Natural family planning

I don't think these should all be redirected into each other. It's generally better form to keep them separate, especially if there's reason to think something can stand as its own entry, and most of these can. Anyone else care to weigh in? TheCunctator

: Uh, what is it that shouldn't be redirected into each other? What topics are being combined? Wesley

From the Free ringtones :Recent Changes/Recent Changes:

The following were combined into this entry
* Majo Mills :Lactational amenorrhea method/Lactational amenorrhea method
* Mosquito ringtone :Symptothermal method/Symptothermal method
* Sabrina Martins :Cervical mucus method/Cervical mucus method
* Nextel ringtones :Basal body temperature method/Basal body temperature method
* Abbey Diaz :Calendar method/Calendar method
* Free ringtones :Rhythm method/Rhythm method

Actually, looking at the edits more carefully, the Epopt created each of the above ''as'' redirects. So at some point someone might want to split them up, but it's not like anyone redirected earlier entries. TheCunctator




"Very effective"? If I understand the statistic correctly (and it's not detailed), that means nearly one in 10 women using it *as described* will get pregnant in any one year of using the method continuously (and, if I've done my sums right, that gives a sexually-active woman who doesn't want a child less than a 1-in-10 chance of making it 20 years without an unwanted pregnancy). IIRC every modern mechanical or chemical contraceptive performs better than this. Majo Mills User:Robert Merkel
* The statistic quoted (vague as it is) refers specifically people who strictly use the calendar method. Since the other methods of NFP are much more precise (relying on signals that a woman's body sends as her fertily changes), it's misleading to apply that statistic to the whole NFP article. I realize that the way to counter this is to come up with some better statistics, and cite them. I'll ask my wife tonight. We've used NFP throughout our seven years of marriage, and it's helped us get pregnant when we wanted to and space our pregnancies out when we wanted to. DGJ
:I would say ''at least as effective'' rather than ''very''. If you read the numbers on various types of the pill they suffer from what is euphemistically knowns as 'break through ovulation' (i.e., sometimes women ovulate anyway), '''especially''' with the more recent (post 1985?) lower dosage pills; condoms, of course, have a failure rate only anecdotally available - and the anecdotes put them between 5 and 10% of total times used, which is higher than 10% per annum. Oh - and, we have to talk about statistics in actual use vs. statistics in studies. 'Breakthrough Ovulation' is probably partially dosage levels and partially dosage irregularity. I'm sure implanted hormonal birth conrtol is much more regular, but it has plenty of unpleasant side effects that lead people to seeking other methods. Natural Family Planning users joke that their biggest statistical problem is that the people who use natural family planning '''want''' more children than the typical average, so they don't tend to show the kind of volume control zero-population growth people would like to see. I tend to agree - I don't think you'll find many people who actually practice any form of NFP who actually want only '''one''' child. I think they could do it, but that's not what they're after; they're looking to usefully or carefully space 5 or 6 or 8 children. Mosquito ringtone User:MichaelTinkler, godfather of a 3rd child in a 5 child family and a 4th child in a 4 child family.
::oh, and now I've gone and looked at some planned parenthood pages (the most important U.S. advocate for all sorts of family planning) and contributed a little to Sabrina Martins oral contraceptives talk. Condoms and birth control pills don't look a lot better than nfp unless 'perfectly used'. Depoprovera is undoubtedly another thing entirely. Cingular Ringtones User:MichaelTinkler
:::Hmmm. Looking at (presumably the same) planned parenthood statistics, it seems that if performed perfectly, the natural family planning methods, mostly beat condoms under the same conditions. The exception is, the calendar method, which under ideal conditions seems to have a failure rate of 9%. The chemical methods are still quite a bit more effective if taken reliably. Might I also point out that comparing the pill under "typical" conditions with nfp under optimum conditions isn't accurate either. joy let User:Robert Merkel
* Good points, Robert. DGJ
::yep - all these 'rates' are in ideal situations, and if you start looking they all refer to a fairly limited range of studies. This is why the subcutaneous implanted types of chemical birth control were invented, to get around the randomness of human pill-taking regimes. I'm not contributing any of this to the entries; I'm hoping that someone who understands more will make sure that no one makes claims for oral contraceptives or condoms that can't be supported. By the way, in the land of anecdote, I know a woman for whom the surgical methods didn't work - talk to almost any O.B.-Gyn and you'll hear about women who get pregnant after 'tube tying' and men whose vasectomies spontaneously reversed themself! MichaelTinkler

