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CFFC in the News - 2006
Birth Control, Naturally
25 March 2006
Forget the rhythm method. Some Catholics – and non-Catholics – are turning to the specific methods of natural family planning to learn when pregnancy is likely
Every morning when the alarm goes off, before getting out of bed, Andy Hebda hands a digital thermometer to his wife, Jill. Emerging from the fog of sleep, she slips it under her tongue, waits a minute and then reaches for a chart to record her temperature. The chart looks a bit like a heart monitor in a hospital, with peaks and jagged valleys marking the fluctuations of her waking temperature over the past few weeks.
To the uninitiated, it's just a graph. But to the Hebdas, it's a way for Jill to pinpoint something most women only guess at: the five to seven days each month when she can become pregnant.
The chart and thermometer — and a dose of will power — are key to natural family planning, the scientifically improved version of what was once called the rhythm method. It enables a woman to predict, with reasonable accuracy, when she will ovulate. And it might give her early warning of potential reproductive health problems if her cycle starts to change.
For the Hebdas, who are Catholic, it's the preferred method of birth control — they even teach it in classes at two local churches. But other, nonreligious couples also practice natural family planning..
"A lot of what NFP requires users to do boosts women's confidence in themselves and in their body," says Elizabeth Pollard-Grayson, a 31-year-old online instructor for the University of Texas' Distance Education Center, who has used the method for 12 years. "The women's movement in the '70s promoted it for that reason."
"We're at a time in American culture, and especially in Austin, where we have a lot of people that are looking to live healthier lifestyles and do more natural things," Andy Hebda says. "With regard to Catholics, I think there's a growing movement toward really embracing the church teaching and understanding what it is."
The Catholic Church forbids birth control measures such as condoms or the pill because it views them as separating sexual intercourse from its consequences. It endorses "natural" methods to avoid pregnancy because they work with the body's fertility cycle rather than blocking conception with hormones or a device.
Despite that dictate, less than 5 percent of Catholics use natural family planning, according to the 2002 National Survey of Family Growth. Some Catholics who do, such as Randy McCaslin and his wife, Nancy, say their original motivation was not religious.
"We were both brought up in the '60s hippie generation, and we were looking for something more natural," he says. The McCaslins converted to Catholicism after learning natural family planning 26 years ago. Randy McCaslin is now executive director of FertilityCare Center of Central Texas, which offers natural family planning instruction and is affiliated with the church.
"Not only was it a good method that was effective and natural, but it really had a profound effect on the way we communicated about sexuality," Randy McCaslin says.
Although the Austin diocese requires engaged couples to attend a one-hour introductory session on the system, most classes are attended by a mix of non-Catholics and Catholics alike. Some couples go because they are having trouble conceiving; some because they're dissatisfied with other forms of contraception.
Indeed, natural family planning is often billed as a lifestyle choice, not a religious one.
That's a problem for pro-choice advocates who question the company that the natural method keeps. This week, a Salon.com story ("The battle to ban birth control") examined a growing movement against all forms of contraception, advocated on Web sites such as NoRoomForContraception.com, which endorses natural family planning.
Frances Kissling, president of Catholics for a Free Choice, says politically motivated advocates emphasize the "natural" aspect of the method to create the appearance of a broad following. "They are looking for groups they can point to who share their perspective on periodic abstinence but have no religious reason for using it, to legitimate their cause," she says. "Even if they don't convert them to all of the philosophy behind NFP, they see it as useful to point to the existence of these people as a source of credibility."
Not grandma's rhythm method
Maybe you know this old joke:
Q: What do you call people who use the rhythm method?
The joke brings a wry smile to Randy McCaslin's face. Like most advocates of natural family planning, he resists references to its predecessor, the much-ridiculed rhythm method.
"It's a misnomer to equate calendar rhythm to natural family planning, because they are quite different things," he says. "But because of the failure of calendar rhythm, people tend to be skeptical about a natural method because they equate 'natural' with rhythm, even if they don't know much about it."
Developed in the 1920s, the rhythm method tried to predict ovulation based on a calendar of past cycles. As any woman whose period has been delayed by stress knows, the menstrual cycle can vary from month to month. Relying on the false premise of regular cycles, the rhythm method was famously unreliable in preventing pregnancy.
"I'm one of five children, and my Irish Catholic grandmother had 17 children, but that's not me," says Bridget Brown, who teaches natural childbirth courses.
After the birth of her third child, Brown and her husband were considering sterilization, but changed their minds after taking a class from the Hebdas. "We're just not surgery people," she says. "I feel like the natural way to go is more 'us.' "
Brown, a former Catholic, says she "glazes over" the religious component of natural family planning, and focuses on something she sees as more elemental.
"I think this is unintentional because it's more of a pagan kind of view, but you start to see the rhythm of the female cycle as mirroring the rhythm of the earth, and there's a respect that your menstruation is not a curse but a spiritual connection to the Earth and to other women," she says.
Kelly and Robert Tavarez are devout Catholics who practice natural family planning, have six children, and are considering having more. Kelly Tavarez acknowledges that their brood raises eyebrows about the effectiveness of their birth control method.
"People think, 'Oh, that's because NFP doesn't work,' but it's not," she says. "Something happens when you practice NFP — you start spending time with people who have bigger families, and you start to want more kids. Babies become more precious to you."
