prompted, the Federal Council of Churches, an organization of Protestant churches in the United States, issued a similar statement.

In a day when artificial contraception is taken for granted, the furor created by these twin departures from traditional teaching is scarcely imaginable. A day after the Federal Council of Churches declaration, a shocked Washington Post editorialized: "Carried to its logical conclusion, the committee's report, if carried into effect, would sound the death-knell of marriage as a holy institution by establishing degrading practices which would encourage indiscriminate immorality. The suggestion that the use of legalized contraception would be 'careful and restrained' is preposterous." A Lutheran theologian, Walter Maier, called the acceptance of contraception "a 20th century renewal of pagan bankruptcy."

As editorial writers and other thoughtful people pondered the meaning of the crumbling of a long-held Christian belief, Pope Pius XI responded with Casti Connubii (Chaste Marriage), an unequivocal condemnation of contraception. A quote from the encyclical captures Pius's sense of the urgency and gravity of the matter:

Since, therefore, openly departing from the uninterrupted Christian tradition, some recently have judged it possible solemnly to declare another doctrine regarding this question, the Catholic Church, to whom God has entrusted the defense of the integrity and purity of morals, standing erect in the midst of the moral ruin which surrounds her, in order that she may preserve the chastity of the nuptial union from being defiled by this foul stain, raises her voice in token of her divine ambassadorship and through our mouth proclaims anew: any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offense against the law of God and nature, and those who indulge in it are branded with the guilt of grave sin.

The Pope And The Pill

Thirty years after Pius XI's strong condemnation of contraception, the Church's teachings were confronted by the strongest challenge yet: the Pill. The Pill used synthetic estrogen and progesterone, similar to the hormones produced in a woman's body, to suppress the release of eggs. Overnight, women had a convenient way to prevent pregnancy. Because the Pill relied on changes in the woman's body instead of a physical barrier to contraception, some argued that the Pill was a licit form of birth regulation.

Pope Paul VI set up a papal commission, composed of theologians, married couples, and other experts, to study the matter. "The mere fact that the Pope had set up a commission to advise him about the Pill," John and Sheila Kippley write in The Art of Natural Family Planning (1997), "led to all sorts of speculation that he was looking for a way to change Catholic teaching on birth control." When the commission advised Paul VI that the Pill was morally acceptable, many thought that change was inevitable. The pope, of course, had the final say. The year after the commission's recommendations, rumors circulated that Paul VI was going to issue an encyclical. Many Catholics hoped that the pope would lift the historical ban on contraception; others worried that their faith would be shaken if the pope did not uphold the teaching.

On July 25, 1968, Pope Paul VI issued one of the most famous papal encyclicals in the history of Catholicism — Humanae Vitae (On the Regulation of Life). Greeted by unprecedented dissent, Humanae Vitae upheld traditional Catholic teaching on Christian marriage and the prohibition against all unnatural forms of birth control. In the encyclical, Paul VI said that he had taken into consideration the then-widespread fears about overpopulation, the recommendations of his own commission, and even the idea that perhaps "the totality of married life" instead of "any single act" was what mattered. None provided a morally acceptable rationale for contraception, however.

Though derided as harsh and "impossible" (as Hans Kung, a Swiss theologian who became almost a cultural icon by denouncing Humanae Vitae, said), the encyclical actually contains moving passages on marital love. Paul VI emphasized the "gift of self" in the act of sexual intercourse and described marital love as "fully human, a compound of sense and spirit," and "not, then, merely a question of natural instinct or emotional drive."

"In preserving intact the whole moral law of marriage," he continued, "the Church is convinced that she is contributing to the creation of a truly human civilization." Indeed, lifting the ban on contraception would have dire consequences, he noted. One was that a man "may forget the reverence due to a woman" and "reduce her to being a mere instrument for the satisfaction of his own desires, no longer considering her his partner whom he should surround with care and affection."

As NFP pioneers John and Sheila Kippley rightly note, in this beautiful but largely unread document, one sentence alone has received almost all the attention: "Nonetheless, the Church, calling men back to the observance of the norms of the natural law, as interpreted by its constant doctrine, teaches that each and every marriage act must remain open to the transmission of life." This infuriated liberal theologians, who responded with, as Kippley puts it, "a verbally violent reaction of dissent that may be without equal in the history of the Church."

Theologians such as Rev. Charles Curran, then of the Catholic University of America, were outraged. Father Curran led more than 600 fellow theologians in making a historic public dissent from the encyclical. But they weren't alone. "I had to fight with all my Protestant friends, who were so angry with the pope," recalls Mercedes Wilson of the Family of the Americas Foundation, which specializes in training people to teach NFP in underdeveloped parts of the world. "I'd say, 'Why are you so angry? I'm Catholic, and I'm the one who should be angry. But I'm delighted.'" Wilson adds, "The reaction of my Protestant friends made me realize that people listen to the pope."