I believe that part of the reason some chemical reasons achieve their effectiveness is their little-advertised second line of defense. If breakthrough ovulation does occur and an egg becomes fertilized, the contraceptives have also irritated the uterus so that the fertilized egg (embryo?) does not get implanted in the wall of the uterus. That's fine for avoiding pregnancy if that's all you're after, but if you happen to be among those who think that life begins at conception, then you would have to call what happens then an a requirement abortion. That would mean that the contraceptive acted more like an abortifacient in that instance. Perhaps NFP's success rate should be compared with other methods of abortion as well? much television user:Wesley/Wesley

:I think you might be right WRT implantation prevention for chemical contraceptives, but surely discussing it belongs on the oral contraceptives page. The only relevance here might be in the context of why a couple might choose to use nfp for moral reasons - they object to the possibility that taking chemical contraceptives might cause an "abortion" (though medicine wouldn't regard it so) of a successfully-fertilised foetus. I don't think I've ever heard that argument advanced. angels hit user:Robert Merkel

:: I think you're right about where this belongs; I just added it to the oral contraceptives page. I have seen this argument advanced in Catholic literature; might have been something put out by the Couple to Couple League. At any rate, it's a logical consequence of the premise that human life begins when sperm fertilizes egg. lords black user:Wesley/Wesley

::The argument in fact ''is'' fairly commonly advanced. In fact, one way that some people become opposed to artificial birth control is because they find out that oral contraception works some of the time by preventing implantation, i.e., by killing the embryo, and hence conclude that oral contraception is immoral. And this in turn makes a number of pro-life folk reassess their whole attitude towards contraception and can lead them to NFP (besides, even on non-moral grounds such as effectiveness, a choice between NFP and barrier methods might well be won by NFP). Medicine does not regard this as an abortion, because abortion is defined as the termination of a pregnancy, and current medical terminology considers a pregnancy to start at implantation, not at conception. But according to many pro-life ethicists, this is a merely terminological point, since what they believe makes abortion wrong is not that it terminates a pregnancy, but that it terminates a human lifewhich the prevention of implantation does, too. plastic case user:Pruss

Someone added 'The "scheduling" of sex required is highly impractical for single women or those who do not live with their partners.' Why is it "highly impractical"? Are there unpredictable times when "single women or those who do not live with their partners" go into heat and absolutely must have sex? Are they biologically incapable of saying "no, it's the wrong time of month?" Unless someone can justify this remark, I will delete the implication that such women lack free will.
free department user:the Epopt/the Epopt

:Would "inconvenient" be a more appropriate word? "Incompatible with their lifestyle"? As you undoubtedly know, many women who are not involved in a regular live-in relationship a) like to have sex, b) have schedules that don't revolve around their menstrual cycle, and c) don't wish to get pregnant at this point in their lives. usoc spokesman user:Robert Merkel/Robert Merkel

::"Inconvenient" might work. How about "women who don't want to use this system will find this system is not one they want to use"?

: Um, I a) like to have sex, b) have a schedule that doesn't revolve around my menstrual cycle, and c) don't wish to get pregnant at this point in my life YET I am not single and do live with my partner so I'd strongly agree with Epopt's suggested deletion. A possible replacement would be "NFP requires significant self discipline and attention to detail on the part of it's users to be effective." this could say "not for you" without insulting single people or people who use NFP. migrated to user:Saracarl/Saracarl

::I think that generally the advocates of NFP are quite willing to say that NFP works best within a committed relationship. Since most of us advocates of NFP appear to tend to be opposed to pre-marital sex, we don't think this is a serious defect. all gre user:Pruss


Here is a table I assembled from http://www.fda.gov/fdac/features/1997/babytabl.html and from
www.plannedparenthood.org/BIRTH-CONTROL/CONTRACHOICES.HTM
perhaps someone can make NPOV use of it.


