A Few Thoughts on NFP

Sometimes you run across an argument which strikes you as wrong in such a way as to crystallize and clarify your thinking on a topic. Such a case, for me, was running into this debate from last week at InsideCatholic on the topic, "Is NFP Misogynous?"

The "yes it is" argument contained the following key elements:

Assuming any methodized sexual intercourse devised to avoid pregnancy by an otherwise open-to-life-marital-couple can actually "work," who bears responsibility for the method? I seriously question whether NFP, for many, isn't a misogynous practice -- imposing upon women an undue share of the physical and emotional burden of the theologically questionable quest of planning pregnancy.

First, we must be real. Modern NFP practices demand daily bodily measurements of women, not men.... A woman most desires sexual intimacy when she is at her most fertile.... This is also the moment when we are most likely to conceive a child. It's the moment NFP-practicing women measure and chart and predict as "fertility awareness," a "maybe-child" zone. For NFP-practicing women avoiding pregnancy, it is the moment they must say "no" to both themselves and their spouses....

I don't buy it. It sounds like a scheme to impose on women who wish to time pregnancies an almost penal practice of self-measurement, self-control, and self-denial, while requiring, at a minimum, a sort of suffering acquiescence from a spouse whose interest in the chart becomes rather strategic....

NFP needs to go the same way as the rhythm method -- which did not "work" and was, more importantly, female unfriendly. In its place, perhaps we all need to suck it up and admit what the theology asks of us: Have sex whenever you both want to... and expect a baby every time. Otherwise, don't copulate. That's a fair burden on both spouses.

The woman presenting the "no it isn't" view did a perfectly decent job of presenting the standard arguments for NFP, but I'd like to dig into one aspect in particular, especially given that by the sixth comment on the article we already see a theology student trying to argue that the "planning" involved in Natural Family Planning is really no different than the use of barrier methods of contraception since it involves "the intention of having sex without baby" and is thus "using one's intellect to create a tool which limits the possibility of procreation".

I'd like to start from a point of biological realism. The bodily organs which are used in this very pleasant thing we call sex are part of the reproductive system, which means than whenever we have sex we are performing an action which is at a biological level meant to be reproductive, in the sense that our bodies would not have this capacity were it not for the fact their function is reproductive in nature. (Interesting side note: think of all the most pleasurable things the human body can do and ask yourself, how does each one of these relate to a basic element of human survival. Generally speaking, the greater the physical pleasure, the greater the relation to survival.)

Within the overall structure of intercourse, a normal, healthy man is capable of begetting children any time he has sex. However, women (like females of virtually all other mammals) are only biologically able to conceive a few days out of the month. (Both of these reproductive strategies make a lot of sense for the individual and the species as a whole at the evolutionary level, but I don't think it's necessary to go into all that here.) Even at the "right time", a woman may or may not conceive as the result of having intercourse. Conditions have to be right for the sperm to reach the egg, the egg has to be healthy, and the sperm has to successfully implant. What this boils down to is that while the probability of getting pregnant from any one random act of intercourse is perhaps 1-10% depending on the people involved, having sex frequently will almost invariably result in pregnancy unless there is a health/age problem involved.

Other creatures, our non-rational brethren in the animal kingdom, do not worry about when they should not reproduce. Driven by instincts and natural compulsions, they mate when it is their season, have as many offspring as they can, and hope (if one may apply that word to the unthinking) that those offspring will thrive. If there are not enough resources to go around, the young, weak, and old die off. We humans see this kind of suffering as something to be avoided, and so human societies in all times and places have striven not to outgrow their resources -- using methods ranging from self denial to slaughter.

From a Catholic point of view, human life is sacred and thus abortion and infanticide are completely unacceptable as means of population control; and the sexual faculties have a moral integrity resulting from their relation to the creation of new human beings and so the sex act should not be modified (as with birth control) to remove its inherent fertility. Thus, for Catholics, the answer to the need not to have more children than one can provide for is to have sex less. Because sex has a clear and inherent reproductive aspect, which we consider it wrong to try to circumvent artificially, if you want to not get pregnant you will have to avoid having sex at least some of the time.

