My First Fisking

This Article in Scientific American is the target of my first fisking. For those of you who don't know what that is, my commentary is in italics. The normal text is: C 1996-2007 Scientific American, Inc. All rights reserved. Reproduction in whole or in part without permission is prohibited.

Modified Rhythm Method Shown to Be as Effective as the Pill-But Who Has That Kind of Self-Control?

Depending on whom you ask, not having babies is easier, or harder, than ever.

By Christopher Mims

For years the birth control methods collectively known as periodic abstinence have been jokingly referred to as "Vatican roulette," a nod to the fact that these techniques are both Vatican approved and quite likely to end in pregnancy. (The World Health Organization reports that on average, women practicing periodic abstinence for a year have a one in four chance of becoming pregnant.)

Are these intentional pregnancies? Most people who practice NFP love children, so they have a lot of them. We are left to assume that they are "unplanned" pregnancies.

A new German study, however, has found that, when practiced correctly, a method of periodic abstinence known as the sympto-thermal method (STM) leads to an unintended pregnancy rate of only 0.6 percent annually. This rate is comparable with that of unintended pregnancies in women who use birth control pills, the most popular method of contraception in the U.S.

Wait, I thought this was the Rhythm Method (see title), suddenly Mr. Mims is using the correct term. Could he educate the public about the term?

For the sympto-thermal method to work, women must keep track of three things: their core body temperature, the fertile days of their cycle as measured by a calendar, and their cervical secretions. Using this information, women are able to abstain from sex during their fertile period, which is the two weeks that surround the day on which they ovulate. According to lead study author Petra Frank-Herrmann, a fertility researcher at the University of Heidelberg in Germany, STM is more effective than the other so-called periodic abstinence methods because it uses more than one type of information to predict the dates of a woman's fertile period.

Actually a good basic description, but why are they "so-called" periodic abstinence methods? Either a method requires periodic abstinence or it doesn't. Not hard to research, every method reports this up front.

As effective as STM can be, experts say it is not right for everyone. Whereas the method is cheap (read: free) and appeals to women who want a natural birth control method, it requires a strong commitment on the part of both partners.

Right, as if every other form of birth regulation is easy as pie. Vasectomies require extensive recovery time and possible testicular swelling (think grapefruits). Tubal ligations cause a variety of menopausal symptoms. And some men refuse to put on condoms which may break and which diminish the sexual experience for men. Oh, and did you know you are supposed to take the pill at the exact same time every day or else you have less effectiveness?

"You really can't extrapolate from this paper," says David Grimes, an obstetrician-gynecologist and vice president of biomedical affairs at the nonprofit public health organization Family Health International. "Naive readers see these results, and they think [STM] is the greatest thing since
laptop computers. The researchers on this paper went back and cherry-picked this data from an ongoing study from the past 20 years. They chose the users who were the best users for this method."

But you could look at this report, and the recent one from India which showed 100% effectiveness, and the 2 or 3 dozen other reports from the past three decades, and all the work of the Pope Paul VI Institute, and extrapolate that Natural Family Planning is highly effective.

Hilda Hutcherson, an ob-gyn and co-director of the New York Center for Women's Sexual Health at New York-Presbyterian Hospital/Columbia University Medical Center, found that her patients often stop using periodic abstinence methods after only a few months. "It's difficult to abstain from sex for two out of four weeks," she says. "That means half the month you can't have sex. That's very difficult for young couples."

It's also difficult for smokers to give up smoking and addicts to give up drugs so we better stop encouraging them to follow the difficult path. Not to mention how difficult it is to potty-train children, better to stay in diapers for their whole life then learn how to control their bodies.

Grimes of Family Health International believes that studies of periodic abstinence are often motivated in part by religious beliefs. "Many of the authors of these studies have religious orientations," he says, "and that clouds the motivations." Some 74 percent of the women who participated in Frank-Herrmann's study, which will be published in the journal Human
Reproduction, listed their religion as Roman Catholic, a faith for which this is the only church sanctioned method of family planning.

And organizations like Family Health International, which open and expand markets for hormonal and barrier contraception in the developing world, have no mixed motivations whatsoever. Hat Tip to Kerrie from the Yahoo CCL-Community for inspiring this point.

But Suzanne Parenteau-Carreau, a researcher and an advisor at Serena, a Canadian volunteer organization devoted to teaching couples how to practice the method, disagrees. She says that although religion was the early impetus, couples who practice STM are now seeking "natural'' birth control. "Now it's more and more from a natural motivation; to be closer to nature," she says. "We often say it's people who like camping, bicycling, outdoor exercise-people who want healthy food and healthy natural family planning."

Complements to Mr. Mims for choosing an eloquent defender of NFP, one who is of comparable credentials to the FHI expert. This statement accurately characterizes our experience as teachers. The health drawbacks of the birth control pill are pushing students our way.

But that notion irks Grimes, who insists it is misleading. "I chafe at the term 'natural family planning,'" he says. "For many couples this is highly unnatural. 'Natural' is methods that you don't have to think about, that allow you to be spontaneous.. STM is very unpopular, hard to use, and has a poor success rate in average couples. Most people aren't willing to put up with it."

As if the term 'birth control' isn't misleading. Ask someone who just spent $20,000 on IVF after being on the pill for a decade. Is she in control of her birth? Once again, the spontaneity bugaboo appears. As if the mature, loving thing is to jump on each other at the drop of a hat. And of course, a re-definition of 'natural' as if norgestimate and ethinyl estradiol (Ortho Tri-Cyclen pill) grow on trees.

Frank-Herrmann acknowledges that one U.S. study conducted in 1980 in Los Angeles had a 90 percent dropout rate after less than two years. But Grimes concedes that STM has its advantages, chief among them that "it is cheap, safe and approved by the Roman Catholic Church.. It is a reasonable part of the mix of contraceptive methods, it's just that for most people it's not an acceptable method."

So we finally find out that there are advantages to the STM. I do wish they would point out that NFP is not contraceptive since it does nothing to act against conception. NFP users merely choose to attempt conception or not to attempt conception.

Whether or not this method will ever gain ground on other contraceptive methods-the most recent data available indicate that less than 1 percent of women who use birth control in the U.S. use any method of periodic abstinence-all observers agreed that STM can only work for couples who stick to the plan 100 percent.

I repeat, try not using condoms or pills 100% of the time and see the results.

"It's not for everybody," Frank-Herrmann notes, "but there is a group of women who are interested in this method, and I think we should offer it to them."

And we should offer a slew of condescension and mis-information too.

The bottom line: all contraceptive methods have their drawbacks, including the potential of passing along the HIV virus and sexually transmitted diseases best prevented by condoms. Ultimately, Grimes says, "the best method for a couple to use is whatever they want. It's counterproductive to try to steer people to one thing or another."

Nothing in the article was about STDs, but a final cheer for condoms which "prevent" STDs. Nothing mentioned about the millions of Africans with free UN condoms and HIV infections. No mention that abstinence is the only course of action which reduced the HIV infection rate in any African country (Uganda's). As to the closing statement, can I choose infanticide to plan my family if that is what I want?