MethodFDAPlanned Parenthood
None15%15%
Continuous Abstinence 100%

Withdrawal (coitus interruptus) 81-96%

"Outercourse" (sex play without vaginal intercourse) nearly 100%

Male Latex Condom86%86-98%
Female Condom79%79-95%
Diaphragm with Spermicide80%80-94%
Cervical Cap with Spermicide60-80%
80-90% for women who have not had a child
60-80% for women who have had a child

Sponge with Spermicide60-80%
Spermicides Alone74%72-94%

Oral Contraceptives (combined pill)Over 95%95-99.9%

Oral Contraceptives (progestin-only minipill)95% 

Emergency Contraceptives75%
IUD within five days: 99.9% effective
"morning after" pill within 72 hours: 75-89%

Injection (Depo-Provera®)Over 99%99.7%

Implant (Norplant®)Over 99%99.95%

IUD (Intrauterine Device)98-99%97.4-99.2%

Periodic AbstinenceAbout 75% (varies, based on method)75-99%

Surgical SterilizationOver 99%99.5-99.9%


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Moved from main page:

:(Note: Where do the above statistics come from, and where is the support for the comparison to "optimally-used hormonal contraceptives"? A Catholic agency (which would presumably be biased in favor of NFP) or a study funded by a pharmaceutical company (which would presumbably be biased against it)? Regarding the context of the statistic quoted above... even a "precise" use of the calendar method is not the best NFP method possible, so the above comparison seems unfair. The calendar method alone is about ten times more effective than chance, but most people who use NFP don't rely simply on counting days. A World Health Organization study reportedly found that when couples used NFP properly, the failure rate was 3% or less; this compares favorably to that of several artificial methods. But statistics quoted by various Catholic sources claim 99% effectiveness; yet statistics compiled by companies that sell artificial methods of contraception describe anyone who has ever abstained from sex in order to avoid pregnancy as a "user of NFP," regardless of whether that person has actually been trained in one of the NFP methods described here. OK, end of digression.)

In response, please examine the discussion above.

* Yes, much discussion has been added since I added the above (or some earlier version of the above).

Some of the statistics might well be worth adding to the main page, but essentially I think the basic conclusions are "calendar is not great", "other NFP methods, strictly followed, are probably better than condoms under the same conditions but not as good as hormonal contraceptives, IUDs etc", and "the statistics are less clear than one might like for this discussion". are valid. criminal pattern user:Robert Merkel/Robert Merkel

* Robert, I think that some language like what you just suggested above ought to go back in the space where that paragraph was removed.



Removed from main page:

:NFP is philosophically attractive to some feminists (because both partners participate equally), naturalists (because it in no way interferes with the body's natural functions) and men (because they get advance warning of the onset of their partner's PMS).

Hmmm. Not the feminists I've read.

* Maybe you should read these.
** http://www.csun.edu/~hbnur004/nfpfem1.htm
** http://dispatches.azstarnet.com/features/1999/1208-944682416.htm
** http://www.udallas.edu/phildept/smith/publications.htm

In fact, access to contraception and abortion was one of the key issues of 1960s feminism (and still is in countries where it's not readily available). I think stating what's a minority position as "some" is kinda misleading. soviet dictatorship user:Robert Merkel

* And I think that removing the whole section, and thus turning the "some" who voice these views into "none," is kinda unfair. If you remove the observation about feminism because you haven't read those feminists, what's the justifictaion for removing the comments about naturalists and men?
::WRT to the feminist view, as far as I can tell, the policies of mainstream feminist organisations are that women should have the right to choose any contraceptive method they feel appropriate. You might also notice that they heavily advocate the availability of drugs for women to control their own reproduction (notably RU-486). Nor is NFP discussed when information on contraception is presented. NFP's close connection with the Catholic Church and thus anti-abortion activism generally pits such groups on opposite sides of the political fence on related issues. Draw your own conclusions.

