In the ensuing contraception debate on my blog, my cohort Alexander Greco conversed with Dr. Alexander Pruss via email. He was kind enough to send us a portion of his upcoming book on the topic of human sexuality. What a blessing it is to have great scholars like Dr. Pruss engaging this most important issue of our time. His blog can be found here. (http://alexanderpruss.blogspot.com/)

Here is what was forwarded to us.

Feel free to forward the following to the person. It is a section of my in-progress book on sexuality.


7.10. Natural Family Planning and periodic abstinence


Modifying either how the sexual act is done, as in the case of the condom or coitus interruptus, or how the reproductive system is functioning, as in the case of hormonal contraceptives, is not the only way to prevent conception. One can also simply abstain. Moreover, a major scientific discovery of the 20th century is that sexual relations, under most circumstances, can only result in pregnancy for about eight or nine days in the woman's cycle. Therefore, abstinence on these eight or nine days will just about ensure that conception does not occur. One can, thus, achieve the same goal of avoiding reproduction over, say, a period of a year through (a) modifying how the sexual act is done, (b) preventing the biological functioning of the reproductive system, (c) abstaining altogether from sexual relations, or (d) abstaining from sexual relations during the potentially fertile days of that year.

In practice, it is not possible to abstain from sexual relations only on the eight or so days of fertility because current methods are not able to precisely delineate these eight or nine days. The fertile time consists in seven days preceding ovulation because that is how long sperm can survive in the female reproductive system, and then 24-48 hours after ovulation, since that is how long an ovum can remain viable for reproduction. For women with regular cycles, the fertile occurs at approximately the same point in each cycle, and hence can be approximately predicted solely by use of the calendar, and then additional days of abstinence can be added before and after the estimated fertile time period for safety. Abstinence guided solely by such data is known as "calendar rhythm", and when the algorithm is followed correctly by a woman with regular cycles, this is a effective method of prevention of conception, where the effectiveness is the percentage of women with average sexual frequency who will not get pregnant annually when using the method correctly.

However, in addition to purely calendaric data, it is also possible for the woman to observe mucus secretions, changes in temperature and other symptoms (including in some cases such things as chemical changes in saliva), which in turn allows for an estimate of the potentially fertile stretch of time even for women whose cycles are not regular. These methods collectively known as "Natural Family Planning (NFP)", when used to prevent conception, typically involve about 1.5 to two weeks of abstinence per cycle, though at certain times (e.g., towards the end of breastfeeding) significantly more. The efficacy of the method when used correctly depends on how much abstinence the users can tolerate. If one adds enough extra days of abstinence "just to be sure" on both sides of the estimated fertile period, then one can obtain just about any degree of effectiveness one might want. There are strict regimens for which anecdotal evidence records no conceptions, while more commonly used regimens have a 98-99% effectiveness rate when used correctly.

Obviously, the effectiveness of periodic abstinence methods depends greatly on how motivated the couple is to follow the method. The couple can, after all, always choose to engage in sexual relations during the fertile part of the cycle, in which case, by definition, conception is not unlikely. They can also make a mistake in estimating the fertile period. Nonetheless, periodic abstinence methods have shown themselves to be effective in practice even in, and perhaps especially in (maybe due to motivational factors), third world conditions. They have the practical advantage over other contraceptive methods of having miniscule on-going costs. Most of the cost is the initial training, as well as the provision of a thermometer in those methods that use one. The small on-going cost is that of pre-printed charts for recording data (which have also been adapted for use by the illiterate).

I have argued that contraception is a betrayal of romantic love, but that abstinence can be morally acceptable. Where does periodic abstinence fit in here? On the face of it, we are pulled in two different directions. The modus operandi of periodic abstinence is abstinence, and hence if abstinence is permitted, so should periodic abstinence on fertile days be. On the other hand, periodic abstinence appears to be a method for "outwitting nature", where the users ensure that conception does not happen without having the honesty to cease having sex, and thus it appears it should be wrong for the same reasons as positive contraception.

