What is NFP?
Natural family planning (NFP), often referred to as fertility awareness-based methods (FABMs), is based upon pinpointing the fertile times in a woman’s body by observing and charting the natural signs in her menstrual cycle.
There are several different ways to classify the primary methods of natural family planning. Some of these definitions overlap. For example, all of the methods listed below require periodic abstinence.1
For the purpose of this analysis, and in the interest of completeness, there have historically been four basic types of natural family planning (each discussed below):
- The old rhythm or calendar methods, also known as the Ogino-Knaus method
- The lactational amenorrhea method
- The cervical fluid/ovulation methods
- The sympto-thermal method (STM)2
Each of these methods, when used to avoid or postpone pregnancy, take into account sperm viability in the female reproductive tract, which averages three days (with a range of from two to seven days) and the fertile period of the ovum, which is about 24 hours. This means the fertile period may be a maximum of seven days before ovulation to two days after and is more typically four days before ovulation to one day after.
The following descriptions of these four methods are merely summaries of the similarities and contrasts between them. Anyone who desires more detailed information on any of the methods should consult one of the national or local natural family planning teaching groups, which have experts all over the country who can help. You might also consider contacting your local Catholic diocesan or archdiocesan office, many of which have NFP teaching programs of their own.
The national teaching groups include the following;
- Couple to Couple League International (CCLI)
- Saint Pope Paul VI Institute for the Study of Human Reproduction
- Billings Ovulation Method-USA (BOMA-USA)
- Family of the Americas Foundation
- Find a Catholic NFP Class (US Conference of Catholic Bishops)
The Different Methods of NFP
“Calendar Rhythm” (Ogino-Knaus) Method
During the 1920s, Drs. Kyusaku Ogino of Japan and Hermann Knaus of Germany performed independent research into the menstrual cycles of a large number of women, and found the following patterns:
- Conception is seldom possible from 20 to 24 days before the next menstruation
- Conception is possible from 12 to 19 days before the next menstruation
- Conception is impossible during the 11 days before the next menstruation
The original research of Drs. Ogino and Knaus laid the foundation for the development of modern natural family planning methods that are currently more effective than most mechanical contraceptives.
The primary advantage of the calendar method is that it is relatively easy to learn and use. A woman simply keeps a menstrual calendar for several cycles, noting when menstruation begins and ends. She then determines the longest and shortest cycles, and applies the “minus 10, minus 20” rule, which means she uses the shortest cycle to find the first fertile day by subtracting 20 days from its length and uses the longest cycle to find the last fertile day by subtracting 10 days from its length.
For example, if the longest cycle has been 30 days, and the shortest cycle 25 days, the first fertile day will be Day 5, and the last fertile day will be Day 20.
However, since the rhythm method does not reflect the actual length of the current cycle, but only an average of previous cycles, long periods of abstinence and a relatively high failure rate compared to the other methods of NFP can be expected, especially if the user’s cycles are irregular. The rhythm method can be very difficult to use after childbirth and miscarriage, and when menopause is approaching, because cycle lengths can be very irregular during these times.
Despite all of these problems, users of the rhythm method experience a user effectiveness rate of 91% during the first year, which is far better than most mechanical methods of contraception.3 The success rate is even better when the method is combined with temperature observations.
Currently only about 1% of women using any form of NFP use the rhythm method.4
Lactational Amenorrhea Method (LAM) of NFP
This method takes advantage of the fact that ecological (complete) or partial breastfeeding can delay the return of the mother’s fertility. It is usually effective for six months after the baby’s birth if full breastfeeding takes place and if menstrual bleeding has not returned. Full breastfeeding means that the baby receives no other solid or liquid food (not even water), or that the baby occasionally receives water, vitamins or other food as needed.5 Mother’s milk is an amazing substance; its composition changes to meet the baby’s nutritional needs and confers lifetime health benefits.
The Cervical Fluid Methods of NFP
These methods of NFP are sometimes called the ovulation charting methods. There are several variations of the cervical fluid methods, including the Billings Ovulation Method (BOM) and Dr. Thomas Hilgers’ Creighton Model FertilityCare System.
The cervical fluid/ovulation method is based upon the regular pattern of changes in the cervical fluid during the menstrual cycle. The quantity and quality of this fluid in terms of slipperiness, stretchiness, wetness and tackiness will change from day to day as a woman approaches ovulation. Ovulation usually occurs within one day before or after the last day of the most slippery or fertile fluid, i.e., the “Peak Day.” Generally, users of the ovulation method start noting the fertile period starting with the appearance of any external fluid after menstruation has ceased. They regard the time of post-ovulation infertility as starting on the fourth day after the Peak Day.
