NFA – the perfect example of Gradualism

I’ve been meaning to revisit the topic of NFP or, as I would prefer to call it, NFA and Joseph Shaw has provided me with the perfect opportunity, with a blogpost critiquing this rather natty little video, promoting the benefits of NFP, as opposed to conventional contraception.

First off, I think Catholics need to stop referring to NFP (Natural Family Planning) and instead refer to NFA – Natural Fertility Awareness. The semantics here are important: the former term implies a contraceptive mindset, validating the secular mindset that every family needs to be meticulously planned in terms of timing and number of children, whereas Natural Fertility Awareness is more accurate in terms of the (more often than not) Catholic mindset of those who adopt this attitude towards their sex lives.

Unlike the secular rigidity of the term Family Planning, favoured by our state health agencies, the phrase Natural Fertility Awareness conveys something of the fluidity and indeed flexibility, of the process. Moreover one does not need to be sexually active in order to monitor one’s own fertility and I’m a great advocate of young women (and indeed young men) being versed in the basic principles, before they may actually need to practice it.

There is nothing inherently immoral about teaching young women how to be aware of and chart their individual fertility – the process takes a few months to get to grips with and do so accurately. The engagement period tends to be a busy and frenetic time. observations can be missed or mistaken. It isn’t unreasonable for a married couple to wish for a short honeymoon period where they aren’t plunged straight into the trials and tribulations of pregnancy at a time when they may be attempting to consolidate financially, especially if they have not previously been cohabiting or sexually intimate.

Indeed if more young women were to monitor their fertility then arguably potential problems could be identified and treated more swiftly. Even, Sir Robert Winston, the IVF pioneer has argued that too many women are being automatically referred for IVF treatment after a failure to conceive, when cheaper and more effective treatments may be available. (Such as for example, the NaPro Centre in Ireland).

Natural Fertility Awareness is scorned by the vast majority of the medical profession, who do not understand it and believe it to be some sort of outdated rhythm method from 50 years ago as opposed to a rigorously scientific method, based on a woman’s own individual fertility, rather than the standardised version assumed by manufacturers of hormonal contraception. This leads to a passive attitude adopted by woman, who are taught to believe that their natural fertility is an out of control monster which needs to be medically  suppressed in order for them to stay healthy.

Last week my youngest daughter came up with an alarming looking rash, (it turned out to be some sort of pityriasis) which needed swift checking out by a medic. Unable to get a GP appointment within a few days, I took her instead to the walk-in centre in central Brighton so she could be seen swiftly. This particular centre also happened to be an anonymous walk-in sexual health and GUM clinic. I was particularly struck by the larger -than-life size posters advertising their sexual health and contraceptive services. Basically there was nowhere you could look without seeing adverts for sexual health prominently displayed. (Which is understandable when you consider Brighton’s considerable LGBT population and the location of the clinic, next to the railway station. You can pop in for an anonymous HIV test).

I was sat in front of an enormous six foot banner stand, which displayed a photograph of a clean-cut, wholesome-looking, causal but modestly dressed, pretty young blond woman, advertising “reproductive health services.’ The image has stayed with me precisely because as I thought at the time, the model was obviously chosen for her ordinary look. The message was crystal clear, all young women will be having sex and therefore they need to ensure that they do not have an unwanted pregnancy or contract any sexually transmitted diseases.

It was precisely the sort of image that I identified with as a teenager or in my twenties, just a normal-looking young woman, probably a professional of some sort, living a normal adult life, in sexual relationships and needing to make sure that she was healthy. Sexual health being just one more adult responsibility that she had to deal with. Take the pill, use condoms with new partners, get checked from time to time to make sure you haven’t inadvertently picked up anything nasty – no big deal, all part of being an empowered grown up.

I had bought into that entire mindset which is why the poster really struck a chord with me.  I too was that ‘empowered’ young woman who believed that all romantic relationships ought to involve sex and that consensual one-night stands were no problem. Sex was  a fun and exciting thing to do and most people who had an unplanned pregnancy had been a bit stupid. (Until it happened to me). Everywhere young women go, they are subtly indoctrinated into a certain way of thinking about sex and their sex lives. The poster was deliberately designed to feature a bland image of an everyday, normal attractive woman, with whom most woman would identify. No doubt in other areas, the models used would vary according to demographics.

