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A Bitter Pill To Swallow

This spring marks the 55th birthday of the birth control pill, championed by many, then and now, as the “best-thing-since-sliced-bread” solution to unplanned pregnancy, child abuse, overpopulation, and marital stress. After more than half a century of living with “the Pill,” however, many facts have emerged that paint a far less pretty picture.

When the FDA approved the sale of Enovid as a birth control pill in May of 1960, it was the first drug in history to be given to a healthy person for long-term use not for a medical, but for a social purpose. In so doing, one of the main disincentives to sex outside of marriage disappeared overnight. The reduction in unplanned pregnancies that the Pill promised was offset by the far greater numbers of people lured into sexual relationships by the false sense of security that the Pill provided. More people having sex has inevitably led to higher rates of unplanned pregnancy, abortion, and STDs, especially among young people, because, to be highly effective, contraceptives have to be used correctly and consistently. The Pill continues to be the most commonly used contraceptive in the United States, and while its perfect use-effectiveness is 98-99 percent, its typical use-effectiveness is only 91-93 percent, according to the Guttmacher Institute, the former research arm of Planned Parenthood. What this means is that, in practice, increased access to contraceptives such as the Pill actually leads to increased rates of pregnancy, STDs, and abortion, especially among young people. Recent studies in England have reaffirmed that increased access to contraception for teens leads to higher pregnancy and abortion rates, as well as a dramatic increase in STD rates among 16-19 year-old girls. Even more strikingly, the Guttmacher Institute’s own research found that the states that ranked highest in access to contraception also ranked highest in per capita abortion rates.

In 1988, the journal Research in Population Economics published a fascinating article by Robert Michael titled Why did the U.S. divorce rate double within a decade? An economist from the University of Chicago, Michael noticed in the course of his research that the divorce rate in the U.S. doubled in the span of one decade, from 1965 to 1976.  After analyzing multiple factors that might have contributed to such a rise, including changes in state laws that made divorce more accessible, he concluded that the most significant factor by far—accounting for more than 50 percent of this rise—was the diffusion of contraception.

The Pill received FDA approval in 1960, and by 1965 more than 6.5 million American women were taking oral contraceptives. Michael ascertained three reasons why the diffusion of contraception affected the divorce rate so dramatically. First, it is known that the presence of young children in the home exerts a protective effect on the marriage bond, and couples who used contraception had fewer children (and those later in marriage). In fact, the total marital fertility rate in the U.S. fell from 3.42 children per married woman in 1961 to 1.63 children in 1974. Second, women with fewer children entered the workplace in greater numbers, and their increased financial independence made it easier for spouses to go their separate ways when their relationship became strained. Third, contraception facilitated much more adultery than before.1

Regarding this last reason, the late Dr. John Billings of Australia—who along with his physician-wife Evelyn, pioneered one the first methods of natural fertility regulation—once recounted that he saw firsthand as a young physician how contraception harmed marriages:

When we say, ‘I do not want your fertility any more,’ or ‘I will not give you my fertility anymore,’ we’re damaging the marriage. The withdrawal of this gift tends to destroy marriages. I was shocked to notice, from the earliest days of my work, to see how marital infidelity in one—or both—of the spouses often followed the introduction of contraception or sterilization.

Interestingly enough, the early feminists also foresaw that widespread use of contraception would facilitate adultery and leave women even more vulnerable to being victimized and ultimately abandoned by their husbands. These 19th-century pioneers had an intuitive sense that contraception degraded the dignity of women, describing it as “unnatural,” “injurious,” and “offensive,” and they feared that its use in marriage would relegate women even further to being regarded as sex objects by their husbands. Mahatma Gandhi once echoed the same sentiment: “Man has sufficiently degraded women for his lust, and contraception, no matter how well meaning the advocates may be, will still further degrade her.”

What we know today about the serious health risks that accompany the most effective contraceptives provides further proof that Gandhi’s prediction was prescient. When a woman’s natural fertility is suppressed through hormonal contraceptives, her health is neither preserved nor enhanced, but actually endangered. Consider the following facts: In July, 2005, the World Health Organization’s International Agency for Research on Cancer announced that, after a thorough review of the published scientific evidence, combined estrogen-progestogen oral contraceptives and combined estrogen-progestogen menopausal therapy cause cancer in humans.2 The classification of hormone replacement therapy as a Group 1 carcinogen made headline news around the world, and resulted in 15 million American women deciding to discontinue their use of synthetic hormones during menopause. Within several years, invasive breast cancer in women over 50 for estrogen-receptive positive tumors dropped 11 percent in our country, which is good news given that breast cancer is the most common cause of cancer death among American women between the ages of 20 and 59.

