Natural Family Planning Preventive Health Care

Anthony Zimmerman
14 May 1991
Reproduced with Permission

In Familiaris Consortio Pope John Paul II takes the logic of Humanae Vitae one step further by stating clearly that all married couples and young people should be given access to knowledge about the body's rhythms of fertility. Married couples, doctors, and experts should help them "through clear, timely, and serious instructions...Knowledge must then lead to self control: hence the absolute necessity for the virtue of chastity and for permanent education in it" (FC 33).

In the intervening years the Pope has been urging us in season and out of season to involve ourselves in the apostolate of natural family planning. For example, he told us at an International Congress on June 9, 1984:

For these (couples who teach the natural methods) are not engaged in a private activity, but their efforts, joined with those of the Church's pastors, are a part of the Church's pastoral responsibility to instill conviction and offer practical help to all married couples so that they may live their parenthood in a truly Christian and responsible manner (cf. FC 35). The promotion and teaching of the natural methods is, then a truly pastoral concern, one that involves cooperation on the part of priests and religious, specialists, and married couples, all working in cooperation with the Bishop of the local Church and receiving support and assistance from him.

Health care workers, esteemed members of the community, who are already quite familiar with the "rhythms of fertility," have every reason to rally to the side of the Pope; his call for a far-reaching and powerful thrust of the NFP apostolate is new in the Church, is timely, and is a formidable challenge. When I studied moral theology in the seminary - forty five years ago - some moralists deemed that couples needed "permission" from the confessor to practice NFP; the confessor would decide whether the couple had sufficient motives. By advocating that all couples learn the system, the Pope tells us that couples themselves are to make the decision, which must be reasonable and responsible.

This new and positive approach to NFP as an apostolate is also daring; some priests and bishops still shy away from it, even frown; some priestly and religious promoters of NFP are treated harshly even today, and isolated from the community.

The challenge is of vast scope indeed. It should be addressed to the 850-880 million married couples - a billion and seven hundred million individuals - who are currently in the child-bearing years; plus a billion young people already in the formative years before marriage.

But the task is not at all impossible. The estimate that 50,000,000 couples learned to use NFP within the past decade is conservative, I believe. When a sufficient part of an enclosed population learns it, it can become local folklore, entrenched as a way of life for generations to come. Some perceptive pastors have already built up consolidated NFP-minded parishes. Fr. Pius Mardian, for example, who wove NFP into his marriage preparation courses for over 20 years at St. Peter's parish, Colman, South Dakota, USA, is confident that 50 percent of the couples "not only accepted this but are living it today" (Our Sunday Visitor, March 31, 1991).

Poland is a few steps ahead of the rest of the Catholic world in this respect. A network of parochial counseling centers began to develop early in the 1950's; then, in 1961, Bishop Karol Wojtyla convened a national congress of 250 family life workers; the congress recognized that, since the natural methods were not being taught by the government at public facilities, there was need for an independent network of Catholic centers organized nationally. This national organization came into being shortly thereafter. In 1967 Cardinal Wojtyla set up the Institute for the Family in Krakow with Dr. Wanda Poltawska as Director. Newly ordained priests, doctors, chaplains and counselors attended, especially on week-ends, and Cardinal Wojtyla often appeared, at least to meet the attendants and to pour the coffee.

By 1970 the Polish Episcopate made attendance at marriage preparation courses mandatory for all couples applying for marriage in the Church; NFP was a significant part of this preparation. There are now 3000 family counseling centers in various parishes of Poland; all couples to be married in Church receive sixteen hours of instructions, including guidance in the natural methods. Our Pope, we see from this, is by no means a new-comer to NFP. (The sources of this information are Dr. med. Wanda Poltawska (private meetings) and an article by Fr. Leon Monko, S.J, who was National Director of the Family Life Apostolate from 1964 until his death in 1980. (See article in Elternschaft Und Menschenwuerde, ed. by E. Wenish, Patris Verlag, 1984, pp. 349-361). Incidentally, a World Fertility Survey made during the early 1980's indicated that 31 percent of married women age 15-44 in Poland were using a natural method; the survey thus awards to Poland the gold medal in the NFP Olympics (see Population Reports, Sept.- Oct. 1985.)

