Cassie can say this SO much better than I can. All I can add to this is that I agree with her completely.
Does NFP Really Work?
This week is NFP Awareness week. NFP advocates are proudly spreading the word that NFP is a highly effective method of family planning.
Unfortunately, the rest of the world doesn’t doesn’t think that NFP and fertility awareness based methods of family planning are so effective. While “perfect use” effectiveness is quite high, “typical use” effectiveness is significantly lower.
Note: For purposes of this post, “fertility awareness” refers to the method alone, while NFP refers to the method taught in the context of Catholic teaching. In other words, NFP is simply a specific way of using fertility awareness.
Scientifically, using any form of fertility awareness requires some work. Partners must learn their fertility, chart their observations, correctly interpret the chart, and follow the rules. This is, admittedly, more work than a set-it-and-forget-it method, like an IUD.
Still, people aren’t afraid to work for their health. How much effort do people put into eating right and exercising? How much time to people spend counting calories, buying local food, working out, or sports training? Compared to this, fertility charting is something very healthy for very little effort.
Nor is charting difficult for most women. With proper instruction, over 90% of women can identify their Peak day on the first cycle. Only a small number of women have problems with using the method, many of which can be resolved with more advanced hormone monitoring, improved diet, or medical intervention.
Fertility Awareness Users Are Different From the General Population
But why is the user method failure rate so high? Why do couples who rely on fertility awareness for family planning seem to have so many children?
One possible explanation of the high user failure rate is Simpson’s Paradox. Simpson’s Paradox is a phenomenon in statistics where when you lump data from unlike circumstances together, trends can disappear and even reverse.
A classic example is batting averages (with a nod to blogger Iowahawk). Imagine two batters, Hitter A and Hitter B.
– Against right-handed pitchers: 300 at-bats, 90 hits (.300 average)
– Against left-handed pitchers: 200 at-bats, 50 hits (.250 average)
Total: 500 at-bats, 140 hits (.280 average)
– Against right-handed pitchers: 100 at-bats, 32 hits (.320 average)
– Against left-handed pitchers: 300 at-bats, 78 hits (.260 average)
Total: 400 at-bats, 110 hits (.275 average)
Hitter B has a higher batting average against both righties and lefties, but Hitter A has a higher overall average. A closer look at the numbers shows that the only reason why Hitter A had the higher average is because he faced more right handed pitchers, against whom both A and B had a better batting average. Hitter B is the better hitter.
What does this have to do with fertility awareness?
Not all couples use fertility awareness based methods. Couples who used fertility awareness based methods for family planning are usually in stable relationships and are disproportionately devoutly Catholic and married.
Think about it: What couples would have the most difficulty with any method of family planning?
- Couples in a committed relationship.
- Couples who enjoy frequent sex. (More opportunities for conception.)
- Couples who don’t have a strong motivation to avoid pregnancy.
- Couples who have an intercourse-focused sexuality.
- Couples who have objections to supplementary methods of pregnancy prevention (i.e. barrier methods).
- Couples who are ambivalent toward family planning.
- Couples dealing with demanding life events, such as having a new baby.
Hmmm, sounds like a lot of happily married, “open to life”, devout Catholic NFP couples, doesn’t it?
Effectiveness Depends on Motivation
With fertility awareness based methods, when couples are OK with becoming pregnant, they tend to start taking chances with the method, and eventually they become pregnant. That’s a big reason why we, and many other couples are “bad at NFP”. We’re simply not motivated to avoid pregnancy enough to actually follow all the rules.
The Catholic Church considers this not to be a bug, but a feature of NFP—because the Catholic Church teaches that babies are good, that married couples should be open to life, and that couples should have good reasons not to avoid pregnancy.
But if a someone does have serious reasons for not becoming pregnant, then what?
In China, the government’s brutal One Child Policy gives ALL users a high motivation for not becoming pregnant. A recent study of the Billings Ovulation Method in China found a user-effectiveness rate of 99.5% with ZERO method related pregnancies. While it is likely the couples used the method very conservatively, fertility education allowed them to safely avoid pregnancy more effectively and more safely than the “highly effective” Copper IUD.