Unfortunately for the more than 10 million American women who take oral contraceptives, hardly anyone reported that the World Health Organization also classified the combination Pill as a carcinogen. In fact, the Pill continues to be the most popular method of contraception in this country, particularly for women under the age of 30.  A little over a year after the World Health Organization announced its findings, the prestigious medical journal Mayo Clinic Proceedings published an article called “Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-analysis.” This analysis assessed the results of 34 studies conducted since 1980 to examine the possible association between oral contraceptive use and breast cancer risk in women younger than 50, and came to following conclusion: “Consistent with the recent International Agency for Research on Cancer classification of OCs as group 1 carcinogens, this meta-analysis suggests that OCs are associated with an increase in premenopausal breast cancer risk, especially among women who use OCs before FFTP [first full-term pregnancy].”

Even more recently, a 2009 study funded by the National Institutes of Health found that “a year or more of oral contraceptive use was associated with a 4.2-fold increased risk of triple-negative breast cancer for women 40 and under. Longer duration of use and early age of first use further increased risk.” In addition to increasing the risk of breast cancer, the Pill has been implicated in several other serious health risks, including cervical cancer, blood clots, heart attack, stroke, and increased risk of acquiring HIV and other STDs.

As if this were not enough, the Pill also doubles the rate of aging of the cervix and can make it more difficult to eventually conceive a child. Dr. Erik Odeblad, chairman of the Department of Medical Biophysics at the University of Umea in Sweden, devoted his professional career to studying the changes that a woman’s cervix undergoes during her fertility cycle and throughout her reproductive life. The cervix functions as a biological valve that opens and closes at critical points in a woman’s monthly cycle. The cervix also contains pockets of cells called “crypts” that produce the mucus that is critical for sperm survival and transport—and therefore, for conception. Odelblad was particularly interested in studying the effects of the Pill on the cervix, and his research led to the following discovery:

While pregnancy counteracts the normal aging process and actually has a rejuvenating effect on the cervix so that the cervix of a 33-year-old woman becomes like that of a 20-year-old, the Pill, especially after long-term use has a reverse effect—the cervix of a 33-year-old woman on the Pill becomes like that of a 45-year-old and the cervical canal becomes much narrower … While the present-day Pill contains progestogens in much lower dosage than previously, the fact is that they are much more powerful and they persist longer in the body… Restoration of the S and G crypts to normal on stopping the Pill takes considerable time. In fact the S crypts may be permanently damaged.

Natural methods of fertility regulation (commonly referred to as NFP, for “natural family planning”) not only do not pose any health risks, but actually can be used to monitor and maintain a woman’s reproductive health. When a woman is taught to identify and interpret the biomarkers that indicate the healthy functioning of her reproductive system, she is also empowered to detect early on any abnormalities. By learning to observe and interpret on a daily basis the signs of fertility that naturally occur in her body, a woman can identify the days on which conception is most likely should she desire to conceive a child, and can refrain from sexual relations on the days when conception is possible should she desire to avoid a pregnancy. According to a 2007 report published online in Europe’s leading reproductive medicine journal Human Reproduction, researchers have confirmed that, if used correctly, the sympto-thermal method (STM) of natural family planning is as effective as the Pill for avoiding unplanned pregnancies. In the largest prospective study of STM, the researchers found that if the couples abstained from sex during the fertile period, the rate of unplanned pregnancies per year was 0.4 percent. The lead author of the report, Petra Frank-Herrmann, assistant professor in the Department of Gynecological Endocrinology at the University of Heidelberg, Germany, concluded:

The pregnancy rate for women who used the STM method correctly in our study was 0.4%, which can be interpreted as one pregnancy occurring per 250 women per year. Therefore, we maintain that the effectiveness of STM is comparable to the effectiveness of modern contraceptive methods such as oral contraceptives, and is an effective and acceptable method of family planning.3

American women have swallowed a bitter Pill—hook, line, and sinker—for more than half a century. Isn’t it time we take a serious look at NFP?4


Readers are invited to discuss essays in argumentative and fraternal charity, and are asked to help build up the community of thought and pursuit of truth that Ethika Politika strives to accomplish, which includes correction when necessary. The editors reserve the right to remove comments that do not meet these criteria and/or do not pertain to the subject of the essay.