Looking For A Method

A pretty young woman from a prominent Guatemalan family — her brother is a former president of the country — and the wife of an Englishman, Wilson had ample reason to be interested in the subject. After the birth of her second child, she'd been told that she would be risking her life if she tried to have another. Wilson began to investigate ways to avoid pregnancy that were acceptable for Catholics.

Wilson's search for a method came at an auspicious moment in history. Until the mid-1930s, the main thing available had been the so-called rhythm method, which was based on calculating a woman's days of fertility by analyzing her menstrual cycle. Since the cycle can be thrown off by a number of factors, including stress or sickness, and since some women do not have regular cycles, it was notoriously risky. "What do you call a couple that uses the rhythm method? Parents," went the old joke.

Rev Wilhelm Hillebrand, a priest in Germany, pioneered a more effective method in the 1930s. Father Hillebrand, whose parishioners experienced a number of surprise pregnancies after he recommended the rhythm method to them, had heard that a woman's temperature rises after ovulation. Father Hillebrand began keeping temperature records for 21 women. From these data, he developed the basal body temperature (BBT) method of NFP, a combination of calendar and temperature calculations. BBT is the temperature of a woman's body when she wakes up in the morning. Progesterone, which is released right after ovulation, raises a woman's temperature. There are three parts of a cycle: before ovulation, ovulation, and post-ovulation. By charting BBT, a woman can tell where she is in her menstrual cycle.

The next giant step in the scientific development of NFP came in the 1950s in Melbourne, Australia, where Dr. John Billings, a neurologist and a Catholic, was asked to help Catholic couples learn how to space children or avoid pregnancy by learning about periods of fertility. Billings found both BBT and rhythm inadequate for women with irregular cycles. Studying the literature, Billings learned that the cervix secretes a mucus at ovulation. Changes in the texture and opacity of the mucus indicate the progress of ovulation. The Billings Ovulation Method would be based, as Billings describes it, on the "discovery that virtually every fertile woman observes, or can be trained to observe, the secretion of a particular pattern of mucus coming from the cervix around the time of fertility." Once cervical mucus is present, a couple must abstain from intercourse. Methods of NFP based exclusively on the signs of mucus and menstruation are often lumped under the name "Ovulation Method" (this is the abbreviated name for the "Billings Ovulation Method").

An early convert to the Billings Method was Mercedes Wilson, who heard about the work Billings was doing when her husband was transferred to Australia. She took a class and liked the method, which at that time still included temperature and calendar rhythm with the observation of mucus. "In 20 minutes I learned a method that was going to be available to me for the rest of my reproductive life," Wilson marvels. But, whenever she encountered a gynecologist and tried to explain the method, the doctor inevitably would pat her on the back and say, "Good luck with your next pregnancy."

But Wilson never again became pregnant. Wilson and others like her learned how to examine the cervical mucus that can be obtained on a tissue at the vulva. The mucus changes from cloudy and sticky to elastic, wet, and slippery during the fertile period. Eventually, whether a child is conceived or not, the mucus thickens and forms a kind of plug at the cervix. A period of dryness — when the woman is not fertile — follows.

Billings, who eventually was joined in his research by his wife, Evelyn, also a physician, wanted to know about the scientific reasons for the mucus changes. When Dr. J.A.B. Brown, who had made a reputation studying estrogen and progesterone in Edinburgh, Scotland, was appointed to the Royal Women's Hospital in Melbourne, Billings asked him to study the relationship between secretions of mucus and hormones. Mercedes Wilson, by now sold on the Billings system, volunteered to collect urine samples from women all over Melbourne for Brown's studies. "I got to know Melbourne really well," she jokes.

According to Mary Shivanandan of the John Paul II Institute in Washington, D.C., Brown found that those changes in the mucus coincided with the levels of hormones in the urine. Further research concluded that ovulation takes place between a surge of a hormone in the brain that triggers the release of an egg and the secretion of progesterone. "Here, then," Shivanandan writes, "was a method of identifying the fertile period based on sound scientific principles and observation, which did not depend on the length or regularity of the menstrual cycle."

