Majority of Couples Experience Improved Relationships With Use of NFP
Natural Family Planning

Richard J. Fehring
Reprint from Current Medical Research
Vol 15, No 1-2, Winter/Spring 2004
Washington, DC
Reproduced with Permission

Over 35 years ago Patrick and Patty Crowley, the founders of the Christian Family Movement (CFM), conducted a study to determine how the practice of Calendar-Rhythm affected marital life.1 The Crowleys were members of the Papal Birth Control Commission that was studying whether the Catholic Church should change its teachings on birth control. The Crowleys distributed a questionnaire to members of CFM throughout the United States and Canada asking them how the Rhythm method helped or harmed their marriage. The responses from the couples were mostly negative, that is, the majority felt Rhythm somehow harmed their marriage. The results of this study were never published but were submitted as a written report to the Papal Birth Control Commission. According to McClury, a religious historian from Northwestern University, this CRM report influenced members of the Papal Commission to recommend that the Catholic Church change its teachings on the use of contraception.2 Since the time of the Crowley study (1964), new methods of NFP, such as the Billings Ovulation Method (BOM), the Creighton Model FertilityCare™ (CrMS), and the Sympto-Thermal Method (STM), have been developed. These modern methods of Natural Family Planning (NFP) are thought to be more scientific and more effective than the old Rhythm / Calendar or BBT methods when used to either avoid or to achieve a pregnancy. Furthermore very little is known on how methods of family planning affect marital dynamics.

Researchers from Marquette University College of Nursing recently replicated the Crowley study among couples who have or were using a modern method of NFP.3 The purpose of this study was to identify the effects of these methods on marital dynamics by asking couples the same open-ended questions the Crowleys posed in their study of CFM members. The open-ended question asked of husbands and wives was whether the use of NFP had been helpful or harmful to their marriages. This open-ended question was part of a longer questionnaire mailed to 1,400 randomly selected couples known to use NFP (either BOM or CrMS) and reside in the United States. Three hundred thirty four couples (23.9%) or 668 individuals responded. Of these, 523 (78.3%) responded to the open-ended question, including 292 (87.4%) wives and 231 (69.2%) husbands. Graduate student coders, in conjunction with faculty researchers, used content analysis to identify meanings and themes in all the responses. A response was not coded under a given theme until 100% agreement was reached. Numeric analyses were used to determine frequency and percent of responses.

The researchers found that 74% of the total responses were positive and only 26% were negative. There were four positive themes identified (enhanced relationships, improved knowledge, enriched spirituality and method successes) and three negative themes (strained sexual interactions, worsened relationships, and method problems). Sub-categories for each of these main themes can be found in Tables One and Two.

Some example responses under the positive theme of "improved relationships" not reported in the published paper are as follows:

Improved Communication

"It [NFP] has helped us to be closer and we communicate on a different level than just the ordinary ways. We seem to be very comfortable with each other."

"Since we speak about our fertility on a daily basis (my husband charts and asks my observations daily) NFP has helped our level of communication remain very deep and intimate and always above-board, open and honest."

Appreciated Sexuality

"Our sexual relationship is incredible. I have no complaints and truly believe the periodic abstinence of NFP causes us never to get in a rut sexually."

Understand Cycles and Bodies

"[NFP was] helpful to understand PMS symptoms for myself and my husband because of our awareness of my cycle. Thus, helped keep our moods / reactions / issues in balance / in perspective."

Self Control

"About the time when you are ovulating is when you're most susceptible to having sex, because it is a natural time to be having sex, but on the other hand it teaches us self-discipline and... priorities."

Enriched Spirituality

"It has helped my relationship with God which has positively affected my relationship with my spouse....I've come to know and love God all the more for learning His beautiful truth about the real...meaning of human sexuality."

Some example negative responses that did not make the cut for the published paper are as follows:

Difficulty with Abstinence

"Abstinence is often difficult and can be prolonged. The 'honeymoon' phase often starts out great, but the full benefit is not obtained because she becomes less receptive and PMS kicks in."

Decreased Spontaneity

"Our sex life has disintegrated quite a bit. All sense of spontaneity is gone. Therefore from a woman's perspective, it takes twice as long to achieve orgasm. The passion is dead, or at least is most often suppressed."

Unbalanced Sex Drives

"My sex drive is very low on infertile days when intercourse is okay. This causes trouble because my husband complains that I never want to have intercourse. I feel that my sex drive is about normal on fertile days, but then we can't have intercourse."

Other Problems

"I wish the medical community were better educated, open-minded, and supportive of NFP. It is an integral part of my experience as a woman, and I would like to feel free to share more about it when I do have doctor visits."

The researchers concluded that compared to the Crowley study the respondents were dramatically more positive about the use of NFP. Although about one-fourth of the comments indicated that NFP presented challenges, the majority expressed that using NFP improved relationship dynamics, most often resulting in stronger bonds, better communication, and improved knowledge. The limitations of the study were that the response rate was low and respondents were a self-selected group of couples that were fairly homogeneous in regard to race, religion and education.

Table 1
Frequency of Positive Responses
According to Major Themes
Theme and Category Number % Percent Theme subtotals
Enhanced Relationship 31%
Deepened relationship 185 (8)
Improved Communication 209 (9)
Shared responsibility 86 (3)
Respected partner 92 (4)
Appreciated sexuality 145 (7)
Improved Knowledge 13%
Understand body and cycles 204 (9)
Learn other lovemaking 100 (4)
Enriched Spirituality 15%
Connected closer to God 153 (7)
Supported Church teachings 88 (4)
Open to new life 94 (4)
Method Successes 15%
Spaced pregnancies 96 (5)
Learned self-control 89 (3)
Remained healthy 100 (5)
Other successes 49 (2)

Table 2
Frequency of Negative Responses
According to Major Themes
Theme and Category Number % Percent Theme subtotals
Strained Sexual Interactions 13%
Difficulties with abstinence 138 (5)
Decrease frequency/spontaneity 106 (5)
Unbalanced sex drives 63 (3)
Worsened Relationships 6%
Anger and frustration 80 (3)
Misunderstandings resulted 51 (3)
Method Problems
Fear of pregnancy 153 (7)
Method failed 42 (2)
Other problems 50 (2)


Drs. VandeVusse and Hanson and two graduate nursing students (not involved with NFP) did the coding and content analysis for this study. I was not active in the qualitative analysis process, thus the NFP couples responses were analyzed and categorized with a fresh and open mind. Further qualitative research needs to take place that provides a more indepth understanding of the marital dynamics involved with NFP. For example, how is couple communication increased with NFP? What coping mechanisms are available for helping couples with abstinence and other difficulties with NFP methods? Quantitative research is needed for tracking psychological and marital responses across time and in comparison with other methods of family planning. (Editor: Richard J. Fehring, DNSC, R.N.)


1 Crowley, P., & Crowley, P. Report to the Papal Birth Control Commission. Notre Dame, IN: University of Notre Dame, Archives, 1966. [Back]

2 McClury, R. Turning Point. New York: Cross Roads, 1995. [Back]

3 VandeVusse, L., Hanson, L., & Fehring, R.J., et al. Couples' views of the effects of natural family planning on marital dynamics. Journal of Nursing Scholarship. 2003;35:171-176. [Back]