Thursday, March 15, 2012

Why Natural Family Planning (NFP) is a non answer

The problem with NFP is the results in practice.  It is the case among people with years of experience who practice in a disciplined way that NFP has a pregnancy rate of .6-1.8% which is in line with chemical methods (study). But actually doing this is rather difficult, for example in the study cited above 13% of the women who had originally expressed interested in NFP refused to continue to use NFP in practice, even with extensive support services made available to them.  Support far beyond what can be given in a widespread way.

When NFP is used by people who take it semi-seriously they have 7.5% chance of getting pregnant per cycle, to put that in perspective couples having frequent sex with no contraception of any type have 28% chance of pregnancy per cycle.

Because differences like this, though generally not this large, are common, when measuring birth control effectiveness: means are evaluated using a "typical use" scale not a "perfect use scale".  So for example condoms when used every time and with a spermicidal gel have a 98% effectiveness rate (i.e. with perfect use a sexually active woman will get pregnant only 2% of the time).    When used by actual people mistakes happen and the actual actual effectiveness rate is measured at 85%.   Where NFP methods are heavily used unintentional pregnancy rates among sexually active women are about 24%. Considering we are talking several decades of sexually active fertility even a 10% failure rate would mean 2-3 extra children over the course of a woman's lifetime.

Western women seem to be heading towards a fertility rate of 1.3 children per woman, and even in America non immigrant woman are at 2.1 children per woman; NFP simple doesn't seem effective enough in the absence of heavy use of abortion.

Moreover, there is a bit of irony.  If one adopts the currently fashionable definition that life begins at conception NFP greatly increases the incidence of implantation failure, which would be miscarriage under this definition, by encouraging sexual activity during the period when women still conceive but the fetus tends to fail to implant successfully. NFP, the Catholic church's recommended practice causes vast vast numbers of natural abortions over the course of a couple's life. So I would strongly disagree with the church, that it is not the intentional killing of children, if one defines life to begin at conception, and one defines "intent" in any consistent way.

The church is simply aiming for an irreconcilable situation:
  1. They have over the last 200 years redefined abortion to apply much earlier than quickening, i.e. when the woman first feels fetal movement. This eliminates the sorts of birth control methods that were popular in previous centuries, which we would today call "abortion inducing drugs". It also introduces the moral issues with NFP I cited above.
  2.  
  3. They have redefined marriage to be primary about sex rather than primary about property and legitimate heirs. Thus there is no longer any distinction made between non-marital and marital pregnancy, as well as making much distinction between adultery and fornication. This to some extent is compounded in our society that has moved towards late marriage.
  4.  
  5. They dismiss artificial contraception of virtually any type as immoral. Thus eliminating the only means humans have discovered that in a widespread and reliable way is capable of keeping a woman's fertility down to 1-3 children per lifetime without heavy use of abortion (in the modern sense of the word).
  6.  
  7. They do aim for their standards to be adopted in a widespread way, and not seen as just theoretical goals that no one in practice actually follows.
When people talk about supporting birth control what they mean is keeping the fertility numbers down at the 1-3 children per woman over the course of their life. Standards of living correlate very strongly with per capita energy consumption. Energy production is not substantially boosted by population, it should be thought of as a limited resource growing slowly. High energy demand, effectively high energy prices, have been "a" if not "the" primary cause of global economic growth being constrained for the last 2 generations.  That is, what is primarily preventing 3rd and 4th world people from having a good standard of living are these high energy prices. While technology is allowing us to boost energy production somewhat every percentage point of population growth is a percentage point of growth not available to raise the living standards of the poor.  This tradeoff translates into millions of lives lost every year, not even discussing quality of life. Quite simply, overwhelming number of people, even people who care deeply about the sanctity of life, on this planet would prefer less children being born to everyone being subjecting to grinding poverty.

If the church wants Humane Vitae to be taken seriously they either need to indicate:

i) What is the unknown secret for massive energy production to allow for a growing population?

ii) How to maintain fertility at the rate of around 1-2.25 children per woman over the course of their life in practice using NFP?

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See also



9 comments:

Brantly Millegan said...

You seem to saying that NFP isn't as effective, and therefore is a non answer. There are different ways of doing NFP, and there is no reason to think that these methods won't improve. The fact that current NFP methods aren't necessarily as effective as contraception doesn't make contraception moral.

You're most interesting point, and you've brought this up before, is that you say that nfp might actually encourage miscarriages. That's a very interesting point, which I will have to do more thinking about

CD-Host said...

You seem to saying that NFP isn't as effective, and therefore is a non answer. There are different ways of doing NFP, and there is no reason to think that these methods won't improve.

Well yes, if NFP were to improve to the point that it had a very high typical effective rate then the counter argument I'm presenting against it wouldn't work.

The fact that current NFP methods aren't necessarily as effective as contraception doesn't make contraception moral.

That's one I address in the second part about energy. I argue that strong effective population control is a moral imperative because energy production doesn't correlate appear to correlate strongly with fertility rates.

You're most interesting point, and you've brought this up before, is that you say that nfp might actually encourage miscarriages. That's a very interesting point, which I will have to do more thinking about

Glad you are thinking about it. And there is no "might" about it. The correlation between late in cycle sex and implantation failure is supported by both theory and experimental data. Deciding to use NFP is deciding to probably have roughly an additional implantation failure / miscarriage every year. Which doesn't strike me, if one believes that life begins at conception as being that much morally different than an abortion per year.