John and Evelyn Billings conducted the first training session in the United States in New Orleans in 1972. Now there are around 300 Billings Ovulation Method teachers in the United States. One, Kay Ek, who trains couples in the method for the St. Cloud, Minnesota, diocese, learned it at that historic meeting in New Orleans. "Our bishop, who was then Bishop George Speltz, realized that this was of great importance to the diocese," Ek recalls. But it was so new that Ek was doubtful: "I reluctantly agreed to go to be trained in New Orleans." Ek, who returned home to see "a huge outpouring of support and need," has been teaching the method since. Her daughter, Sue, coordinates teacher training nationally from the St. Paul-based Billings Ovulation Method Association-USA.

Throw Away Your Thermometer

After learning a method of NFP at the Billings clinic in Melbourne, Wilson found herself spending several months in her native Guatemala. Her husband had been transferred to the United States, and she had to wait for a green card. She confided to a priest-friend that she'd learned an easy and convenient method of natural family planning. "You can't keep that to yourself," he told her.

Wilson agreed to give a talk on the Ovulation Method. "I was scared to death — they had to push me into the room," she remembers.

Wilson's lecture in Guatemala was a hit, and many women were eager to learn how to space their pregnancies. But there was a hitch: Most of the women could not read. That meant that using thermometers and recording their temperatures, at that time still part of the Billings program, was impossible. Calendar rhythm was also impossible. Wilson decided to teach a mucus-only system that would use colored stamps on a chart to indicate periods of fertility. She went to a local printer and said, "I want you to make me a set of stamps, some red and some green."

There were, all told, three kinds of stamps: red for menstruation, green for infertile times, and white "baby stamps" for fertile times. Later, brown was substituted for green because a Maryknoll missioner pointed out that many in the developing world were likely to associate the color green with fertility.

Wilson then faced a private dilemma: How could she ask poor women in Guatemala to put their trust in the mucus-only system she was teaching them when she was still supplementing observation of mucus with recording her temperature? Wilson decided that she could not advocate the mucus-only system for poor women if she was unwilling to rely solely on it herself. She realized, "I'm going to have to throw away my thermometer."

Wilson's Family of the Americas Foundation now teaches NFP in more than 100 countries, including China. "God would not be so cruel that unless you can read you can't follow natural family planning," she insists. "Why make it so complicated?"

Wilson's bold decision to dispense with the thermometer and rely solely on observations of mucus was followed by the Billings in Australia several years later. This would have a profound effect on the NFP movement because other NFP advocates remain committed to using both.

"That," Wilson sighs, "is when all the fighting began."

Another Approach

After Humanae Vitae, John Kippley, a layman, was moved to write a defense of the Church's teaching on contraception. In doing so, he found himself thinking about a passage in Luke's gospel: "Woe to you lawyers also, for you load men with burdens hard to bear, and you yourself do not touch the burdens with one of your fingers." In other words, what could Kippley do to help couples who wanted to follow the Church's teachings on natural family planning?

In 1971, Kippley and his wife, Sheila, joined with Dr. Konald Prem, a physician and a professor of obstetrics and gynecology at the University of Minnesota, and held the first class in natural family planning in what would become a worldwide organization known as the Couple to Couple League. The first meeting was held in a church in suburban St. Paul, Minnesota. The Couple to Couple League is now headquartered in Cincinnati.

While Billings came to rely on mucus only, the Kippleys teach what is called the Sympto-Thermal Method. This method incorporates all the signs of ovulation — monitoring temperature changes (using a special thermometer — that came with an accompanying booklet instructing women to observe their cervical mucus — developed by Dr. Edward Keefe in the 1940s), observing mucus, and the optional examination of changes that take place in the cervix (this raises the hackles of the Billings camp, which considers this conducive to masturbation and potentially unsanitary).

"We make use of research on both sides of the fence. The principle is cross-checking," John Kippley says. The Couple to Couple League trains ordinary couples to teach NFP to other couples. There are now about 600 teaching couples in the United States. The goal of the league is to have at least one teaching couple for every 100 Catholics in urban areas in the United States and one teaching couple for each rural population center.

While John Kippley insists that using all three symptoms adds to confidence, he adds that if a couple wants to rely on one aspect of the program offered, "It's their choice."

Sheila Kippley is also a pioneer in promoting "ecological breastfeeding," which can be used to space children. Ecological breastfeeding delays the return of fertility. This is different from "cultural breastfeeding," the form of breastfeeding common in Western culture: Ecological breastfeeding includes more frequent suckling (basically whenever the child is hungry) and continues longer than breastfeeding ordinarily does. "We end up encouraging mothers to stay with babies, and that is counter-cultural," John Kippley says.

A Way Of Life

Like all Catholic-based NFP programs, including the Billings Ovulation Method, the Couple to Couple League offers more than just charts or a system to space children. It has been called a way of life. The Art of Natural Family Planning, co-authored by the Kippleys, explains the Church's reasons for forbidding contraception, complete with selections from the relevant documents. The motto of the Couple to Couple League is "Building healthy marriages through Natural Family Planning."

