New Life for Family Planning

By Michael P. Harris

In his 1968 encyclical Humanae Vitae, Pope Paul VI strongly reaffirmed his church's traditional opposition to artificial means of birth control. That authoritative teaching left Roman Catholic couples with only two ways to limit the size of their families: 1) use the morally acceptable rhythm method, which was then so unreliable as to justify the sobriquet "Roman roulette"; or 2) follow their consciences rather than papal counsel and adopt such forbidden means of contraception as diaphragms, condoms or the Pill -- which millions did.

Twenty years later, the Vatican's support for Humanae Vitae is as strong as ever, but with a twist. The church has now become the world's most active proponent of natural family planning, a more effective version of the old unreliable rhythm method. A new department has been set up within the Curia, the Vatican's bureaucracy, to promote birth regulation. In Rome, Gemelli Hospital houses a twelve-year-old N.F.P. clinic run by a Catholic university and headed by a nun. Since it opened, the clinic has taught N.F.P. methods to 1,660 couples, and claims that not one of the women who took the course has become pregnant by accident.

The Catholic Church teaches that no outside agent, be it pill, diaphragm or condom, can be used to prevent conception, which is the "natural" end of sexual intercourse. But a couple may licitly refrain from conjugal relations during a woman's fertile period, which usually lasts ten to twelve days during each menstrual cycle. The improved way of precisely determining those days is known as the ovulation method, or Billings mucus method, which was introduced by and named for an Australian Catholic couple in the 1970s. Using it, a woman carefully monitors changes in her cervical mucus to determine when she is ovulating, and thus capable of conceiving a child. A 1976 study by the World Health Organization concluded that the Billings method compares favorably with artificial means in effectiveness at preventing conception.

The church has been particularly aggressive in promoting natural family planning throughout the Third World. Mother Teresa's Missionaries of Charity run an N.F.P. center in Calcutta in a former chemicals warehouse. The sisters have taught the method to 64,000 women in the Indian state of West Bengal. Teachers use everyday agricultural images to explain a woman's menstrual cycle: seeds are planted during the monsoon, when the soil is soft and moist; cows are inseminated when they produce mucus at the cervix, fertility's telltale sign. Some women who cannot afford pencil or paper dutifully chart their fertile days in simple symbols drawn with burned wood. In Brazil, Sister Cecilia heads an agency that runs 18 N.F.P. centers; she argues that in countries where poverty and illiteracy prevail, N.F.P. is an ideal method of limiting family size. "The ovulation method doesn't cost anything, and women don't have to read or write to figure out which are their fertile days," she says.

In practice, N.F.P. is not quite that easy. Its users must undergo a training period, usually of about four months. The couple must be strict about abstaining from sex during the woman's fertile days, which can be difficult in societies in which males are taught to be macho and consider abstinence an insult to their manhood. By contrast, the IUD and the Pill require little if any training and follow-up procedures. Moreover, because of its simplicity as a means of limiting family size, sterilization is actively promoted by government-sponsored programs in India and elsewhere. Frances O'Gorman, a Canadian-born Catholic lay worker in Brazil's spirit-crushing favelas, says that most women in such desperate circumstances find it hard to rely on N.F.P. techniques. "They may be cheap and easy to use," O'Gorman says, "but natural methods are more suitable for the middle or upper classes, where the husband and wife can discuss family planning. Life in the slums is a whole different reality."

A 1986 study showed that only 4.3% of Brazilian women used N.F.P.; they preferred sterilization (27%) and the Pill (25%). In India an estimated 10 million people have been introduced to the Billings method over the past decade. But experts believe that for every five couples who faithfully maintain N.F.P. records and charts, an equal number of husbands and wives trying to practice N.F.P. do not.

The church's attempt to promote N.F.P. is often frustrated by indifference or opposition by international agencies and governments. In June a conference in Bangkok, which included both WHO and the United Nations, examined the ethics and human values in family planning. Vatican officials were not allowed to speak officially, but they did submit a withering attack on the "contraceptive imperialism" of agencies and companies that impose IUDs, pills, antifertility vaccines and other products on illiterate women without warning them of the potential medical dangers. "It's dated," says Father Peter Elliott, an executive with the Vatican's Pontifical Council for the Family, for priests to tell women to use contraception depending on their consciences. "Women don't want to use it because it's become a question of their health. People are fed up with being exploited."

Church officials emphasize that their promotion of natural family-planning methods is for all people. "These are not Catholic methods," notes Father Elliott. "They are used in Pakistan and China too, but through our morality, we have become the promoters of natural family-planning methods. The church finds she has a mission to the world to make the method of spacing births known."

With reporting by Cathy Booth/Rome and John Maier/ Rio de Janeiro