While Poland was racing forward with NFP, the USA almost raced in reverse. John F. Kippley, President of Couple to Couple League, using government survey data, indicates that in 1965, among Catholics who used family planning, 31.9 percent used natural methods; only 8.9 percent used it in 1976; 6 percent in 1983; and 3 percent in l988 (See Fellowship of Catholic Scholars Newsletter, June 1991, p. 12). In 1982, before the percentage fell from 6 percent to 3 percent, their actual number would have been about 546,000 (see Robert Kambic and James T. McHugh, International Review of Natural Family Planning,Fall 1987, p. 249).

In contrast, 13.8 million women in the USA are currently using the pill. By now pill related income has become a substantial, even a major part, of the gross annual income for pill prescribing doctors; to not prescribe the pill would presumably occasion a formidable financial crisis for them. Similarly, USA pharmacists realize a gross annual income from pill sales totaling 3.3 billion USA dollars; divided among 160,000 pharmacists, the gross income for pill sales for individual pharmacists in the USA is about $22,500 annually. (For details, see article by Paul Glanville, MD, Pharmacists for Life Newsletter Beginnings, February 1991, pp. 3-6).


Global statistics indicate that among the 850-880 million married couples in the reproductive ages, close to 40 percent use some form of artificial contraception, or are surgically sterilized:

Couples surgically sterilized 155,000,000
IUD 80,000,000
Pill 55,000,000
Condom 38,000,000
Injectable 6,000,000
Total(38% of 880 married couples) 334,000,000

There are also about 40-60 million legal and illegal induced abortions per year. (Statistics from Studies in Family Planning, The Population Council, Inc. New York, November-December, 1988.) Sterilizations are not spread evenly through the age brackets, but tend to increase sharply as the woman reaches her mid-thirties. The sterilized percentage of this population may then become very high. A study in Quebec, for example, indicates that 61% of couples were sterilized when the woman was age 35-44; and 75.8% when three or more children were already born (Serena Canada Newsletter, March-April 1983). I have heard estimates of 50%, 60%, even 80% of Catholic couples in the older age groups sterilized in one or the other diocese in the USA. When the NFP coordinator goes around to canvass students, only a trickle comes forward; the rest "don't need it."

We admit before God, heads hung in shame, that perhaps more than half of the human race of our generation now uses, or is going to use, methods of birth control which offend Him deeply; methods which also generate enormous health problems; revolting practices which deform public morals and paralyze religious fervor in the Church. The serenity of youth is disturbed by untimely sexual activity; callous doctors rip unborn children out of the wombs of glassy eyed girls, many of whom are damaged physically, who will also have to live with Post Abortion Syndrome for the rest of their lives. Contraception is love turned inside out, which sensitive partners cannot help to perceive; family life becomes hell, children cry, families are torn asunder; sterilization makes a mockery of impotent love; people lose joy in life, lose faith in God, sample sects and atheism, stumble thoughtlessly into drugs and perversions, and finally find themselves trapped terminally by AIDS. The shadow of AIDS lengthens to cover whole sections of the human race, crushing health facilities and testing health care personnel. All this is not inevitable, I believe, if we take up the apostolate of natural family planning with solid conviction and proportionate energy. NFP: THE INDICATED THERAPY FOR FAMILIES TODAY

Sister Helen Paul observed that the 4,000-5,000 Philippine families, whom she and her co-workers were able to educate in the art of natural family planning during eight years, exhibited an entirely new hold on life when they adopted NFP. "The couples succeeded in controlling their fertility and much more, as the report of the employer indicated: population growth diminished, and a remarkable improvement in the law-and-order situation in the camps of the laborers was noticeable.

"The thing that impressed me most, and keeps me interested in the program today, is the fact that it's a beautiful opportunity to observe persons grow. A change seems to occur in an individual's self-image, the way a man sees himself as a man. He becomes a person aware of his dignity, a person worthy of respect; a person who can expect respect from his peers, from his wife, and his children. His personal discovery of self-control in his sexual life opens up to him the opportunity for change in other areas: gambling, smoking, alcohol. It is interesting that a change in an individual's self-image opens to him a possibility for change in many areas of life.

"The children used to comment about the change in mom and dad. No more fighting at home, they say. And when this happens within a home, the children apply it in their own relationships. We see this change in behavior of children because of the change in the parents...