Unlike in the case of positive contraception, we do not have enough data in either scripture or the Christian tradition to settle the case definitively. The Christian tradition, with some reluctance from certain quarters, generally permitted sexual relations at times at which it was known that conception was very unlikely, such as during a woman's pregnancy or old age. There apparently was some speculation, in part accurate[1] , by women that the time of menstruation was an infertile time. Augustine condemned periodic abstinence based on that speculation, but we do not have enough data to see whether this condemnation of periodic abstinence was generally accepted by the Christian tradition. For instance, while Aquinas apparently[2] condemned sexual relations during menstruation, his condemnation was based on the grounds of a false empirical belief that conception during that time would result in a deformed child: evidently, Aquinas does not think that that time is infertile, and so we do not know what he would say if he thought that it was.

In the 19th century, methods of periodic abstinence for avoidance of conception were developed. As a matter of fact, these methods incorrectly estimated the fertile period, and in at least some cases if correctly followed would have increased the chance of conception, but of course this was not known at the time and hence did not affect the theological discussion at the time. The only major overt reaction I know of on the part of Christians is several decisions by parts of the Catholic hierarchy not to disturb the consciences of those using these methods. This suggests that the methods were not seen as clearly immoral. Finally, in 19??, research came obtained a more accurate way of determining the fertile period, which made possible the rhythm method. In 1930, Pope Pius XI, in the encyclical Casti Connubii, after condemning contraception, wrote:

Nor are those considered as acting against nature who in the married state use their right in the proper manner although on account of natural reasons either of time or of certain defects, new life cannot be brought forth. For in matrimony as well as in the use of the matrimonial rights there are also secondary ends, such as mutual aid, the cultivating of mutual love, and the quieting of concupiscence which husband and wife are not forbidden to consider so long as they are subordinated to the primary end and so long as the intrinsic nature of the act is preserved.

During the 20th century, use of periodic abstinence to avoid conception in cases where there is a sufficiently good reason for such avoidance was generally accepted by Catholics of all stripes and at all levels of the hierarchy, including in Paul VI's famous encyclical Humanae Vitae against positive contraception, and in John Paul II's remarks that periodic abstinence is an exercise of the virtue of temperance.

Currently, it is the official position of the Catholic Church that positive contraception is wrong and periodic abstinence can be acceptable, though the position probably has different theological weight in the two cases: it is held to be an unchangeable ("irreformable"[3] ) teaching that positive contraception is acceptable whereas the teaching about the acceptability of periodic abstinence seems to rest on the present-day agreement of theologians, hierarchs and the flock rather than on any tradition or teaching of comparable weight.[4] Orthodox Christians differ among each other. Some hold that positive contraception is forbidden and that periodic abstinence may be used with permission of one's parish priest. Others would permit both in some circumstances. And there seem to be some who would prohibit both. Protestants tend to accept positive contraception and, by implication, to accept periodic abstinence as long as the length of abstinence is not a problem vis-à-vis Paul's injunction for the couple not to separate.

The Christian tradition, thus, may leave some room for disagreement whether periodic abstinence is sometimes morally acceptable or is never acceptable. I will argue on philosophical grounds that indeed it is morally acceptable.

First, consider a scenario. Let us imagine Joanne who has internalized the detection of fertility in such a way that without any conscious effort, she just knows at any given time whether she is likely to be fertile or not. Anecdotal data suggests that experienced NFP users can do that, because the mucus sign is seen whether one wants to see it or not. Note that even an opponent of periodic abstinence should admit that learning NFP is morally acceptable, because the signs of fertility are used not just for preventing conception but also for promoting it in the case of couples of low fertility, and it cannot be controversial that the use of NFP to promote conception is permissible.

Joanne, then, has a very good idea at any given time whether she is fertile or not. Let us suppose further that the initiative in sexual relations is always hers and not her husband's, and assume also that Joanne has such a good reason for avoiding pregnancy that we all agree that if total abstinence were the only way to prevent pregnancy, total abstinence would be morally justified. For instance, Joanne might have health problems making pregnancy imprudent, while we may suppose that neither she nor her husband has particularly strong sexual desire, so that abstinence does not seriously endanger the relationship.