Which is why it is so important that women are introduced into another way of thinking about their fertility, namely monitoring their own individual cycles instead of being duped into a passive acceptance of long-term hormonal suppression as being the norm.

This is why I don’t have so much of a problem as Joseph Shaw does, in terms of the secular nature of the video, which is perhaps designed to reach beyond the Catholic faithful.

I’ve personally found NFA to be so enriching for my marriage, despite not always managing to avoid pregnancy, that I want to share it with others because it’s a great thing in and of itself, and as Dr Shaw notes, the fewer people pumping estrogen into atmosphere or suffering from potential side effects, the better. Sceptic readers could do worse than read Sweetening the Pill. In January 2014, Vanity Fair published a 10,000 word expose of the Nuvaring, which has been responsible for thousands of avoidable blood clots and hundreds of deaths, all suppressed by the manufacturers who are now facing lawsuits. Wanting to get women off this stuff is an act of charity and mercy.

Advocating NFA to non-Catholics is the perfect example of graduality – get women onto a more natural and healthier way of avoiding pregnancy and it may well prove a useful first stepping stone in terms of evangelisation. It also might do something to engender better attitudes to sex and the rejection of female instrumentalisation, which has to be in the interests of the common good. I cannot emphasise how much of an uphill battle it is to overturn the entrenched attitudes hammered into children by well-meaning but ultimately ideologically blind professionals, since pre-adolescence.

T1593_300
Every secular priest ought to read this too. Ideally have a copy on hand to lend to couples.

For Catholics struggling with NFA, I strongly recommend Simcha Fisher’s Sinner’s Guide to Natural Family Planning, which is unashamedly written from a Catholic perspective. The book does not tell you how to chart, it does not give the pros and cons of NFA, it does not moralise, or tell you how many children you ought to have, but rather it acts as a spiritual accompaniement purely in terms of the sex and relationship issues related to NFP. If only it had been written two years ago when I was struggling with an unplanned pregnancy, in extremely challenging circumstances. Not only should married couples read it, but anyone involved in any sort of ministry involving engaged and married couples and yes priests, I mean you – it’s not a heavy theological tome, it’ll take a couple of days at most, but most definitely a decent use of your time.

Like Joseph, Simcha identifies the notion of being ‘baby-phobic’ but nonetheless she expclicity rejects the idea of the ‘contraceptive mentality’ that many Catholics using NFA have supposedly adopted. Certainly every Catholic I know who uses NFP, does so with a prayerful mentality and to accept NFA is also to accept that sex could always result in a baby, something that our experience has taught us.

In the aftermath of the Synod, there is a troubling narrative doing the rounds, namely that Catholics who avoid children must have a critical reason for doing so. As I said last year, this is explicitly, not the case, and to get hung up on the ‘grave and serious’ reasons for avoiding conceptions, ignores the actual teaching of Humanae Vitae.

What I said in August 2013, still seems pertinent.

Ultimately if a faithful Catholic couple is using NFP then they are still accepting and participating in God’s plan for creation. NFP/NFA accepts that no method of pregnancy avoidance, bar total abstinence is 100%. It is hugely unlikely that such a couple would then opt for abortion or reject an unplanned pregnancy. Practicing NFP constantly reminds one that this is always a possibility which is why NFP encourages spouses to care for and take responsibility for each other.

We should not berate those who use it in good conscience, procreation is one of the missions of marriage but not the sole mission, there are other ways of building the kingdom, the church does not treat children as a moral good to be pursued at the expense of all other moral goods. Gaudium et Spes 50 suggests that having a large family would be the generous thing to do, but also states that it is up to couples to decide.

But berating those for using NFP to avoid in good conscience, or discouraging discussion of using NFP to plan a family responsibly, is not the way to go, particularly for those encountering these concepts for the first time, which sadly seems to be a not insignificant proportion of the faithful.