  • helen alvare

    Fabulous data Lisa, brava!

  • Steve D.

    “…the sympto-thermal method (STM) of natural family planning is as effective as the Pill for avoiding unplanned pregnancies.”

    Hmmm, sounds to me like NFP is just another form of birth control.

    • Gloria

      There is one “end” that is the same for contraception and NFP: the ability to postpone a pregnancy. However, with such a drastic difference in the means of doing so, that the other physical, emotional, and spiritual “ends” of each are radically different.
      Eat junk food or eat a nourishing meal- you will get the same “end” of satisfaction in the moment. But the means of doing so will lead to drastic differences in many other ways.
      Reduce sex or food to recreation by making choices to preserve all the “goodies” while simultaneously acting against their inherent meaning, and you get, well, a lot of pain.
      Birth control=controlling births…good and bad ways to do this. Contraception=against life…never a good way to do this.

    • Jame

      You can build muscle by going to the gym and working out or you can build muscle a lot faster by using steroids.

      The intent is the same, the ends (of building muscle) are the same, but the means are different. Furthermore, the means are so different that many of the ends are different. One leads to improved health and increased self-discipline, the other leads to health problems and side effects.

  • David D.

    Steve, avoiding pregnancy can be a responsible decision, especially if prayerful discernment and good communication is involved. The difference between NFP and birth control is how pregnancy is avoided, and whether the marital embrace communicates love and responsibility, or use.

  • Disqus User

    I’m not Catholic, but I believe the Catholic Church teaches that NFP should be used for justifiable purposes and not merely to avoid having children or more children. It appears that the Church anticipates couples seeking spiritual counseling as to whether their planned use is justifiable. I’ve not seen any indication as to what circumstances might be justifications. I assume that may vary depending on situations.

    So, to Steve D.’s point, NFP could be used as many use AC, but it shouldn’t be.

    • James

      Yes, there are many circumstances that might be justifications for avoiding pregnancy. While spiritual counseling may be helpful, couples do NOT need “permission” from a priest or spiritual advisor to use NFP to avoid pregnancy. Decisions on whether or avoid pregnancy or to pursue it are a matter of discernment between the spouses and God.

      Or, to summarize: Married couples do not need a reason to have a child, they need a reason not to.

      • Disqus User

        “Married couples do not need a reason to have a child, they need a reason not to.”

        And as a Protestant, I can agree wholeheartedly with that, as do many Protestants. Statistically speaking, as a percentage, slightly more Protestants eschew artificial contraception than do Catholics. In practice, the traditional Christian teaching on this subject is accepted and observed by about the same proportion of Catholics and Protestants. Scripture teaches that children are a blessing from God and those to whom He gives many are especially blessed, so, if I may rephrase your spot on remark, Christian married couples do not need a reason to be open to God’s blessing of children; they need a reason not to be.

    • ana

      D.User^^ Humanae Vitae {Of Human Life} is a writing that does list categories of reasons to possibly avoid pregnancy for a time: physical, psychological, economic or social. The couple must be prudent as well as generous in their prayerful decisions. There are some links for it at

  • These are good points. I’m in favour of replacing “avoiding pregnancy” with “postponing pregnancy”. Research shows that when committed couples use NFP to postpone pregnancy, 21% will change their minds and want to achieve pregnancy. This is what I see in my NFP practice. Avoid is a term better used for couples not in a long term committed relationship.

  • ana

    These comments show that what is needed is the ”right kind” of NFP instruction. There must be a basic theological section including just reasons for spacing babies {as in Humanae Vitae}, and not using contracepting behaviors such as ”withdrawal” {Bible plus Catholic Catechism}, plus an explanation why NFP is not artificial birth control. The only book that covers this is “Natural Family Planning, The Complete Approach”, by Kippley.
    Many medical models that teach NFP include no such teaching. As a Catholic nurse, it also seems unethical to me that they only teach one fertility sign, when there are three: mucus, temperature and cervix. Where is the ethics in this omission? When we learned natural family planning, I wanted to know everything that there was to know and then my husband and I used the information as we needed. Over the years, those needs varied, thus, the usefulness of knowing multiple signs.