Sympto-Thermal Method (STM)
The sympto-thermal method refined by Couple to Couple League International combines observations of basal body temperature and cervical fluid. As an optional cross-check, it adds an examination of the cervical os (mouth of the cervix). During fertile times, the os opens, the cervix rises, and its tip becomes softer. Some women also experience regular episodes of mittelschmerz, or pain associated with ovulation. During infertile times, the os closes, the cervix descends, and the tip becomes firmer.
The end of pre-ovulation infertility is determined in several different ways. As a general rule, couples may resume intercourse on the fourth day following the “peak day” of cervical fluid and the third day of upward thermal shift. As with other methods of natural family planning, the period of abstinence may be relatively long for the first few cycles of practice, after childbirth or miscarriage, or after switching from an abortifacient method involving hormones. The average experienced couple using the sympto-thermal method has about 9 or 10 days of abstinence each cycle. Every time that a fertile type of cervical fluid appears before ovulation, they must abstain for three days. Once ovulation occurs, the couple are sterile until menstruation and usually sterile during the first two days of menstruation.
Refinements of Natural Family Planning
Today there are a number of devices available to help couples estimate the day of ovulation. One of the most practical and effective of these is the ClearBlue fertility monitor, which checks urinary hormone levels.
Several other approaches to improving the effectiveness of NFP are under study. One device would measure hormone levels in urine and would therefore be a true ovulation predictor or detector. Another would accurately measure the water level in cervical fluid. Others would detect pre-ovulatory rises of estrogen in saliva and cervical fluid. In addition, changes in breast milk and in the electrical resistance of cervical fluid are under investigation.
One conclusion is certain: More than half a century of contraceptive and abortifacient research have shown that there is no way to subdue our fertility without paying a steep price, both on the individual and societal level. The only way to be in harmony with our fertility is to let it take its natural place in our lives as a friend to cooperate with, not as an enemy to be defeated, subdued or snuffed out.
Effectiveness of NFP at Preventing and Achieving Pregnancy
Many medical professionals quote a failure rate of 12% to 24% for natural family planning. This range is based on a deeply flawed 2012 Centers for Disease Control (CDCs) study in which 86% of the women interviewed were using the rhythm method. A small minority were using the more refined and effective modern methods of natural family planning.6
The only 100% effective “birth control” methods are abstinence and complete castration (or hysterectomy). Even surgical sterilization occasionally fails to prevent pregnancy, and abortion sometimes fails to prevent births.
Natural family planning, if learned and used properly, is much more effective than any method of mechanical contraception, including the male and female condoms, cervical cap, cervical sponge, and diaphragm. The barrier methods of contraception have method failure rates from 15% to 32% in the first year of use. The method failure rates for abortifacient methods range from 0.1% to 8% in the first year of use, and their user failure rates can be as high as 8 to 12%.
As with any method of birth regulation, user motivation and care figure heavily into how effective a method will really be. The percentages above are method failure rates, which apply only if users employ the method perfectly. When imperfect use is factored in, there are more pregnancies with NFP, as with any unnatural method of birth control. This is called the “user failure rate.”
According to Contraceptive Technology, the “family planner’s bible,” the ovulation method of NFP has a 3% method failure rate; the Standard Days Method has a 4% method failure rate; and the sympto‑thermal method has an 0.4% method failure rate.7
A 2018 study summarized 53 studies on eleven types of FABMs and found that their unintended pregnancy rates ranged from 2% to 14% per year.8 A slightly earlier study (2013) determined that they had an average of a less than 5% unintended pregnancy rates “comparable to those of commonly used contraceptives.”9
The medical profession has recognized the high effectiveness rate of the natural methods for decades, so there is absolutely no excuse for medical and teaching personnel to be ignorant of it. Eight previous major studies in the 1990s showed that, when properly used, the effectiveness of typical methods of natural family planning has an average user failure rate of 2.8%. These studies were carried out in a wide variety of cultures in Moslem, Hindu, Chinese and Christian cultures. The user failure rates by country were:
- United Kingdom 2.7%
- Indonesia 2.5%
- India 2.0%
- Germany 2.3%
- Liberia 4.3%
- Europe 2.4%
- China 4.4%
- Belgium 1.7%10
Most population suppression organizations do not even consider employing natural family planning in their programs because of its allegedly high failure rate. Almost all of the “failures” experienced by users of NFP can be attributed to improper use of the methods. To say that NFP has a high failure rate because some people use it improperly is as unfair and unscientific as saying that a condom failed because a couple originally intended to use it but then just left it on the bedside table.