Anecdotally, couples with a very serious reason to avoid pregnancy DO use the method very cautiously. Some will feel like their need to avoid pregnancy is so serious that they do need to completely abstain from intercourse. (This is more common among unmarried women.) Because the methods give women and couples an awareness of their fertility, they can adjust the methods to meet their needs by being more conservative. You can’t do that with a Pill.
While women who have difficulty with the method are generally excluded from most studies, this number is low. According to BillingsLife, 90% of women are able to identify fertility on the first cycle with the Billings Method, with only 10% requiring additional help, while another study from Dr. Richard Fehring at Marquette University found that method problems affected only 7% of couples. As research and technology advances, I expect this number to drop.
The other reason for the low user effectiveness rate is the wide variety of quality of instruction. We have taken three different classes and read the classic Taking Charge of Your Fertility. Different instructors take different approaches, some of which are more effective than others.
Good instruction allows a woman to understand how her body works and how to recognize her own pattern of fertility. Good instruction will teach men to notice the changes in their partners throughout the month. Instruction that is primarily rule-based, primarily ideological or religious in content, or inaccurate or outdated, will not give couples the information they need to be able to effectively use the method.
Poor teaching is a solvable problem. Just like Wikipedia has given the world access to a better encyclopedia than could even be imagined 15 years ago, technology will allow the best practices and best methods to come to the forefront. When it was difficult to find any information, bad information was rampant. As information becomes more available, what is good and what is bad will become more apparent. Online classes will make the best methods accessible to everyone, not just those near a teacher.
Confirmation Bias and Religious Prejudice
But looking at the data, the problem is not so much that “NFP doesn’t work” as it is a matter of confirmation bias. People make of their minds about fertility awareness based methods and they pay attention to the data that agrees with their position. It’s why people remember “NFP surprises”, but forget all the “Pill babies” out there, even though the real-world pregnancy rates are about the same.
Often the bias is rooted in a distrust or dislike of the Catholic Church:
- “Everybody knows” NFP is the rhythm method.
- “Everybody knows” the rhythm method doesn’t work.
- “Everybody knows” that’s why the Catholic Church wants couples to use it—to make more Catholics.
- “Everybody knows” the Catholic Church hates women.
- “Everybody knows” the Catholic Church hates sex.
- “Everybody knows” the Catholic Church hates science. (Galileo! Galileo!)
- “Everybody knows” the Catholic Church wants nothing more that to make married couples miserable.
Recently, Real Clear Science editor Ross Pomeroy decided to study “Catholic birth control”. To his surprise, it was scientific and effective.
To me, [the Catholic argument against contraception] seems a dogmatic and unscientific argument. So I assumed that the method itself would be similarly lacking in evidence. But to my surprise, I was wrong.
Pomeroy is no fan of the Catholic Church, but he acknowledges that despite his views of Catholic theology, fertility awareness based methods are indeed effective.
The Catholic Church’s official stance condemning contraception is, in my view, dubious and disempowering to women. But though dogmatic religious leaders may deny the overt benefits of contraception, an open mind cannot deny based on the available evidence that their lone alternative is indeed effective.
This is why even though most users are highly satisfied with NFP/FAM, the negative stories get the most attention. Looking closer at the negative experiences, only 7% of couples have a negative experience due to the method, with the rest struggling due to relational or spiritual issues.
Fertility awareness based method require cooperation between the couple. No matter how the couple uses the method, each partner must sacrifice his or her desires (at some level) for the good of each other. If a couple has relational problems, then the method is going to bring them to the surface. Often the “problems with NFP” are a sign of broader sexual problems or are a sign that the couple may be using sex to cover up other problems in the relationship.
If a couple is using the method for religious reasons and they have a negative or unhealthy view of God and spirituality, then of course they are going to be miserable. This is common with “strict Catholics” who believe in a God that wants them to suffer and is waiting to send them to hell for any infraction. (This is not actual Catholic theology, by the way.) If you believe that God (or the Catholic Church) wants you to be miserable, then you’re not going to be surprised when following “God’s laws” makes you miserable. But having an axe to grind against God, the Catholic Church, or countless individual Catholics, is not a problem with the method. The problem is spiritual, therefore the solution is to gain a healthier, more positive, spirituality. (I write about this frequently at realcatholicloveandsex.com.)
