Chapter 6 - Natural Family Planning. Ogino's Discovery


A. Pope wants pastors to provide teaching of NFP

In Familiaris Consortio Pope John Paul II takes the logic of Humanae Vitae one step further by stating clearly that all married couples and young people who are preparing for marriage should be given access to knowledge about the body's rhythms of fertility. Married couples, doctors, and experts should help them "through clear, timely, and serious instructions...Knowledge must then lead to self control: hence the absolute necessity for the virtue of chastity and for permanent education in it" (Familiaris Consortio No. 33).

In the intervening years the Pope has been urging us in season and out of season to involve ourselves in the apostolate of natural family planning. For example, he advocated that Bishops should take a positive attitude in the apostolate of natural family planning, and the clergy, religious and lay leaders should cooperate:

For these (couples who teach the natural methods) are not engaged in a private activity, but their efforts, joined with those of the Church's pastors, are a part of the Church's pastoral responsibility to instill conviction and offer practical help to all married couples so that they may live their parenthood in a truly Christian and responsible manner (cf. Familiaris Consortio No. 35). The promotion and teaching of the natural methods is, then, a truly pastoral concern, one that involves cooperation on the part of priests and religious, specialists, and married couples, all working in cooperation with the Bishop of the local Church and receiving support and assistance from him (To International Congress on NFP, 9 June 1984).

The Pope asks that the teaching of natural methods to regulate fertility within families be an integral part of the "culture of life." He had pioneered the establishment of centers for marriage preparation, which include NFP in the courses, when Archbishop of Krakow. He now requests, in Evangelium Vitae, that such centers be established everywhere:

Centers for natural methods of regulating fertility should be promoted as a valuable help to responsible parenthood (No. 88).

The work of educating in the service of life involves the training of married couples in responsible procreation. In its true meaning, responsible procreation requires couples to be obedient to the Lord's call and to act as faithful interpreters of His plan... The Church is grateful to those who, with personal sacrifice and often unacknowledged dedication, devote themselves to the study and spread of these methods, as well as to the promotion of education in the moral values which they presuppose (No. 97).

This call for a far-reaching and powerful thrust of the NFP apostolate is relatively new in the Church, is timely, and is a formidable challenge. When I studied moral theology in the seminary - fifty years ago - some moralists deemed that couples needed "permission" from the confessor to practice NFP; the confessor would decide whether the couple had sufficient motives. By advocating that all couples learn the system, the Pope tells us that couples themselves are to make the decision, which must be reasonable and responsible. Of course, discussion with a priest may help them to decide wisely and generously.

This new and positive approach to NFP as an apostolate is also daring; some priests and bishops still shy away from it, even frown; some priestly and religious promoters of NFP are treated harshly even today, and isolated from the community.

The challenge is of vast scope indeed. It should be addressed to the 850-880 million married couples - a billion and seven hundred million individuals - who are currently in the child-bearing years; plus a billion young people already in the formative years before marriage.

But the task is not at all impossible. The estimate that 50,000,000 couples learned to use NFP within the past decade is conservative, I believe. When a sufficient part of an enclosed population learns it, it can become local folklore, entrenched as a way of life for generations to come. Some perceptive pastors have already built up consolidated NFP-minded parishes. Fr. Pius Mardian, for example, who wove NFP into his preparation course for over 20 years at St. Peter's parish, Colman, South Dakota, USA, is confident that 50 percent of the couples "not only accepted this but are living it today" (Our Sunday Visitor, 31 March 1991).

Poland is a few steps ahead of the rest of the Catholic world in this respect. A network of parochial counselling centers began to develop early in the 1950's; then, in 1961, Bishop Karol Wojtyla convened a national congress of 250 family life workers; the congress recognized that, since the natural methods were not being taught by the government at public facilities, there was need for an independent network of Catholic centers organized nationally. This national organization came into being shortly thereafter. In 1967 Cardinal Wojtyla set up the Institute for the Family in Krakow with Dr. Wanda Poltawska as Director. Newly ordained priests, doctors, chaplains and counsellors attended, especially on week-ends, and Cardinal Wojtyla often appeared, at least to meet the attendants and to pour the coffee.

By 1970 the Polish Episcopate made attendance at marriage preparation courses mandatory for all couples applying for marriage in the Church; NFP has thus become a fixture of great meaning in the standard course of marriage preparation in Poland. Incidentally, a World Fertility Survey made during the early 1980's indicated that 31 percent of married women age 15-44 in Poland were using a natural method; the survey thus awarded to Poland, at that time, the gold medal in the NFP Olympics (see Population Reports, Sept./ Oct. 1985.)