The key to any method of NFP is identifying the woman’s fertile time. This is possible for all women, but it can be more difficult at times, such as when approaching menopause, during the post-breastfeeding transition period, after childbirth or miscarriage, after abandoning a hormone-based abortifacient method which often leads to irregular or missing cycles, or during periods of extended illness.
One important point should be kept in mind: According to the World Health Organization (WHO), sexual “risk taking” during fertile days probably accounts for many more pregnancies than the inability to correctly use the natural methods or interpret charts.11 In other words, if a husband and wife don’t “take a chance” on the first or second day of fertility, all of the NFP methods are much more effective.
In addition to being effective at avoiding pregnancy, NFP can do one thing that no method of artificial birth control can do: It can help achieve pregnancy. In fact, many fertility counselors advise couples who are having trouble conceiving to begin charting their cycles.
The effectiveness of NFP at helping a couple achieve pregnancy depends, of course, primarily upon their individual situation. If the man or woman is physically infertile, no amount of charting will help them to conceive. However, NFP can maximize the probability of conception if there is any possibility of doing so. In addition, learning and using NFP can improve the psychological state of mind of the couple trying to conceive by showing them how the woman’s body works and giving them a sense of working with it in a natural way for the purpose of achieving pregnancy.
Advantages of Using NFP
NFP Strengthens Marriage
The natural methods of fertility regulation offer many advantages over the barrier or abortifacient methods of birth control. The most important of these is how NFP promotes closeness between married couples.
People who can’t be bothered to do any research into NFP only see one glaring disadvantage — abstinence! To them, this is a deal-breaker. Maybe if they took the time to look a little deeper, they would realize that occasional abstinence is a huge advantage, not a disadvantage! This is because it strongly promotes alternative means of communication between the husband and wife when they have decided that they would like to forego marital relations in favor of delaying pregnancy.
Recent comprehensive studies have concluded that nearly one-half of all marriages now taking place in the United States will end in divorce, annulment or separation.12
Contrast this abysmal failure rate with that of married couples who use natural family planning: The average divorce/separation rate among these couples is less than one in thirty.13
NFP can’t take credit for all of this huge discrepancy, of course, but it undoubtedly contributes greatly to marital fidelity and endurance by fostering an atmosphere of knowledge, communication and intimacy between husband and wife. It also manifests a couple’s willingness to forego immediate self-gratification for each other, to say nothing of giving a good example of self-control and chastity to their children. The most important feature of NFP is not the physical method itself, but its spiritual aspect. Nothing is more certain than the fact that contraception, abortion, and sterilization do not make couples happy, and the contrasting divorce rates between contraceptors and NFP users provide stark proof of this fact.
There have been very few statistical studies on how NFP has specifically helped or hindered marriages, but one survey conducted in 1970 showed that 74% of husbands and 75% of wives thought NFP did help their marriages. Only 9% of husbands and 8% of wives thought it hindered their marriages (17% of both husbands and wives had no opinion).14 This trend is consistent through time; another study performed in 2008 showed that 71% of wives believed that NFP enriched their marriages, and that 68% said that their “family life became more pleasant” when they began using it.15
How, exactly, does NFP strengthen marriage?
It increases the husband’s respect for his wife’s fertility and deepens his understanding of her psychology. It lets husband and wife share the responsibility for their fertility equally, thus living up to the ideal of “conscious parenthood,” which is the conceiving and bearing of children by choice and by will, truly the fruit of unselfish love. Finally, the wife appreciates being able to avoid the harmful effects of contraceptives and abortifacients. Many women deeply appreciate the “freeing” sensation they receive when they give up powerful drugs that suppress their natural body functions and take up NFP, becoming aware of the beauty and the power of their own fertility.
When one considers how endearing and unifying it is for a husband or wife to abstain despite their desires, out of consideration for each other or family, abstinence becomes a unifying act of love. In contrast, in a chemically or surgically sterile marriage, abstinence by either husband or wife is considered a burden and becomes a disunifying event.
Finally, studies have shown that a regular period of abstinence helps strengthen marriages by obliging couples to show their affection in other ways for a while every month, thereby improving vital communications skills.