Conventional Wisdom is About Fertility Awareness is Wrong
The conventional wisdom in the secular world is that fertility awareness based methods are best for married couples who can afford to make a mistake with the method because the user failure rate is high. The reality is that the user failure rate is high because couples who chose to use such methods are often the ones who are least motivated to avoid pregnancy.
The conventional wisdom among some in the Catholic world is that teaching people who are not married or preparing for marriage these methods encourages people to use the method to engage in non-marital sex. The reality is that when young women learn about their bodies, they often make better decisions about sex. Knowing how her body works can tell women when it’s love and when it’s just hormones. (Plus, it’s good medical information.)
The conventional wisdom is that fertility awareness is difficult to learn and that not every woman can know her own body. But as long-time fertility awareness and women’s health advocate Laura Wershler tweeted:
Thinking women can’t learn how to chart their menstrual cycles, is like thinking girls can’t learn to read. Thinking women w/problem periods can’t learn
#fertilityawareness is like thinking those with dyslexia can’t learn to read. Not teaching girls and women the signs of fertility and how their menstrual cycles work contributes to unintended pregnancies. Teaching girls & women signs of fertility & how their cycles work would decrease unintended pregnancies.
It’s also important for the guys too. Knowing what my wife’s body is doing allows me to better respond to her and to better understand her. This understanding has allowed me to be a better husband and a better lover.
Fertility awareness empowers women and empowering women empowers men. It is knowledge that every woman should have about her body (and something guys should know a bit about too.)
Last night was a rather uneventful evening. We put the kids to bed. We watched Thor on Netflix. We went to bed.
Almost as soon as we got into bed, K had a sharp shooting pain in her abdomen.
We called the midwife. We called a neighbor to watch the children. We called my mother, who lives nearby. The we rushed to the ER at about 11:30.
Shortly after arriving, K fainted. She was taken to ultrasound after she came to. The ultrasound showed an ectopic pregnancy with significant internal bleeding. They called the doctor, prepped her for surgery and operated a 4 am.
The surgery was a success. K is currently resting, recovering, and doing well.
We have mixed emotions about all of this. Although this pregnancy was a surprise, we had gotten past the initial shock and we were really looking forward to growing our family. Our older daughters were especially excited about being big sisters. (I had a post written about all of this that is still in draft.)
We are sad that we lost the baby. We are sad that we will never get to meet our “baby Bean” as our daughters called him.
But our grief will have to wait for another day. Today we are thankful. The doctor showed us the pics of the surgery. Several nurses said it was one of the worst ruptured ectopic pregnancies they had ever seen.
We are thankful for family and friends.
We are thankful we had good medical help available.
We are thankful that K is alive.
And we are thankful for all the prayers that were offered for K, both in this world and the next. I was a nervous wreck and I don’t think I could have gotten through this all without prayer.
I’m exhausted and will be very busy over the next few weeks, so I probably won’t be posting. Prayers are appreciated, as always.
Originally posted at realcatholicloveandsex.com
Yesterday’s post on why the clergy isn’t very supportive of Humanae Vitae was a bit of a downer. Here are seven reasons why I remain hopeful.
Yes, Mr. Hope and Change himself gives me hope.
Because the HHS Mandate was a wake up call for a lot of Catholics. We would never have reconsidered our contraceptive use if it weren’t for conversations that arose about the mandate.
The more he antagonizes the Church, the more Catholics have to stand up and defend the faith. As Tertullian said, “The blood of the martyrs is the seed of the Church.” (Conversely, “In the absence of martyrs, there’s a presence of thieves.” as the Jennifer Knapp song goes.) Although bureaucratic interference is far from martyrdom, the Church has always grown through difficulty and stagnated in times of privilege.
Oh, and the HHS Mandate does include a lot of maternity care benefits. It’s not all bad.
Bloggers and Internet Discussion
Much of the discussion over the HHS Mandate and Church teaching has happened over the internet. Some of it good, much of it not so good.
But the important part is that people are talking. People are sharing their stories. People are arguing. Sometimes people are won over.