"We're not saying contraception is the only cause of the terrible increase in the American divorce rate," the Kippleys write. "However, we're convinced that it's either the major cause or at least one of the most important causes." NFP families, whether Couple to Couple or Billings followers, report an astonishingly low divorce rate — one informal study puts it at 1.3 percent, as compared with about 50 percent in society at large. Even accounting for the high level of dedication of the NFP group studied, experts estimate that the divorce rate for NFP couples does not go above 4 percent. Wilson's Family of the Americas has a study that shows a 2 percent divorce rate.

Advocates say that NFP promotes communication between husband and wife because both must be involved. Husbands are encouraged to help with the charting. "For NFP to succeed," Mercedes Wilson says, "the husband must love the wife. If they don't love each other and just want to use each other, it won't work." Richard Fehring, a registered nurse and NFP provider, describes NFP as "a holistic approach to family planning" in which "both husband and wife understand their fertility, emotions, and family planning intention (whether to have children or not)."

Catholics who've ridiculed NFP as hopelessly backward might be surprised that it's gaining semi-support from a decidedly secular source, a "fertility awareness" method (FAM). Author Toni Weschler in Taking Charge of Your Fertility, a guide to "natural birth control and pregnancy achievement," shows how to check for cervical mucus and chart temperatures. Though her approach is a far cry from NFP (she recommends using barrier methods of birth control coupled with masturbation during the fertile times), it nevertheless co-opts some of its more successful techniques — and language:

"The beauty of charting," she writes, "is that a man can be just as involved as his partner — taking her temps, jotting down fertility signs, determining when her fertile phase has begun and ended. And rather than perceiving it as work, most people agree that the minute or two a day is so enlightening that it can be fun rather than a chore. Men who help their partners chart find that they learn a lot about them in the process. Ultimately, FAM can draw couples closer."

Attracted by the naturalness of "fertility awareness," Weschler also points out something else that NFP providers often stress: the relative costs. A lifetime supply of birth control pills costs thousands upon thousands of dollars. FAM and NFP generally require a modest fee for a training session and a packet of charting materials — and that's it. Church-based organizations that teach NFP are also generally willing to help people who can't afford the course.

"We've never turned anybody away because of money," says Rose Fuller of Northwest Family Services in Portland, Oregon. The entire cost of their course is around $85.

Make no mistake: FAM is not NFP. It's simply another form of birth control, and unacceptable for the Catholic. Nevertheless, by recognizing the effectiveness of charting temperatures and checking cervical mucus to determine fertile times, FAM gives NFP a backhanded compliment.

Clearly, all is not well in the artificial contraception camp. For example, unlike NFP, the Pill can cause breast cancer, blood clotting, and liver tumors among younger women. Fatal heart attacks are approximately twice as frequent among women who take the Pill. Moreover, all chemical forms of birth control can act as abortifacients. "The number of early abortions caused by hormonal birth control may well exceed the number of surgical abortions each year," the Kippleys write.

While contraception has generally been regarded by the public as more effective in avoiding pregnancy, the difference is a small one. A 1994 study found the rate of "accidental pregnancies" among NFP couples to be around 2 or 3 percent in the first year for either the Ovulation or Sympto-Thermal methods. NFP experts say that when a couple understands and follows the method, NFP is about 99 percent effective in avoiding pregnancy. Only IUDs are more effective than NFP.

But the emotional rewards are always greater for couples who practice the natural method. Mary Drake, whose husband, Tim, helps her with her charting, says that NFP helped foster a stronger bond of trust between them. She notes that if he is willing to abstain during fertile times when they're together, she can trust him when they're apart. Like Tim, many NFP husbands report a "courtship and honeymoon" effect of practicing intervals of abstinence followed by marital relations.

The Drakes have also switched to an NFP-only physician. When a physician decides to run an NFP-only practice, he initially suffers a dramatic loss of patients — but is then able to rebuild. "Thirty thousand dollars a month walked out of my practice," Dr. Paul Hayes, who made the change in the mid-1990s, recalled in an interview for the National Catholic Register.

A one-time devotee of Transcendental Meditation, Hayes, a baptized Catholic, had not been practicing before a powerful conversion experience that would change his career path. "As an OB-GYN," Hayes observed in the Register interview, "you're on the front line. You're clearly either with the Church or against it. If you're even slightly askew, you're running from Church teaching.

"Everything an OB-GYN does," he added, "revolves around birth control. If a woman bleeds heavily or irregularly, if a woman has painful periods, or if a woman has ovarian cysts or PMS, the doctor prescribes the birth control pill. It's a treatment for everything."