To be clear, Joe Shaw did not advocate that everyone should have 10 children, nor did he insist that the reasons for avoiding children ought to be life-threatening, but he was stating that the vocation of marriage must include openness to children. The challenge is how to communicate this beyond the Catholic faithful.

Postscript for the sake of transparency

I am extremely happy to go on record as saying that following the birth of our fifth (God willing, living) child in March, I am no longer open to pregnancy.

I should not need to justify this to the Catholic faithful and it speaks volumes that I immediately feel defensive about this decision. Couples ought to be trusted to prayerfully discern what is right for them in their particular circumstances without having to defend themselves to random shouty online strangers.

For those wishing to ‘judge’ my Catholicity, the reasons are as follows:

  1. As I age, pregnancy is exacting an increasing toll on my body physically. This is in turn having an impact on the rest of the family as I am constantly exhausted and unable to function at full capacity. Due to the transient nature of our living circumstances over the past few years, there are no family or friends close by to help pick up the slack. While pregnancy is only a temporary stage, this recent piece from First Things notes that Catholics should not shy away from accepting and validating its difficulties. I am one of those women for whom pregnancy is a form of the Passion.
  2. I am facing my fourth cesarian section. While I know of women who have had as many as seven, 4 is considered the upper limit for this to be performed safely by most surgeons. During the birth of our youngest daughter there were some difficulties in terms of scar tissue and a large amount of adhesions; this next procedure is expected to be complicated and may well result in some damage to surrounding organs or emergency hysterectomy. A recent ante-natal appointment resulted not in discussion of the wellbeing of my unborn baby, but my being exhorted to accept sterilisation while I was on the table. An option which I have declined.

So no doubt in being very clear that we wish to avoid pregnancy – we fall into the scandalous contraceptive mindset. Perhaps the difference is that it’s not that we reject the idea of further children, but of further pregnancies?

However if the Catholic Church really wishes to throw off her image of misogynistic judgementalism, perhaps advocates of the vocation of marriage, ought to embrace the positive instead of loudly critiquing what they believe to be the motivations of the imaginary minority. I don’t need some shouty man imagining that he can persuade the world to tell me how I need to put my health and family at risk if I wish to save my soul or trying to engage me in online discussion about how married couples need to be open to life 100% of the time. Actually this is one issue where the feminists have a point, there is something particularly grating about a man who does not ever experience the physical tribulations of pregnancy and childbirth telling women how they ought to feel about the subject, no matter how logical, rational or theologically correct he may be.

Using NFA requires trust and a whole new way of thinking. Let’s encourage people to do that without telling them exactly what their decisions should be or implying that they ought to have fifty children until their uterus drops out.

Catholics and Family Size

Francis Philips made some excellent points in her Catholic Herald blogpost this week, asking whether the Church has succumbed to an anti-family culture and reminding Catholics that they should not feel the need to limit their family size.

She quotes one Christopher Gawley who posits that while the Church abhors the small-family contraceptive mentality, it does not present the true message of Humane Vitae, namely the obligation of married couples to have children and not to limit their family size. According to Gawley, this is because the Church does not teach NFP properly, citing it as the natural alternative to artificial contraception and thus couples fall into the contraceptive mindset, using NFP as a form of contraception in order to avoid pregnancy.

That’s certainly a criticism that has cropped up a lot in my combox over the years, with non-Catholics claiming that NFP is merely semantics or a form of sophistry, NFP it is claimed, is just another form of contraception. To be fair, one cannot blame the non-catechised for taking this view, it can be confusing, especially considering that NFP is even described as a form of contraception by the NHS. We Catholics can also play into this perspective, when trying to persuade others of the efficacy and morality of NFP compared to other forms of contraception. There can be little doubt, that religious principles aside, there are compelling reasons for a couple to use NFP, which is entirely natural, leaves no ecological footprint and does much to enhance the relationship between husband and wife on both a physical, psychological and for Catholics, spiritual level.

Which is why we should probably attempt a Catholic boycott of the phrase and instead plump for something along the lines of NFA, Natural Fertility Awareness which is the essence behind NFP for Catholics. It’s not simply about planning one’s family in a utilitarian fashion, but a couple together monitoring a woman’s fertility and every month making prayerful decisions as to the best course of action.