When we tried NFP earlier in our marriage, we were very isolated and very frustrated. We thought we were the only people who did that, except for the really Catholic mommas with the mantilla and the maxi-van full of kids. (Not that there’s anything wrong with mantillas and maxi-vans.) When we struggled with the method, we had few places to turn to understand why. When we were struggling with issues about Church teaching, we thought we were the only people who did so. We saw Church teaching as limiting our options and forcing us into a certain lifestyle.
Social media has given us access to a wider variety of people. People like us are following Church teaching. People like us are even driving maxi-vans. You can follow Church teaching without having to become someone you are not.
Through social media, we have been able to see the positive side of Church teachings. We have also been able to see that challenges and struggles are normal. It’s not just for the super devout or the extra holy, it’s something that is good for for everyone.
Technology has made living Church teaching far easier than it had been in the past.
Gone are the days of paper charts, limited information, and the textbook-like Art of Natural Family Planning. Gone are the days of having to drive for an hour to a stranger’s house to talk about the most intimate details of your body and love life.
Electronic charting means no more paper charts to worry about. Online classes via Skype mean that you can learn the method in the convenience of your home. Online research means you can learn more about the methods if you are having a problem or if you are just into that sort of thing.
Technology is also making the methods easier. The new Marquette Method uses a ClearBlueEasy fertility monitor to determine the fertile times. As technology gets better and cheaper and as interest in natural methods grow, I expect more devices to make things even easier.
Increased awareness of Fertility Awareness as a woman’s health issue.
People are going green, and filling your body with artificial hormones isn’t compatible with a natural, healthy lifestyle.
Not only are non-Catholics starting to appreciate the method, but more Catholics are talking about the women’s health benefits of fertility charting. Church teaching is not a burden placed on women by the old guys in Rome, but part of a healthy way to live.
People Crave Challenges and Self-Improvement
People do crave a challenge. People like to improve themselves. That’s why more and more people run marathons.
Getting in shape takes perseverance, sacrifice and hard work. But, everyone agrees that the end result is worth the effort. Look at marriage, a career, owning a home, staying out of debt, buying a car, and living life as responsible human being… every aspect of life requires some amount of sacrifice, self discipline and work to achieve a positive, desired end result.
So why is it, when it comes to our fertility, that we all of a sudden throw the need for effort out the window? For some, it is enough effort to try and remember to take a pill every day. The result for this effort? A false sense of security that pregnancy is no longer a concern for the duration of her prescription.
One of the benefits of charting fertility is that it gives women important data about their bodies. As Kati Bicknell of Kindara Fertility put it:
By recording your daily fertility signs a whole world of possibility opens up for you! While it’s true that fertility charting can be, and often is used to achieve or prevent pregnancy, the benefits of it don’t stop there. Fertility charting can answer important questions about our ovulation, luteal phase, cycle health, thyroid function and more. I have friends who have finally figured out the root of several food allergies, from charting their fertility. I myself have learned that a diet high in animal fat keeps my cycles regular. One reason I’m so excited about what we’re doing at Kindara is that as more and more women start quantifying their fertility, we’ll start to generate new knowledge about fertility for the benefit of humankind, creating a virtuous feedback loop that will help each woman feel calm and confident with her fertility in her specific situation.
For us, charting allowed K to spot that she was Vitamin D deficient, which allowed me to figure out I was too. By adding Vitamin D supplements to our diet, we were able to avoid the “winter blues” and have more energy.
It also gives couples data about their love life. How many “I”s this month?
All fertility awareness based methods work based on self-awareness, self-control, and self-sacrifice. Making these a part of your relationship makes it stronger. Even non-Catholic couples often notice positive changes in their relationship when they switch from contraception (especially hormonal contraception) to a natural method. Not only is it good for women’s health, but it works to build cooperation between the spouses. Or as life an intimacy coach Kim Animi explained:
Women: Take control of your own body.
Men: Support women to take control. You can do it with them.
Theology of the Body
Promoting fertility awareness as a health and relationship tool is great, but there is more.
For years, Catholic teaching on sexuality was presented very negatively—”Don’t”. The teachings was presented as a series of rules and obligations and often with a very judgmental tone.
Then it became a matter of “Don’t ask, don’t tell”, where nobody talked about it.
While Theology of the Body is about far more than just sexuality, it presents Catholic teaching on sexuality in the context of the human person. It’s not about a technical discussion of how God and nature designed the “parts” to “fit”, but about how sexuality fits into friendship and love.
