Another Theology of the Body, Part XVIII--I Take Back Everything I Said (Sort Of) About NFP

When people start talking past one another, the solution is almost always to reframe the parameters of the discussion.  On complementarity, I relied on a professional theologian to help reframe the issues.  Unfortunately, I could not find anything Professor Coakley has written about another issue that has become completely stuck (at least among Catholics)--birth control.  So, I did the next best thing--I called my friend Jason.

Now, my friend Jason is Jewish, and generally speaking identifies with the Reform movement in Judaism.  The truth is that I asked Jason to think through and give his perspective on this topic because he is my friend and that I knew he would do it.  But, as it turns out, Jason is a perfect conversation partner for this topic.  As someone who takes his Judaism seriously, he is open to the idea of moral and ethical rules that are derived from religion, even if they are counter-cultural.  On the other hand, the Reform approach to Judaism encourages critical, but respectful, engagement with that tradition from a practical perspective.  Similarly, Judaism is both similar enough to Catholicism to be able to relate to the concerns at issue, and different enough to be able to provide a fresh perspective.

I began the conversation by establishing (as I expected) that he would be unwilling to embrace the Humanae Vitae/NFP approach to married sex.  I then came up with a series of tweeks to NFP that I thought would make it more palatable, all of which revolved around relaxing the requirement of abstinence during the fertile periods.  It was quickly apparent that I was barking up the wrong tree with Jason.  The problem for Jason with NFP is not the abstinence period, but his lack of confidence in the reliability of NFP to determine the infertile periods when intercourse was OK.  He put it to me very clearly "if you told me that I could only have sex 15 days a month, but I could be confident that my wife wouldn't get pregnant on those 15 days, I'd be fine with that.  But NFP can't promise that."

It's worth saying a little bit about what failure rates for birth control methods really mean.  The CDC says that the "typical use" failure rate for NFP is 24%.  What that means is that, for every 100 couples who use NFP in the United States, 24 of those couples will be pregnant by the end of the first year--slightly less than one in four.  Now, NFP defenders will object "well, those couples aren't doing it right!"  And they are right, but that's the point of typical use--it's not how the couples should use it, but how they do use it.  And using it correctly is hard, so they often screw it up.  This (slighlty old) study makes that point--if you screw up the charts and the temperatures and all that, your chance of getting pregnant in the first year is 84.2%.  In essence, if you screw up, you will get pregnant.  For Jason, that's not remotely good enough.

Jason's focus on reliability clarifies, at least for me, the real issue at the heart of all discussions of birth control in a Catholic context.  For Jason, and (I would assert) for the majority of Catholics who do not follow Humanae Vitae, the issue here is the "control" part of "birth control."  What they want is the ability to say "we want to have sex for some fixed period of time, while having control over fertility such that we have an acceptable level of confidence that we will not get pregnant.  Because, at the end of the day, we want to have sex and not get pregnant."

Before you get to any discussion of method, you must first ask the question "is that a legitimate desire from a moral perspective?"  According to Humanae Vitae, the answer to that question must be "no," even if it is a qualified "no."
After all, Humanae Vitae says that "each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life."  (HV 11).  And that, for Jason (and, again, I think for most married couples) is the deal breaker, because for them the answer has to be an unqualified "yes."

Along those lines, Jason helped me think through the difference between "birth control" and "changing the expected value of the number of children you are going to have" (unlike myself, he's a math guy).  The expected value idea goes something like this: "well, if we as a couple just have sex whenever, with no thought to the number of children we will have, we can expect to have eight children during the course of our fertile period (i.e. the expected value of our children is eight).  That's high.  So, we are going to do this NFP thing, and it will drop our expected value to, let's say, four."

If that is a couple's approach, then NFP is going to work fine.  But that's not the same thing as "birth control" as it is generally understood by most couples.  Critically, it doesn't really allow a couple to say "we absolutely can't get pregnant for the next two years"--the expected value idea is about averages over time, not particular, isolated outcomes.  It doesn't even guarantee they will end up with four kids--it just means that four is the midpoint of the bell curve of possibilities.  Four is the most like result, but higher (or lower) numbers are not off the table.