The Tavarezes are instructors in the Couple to Couple League, a Catholic organization that promotes natural family planning as part of a lifestyle that focuses on traditional values. Fifteen-passenger vans that carry single families are not an uncommon sight at the biannual Couple to Couple League conference, Tavarez says.
Robert Tavarez says being abstinent for a while each month forces the couple to be more creative and show their love in ways other than sex. "I don't look at her chart and slam it down and say, 'Darn it!' " he says.
An unlikely marriage
Today's natural family planning techniques grew out of an unlikely marriage: a feminist awareness that encourages women to take charge of their reproductive health, and the Catholic Church's desire for a method of family planning that could be taken seriously in a culture that accepts widespread use of birth control. A key component is the need for cooperation between both partners in a sexual relationship.
"It can't work in a lot of families if the man doesn't respect the woman, or if he feels like he has a right to her body whenever he wants it," Pollard-Grayson says.
Yet she thinks the feminist movement has mistakenly overlooked natural family planning in recent years, perhaps because of its close ties to the male-led Catholic Church. With graduate degrees in theology and American studies, Pollard-Grayson investigated natural family planning for a research paper and concluded that "when NFP is mentioned in feminist writings, it is in a negative light or it is incorrectly defined."
"The perception, I think, is that the only people who use NFP are the uneducated people who just want to stay home and have lots of babies," said Austin obstetrician/gynecologist Mikael Love, who refuses to prescribe contraceptives for his patients. "I find that kind of interesting, because I've seen very educated women — physicians, Ph.D.s — who use it because it helps them understand more about their body, as opposed to just popping a pill and not knowing what's going on."
Those are often the sort of women Connie Ryan sees at her Central Family Practice, which uses both Eastern and Western approaches to medicine. Ryan, a nurse practitioner, estimates that about half her patients use some form of fertility awareness, but use barrier methods such as condoms rather than abstaining during fertile periods. Religiously motivated patients are a smaller group in her practice, she says.
"It's a great method in that it empowers women to understand their fertility, and it gets their partner participating," says Ryan, a former midwife who learned the technique from "A Cooperative Method of Natural Birth Control" by Margaret Nofziger. The book, published in 1977 by a Tennessee commune called The Farm, shows women how to monitor their monthly cycle by checking their basal body temperature and cervical mucus.
"A lot of my patients use other (birth control) methods during the fertile time, because the reality is that at the time women most want to have sex — it's difficult to abstain because of the surge in hormones," Ryan says. "It's a biological urge to create babies, and that's the flaw in the thinking of those who advocate abstinence during the fertile time."
Abstinence, it appears, is the Achilles' heel of natural birth control. Contraceptive Technology, a manual for health care providers, says that in "perfect use," natural methods are 91 percent to 99 percent effective — as effective as the pill. But in the real, nonperfect world, natural methods are only 75 percent effective. Most people who teach natural family planning say that reflects the challenge of abstaining from intercourse during risky times.
Ryan says a number of her natural family planning patients have become pregnant, but almost always because the couple ignored signs that the woman was ovulating. McCaslin says the FertilityCare Center sees between five and 10 unplanned pregnancies out of 200 new users each year, but "very rarely do we find one that doesn't have an explanation as to why it occurred."
Mary Cullinane, a nurse practitioner and director of patient services at Planned Parenthood of the Texas Capital Region, says the majority of Planned Parenthood patients who use fertility awareness are educated, interested in natural health, and are in stable relationships with a partner who is willing to abstain. But, she says, she can count on one hand the number of these women she sees in a year.
"Any method that requires a lot of user thought and preparedness, or cooperation from the partner, is going to be less effective than the methods where you don't have to do anything — where you just take a pill every day, or you put an IUD in and it lasts for years, or you get implants in your arm. It takes a lot of motivation, education and cooperation, and not everybody has that in their relationship or their life," she says.
Still, motivated users like Brown wish more people would take a new look at natural family planning.
"I'm so impressed with the amount of information, and I think it's such a disservice to the method that people still think of it as rhythm," she says. "I feel like they should teach this in high school. It's not the rhythm method anymore."
How does natural family planning work?
Each month, estrogen causes a woman's uterine lining to build up in preparation for a potential pregnancy, while an egg ripens in one of her ovaries. At midcycle she ovulates: The egg is released to the fallopian tube, where it must be fertilized by a sperm within 24 hours before entering the uterus, or it begins to disintegrate. Because most sperm can live three to five days, a woman is usually fertile during a window of about five to seven days per month.
Some women can actually feel the moment of ovulation with a slight pain in their side, but most don't know exactly when it happens. However, there are other signs that correlate with ovulation. Mucus from the cervix becomes more slippery. The cervix itself changes position. A woman's basal body temperature — her temperature at rest, first thing in the morning — rises about half a degree and stays elevated for about two weeks.
A natural family planning chart includes daily entries noting changes in body temperature and vaginal secretions. The most likely time for conception includes the 'peak day' and a few days following ovulation. If a woman wants to avoid pregnancy, she abstains from intercourse before and during that time period.
This article originally appeared in the 25 March 2005 edition of the Austin American-Statesman.