Setting the Example for Teens
A husband and wife who use natural family planning set a fine example for teenagers. Father Paul Marx, founder of Human Life International, liked to say that “contracepting parents beget fornicating teenagers.” This is nothing more than common sense. Teenagers are not stupid. You cannot live in the same house with someone and keep even your most intimate secrets from them for 18 years. Teens see what is going on in the family and they can easily deduce their parents’ attitudes toward sexuality from their actions. Parents who intelligently practice NFP are conscious of their true sexual nature and not only become excellent moral examples to their children but are the best possible sex educators for them as well.
Teenagers rightly reject the hypocritical attitude “do as I say, not as I do.” If teens are aware that their mother and father use contraceptives, the parent’s admonitions to avoid premarital sex are not going to carry much weight with their children. However, if parents demonstrate love and affection for each other through respect of fertility and each other’s circumstances by the periodic abstinence in NFP, this message will shine bright and clear, in a manner that is unmistakable to their teenagers. It will also help parents ― and their children ― strengthen and nurture their Faith, for obvious reasons.
Other Advantages of NFP
Natural family planning methods have many other advantages, including spiritual ones:
- NFP does not interfere with the natural reproductive system and process designed by God.
- NFP is morally acceptable to all religions and cultures.
- NFP avoids the use of mechanical devices or powerful hormones which may have harmful effects — including the ending of the lives of newly conceived lives by the hormonal (abortifacient) methods.
- NFP is among the most effective methods of nonpermanent fertility regulation known when learned and used properly — up to 99%.
- NFP is virtually free of charge, whereas contraceptive and abortifacient methods cost anywhere from $175 to $700 annually.16 This point is particularly crucial in areas of developing countries where health care is rudimentary and expensive.
- Of all of the methods of fertility regulation, only NFP allows the couple to make love as God and nature intended. It is amusing that “lovemaking manuals” try to work condoms, diaphragms, and various messy jams and jellies into the act of making love — “getting rigged to make love,” as one noted gynecologist called it. It is an enduring contradiction that many of the same people who pride themselves on the “natural” aspects of their lives don’t hesitate to pollute their bodies with drugs and devices and cannot let the most intimate aspect of their existence be truly natural and human.
- Finally, NFP, unlike all contraceptive and abortifacient methods, lets women and men learn about their bodies and work with them, rather than remaining ignorant and subduing them with chemicals. And NFP allows husbands to more intimately understand the psychology of their wives by understanding the nature of their menstrual cycles.
Tips for Learning and Practicing NFP
Motivation is Everything
As with all worthy efforts, the key to learning and practicing natural family planning is motivation. If a husband and wife truly want to make the Gospel of Life part of their lives, they will take the time to learn NFP. With NFP, attitude is everything ― the more the couple truly want their relationship with each other and with God to grow in maturity and grace, the easier the methods will be to learn. The secret is to make NFP an integral part of one’s life, like a weekly “date” enjoyed by husband and wife or frequent Mass attendance.
Adopting the philosophy of natural stewardship of fertility soon becomes so much a part of one’s life that the very concept of contraception becomes unnatural and unthinkable.
The Three Primary Concerns
The three primary concerns of couples inquiring about NFP are the result of a pervasive propaganda campaign by medical professionals, pro-abortionists, population controllers and others. These fears are that NFP is ineffective; that too much abstinence is required; and that it is too difficult to learn.
All of these misconceptions can be dispelled by proper instruction.
NFP is more effective than all artificial contraceptive methods and as effective as most abortifacient methods. The maximum amount of abstinence required each month is about nine days using the most advanced methods of NFP. The only remaining concern voiced by most couples is the difficulty of learning a method of NFP.
The simplest method of NFP is calendar rhythm. Couples need to determine the length of the longest and shortest menstrual cycles over the past 12 months. NFP instructors can quickly teach this method to country women in developing nations, even if they cannot read, because the concepts are very easy to explain.
The most complex and reliable method of natural family planning is the sympto-thermal method. Depending upon the instructor, this method will take up to 12 hours of careful study at first and will require careful charting thereafter. In addition, if the woman’s cycles are in any way atypical, some coaching or consulting with an experienced NFP practitioner will probably be required.
Simply assessing how difficult it is to learn NFP is only a small part of a proper analysis. NFP’s great advantages over contraceptives and abortifacients (particularly the intangible benefits) must be carefully weighed.
Physical Complications Associated with NFP
The most commonly used methods of “birth control” are, to put it bluntly, killers. Condoms sometimes break or slip and thus allow the transmission of AIDS and deadly venereal diseases. The intrauterine device (IUD) has killed hundreds of women, not to mention the fact that all IUDs are abortifacient. The birth control pill has killed more than 35,000 women through cardiovascular and other complications since 1960 in the United States alone and has been classified “unavoidably unsafe” by the courts.17
Death is only one of the very long list of severe side effects that even feminists recognize as an inescapable result of the widespread use of unnatural means of birth control: Stroke, severe bleeding, sterility, repeated miscarriages, blindness, perforations, infections, etc.