    • James

      We learned the Kippley method via CCL before CCL changed to a newer system. We were not impressed. The method we learned was an older method that puts a heavy emphasis on the temperature sign, in contrast with more recent discoveries. The Kippley method also used “rhythm counts”, such as the 21 day rule and the Doering Rule. The discussion focused heavily on interpreting the temperature graphs and calculating the rhythm counts and spent very little time on the mucus symptom. The method was also far more complicated than other methods and harder to understand. In theory, teaching all signs would be better, but in practice, teaching the secondary signs often comes at the expense of teaching the primary mucus sign.

      • ana

        James^^ it is actually a Dr. Prem method {OB/GYN}, which the Kippleys helped modify to include various options for various circumstances…quite comprehensive in my and my husband’s opinion. On the contrary, they rely equally on temperature sign plus mucus, as any symptothermal method does….because temps are an objective sign, versus a mucus sign which has quite a bit of subjectivity to it. CCL switched/leaned to a Dr Roetzer emphasis which Kippley had also included { their “Rule R” } which may sometimes add a day of abstinence that may not be necessary. The Prem/Kippley rules of “rhythm” counts are specified to the client’s prior cycle history and are negated if mucus is present. Possibly a further look into its
        exquisiteness can dissipate your dissatisfaction with it? On the other hand, my spouse comments, that your personal goal of ”less abstinence” may often/has often resulted in pregnancy {understandably}.

        • James

          Why learn the rhythm counts if you are looking for mucus anyway? As for the dissatisfaction, rhythm counts would give us no Phase 1.

          The reading on the thermometer is “objective” but there is a lot that can throw it off. Interrupted sleep patterns, temperature of the room, etc. It can be useful to some, but confusing to others.

          In theory, Rule K and Rule R could lead to less abstinence, but for us under Kippley rules, Rule K has never applied, Rule R has applied once, and Rule B has applied every other time, and often not until a day or two after the Billings Peak+4 rule.

          There is a tradeoff between abstinence and security, yet somehow Billings manages 99%+ perfect-use effectiveness. It does have a higher user-failure rate, though, because of the reduced margin of error. But if abstinence isn’t an issue, why use NFP at all? Complete abstinence is 100% effective.

          • ana

            James, since you asked: some women have no mucus signs, some have scant mucus signs { too little to effectively use mucus-only rules}, some have all-the-time mucus, some abhor any mucus observations, and many women, as they age, will lose the mucus sign. Thus, the Prem/Kippley method teaches other nifty ways to determine phase 1 endings { “rhythm” counts which is an inaccurate name that you apply to them}. You seem to be saying that this method did not work for you and I am sorry about the disappointments. Many women have a very serious reason to avoid pregnancy, and these more conservative rules often give a definite day to begin abstaining, yes, sometimes even before mucus starts. Personally they were a huge help for us quite a few times. Also, it is understood among many NFP-professionals not to use “perfect-use” effectiveness rates in discussions, but rather other study-determined effectiveness-rates. There undeniably does exist a less-effectivenss rate for mucus-only methods in real-time use, and using perfect-use rates might muddle discussions unethically.

          • James

            If the Kippley method works for you, then by all means use it. But it is an older method and it’s not the best method for everyone.

            Furthermore, when you call another method “unethical” that’s a pretty big accusation.

          • ana

            Excuse me, I was saying that ”your” using the “perfect-use” data above in this posting ^^ might muddle discussions unethically….I did not call another method unethical, nor did I say that you were personally being unethical. I am sorry if I worded it poorly….thanks for the “tete-a-tete”. Peace…

          • ana

            ….and only to further clarify my point…. {and James: I am not trying to win an argument here or have the last word – online discussion is woefully inadequate} ….I have a NaPro Method brochure here and I think that it is more informative when they say in it that CrM is 99.5 perfect-use effective and 96.8 typical-use effective. This can help readers better understand what is being discussed/what more clearly is being said, versus only saying perfect-use data….this is my perspective. Thanks for the input!