Hayes, who felt he could no longer practice that kind of medicine, resigned from his practice in Florida and spent 18 months studying with Dr. Thomas Hilgers, director of the Pope Paul VI Institute for the Study of Human Reproduction in Omaha, Nebraska. The institute provides not only training in NFP but also works with couples who want to conceive but have been unable to. Hilgers has developed NaPro Technology, which helps couples conceive through a normal act of sexual intercourse rather than through practices like in vitro fertilization that the Catholic Church has emphatically rejected.

After his stint at the Pope Paul VI Institute, Hayes moved to Lincoln, Nebraska, where he was invited by the local bishop to establish a clinic called Holy Family Medical Specialists. The practice has about 6,500 patients. When another physician, Dr. Timothy Fischer, joined the practice, it was feared his patients wouldn't follow him. Most did.

"Sooner or later," Hayes predicted, "women will recognize that the contraceptive mentality treats them as objects, and they will turn to NFP. It's just a matter of time." (To find an NFP physician in your area, consult the Web site of One More Soul, an organization with an extensive listing of NFP-only doctors.)

As enthusiastic as they are about NFP, Tim and Mary Drake warn that there is a peril: NFP can be practiced with a "contraceptive mentality." The Drakes had been married five years when they realized they were doing this very thing. "We were following the letter of the law and not the spirit," Mary says. The Drakes thought about their situation and decided it was time to be open to children. They now have four children, including twins and a new baby.

While Pope John Paul II has always made it clear that NFP is acceptable for the spacing of children when there are good grounds for doing so, a couple can't rule out children altogether (absent a grave reason). When, for example, Mercedes Wilson was told that she would not survive another pregnancy, she obviously had a good reason to practice NFP.

"I realize that many people think that the Church is 'behind the times,' or simply irrelevant when it comes to its teaching regarding contraception," writes Dr. John T. Bruchalski — a fellow of the American College of Obstetricians and Gynecologists and a practitioner in Fairfax, Virginia — in a pamphlet on NFP.

"The antithesis of Church teaching," Bruchalski continues, "is the idea adopted by our culture that individuals have a right to sexual relationships outside marriage, and that, whether single or married, individuals have a right to sexual intercourse free from any concern that a child might result."

People often insist that if the Church would "ease off" on artificial birth control, it would have more credibility in fighting abortion. Not so, say NFP advocates. "The record shows that whenever a denomination compromises on contraception, it has ended up accepting abortion," John Kippley notes.

Fighting Each Other

While offering people a way to live out the teachings of the Church, the early NFP movement split into two warring camps — the Billings people, who espoused the mucus-only system, versus the Sympto-Thermal people, who monitored mucus and temperature changes.

A Couple to Couple League suggestion — that women perform examinations of their cervixes — further upset those who followed the Billings Method. As ovulation draws near, the cervical os (mouth) opens slightly, and the cervix becomes softer and elevated. CCL teaches women to monitor these changes, using the middle finger to examine the cervix. Not only do the examinations help women observe these changes, but CCL advocates say that such examinations are important for another reason: It's sometimes difficult to find cervical mucus without them.

The Billings camp maintained that such an examination of the cervix was immoral. Reportedly, they lobbied the Vatican to declare it sinful in the early 1980s. "We've always been at odds over this," says Wilson, who sidesteps the subject of masturbation and insists that the problem with cervical self-examination is that, especially in developing countries, it can introduce bacteria or infections. However, Kippley says that Dr. Edward Keefe has long advocated that ordinary soap-and-water hygiene is sufficient: "In other words, the hygiene required for food preparation is sufficient for internal observation."

If a woman finds that the cervical exam stimulates her sexually, CCL types argue, she can simply dispense with that particular part of the program. "Many women will notice mucus at the cervical os several days before they notice it at the vulva," Kippley says. "If mucus can flow, a sperm can migrate. That's our belief. Sperm are very small, and they're good swimmers."

Some in the Sympto-Thermal movement, however, claim that something more than the detection of mucus enters into the equation. "The problem," one says, "is that people have deified John Billings, and he has said that all you need is an examination of the mucus as you experience it at the vulva by direct feeling or on a tissue paper."

While the world embraced a contraceptive mentality, factions of the NFP movement squabbled with each other. A Church insider describes the competition between the two approaches during the 1980s as "fierce." In 1982 Pope John Paul II himself seemed to call for amnesty. "It is necessary that various groups dedicated to this noble work appreciate their respective work and mutually exchange experience and results," the pope urged, "firmly avoiding tensions and disagreements, which could threaten this important and difficult work."

