Obviously, not everyone has regular fertility. In fact, infertility in both men and women has been on the rise in the last 20 years. This is where things get even more awesome. A woman charting her fertility cycle with a natural method of family planning can work in conjunction with a doctor trained to practice Natural Procreative Technology.

Natural Procreative Technology — or Naprotechnology [NPT] — is a practice of medicine that uses a woman’s own knowledge of her fertility to diagnosis and treat any female reproductive health problems. A woman records her observations of her fertility cycle in her charts, and these charts reveal basic problems, such as — but not limited to — hormone deficiencies or physical defects. The techniques used by NPT-trained doctors have proven to be more successful in treating infertility than conventional treatments.

The following chart compares the effectiveness of NPT (in blue) at treating endometriosis with a similar non-NPT approach taken at Johns Hopkins University is shown.

A similar study showing a comparison of a NPT approach to the treatment of women who have polycystic ovarian disease and comparing it to the work at Johns Hopkins University also shows a significant improvement.

Even more amazing than its superiority over conventional treatments is the fact that Natural Procreative Technology is comparable with artificial technologies such as IVF at helping couples suffering with infertility achieve pregnancy. A 2008 study published in the Journal of the American Board of Family Medicine found that “NPT provided by trained general practitioners had live birth rates comparable to cohort studies of more invasive treatments, including ART [artificial reproductive technologies].” (1) The study looked at the results of NPT at a general practice in Ireland. According to The European IVF Monitoring Programme, the live birth rate per cycle for women undergoing IVF in Ireland is 21.1 per cycle, 25.4 per aspiration, and 27.4 per transfer. Thus the practice’s live birth rate of 25.5 per woman treated for infertility is well within comparable range.[1. Stanford et al, Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice, Journal of the American Board of Family Medicine, September-October 2008, Vol. 21, Pages 375-384]

A similar study, published in 2012 in the medical journal Canadian Family Physician, found the same results at a family practice in Canada. 47% of the women treated for infertility with NPT conceived children. (2) If the results of these small studies are evidence of the overall success of NPT, then this natural method can be easily compared to IVF, the success rates of which remain in the range of 50% (3) (4). Larger cohort studies are needed before any final conclusions can be drawn. But so far, NPT has proven to remarkably successful.

The success of NPT seems especially relevant for couples diagnosed with “unexplained infertility,” given that there is no conclusive evidence that finds IVF any more successful at treating “unexplained” infertility than natural treatments. (5) In fact, recent research suggests that couples diagnosed with “subfertility” have as good chances of conceiving in three years of just having sex than in having an IVF procedure. (6)

There are 4 main differences between IVF and Naprotechnology that are worth considering:

1. Naprotechnology is entirely natural.

It doesn’t treat infertility by forcing ovulation. It treats infertility by finding the underlying problem causing a couple’s infertility. The ability to find underlying causes by working with a couple’s charts of their fertility cycle is apparent. In the study “Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice”(2) it was found that “a high proportion of women reported having unexplained infertility (40%) and at least 1 unexplained miscarriage (29%) before starting NPT. With NPT evaluation, it was found that only 1% had unexplained infertility and 2% had unexplained miscarriages, while 62% of the women had low progesterone, 50% had low luteal estrogen, 50% had low follicular estrogen, and 9% had limited cervical mucus. Also, more women were identified as having anovulation and polycystic ovary syndrome (14% vs 2% and 6% vs 3%, respectively) after NPT evaluation than before therapy.”

As shown, Naprotechnology finds the underlying problem causing infertility and works to fix it. It doesn’t try to force a pregnancy. Rather, it seeks to restore a woman to her natural state of fertility so couples can achieve pregnancy on their own.

2. A 2002 study published in The New England Journal of Medicine showed that children born of IVF or intracytoplasmic sperm injection are 2.0 times more likely to have a major birth defect than children conceived naturally. (7) Because NPT is completely natural, it avoids this added risk. Similarly, NPT avoids the increased risk of multiple births that IVF poses. About 1 in 4 IVF pregnancies are multiple pregnancies. This is around 20 times higher than the rate after natural conception.

3. The use NPT also lowers the miscarriage rate. NPT has an effective protocol for the prevention of preterm birth, which is a major cause of newborn death. Where it has been implemented, this protocol has reduced the preterm birth rate from the typical U.S. preterm birth rate of 12% to 7%.

4. One cycle of IVF alone can cost $10,000-$15,000. On the other hand, many NPT patients are able to achieve pregnancy without any surgical intervention, resulting in a significantly reduced cost.  For those who may require surgery, the combined physician’s and hospital’s fees are usually still less expensive than IVF/ART.  In addition, most NPT treatments are covered by health insurance, because NPT focuses on diagnosing and treating the cause of the infertility, in addition to helping the couple get pregnant.

