Friday, July 27, 2007

"Multiple Births Bring Dangers"

Multiple Births Bring Dangers; Church Teaching Urges Caution

Maria Wiering July 27, 2007

When Brianna Morrison gave birth to sextuplets at Abbot Northwestern Hospital in Minneapolis June 10, only 22 weeks into her pregnancy, the children weighed between 11 ounces and 1.3 pounds and were considered to be at the extreme limit of viability.

Within two weeks, three boys and one girl had died. In mid-July, a boy and a girl --- Sylas and Lucia --- remained in neonatal intensive care at Children's Hospital of Minneapolis.

Pregnancies resulting in multiple babies are increasing as more couples, like Brianna and Ryan Morrison of St. Louis Park, turn to fertility treatments or in vitro fertilization to conceive. However, such methods often lead to complications, as the Morrisons have experienced.

The Morrisons, both 24, said their Christian faith is sustaining them through their grief. The couple rejected "selective reduction" --- aborting some of the fetuses so that the remaining have a better chance at healthy growth and survival. On their Web site, Ryan Morrison said aborting fetuses was never an option for them, as they consider each baby a "miracle given to us by God."

Ten hours after the Morrison sextuplets were born, Jenny Masche gave birth to another set of sextuplets in Phoenix. Jenny Masche suffered acute heart failure several hours after the birth, but is recovering and all six of the infants survived.

The Morrisons used fertility drugs to achieve pregnancy; Masche and her husband, Bryan, used artificial insemination. The health complications associated with multiple births have resurfaced difficult questions regarding how to treat infertility.

The most common methods to assist couples trying to conceive are assisted reproductive technology and controlled ovarian hyperstimulation, according to the March of Dimes.

The first of the two methods involves procedures, such as in vitro fertilization, in which sperm and eggs are united in a laboratory and then implanted in the uterus.

Controlled ovarian hyperstimulation treatments include injectable medications that stimulate a woman's ovaries to accelerate egg growth and maturity. It often is combined with artificial insemination, in which sperm is placed directly into the uterus by a doctor.

The Catechism of the Catholic Church teaches that reproductive techniques that disassociate sex from reproduction --- such as artificial insemination --- are morally unacceptable, even if the sperm and eggs are from the husband and wife, because they disrespect the gift of sex and the dignity of the child to be conceived.

However, controlled ovarian hyperstimulation can be used alone, without combining it with reproductive techniques that disassociate sex from reproduction. This use has not attracted the attention of church documents or moral theologians, said Paul Wojda, a bioethicist and theologian at the University of St. Thomas in St. Paul.

"The general rule here is that as long as technologies don't replace the natural function but help it to achieve its intended function, it's morally permissible," he said in an interview with The Catholic Spirit, newspaper of the Archdiocese of St. Paul-Minneapolis.

Hyperovulation medication attempts to assist a natural process to do what it naturally does, he said.

It's important to remember that couples do not have a right to a child, said Father Peter Laird, a moral theologian who teaches at St. Paul Seminary. "Children are gifts," he said. "Couples that suffer infertility suffer a great cross. That's no easy reality."

Although not morally problematic in themselves, controlled ovarian hyperstimulation treatment methods may not be prudent for a variety of reasons, including the health of the mother or the babies. "Catholic principles tend to argue for a more conservative approach," Father Laird said.

While greater care has been taken in the United States in recent years to avoid pregnancies involving multiple fetuses, such cases mostly involve in vitro fertilization, which is morally impermissible, Wojda said.

Not only does in vitro fertilization disassociate sex from reproduction, it is also often complicated by "excess" embryos that are never implanted in the womb. Embryos deserve the full respect of human dignity, and the church teaches that to discard them or use them for research violates that right.

"Catholic couples who are having infertility problems really need to do their homework," Wojda said. "They really need to find the right fertility doctor and make sure that they're getting the best information possible on their infertility, its causes and the risks involved in using hyperovulant drugs.

"They can't simply assume that any old fertility doctor is going to be on the same page as they are as far as what's acceptable and unacceptable" from the perspective of church teaching, he said.

Couples struggling to conceive should learn natural family planning, which teaches couples their bodies' natural fertility cycles and maximizes the possibility to achieve pregnancy, Father Laird said.