Let us now suppose that on a given night Joanne is trying to decide whether to initiate sexual relations with her husband. She simply reflects on the fact that she has the health problems, and as it happens she can't remember any signs of fertility or infertility. She chooses to abstain. There does not appear to be anything morally wrong with this decision. We have assumed that the health problems were sufficient to justify total abstinence.

Two weeks later, Joanne is trying to make up her mind again whether to initiate sexual relations. She decides that she should probably abstain for the same reasons above. But then she remembers that her involuntary observations show her to be infertile. And so she says to herself:

Wait a second! I am actually infertile today. If I am infertile today, then my reason for abstinence no longer applies. The reason for abstinence two weeks ago was that sexual relations were likely to cause conception and thereby seriously damage me physically. Two weeks ago, it didn't occur to me to think about fertility issues. But now I know I am infertile. Since I am infertile, sexual relations would not lead to serious physical problems, and so I have no reason for abstinence.

This is surely sound moral reasoning. The argument is quite compelling given that married couples should not abstain over a significant period of time except when they have a serious reason to do so, and in this case there appears to be no reason to abstain.

But now if Joanne follows this reasoning on a day-by-day basis, she will end up abstaining whenever she is fertile, since then she does have a good reason to abstain, but she will not abstain on every infertile day, since those days are a period of time during which she lacks sufficient reason to abstain.

However, why should Joanne have to engage in the same reasoning on a day-by-day basis? Surely it would be equally acceptable for her to sit down once and figure out ahead of time what conclusion her reasoning would yield: "Fertile day, abstain; infertile day, maybe have sex." And then instead of going through the reasoning on a day-by-day basis, she could apply the rule. Of course a certain day-by-day element might be required. We need to adapt to changing circumstances, and for instance she needs to monitor whether she continues to have the health problems that gave her the reason for abstinence.

The case of Joanne does, however, miss one ingredient in the typical case of NFP. The typical NFP-using woman, unlike Joanne, goes to some deliberate and pre-planned effort to find out when she is fertile. She may buy a thermometer, fill out charts and make deliberate mucus observations. She is not someone who "just knows." Let us suppose that Martha is such a person, and that she has just as good reason to avoid pregnancy as Joanne does. I will now argue that given the moral permissibility of Joanne's actions, the permissibility of Martha's follows.

Joanne's decisions are rational given the information she has. It seems that to provide oneself with the information to make rational decisions is intrinsically a good thing, as long as one is not obtaining the information in a morally illicit manner, say by stealing documents. Thus, it should be acceptable for Martha to act so as to gain the information that Joanne instinctively has. In fact, it seems that, unless we are dealing with people's secrets, misleading facts, or irrelevancies, it is always better to have more information than less. It should not be a secret to Martha how her body is functioning. Nor is the information irrelevant or misleading, given that it is the same kind of information as crucially affects the rational decisions that Joanne makes on the basis of the information. The method for gathering the information, taking temperatures, checking mucus, etc., is intrinsically morally neutral. Thus, Martha is not doing wrong.

The discussion of Joanne and Martha appears to yield a sound argument showing that if abstinence is permissible in a circumstance, so are standard methods of periodic abstinence. But now an opponent can turn this argument into that which I have earlier said is hard to come by, an argument for the permissibility of positive contraception. This argument would go as follows. Periodic abstinence is morally acceptable since abstinence clearly is. Both periodic abstinence and positive contraception are morally the same kind of thing: actions to ensure that sexual intercourse does not result in conception. Thus, positive contraception is also morally acceptable. This argument can be used to counter my argument for the impermissibility of positive contraception, or else to produce a paradox: there is a strong argument against positive contraception and now a strong one in its favor.

However, there is a crucial difference between the case of periodic abstinence and that of positive contraception. The difference is in regard to what can be said of the sexual acts performed. In the case of positive contraception, if a sexual act is performed at a given time, one can say that the couple did something to render that act sterile. They engaged in withdrawal, say, or used a drug that rendered the woman anovulatory. In other words, they are willfully trying to frustrate the reproductive striving in that act.