"I believe that couples need to be challenged to try NFP. Marriages today are in dire need of assistance. One of the strongest ways to assist marriage is for the Church, doctors and others to offer couples the practice of NFP.

"I believe that if couples are encouraged to try - encouraged by their clergymen and their doctors - then NFP is for all couples, regardless of their standing in society. I believe that not to challenge them is to underestimate their potential, that God-given potential which lies within each person." (A Philippine Experience, in Natural Family Planning: Nature's Way - God's Way, ed. by A. Zimmerman, Milwaukee, Wisconsin, USA, De Rance, Inc. 1980, pp. 10-11).

I have yet to meet an experienced teacher of NFP who does not agree with what Sr. Helen Paul said, provided the local clergy, doctors, and community all support each other in the venture. NFP works when the community agrees that it should work (cf. HV No. 28). The experience of shared goodness in the community then fortifies and amplifies successful use of NFP:

"This discipline which is proper to the purity of married couples, far from harming conjugal love, rather confers on it a higher human value. It demands continual effort, yet, thanks to its beneficent influence, husband and wife fully develop their personalities, being enriched with spiritual values. Such discipline bestows upon family life fruits of serenity and peace, and facilitates the solution of other problems; it favours attention for one's partner, helps both parties to drive out selfishness, the enemy of true love, and deepens their sense of responsibility. By its means, parents develop a capacity of having a deeper and more efficacious influence in the education of their offspring (HV 21; FC 33).


"When we switched from contraception to periodic abstinence, we felt as though soot in the stove pipes of our marriage had been cleaned out," one couple told me. Another wife said: "When we have sexual relations, my husband looks at me again." Such witness can be multiplied without end. Nona Aquilar found the following answer to be typical among the 164 couples interviewed, who were now using NFP, the majority of whom had formerly used contraception:

I went through many kinds of pills, experiencing vomiting, migraines, irritation, dissatisfaction. I also felt used - an object used for sex. The memories of us and our marriage were not pleasant, and when we went on NFP, both we and our marriage improved. We tend to think our earlier problems were related to our birth control. (The New No-pill No-risk Birth Control, Rawson Associates, New York, 1986, p. 201).

Nona observes that wives may be very pleasantly surprised when they challenge their husbands, and find them more than equal to the challenge: "Many individuals have told me that the change to NFP improved their self-esteem and at the same time deepened mutual respect. As one woman said, `I never realized how much my husband loved me until he threw away my Pills and made me go with him to our first class.' Another woman said, `I never thought Hal would be able to abstain for two days much less for almost two weeks. I guess I didn't think much of him either.'

"That may be one of natural family planning's greatest contributions: the fact that it encourages some of the finest qualities in ourselves - and in our mates - to blossom" (Ibid. p. 222).

We hasten to add that partners in a deeply troubled marriage typically will not agree on NFP nor succeed in its use, unless they reach a certain level of harmony in the marriage itself. As a whole, however, couples who use NFP very seldom divorce, and very seldom have an abortion. All long-term teachers of NFP agree on that. So does Mother Teresa, who provides that at least one of the sisters in her convents is a teacher of NFP. Mother Teresa told 20,000,000 people viewing her on television in Japan: "We are teaching the young people natural family planning, so that the future will become simple for them; and the poor people told me that from the time we are practicing this way of life our family has remained united, our family is healthy, and we can have a baby whenever we like. And this has brought so much peace and unity in the life of our poor people" (Tokyo, NHK-TV, May 24, 1981).


Perhaps the hearts of our priests tend to bleed for couples who make the formidable sacrifice of periodic abstinence. But Rabbi Norman Lamm tells how the periodic restraints of Family Purity are essential, in the Jewish tradition, to strengthen, purify, exalt and ennoble marriages:

Marriage and the problems related to it form a significant part of the entire Talmudic literature...Of special importance are the sexual aspects of marriage, in which the Talmud devotes a full tractate, called NIDDAH...

Jewish Law forbids a husband to approach his wife during the time of her menses, generally from five to seven days, and extends the prohibition of any physical contact beyond this period for another seven days, known as the `seven clean days.' ...During this time husband and wife are expected to act towards each other with respect and affection but without any physical expression of love...At the end of this twelve to fourteen day period (depending upon the individual woman), the menstruant (known as the niddah) must immerse herself in a body of water known as a mikvah and recite a special blessing in which she praises God for sanctifying us with His commandments and commanding us concerning immersion (tevillah)...