"God has, by design, allowed for a proper way of spacing or planning births," he said, in that a woman is fertile during only a portion of her natural cycle, while men are always fertile.

"The more that a couple learns about these truths," he said, "the more a husband will be able to respect his wife and respect her body and (the) uniqueness of his body." ----CNS

Thursday, July 26, 2007

A Caution Against Coveting Parenthood

Throughout all the scientific advances and research that aid our knowledge and further our understanding of God's ingenious reproductive process, this article serves as a reminder that we must evermore guard our hearts by prudently discerning even the noblest of our human yearnings.

A Theological Caution on NFP

Rev. Benedict M. Guevin, OSB., Ph.D., S.T.D.

Ethics and Medics September 2000
Volume 25 Number 9

In “The Science of Natural Family Planning” (Ethics & Medics [25:5] May 2000), Mary E. and Robert T. Kambic of The Johns Hopkins University of Public Health review the scientific findings that are the foundation of Natural Family Planning [NFP] in the hope that preachers and teachers will use the information to renew acquaintance with and commitment to its practice. Having described the various methods of NFP, their effectiveness and certain misconceptions surrounding them, they discuss the benefits that come from their use: increased intimacy, lower divorce rates, and the diagnosis and treatment of infertility. Being a proponent of NFP in my upper level college course on sexual ethics, I laud the clear and accurate presentation of these two scientists.
Desire to Be a Parent
But I would like to issue a word of caution, not so much to the Kambics, but to those who may become or who are already committed to the use of NFP. This caution does not concern the practice of NFP itself, but rather what may be an unrecognized attitude toward future children that may be present in those who otherwise practice these methods in good faith. This unrecognized attitude can be stated as follows: to see future children not as a gift from the creative hand of God but as a means to satisfy the desire to be a parent.

Natural Family Planning is an effective method for spacing and limiting the birth of children. Such limiting and spacing is part of responsible parenthood when, for physical or psychological conditions of the husband or wife, or for external conditions (see Humanae Vitae [HV], n. 16) a couple decides to avoid for the time being, or even for an indeterminate period, a new birth (HV, n. 10).
But, as the Kambics indicate, NFP may also be used to plan a pregnancy: either because the couple has decided that the time is right, or because previous attempts at becoming pregnant have failed. If there is no medical problem, the charting of the most fertile times, and the discovery of irregularities in the woman’s signs and symptoms, can help many couples achieve a pregnancy of which they once despaired.

The avoidance of a pregnancy, either now or for an indeterminate period of time, for the legitimate reasons stated above, generally marks the attitude of parents using NFP. It is a responsible exercise of parenthood.

But what about the attitude of a couple who is using NFP in order to conceive a child? Undoubtedly, many couples do so with an outlook that is theologically commensurate with the method. Others, however, with good faith, may harbor the view that sees children as a means of satisfying their desire to be parents. Is such an approach in harmony with the theology that lies behind Natural Family Planning?

Children as God’s Gift
It is, of course, legitimate for a couple to want to have children. Among the characteristic features of conjugal love—a love that is human, total, faithful and exclusive—is that it is also fecund (HV, n. 9). In other words, conjugal love is not exhausted by the union of husband and wife, but is destined to continue by bringing forth new life (HV, n. 9). Indeed, [m]arriage and conjugal love are by their nature ordained toward the begetting and educating of children. Children are really the supreme gift of marriage and contribute substantially to the welfare of the parents (Gaudium et spes [GS], n. 50).

The Second Vatican Council recognizes that children are first and foremost gifts, indeed, the supreme gift of marriage. It recognizes, too, that children contribute to the welfare of their parents. But in what does this contribution consist? It consists, in the first instance, in the sanctification of the parents (GS, n. 48); second, “[w]ith sentiments of gratitude, affection and trust, they will repay their parents for the benefits given to them and will come to their assistance as devoted children in times of hardship and in the loneliness of old age” (GS, n. 48).

The gift of children can and, indeed, does bestow benefits on parents: sanctification and assistance in times of need. But nowhere is the satisfying of a couple’s desire to be parents a part of the Church’s understanding of the fecundity of conjugal love. Thus, while it is legitimate for a couple to want a child, a child, moreover, who may in fact, once conceived, satisfy a couple’s generative desires, it is not permitted for a couple to want a child in order to satisfy parenting needs. Such a desire would reduce the not-yet-born child to a means rather than an end. To avoid an attitude that may, unwittingly, reduce the not-yet-born child to a means rather than an end, couples should consider the extent and limits of their role in planning a pregnancy.