:::Remember that there are women and men who consider themselves feminists but who are strongly opposed to abortion. See, e.g., http://www.feministsforlife.org. Of course this is not mainstream feminism nowadays (even if a number of the famous feminists of the 19th century apparently held such viewssee http://www.feministsforlife.org/history/foremoth.htm), but to claim that it is not feminism at all would be dubious, and indeed an expression of a particular POV on what feminism is supposed to be. And it would not be surprising if some of these kinds of feminists might be opposed to artificial birth control (e.g., Janet Smith (see, e.g., http://www.aodonline.org/aodonline-sqlimages/SHMS/Faculty/SmithJanet/Publications/FeminismWomenFamily/FeminismMotherhood.pdf), a Catholic moral philosopher, thinks of herself as a feminist, and is opposed to artificial birth control). Moreover, the claim under discussion is that some feminists find NFP ''philosophically attractive''. Doesn't that claim seem to be logically compatible with a belief that abortion and artificial birth control are morally acceptable and should be legal? If so, then NFP could be attractive to some pro-choice feminists as well. It is a fairly standard part of feminism to have a suspicion of a generally male-run medical system. Moreover, NFP could be attractive in that it involves a woman's gaining a more thorough understanding of how her body works. This would seem like something that could be attractive to a number of feminists. - court james User:Pruss

:WRT academic feminism, I don't follow the developments in academic feminism beyond what gets reported in the popular press. Somebody with a women's studies might wish to comment on perspectives from there. I suspect, but have no particular evidence for, that NFP advocacy would be very much a minority position there as well.

:WRT men, the comment about PMS struck me very much a throwaway line and hardly a serious reason to advocate NFP.

:As to naturalists, that aspect makes sense.


Oh, by the way, while Planned Parenthood might be argued to be in favour of chemical contraception, I find it highly doubtful that the FDA is some kinda of advocate for the Pill. That's why I removed the reference to them as proponents of chemical contraception (though obviously on the Planned Parenthood article you'd make that point).

: Why would it be highly doubtful that the FDA would be in favor of the Pill? As a government agency, they are at least potentially vulnerable to lobbying dollars like anyone else. NFP doesn't present nearly as much of a profit center as most artificial contraceptives, so there are less hypothetical lobbying dollars on its side. This is pure speculation as far as I know, but it doesn't strike me as being at all unreasonable to suppose that the FDA would favor drug companies. A similar factor is at work in reporting the health benefits of breastfeeding compared to formula feeding: formula manufacturers spend lots of money promoting their product, but there are no "breastfeeding manufacturers" with comparable resources to promote it. prudie tactfully user:Wesley/Wesley

::Because its a government bureacracy whose job isn't to advocate anything. Its job is to evaluate foods, drugs, cosmetics, and the like to find out whether they are acceptably safe and effective. It's not a lobby group. notes how user:Robert Merkel/Robert Merkel

::: yes, it's a government agency. I hope I didn't say it's a lobby group; I certainly didn't mean that. The fact that it's a government agency doesn't make it automatically neutral, or non-partisan, or benevolent. It doesn't make it automatically corrupt either. Any government agency that regulates a lucrative industry is going to be subject to a certain amount of pressure from industry lobby groups, both directly and from elected presidents and congressmen who themselves are lobbied. Both the FDA and FCC fall into this category. It's just a fact of life. And it's next to impossible for them to avoid at least the appearance of bias in at least some cases, whether that bias appears to be in favor of consumers, large corporations, or whomever.


Why can't people simply do a bit of a medline search? Here's some recent data. I'm including everything that has effectiveness data subject to the following restrictions: omit everything before 1998, include only articles with "natural family planning" in the title, and omit studies with less than 100 participants, studies involving fertility monitoring devices (other than simple thermometers), studies which estimate pregnancy probabilities on semi-theoretical grounds (based on cycle day conception probabilities, say), and articles with no abstracts on medline. All effectiveness figures are per woman per year unless noted otherwise.