Even one of the original inventors of the birth control pill, Dr. Carl Djerassi, admits that we have gone as far as we can go with contraceptive methods. He said that what the world needs is a “jet-age rhythm method” that can be used to avoid all the ill effects of his and other “birth control” methods.18
Natural family planning is not only free of side effects, but it lets women know and “read” their bodies so well that they may be able to detect certain diseases and injuries to their reproductive systems earlier than they would have been able to otherwise. The ability to track symptoms and anomalies can save lives in cases of various cancers of the female reproductive tract.
Finally, NFP can do one thing that no method of “birth control” can ever do: help a couple get pregnant. In fact, many infertility centers begin their investigations of a couple by teaching them the basics of natural family planning (primarily temperature taking) and having them observe the woman’s cycles for several months in order to time intercourse for periods of maximum fertility.
Why the Catholic Church Permits NFP
Contraception is unacceptable to the authentic tradition of virtually every religious denomination. Today, however, only the Catholic Church and a number of small Protestant and Jewish denominations teach that the only morally acceptable method of birth regulation is natural family planning.
For 1,900 years, all Christian denominations stood united in their condemnation of contraception. Only since after 1930 have the “mainline” Protestant churches allowed unnatural means of fertility regulation.
We must ask ourselves a fundamental question: which is truly the fruit of the Holy Spirit ― the teaching that has endured for nearly 20 centuries or the contraceptive mentality that is only a few decades old?
Common sense should reveal the answer to any person who is being honest with himself.
The Catholic Logic
The Catholic Church has always allowed the use of infertile periods to space children for authentically serious reasons. Pope Paul VI said in Humanae Vitae [¶10,16]:
In relation to physical, economic, psychological and social conditions, responsible parenthood is exercised, either by the deliberate and generous decision to raise a numerous family, or by the decision, made for grave motives and with due respect for the moral law, to avoid for the time being, or even for an indeterminate period, a new birth…. If, then, there are serious motives to space out births, which derive from the physical or psychological conditions of husband and wife, or from external conditions, the Church teaches that it is then licit to take into account the natural rhythms immanent in the generative functions, for the use of marriage in the infecund periods only, and in this way to regulate birth without offending the moral principles which have been recalled earlier.
Some may equate these conditions to those that anti-lifers commonly use to justify contraception, sterilization and even abortion. But the truthful answer to the question of what constitutes a truly serious impediment to having more children is rooted in honesty and a properly formed conscience. Pro-abortionists, since they lack the virtue of self-sacrifice, interpret any and all reasons as “serious.” True followers of Christ can be more honest in their assessments of their own personal situations in light of the natural moral law and Church teaching.
The Catholic Church does not simply make up rules in order to control people, as critics often allege. The Church uses as its guide the natural moral law instituted by God Himself, and therefore can never change the teachings rooted in it. Nowhere is the natural moral law more reliable or needed than in matters involving human sexuality. The Church recognizes that contraception is one of the starting points for a true “anti‑life mentality” which, once accepted, knows no bounds.
In Familiaris Consortio [¶32], Pope John Paul II explained that the fundamental difference between contraception and NFP lies in the worldview of the people involved:
Theological reflection is able to perceive and is called to study further the difference, both anthropological and moral, between contraception and recourse to the rhythm of the cycle: It is a difference which is much wider and deeper than is usually thought, one which involves in the final analysis two irreconcilable concepts of the human person and of human sexuality. The choice of the natural rhythms involves accepting the cycle of the person, that is the woman, and thereby accepting dialogue, reciprocal respect, shared responsibility and self‑control. To accept the cycle and to enter into dialogue means to recognize both the spiritual and corporal character of conjugal communion and to live a personal love with its requirement of fidelity. In this context, the couple comes to experience how conjugal communion is enriched with those values of tenderness and affection which constitute the inner soul of human sexuality, in its physical dimension also. In this way, sexuality is respected and promoted in its truly and fully human dimension and is never “used” as an “object” that, by breaking the personal unity of soul and body, strikes at God’s creation itself at the level of the deepest interaction of nature and person.