Natural methods of family planning offer women and couples something truly unique. By educating them about their own fertile cycle, these methods empower women to take charge of their bodies and to become partners with their physicians in treating their own infertility. Perhaps the best part is this: By charting, and recognizing problems in her fertile cycle, a woman can begin working to treating any of her reproductive problems before she even starts trying to conceive. Now that’s empowering.

(Graph 1) Figure 51-5, p. 682 from the NaPro textbook. Cumulative pregnancy rate of patients with endometriosis treated with NaProTECHNOLOGY compared to conservative surgery only. Patients with normospermic husbands only (From: Pope Paul VI Institute research, 2004 and Rock JA, Guzick DS, Sengos C, et al: The Conservative Surgical Treatment of Endometriosis: Evaluation of Pregnancy Success with Respect to the Extent of Disease as Categorized Using Contemporary Classification Systems. Fertil Steril 35:131-137, 1981).

(Graph 2) Figure 51-13, p. 683 from the NaPro textbook. Cumulative pregnancy rate for patients with polycystic ovarian disease treated with NaProTECHNOLOGY compared to surgical wedge resection only. (From: Pope Paul VI Institute research, 2004 and Adashi EY, Rock JA, Guzick D, et al: Fertility Following Bilateral Ovarian Wedge Resection: A Critical Analysis of 90 Consecutive Cases of the Polycystic Ovary Syndrome. Fertil Steril 36:320-325, 1981).

(1) Stanford et al, Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice, Journal of the American Board of Family Medicine, September-October 2008, Vol. 21, Pages 375-384

(2) Tham et al, Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice, Canadian Family Physician, May 2012, Volume 58, Pages 276-274

(3) Lintsen et al, Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study, Human Reproduction, 2007, Volume 22, Pages 2455-2462.

(4) Collins et al, Overall prognosis with current treatment of infertility, Human Reproduction, 2004, Volume 10, Number 4, Pages 309–316

(5) Pandian Z, Gibreel A, Bhattacharya S. In vitro fertilisation for unexplained subfertility. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD003357. DOI: 10.1002/14651858.CD003357.pub3

(6) Stanford et al, Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments, Infertility, Volume 93, Issue 7, May 2010, Pages 2175–2181

(7) Hansen et al, The Risk of Major Birth Defects after Intracytoplasmic Sperm Injection and in Vitro Fertilization, The New England Journal of Medicine, 2002, Vol. 346, Pages 725-730

In my last post, I posited that the way the United States Agency for International Development (USAID) determines an “unmet need” for family planning in developing countries is weird. They claim that most women who aren’t using contraception “need” contraception, when this might not necessarily be the case.

Furthering the questions I asked regarding the awkward algorithm which determines “unmet need”, it seems there was an excellent conversation regarding this very issue on Worldbank.org. Berk Ozler, an economist, discusses a paper which shows that there was very little change in fertility rates after a birth control intervention in Zambia, suggesting that the “unmeet need” wasn’t quite so unmet.  What follows are quotes from the American development economist Lant Pritchett, who left his comment, arguing — quite definitively — that there is “no need for unmet need.”

My claim is that the usual numbers bandied about for estimates of “unmet need” do not correspond to any definition of “unmet need” that any economist (or just common sense) could agree to. They are an advocacy construct that has been successfully used in the overall political agenda for promoting family planning. But ultimately I have also argued the notion of “unmet meed” has been counter-productive even within the movement.

…the usual use of the word “need” implies stronger intensity that “want” or “wish” and we usually, for competent adults, don’t say people “need” things they don’t “want.” Yet the usual “unmet need” numbers include every woman of a certain age who says they do not want a child now who is not using contraception was having an “unmet need” for contraception. This is in spite of the fact that the same DHS surveys have responses from women who do not want a child and are not using contraception about why they are not using, which includes answers like that they dislike the side effects, that they are no longer fecund, they are sexually inactive, that they have religious objections, that their husband is out of the country for a year. That is, many women give reasons suggesting they do not want contraception and only a few cite access or price as reasons for their “unmet need” status attributed to them.

…the numbers for “unmet need” consisted (when I last looked at them) predominantly of women who don’t express any current desire to use contraception.

I am convinced the “unmet need” numbers were created to counter the objection many countries had to expanding family planning programs that women didn’t really want it. But, while appearing to counter that objection, it doesn’t because it doesn’t measure women’s expressed “want” it measures some completely arbitrary attribution of “need.”

…I have argued the concept of “unmet need” has actually been counter-productive for the movement, in two senses.

One, it is symptomatic of the of the deep disrespect for women and their agency that the demographically driven family planning programs have often displayed. As Matthew Connelly has argued the coercion in the family planning programs in India and China was not a “mistake” it was a logical consequence of people (men mostly) who believed that women needed to use contraception to reduce population growth –whether they wanted to or not. The fact that the movement has consistently attributed “need” for contraception to women who have articulated reasons why they don’t want it reveals the paternalistic approach inherent in demographically driven family planning programs–we population bomb advocates can override what you want with what you need.