Planning a Pregnancy
Clearly, couples who use NFP in order to become pregnant are not leaving conception to chance. Among other things, responsible parenthood entails knowledge of and respect for the biological processes that make conception possible (HV, n. 10). Such knowledge and respect, as the Kambics point out, are gained by using NFP. But knowledge of and respect for these biological processes do not bring dominion over these processes with them. A conjugal act that “remains open to the transmission of life” (HV, n. 11) “capacitates” (HV, n.12) a couple for the generation of such new life. Couples are not the “arbiters of the sources of human life, but rather the ministers (emphasis added) of the design established by the Creator” (HV, n. 13).

Parents cooperate with God in the gift of transmitting human life by acknowledging the extent and limits of their role in planning a pregnancy. Such cooperation also acknowledges that God is the principle of human life which, from its inception, reveals the creating hand of God (HV, n. 13).

Parenthood is a worthy and God-given vocation which is rightly desired. This vocation allows husbands and wives to share in God’s own creative activity. NFP is a laudable means of sharing in God’s creation of new life. This new life is desired by God for its own sake and is sheer gift to be desired by parents for its own sake. The benefits such a new life bestow on parents are real, but such benefits should first be regarded as gifts from God.

Rev. Benedict M. Guevin, OSB., Ph.D., S.T.D.
Associate Professor of Theology
Saint Anselm College
Manchester, NH

Wednesday, July 25, 2007

The History and Science behind NFP

The following articles are in depth discussions on the evolution of NFP and its methods over the years, the scientific background involved in the different methods, the successfulness of NFP as a whole, and some advantages of NFP as opposed to forms of contraception.

After Rhythm: The Development of NFP

Mary Shivanandan, S.T.D., John Paul II Institute

Ethics and Medics
April 1995
Volume 20 Number 4

Enormous confusion exists among Catholics and non-Catholics alike about the various methods of natural family planning (NFP), and more importantly about its comparative effectiveness over against artificial forms of contraception. As the failure rates, abortifacient action, and health risks of hormonal contraceptives (e.g., bloodclotting, pulmonary embolism, and cerebral and coronary thromboses) have become more widely known, NFP has been increasingly recognized as a healthier and effective alternative. NFP has the further incomparable advantage of being in conformity with God's plan for our sexuality as reflected in Scripture and expressed in the Church's teaching on the inseparability of the unitive and procreative dimensions of sexuality. An historical survey of the development of NFP and a comparison of its effectiveness in both achieving and avoiding pregnancy may help to clarify its superiority vis-a-vis contraception.

Historically, advances in endocrinology made possible the development of both hormonal contraceptives, which suppress fertility, as well as the natural methods of family planning, which accept the natural rhythms of fertility. The first prerequisite for the development of both the Pill and NFP was a thorough understanding of the menstrual cycle and the effects of hormones on the cycle. Two signs of variations in the woman's menstrual cycle (aside from the menstrual flow) were observed by various researchers in the 19th and 20th centuries, the thermal or temperature sign and the cervical mucus sign, but there was still no understanding of how these changes related to the hormonal events of the menstrual cycle. It was only in the 1920s and early 1930s that the hormones, estrogen and progesterone, and their action on the reproductive system were discovered. The rise in estrogen is related to the ripening of an ovum or egg in the ovary while progesterone is secreted by the corpus luteum or yellow body left behind by the egg's rupture from the follicle.

The Rhythm Method (1929-32)
The Rhythm method was the first attempt to time intercourse according to the phase of the menstrual cycle. Kyusaku Ogino in Japan, from earlier research on corpora lutea, determined a formula for identifying fertility in women in 1932. It was based on the fact that after ovulation the duration of the period before the next menstruation is more or less constant with a normal range of 10-16 days. By counting backwards from menstruation, Ogino calculated the possible days of fertility and infertility. At about the same time, Herman Knaus in Austria also proposed a method of determining the fertile period based on his study of corpora lutea. Rhythm was not a satisfactory method of determining the fertile period because it depended too much on guesswork and not enough on scientific observation.