Now if one says that life beings at pregnancy, implantation, or later this argument wouldn't apply.

Ernie Baier said...

http://www.sciencedirect.com/science/article/pii/0002937895904980

This article states that there is no correlation between using NFP to plan a pregnacy and an implantation failure (i.e. spontaneous abortion). I would like to see evidence that supports the argument that NFP increases failures.

CD-Host said...

The study you cited says the exact opposite of what you are claiming:

Of the 361 conceptions judged to have occurred during the optimal time frame, 33 (9.1%) were spontaneously aborted. The miscarriage rate among the 507 conceptions that occurred at nonoptimal times was 10.9% (55) And that btw doesn't include fertilizations that never implant at all because they were using mucus measurements.

I don't see how the study you cited doesn't support my contention regarding conception. Mostly though I'd also question whether there is selection bias here. He's likely looking at women trying to get pregnant and failing, not women trying not to get pregnant which is going to push sexual activity later.

David Meyer said...

I agree with Brantly. I have a couple of reservations about NFP, and you just gave me another one to think about.

Your issues about energy and whatnot are non-starters imo. If contraception is morally wrong, then the Church cannot say it is acceptable. And it is the view of the Catholic Church that contraception is a grave moral evil. Other concerns that migh come from that can be addressed seperately.
Similarly, being against capital punishement may make some situations more complicated (taking care of prisoners, etc) but that should not weigh on the morality of CP.

Another point I scratched my head at was when you said something about contraception being the "only means" available of reliably keeping fertility rates down.
I get what you mean here, and I think the demographic transition helps prove your point. Yes, contraception is probably needed to get truly and consistently low fertility rates in a society. (incidentaly this is what I was trying to prove to you on my blog today) But this assumes we should want the rates that low. And we should not.

And the fact that contraception is the only way to realistically keep the TFR down does not make contraception right. In fact it is moraly wrong.

There is a 100% effective fertility rate negater, which will bring the TFR to near zero, and it is called celibacy.

Fun facts:
1. Humans do not need to have sex.
2. Human women who do not want to get pregnant should not engage in sexual activity.

This is the worst thing about contraception (or even badly used NFP), that women who did not want to be pregnant get pregnant. This often is no big deal, but often can lead to abortion or bad parenting.

Modern people seem to think both my #1 and #2 above are somehow strange concepts that need to be circumvented and denied, but they are just basic laws of life.

CD-Host said...

@David --

There is no evidence that human sexual behavior is mostly voluntary. The USA today provides a wonderful case study. We have huge chunks of the population who believe that sexuality is a natural part of teenage years and the goal of parents and society is to encourage teens to express their sexuality responsibly. We have a huge chunk of society that believes that sexuality outside of marriage is sinful and destructive and teens should be discouraged from engaging in it. Teen's beliefs correlate strongly with their parents.

The data is in. Teens who hold the later, traditional, Christian view, are slightly more sexual active than the ones who believe it is a healthy behavior to be encouraged. For example on average have their first sexual experience 9 mo. earlier and have more sexual partners. Some of these facits remain even if we correct for parental income.

There is simply no evidence and lots of counter evidence that believing one shouldn't engage in sex is an effective means of not engaging in sex.

There is a 100% effective fertility rate negater, which will bring the TFR to near zero, and it is called celibacy.

And with the above you can see this is not true. Obviously actually not having sex is very effective. But committing to not have sex is not a terribly effective means of maintaining low fertility.

Yes, contraception is probably needed to get truly and consistently low fertility rates in a society. (incidentaly this is what I was trying to prove to you on my blog today)

I'd argue that infanticide and frequent abortion (modern definition) seem to work as well. But since most people (rightfully) reject these earlier methods contraception seems like the best option.

On your blog you were arguing that fertility rates had never been this low. That the desire for low fertility is unprecedented, that's false.

But this assumes we should want the rates that low. And we should not.

Then you have to solve the energy issue.

oogenhand said...

If abstinence, or moral restraint, as Thomas Malthus called it, was viable for everyone, religious people wouldn't have large families. However, lowering birthrates skews the demography towards old, creating its own set of problems.

https://oogenhand.wordpress.com/2013/05/26/premature-death-should-visit-the-human-race/

CD-Host said...

@ oogenhand

Hi oogenhand welcome to the blog.


If abstinence, or moral restraint, as Thomas Malthus called it, was viable for everyone, religious people wouldn't have large families.


I'm not sure if I follow that. Religious certainly increases the size of family but both the religious and the non-religious have families far smaller than they would without heavy use of birth control.

However, lowering birthrates skews the demography towards old, creating its own set of problems.

Yes, absolutely. A replacement level population is going to skew quickly towards the 1/2 the average age of death and a sub-replacement population will be much older than that.

oogenhand said...

When I said religious, I meant people who do not use birth control. If abstinence would be viable, people who do not want to have children would not need birth control for small families, but would use abstinence instead. So, if the availability of birth control leads to far smaller families, it is obvious the same people wouldn't use abstinence, because of its difficulties.