Second, suppose you actually believed your own advocacy and thought that 25 to 35 percent of women having “unmet need” actually meant they had “need” in the usual sense of the word. Then meeting “need” is just logistics–all I have to do is slap the stuff out there and it will fly out the door. I don’t have to worry about the client, don’t have to be nice, don’t have to worry about side effects, don’t have to worry about arrays of methods. There is a huge difference between famine relief (delivering food to people who need it) and selling macaroni and cheese (where people might not want it and need to be sold on it).

The lesson that actual implementation of family planning programs has consistently found is that getting uptake is hard, not just slapping it out there, which is not at all surprising, it is true of every consumer good. It is only the contradiction between the advocacy needs of the movement (convincing governments that people wanted it) and the implementation needs (actually needing to create demand–and meet much women’s actually desires with more specific demands of methods, convenience, side effects, respectful non-coercive treatment, etc) that created the confusion.

So I think independently of one’s sophisticated views on topics around fertility and contraception (e.g. how much of women’s expressed reproductive intentions represent “just” social norms), everyone should be able to agree that the usual numbers on “unmet need” are an advocacy tool, not particularly relevant to conceptually or empirically informed discussions.

The alarm comes from analysis published in The Lancet by Alkema et al: “National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis” The study claims that an “increased investment is necessary to meet demand for contraceptive methods.”

I have a few honest questions about the study, though I ask them as a layman.

To determine the “demand for contraceptive methods”, the study looked at “women who use contraceptives or who have an unmet need for family planning.” How does one determine an “unmet need” for family planning?

According to the study, “observations of unmet need for family planning in our database are, whenever possible, based on the revised algorithm of the indicator designed to improve comparability within and across countries.”

This revised algorithm was developed by the United States Agency for International Aid (USAID), and can be found here. It gives a whole number of women whose situation indicates an “unmet need” for either “spacing” or “limiting” [having no more] births. The Lancet study considers that this unmet need for spacing or limiting is an “unmet need for modern contraceptive methods.” This is where things get odd. According to USAID, and I quote:

All fecund women who want a/another birth in 2+ years or are undecided if or when they want a/another birth are categorized as having an unmet need for spacing.

Does indecision over when or if a woman wants a child necessarily indicate a “demand for contraceptive methods”? It seems that a couple with health objections could express indecision over when they’d like to have their next child, and still have no desire for the use of contraception. A couple with a religious objection to the use of contraception could be in the same boat, and given that The Lancet study looks at a multitude of Muslim and Catholic regions, this seems like an important factor to consider. It goes on:

Current pregnancy/last birth wanted later = unmet need for spacing (even if pregnancy/birth was due to contraceptive failure).

Current pregnancy/last birth unwanted = unmet need for limiting (even if pregnancy/birth was due to contraceptive failure).

So — unless I’m reading this wrong — if a woman becomes 1 of the 8 out of every 100 women who experience an unintended pregnancy while taking oral contraceptives, she has an “unmet need” for spacing, and this is the same “unmet need” used to promote the idea that an “increased investment is necessary to meet demand for contraceptive methods,” (Alkema et al) which would include the very oral contraceptives the woman was taking when she got pregnant. So my next question is this: How does the failed use of contraception indicates a unmet need for contraception? And there is another problem:

Say a couple using a fertility awareness method to avoid pregnancy accidentally got pregnant. This pregnancy would be “a birth wanted later”. According to USAID’s algorithm, this woman would be characterized as having an “unmet need for spacing births”, and she would be assumed into a whole group of women with a similar unmet need, a need great enough to have Alkema et al determine that “increased investment is necessary to meet demand for contraceptive methods” despite expressing no desire to use contraception. 

Women who are pregnant/postpartum amenorrheic and said their current pregnancy/last birth was not wanted at all = unmet need for limiting, irrespective of whether they want another child in the future.

Again, this seems odd. In their definitions of spacing and limiting, USAID defines women with an unmet need for limiting as “women who did not want more children” (DHS 25, 1.1.1) How then, can a woman who does want children in the future represent an unmeet need for not having any more children? Yet there it is.

It may be a jump to say that the U.N. and USAID are manipulating data so as to promote the use of contraception in developing world, but, at the very least, surely they could be asking better questions. If USAID and the U.N. are using these surveys to determine the unmet need women have for spacing births, why not ask women whether they have an unmet need for spacing births? If we are going to claim that this data “support[s] calls to increase investments in family planning, especially in regions where contraceptive prevalence is still low,” why are we not asking women whether they need increased in investments in family planning and more contraception? In short, why is the one question missing from the number of questions directed at women who are not using contraception: Do you want contraception?

These surveys seem to take a “we know what’s best for you” approach towards people. It seems a leap to say that a woman undecided whether she wants another baby represents and unmet need for contraception, but The Lancet, and the whole flood of media reports that followed the analysis published there, are quite happy to make this leap of faith.