The Basal Body Temperature Method (1935)
A German Catholic priest, Wilhelm Hillebrand, began to recommend to his parishioners the Knaus calculations, but soon found a number of unplanned pregnancies occurring. Recalling the 1926 statement of T. H. Van de Velde that the corpus luteum causes a rise in temperature in the menstrual cycle, he began in 1935 to collect temperature records from 21 women. From the results he obtained, he developed the calculo-thermal approach (also called the basal body temperature method or BBT), which combined a calendar calculation for the beginning of the cycle and the temperature rise for the postovulatory phase. For the first time a woman had available an accurate scientific observation for identifying the postovulatory phase of the cycle which, if intercourse was confined to the postovulatory period, provided a method almost as effective as the contraceptive pill developed more than two decades later (see Christopher Tietze, "Ranking of Contraceptive Methods by Levels of Effectiveness," Advances in Planned Parenthood, 6 [April 9-10, 1970]). But such a method required too much abstinence if intercourse was postponed until the postovulatory phase and did not provide accurate information on the preovulatory phase where most of the variation occurs.

The Billings Method: Monitoring Mucus (1950s)
Two decades later, Dr. John Billings, a neurologist, was asked to assist married couples coming for instruction in fertility regulation at a Catholic marriage guidance center in Melbourne, Australia. He found both Rhythm and BBT inadequate for irregular cycles, which occur in all women sometimes, especially during breastfeeding and premenopause, and in some women most of the time. Especially during lactation, ovulation may occur without a previous menstruation, so that menstruation is not a good marker for predicting the onset of the fertile period. In searching the literature he found that a certain kind of mucus secreted by the cervix accompanies ovulation and he set about to study it.

Working with the women who sought advice from the center, he discovered that they could readily identify changes in the quality of mucus as ovulation approached. Professor J. A. B. Brown assisted the research on the mucus pattern by monitoring the menstrual cycles of the women through daily measurement of estradiol and pregnanediol. It was found that the women's observations of the mucus as it changes from cloudy and tacky to clear, slippery, and stringy, coincided with the levels of estradiol and pregnanediol found in the urine. Further hormonal studies with the help of Dr. H. G. Burger monitored the occurrence of the pituitary gonadotropins, FSH and LH, in the menstrual cycle. It was clearly shown that ovulation occurs between the LH surge and the secretion of progesterone. Here, then, was a method of identifying the fertile period based on sound scientific principles and observation, which did not depend on the length or regularity of the menstrual cycle. Dr. John Billings and his wife, Dr. Evelyn Billings, were not the first to incorporate the mucus sign into a method of natural family planning, but they were the first to rely on the mucus sign exclusively and to develop rules for its use as a complete method in itself.

The Sympto-Thermal Method (1950-70) While the Billings abandoned the temperature and additional signs of fertility such as the opening and closing of the cervix (a sign discovered by Dr. Edward F. Keefe in the early 1950s), other physicians and couples incorporated all the signs into the symptothermal method of natural family planning. Foremost among these were John and Sheila Kippley, who founded the Couple to Couple League, SERENA of Canada, and Dr. Joseph Roetzer of Austria. By the mid-1970s two highly effective methods of natural family planning had been developed, which could be successfully applied by couples either to avoid or achieve pregnancy throughout their reproductive life span.

Many other medical researchers have since contributed to the refinement of natural family planning, most notably Eric Odeblad of Sweden who has identified four different types of mucus and their effect on sperm migration and Thomas Hilgers of the Pope Paul VI Institute, Omaha NE, who has documented extensively the effect of inadequate fertile mucus on the occurrence of infertility. These developments are especially remarkable in view of the scarcity of funds for natural family planning research compared to funds and expertise available for contraceptive research from major foundations, medical institutions, government and private industry.

Effectiveness of NFP vs. Other Methods
While for many years natural family planning was classified with "traditional" or "folk" methods of family planning and considered equally unreliable, the family planning field has come to recognize the high method-effectiveness of modern NFP. Contraceptive Technology, ed. Robert A. Hatcher et al. (NY: Irvington, 1994) cites 2 and 3 percent as the "accidental" pregnancy rate within the first year of use if the sympto-thermal and ovulation methods are used perfectly (p. 652). Dr. Hanna Klaus cites an even lower rate of 0-2 percent pregnancies ("Action, Effectiveness and Medical Side-effects of Common Methods of Family Planning," Current Medical Research [Washington, DC: DDP for NFP, 1993]). Since couples are often ambivalent about another pregnancy, the range of use-effectiveness varies from a high of 99 percent to 80 percent. (Use-effectiveness rates refer to the success with which couples use the method in everyday life.) Competent instruction also affects pregnancy rates. Some of the highest use-effective rates have been recorded in developing countries such as India and Indonesia.