Pope Paul VI prophetically indicated the benefits which couples reap from the family discipline of NFP in this memorable passage:

This discipline which is proper to the purity of married couples, far from harming conjugal love, rather confers on it a higher human value. It demands continual effort, yet, thanks to its beneficent influence, husband and wife fully develop their personalities, being enriched with spiritual values. Such discipline bestows upon family life fruits of serenity and peace, and facilitates the solution of other problems; it favors attention to one's partner, helps both parties to drive out selfishness, the enemy of true love, and deepens their sense of responsibility. By its means, parents develop a capacity of having a deeper and more efficacious influence in the education of their offspring (Humanae Vitae No. 21; Familiaris Consortio No. 33).

B. Experience of NFP couples

One NFP user told me that "when we switched from contraception to periodic abstinence, we felt as though soot in the stove pipes of our marriage had been cleaned out." Another wife said: "When we have sexual relations, my husband looks at me again." Such witness can be multiplied without end. Nona Aguilar found the following answer to be typical among the 164 couples interviewed, who were now using NFP, the majority of whom had formerly used contraception:

I went through many kinds of pills, experiencing vomiting, migraines, irritation, dissatisfaction. I also felt used - an object used for sex. The memories of us and our marriage were not pleasant, and when we went on NFP, both we and our marriage improved. We tend to think our earlier problems were related to our birth control (Aguilar, p. 201).

Aguilar observes that wives may be very pleasantly surprised when they challenge their husbands, and find them more than equal to the challenge:

Many individuals have told me that the change to NFP improved their self-esteem and at the same time deepened mutual respect. As one woman said, "I never realized how much my husband loved me until he threw away my Pills and made me go with him to our first class." Another woman said, "I never thought Hal would be able to abstain for two days much less for almost two weeks. I guess I didn't think much of him either."

That may be one of natural family planning's greatest contributions: the fact that it encourages some of the finest qualities in ourselves - and in our mates - to blossom (ibid. p. 222).

We hasten to add that partners in a deeply troubled marriage typically will not agree on NFP nor succeed in its use, unless they reach a certain level of harmony in the marriage itself. As a whole, however, couples who use NFP very seldom divorce, and very seldom have an abortion. All long-term teachers of NFP agree on that. So does Mother Teresa, who provides that at least one of the sisters in each of her convents is a teacher of NFP.

The Jewish Tradition of Periodic Abstinence

Perhaps the hearts of our priests tend to bleed for couples who make the formidable sacrifice of periodic abstinence. But Rabbi Norman Lamm tells how the periodic restraints of Family Purity are essential, in the Jewish tradition, to strengthen, purify, exalt and ennoble marriages:

Marriage and the problems related to it form a significant part of the entire Talmudic literature...Of special importance are the sexual aspects of marriage, to which the Talmud devotes a full tractate, called Niddah...

Jewish Law forbids a husband to approach his wife during the time of her menses, generally from five to seven days, and extends the prohibition of any physical contact beyond this period for another seven days, known as the `seven clean days.' ...During this time husband and wife are expected to act towards each other with respect and affection but without any physical expression of love...At the end of this twelve to fourteen day period (depending upon the individual woman), the menstruant (known as the niddah) must immerse herself in a body of water known as a mikvah and recite a special blessing in which she praises God for sanctifying us with His commandments and commanding us concerning immersion (tevillah)...

Mikvah becomes the sacred instrumentality whereby morality and sexuality are reconciled, bringing husband and wife to each other in purity and delicacy, their love undefiled by the guilt and shame that are relics of obsolete inner struggles.

No philosophy of sex, no matter how well and cogently articulated, can ever be as psychologically meaningful and compelling as the observance of Family Purity... For marriage to thrive, the attractiveness of wife and husband for each other that prevailed during the early period of the marriage must be preserved and even enhanced. And it is the abstinence enjoined by Family Purity that helps keep that attraction and longing fresh and youthful. This is how the Talmud explained the psychological ramifications of taharat ha-mishpahah (the purity of the family):

"Because a man may become over-acquainted with [his wife] and thus repelled by her, therefore the Torah said that she should be considered a niddah for seven days, i.e. after the end of her period, so that she might become beloved of her husband on the day of her purification even as she was on the day of her marriage" (Niddah, 31b).

Unrestricted approachability leads to over-indulgence. And this over-familiarity, with its consequent satiety and boredom and ennui, is a direct and powerful cause of marital disharmony. When, however, the couple follows the Torah's sexual discipline and observes this period of separation, the ugly specter of over-fulfillment and habituation is banished and the refreshing zest of early love is ever present" (Lamm, pp. 32-35; 56-57).