Though lingering tensions still exist in the NFP movement, the hostilities of the 1980s are over. "The big thing now," John Kippley says, "has nothing to do with the differences of the various methods. The big thing is: When is the Church at the parish level going to get sufficiently serious about Humanae Vitae that the folks in the pew can't help but take notice?

"If you want to talk about secrets within the Church," he adds, "NFP is one of the best-kept secrets. Father Curran and his ilk made it appear that those of us who accept Church teaching are either an effete elite with no sex drive or blind slaves to bureaucratic teaching."

Around The World

The United States isn't the only place where the merits of NFP versus contraception are weighed. At one point, Mercedes Wilson received a grant from the United Nations (UN), and a jealous Planned Parenthood, which receives money from the United States, was up-in-arms. The World Health Organization, however, does include NFP among the methods of family planning taught in emerging nations.

A former Guatemalan delegate to the UN, Wilson feels that the family planning activities of the UN and other international bodies are reprehensible. She once confronted a USAID official in Guatemala. "I want you to take your pills and IUDs back to the U.S.," she told him. "He nearly flipped. Who is this woman? But I said, 'It's our country and our religion.' He nearly threw me out."

In the end, he helped find money for training people in NFP after Wilson made a none-too-subtle threat: "If you don't give me the funds," she said, "I'll take them out of my own pocket. But I'll tell the world."

A number of private organizations — including Wilson's Family of the Americas — provide NFP training to the needy in Latin America. But these providers are smaller than government sources, which favor artificial contraception. "Sadly," writes Rebecka Lundgrer in the NFP Forum, a quarterly newsletter published by the USCCB, "very few government providers recognize the need for their systematic training in NFP. In general, public health providers maintain their opposition to the natural methods because they do not believe women would use them correctly."

Georgetown University's Institute of Reproductive Health (IRH) has tried to raise awareness of NFP in Latin America. The institute has conducted studies on the state of NFP in Latin America and is working to develop partnerships between NFP providers and the government. Honduras has done particularly well in introducing NFP to the poor. The state and Church have both been involved. A program called RENAFE has trained 400 couples to train those who want to use NFP. (They use the Billings Ovulation Method.)

Georgetown's IRH is also experimenting with a simplified system in Honduras and Nicaragua-the Standard Days Method (SDM). "Developed by the IRH, the SDM is based upon recent research that identifies more precisely when during the reproductive cycle a woman can become pregnant. The method is based on the identification of a fixed 'window' of fertility," Lundgrer writes.

A recent study conducted in Guatemala by Family of the Americas indicates that, even without the simplified method, couples can successfully avoid pregnancy with the Billings Ovulation Method. Wilson claims an effectiveness rate of 99 percent among "the poorest of the poor" in Guatemala. "There's no excuse anymore to pretend that only those with strong religious convictions can follow natural family planning," she writes.

Speaking of following NFP without religious motivations, famously atheistic China has begun to use NFP. In fact, Wilson herself has been to China to teach it. She's invited by the government, even though she reserves the right to speak out against abortion while there. "When I teach in China," she says, "people are like sponges. When I go to a university in the United States, the attitude is often 'Do I have to listen to this woman?' Often people are already living together. In China, I get a standing ovation, even though I talk against their government's policy. I also tell them, 'You will destroy yourselves if you follow the ways of the West.'"

From Fiasco To Familiaris Consortio

"We're still living in a transitional period," says Theresa Notare of the USCCB. The Church hasn't quite recovered from the "fiasco of the 1960s" and the confusing dissent that followed Humanae Vitae, she observes.

Wilson says that doctors — and sometimes even priests — are the hardest people to persuade about NFP. "They get the hardest cases — my husband is a drunk, and he abuses me," she says. "The priests are often still thinking rhythm method, which doesn't work. In their compassion, they say 'Follow your conscience.' That's where the problem is."

Another past sticking point was that NFP enthusiasts weren't always prepared to teach it. "They were very enthusiastic, but the details were lost," says Rose Fuller, who runs the non-profit and non-sectarian Northwest Family Services in Portland, Oregon. Fuller observed that in some cases "poor teaching with no standardization" led to women becoming pregnant: "When my husband and I wanted to use NFP and were trying to find out about it in the mid-1970s, we got contradictory information. Somebody needed to make it clearer."