Catholic teaching on chastity is a new way of thinking for traditional Catholics, Protestants coming from “Purity culture”, and secular people accustomed to the sexual revolution. It’s not about saying “No”, but about saying “Yes” to deeper and more intimate relationship. It’s not about rules, but about self-discipline.
As the culture is into self-improvement, the idea that chastity can improve relationships and personal well-being will cause people to be more interested in it.
I love our “frank” new Pontiff.
One of his big themes is about the importance of the laity being laity. We do not all need to be Extraordinary Ministers and distribute communion like the Priests. Nor do we need to be amateur theologians, giving our own personal spin to the teachings of the Magisterium.
What we do need to do is live our lives with holiness and joy.
For lay married couples to share with lay married couples ways to make their marriage better does not require the permission of a priest. It’s something that we can all do. It’s part of our vocation, not theirs. We don’t need to wait for Father to give the Big Homily On Contraception, we can tell our friends, family, and fellow Catholics what we have. Here. Now.
And I’m starting to see this promotion on the internet through sites like iusenfp.com, livingthesacrament.com, and many other blogs and websites dedicated to helping married couples have better marriages.
Which is why I am hopeful for the future.
For more Quick Takes, visit Conversion Diary!
The last few weeks have been rather stressful for me. When I find that I am over stressed and have difficulties in my life, I find that it is usually time to go to confession. There is probably some sort of sin in my life that is holding me back. If nothing else, I could use the spiritual guidance.
So Saturday morning I went to confession in the hopes that my soul would be unburdened. My regular confessor was out of town, so we had a substitute priest.
What I was looking for was help in dealing with the unexpected blessing that we found out about a few weeks ago. When you’re married to someone who is somewhere between highly skeptical and outright hostile to Catholic teaching on sexuality, an unplanned pregnancy can have serious consequences in your marriage. What I was looking for was reassurance, advice, and comfort.
What I got was not-so-subtle hint to just ignore the Church.
The priest was rather incredulous that anyone would have a third child after having two, much less that anyone would ever try to follow Church teaching on the matter. He told me:
I have to be careful about what I say, but, umm, you know more about your marriage than the Church does. These teachings aren’t infallible, you know.
Then I realized that in trying to unburden my soul, I had just scandalized a priest in the confessional. I had inadvertently reassured his doubts and dissents on Church teaching.
The Blind Leading the Blind
This is not an attack on this individual priest. Given his age, he was likely formed in the wake of Vatican II. He was likely told of the dangers of the clericalism that was prevalent before the council. He was probably lectured frequently on how little he knows and how unimportant he is—a “They are the Church” formation in the “Spirit of Vatican II.” (Note: This was not to say all was rosy before Vatican II. Clericalism, moral rigor, and legalism were real problems, especially in the United States, and they led to many of the problems after the council. Put another way, when you tell people that eating meat on Friday is as bad as having an abortion, you shouldn’t be surprised when they conclude that having an abortion is no worse than eating meat on Friday.)
Marital issues, especially sexual issues, are always awkward in the confessional. Most priests feel very uncomfortable with the subject and for good reason. It’s not their vocation.
They have no personal experience with marriage.
They have no personal experience with parenting.
They have no personal experience with marital sexuality.
They have no personal experience with women’s health.
As a result, many priests assume that the Church knows as little about it as they do. They assume that married couples appreciate advice from a priest on the most intimate aspects of marriage as much as they appreciate parishioners giving them detailed instructions on how to say mass. They assume we don’t want guidance from the Church or that we don’t need it. They are afraid that Catholics will stop coming to Church, or more cynically, stop giving.
They see difficult and unpopular teachings like Humanae Vitae, not as being the true teaching of Church protected from error by Holy Spirit, but as yet another example of clericalism run amok. They see the encyclical not as being about marriage and sexuality, but about a raw assertion of Church authority.
They see clergy who support the teaching not as faithful Catholics, but as careerists looking for a promotion from Rome. They are suspicious of Catholics who follow the Church as being radicals. (Admittedly, not always without reason—sometimes well-meaning, but overzealous and ill-informed lay Catholics can do serious harm to couples.) Because they were taught that the Church’s teaching is based strictly on authority, they don’t see how anyone who wasn’t power hungry could support it.