Humanae Vitae [¶16] explains that the difference between the practice of contraception and natural family planning lies in the fact that NFP cooperates with the human reproductive system as God designed it, whereas contraception conflicts with it:
The Church is coherent with herself when she considers recourse to the infecund periods to be licit, while at the same time condemning, as being always illicit, the use of means directly contrary to fecundation, even if such use is inspired by reasons which may appear honest and serious. In reality, there are essential differences between the two cases; in the former, the married couple make legitimate use of a natural disposition; in the latter, they impede the development of natural processes. It is true that, in the one and the other case, the married couple are concordant in the positive will of avoiding children for plausible reasons, seeking the certainty that offspring will not arrive; but it is also true that only in the former case are they able to renounce the use of marriage in the fecund periods when, for just motives, procreation is not desirable, while making use of it during infecund periods to manifest their affection and to safeguard their mutual fidelity. By so doing, they give proof of a truly and integrally honest love.
In summary, then, when a couple contracepts, they say to God “we will try to frustrate Your will [through contraception] if it is to create a child and will take action to negate it [through abortion] if You do create a child.” When a couple uses NFP, they instead say “we will allow every instance of our marital act to be open to Your will, regardless of whether the probability of conception is likely or remote and will respect Your awesome gift of fertility in exactly the form You gave it to us.”
If NFP Has So Many Advantages, Why Don’t More Couples Use It?
Despite constant Church teaching that natural family planning is the only moral means of fertility regulation, studies show that only about 4% of married Catholic couples of childbearing age in the United States use NFP.19
If natural family planning boasts all of the advantages referred to previously, why don’t more couples use it?
There are four basic reasons: ignorance, laziness or fear of abstinence, money, and a failure to understand the nature of true marital love.
NFP runs counter to the “free and easy sex” philosophy adopted by most people. Pro-abortion groups lump all methods of NFP under the banner of the old and unreliable “rhythm” method, even though they know better. This pervasive propaganda frightens many men and women into believing that natural family planning is backward and ineffective.
It’s a different story for the doctors. Despite their many years of education, most are appallingly ignorant about NFP. A doctor who knows little or nothing about NFP is unlikely to promote it but will instead prescribe the drugs that are so readily presented to him by the representatives of the major pharmaceutical corporations. Additionally, many doctors believe that women are too unmotivated or unintelligent to learn NFP. Finally, there is great profit to be made in the development, manufacture and distribution of contraceptives and abortifacients; no such profit motive exists with NFP.
The clergy must share the blame for the ignorance of the faithful regarding NFP. For many years, and in many countries,
This divided position of the clergy [on contraception] has contributed, more than any other factor, to the confusion of the layman ― after all, who is the layman to follow except the pastor? In espousing such a position, that the layman must be guided exclusively by his conscience, such clergymen have done more harm to the layman than they imagine, and inestimable disservice to the Church itself.20
This point is especially telling in Western countries. How many U.S. or European Catholics have ever heard contraception condemned, even in the vaguest terms, from the pulpit? How many bishops have made pronouncements against it? The primary reason that so many Catholic men and women use contraceptives and abortifacients is that their bishops and priests have never told them not to. Often, priests do not preach against anti-life practices because of their faulty seminary education in sexual morality, which is frequently delivered by dissenters from Church teaching.
NFP takes some time and effort to learn. In this age of instant gratification, the equation “FAST + EASY = GOOD” is an almost inviolable law. If a method of birth regulation requires any effort, most people summarily disqualify it. Most Western women would rather take a long-term gamble on their health than put a short‑term effort into learning about their own bodies. And, sadly, most men couldn’t care less which method of contraception their wives use, as long as they themselves aren’t inconvenienced and have access to sex at all times.
As Erma Clardy Craven has said, “Women are being seen as wombs to be deactivated rather than human beings with lives to be fulfilled.”21
The contraceptive makers and most gynecologists would have the public believe “quick ‘n easy” contraception is the only way to go. The manufacturers say this because they are making huge amounts of money off women who willingly and ignorantly drug their reproductive systems ― and the profits from the sale of these drugs amount to more than $5 billion per year! This sum does not include the profits reaped by individual doctors and population control organizations such as International Planned Parenthood Federation (IPPF).
Curiously, NFP practitioners will probably agree with a writer for the Feminist Womens Health Centers, a chain of low-budget abortion mills, as she summarizes the real reasons why NFP is not more widespread:
Fertility Awareness poses a big threat to the hormonal contraceptive industry. If women are given the choice of the Pill or implants with their side effects, lack of STD protection, expense, and reliance on doctors; or Fertility Awareness, with or without barrier methods, which seems the more logical choice? Both have the same effectiveness (98.5-99.2%). Fertility Awareness costs nothing to use, has no side effects, and puts reproductive responsibility firmly in the hands of the user.22
Time is money for busy health professionals. When they are faced with a choice between an easy $20 for a five-minute birth prevention pill prescription or referring a couple to an NFP teacher, the lure of quick money usually wins out.