But this is changing. The USCCB through the bishops' Committee for Pro-Life Activities has developed national standards for diocesan NFP ministry. Wilson, the Couple to Couple League, Thomas Hilgers of the Pope Paul VI Institute, and others were consulted in the process of preparing the guidelines. In addition to learning about human fertility, teachers must understand Church teaching. A required reading list for NFP teachers includes Casti Connubii, Humanae Vitae, and Pope John Paul II's 1980 Familiaris Consortio. Notare adds that young men in seminaries today are being given a solid grounding in NFP. This wasn't always the case with the generations that went through the seminaries in the wake of the Humanae Vitae controversy.

What kind of NFP program will be provided in a diocese is up to the bishop. To complicate matters, there is a shortage of NFP teachers. Teaching NFP, which is customarily done by volunteers, takes a significant time commitment. "We talk about an NFP ministry rather than a program," Notare says. There are NFP teachers in all U.S. dioceses, and almost all providers offer a correspondence course in certain circumstances. Still, some dioceses don't emphasize NFP. For some couples, a brief NFP workshop during marriage preparation may be the only encounter they have with NFP. The 1980s in-fighting in the NFP movement didn't help.

A more general concern, Notare says, is that Catholics often haven't received the religious education that enables them to understand why the Church teaches what it does about contraception. "You can't wait until marriage preparation to teach Catholics about natural family planning," Notare says. "There is always the big question: Did they get solid instruction on Church teachings regarding conjugal love and responsible parenthood?"

Pope John Paul II has been eager to return the Church to its traditional teachings and to promote NFP. Notare says that the pope, in his writings, "has gone a long way towards reclaiming what St. John Chrysostom was talking about. He has reclaimed and resurfaced a tradition that was always there." Chrysostom wrote letters on marriage and was one of the first to refer to the family as a "domestic church."

Familiaris Consortio, which is liberally sprinkled with references to Humanae Vitae, is essential to understanding the pope's commitment to NFP. John Paul emphasizes the "total" self-giving of both husband and wife. He elaborated on this theme in a letter to Dr. Anna Cappella, director of the Center for Research and Study on the Natural Regulation of Fertility at Rome's Catholic University of the Sacred Heart:

The truth of this marital act stems from its being an expression of the spouses' reciprocal personal giving, a giving that can only be total since the person is one and indivisible. In the act that expresses their love, spouses are called to make a reciprocal gift of themselves to each other in the totality of their person: nothing that is part of their being can be excluded from this gift. This is the reason for the intrinsic unlawfulness of contraception: it introduces a substantial limit into this reciprocal giving, breaking that "inseparable connection" between the two meanings of the conjugal act, the unitive and the pro-creative, which, as Pope Paul VI pointed out, are written by God into the nature of the human being.

Why, some might ask, is it necessary to become immersed in papal documents? "The teachers need to be believers or struggling to believe," Notare says. "It's easy to forget that this is a specific way of living out larger truths. Sometimes you lose sight of the larger picture."

Catholics lost sight of the larger moral issue of NFP in the wake of the Humanae Vitae controversy — but with even the secular world embracing "fertility awareness" instead of the Pill, the time is right for Catholics to rediscover one of the Church's most uplifting truths.

Must-Reads For NFP

By Dimitra Bolger and Charlotte Hays

The Art of Natural Family Planning

By John F. Kippley and Sheila K. Kippley (The Couple to Couple League International, Inc.)

An indispensable and well-written source that features everything from incisive explanations of Church documents to information on how to chart mucus and temperatures to the history of the Pill. More than 400 pages, it is possibly the most comprehensive NFP text available.

Arcanum Divinae Sapientiae


This 1880 encyclical summarizes and completes the teachings of the magisterium for centuries. Its main thesis is to affirm marriage as a vocation and a means of sanctification that can only be understood through Christ.

Billings Method

By Dr. Evelyn Billings and Ann Westmore (Life Cycle Books)

Another classic of the NFP movement, Dr. Billing's book has sold over a million copies since it was first published in 1980. The approach taken here is a good balance to the Sympto-Thermal Method and allows one to get a broader understanding of various NFP techniques.

Breastfeeding and Natural Child Spacing: How Ecological Breastfeeding Spaces Babies

By Sheila K. Kippley (The Couple to Couple League International, Inc.)

Based on scientific research but written as one mom to another, the book shows mothers how they can enjoy this form of mothering.

Casti Connubii

By Pius XI

This 1930 encyclical is one of the most comprehensive of the Church documents on marriage. Pius XI takes a fourfold approach to explain the Church's teachings on marriage beginning with an examination of the nature and purpose of marriage, the three ends of marriage, errors and vices opposed to marriage, and how to respond to these vices.

The Christian Meaning of Human Sexuality

By Paul Quay, S.J. (Ignatius Press)

Using fascinating material from the early Church fathers and Scripture, Quay makes a truly profound argument showing not only what sexual sins (homosexuality, masturbation, and contraception) are wrong according to Church teaching but why they are wrong. Combined with common sense and natural law, Quay's book is truly unique in the realm of sexual ethics.

