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Natural family planning (NFP) is a term referring to the family planning methods approved by the Roman Catholic Church. In accordance with the requirements for sexual behavior in keeping with the dignity of the human person, as maintained by the Church, NFP excludes the use of other methods of birth control.
Periodic abstinence and the natural infertility caused by breastfeeding are the only methods deemed moral for avoiding pregnancy. When used to avoid pregnancy, NFP limits sexual intercourse to naturally infertile periods: portions of the menstrual cycle, during pregnancy, or after menopause. Various methods may be used to identify whether a woman is likely to be fertile; this information is used to either try to avoid or try to achieve pregnancy.
History
Pre-20th century
Possibly the earliest Christian writing about periodic abstinence was by St. Augustine. In the year 388, he wrote, " Is it not you who used to counsel us to observe as much as possible the time when a woman, after her purification, is most likely to conceive, and to abstain from cohabitation at that time...? " The Manichaeans (the group the early church father St. Augustine wrote of) believed that it was immoral to create any children, thus (by their belief system), trapping souls in mortal bodies. Augustine condemned them for their use of periodic abstinence: " From this it follows that you consider marriage is not to procreate children, but to satiate lust. "
If the Manichaeans had an accurate idea of the fertile portion of the menstrual cycle, such knowledge died with them. Documented attempts to prevent pregnancy by practicing periodic abstinence do not appear again until the mid-nineteenth century, when various calendar-based methods were developed "by a few secular thinkers." The Roman Catholic Church's first recorded official statement on periodic abstinence to avoid pregnancy is from 1853, where a ruling of the church's Sacred Penitentiary addressed the topic of periodic abstinence to avoid pregnancy. Distributed to confessors, the ruling stated that couples who had, on their own, begun the practice of periodic abstinence—especially if they had "legitimate reasons"—were not sinning by doing so.
In 1880, the Sacred Penitentiary reaffirmed the 1853 ruling, and went slightly further. It suggested that, in cases where the couple was already practicing artificial birth control, and could not be dissuaded to cease attempting birth regulation, the confessor might morally teach them of periodic abstinence.
Early 20th century
In 1905 Theodoor Hendrik van de Velde, a Dutch gynecologist, showed that women only ovulate once per menstrual cycle. In the 1920s, Kyusaku Ogino, a Japanese gynecologist, and Hermann Knaus, from Austria, working independently, each made the discovery that ovulation occurs about fourteen days before the next menstrual period. Ogino used his discovery to develop a formula for use in aiding infertile women to time intercourse to achieve pregnancy.
In 1930, John Smulders, a Roman Catholic physician from the Netherlands, used Knaus and Ogino's discoveries to create a method for avoiding pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, and this was the official rhythm method promoted over the next several decades. While maintaining procreation as the primary function of intercourse, the December 1930 encyclical Casti Connubii by Pope Pius XI gave the highest form of recognition to a secondary—unitive—purpose of sexual intercourse. This encyclical stated that there was no moral stain associated with having marital intercourse at times when "new life cannot be brought forth." Although this referred primarily to conditions such as current pregnancy and menopause, the Sacred Penitentiary in yet another ruling in 1932, and the majority of Catholic theologians also interpreted it to allow moral use—for couples with "upright motives"—of the newly created rhythm method.
In 1932 a Catholic physician published a book titled The Rhythm of Sterility and Fertility in Women describing the method, and the 1930s also saw the first U.S. Rhythm Clinic (founded by John Rock) to teach the method to Catholic couples. It was during this decade that Rev. Wilhelm Hillebrand, a Catholic priest in Germany, developed a system for avoiding pregnancy based on basal body temperature.-
Later 20th century to present
Into the early twentieth century, it was believed by some Christians that the only licit reason for sexual intercourse was an attempt to create children. A minority of Catholic theologians continued to doubt the morality of periodic abstinence. Some historians consider two speeches delivered by Pope Pius XII in 1951 to be the first unequivocal acceptance of periodic abstinence by the Catholic Church. The 1950s also saw another major advance in fertility awareness knowledge: Dr. John Billings discovered the relationship between cervical mucus and fertility while working for the Melbourne Catholic Family Welfare Bureau. Dr. Billings and several other physicians studied this sign for a number of years, and by the late 1960s had performed clinical trials and begun to set up teaching centers around the world.
Humanae Vitae, published in 1968 by Pope Paul VI, addressed a pastoral directive to scientists: "It is supremely desirable... that medical science should by the study of natural rhythms succeed in determining a sufficiently secure basis for the chaste limitation of offspring." This is interpreted as favoring the then-new, more reliable symptoms-based fertility awareness methods over the rhythm method. Just a few years later, in 1971, the first organization to teach a symptothermal method (one that used both mucus and temperature observations) was started. Now called Couple to Couple League International, this organization was founded by John and Sheila Kippley, lay Catholics, along with Dr. Konald Prem. During the following decade, other now-large Catholic organizations were formed: Family of the Americas (1977), teaching the Billings method, and the Pope Paul VI Institute (1985), teaching a new mucus-only system called the Creighton Model.
Today, use of the term natural family planning to describe calendar-based methods is considered incorrect by the United States Conference of Catholic Bishops: it considers such methods "inaccurate". Still, some organizations still consider calendar-based methods to be forms of NFP. For example, in 1999 the Institute for Reproductive Health at Georgetown University developed the Standard Days Method (SDM), which is more effective than the rhythm method. SDM is promoted by Georgetown University as a form of natural family planning.
Prevalence
It is estimated that 2–3% of the world's reproductive age population relies on periodic abstinence to avoid pregnancy. Breastfeeding is believed to reduce the world's fertility rate by 30–45%. However, what portion of this population should be considered NFP users is unclear. Some Catholic sources consider couples that violate the religious restrictions associated with natural family planning to not be NFP users.
There is little data on the worldwide use of natural family planning. In Brazil, NFP is the third most popular family planning method. The "safe period" method of fertility awareness is the most common family planning method used in India, although condoms are used by some.
Use of NFP in developed countries is low, even among Catholics. While Catholics made up 24% of the U.S. population in 2002, of reproductive age American women using birth control, only 1.5% were using periodic abstinence.
Use of NFP is not restricted to Catholic couples. In 2002, Sam and Bethany Torode, then a Protestant Christian couple, published a book advocating NFP use. (Five years after writing the book, the Torodes retracted their advocacy of pure NFP and also supported barrier methods as moral; the couple also converted from Protestantism to the Eastern Orthodox Church.)
Not contraception
Some proponents of NFP differentiate it from other forms of birth control by labeling them artificial birth control. Other NFP literature holds that natural family planning is distinct from contraception . Proponents justify this classification system by saying that NFP has unique characteristics not shared by any other method of birth regulation except for abstinence. Commonly cited traits are that NFP is "open to life," and that NFP alters neither the fertility of the woman nor the fecundity of a particular sex act. That NFP can be used to both avoid or achieve pregnancy may also be cited as a distinguishing characteristic.
Methods
There are three main types of NFP: the symptoms-based methods, the calendar-based methods, and the breastfeeding or lactational amenorrhea method. Symptoms-based methods rely on biological signs of fertility, while calendar-based methods estimate the likelihood of fertility based on the length of past menstrual cycles. According to the Couple to Couple League, "the fact that some methods of NFP can be 99% effective in the avoidance of pregnancy seems unknown to most of the general public-including many health care professionals." Clinical studies by the Guttmacher Institute, semi-autonomous division of The Planned Parenthood, instead, showed a much lower efficacy, with 25.3% of failures in typical use condition.
Symptoms-based
Main article: Fertility awarenessSome methods of NFP
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