In discussing birth control and population issues when visiting the Philippines recently, Pope Francis said the Catholic Church promoted “responsible parenthood” that didn’t require good Catholics to be “like rabbits.” The frank imagery prompted a flurry of playfully creative headlines that ranged from mocking to woeful. And the byproduct of such reaction stories? The continued misinformation on what Catholics currently practice and what the Catholic Church actually teaches when it comes to family planning.
The pope’s remarks referenced Catholic teaching that prohibits artificial birth control. Family size, according to the Church, should be regulated by abstinence or a form of Natural Family Planning, sometimes characterized simply as trying really hard not to have sex when you’re “not supposed to,” which often fails and results in a ton of kids. Proponents of NFP say the method(s), and its practitioners, are too often misunderstood.
NFP for pregnancy prevention involves charting a woman’s cycles by testing for various biological markers — like basal temperature or cervical mucous — in order to assess fertile days and abstain from sex during that time. According to the World Health Organization, fertility awareness methods like NFP are 95-97 percent effective when used correctly and consistently (75 percent with typical use), and individual NFP models claim higher effectiveness.
Practicing NFP can certainly be complicated, especially when taking into account marriage and family dynamics that aren’t always conducive to the attention it requires.
But while it may be more difficult than, say, popping a daily pill or using an IUD, modern technology — like tracking apps and temperature-monitoring gadgets — is simplifying the process and coinciding with a resurgence in popularity. NFP practitioners say they appreciate the choice it offers — whether the motivation is following Church teaching or simply avoiding synthetic hormones.
Haley Stewart, a writer and blogger who began using NFP after she and her husband converted to Catholicism, said a big misconception is that the method is the same thing as the outdated “rhythm” or calendar methods.
“I think most people have no idea how effective modern, science-based NFP is,” she said.
Those “modern” forms of NFP have been around for decades, but the research behind them has become much more established in recent years. Following Pope Paul IV’s 1968 controversial encyclical Humana Vitae (Latin for Of Human Life), which denounced again the use of artificial birth control and claimed a future degeneration of the family, many went to work creating practical ways to avoid the pill.
Thomas Hilgers, an OB-GYN and founder of the Pope Paul VI Institute for the Study of Human Reproduction, took seriously the pope’s call for people of science to come up with more ways to help couples abide by church teaching. What Hilgers and his associates’ research discovered was that the Creighton Model, when used correctly, accomplishes that goal at 96-99.5 percent effectiveness. But the research actually went further.
“I’m convinced that had I found Dr. Hilgers sooner than I did, we would have been able to have a family,” said Kathy Hirkala, a registered nurse and NFP instructor and trainer who has worked with Hilgers.
According to Hirkala, doctors trained in Hilgers’ NaPro (Natural Procreative Tracking) technology take symptoms of infertility and use a woman’s chart to better diagnose the problem. Generally a couple is not considered infertile until they have tried unsuccessfully for pregnancy for an entire year. “But [when using the Creighton FertilityCare System] if she is not pregnant by the sixth or seventh cycle, we can start to analyze,” Hirkala said.
Because of NaPro, women are now utilizing NFP to diagnose underlying infertility issues in order to get pregnant.
Kaitlin Alfermann struggled with debilitating pain every month — coupled with extended absences from class and countless OB visits — throughout her teenage years before her mother consented to letting her go on the pill at age 18. It helped, but in college, she rethought her treatment. After charting her cycles, she visited an NFP practitioner who immediately diagnosed her with endometriosis, a painful condition in which the uterine lining grows outside of the uterus, often treated with surgery.
“I saw close to a dozen different doctors before I graduated — not a single one of them ever mentioned endometriosis,” Alfermann said.
A few years later, another obstetrician told her because of her condition she’d never get pregnant without in-vitro — which her belief told her was not an option. Instead, she returned to her NFP practitioner. With the help of NaPro, which uses the Creighton Model’s biological markers to track fertility rather than basing it on a typical 28-day cycle, Alfermann conceived — and is now pregnant with her third child.
Hirkala says Alfermann’s story is not unique — doctors often prescribe the birth control pill to alleviate symptoms for a whole host of issues, from heavy periods and ovarian cysts to acne. While taking the pill is successful in alleviating many of those symptoms, Hirkala says it doesn’t address the underlying problem. And women learning the Creighton model are being given an alternative.
Of course, this conversation is happening in the vacuum of the American context, where many women have access to Creighton and NaPro practitioners as well as any and every form of birth control method possible. But the Catholic Church’s mandate is not limited to American or Western privilege.
According to the Bill & Melinda Gates Foundation, “more than 220 million women in developing countries who don’t want to get pregnant lack access to contraception and voluntary planning information and services.” Further, in 2012, “an estimated 80 million women in developing countries had an unintended pregnancy; of those women, at least one in four resorted to an unsafe abortion.”
When the very real result of unintended pregnancy could be health consequences like obstetric fistula or even death, the approach deserves more consideration.
More than three quarters of American Catholics think that the Church should sanction birth control; more than half think a change in Church teaching will happen by 2050. And a 2014 international poll by Univision showed that global Catholics echo that: 78 percent of Catholics worldwide support the use of contraceptives.
Pope Francis’ recent remarks clearly don’t suggest any change in the Church’s stance. But they do reinforce the idea that NFP is not to be conflated with irresponsible attitudes about procreation. The practitioners of NFP I spoke with, who have been instructed extensively and take the method seriously, say the results they’ve seen are hard to argue with.
Haley Stewart, who ran a series of stories from women who practice NFP on her website Carrots for Michaelmas, said her biggest takeaway from the series was how NFP respects and empowers the whole woman.
“Regardless of the variety of situations in which a woman might practice NFP — including helping her conceive due to infertility struggles, helping her avoid a new pregnancy due to significant medical risk, helping her navigate confusing postpartum cycles to naturally space children, or address health concerns like [polycystic ovarian syndrome] — NFP acknowledges the whole woman and treats her as a unique and respected individual capable of making educated decisions based on knowledge of her own body.”
And the characterization that those using the method find excuses to breed “like rabbits?” Hirkala has a different take:
“Sometimes people who practice NFP have large families, and everybody assumes it’s because it doesn’t work,” she said. “… You can’t do this and not get an appreciation for how you do this and how your body is made. And oftentimes when the couples start getting that appreciation, they become more open to life.”
Whether talking about artificial contraception or natural family planning, there is one consensus: Access and education are essential.
When it comes to NFP, practitioners insist more training, more knowledge, and more access are key. Since many classes are taught through individual parishes, a lot of that dissemination of information is dependent on a priest who is educated in the methods — and comfortable discussing them.
“I wish I could clone priests who are really good at talking about it,” Hirkala said. “There are groups of priests who are supportive but uncomfortable talking about it.”
In a male-dominated hierarchical structure like the Catholic Church, leadership’s comfort level in discussing things like ovulation and cervical mucous certainly plays into the access question. But if Pope Francis’ continued openness on issues like family planning, breastfeeding in public, women in leadership, etc., is any indication of the Church’s progress beyond gender-based “taboos,” there is reason to be optimistic.
Sandi Villarreal is Web Editor & Chief Digital Officer for Sojourners. You can find her on Twitter @Sandi.