On the other hand, in the case of periodic abstinence, one cannot say that the couple did anything to render that particular act sterile. Their abstinence from sexual activity at fertile times does nothing to render sterile the acts that they do engage in.[5] Their engagement in sexual activity during infertile times also does nothing to render the acts sterile: on the contrary, if they did not engage in sexual activity, conception would be less likely. Finally, the information gathering and recording does not affect fertility.[6] So nothing they did rendered the act infertile, and hence they have not contradicted the innate reproductive striving of the act.

This may well seem like sophistry. After all, has not the couple moved their fertile acts to infertile times, thereby rendering the acts infertile? But this is a misunderstanding of the nature of actions. One cannot step into the same water in a river twice. Likewise, one cannot perform Monday's action on Tuesday instead: it will be a different action, even though perhaps of the same type. The couple has not rendered a sexual act infertile, but they have abstained from one act, and engaged in another.

One may object, however, on the grounds that likewise it is incorrect to say that the couple made a contracepted act infertile. For if the act were not contracepted, there would have been a different act. Thus just as the couple engaging in periodic abstinence cannot be said to be changing a fertile act into an infertile one, so too the contracepting couple are not changing an infertile act into a fertile one. Instead, both couple are doing the same thing: they are substituting an infertile act for the fertile one that they would have done otherwise. This is a particularly sharp form of the argument for the permissibility of positive contraception from the analogy between positive contraception and periodic abstinence.

One response could be that if the couple engaging in periodic abstinence are substituting an infertile act for a fertile one, then they have a "contraceptive mentality" (a term used, usually without definition, in some NFP circles??ref). But substitution is not the only possibility. If the couple would have had sex twice a week if they were not trying to prevent conception, and given NFP they would have sex twice a week during infertile times and not at all during fertile times, then we cannot say that there is substitution. There is only abstinence. In practice, however, it appears likely, based on anecdotal data and human nature, that the sexual frequency of NFP users during infertile times is higher than the frequency that would have obtained had there been no use of NFP at all, especially right at the beginning of an infertile segment of time. Still, it is not clear how the alleged substitution is supposed to work. Let us say the couple abstains on Monday and Tuesday, but then has sex on Wednesday and Thursday, and let us even grant that they would not have had sex on Wednesday and Thursday had they not abstained on Monday and Tuesday. Is the sex on Wednesday a substitution for the sex on Monday? Or is it a substitution for the sex on Tuesday? It seems hard to make precise the notion of substitution that this argument for the parallel between NFP and positive contraception requires.

A further response to the sharpened version of the analogical argument for the permissibility of contraception is that to affect and to change are not the same thing. In change, there is a relationship of temporal succession. First things are one way, and then another. On the other hand, if Atlas from all eternity and for all eternity were to hold up the heavens, his activity would be affecting the position of the heavens-presumably, they are where they are because of his holding them up-but if he did his job right, the position of the heavens would never change.

It is indeed incorrect to say that either couple changed the sexual act from a fertile one to an infertile one. To say that would imply that one time there was a fertile act and then there was an infertile one. When we act, however, we affect things, and we can gauge the effect of our action by looking at the causes and explanations of things. In my modified version of the Atlas myth, the heavens are where they are because of Atlas' unceasing activity. Likewise, it can be true that the lawn on Tuesday is neat because of Jones's mowing the lawn on Monday. Thus, Atlas' eternal activity affects the position of the heavens, while Jones' activity on Monday affects how the lawn is on Tuesday. Now, the contracepted act is infertile because the couple made it so. But the act in the case of periodic abstinence is infertile because that is just what acts at that point in the cycle are like. Thus, the explanation of the infertility of the contracepted act involves the agency of the couple, and hence the couple have affected the act by making it infertile. But the explanation of the infertility of the sexual act of the couple practicing periodic abstinence has nothing to do with their actions.

Compare the case of Getrude and Matthew, who are mid-level chess players each of whom is afraid of victory, because each believes that victory makes one haughty. But they still want to play the game because they find it pleasant. They use different methods to insure defeat. Thus, Gertrude only plays grandmasters. Matthew plays anyone, but takes a drug that clouds his mind. Let us suppose Gertrude played Kasparov and Matthew played someone close to his own level. We can now ask: "Why did Gertrude lose his game?" Surely the answer is that Kasparov was a great chessplayer, much better than Gertrude could ever be. On the other hand, the answer to the question of why Matthew lost his game is that Matthew drugged himself. What Matthew did, namely take the drug, negatively affected the success of his game. On the other hand, what Gertrude did did not negatively affect the success of her game-we may suppose that she struggled valiantly against Kasparov, but victory was unattainable, and hence her modesty was safeguarded.

