Tuesday, May 10, 2005

What's so great about NFP anyways?

I’m the first to admit that NFP and I have a classic love-hate relationship. Through fluctuations in my cycles due to years of pregnancy and breastfeeding, and just plain aging and heredity, monitoring my fertility has been challenging at times. Now, because of hormonal problems which will probably cause miscarriage, I am forced to use NFP to avoid conception. But what is really the cause of my hatred? Frankly, I hate it because it calls me to self-control, which is probably the least well exercised of all virtues in my life. NFP all too plainly points out my faults, expecting me to answer “no” when I’d dearly love to say “yes”. The siren call of the world today, instead of endorsing virtue, rather says, “You can have it all…say ‘yes’, no consequences”. ‘Consequences’ of course are strictly defined as children, and nothing else. But are the only consequences of sex and birth control, children? As a student midwife, and as a Christian wife and mother, I have done much research on this and come to some surprising conclusions.

Before I begin, though, I’d like to debunk the myth that NFP is “Catholic birth control”. Nothing could be further from the truth. NFP, properly defined, is simply gathering data. There are a few different methods, but the end result is identifying a woman’s own pattern of fertility and infertility. This is what the Church has permitted, that a woman can licitly and legitimately gather medical information about herself. The Church also permits a husband and wife to abstain. Logically, the Church either permits occasional abstinence, or is forced to define when and how often a husband and wife should be intimate. The latter is obviously an invasion of privacy, assault against prudence, and would imply that many lives of canonized saints were full of grave sin. So instead the Church has made guidelines which the faithful Catholic will keep in mind when deciding what to do with the information that has been gathered. The Church is clear that we are never to engage in the “contraceptive mindset” that would use NFP as nothing more than birth control. Such a mindset places the primary purpose of the marital embrace as unitive, while devaluing the bearing of children as a “consequence” which is nice if you’d planned it, but otherwise to be avoided. On the contrary, the Church emphasizes both the unitive and procreative purposes of the marital embrace.

All Christians should likewise emphasize the two-fold purpose of the marriage embrace, because the contraceptive mindset eliminates the purpose of male-female marriage. If marriage is primarily unitive, than the marriage act is appropriate for any two individuals who wish to be united. If the marriage act is equally procreative, it becomes necessary that marriage be between a man and a woman only. By observing our culture over the last two generations, it is quite clear that the Catholic Church has been wise. Not only has the contraceptive mindset lead to the population implosion of western civilization (see news articles on depopulation), but we are now in the midst of the new cultural revolution, which demands equality of status between traditional marriage and homosexual unions. As all Christian denominations have fallen for the lie that birth control is permissible, they have lost the key argument against homosexuality, that is, that they cannot procreate. Until the 1930s, no Christian anywhere would have ever considered birth control as morally licit.

That being said, there are times in a marriage where the further begetting of children would cause serious harm. We must be cautious when examining ourselves to determine if we have just reasons for avoiding the bearing of children and guard against a contraceptive mindset. It is helpful to have recourse to spiritual direction when making this decision. But, such scenarios might include economic hardship, health conditions, or psychological conditions. During such a time, it may become morally licit to postpone the further bearing of children, and for that end, the information gathered while practicing NFP can be surprisingly effective, even when compared with all the contraceptive alternatives available. NFP may also be licit to healthily space births, as research shows that births within a year and a half can have detrimental health effects on both mother and child.

All artificial birth control can be classified into two main categories: hormonal and barrier, with the exception of the IUD which I will discuss separately. When evaluating the varying alternatives, I will focus on function, user-effectiveness and side effects.

Hormonal birth control is available in a variety of forms these days. There is the ubiquitous combination pill, the progesterone only mini-pill, the patch, Depo-Provera, Norplant, etc. Despite the variations, they are all similar in function and side-effects. Hormones have a three-fold function. The first is to prevent ovulation. The second and third are to guard against failure of the first--the vaginal mucosa is thickened to delay the movement of sperm, the function of the fallopian tubes is slowed, and the uterine lining is altered. Statistics show that most women experience up to 1-2 breakthrough ovulations per year while on the pill. When this happens, the other functions of the pill come into play. If a baby is conceived, the hormones of the pill create an environment which make it difficult for the baby to implant and thus an early abortion occurs. The progesterone only pill is even less effective than the combination pill at preventing ovulation. Up to 60% of cycles will result in breakthrough ovulation while on the mini-pill. The user-effectiveness of hormonal birth control is 97%. While hormonal methods are the most effective, they also carry the greatest health risks. Side-effects range from headaches and weight gain, to blood clots, stroke, breast and cervical cancers, and a 2 fold increased risk of heart attack. Studies have also shown that use of artificial hormones can lead to depression and bipolar disorder as the woman’s natural hormone levels may be irreversibly altered. Families with a history of mental illness, especially clinical depression and bipolar disorder, should be exceptionally wary about using hormonal methods of birth control. Use of hormonal birth control may also lead to either short term or long term infertility. Other risks if one conceives while using hormonal birth control are abortion, ectopic pregnancy (due to the impaired action of the fallopian tubes), impaired function of the corpus luteum which sustains the early pregnancy, abnormally implanted placenta, and exposure of the developing baby to artificial levels of hormones.