What do you think?

As a family law scholar who publishes regularly on issues of marriage, human sexuality, and contraception, Professor Helen Alvaré is a leading voice inthe fight for the organic culture.  Prof. Alvaré encourages us to look beyond the sex-ed wars and, when not publishing law review articles, advocates for women to speak for themselves.  This was not a standard Q-and-A interview, but rather a fascinating conversation about human sexuality, the pro-life movement, and the current battle against the contraceptive culture, all through the lens Prof. Alvaré’s deep personal experience.

Part 4.1: Contraception, Abortion, and Women’s Health

The final part of our interview delved into Prof. Alvaré’s work relating to contraception, abortion, and human sexuality.

To recap part 1, Prof. Alvaré began her career with a focus on abortion.  But, the problems she handled were never “about abortion alone.  People who say [abortion] is a single issue haven’t even begun to think about it.”  Prof. Alvaré stated that her realization of the complexity of abortion led her to study the “demand side of abortion—what leads people to the marketplace for abortion.”

When we asked her directly about her thoughts on a common mantra of the day—that contraception helps reduce abortion—her response was equally direct: “That could not be more wrong.”  (For a brief look: part 1, part 2, part 3).  Unfortunately, this false mantra is motivating the current pro-contraception culture, as evidenced by the mandatory “no-cost” contraception coverage in the Affordable Care Act.

Why, of all things, is the government mandating “free” contraception?  Prof. Alvaré recapped the government’s argument: making contraception free increases the usage, which then lowers unintended pregnancy rates and improves women’s health.  Prof. Alvaré breaks down this argument for us step-by-step.

 Step 1

 “89% [of women] say they currently use [contraception].”  The government believes “that making [contraception] free will increase usage…In fact, the people who have it free already, which are mostly the poor or the near poor (who actually have the largest number of unintended pregnancies), have decided not to use it for a variety of reasons.”  Because these people can get contraception free already, cost cannot be one of these reasons.

“There’s also a hefty percentage [of non-using women] who don’t want [contraception] because they don’t like the side effects, they worry about their health, [or] they have religious or moral objections.”  In other words, you couldn’t pay the women in this category to use contraception.

“It’s a tiny percentage of that 11% [of non-using women] that would actually say they can’t afford it.  But if they really couldn’t, there are already government programs [to pay for it].”

In short, “free” is unlikely to increase actual usage.  Like all good lawyers, Prof. Alvaré further refutes the government’s argument even after success at step 1.

STEP 2

“Then there’s the question of the relationship between [contraception] usage and unintended pregnancy.  And again, it turns out that even if you use the pill according to package directions, somewhere between 10 and 12% of [women] are going to be pregnant anyway.”

But the problems with contraception and unintended pregnancy do not stop with failure rates.  We must also consider “the question of risk compensation.  More people come into the marketplace for sex when you engender the perception that the risk of pregnancy is very low. It’s the same way that more people die speeding when you have seatbelt laws, etc. Economists who have written about the phenomenon of contraception and abortion point out that we have more out of wedlock pregnancies, more abortions, and more unintended birth” because of contraception’s effect on risk compensation.

Contraceptive use doesn’t reduce unintended pregnancy across the population.

STEP 3

This is the final step. “Even if we got more people on [contraception], and there were fewer unintended pregnancies,” we still must ask, “‘Would it improve women’s health?’”

To legitimize its plan for “no-cost” contraception, the government cites studies that purport to show that unintended pregnancy cause harm to a woman’s health.  But “if you actually go read all these studies” they state that the results are inconclusive.

There appears to be a correlation between unintended pregnancy and women’s health, but it may not be causational for two possibilities.

First, we need to consider reverse causation: poor health indicators could lead to unintended pregnancies.  Something like “smoking, or domestic violence, or drinking, or depression” could lead to unintended pregnancy, “not the other way around.”

Second, we need to consider other factors.  Perhaps “a third factor, what economists call a confounding factor, causes both phenomena. A woman is a ‘risk taker’, or she has depression, and it causes drinking, smoking, [or] taking a bad mate, and [consequently] unintended pregnancy.”

“Even if every other piece in [the government’s argument] were true—that making [contraception] free gives you more usage, and that more usage gives you less unintended pregnancy, [the government] still couldn’t meet the burden [of] showing that less unintended pregnancy would improve women’s health.”

There simply is not a causal relationship between free contraception and women’s health.

Part 4.2: Sexualityism?

After debunking the government’s purported reason to incentivize contraception, Prof. Alvaré suggests an alternative theory to explain what is really driving the current government and the contraceptive culture in general.  This theory is called “sexualityism.”