Mikvah becomes the sacred instrumentality whereby morality and sexuality are reconciled, bringing husband and wife to each other in purity and delicacy, their love undefiled by the guilt and shame that are relics of obsolete inner struggles.

No philosophy of sex, no matter how well and cogently articulated, can ever be as psychologically meaningful and compelling as the observance of Family Purity...

For marriage to thrive, the attractiveness of wife and husband for each other that prevailed during the early period of the marriage must be preserved and even enhanced. And it is the abstinence enjoined by Family Purity that helps keep that attraction and longing fresh and youthful. This is how the Talmud explained the psychological ramifications of taharat ha-mishpahah (the purity of the family):

`Because a man may become over-acquainted with [his wife] and thus repelled by her, therefore the Torah said that she should be considered a niddah for seven days, i.e. after the end of her period, so that she might become beloved of her husband on the day of her purification even as she was on the day of her marriage' (NIDDAH 31b).

Unrestricted approachability leads to over-indulgence. And this over-familiarity, with its consequent satiety and boredom and ennui, is a direct and powerful cause of marital disharmony. When, however, the couple follows the Torah's sexual discipline and observes this period of separation, the ugly spectre of over-fulfillment and habituation is banished and the refreshing zest of early love is ever present" (Norman Lamm, A HEDGE OF ROSES, Philipp Feldheim, Inc., New York, 1968, pp. 32-35;56-57).

The Jewish tradition of periodic abstinence, surely known to Christ and the early Christians, is not mentioned, at least not explicitly, among other rulings of the so-called first general council of Jerusalem: "Eat no food that has been offered to idols; eat no blood; eat no animal that has been strangled; and keep yourselves from sexual immorality" (Acts 15:29). Today, nevertheless, couples adopt periodic abstinence to space births in an orderly manner. It should surprise no one if it also has the side effect of keeping a marriage ever fresh and youthful.


The pill's much vaunted advantage was that it made the wife available for sexual intercourse at all times. But that may actually wreck a marriage instead of healing it. We see that an explosion of divorces followed in the immediate wake of the pill take-off. In 1960, pill take-off year, there were 393,000 divorces in the USA; in 1975 there were 1,036,000. During the pill era ever since, there are over 1,000,000 divorces annually in the USA. Health care workers know better than most others the trauma which stormy family life and final separation of father and mother tends to inflict on the children; and the stormy violent emotions which continue to trouble most divorced people for the rest of their lives. This, and the leakage from the Church which tends to follow when the divorced parents lose joy of life, and the children feel an emptiness and loneliness in broken families or those lacking warmth (see Report of Cardinal Angel Suquia Goicoechea to Fourth Extraordinary Consistory, Osservatore Romano, English edition, 15 April 1991, page 8).


In FC 33 the Pope asks doctors, experts, and married couples to give access to all about the rhythms of fertility. In FC 34, one number later, he asks priests to do their part. Is the sequence correct? Is the teaching Church asking health care workers to prepare the people first, so that the priests can do their part more effectively? Let us consider the actual situation of a parish today.

A minority, or even a majority of parishioners in the child-bearing years, who occupy the pews while the pastor preaches the sermon, probably have a mind-set that contraception is permitted; not only permitted, but necessary to prevent world overpopulation. A majority of them may now be practicing contraception, may have done so in the past, may believe that they will have to do so in future. Among the older married couples before the priest in the pulpit, a majority may be surgically sterilized. Furthermore, the majority may adhere without question to the pseudo-gospel that NFP is not reliable, is not necessary, is heroic and esoteric, not at all required of common believers. The priest, therefore, must consider whether a blunt denunciation of contraception from the pulpit, without previous preparation, will be counterproductive; whether he thereby departs from the example of Christ, of whom Isaiah wrote: "The bruised reed he will not crush; the smoldering wick he will not quench until judgment is made victorious" (Is 42:2-3; Mt 12:19-20). Note the final words: "Until judgment is made victorious." Good judgment about the evil of contraception must be made victorious BEFORE a preacher alienates his flock and ruptures their credibility by an inept denunciation. There are exceptions: some pastors, some mission preachers, relying on the power of the spirit, CAN bring their flock into the fold of obedience to this law of God from the pulpit; also confessors CAN bring individual sinners to do penance and convert. But in general we have a community - wide malaise of contraception now, which needs community-wide cure.