Contraceptive Technology rates modern NFP higher in method-effectiveness than all barrier methods, giving only hormonal methods and the IUD a higher rating. The Alan Guttmacher Institute also rates its use-effectiveness as comparable to the condom and more effective than other barrier methods (Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States [NY: Alan Guttmacher Institute, 1991]). In addition it has one of the highest continuation rates of any family planning method. Couples particularly appreciate its unique capacity among family planning methods to achieve as well as avoid pregnancy, the equal responsibility it calls for from husband and wife, and the opportunities it provides to enhance marital communication.

In spite of NFP's high effectiveness rates, couples are still routinely steered to "a more reliable method" of contraception (See, e.g., Contraceptive Technology, 330). It may be surmised that effectiveness is not so much the issue as the abstinence, or, in Christian terms, marital chastity, required to practice natural family planning (8-12 days in an average cycle).

The Science of Natural Family Planning

Mary E. Kambic, Robert T. Kambic, MSH
Ethics and Medics May 2000
Volume 25 Number 5

Despite the Church’s official support for the use of natural family planning (NFP), Catholic couples use the pill, condom, diaphragm, and get sterilized at the same rate as non-Catholics [F. Althaus, “U.S. Religious Groups Vary in Patterns of Method Use, But Not in Overall Contraceptive Prevalence,” Family Planning Perspectives, 23.6 (Nov.–Dec. 1991): 288–90]. The reasons for this are complex, but include the fact that the message is neither preached by clergy nor accepted by laity. On the other hand, there is both interest in and misinformation about NFP today. We find people around the world dedicated to its promotion and development. The purpose of this article is to review the scientific findings which are the foundation of NFP with the expectation that both preachers and teachers of NFP will use this information to renew acquaintance with and commitment to NFP.

We begin by reviewing the methods themselves and how well couples use them to time the births of their children. The effectiveness of NFP methods, when properly used, is equal or greater than that of barrier methods. We touch upon the shibboleth that the use of these methods may lead to birth defects or spontaneous abortions. The question of abstinence and reduced intimacy is examined and acknowledged. Finally, we examine the role of NFP in the diagnosis and treatment of infertility.

Various Methods of NFP
Most adult women in the world know that they can become pregnant for only a few days each month, generally about midcycle for women who are regular in their cycle. NFP is a body of knowledge based on naturally occurring signs and symptoms, that teaches women how to identify these days. The modern methods can identify the fertile time even in women who are irregular and amenorrheic.

The Calendar Rhythm method is the original NFP method developed simultaneously in Japan and Germany in the 1930s. It is the method commonly associated with NFP but has an undeservedly bad reputation because couples neglect to use it properly. It is simple and does not require daily observations as do the modern methods, but the lack of daily observations means chance is involved in its use.

The Basal Body Temperature (BBT) method became popular in the 1940s. The monthly temperature rise around midcycle gives a clear sign that the time of fertility is past but tells the woman nothing about the fertility of days prior to the rise. Then in the 1960s in Australia, Drs. John and Evelyn Billings realized that women who are aware of their daily cervical mucus secretions can know for each day of the menstrual cycle whether or not they are able to become pregnant on that particular day. This stunning discovery meant that irregular and breast-feeding women could use mucus observations to avoid conception and freed NFP users from the need for cycle regularity. Mucus awareness will be used by generations of women in the future to monitor reproductive health and plan families.

The three major methods, calendar, BBT, and mucus, are taught alone or in combination and have been christened many names—Sympto-thermal (ST), Ovulation Method (OM), Creighton Method, Billings Method, etc. Biologically, the methods are the same whatever the alias, and a woman’s charting of her symptoms is universally understood. In addition to the three major NFP methods there are other minor fertility signs such as intermenstrual pain and breast tenderness.
Effectiveness of the Methods
As health educators, we want to know about couples’ birth spacing intention and behavior. First, do couples want children now, want children later, or do they want no (more) children? Secondly, if they are using a birth control method, are they using it correctly? These two factors largely determine whether or not a woman will become pregnant while using any method. Couples who are determined to avoid pregnancy will have far fewer pregnancies than those who want more or are undecided about more children. And couples who bend or break the rules of the method of birth spacing they are using will become pregnant much more often, especially those who do not follow the rules of NFP.