Health Care for Families

The pill's much vaunted advantage was that it made the wife available for sexual intercourse at all times. But that may actually wreck a marriage instead of healing it. We see that an explosion of divorces followed in the immediate wake of the pill take-off. In 1960, pill take-off year, there were 393,000 divorces in the USA; in 1975 there were 1,036,000. During the pill era ever since, there are over 1,000,000 divorces annually in the USA. Children of broken families know better than most others the trauma which stormy relations of the parents and final separation of father and mother tends to inflict on them. Bitterness also tends to dog divorced people for the rest of their lives. Leakage from the Church tends to follow when the divorced parents lose joy of life, and the children feel an emptiness and loneliness in broken families or those lacking warmth (see Report of Cardinal Angel Suquia Goicoechea to Fourth Extraordinary Consistory, L'Osservatore Romano, Weekly Edition in English, 15 April 1991, page 8).

C. Should priests or lay people lead the way?

In Familiaris Consortio No. 33 the Pope asks doctors, experts, and married couples to render knowledge concerning the rhythms of fertility accessible to all married people, and also to young adults before marriage. In Familiaris Consortio No. 34, one number later, he asks priests to do their part. Is the sequence correct? Is the teaching Church asking health care workers and other lay people to prepare the people first, so that the priests can do their part more effectively? Let us consider the actual situation of a parish today.

A minority, or even a majority of parishioners in the child-bearing years who occupy the pews, probably have a mind-set that contraception is permitted; not only permitted, but necessary to prevent world overpopulation. A majority of them may now be practicing contraception, may have done so in the past, may believe that they will have to do so in future. Among the older married couples before the priest in the pulpit, a majority may be surgically sterilized. Furthermore, the majority may adhere without question to the pseudo-gospel that NFP is not reliable, is not necessary, is heroic and esoteric, not at all required of common believers. The priest, therefore, must consider whether a blunt denunciation of contraception from the pulpit, without previous preparation, will be counterproductive; whether he thereby departs from the example of Christ, of whom Isaiah wrote: "The bruised reed he will not crush; the smoldering wick he will not quench until judgment is made victorious" (Is 42:2-3; Mt 12:19-20). Note the final words: "Until judgment is made victorious." Good judgment about the evil of contraception must be made victorious BEFORE a preacher alienates his flock and ruptures his credibility by an inept denunciation.

There are exceptions: some pastors, some mission preachers, relying on the power of the Spirit, CAN bring their flock into the fold of obedience to this law of God from the pulpit; also confessors CAN bring individual sinners to do penance and convert. But in general we have a community-wide malaise of contraception now, which needs a community-wide cure.

Beyond all this, there is a problem of conviction on part of priests and bishops themselves. Are most of them convinced about the evil of contraception? One archbishop wrote to me: "Please send statistics." I did; but he is not very convinced, perhaps because some of his Catholic doctors are not convinced. Another bishop answered: "Theologians are not yet sure about it; therefore..." The malaise of the contracepting flock very likely reflects a malaise of disbelieving shepherds. "If the man who plays the bugle does not sound a clear call, who will prepare for battle?" (1 Cor 14:8).

But doctors, experts, and experienced married couples are in an advantageous position to convince both clergy and laity, by word and by action. Once they have done their work of giving access to knowledge about the rhythms of fertility and about the need of chastity, always under the leadership of their priest, then the priest can, with new conviction, do his work in the pulpit and the confessional more easily and effectively. Health care workers today are on-stage, and the angels are watching their performance; if they perform as they can and ought, they can direct global traffic to make a massive U-turn away from contraception and toward natural family planning. To convince ourselves, let us review the basics of scientific NFP as we re-trace the history of its beginnings.

D. How Ogino discovered the basis for NFP

In 1923, in the February issue of the Hokuetsu Medical Journal, Dr. Kyusaku Ogino of the Niigata University Hospital first published his horizon-spanning theory about the time of ovulation during the menstrual cycle. From that article we can easily see that he was a methodical observer and had great interest in his work. Before he operated, he would ask his patients whether their cycles were regular or irregular; he followed through only with those who said they were regular; if regular, he next asked when they expected the next menstruation. He would note down the date, then operate, and ascertain the condition of the ovary and corpus luteum; if possible, also of the endometrium; from this he would ascertain whether ovulation had already taken place or not.

When he had 65 cases, he lined up his findings on a chart. In the first attempt, he made day one of the first day of menstruation his starting point for lining up the 65 cases. Then he put in the estimated day of ovulation; finally the expected end of the cycle. Nothing matched. Ovulation appeared to be scattered at random all over the chart.

He tried again; this time he started by counting backwards from the expected day of menstruation, making the right side of the chart a straight column. He counted backwards from there to the estimated time of ovulation and the first day of the cycle. Suddenly everything fell into place. He drew lines down the chart isolating the days 16 to 12 days before the menstruation. He wrote in his article:

From the first day of the last menstruation to the 17th day preceding the expected menstruation, follicles have not yet ovulated in all cases except the 2nd and the 10th cases. (Number of cases: 21; exceptions: 2).