I do not agree that the Church is implicitly buying into the contraceptive mentality by the way it teaches and presents NFP, because let’s be honest here, sadly many practicing Catholics are using contraception and actually see no problem with this, such as for example, the former editor of the Catholic Herald, Cristina Odone. The problem is not, in my experience, that the Church is not teaching NFP or Humanae Vitae correctly, the problem is that it isn’t really being taught at all. Perhaps I’m being unfair, but I think I’ve heard it alluded to once during a homily over the past five years. I once spoke at a neighbouring parish on the theology of NFP, together with a practitioner who did the mechanics and once I’d got over the embarrassment of telling a group of engaged and co-habiting couples that they ought to consider chastity, what was clear was that none of them had ever really considered the doctrine on contraception, let alone the reasons behind it or even putting it into practice.

We are really fooling ourselves if we believe that the reason that Catholics are having small families is because they are misusing NFP. those Catholics who do use it, are the ones who fully understand it and tend to have larger families anyway. In the absence of stats, it’s impossible to make generalisations, but the priority should not be Catholics with say two or three children, who may be using NFP with a contraceptive mentality.

The expert moral theologian in this area, Janet Smith, says that often, the graveness of the valid reasons for avoiding pregnancy can be overstated. I would tend to agree, because what constitutes ‘grave and serious’ reasons is entirely subjective and depends upon the individual couple. While childbearing shouldn’t be postponed for trivial social reasons such as planning a holiday for example, it is totally valid for a woman who has given birth in the last year, for example, to use NFP/NFA to space out her children and give her body adequate time to recover before the next pregnancy. That may not come under the life-threatening implications of ‘grave’ but so long as she doesn’t postpone indefinitely and the decision is taken carefully and prayerfully, it isn’t one that should attract censure. Janet Smith suggests that ‘just’ reasons would be a more suitable phrase.

Humane Vitae admittedly uses the terms ‘serious’ and ‘grave’, as follows:

“If we look further to physical, economic, psychological and social conditions, responsible parenthood is exercised by those who, guided by prudent consideration and generosity, elect to accept many children. Those are also to be considered responsible, who, for serious reasons [seriis causis] and with due respect for moral precepts, decide not to have another child either for a definite or an indefinite amount of time.” (HV10)

Certainly, there may be just reasons [justae causae] for spacing offspring; these may be based on the physical or psychological condition of the spouses, or may be based on external factors.” Further on it states the spouses may have worthy and weighty justifications (argumenta . . . honesta et gravia); defensible reasons (probabiles rationes); and just reasons (iustae rationes) for limiting their family size.” (HV16)

So in planning family size, a couple needs to think about ALL their commitments, to each other, to their existing children, to other family members who may be dependents, such as an elderly parent, basically, the decision has to be defensible, and not selfish, but directed towards a good beyond their own comfort. There are a multitude of good reasons why a couple may decide to use NFP and their decision to do so should be between themselves, taking into account Church teaching on the matter, based on prayerful discernment. The external factors referred to in HV16, obviously refers to compelling financial and social reasons, and can in themselves be a defensible reason, i.e it does not need to be a matter of life and death.

Gaudium et Spes 50 has a passage which is also helpful in discerning what constitutes a just decision.

“takes into consideration their own good and the good of their children already born or yet to come, an ability to read the signs of the times and of their own situation on the material and spiritual level, and finally, an estimation of the good of the family, of society, and of the Church.”

On the matter of how many children one should have, John Paul II had something interesting to say:

“The family is an institution created by procreation within the framework of marriage. It is a natural community, directly dependent on the parents for its existence and functioning. The parents create the family as a complement to and extension of their love. To create a family means to create a community, since the family is a social unit or else it is not a family. To be a community it must have a certain size. This is most obvious in the context of education. For the family is an educational institution within the framework of which the personality of a new human being is formed. If it is to be correctly formed it is very important that this human being should not be alone, but surrounded by a natural community. We are sometimes told that it is easier to bring up several children together than an only child, and also that two children are not a community – they are two only children. It is the role of the parents to direct their children’s upbringing, but under their direction the children educate themselves because they develop within the framework of a community of children, a collective of siblings.”