Sexualityism is the belief that individual sexual expression (defined as actions with those parts of the body that are sexual) is a right, an inherent good, and an essential freedom.  Usually sexual expression occurs in the context of a relationship, but it need not be in order to retain is goodness.  “It is simply, ‘I wish to be sexual, to express myself with the sexual parts of myself, and that’s a right.’”

There are four important points to sexualityism.

1. It is “an ideological agenda that wants to render both women and men infertile after sex.  Men don’t carry babies,” and, by pushing contraception, “women won’t either.”  Prof. Alvaré argues that this part of the theory comes from a form of feminism that “mandates…absolute sameness” between men and women.

 2. Sexualityism is “a form of materialism, that suggests that caring for people is a disadvantage to what [it’s proponents] describe as success.”  Success is defined as “worldly-recognized accomplishments, the ability to earn in the marketplace, the ability to get more degrees, basically not doing free work at home.”

After explaining these first two parts of sexualityism, Prof. Alvaré quickly showed why it could be an attractive theory:

I’m not casting blame—[some parts of the theory] seem logical on their face to a lot of people.  I’ve had many days where I’d go do some TV show, and then I come home, in my suit, [with] my giant face of makeup on.  I walk in the house, and it looks like a tornado hit it…I have two boys and a girl…and I’m literally on my knees, in my suit, and I’m sort of sweeping crumbs and french-fries from under the table in my bare hands and putting them in a garbage can.  And of course that looks a lot less free and fun than what I was doing an hour before that, right?  So it’s only natural that some people would go along with [sexualityism]…it’s very hard to buck the world’s tide that says that material, public, and celebrated accomplishments are freedom and happiness and progress. And, sweeping french-fries up with your bare hands does not look like that.

3.  Sexualityism represents “the rush to technological solutions” typical of modern society.  “Contraception looks like it enables you to manage your planning for life, with nifty scientific solutions.”  However, as we have noted before, contraception can fail.

4.  Sexualityism explains why contraception is pushed as humanitarian aid.  As Prof. Alvaré notes, citing the work of Harvard’s Lant Pritchett, even though we push contraception, “Women basically have as many children as they actually want.”  Even in populations that have difficulty securing a doctor during childbirth, women have “as many children as they think they and their family need and want.”  So in reality, society is pushing contraception because it believes it is required for the human rights of women.  All sexual expression is an inherent good, and contraception (and ultimately abortion) “is the guarantor of [the] sexual life.”

Sexualityism is the opposite of the organic culture.  Sexualityism views sex as a right owed to the individual; the organic culture views sex as a gift given and shared in marriage.  Sexualityism depends on contraception and abortion; the organic culture depends on love and sacrifice.

Part 4.3: Towards the Future 

Prof. Alvaré concluded our interview with her thoughts on the future of the organic culture and the contraceptive culture.

 The Future of the Contraceptive Culture

The contraceptive culture’s “new greatest hit” is long acting, reversible contraception “that essentially sterilizes [women] for 3 to 5 to 10 years.”

However, Prof. Alvaré does not believe that LARCs are being marketed in a neutral way.  “The last couple decades of Guttmacher reports, Planned Parenthood reports, the Institute of Medicine [reports, and the St. Louis LARC study]” all state that LARCs should be “free to working women.”

But working women are already using contraception at high rates, and have very low rates of unintended pregnancy.  To me, this provides a bit of a cloud to cover over [these institutions’] deepest wish, which is to get the poor using contraception. They’re certainly not attending to the needs of the poor—nobody is right now, if you ask me—but they’re particularly not attending to the needs of the poor for stable family and marriage.  Contraception is an attempt, from their limited point of view…to say the poor are fine without fathers and marriage, etc.

The Future of the Organic Culture

“I have to say, the fact that we have even kept alive the question of ‘whether contraception is an unmitigated good’ is a miracle and should be seen as such.”  The future of the organic culture depends on us meeting people where they are.  We need to show people that we understand the difficulties inherent in forgoing contraception, rather than take a holier than though attitude.  Let’s face it:

It is hard to imagine that we come here, and at some point in our lives, the vast majority of us are supposed to turn over the vast majority of our gifts to needy, vulnerable people—our children.  And that once we have [kids], it is impossible not to be thinking about them for the rest of our lives, and working for their good…that is hard to swallow, [because] I’m a selfish person like everybody else.

It’s hard to get along in the world as it is, and then we’re supposed to be in service to human beings…how’s this supposed to work out?

But then [we need] to explain all the downsides of living for oneself, in particular in connection with sex, relationships with the opposite sex, marriage, and children.  And then [we must] explain the happy side—the rewarding side, [the] ‘nothing-else-is-like-this’ side—of placing yourself at the service of other people, in particular ones that you love so much: children.

In order to find yourself you must lose yourself.  To give of yourself fully to the other is to truly discover your purpose.  The organic culture’s way of life is difficult and full of sacrifices, yet adherence leads to deep fulfillment unmatched by the contraceptive culture.  This is not to say that we must never attempt to postpone or avoid pregnancy.  Rather, this is to say that we must constantly remind ourselves of the purpose of marriage, and sex: to give of ourselves fully to our spouses and, if we are so blessed, to our children.