Then I realized why the USCCB isn’t doing more to promote NFP and is so resistant to those who would try: Not only do most Catholics disagree with the teaching, but so do a significant number of priests and bishops.
None of us should be surprised at how many pastors and bishops promote NFP less-than-enthusiastically.
Nor should we be surprised when Melinda Gates sees promoting contraception worldwide as fulfilling her Catholic faith. The Ursuline nuns who educated her told her “[W]e absolutely believe that you’re living under Catholic values.“
Nor should we be surprised when the product of a Catholic education from kindergarten to college tweets about how we should spend more money on family planning (contraception) for the developing world.
Nor should we be surprised when a majority of Catholics—more than the general population—believe that employers should cover contraceptives in their health plan.
Nor should we be surprised when a majority of Catholic use contraception.
Nor should we be surprised when it’s so hard to find guidance and support in living the Church’s teaching.
Yet I remain hopeful.
…to be continued.
This week begins the USCCB’s Fortnight for Freedom.
But the Fortnight for Freedom is doomed to fail.
I’m not too concerned about the HHS Mandate itself. It will likely be struck down by the Supreme Court. Let’s just say the six Catholics and three Jews on the Court frown upon government intrusions on religious freedom. I fully expect the Administration to get bench-slapped by the Supremes.
So why is the fortnight doomed to fail?
Because even though the bishops may win in the Supreme Court, they are losing in the court of public opinion. Badly.
The Bishops are frequently the butt of jokes
The bishops are being used by a cynical Administration who is quite good at playing politics and buying votes. They make an easy punching bag.
Because the public doesn’t see the debate as one over religious freedom, but one over women’s health care
and the bishops are losing.
But Wait! What about Natural Family Planning!
It teaches women about their bodies. ALL about their bodies.
But how do Catholics promote this alternative view of women’s health? With professional advertisement; prayer, fasting, and special masses; and lots of media attention?
Ehhh, not so much…
When lay Catholic women do try to promote this “revolution in women’s health“, they get a less-than-enthusiastic response.
The Project Chick says it best. (She’s passionate about NFP for a reason.)
So, while the USCCB keeps fighting battles over “freedom”, they continue to lose the war.
But the real losers are women.
#7QT from the beach! We’ve had a great time in the sand and the surf. (And taking advantage of child-free moments when we get them.) We’re headed back tomorrow.
While on vacation, I met my first blogging friend in real life. We ended up going to 5:00 PM mass at Alison Griswold’s home parish. We connected on Twitter and I found out that she was there too. We met briefly after mass, and got to know each other in real life. We’re both from South Carolina (although opposite ends of the state) so we had a lot to talk about.
It was strange to meet someone in real life, especially someone I have argued with online in the past, when I spend so much effort to be anonymous. But I think for all of us bloggers there is a difference between the blogging persona and the real live person. Blogging gives you such a one dimensional perspective of someone that it’s easy to forget how much you really have in common in real life.
One of Alison’s articles convinced me to go to daily mass. Because more is better.
I found this while doing a Google image search.
Does Planned Parenthood know what causes that? Because, last I checked, it sure ain’t abstinence.
But to be fair, even abstinence has a failure rate…
For some reason, I don’t think that’s what Planned Parenthood was getting at.
Have trouble with swearing at work? Enjoy this hilarious guide to clean language in the office. (Warning: NSFW)
As someone whose mother DID only have one child, I would have loved a little less adult attention. When you’re the only child you get all the attention and all the pressure.
Most importantly, you never have a sibling to blame everything on.
All that pressure of being an only child can just turn you into a perfectionist. Here’s a great article about how perfectionism can limit your life.
Recently we went to a potluck at our parish.
At the potluck, one parishioner happily stated while drinking a beer, “Being Catholic is great! We can drink beer, we can gamble, and we can have as many children as we want!”
I mentioned this to a friend who replied: “Why would anyone want to drink, gamble, or have more than two children?”
I was rather dumbfounded. I’m not sure how to respond to something like this. Ideas?
Update: Right after I posted this, Brandon Vogt randomly put up this a Chesterton quote on Twitter.
For more Quick Takes, visit Conversion Diary!