Beyond all this, there is a problem of conviction on part of priests and bishops themselves. Are most of them convinced about the evil of contraception? One archbishop wrote to me: "Please send statistics." I did; but he is not very convinced, perhaps because some of his Catholic doctors are not convinced. Another Bishop answered: "Theologians are not yet sure about it; therefore..." The malaise of the contracepting flock very likely reflects a malaise of disbelieving shepherds. "If the man who plays the bugle does not sound a clear call, who will prepare for battle?" (1 Cor 14:8).

But doctors, experts, and experienced married couples are in an advantageous position to convince both clergy and laity, by word and by action. Once they have done their work of giving access to knowledge about the rhythms of fertility and about the need of chastity, always under the leadership of their priest, then the priest can, with new conviction, do his work in the pulpit and the confessional more easily and effectively. Health care workers today are on-stage, and the angels are watching their performance; if they perform as they can and ought, they can direct global traffic to make a massive U-turn away from contraception and toward natural family planning. To convince ourselves, let us review the basics of scientific NFP as we re-trace the history of its beginnings.


In 1923, in the February issue of the Hokuetsu Medical Journal, Dr. Kyusaku Ogino of the Niigata University Hospital first published his horizon spanning theory about the time of ovulation during the menstrual cycle. From that article we can easily see that he was a methodical observer and had great interest in his work. Before he operated, he would ask his patients whether their cycles were regular or irregular; he followed through only with those who said they were regular; if regular, he next asked when they expected the next menstruation. He would note down the date, then operate, and ascertain the condition of the ovary and corpus luteum; if possible, also of the endometrium; from this he would ascertain whether ovulation had already taken place or not.

When he had 65 cases, he lined up his findings on a chart. In the first attempt, he made day one of the first day of menstruation his starting point for lining up the 65 cases. Then he put in the estimated day of ovulation; finally the expected end of the cycle. Nothing matched. Ovulation appeared to be scattered at random all over the chart.

He tried again; this time he started by counting backwards from the expected day of menstruation, making the right side of the chart a straight column. He counted backwards from there to the estimated time of ovulation and the first day of the cycle. Suddenly everything fell into place. He drew lines down the chart isolating the days 16 to 12 days before the menstruation. He wrote in his article:

From the first day of the last menstruation to the 17th day preceding the expected menstruation, follicles have not yet ovulated in all cases except the 2nd and the 10th cases. (Number of cases: 21; exceptions: 2).

On days 16-12 he found some had already ovulated, others not: "For 5 days, from the 16th to the 12th day preceding the expected menstruation, follicles have ovulated in some cases, and in other cases they have not yet ovulated. Number of cases: 13."

From day 11 before expected menstruation all 65 had already ovulated. "From the 11th day to the beginning of the expected menstruation, I found corpora lutea in the proliferative phase in all cases. Number of cases: 31.

He then drew the conclusion, which is the base for natural family planning: "Based on the views stated above, I conclude that the period of ovulation is 5 days from the 12th to the 16th day preceding the expected ovulation. This period is the same in all cases whose menstrual period is from 23 to 45 days.

What about the two exceptions? "To my regret, as I could not examine the organization of the corpora lutea and the endometrium, I can't explain the exceptions based on a histological study. But I guess the next menstruation will come a few days earlier than the expected time in these cases. I think two exceptions in sixty-five cases can be admitted, considering the character of the expected menses." (Translation from original by Hiroshi Ogino, MD, son of Kyusaku; private correspondence.)

The theory first proposed in 1923 is undisputed today. In 1924 Dr. Ogino added another 53 cases to the 65 already reviewed, and confirmed his theory (Japan Gynecological Journal, vol. 19, No. 6, 1924). He added, from studies of animals published in the literature, that sperm can survive in the uterine cavity for three days after a coitus; that sperms which survive for 4 to 8 days are exceptional cases. And from animal studies reported in the literature he assumed that the ovum will die shortly after ovulation if not fertilized. "Certainly the ova do not remain fertilizable for some days or weeks." His summary:

The period of conception in mankind consists of the ovulation period and 3 days preceding the ovulation. During 4 to 8 days preceding the ovulation, conception can take place only rarely, while no conception occurs before this period. No conception takes place a day after ovulation.