Now, this is where the question of whether Natural Family Planning (NFP) as practiced by modern Catholic couples is "natural" comes in. The woman's body gives certain signs of when it is likely to be fertile. These signs are rather less obvious than those of many of our fellow mammals. Female chips, for instance, have a large pink swelling around their genital area when they become fertile, such that one can tell if she is fertile from quite some distance away.

Signs of human female fertility are much more subtle. (The evolutionary reason for this would make a very interesting inquiry, I can think of a few very interesting reasons.) However they are now pretty well understood and easily learned.

So, what are the options for the Catholic couple who are seeking to remain true to the Church's understanding of human sexuality and the human person and also seeking to avoid having more children then they can raise and support?

Ms. Campbell advises, "Have sex whenever you both want to... and expect a baby every time. Otherwise, don't copulate. That's a fair burden on both spouses."

The thing is (leaving aside the dangerous problem of trying to figure out what is "fair" for both spouses in some sort of power politics sense) that this is in a sense not actually all that natural. We are not made such that sex results in a baby "every time". Sex is somewhat likely to result in a baby perhaps 30% of the time, and highly likely to do so only about 10% of the time at best. Since unlike a lot of our fellow creatures, our sex drives are not only "on" when we're fertile, the rest of the time sex serves to strengthen and deepen the bond between a couple who are going to have a lot of work and difficulty together raising children. So if you only, ever have sex when you absolutely expect to have a baby, you're actually using sex in a more minimal fashion than we're physically designed for.

If they know anything at all about their biology (from experience if nothing else) a couple is going to know they won't get pregnant every time. And knowing this, the drive is strong to say, "Surely this time is okay." Though husbands should try hard to be sensitive to the greater difficulties that pregnancy means for their wives than for them, this line of thinking is naturally going to appeal more to the man than to the woman. Desires for "fairness" aside, pregnancy is naturally going to effect the woman more directly than the man.

Given that we have the understanding of female fertility signs available to us quite easily in the modern world, it is going to cause significantly less stress without couples to use that knowledge to actually know "we might get pregnant now" versus "we almost certainly won't get pregnant now" rather than relying the more more amorphous "chances are decent we won't get pregnant this one time" or the inaccurate "we shouldn't have sex unless we're absolutely sure we want to get pregnant."

NFP works within the natural structure of what sex is -- a natural act which has both unitive and procreative elements. It encompasses self denial in that it accepts that if you want to avoid pregnancy for a while you are going to have to forgo having sex, but it provides system and achievability to that self denial by telling a couple when it is that they need to forgo sex. If you need to avoid having another child for the next year or two, you may end up having to avoid having sex nearly half the time. However, that is much more achievable and healthy for a couple than attempting to avoid it entirely for those same years -- and the differentials of fear and desire that would result from such an attempt.

Philosophy and Health

Philosophy is often seen as one of those highly impractical, strictly academic fields, and yet, it has a way of being at the root of everything.

I was struck, recently, by a contrast in two statements about medicine. In an article about the importance of finding medical ways to enhance female sex drive, I ran across a claim along the lines of, "Many experts believe that more than 50% of women over 30 suffer abnormally low interest in sex and would benefit from sexual drive enhancing medication if it became available." The immediate connection my mind made was: No more than 5% of the population is attracted primarily to his or her own sex, and yet this is not considered a medical abnormality.

These two together show that the medical community (and our society in general) clearly has some sort of philosophy of the human person and philosophy of sexuality, which is doubtless assumed and unstated. Women, it is believed, ought to have a sexual drive equal to that of men, regardless of whether that is what we find in nature or not. (Even though there are some obvious evolutionary reasons why males would be physically more interested in frequency of copulation than females.) And yet if one primarily experiences sexual attraction to one's own sex, even though that both "doesn't fit the plumbing" and is evolutionarily useless, that is perfectly fine and healthy, even if this is a condition found in only a small percentage of the population.