4. Misunderstanding of NFP’s Place in Marriage
NFP can be used for contraceptive motives.
Most Catholic married couples in developed countries have only one or two children. This is not because they use NFP effectively, but because they use contraceptives and abortifacients at about the same rates as all other groups. Some Catholics will use NFP for a few years and then, when they have had all the children they want, will switch to the pill or even get sterilized.
As St. Augustine wrote in his treatise On the Morals of the Manichaeans:
Sometimes this lustful cruelty or cruel lust goes so far as to seek to procure a baneful sterility, and if this fails, the foetus conceived in the womb is in one way or another smothered or evacuated, in the desire to destroy the offspring before it has life, or if it already lives in the womb, to kill it before it is born. If both man and woman are party to such practices, they are not spouses at all; and if from the first they have carried on thus they have come together not for honest wedlock, but for impure gratification; if both are not party to these deeds, I make bold to say that either the one makes herself a mistress of the husband, or the other simply the paramour of the wife.23
More than half a century ago, Mahatma Gandhi illustrated the greatest problem of the “contraceptive mentality” in marriage when he said:
It is dinned into one’s ears that the gratification of the sex urge is a solemn obligation like the obligation of discharging debts…. This sex urge has been isolated from the desire for progeny and it is said by the protagonists of the use of contraceptives that conception is an accident to be prevented except when the parties desire to have children…. Marriage loses its sanctity when its purpose and highest use is conceived to be the satisfaction of the animal passion without contemplating the natural result of such satisfaction.24
It is certainly possible to use natural family planning exclusively throughout the reproductive years in a selfish manner, without sufficiently serious reason to avoid pregnancy. After all, what gift of God cannot be misused? Any method of birth regulation (including NFP) is evil if the intent is to deny God’s will for our reproductive lives. A couple who uses NFP to avoid having children that they could properly care for may either be ignorant of the evil of doing so or may have essentially selfish motivations.
 A fine summary of the NFP/FABM methods is Anne Marie Williams, RN, BSN. “Surprise! Natural Family Planning Methods are Far More Effective than You’ve Been Told.” Live Action, May 31, 2019.
 Since the early 1980s, there has been discussion regarding the best term that could be applied to the methods used by couples who want to place their reproductive lives in the hands of God. Many pro‑lifers object to the term “natural family planning,” saying that it smacks of utilitarian Planned Parenthood‑type thinking. They prefer instead “natural fertility awareness” (NFA) or “natural fertility regulation” (NFR). NFA refers to the teaching of signs and symptoms of fertility to mature teens in preparation for marriage and is thus different from NFP. NFR is a term that is certainly appropriate for people who have been using the methods for some time and are therefore knowledgeable enough to avoid the confusion brought on by the use of several different terms for the natural methods.
However, the term “natural family planning” (NFP) has two distinct advantages. First, it appeals strongly to couples using contraception and considering changing to the natural methods, but who still possess lingering traces of the “contraceptive mentality.” Pro-lifers should always try to wean their friends and acquaintances away from abortifacients and contraceptives. Secondly, the term “NFP” is used by many teachers in developing countries to draw a sharp contrast between natural methods of fertility regulation and contraceptive or abortifacient methods. These teachers find that their students, who often have little education, are confused by other terms.
For these reasons, the term “natural family planning” (NFP) is used throughout this article. This is no way implies that other terms are less appropriate.
 Robert A. Hatcher, et. al. Contraceptive Technology, 21st revised edition (New York City: Ardent Media, Inc.), 2018. Table 26-1, “Percentage of Women Experiencing an Unintended Pregnancy During the First Year of Typical Use and the First Year of Perfect Use of Contraception and the Percentage Continuing Use at the End of the First Year: United States,” page 844.
 National Survey of Family Growth Key Statistics webpage, accessed on March 5, 2021.
 United Nations World Health Organization (WHO) and United States Agency for International Development (USAID). Family Planning: A Global Handbook for Providers. Chapter 20, “Lactational Amenorrhea Method.”
 “Petition the CDC: Women and Medical Professionals Need Accurate Information on Family Planning.” FACTS website, May 3, 2017.