# Arevalo M.; Jennings V.; Nikula M.; Sinai I.: "Efficacy of the new TwoDay Method of family planning", Fertility & Sterility. 82(4):885-92, 2004 Oct. Sample size 450. Locations: Guatemala, Peru, Philippines. Correct use efficacy: 96.5%. Overall efficacy (including incorrect use): 86.3%.
# Che Y.; Cleland JG.; Ali MM. "Periodic abstinence in developing countries: an assessment of failure rates and consequences", Contraception. 69(1):15-21, 2004 Jan. This is a survey of 15 national surveys. No distinction made between correct and incorrect use, and the abstract says that most of the users are using simple calendar rhythm (rather than the more sophisticated NFP methods). '''Overall efficacy: 74%.''' (Remark: Not very useful for assessing NFP as opposed to rhythm.)
# Howard MP.; Stanford JB. "Pregnancy probabilities during use of the Creighton Model Fertility Care System" Archives of Family Medicine. 8(5):391-402, 1999 Sep-Oct. Sample size: 701. Location of study: Houston TX. Per 100 couples, the following were observed. '''0.14 couples got pregnant despite perfect use. 2.72 couples got pregnant due to user/teacher error. 12.84 couples got pregnant because they had sex at a time at which they knew themselves to be fertile. 1.43 couples had "unresolved pregnancies".''' (Remark: So perfect use pregnancy is not at all likely given NFP, but if you have sex while knowing that you're fertile, you might well get pregnant.)
# Anonymous(!). "European multicenter study of natural family planning (1989-1995): efficacy and drop-out". Advances in Contraception. 15(1):69-83, 1999. Overall sample size: 1328 women. All data is over 12 cycles, not over a year (though the two are pretty close). '''Double check methods:''' '''Unintended pregnancy rate: 2.61%''' over 12 cycles. Drop-out rate: 3.9%. Lost-to-follow-up rate: 3.1%. '''Single check methods:''' '''Unintended pregnancy: 8.5%.''' Drop-out rate: 3.0%. Lost-to-follow-up rate: 23.4%. '''Additional information''': "Most pregnancies occurred because of deliberate unprotected intercourse in the fertile phase". (Remark: I have no idea why Medline lists this as anonymous, but it is published in what I assume is a refereed journal.)
# Hilgers TW.; Stanford JB. "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness." Journal of Reproductive Medicine. 43(6):495-502, 1998 Jun. Overall sample size: 1876 couples. Location: U.S. '''Perfect use effectiveness:''' 99.5%. '''Actual use effectiveness:''' 96.8%. Discontinuation rate: 11.3%.
# Ecochard R.; Pinguet F.; Ecochard I.; De Gouvello R.; Guy M.; Huy F. "Analysis of natural family planning failures. In 7007 cycles of use". Fertilite Contraception Sexualite. 26(4):291-6, 1998 Apr. Sample size: 626 couples, mostly French, some Swiss and Belgian. '''Method effectiveness:''' 98.9%. '''Method+user effectiveness:''' 93.5%. (Remark: My guess based on the abstract only is that this number is what we get if we drop the people who quit using NFP during the study or something like that and then calculate the pregnancy rate in the remaining population, while the next number is the overall number.) '''Overall non-pregnancy rate:''' 82.42%. (Remark: I suspect this includes people who quit using the method. It's hard to tell from the abstract.) -redeemed through User:Pruss

By the way, something worth mentioning somewhere in the article is the way that NFP users can adjust the amount of abstinence to obtain the effectiveness they want, by adding additional "safety days" on both sides of the identified fertile period. Strong anecdotal evidence suggests that once one adds enough of these, the chance of pregnancy becomes close to that which one gets in the case of sterilization. This is up to the individual couple. The methods normally presented to users are a bit of compromise between effectiveness and not having too much abstinence. But in cases where there is a strong enough need to avoid pregnancy, strong anecdotal data suggests that extremely high effectiveness (perhaps rivaling sterilization) can be achieved by adding enough safety days. It's a rather nice thing about NFP that one can tailor the amount of abstinence to get the effectiveness one wants. For instance, if one abstains except on one very carefully chosen day each cycle, I suspect one can probably ensure that the chance of conception is effectively nil. I don't think there really are any studies in these extensions, because of difficulties in compliance I expect. -former trustee User:Pruss