It was after Dr. Ogino published his findings in Germany in 1930 as a Sonderdruck Aus Dem Zentralblatt Fuer Gynaekologie 1930 (Leipzig) that his theory found its way into the world medical literature. In it he set forth the Ogino theory for natural family planning:

Upon reading that article, Prof. Dr. Hermann Knaus sent him a letter of congratulations. He had arrived at similar conclusions by another route, which he published in the Muenchener Medizinische Wochenschrift of 12 July 1929, so six years after Ogino's original publication. In a note treasured by Dr. Ogino, Dr. Knaus thanked him for having made those careful studies in Japan which enable one to identify the naturally fertile and infertile times of the cycle, and which make it possible now to choose whether to achieve or to avoid a pregnancy.

We know today that the ovulation event, governed by cyclic hormonal secretions, occurs but once during a cycle. (If there are several ovulations, they occur within 24 hours of each other.) The time of ovulation is usually 12-16 days before the expected menstruation. In the meantime a great deal more has been learned: the temperature shifts upward slightly with ovulation, leaving a pattern of low level temperature before ovulation, followed by a shift, and then a consistently high level temperature until it drops to announce the imminent onset of menstruation. The temperature shift has become a clear marker to identify the potentially fertile times, and the infertile times.

The cervical mucus sign, which many women can perceive and monitor quite easily, comes and goes with the ovulation episode. It is another sign to identify fertile and infertile times. The condition of the cervix itself is still another sign which some learn very well; it is popular with flight attendants who deal with time lags, irregular hours, and stress. Some users are perfectly happy with one sign which is for them consistent and adequate; others find greater certitude - and a shorter period of abstinence perhaps - by combining several signs and pinpointing the fertile days quite precisely.


When quick digital thermometers came on the market in Japan, many women snapped them up to experiment with the temperature method of identifying fertile and infertile days; 65% of Japanese women tried this according to the findings of Dr. Shigeru Murayama. But the thermometers are not sufficiently exact, and back-up teaching was imprecise. Most gave up again.

Inventor Kinji Nishimura noted all this, and began to work on the problem of exact thermometers and precise temperature measurements; then he added a micro-processor and a mini-computer to memorize data and calculate the fertile days of current cycles in the future from data already in the memory. Cycle and temperature data, he insisted, must enter the memory exactly and automatically, lest imprecision and human error distort the calculations. Six years later he emerged with a device he terms L Sophia, small enough to fit into a lady's purse, clever enough to automatically display the fertile days of the cycle on the liquid crystal window. Husband and wife can now watch the signs and decide accordingly. It becomes a kind of family game. During one year sales increased from an initial several hundred to about 10,000. The current feedback is positive, even enthusiastic. L Sophia and similar devices may now launch NFP into a profitable business, elbowing a niche for itself, where the pill, condom & company now enjoy a monopoly. The retail price is 32,000 yen in Japan, ($245) which, in the USA, equals about half the cost of a pill regime for one year. Christ - whose human nationality we know - will not be opposed, I suggest, if NFP becomes a profitable business and so helps to firm up the ten commandments.

At any rate, whether by electronic devices, or by simple observation, reliable NFP is now available for all in the world who want seriously to use it. Difficult cases may need special advice, care, vitamins, diet, more regular lifestyle, therapy, longer abstinence. Sometimes nursing mothers - if signs remain uncertain and abstinence lasts for week after week - may dialogue with husbands about what is best for the family.

At any rate, for every couple in the world, if there are fertile days, there are also infertile days of the cycle. Catholic doctors, pharmacists, nurses, health care workers of the entire world - with the fervent blessing of the Pope - are willing, we are confident, to help couples identify them. Thereafter pastors can waggle a finger at the congregation and pound on the pulpit: "Children, families: be chaste!" Couples who are faithful, who strengthen their children in the practice of rugged chastity, are the ones who will survive the AIDS epidemic, and so carry the Church and the human race into the post-AIDS future. So be it!