Our great thanks to Prof. Alvaré, keep up the revolution.

As a family law scholar who publishes regularly on issues of marriage, human sexuality, and contraception, Professor Helen Alvaré is a leading voice inthe fight for the organic culture.  Prof. Alvaré encourages us to look beyond the sex-ed wars and, when not publishing law review articles, advocates for women to speak for themselves.  This was not a standard Q-and-A interview, but rather a fascinating conversation about human sexuality, the pro-life movement, and the current battle against the contraceptive culture, all through the lens Prof. Alvaré’s deep personal experience.

Part 3: Men, Women, and Life

Perhaps it is controversial to say in today’s popular culture, but it must be asserted: men and women have inherent differences.  These differences are seen quite clearly when considered in relation to children.

After I had our first child, three days later my husband was getting dressed for work.  I thought, “Seriously?!” And then he came home that night at 7, and I thought, “Really?! I’ve been here all day with only one thing on my mind!”

I would put a spoon in a cup of yogurt and find it 12 hours later and think, “Right, I was going eat breakfast…” He had the space in his brain to get dressed for work, to go to work, and then to come home late!  It seemed impossible to me. I didn’t know how a human being could do that when this baby now existed and was his. That is as clear as an insight as I can give you into a woman’s psyche.

My whole life, nothing was the same [after having a child]. Birth and death does it.  When my sister died—when you have an untimely death—it does it.   When you have a birth, it does it.

But with men, apparently, [birth] doesn’t do it in the same way.  It does alter their life—my husband is a different man with different priorities, and he spends his day differently—but not from day one! And it’s no fault of his. I believe it’s the way he was made. I’ve noticed it’s true of other men.

Prof. Alvaré continues, between laughs:

 My husband always [said], “Listen, I’m really grateful to you, I’ll take care of you for these nine months, but once the baby is born, it’s kind of both of our responsibilities, and I can’t actually pity you more.”  He’s a very realistic guy, and I actually felt the same way.

It was not an exhaustive study into gender differences and childrearing that convinced Prof. Alvaré of the differences between men and woman, it was pure lived experience.  Real life is oftentimes the best teacher.

The conversation shifted:

[Pregnancy] actually was far more fun than it was difficult—it’s so amazing. It’s the most unbelievable, out of control—someone is making a baby, and you are carrying that baby—it’s amazing, and it’s fascinating. You’re obsessed with [the making of the] baby. Nothing like this has ever happened to you before, and it’s really hard to put into words.

Trips to the doctor are like going to Disney World—it’s like, “Wow, this is so cool!” It’s the only time you go to the doctor and it’s fun.

Now, I also had four miscarriages, and some of them were later, and some of them were in my 40s when I was hoping to have more than the three children I had.  So there is also this grief, the horrible grief—oh my gosh, when you have a miscarriage at 3-5 months—and the doctor has to get on with the next patient, and you can’t believe he’s moving on. All of that is just another side of it.

We should be in awe at the amazing gift of life, like Prof. Alvaré’s response to her pregnancies.  Before we could even hope to successfully counter the contraceptive culture, we have to know why we fight.  We are not simply fighting against contraception; we are fighting for a culture of life.

We are fighting for the good, the true, and the beautiful that is authentic human relationship.  We are fighting for the true understanding of what it means to be a person in a relationship with others.

How can that possibly relate to contraception?  Prof. Alvaré lays it out in part 4.

1. The mini-pill (progesterone only) is linked to an increased risk of chlamydia. Why? According to the study “Interferon-ε Protects the Female Reproductive Tract from Viral and Bacterial Infection” published in Science Magazine, progesterone suppresses the protein Interferon-epsilon, which is essential to a women’s immune system. A review of the study noted that: “When women are taking this mini pill, their bodies receive high levels of progesterone. The extra amounts of progesterone in combination with the high levels of oestrogen in the body cancel out the effects of the epsilon.”

2. The study “The intracellular progesterone receptor regulates CD4⁺ T cells and T cell-dependent antibody responses” published in the Journal of Leukocyte Biology suggests a possible reason why women taking birth control shots have a higher risk of malaria, Listeria, HIV, and the herpes simplex virus: Progesterone suppresses interferon gamma — a protein critical for immunity against viral and intracellular bacterial infections – in T cells. All the cool kids promoting LARCs should take note.  

3. PETA made us laugh. “The bottomline is that animals would if they could, but sadly or unfortunately they cannot use condoms, so it is upon us to sterilise them. It is our responsibility.” We’re all for anthropomorphizing the hell out of puppies, but chances are they’re not pining away for condoms.

4. CNN reports quite well on the study ”Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009″ published in the Journal of the American Medical Association.