Granted, there is a sense in which Matthew would have played a different game had he not drugged himself, just as Gertrude would have played a different game had she played a weaker player. But the difference between the two cases is morally significant. Matthew was not really trying to beat the opponent he was playing against, because it was a part of his intention that he drug himself into defeat, assuming of course that that intention remained while playing.[7] Matthew threw the match; we might even say he was not really "playing the game" (compare ??backref). But Gertrude did not throw the match: she did nothing that decreased the chance of victory in that match which she played, though she did do something to ensure that in general she would not play in matches where she would have a decent chance of winning.

Matthew negatively impacted his striving. Gertrude did not negatively impact hers. In the same way, the contraceptive couple are positively opposing their reproductive striving. The couple engaging in periodic abstinence are not engaged in such opposition.

If this response to the argument alleging a parallel between NFP and positive contraception fails, then NFP will still be disanalogous to positive contraception in the case where there is no "substitutive" mentality, where the couple does not choose to have sex on infertile days instead of on fertile ones. For between such a case and contraception the difference is completely clear. Such an approach would be had by the couple who made a day-to-day decision whether or not to have sex in light of the fertility information on that day, and the reasons if any they had to avoid conception. It may even be that an approach of this sort is morally preferable, as the best way to safeguard spontaneity. Deliberately choosing to postpone sex to a later infertile day means that the decision to have sex is made ahead of time and this may be seen as decreasing the spontaneity of the activity on that infertile day. The opposite case, that of choosing to have sex earlier on an infertile day instead of later on a fertile one, on the other hand, may seem unduly calculating, since it implies that the couple did not really have sufficient interest in the sexual act on that day to engage in the act were it not for the abstinence ahead. Thus, there is something to be independently said against the "substitutive" approach to periodic abstinence. Thus, the position that only "non-substitutive" periodic abstinence is permissible, where the couple do not think of themselves as "moving" their sexual relations from day to day, but rather as making prudent daily decisions whether to engage in sexual relations, is not an implausible one, though I do not endorse it.

In all of the above, I have assumed that the couple engaging in periodic abstinence has a good reason, a reason that would have been good enough to justify total abstinence. That a good reason is needed is clear, since in refraining from reproduction, they are refraining from cooperating in producing a great good, a new person in the image and likeness of God. To refrain from that good surely does require powerful considerations to the contrary.


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[1] In fact, in most cases, the days of heaviest flow are infertile, except when this is not a genuine menstrual period but "breakthrough bleeding." However, in practice, it is not easy to recognize the difference without Natural Family Planning methods.

[2] The source is the Supplement to the Summa, written by a disciple of Thomas's based on Thomas's ideas.(??ref)

[3] ??ref

[4] Catholics believe that when the Church as a whole believes something in a definitive way, this is infallible. In the past, it is clear that the Church as a whole believed in a definitive way that contraception is wrong. It is not completely that the teaching on the permissibility of periodic abstinence, though it appears quite universally accepted, is accepted with the same definitiveness.

[5] Indeed, the contrary may sometimes be true, in that the earlier abstinence may make for greater sperm availability during the acts that they actually engage in.

[6] And even if it were found that there is some strange effect, such as that thinking about fertility makes one less fertile, the question should not really be whether fertility is affected in this way, but whether it is intentionally affected.

[7] If not, then the case is like that of a wife who used an oral contraceptive and then changed her mind, wishing she hadn't used the contraceptive. In such a case, I would argue, she did wrong in taking the contraceptive, since she intended to engage in contracepted sex, but she did not do wrong in engaging in sex after she changed her mind, because there no longer was a contraceptive intention in her mind; there was no assent of will to her act of contraception at the time of the sexual act. For the same reason, it is permissible for a person who has a sterilization and then has a change of heart to engage in marital intercourse even without reversing the sterilization (e.g., because the reversal is impossible or too expensive).