Silver bullet or ‘Vatican roulette’?

Natural Family Planning (NFP) is offered by some as a “silver bullet,” an alternative to contraception, and scorned by others as an unreliable game of “Vatican roulette.” Claims on both sides are made easier by the scarcity of reliable data from the field on how acceptable it is to ordinary couples, and how effective it is in avoiding unwanted pregnancies.

In an effort to fill this gap, our institute began an NFP program in a working-class barangay of Quezon City in 2009, preparing local trainers in the Standard Days Method (SDM) of fertility awareness. This consists of counting the days following a woman’s menstruation in order to identify the “fertile period” during which she should not have intercourse if she wishes to avoid pregnancy. Statistical analysis of some 7,500 women’s cycles had shown the method to be highly reliable for the great majority whose cycles are between 26 and 32 days.

The trainers met with women in their homes, organized neighbourhood seminars, and eventually obtained a desk in the barangay health center. Over a period of almost two and a half years they contacted more than 800 women, instructed those who were interested, and followed them up in their homes. Then, during the summer break from school, 20 of our college-level scholars interviewed as many of the women (347) as they could locate.

The 347 women interviewed are predominantly Catholic; their husbands are manual workers (construction, tricycle drivers, etc.) or lower non-manual (security guards, supervisors etc.); they themselves are mostly housewives. About 60 percent had some high school education. Eighteen percent of the couples were married in church, 38 percent had civil weddings only, and 42 percent had no formal wedding.

Of the 347 women, 40 percent had begun practicing NFP, and 27 percent were still practicing it. We call these two groups the “acceptors,” and the 60 percent who never practiced the “non-acceptors.”

The most common reason given for not trying NFP was that they did not know how (apparently after the initial contact they were not followed up by the trainers). Other reasons were that they were already using another method, that their cycles were irregular, fear of pregnancy, and the supposed difficulty of NFP. Contrary to our expectations, only seven cited husband’s opposition.

Acceptors are on the average 32 years old, and non-acceptors 29. The former group has an average of 2.49 living children, while the non-acceptors have 2.57. The differences seem negligible, but in view of the fact that acceptors are three years older than non-acceptors, they become more significant. Moreover, when we compare the number of children of the older acceptors and non-acceptors, who were born in 1970 or earlier and have almost completed their fertile years, the differences are greater. The 14 acceptors have an average of 2.8 living children while the 13 non-acceptors have 4.5. Thus the acceptors seem well on the way to having smaller completed families than the non-acceptors.

Interestingly, a higher proportion of the acceptors had church weddings, but a higher proportion of them also had civil weddings, while fully half of the non-acceptors were in live-in arrangements or were separated. It seems that those in more stable unions are more likely to accept NFP.

Putting these two findings together we see acceptor-couples as those who early on decided on stable marriage relationships and a limited number of children.

Turning to the key question of effectiveness, we find that the acceptors had practiced NFP for a total of 218.17 years. During this time there were 24 pregnancies among them, or one pregnancy every 9.09 years of practice or 11.0 percent chance of pregnancy each year. Of the 24 pregnancies, 10 mothers reported that they were deliberate (“sinadya”), while 14 were indeliberate (“maling paggamit,” or “nakalimutan ang pag-gamit”) and only one claimed to have “followed the rules and still became pregnant.”

It is possible that some of the 10 who said their pregnancy was deliberate were actually covering up their failure to use the method properly. However, if we take them at their word and consider only the 14 women whose pregnancies were said to be indeliberate, we have only one pregnancy every 13.67 years of practice or 7.3 percent risk of pregnancy each year.

These findings would indicate that the effectiveness of NFP and the SDM in the field is comparable to that of contraceptive pills, which are estimated to involve a 9 percent annual risk of pregnancy in typical use.

The great majority of those who were using or had used NFP said that they were satisfied with it. Reasons given were that it has no side effects, is reliable and easy to us, safe and inexpensive. Five said that it is natural—the reply closest to the Catholic Church’s fundamental reason for approving it.

It would seem then that NFP has definite advantages: reliability, absence of side effects and lack of expense. It is by no means “Vatican roulette.” Unfortunately, the value elements of the method have not been fully communicated; the advantages cited are mainly practical and it is seen as merely another technique for family planning. There is no mention of respect for the integrity of the marriage act, the emotional bonding of husband and wife in what must be a mutual effort, the discipline required during the period of abstinence. Here we see the need to communicate NFP not as a stand-alone program but as one element in a broader program of formation in family values.

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