On days 16-12 before the expected menstruation, he found some had already ovulated, others not: "For 5 days, from the 16th to the 12th day preceding the expected menstruation, follicles have ovulated in some cases, and in other cases they have not yet ovulated. Number of cases: 13."

From day 11 before expected menstruation all 65 had already ovulated. "From the 11th day to the beginning of the expected menstruation, I found corpora lutea in the proliferative phase in all cases. Number of cases: 31."

He then drew the conclusion, which is the base for natural family planning: "Based on the views stated above, I conclude that the period of ovulation is 5 days from the 12th to the 16th day preceding the expected menstruation. This period is the same in all cases whose menstrual period is from 23 to 45 days."

What about the two exceptions? "To my regret, as I could not examine the organization of the corpora lutea and the endometrium, I can't explain the exceptions based on a histological study. But I guess the next menstruation will come a few days earlier than the expected time in these cases. I think two exceptions in sixty-five cases can be admitted, considering the character of the expected menses." (Translation from original by Hiroshi Ogino, MD, son of Kyusaku; private correspondence.)

The theory first proposed in 1923 is undisputed today. In 1924 Dr. Ogino added another 53 cases to the 65 already reviewed, and confirmed his theory (Japan Gynecological Journal, vol. 19, No. 6, 1924). He added, from studies of animals published in the literature, that sperm can survive in the uterine cavity for three days after a coitus; that sperms which survive for 4 to 8 days are exceptional cases. And from animal studies reported in the literature he assumed that the ovum will die shortly after ovulation if not fertilized. "Certainly the ova do not remain fertilizable for some days or weeks." His summary:

The period of conception in mankind consists of the ovulation period and 3 days preceding the ovulation. During 8 to 4 days preceding the ovulation, conception can take place only rarely, while no conception occurs before this period. No conception takes place a day after ovulation.

It was after Dr. Ogino published his findings in Germany in 1930 as a SONDERDRUCK AUS DEM ZENTRALBLATT FUER GYNAEKOLOGIE 1930 (Leipzig) that his theory found its way into the world medical literature. In it he set forth the Ogino theory for natural family planning:

Upon reading that article, Prof. Dr. Hermann Knaus sent him a letter of congratulations. He had arrived at similar conclusions by another route, which he published in the MUENCHENER MEDIZINISCHE WOCHENSCHRIFT of 12 July 1929, so six years after Ogino's original publication. In a note treasured by Dr. Ogino, Dr. Knaus thanked him for having made those careful studies in Japan which enabled one to identify the naturally fertile and infertile times of the cycle, and which made it possible now to choose whether to achieve or to avoid a pregnancy.

We know today that the ovulation event, governed by cyclic hormonal secretion, occurs but once during a cycle. (If there are several ovulations, they occur within 24 hours of each other.) The time of ovulation is usually 16-12 days before the expected menstruation. In the meantime a great deal more has been learned: the temperature shifts upward slightly with ovulation, leaving a pattern of low level temperature before ovulation, followed by a shift, and then a consistently high level temperature until it drops to announce the imminent onset of menstruation. The temperature shift has become a clear marker to identify the potentially fertile times, and the infertile times.

The cervical mucus sign, which fertile women can perceive and monitor quite easily, comes and goes with the ovulation episode. It is another sign to identify fertile and infertile times. The condition of the cervix itself is still another sign which some learn very well; it is popular with flight attendants who deal with time lags, irregular hours, and stress. Some users are perfectly happy with one sign which is for them consistent and adequate; others find greater certitude - and a shorter period of abstinence perhaps - by combining several signs and pinpointing the fertile days quite precisely.

At any rate, whether by electronic devices, or by simple observation, reliable NFP is now available for all in the world who seriously want to use it. Difficult cases may need special advice, care, vitamins, diet, more regular life-style, therapy, longer abstinence. Sometimes nursing mothers - if signs remain uncertain and abstinence lasts for week after week - may dialogue with husbands about what is best for the family; that is, whether to wean the baby in order to reestablish the cycle with its signs of the fertile and infertile days.

For every couple in the world, if there are fertile days, there are also infertile days of the cycle. Catholic doctors, pharmacists, nurses, health care workers of the entire world - with the fervent blessing of the Pope - are willing, we are confident, to help couples identify them. Thereafter pastors can waggle a finger at the congregation and pound on the pulpit: "Children, families: be chaste!" Couples who are faithful, who strengthen their children in the practice of rugged chastity, are the ones who will survive the AIDS epidemic, and so carry the Church and the human race into the post-AIDS future. So be it!

Next Page: References and Recommended Additional Reading
1 , 2 , 3 , 4 , 5 , 6 , 7, 8