The results of the many USA and international NFP studies lead to an incontrovertible conclusion. NFP use is as effective as barrier methods of family planning, which include the condom, foam, and diaphragm. Between 10 and 15 of 100 couples will become pregnant over the course of a year using NFP. Most of these pregnancies will occur because the couple did not follow the rules for NFP use. On the other hand, when used according to the rules, NFP is very effective. Most interestingly, when the rules are scrupulously followed, only 1 to 3 couples of 100 over the course of a year will become pregnant. The couple has control of their use of the method and their behavior determines their chances of becoming pregnant. Thus NFP can be used with assurance to avoid conception [R.T. Kambic, “The Effectiveness of Natural Family Planning Methods for Birth Spacing: A Comprehensive Review,” in Human Fertility Regulation: Demographic and Statistical Aspects, Sandro Girotto and Franco Bressan eds. (Verona: Edizioni Libreria Cortina: 1999), 63–90.

Even today one can still read in obstetrical and gynecological textbooks that NFP use may cause birth defects. These allegations are the result of hastily written attacks on Humanae vitae after its publication in 1968. Papers in scientific journals stated that periodic abstinence (natural family planning) users could have more spontaneous abortions or birth defects directly related to the use of these methods. These reports are few in number and methodologically unsound, but their shadow lingers on.

Johns Hopkins and colleagues from research institutions around the world conducted the first scientific study of NFP pregnancies in 1994. This study of 868 women and their babies found no relationship between spontaneous abortion and NFP or birth defects and NFP. Indeed, NFP users seemed to be a bit healthier than average [R.H. Gray, J.L. Simpson, R.T. Kambic, J.T. Queenan, P. Mena, A. Perez, M. Barbato, “Timing of Conception and the Risk of Spontaneous Abortion among Pregnancies Occurring During the Use of Natural Family Planning,” American Journal of Obstetrics and Gynecology 172 (1995): 1567–1572.]

Abstinence and Intimacy
NFP is used with abstinence from sexual intercourse during the fertile time if the couple wants to avoid pregnancy. It is possible to monitor fertility and to use barrier methods during the fertile time to avoid conception. However, NFP should be used with abstinence. There are several reasons for this. First is the Catholic Church’s proscription against any form of artificial method use. Second, the only time that women can get pregnant is the fertile time, which is the time during which barrier methods actually work to prevent pregnancy. If a woman does not want to become pregnant, but has sexual intercourse during a fertile time, there remains the possibility of pregnancy through contraceptive failure.

Detractors point out that NFP users have less opportunity for physical intimacy. On average, people in the USA have sexual relations about seven to eight times per month. There are a few studies of the frequency of sexual relations among NFP users. Our study at Johns Hopkins shows that for NFP users intending to avoid conception, sexual relations occurred between five and six times per month and for those not trying to avoid conception, seven to eight times per month. It is true that NFP users not wanting a child have less frequent sexual relations than the average American.

There are benefits to using NFP that place abstinence in context. First, there are no medical contraindications and no side effects to NFP use. Neither the husband nor the wife has the burden to bear alone. NFP use provides a deep and rich understanding of sexuality and reproduction in the context of the marriage relationship. Through awareness of and education about the respective reproductive functions of the male and female body, NFP provides an additional dimension of communication and respect within the marriage bond.

NFP users themselves learn to deal with abstinence in the context of their relationship. Each couple is different and if the couple is committed to NFP, they work on this issue as they do with other areas of their relationship. Some couples find that the time of abstinence is a time of anticipation, much like an engagement. Others have intercourse more frequently during the infertile time and still others focus their energy in other directions.