And here is where people are talking past one another.  When the NFP crowd and Humanae Vitae talk about "responsible pregnancy" and "not breeding like rabbits," they are talking about expected value idea; when everyone else talks about these topics, they are talking about birth control.  The question is not whether NFP "works," or whether the expected value can be reduced from eight to four or eight to two--which, in a sense, is what much of the failure rate rhetoric is about.  The question is whether the expected value idea is a a good enough substitute for actual birth control.

Go back and take a look at the people complaining about NFP that I cited during the Holy Sex! NFP discussion.  They all follow the same pattern.  The couple starts out on NFP, and everything is more or less OK.  Sure they have a couple of kids, but they planned to have kids anyway, so its fine.  In other words, we are completely in expected value land.  Then something happens, and the couple decides that they absolutely, positively cannot have children for some period of time.  In other words, expected value is out the window, and birth control is in.  And it is at this point that NFP breaks down.  To get the kind of certainty that they require, they must use such a conservative interpretation of the fertility data that they stop having sex at all, and NFP collapses in on itself.

In truth, there is a sense in which this can be chalked up as "user error."  These couples are trying to do something that NFP is not designed to support, and is arguably contrary to the spirit of Humanae Vitae itself.  I would suggest, however, that the blame for this should be laid at the feet of NFP advocates, including Dr. Greg.  If NFP and Humanae Vitae is about expected value, and cannot reliably support (nor should it, morally) the "no way, no how do want kids during this period" mentality, then they need to make that clear.  Instead, they hide the ball by not defining clearly what a couple can and cannot reasonably expect from using NFP.  They try to convince people that, as a practical matter, NFP is morally acceptable Catholic birth control.  It's not, or at least it cannot reliably counted on to be that, and really isn't supposed to work that way.  It's about "spacing children," as Humanae Vitae states, or in other words its about expected value.

A qualifier might be appropriate here.  It is pretty clear that, for some women, their biological rhythms and patterns are so regular, and so clear, that they actually can get "control" of their fertility via NFP.  For those women (and couples), not only is the expected value of children they have essentially whatever they want it to be, but also the distinction between expected value and birth control is collapsed.  That's awesome for those couples.  But I would mention a couple of things.  First, obviously, that is of no help to women for whom that is not true.  Second, in many cases the only way for a woman to learn she is not one of these women is to use NFP and get pregnant.  That could be a big problem, depending on the circumstances.  Third, women for whom this is the case are likely to gravitate toward being strong NFP advocates.  That's understandable, but I think it also contributes to the somewhat disingenuous presentation of NFP.  Using best case scenarios creates unreasonable expectations about what NFP is going to be able to do for the majority of couples.

Nevertheless, I need to retract some of my previous statements.  I basically take back what I said about NFP in my review of Dr. Greg's book.  I said that I couldn't see any difference between NFP and artificial contraception.  That's wrong, though in my defense folks like Dr. Greg try to confuse the issue.  There is a fundamental conceptual distinction between the Catholic approach to "spacing births" (or whatever you want to call it) and the approach underlying using artificial contraception.  And, while I am not entirely sure that NFP can be fairly said to be open to the transmission of life with every sexual act, I recognize that there is an important sense in which the expected value approach is more open to the transmission of life than using artificial birth control.  My objections to NFP and Dr. Greg's presentation are not the right way to approach the question.

But all of this brings us back to what is, in fact, the real question, and it was well framed by Jason.  At the end of the day, is it OK to say "we absolutely don't want to have kids right now, but we still want to have sex"?  Or, to reframe that question in terms of Humanae Vitae, must every act of sex between married couples be open to the transmission of life?  I still think the answers to those questions are respectively "yes" and "no."  I don't think there is anything wrong with a couple having sex while at the same time conclusively not wanting to get pregnant, because I don't believe that every act of sex must be open to the transmission of life.  I don't see anything in Scripture that compels that requirement, nor anything in the logic of a married relationship.  Nor anything in human biology and anthropology.  [Edit:  See also this article which. while about same sex relations applies with equal force to birth control].  I understand that this idea has a long history in the Catholic Tradition, but I think it is a problematic idea, a legacy of misogynistic and anti-sex ideas.  The Protestant churches have abandoned the idea, and I think they are right to do so.

That, at the end of the day, is the only issue that really matters.  Everything else, including considerations of NFP, are completely dependent on and flow from that issue.  Talking it through with Jason helped me to see that, for which I am very grateful.  

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