“Diagnosis of metastatic breast cancer in women younger than 40 has increased 2% a year, every year, from 1976 to 2009, according to a study published Tuesday in the Journal of the American Medical Association.

The increase was seen in women aged 25 to 39 of all races and ethnicities, living in both rural and urban areas.

It’s a devastating diagnosis, particularly because a woman younger than 40 who is diagnosed with breast cancer is more likely to have an aggressive form of the disease and face lower survival rates.”

But they don’t mention that since the sixties more and more young women have been using hormonal contraception, which is associated with an increased risk of breast cancer. We dunno, seems worth a passing note. From WND:

The American Council on Science and Health calls the increase “slight.” But Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, points out there has been no corresponding increase in older women.

Karen Malec, president of the Coalition on Abortion/Breast Cancer, said it was “utterly stunning” that JAMA lead author Rebecca Johnson’s team called the increased incidence in advanced cancers among young women “small.”

“That’s a nearly doubled increase in the incidence of a disease with a mean five-year fatality rate of 69 percent,” she said. “By contrast, the mean five-year fatality rate among women with breast cancers that have not spread to distant sites is 13.2 percent.”

And what distinguishes the younger women from the older? The sexual revolution, says Orient.

“Young women in huge numbers have taken higher doses of hormones than their menopausal sisters – in birth-control pills,” she said.

Yup.

As a family law scholar who publishes regularly on issues of marriage, human sexuality, and contraception, Professor Helen Alvaré is a leading voice inthe fight for the organic culture.  Prof. Alvaré encourages us to look beyond the sex-ed wars and, when not publishing law review articles, advocates for women to speak for themselves.  This was not a standard Q-and-A interview, but rather a fascinating conversation about human sexuality, the pro-life movement, and the current battle against the contraceptive culture, all through the lens Prof. Alvaré’s deep personal experience.

Part 2: Sex and Marriage

The link between sex and marriage was always apparent to Prof. Alvaré, because of sex’s intrinsic connection to children.

Whether you were thinking about [the link] or not, sex made babies, and that conditioned sex whether you articulated or acknowledged it or not, in every case.

But beyond this, something about the act itself reinforced this connection.

[The] whole sexual transaction, the physical structure, the emotional environment, one knew that thinking about [sex] separate from marriage…didn’t make a lot of intellectual sense. There was something that was very different about your relationship with this man, and it didn’t seem to fit into an ongoing single life.

We argued this point— that sex and marriage should go together—from a philosophical approach, but Prof. Alvaré’s remarks come from an entirely different angle.

I wrote an essay called About Last Night, which was a reflection on the book Kristin Lavransdatter.  [The story] has this encounter where Kristin, a single girl, has her first sexual encounter with Erlend, the married man.  [Erlend] is dragging her away from everything she believes, and they have sex, and she looks at him and she says, “He was to leave now, but she couldn’t understand how this could be so.”  Wasn’t it a new day, wasn’t it a new world?  They had had a sexual encounter, wasn’t there something definitely new between them?

And I wrote that essay because it struck me as just so darn true.  “He was to leave now, but she couldn’t understand how that could be so.” And it also very much reflected a woman’s thinking about this, which has been confirmed with psychological and sociological studies about how women think about sex.  So I very much understood the connection [between sex and marriage], and I don’t mean causal sex makes babies, just the whole connection between sex and permanency, and sex and a relationship that had to be ongoing.

According to Prof. Alvaré, sex and marriage go together.  However, they should go together not just because sex leads to babies—helpless people who rely on stable relationships with their parents.  Sex and marriage should go together because of what sex says to the participants.  The two becoming one flesh means something, at times despite our own efforts.

Part three to come soon.

Studies regarding intrauterine devices (IUDs) are commanding considerable media attention in recent weeks. This coverage could be due, in part to the ongoing lawsuits facing the Mirena contraceptive, as well as the fact that the Food & Drug Administration (FDA) has just approved the first new IUD in 12 years. Also just published is a new study  in Contraception entitled “Perceptions of Intrauterine Contraception among Women Seeking Primary Care.” The study, by authors Lisa Callegari, Sara M. Parisi and Eleanor Bimla Schwarz, surveyed 1,626 women age 18-50 who were eligible for an IUD, to determine women’s degree of knowledge and attitudes toward these contraceptives. The authors note that IUD usage is lower in the United States in spite of the fact that that the IUD is more effective that the standard birth control pill poses no additional risk for sexually-transmitted diseases and is more cost-effective when used for 3 years. Ultimately, this study poses serious questions about data validity, data reporting and of course, the implications of these results.