Medicine is, in its modern form, generally an empirical field. Yet the question of "What is normal?" and "What is abnormal?" is a question that we always answer philosophically rather than empirically.

Necessarily so. Often our sense of what "ought" to happen is directly contrary to the observed usual occurrence. "Health" is not simply what we observe to be the usual, otherwise we would consider the "healthy" result of a diagnosis of lymphoma to be death.

We chase the telos just as much as in Aristotle's time, and yet we do not acknowledge that what we are doing is anything other than an "empirical science".

Empirical Methodology vs. Human Nature

Sorry to be naught but a linker this week, but things have been busy...

This New York Times Magazine article, interviewing three female researchers studying female desire, struck me as an interesting example of how scientific methodologies are of limited use in describing the human person. Many of their conclusions and ideas are interesting, and you can see how they reflect lived experience to a limited extent, but the fruits of all this research are also startlingly inadequate in describing something as universally experienced as human love and sexuality. And necessarily so, I would tend to think.

Researcher Ravages Virginity Pledges

This was originally going to be a post about how stupid or ideological reporters took a study and drew unreasonable conclusions about it. Then I read the original study and realized it was actually a case of a researcher trying to draw conclusions that do not even remotely follow from the results of her study.

It seems that Janet Elise Rosenbaum of Johns Hopkins University did a study entitled, "Patient Teenagers? A Comparison of the Sexual Behavior of Virginity Pledgers and Matched Nonpledgers," which was published in the January 1st edition of Pediatrics..

The methodology was to compare teenagers who took virginity pledges with teenagers who were similar in all other respects (religiosity, family life, attitudes towards sex, etc.) but did not take the pledges.

SUBJECTS AND METHODS. The subjects for this study were National Longitudinal Study of Adolescent Health respondents, a nationally representative sample of middle and high school students who, when surveyed in 1995, had never had sex or taken a virginity pledge and who were >15 years of age (n = 3440). Adolescents who reported taking a virginity pledge on the 1996 survey (n = 289) were matched with nonpledgers (n = 645) by using exact and nearest-neighbor matching within propensity score calipers on factors including prepledge religiosity and attitudes toward sex and birth control. Pledgers and matched nonpledgers were compared 5 years after the pledge on self-reported sexual behaviors and positive test results for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and safe sex outside of marriage by use of birth control and condoms in the past year and at last sex.

RESULTS. Five years after the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted diseases, and anal and oral sex variables. Pledgers had 0.1 fewer past-year partners but did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched nonpledgers used birth control and condoms in the past year and birth control at last sex.

CONCLUSIONS. The sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and disease before marriage. Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex. Clinicians should provide birth control information to all adolescents, especially virginity pledgers.

Watch the slight of hand here: Previous studies had showed that people who take virginity pledges delay sex longer and have fewer partners, statistically, than those who don't. However those who take virginity pledges are generally much more religious, come from stabler and more religious families, and have more negative attitudes towards premarital sex and birth control than the general population. So this study takes those who have taken virginity pledges and compares their outcomes to people with the same levels of religiosity, family support, and sexual attitudes -- and (surprise, surprise) finds that people who take virginity pledges and those who share their beliefs and lifestyles but haven't taken pledges have very similar outcomes. The piece of paper itself does not prevent premarital sex! Who would have thought?

Now the study author has a point that whereas the number of virginity pledges signed is often taken as a measure of success for abstinence-based programs, it could well be that these programs are simply making more measurable a segment of the population who are already showing a higher than average propensity to delay sex till marriage. Of those in the study who had taken virginity pledges or who had similar characteristics to those who had, roughly 55% had had pre-marital sex by around age 25. By comparison, a 2002 survey found that 75% of all Americans have had premarital sex by age 20. (There's some fuzziness here in that from the working I think the data in the Pediatrics study may only be the pre-marital sex rate for those who are unmarried -- but I would assume that the pre-marital sex rate for those who are married would not necessarily be higher than for those unmarried so I'm assuming that the statistic holds.)