 Robert A. Hatcher, et. al. Contraceptive Technology (21st Revised Edition) [New York City: Ardent Media, Inc.], 2018. Table 26-1, “Percentage of Women Experiencing an Unintended Pregnancy During the First Year of Typical Use and the First Year of Perfect Use of Contraception and the Percentage Continuing Use at the End of the First Year: United States,” page 844, and Chapter 12, “Fertility Awareness-Based Methods.”
 Rachel Peragallo-Urrutia, MD, MS, et. al. “Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review.” Obstetrics & Gynecology (journal of the American Association of Obstetrics and Gynecology), volume 132, Number 3 (September 2018), pages 591 to 604.
 Michael D. Manhart, Ph.D. “Fertility Awareness-Based Methods of Family Planning: A Review of Effectiveness for Avoiding Pregnancy Using SORT.” Osteopathic Family Physician, Volume 5, Number 1 (January–February 2013), pages 2 to 8.
 Bob Ryder and Hubert Campbell. “Natural Family Planning in the 1990s.” The Lancet, July 22, 1995, page 233. Also see R.E.J. Ryder. “‘Natural Family Planning’: Effective Birth Control Supported by the Catholic Church.” British Medical Journal, 1993;307:723-726.
 Robert A. Hatcher, et. al. Contraceptive Technology, 21st Revised Edition (New York City: Ardent Media, Inc.), 2018. Table 26-1, “Percentage of Women Experiencing an Unintended Pregnancy During the First Year of Typical Use and the First Year of Perfect Use of Contraception and the Percentage Continuing Use at the End of the First Year: United States,” page 844, and Chapter 12, “Fertility Awareness-Based Methods.”
 ProQuest LLC. ProQuest Statistical Abstract of the United States, 2019, 7th Edition (Bethesda, Maryland), 2018. Table 81, “Live Births, Deaths, Marriages and Divorces: 1960 to 2016.”
 Personal communications by the author with 14 major national NFP groups and leaders over the time period 1990-2020. Average number is shown (the range is from 0.6% to 6%). The lowest figure quoted is 0.6%, from Nona Aguilar’s book The New No-Pill No-Risk Birth Control (New York City: Rawson Associates), 1986, page 188.
 John Marshall and Beverley Howe. “Psychologic Aspects of the Basal Body Temperature Method of Regulating Births.” Fertility and Sterility, January 1970, pages 14 to 19.
 Professor Walter Rhomberg, M.D., Michaela Rhomberg, M.D. and Hubert Weißenbach, DI. “Natural Family Planning (NFP): The Symptothermal Method (Rötzer) as a Family Binding Tool.” Catholic Social Science Review, 2008.
 “The Real Cost of Birth Control.” U.S. News and World Report Alpha Consumer, March 5, 2012; indexed to 2021 values with the Consumer Price Index (CPI) from the website of the Federal Reserve Bank of Minneapolis.
 Warren Hern. Abortion Practice (Boulder, Colorado: Alpenglo Graphics), 1990, page 41; United States Department of Commerce, Bureau of the Census. Reference Data Book and Guide to Sources, Statistical Abstract of the United States (Washington, DC: United States Government Printing Office).
 Carl Djerassi. The Pill, Pygmy Chimps, and Degas’ Horse (New York City: Basic Books), 1992, page 263.
 National Survey of Family Growth (NSFG) described in Catholic News Service. “Most Catholic Women Ignore Church-Accepted Form of Birth Control.” The Portland, Oregon Catholic Sentinel, January 24, 1992, page 7. This statistic was confirmed by a 2011 Guttmacher Institute study (Rachel K. Jones and Joerg Dreweke. Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use [New York: Guttmacher Institute], 2011).
 Vincent J.A. Rosales, M.D. “The Catholic Choice of Rhythm.” Unitas (Manila), December 1976, pages 474 to 501.
 Erma Clardy Craven, quoted in ALL about Issues, July/August 1980, page 5.
 Suzanne Cooper Doyle. “Fertility Awareness: Reclaiming Reproductive Control.” WomenWise (publication of the New Hampshire Federation of Feminist Women’s Health Centers), Summer 1991, pages 6 to 8.
 St. Augustine, “On the Morals of the Manichaeans” (De Moribus Manichaeorum). Chapter 18, paragraph 65, as quoted in Pius XI, Encyclical Casti Connubii, December 31, 1930, VII (“Vices Opposed to Christian Marriage”).
 Mahatma Gandhi, Harijan, March 28, 1936. Louis Fischer (editor). The Essential Gandhi: His Life, Works, and Ideas (New York City: Vintage Books), 1962, page 241.