          • James

            Do you have any data on trials of the Kippley method?

            The perfect use/typical use/all pregnancies rates for the Roetzer method (Frank-Hermann study) is 99.6/98.1/92.5. The trade off is that this method has more abstinence than other methods.

            I’m not surprised that CrM has a lower typical-use effectiveness. It’s a complicated method, even though it’s only one sign.

            Billings is the most studied. Newer studies tend to have lower failure rates as the method has improved and the teaching techniques have improved. Billings has put a heavy emphasis on teaching the method.

            We took the CCL class with the old Art of NFP before the change. (This is the same as the NFPI course, correct? CCL has moved in a different direction.) Creighton, and Billings. Our experience was that the CCL instructors did not seem well trained. They could read the book, but couldn’t answer more complicated questions. The method seemed especially deficient for breastfeeding, when temps and cycles are irregular. Our Creighton instructor was knowlegable, but the method was far too complicated. It seemed like it was designed more for pregnancy achievement than avoidance. Billings was by far our best experience because of the simplicity of the method and the quality of instruction. Other people may have had a different experience.

          • ana

            NO it is NOT the same! NFPI is in no way associated w/CCL. Read John’s memoirs, “Battle-scarred”. Some studies may be at the NFPIntnl site. They may also be in the footnotes to the “Natural Family Planning: The Complete Approach” book. A lot of John’s stuff was copyrighted to CCL, including THE ART { see effectiveness chapter – you have it still, right? } Some studies are IN the^^ old “Art” but there have been slight changes to rules { improvements} w/NFPI as well. CCL added a day of dry-up to Roetzer, did they not? so it may have even more abstinence, possibly…

          • ana

            Are you able to locate and share where you read about this Billings 99%+ perfect-use effectiveness? I am not sure that I have ever seen that….thanks…

          • James

            Here is a summary of Billings Method Studies.


          • ana

            This seems to show a summary where only about 1/2 of those studied were Billings method; it seems to be a multi-method study, maybe even some STM? I prefer to see the study itself, not a summary, but that’s just me….this still leaves me my question, plus, what is the “user-failure rate”. Thanks much anyways / glad that you shared it! Have a great weekend…

    • James

      Additionally, even if all symptoms are taught and understood correctly, this may not be the best fit for the couple. The cross-checking of the STM gives couples additional security, but this additional security can come at the price of additional abstinence.

      If a couple is looking for a secondary sign, OPKs (LH test strips) do a good job of corroborating peak and ovulation. They aren’t perfect, but they are relatively foolproof.

      • ana

        OPKs/LH test strips do have caveats and false-reads. Maybe a clarification of ”foolproof” would be helpful here to readers. OPKs have helped some couples during breastfeeding times and/or helped someone learn symptothermal, but temperatures can give a lot of the same information. I am not aware that their use has any higher effectiveness over symptothermal, nor heard any such claims. It is also opinion that mucus-sign is ”primary”. The original posting is in error that Dr. Billings “pioneered” a first NFP method. He knew of symptothermal as well as temperature-only methods and went on to use mucus-only.

        • James

          OPKs are an objective sign that is less prone to variation than temperature and requires no interpretation. They are less accurate due to false-reads, but also less prone to user error.

          • ana

            The only variation that one has to worry about with temperatures is if a temperature is taken late, and then you simply ignore it if it happened to be taken. Otherwise, one is only looking for 3 temperatures adequately above the previous 6. You seem pleased with the OPKs for now; that’s good. I personally would not have been able to manage urine timings or be paying for disposable sticks time and time again. Best wishes…

        • ana

          I just read a newsletter from One More Soul that mentions Mercedes Wilson w/FAF felt that the temperature sign was a burden for her third world clients and so she went to Australia to speak to Drs Billings about the temperature sign along these lines. Their director interviewed her today. I am sorry that I missed that.

          • James

            This article implies that one reason Drs. Billings dropped the temp sign is that relying on temperature was leading to complete or nearly-complete abstinence in perimenopausal women. The women were rarely ovulating, but could not determine pre-ovulatory infertility.


            I remember another article where Dr. Evelyn Billings discusses the temp sign. She said they dropped it for pedagogical reasons. They found women who were temping were more likely to ignore or downplay the mucus sign.