Familiaris Consortio

By John Paul II

John Paul II calls this 1981 encyclical his "summa" of the Church's teachings on family. Observing that the "future of the world passes through the family," the pope goes on to examine the fundamental nature of the family, challenges today's families face, and the future mission of the family.

Humanae Vitae

By Pope Paul VI

Paul VI's 1968 encyclical answered moral dilemmas raised by the Pill. This is the starting point for Catholics who want to deepen their understanding of marriage and sexuality.

Love and Fertility, How to Avoid or Achieve Pregnancy — Naturally

By Mercedes Azu Wilson (Family of the Americas)

Wilson uses pictures to explain a woman's fertility cycle and relate it to cycles in nature. There are charts and pictures of mucus at various stages. This book is helpful to any woman who wants to learn more about NFP.

Love and Responsibility

By Pope John Paul II (Ignatius Press)

Published when Pope John Paul II was bishop of Krakow, Love and Responsibility is a work in which "doctrinal meets pastoral theology." The book grew from the pope's many experiences counseling young men and women. This book explains why contraception is morally wrong. Many readers may be surprised by the direct way the pope deals with the issues.

Man and Woman

By Dietrich von Hildebrand (Sophia Institute Press)

Hildebrand addresses the philosophical nature of man and woman and shows what marriage and sexuality ought to be from the highest ideal. It has an easy-to-read style and is a moving, idealistic book.

Marriage and Family Documents in the Magisterium: A Course in the Theology of Marriage

By Ramon Garcia de Haro (Ignatius Press)

This is one of the best available books on marriage and the family from the perspective of Church tradition and Scripture. It focuses most notably on Paul VI and John Paul II to show how these two modern popes have not only upheld Church teaching, but have elevated it and explained it in new ways.

The Ovulation Method of Birth Regulation: The Latest Advances for Achieving or Postponing Pregnancy — Naturally

By Mercedes Arzu Wilson (Van Nostrand Reinhold Company)

This resource covers much of the same territory as Love and Fertility but without the aid of pictures and in an often-complex format. It covers everything a woman needs to know about charting mucus and offers helpful information for women who have chosen to stop using the Pill.

Sex and the Marriage Covenant

By John F. Kippley (The Couple to Couple League International, Inc.)

Explains why the marriage covenant excludes contraception. God fashioned human sexuality, and that is the basis of sexual morality. This powerful book helped Scott Hahn find his way into the Catholic Church.

Why Humanae Vitae Was Right: A Reader on the 25th Anniversary of Humanae Vitae

Edited by Janet E. Smith (Ignatius Press)

This is a compilation of essays by key theologians and philosophers on various aspects of Humanae Vitae. The essays show that the encyclical was right in its teachings and tragically correct in predicting the damage that contraception and the anti-life mentality would inflict upon society.

Learn More About NFP

Billings Ovulation Method Association, 316 N. 7th Avenue, St. Cloud, Minnesota 56303; 320-252-2100, fax 320-252-2877, e-mail [email protected]. Provides training in the authentic Billings Ovulation Method.

The Couple to Couple League, P.O. Box 111184, Cincinnati, Ohio 45211-1184; 513-471-2000, fax 513-557-2449, e-mail [email protected], Teaches the Sympto-Thermal Method and ecological breastfeeding.

Family of the Americas, P.O. Box 1170, Dunkirk, Maryland 20754; 301-627-3346 or 800-443-3395, fax 301-627-0847 or 800-443-3395, e-mail [email protected], Specializes in the Billings Ovulation Method of NFP.

Northwest Family Services, Inc., 4805 N.E. Glisan Street, Portland, Oregon 97213; 503-215-6377, fax 503-215-6940, e-mail [email protected], Teaches the Sympto-Thermal Method of NFP.

One More Soul, 1846 North Main Street, Dayton, Ohio 45405; 800-307-7685, fax 937-279-2370, e-mail [email protected], Provides information on NFP and a listing of NFP-only physicians and medical professionals by state and zip code.

Pope Paul VI Institute for the Study of Human Reproduction, 6901 Mercy Road, Omaha, Nebraska 68106-2604; 402-390-6600, fax 402-390-9851, Treats infertility with morally acceptable methods and teaches The Creighton Model Fertility Care System, based on the observation of cervical mucus.

Charlotte Hays, editor of the Women's Quarterly, lives in Washington, D.C.

Dimitra Bolger is research assistant for the United States Conference of Catholic Bishops.

© 2001 The Morley Institute

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