The real question one should ask, if trying to judge the worth of abstinence based sex ed programs in schools, is whether these programs create a larger demographic of young people who have the characteristics of the pledge takers -- or at least reduce defection rates among those who already have those characteristics -- not whether the piece of paper itself is instrumental in keeping people from having sex. This study does nothing to show whether abstinence based programs increase or decrease the number of students with the cultural characteristics that would assist in saving sex for marriage. Indeed, as constituted, the study doesn't really produce any interesting or useful results at all.

My guess, if someone were to ask, is that public school abstinence programs do not actually achieve much of anything (indeed, the evidence is that no kind of sex ed works) because the principles of cultural and religious impartiality at play in our modern public school system preclude giving students much support in developing a worldview in which saving sex for marriage would seem a worthwhile endeavour. However, one would have to conduct a different study to prove that.

Sex Ed Does Not Work

Several times -- when I have observed that I know from my own experience that if one simply does not have sex until getting married, one will in the normal course of things successfully avoid STDs and unplanned pregnancies -- I have had quoted to me the "well known fact" that abstinence only sex education does not work. A quick browse around for studies showed several solid ones, including one commissioned by congress and the Department of Health and Human Services. These all showed that rates of sexual activity, pregnancy and STD infection were not decreased by "abstinence only" sex ed programs.

This didn't really seem like a surprise to me. That a school makes kids sit through several years worth of classes which emphasize that they should wait until marriage to have sex does not by any means mean that the students themselves will resolve to follow that course of action. Heck, schools try hard to teach history, reading, math and science, and students often don't absorb those lessons either -- despite the fact that there is nothing but upside to knowing about those subjects. One must assume that students will be even more unlikely to absorb lessons about abstinence -- since that involves "not getting any" and being something of a social oddity.

I and a number of my peers avoided sex until marriage, but that's because within our particular sub-culture of orthodox Catholics there was a strong reason not to -- something called "mortal sin" that we all believed in. If I had not believed that it was a mortal sin to have sex before marriage, and belong to a peer group that strongly supported that belief, it seems highly unlikely that I would have followed that course. MrsDarwin and I had been dating for nearly four years by the time we were finally able to get married. If we hadn't had a very, very strong motivation to wait -- then why do it?

So I'd essentially figured that the reason why abstinence education "didn't work" was because most of the kids were just sitting there in class thinking "this is stupid" and didn't make any particular effort to be abstinent.

I continue to think I'm right on that, but I ran across a post by Megan McArdle who pointed out something that I hadn't noticed: The most comprehensive recent controlled study to date, the one commissioned by the DHHS, found that groups of student put through several years of one of four commonly used abstinence-only programs did not abstain from sex (or get pregnant or get STDs) at different rates from those in the "control" groups. In two of the studied school districts, the control group was receiving only a "health and science" class which provided little to no information on contraception and STDs. In the other two districts, the control group received a fairly comprehensive sex ed program centering on contraception.

In all four districts, there was no significant difference between the students getting abstinence-only education and those in the control group.

What that means is not just that "abstinence-only sex ed doesn't work", it means that neither form of sex education significantly changes the way teenagers behave. There might as well be no sex education at all -- which to my mind would be just fine. This is one of those areas in which any particular approach to teaching on the topic is going to go against the sensibilities of at least some parents. And results like these only serve to underline that there are some areas which public schools (or indeed schools in general) simply don't have much ability to change behavior. This is one of for the parents and culture, not the schools.

The Pill and Mate Selection

This has been bouncing around the Catholic blogsphere due to being picked up by the blog at First Things, but I post it here in hopes of perhaps drawing a comment out of Razib or someone else with some more serious biological knowledge. It would seem that evolutionary psychologist Stewart Craig Roberts has a paper coming out in the current issue of the Proceedings of the Royal Society: Biological Sciences in which he presents data that women show different odor-based preferences in regards to men when they are pregnant and when they are on The Pill (which uses hormones to reproduce some effects of pregnancy, thus surpressing ovulation.)