Key concerns about this study include:

• The authors use the unfamiliar term IUC (intrauterine contraception) rather than the more commonly-known term IUD.  The authors also fail to define what qualifies as an IUC. Since the survey is not available, it is unclear if they used this unfamiliar and undefined terms in the survey itself (against conventional wisdom from scientists in survey creation) and if that affected the quality of the data.
• The survey also defies best practices of methodologists in that it contained 75 questions, which is an excessive length. Lengthy surveys are ill-advisedas they elicit hasty responses, skipped questions and otherwise promote non-response bias that limits the validity of the data.
• In addition to being problematic due to length, the survey used 75 questions to gather data on only 3 items, with other questions covering demographics. According to charts, there were only a 20 total items, the three items of inquiry and 17 demographic items. This creates a significant discrepancy between the amount of data reported and the amount (and type) of data gathered. This leads readers to ask what was omitted from the paper and why.
• Most importantly, this study neglects to address the health risks exclusive to the IUD such as uterine perforation, increased menstrual pain and bleeding, and increased risk of type 2 diabetes in obese women. This is not considering the risks to the baby if pregnancy does occur (i.e. ectopic pregnancy and miscarriage and birth defects) as well as lifestyle concerns- like unwillingness to commit to delaying pregnancy for years, which is required to make the IUD cost-effective.

Callegari and her co-authors determine there is a “critical need to educate reproductive-aged women who seek primary care about the advantages of IUC” (p. 9)  but present no findings to suggest anything critical about promoting this particular contraceptive that has its own inherent risks. Likewise, there is not sufficient evidence that women reject the IUD solely because they are unaware of the three selective advantages of IUDs over OCPs that the authors chose to promote. While education on these methods may very well increase their prevalence, the authors oversimplify complex rationale on contraceptive choices and the fact that the IUD is intended to be a long-term commitment, a commitment that many women may not wish to make. There is no acknowledgment of reasons why women may reject the IUD in spite of its benefits over OCPs.  Please see RRA’s full report for complete information.

The Kinsey quote is taken from Calderone’s Abortion in the United States: a conference sponsored by the Planned Parenthood Federation of America, inc. at Arden House and the New York Academy of Medicine. The CDC quote is from their annual Abortion Surveillance report.

From these reports, it has been shown that women undergoing abortions were using contraception in the month they got pregnant at the following rates: 50% in 1988, 58% in 1993 and 1994, 58% in 1995, 58% in 1996, 58% in 1997, 58% in 1998, and 54% in 2000.  Kinsey’s 1955 observation appears true today.

The claim that increasing use of contraception will lead to a decreased incidence of abortion should be met with a healthy skepticism.  

As a family law scholar who publishes regularly on issues of marriage, human sexuality, and contraception, Professor Helen Alvaré is a leading voice in the fight for an organic culture.  Prof. Alvaré encourages us to look beyond the sex-ed wars and, when not publishing law review articles, advocates for women to speak for themselves.  This was not a standard Q-and-A interview, but rather a fascinating conversation about human sexuality, the pro-life movement, and the current battle against the contraceptive culture, all through the lens Prof. Alvaré’s deep, personal experience.

Part 1: The Pro-life Cause and Human Sexuality

Prof. Alvaré worked extensively in the pro-life field at the beginning of her career.  Under the direction of the U.S. Conference of Catholic Bishops, Prof. Alvaré spent a year interviewing post-abortive women.  While working with these women, a startling connection revealed itself to Prof. Alvaré:

I will say that when I was doing the pro-life issues in the 90s, I didn’t think I would be moving much towards the question of human sexuality, and contraception, and generosity to children as I have. In fact, I would have said at that time that that might be a conversation stopper on abortion, and that I couldn’t risk it.

These post-abortive women never told her their thoughts on abortion. Instead:

 The stories they told me were about the environment they grew up in, the relationship with their boyfriend- because it was always the boyfriend.  Maybe 13 to 17 percent of abortions—I forget the exact figure—are marital.  The vast majority are single women.

So it was the relationship with their boyfriends, the way that sex figured into that relationship—and it usually was assumed that it would happen, it wasn’t very important, they didn’t think about it a lot…Then all of a sudden, after they’re pregnant, the questions [are asked]:

‘What is my relationship with this man?’

‘What will it be in the future?’

‘What has it been in the past?’

‘Who am I as a potential mother, parent, or wife?’

‘What is the relationship between my life and a baby?’

And, [these questions] hit them like a ton of bricks, questions they had never considered before having the child, or even before having the sexual relationship.

Society’s promotion of contraception and abortion—reflective of our misunderstanding of human sexuality—affects the lives of real people.  Prof. Alvaré’s intimate interaction with the post-abortive women confirms this point.  Hers is a humanized understanding of the issues, gained from working with those affected most directly.

It seems clear that the questions Prof. Alvaré encountered with her interviewees should have been posed and answered before their unexpected pregnancies.  While some may disagree about sex before marriage, prudence and respect for the other should compel us all to answer the question, “What is my relationship, and what will it be in the future?” before forming a sexual union.

Be on the lookout for Interview with Prof. Alvaré Part 2.