On the other hand, barrier methods have fewer side effects but are far less effective birth control. The primary function of barriers is to prevent sperm from reaching the egg. Condoms, diaphragms, and cervical caps are the most popular forms of barrier birth control methods. These methods are usually used in conjunction with spermicidal creams, foams, or jellies. These methods have a wide range of user-effectiveness, but for the most part condoms with spermicide are the most effective at a user-effectiveness rating of 89%. Other barrier methods become increasingly less effective the more children one bears. Side-effects may include allergies, both to the latex and to the spermicide. By using spermicide, one also risks the conception of a child by a sperm injured by the spermicide. While not exactly a “side-effect”, barrier methods can also impede the natural flow of the marital embrace and can cause discomfort during use.

The IUD is a whole ‘nother animal. There are basically two types of IUD, hormonal and traditional. Both work primarily as an abortifacient by irritating the uterine lining to prevent a conceived baby from implanting. The hormonal IUD has an added progesterone element to prevent ovulation, however it is as effective as the mini-pill discussed above, that is it may fail to prevent ovulation up to 60% of the time. IUDs are 98-99% effective. Side-effects of the IUD include risks of uterine perforation, increased risk of vaginal and/or uterine infection, the IUD becoming imbedded in the uterus, sterility, ectopic pregnancy, longer and heavier periods, and in the case of the hormonal IUD, all the additional side effects of hormonal birth control. In addition, the IUD must be checked regularly to be sure it is still in place, and may sometimes be lost without the user knowing. If a woman becomes pregnant while using the IUD, removal of the IUD may cause abortion, while leaving it in place may cause premature birth and placental insufficiency. The IUD may also cause abnormal implantation of the placenta. The IUDs which include a copper component can carry an additional risk to women who have Wilson’s disease or are allergic to copper.

NFP can be used to avoid conception, by abstaining from the marital embrace during the woman’s fertile time. The fertile period can be observed by collecting data such as the basal body temperature, observation of vaginal mucus, and position of the cervix. The method has a user-effectiveness rating of 85-95% (some studies even showed 99% effectiveness). Method failures usually occur when the rules are not followed. There are no side effects. The method can also identify other health issues such as infertility or luteal phase defects. Additionally, NFP can be used to achieve pregnancy, which no birth control can ever do, by identifying the period in which conception is most likely to occur. NFP user effectiveness can be similar to condom user effectiveness because the couple must decide before every act whether to prevent pregnancy or not. The difference between the two, however, is that if a couple abstains during the fertile time, they will not conceive, while if a couple decides to go ahead and use a condom during the fertile time and the condom fails (3-5% probability of condom failure), they will probably conceive. When comparing NFP to other non-barrier methods, one must evaluate not only whether the sizeable health risks are worth added user-effectiveness, but also consider the fact that NFP can be as effective as hormonal birth control if used carefully and consistently. Non-barrier methods risk abortion of the conceived child, while NFP will never cause an abortion.

In addition to the above information, Christians have additional concerns when evaluating birth control. As Christians, our purpose on earth is to prepare ourselves for our inheritance and through our behavior to draw others to Christ. Marriage has been used in Scripture as an illustration of Christ’s relationship with us, the Church. Just as Christ gave all of himself for us, so are we as spouses to give all of ourselves to each other. Christ withheld nothing from us, we should withhold nothing from each other. As parents, we are given countless opportunities to grow in grace and holiness daily. We learn how to sacrifice our self for others, not only within the marital embrace, but in our every day family life. We also are enjoined by Scripture to take good care of the temple of our bodies, as we house the Holy Spirit. In considering these facts, how does artificial birth control meet these demands? How does it cause one to increase in holiness, self-sacrifice, love for others, and care of our bodies? Does NFP foster this growth? As Christians, are we not commanded to follow Him, even if it is the more difficult road?


At 8:52 AM, Blogger dcs said...

because of hormonal problems which will probably cause miscarriage, I am forced to use NFP to avoid conception

AFAIK there's no obligation to abstain because a miscarriage might follow upon conception. I'll check Jone when I get home, but I'm pretty certain that he says materially the same thing.

At 10:16 AM, Blogger Chris said...

Very nicely written and very informative. Thank you for the wonderful article. More people should think about the topics that you have dicussed -- Catholics included.

At 3:11 PM, Blogger BekahS. said...

You are most probably correct. Frankly, I'm fearful about experiencing miscarriage after miscarriage, and I'm also afraid that the consequential fluctuations in hormone levels would leave me in an even more precarious state of health. At the moment I am waiting on an endocrinologist appointment to see if the cause of my problems can be determined (although I'm already fairly certain it is thyroid issues) and treated. Until that time, we're being cautious.

Additionally, if I am right and the issue is thyroid, should I conceive and not miscarry, there is also the possibility that the child's health would be jeopardized, not to mention the added stress of pregnancy on my thyroid.

At 5:21 AM, Anonymous Anonymous said...

My name is Janice Still and i would like to show you my personal experience with Depo-Provera.

I am 24 years old. I have been on Depo for 9 years and did not realize that the symptoms I experienced might be related to the shot. I am now facing thousands of dollars in dental work due to bone density loss, and will probably end up with osteoporosis. I am getting off Depo and will never touch it again!

I have experienced some of these side effects-
Low libido, joint pain, bone density loss, dental problems, headaches, fatigue, out of control eating, gained 40 lbs., depression

I hope this information will be useful to others,
Janice Still

Depo-Provera Prescription Information


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