While several factors can send a woman swooning, including big brains and brawn, body odor can be critical in the final decision, the researchers say. That's because beneath a woman's flowery fragrance or a guy's musk the body sends out aromatic molecules that indicate genetic compatibility.

Major histocompatibility complex (MHC) genes are involved in immune response and other functions, and the best mates are those that have different MHC smells than you. The new study reveals, however, that when women are on the pill they prefer guys with matching MHC odors.

MHC genes churn out substances that tell the body whether a cell is a native or an invader. When individuals with different MHC genes mate, their offspring's immune systems can recognize a broader range of foreign cells, making them more fit.

Past studies have suggested couples with dissimilar MHC genes are more satisfied and more likely to be faithful to a mate. And the opposite is also true with matchng-MHC couples showing less satisfaction and more wandering eyes.

"Not only could MHC-similarity in couples lead to fertility problems," said lead researcher Stewart Craig Roberts, an evolutionary psychologist at the University of Newcastle in England, "but it could ultimately lead to the breakdown of relationships when women stop using the contraceptive pill, as odor perception plays a significant role in maintaining attraction to partners."

The study involved about 100 women, aged 18 to 35, who chose which of six male body-odor samples they preferred. They were tested at the start of the study when none of the participants were taking contraceptive pills and three months later after 40 of the women had started taking the pill more than two months prior.

For the non-pill users, results didn't show a significant preference for similar or dissimilar MHC odors. When women started taking birth control, their odor preferences changed. These women were much more likely than non-pill users to prefer MHC-similar odors.

"The results showed that the preferences of women who began using the contraceptive pill shifted towards men with genetically similar odors," Roberts said....

"When women are pregnant there's no selection pressure, evolutionarily speaking, for having a preference for genetically dissimilar odors," Roberts said. "And if there is any pressure at all it would be towards relatives, who would be more genetically similar, because the relatives would help those individuals rear the baby."

So the pill puts a woman's body into a post-mating state, even though she might be still in the game.

”The pill is in effect mirroring a natural shift but at an inappropriate time,” Roberts told LiveScience.

Obviously this is just one factor in relationship dynamics, but it does strike me as interesting in that it seems http://www.blogger.com/img/gl.link.gifto me that birth control is a fairly culturally disruptive technology which generally speaking was taken up without a whole lot of thought about anything other than the obvious benefits.

It's also an example of the ways in which things we don't think of affect our feelings and actions. No one, I'm sure, would think, "Boy, my boyfriend just doesn't smell alluring anymore." (Unless, perhaps, she was about to tell him to go take a shower rather than plopping down on the couch next to her after returning from the gym.) But a thought of, "He just doesn't seem exciting anymore" or "We just don't seem to have a spark these days" might well include a response to senses that we do not actively think about.

UPDATE: Razib puts up a good post on the question here. And provides a link to the original study here.

Worth noting is the confluence of interests that gives this story so much play. In the mainstream press, it's a quirky result about something which nearly everyone takes -- probably good mostly for a laugh. "Hey, did you hear the one about how your girlfriend is more likely to dump you for her brother when she's on the pill?"

Meanwhile, in the small subculture of those who have rejected birth control, it serves as a bit of an "I told you so".

In the end, it strikes me as a bit interesting -- more as an example of how a physical reaction can unconsciously affect our personal choices than as a proof that women on the pill will form bad relationships. (After all, there's nothing that would necessarily make a relationship with someone who happened to have a more similar immunity profile a "bad relationship".) Much more concerning, if one is listing off reasons to be cautious of the wide use of birth control, is that having fertility be strictly optional removes the biological incentive from a lot of ancient social structures that we pretty much take for granted, and don't want to see go away.