          • ana

            J, this article addresses their BIPattern development, in hopes to reduce pre-O abstinence. The study looked at gals age >37 who had long cycles; close to half were >45. This is not average gals. They said that temps would not help with pre-O abstinence, but the purpose of temps is for post-O abstinence. Temps sure helped me w/this change of life +many women learn temps at this time as the mucus does decrease. Temps are the only sign that O has occurred; even OPKs cannot show that O has occurred. A false read will then expect a period that won’t be coming! Plus, that is a generalization that temping gals will “ignore or downplay” the mucus. Even one of the gals they cited here who became pregnant, became “complacent” with her mucus, while only observing mucus, and conceived. Even Kippley has “Extended phase 1” rules, but they don’t say stop temp-taking, unless a woman chooses to. Temps tells so much! Even pregnancy! Plus, they help with effectiveness, too. But an interesting read! thnx…

          • ana

            Actually w/further reflection on my post^^, using Dr. Doering’s temp-only rules, { in studies= excellent effectiveness / adding mucus further improves effectiveness}, or sometimes using a “stair-step” temp-drop, that some folks have, the temps can be very useful for pre-O and help define a time to begin abstaining if needing to avoid pregnancy. We occasionally used them. I guess Drs. Billing don’t address that as their opinion is that their mucus-only is best, or as they try to reduce abstinence, but that can be at a cost of reducing effectiveness. However, that is also the instructor determining what the client will use, right? That’s not optimal education, in my opinion, as a nurse. Better is teaching all the signs, as NFPInternational does, allowing the client to decide what signs that they want to chart. I wanted to learn everything that there was, which was known to learn NFP, and then tailor it to my circumstances…not running around trying to learn more later and/or catch-as-catch-can and hope to get all the data when mucus-only became inadequate. Just my 2cents…

    • James

      As for the theology, there’s always a danger in untrained laypersons teaching theology, especially when doing so without oversight. It is not appropriate for instructors to take on roles appropriate to confessors or spiritual advisors when they do not have the training (or sacramental vocation) to do so.

      • ana

        James, you sound to me as if you have a ”chip on your shoulder” or are set on bashing a provider. HVitae was written for the people to read/ study and pray about. There is nothing improper about quoting Church documents for the lay people to learn from. Many stories can be told about lives being changed for the better because they read HVitae. In addition, couples not only have access to the Holy Spirit, but they have special matrimonial graces with which to discern with even without anyone ”trained” in theology helping them. Maybe we should abolish lay persons reading the Catechism plus its references if this vein of thinking extends itself? Maybe you also believe erroneously that health care providers ought to leave their religion outside the doors of the classroom? Many other documents exist about the laity leavening the temporal order. If not them, then who? They are where the priests are not.

        • James

          Our experience with the Kippley material was quite negative as we were told some things we later found out to be incorrect. Without going into detail, these errors ended up being very damaging to our faith and to our marriage.

          Nor are we the only people who have had bad experiences with well-intentioned, but poorly informed laypersons trying to teach theology. Not all of them taught through CCL/NFPI, but some have.

          • ana

            I think that you should talk these instructor-episodes up with the organizations themselves. Sadly, many Catholics, instructors, lay people and even priests are very misinformed. God love you.

          • ana

            …and, again, only to possibly clarify other comments to other readers, NFPI is not associated with CCL. Maybe you used an older “Art of NFP”? The book that I referenced above is copyrighted 2009. Different methods help different situations but it sure is hard trying to compare “apples and oranges” and even more-so online… They are all very different…

          • James

            True. Priests can be terribly misinformed. The importance is training, not ordination. I was not clear on that.

            Personally, I think it would be best to have trained catechists teach couples the theology, then refer them to health educators to learn the method. Very few people or couples can do both well.

          • ana

            I disagree that so few can do both. Maybe some don’t want to teach both…. and some training of some sort would be needed in both….. It seems that maybe a bad experience has given you this thinking? It is not clear to me why you make this generalization? But that’s okay anyways….bye..

  • Marybeth Adams

    Steve, you are right. It is another form of birth control – where God is in control, allowing man to cooperate with his will. If it were the same as contraception, everyone would be using it 🙂