So ideally, a family should constitute more than two children.

It seems to me that getting too hung up on the grave and serious nature of reasons for avoiding childbirth, ignores the actual teaching of Humane Vitae. I also think that to do so, encourages us to fall into the trap of judging others on the basis of their family size. There’s many a time that I look at some of these marvellous Catholic families with 6 or more children wistfully and wish I’d met my husband when in my twenties so we could have got going a lot earlier and had plenty more, but such is life. We’ve not been doing too badly in the reproductive stakes, to put it mildly.

But we shouldn’t be too keen to judge a family’s Catholicity on the basis of family size. A family may only have one or two children for reasons that are unknown to the outsider and could well be a source of pain for them. A small Catholic family is not a scandalous situation and neither should we hector those who prayerfully chose to employ NFP to achieve or avoid pregnancy, the two being different sides of the same coin.

Ultimately if a faithful Catholic couple is using NFP then they are still accepting and participating in God’s plan for creation. NFP/NFA accepts that no method of pregnancy avoidance, bar total abstinence is 100%. It is hugely unlikely that such a couple would then opt for abortion or reject an unplanned pregnancy. Practicing NFP constantly reminds one that this is always a possibility which is why NFP encourages spouses to care for and take responsibility for each other.

We should not berate those who use it in good conscience, procreation is one of the missions of marriage but not the sole mission, there are other ways of building the kingdom, the church does not treat children as a moral good to be pursued at the expense of all other moral goods. Gaudium et Spes 50 suggests that having a large family would be the generous thing to do, but also states that it is up to couples to decide.

The subject of children and family size is a fraught one to which we must be sensitive. I’ve been hurt by thoughtless comments from well-meaning Catholics, concerning the sex of my children, or suggestions that I ought to be trying for more to set a good example, when in fact we had very sound reasons to be thinking about avoiding. Tip, the last thing one should say to a woman with a newborn baby girl staggering into Church following her third cesarian is “oh what a pity, when are you going to try again”?!

Using NFP takes courage in this day and age, where most have us have been conditioned into wanting to and believing that we can control every aspect of our lives, including childbearing. NFP is liberating and empowering it paradoxically puts a woman in charge of her own fertility (far more so than artificial methods of contraception) but with that liberation comes a submission to God’s will. One innately understands that ‘accidents’ can happen and when they do, you are in a far better position to be able to make the heroic sacrifice required.

There is still so much work to be done in terms of catechesis and educating the faithful on this matter, far better to evangelise on the spiritual goods and moral imperatives of NFP as opposed to be hammering home the message that Catholics should expect to have as many children as humanly possible, continuing to reproduce like rabbits until their uterus falls out.

Yes, generosity is expected and required and this is something that we should be passing onto our children by word and example. But having a large family is not the only way in which one can exercise generosity and perhaps it’s a case of carrot and stick. Once the faithful have been convinced of the good of NFP, constant reminders of the grave and serious reasons to avoid may well become superfluous. Once you’ve understood the teaching in its entirety, not simply the logistics or mechanics, then the rest follows on holistically.

But berating those for using NFP to avoid in good conscience, or discouraging discussion of using NFP to plan a family responsibly, is not the way to go, particularly for those encountering these concepts for the first time, which sadly seems to be a not insignificant proportion of the faithful.

Postscript

Upon reflection it occurred to me that Christopher Gawley, the writer referred to is American, where it is normal pastoral practice for couples to receive NFP instruction as part of their marriage preparation. Perhaps Gawley is justified in critiquing the way this is taught if it only focuses upon the method itself as opposed to the underlying theology. This isn’t the problem in the UK where qualified NFP practitioners are in short supply and NFP is barely mentioned in many parishes or schools.

I still feel that faithful couples practicing NFP should be treated in good faith. It is highly likely that an orthodox couple who are using NFP to avoid pregnancy or space their children will be sufficiently motivated and well informed to understand their obligations in the light of Church teaching.