NFP, Divorce and Infertility
A commonly held perception is that NFP users do not get divorced. Somehow the use of NFP acts as a glue and keeps the marriage together and on track. NFP teachers are liable to promote NFP as a way to keep marriages healthy. We polled NFP leaders about their experience. They reported that the percentage of users getting divorced was minuscule compared to the general population rate of about 50%. The impression that NFP users do not separate is supported by the experience of NFP program directors. The National Catholic Register Foundation has funded a study of NFP and divorce in order to look into this matter in detail.

If these verbal reports are borne out by the study, NFP users probably do rarely divorce. But NFP use is most likely a sign of underlying harmony, strength of relationship, and commitment, rather than a cause. NFP use can strengthen these aspects of a relationship but cannot create them where they do not exist. Most NFP programs ask the husband and wife to come to instruction as a couple. The man participates by learning about his wife’s reproductive system, her signs, symptoms, and helps with charting and support.

Increasingly today, there are many couples who come to NFP to plan a pregnancy. A woman is fertile for many years until menopause and the average couple will have only two children during these years. Young couples may decide to delay having their first pregnancy until years after they are married and then when they try to become pregnant find that pregnancy is not forthcoming. When a couple is not able to become pregnant after one year of attempting to conceive, they are ready for infertility consultation, a large lucrative business.

One avenue open to these couples is to chart their most fertile times and discover any irregularities in the woman’s signs and symptoms. (Women are infertile in about 50% of the couples coming for counseling and the other 50% is either male infertility or unknown .) Knowing about their fertility increases confidence and helps to reduce the anxiety of infertility by giving couples some indication of their fertility status. Additionally, NFP charting is helpful to the infertility specialist working with the couple to achieve a pregnancy.

Those wanting to use NFP should work with an experienced teacher. There are NFP programs and teachers throughout the USA and around the world. NFP is healthy, safe, and effective. Catholics should review the reasons behind the Church’s commitment to it and reflect that it has something to teach us all about our continuing struggle with life here on earth.

Mary E. Kambic
Robert T. Kambic, MSH
Associate Scientist
The Johns Hopkins University
School of Public Health
Baltimore, Maryland

Tuesday, July 24, 2007

"Why NFP Differs from Contraception"

These excepts are from a letter by Pope John Paul II, found on the United States Conference of Catholic Bishops website. It is a brief summary that illustrates the morality of NFP and why it is not a form of contraception, but rather a cooperative effort with God by couples trying to follow His will for their family.

John Paul II

I hope that everyone will benefit from a closer study of the Church's teaching on the truth of the act of love in which spouses become sharers in God's creative action.

The truth of this act stems from its being an expression of the spouses’ reciprocal personal giving, a giving that can only be total since the person is one and indivisible. In the act that expresses their love, spouses are called to make a reciprocal gift of themselves to each other in the totality of their person: nothing that is part of their being can be excluded from this gift. This is the reason for the intrinsic unlawfulness of contraception: it introduces a substantial limitation into this reciprocal giving, breaking that “inseparable connection” between the two meanings of the conjugal act, the unitive and the procreative, which, as Pope Paul VI pointed out, are written by God himself into the nature of the human being (HV, no. 12).

Continuing in this vein, the great pontiff rightly emphasized the “essential difference” between contraception and the use of natural methods in exercising “responsible procreation.” It is an anthropological difference because in the final analysis it involves two irreconcilable concepts of the person and of human sexuality (cf. Familiaris consortio, no. 32).

It is not uncommon in current thinking for the natural methods of fertility regulation to be separated from their proper ethical dimension and to be considered in their merely functional aspect. It is not surprising then that people no longer perceive the profound difference between these and the artificial methods. As a result, they go so far as to speak of them as if they were another form of contraception. But this is certainly not the way they should be viewed or applied.

On the contrary, it is only in the logic of the reciprocal gift between man and women that the natural regulation of fertility can be correctly understood and authentically lived as the proper expression of a real and mutual communion of love and life. It is worth repeating here that “the person can never be considered as a means to an end, above all never a means of ‘pleasure.’ The person is and must be nothing other than the end of every act. Only then does the action correspond to the true dignity of the person.” (cf. Letter to Families, no. 12).

The Church is aware of the various difficulties married couples can encounter, especially in the present social context, not only in following but also in the very understanding of the moral norm that concerns them. Like a mother, the Church draws close to couples in difficulty to help them; but she does so by reminding them that the way to finding a solution to their problems must come through full respect for the truth of their love. “It is an outstanding manifestation of charity toward souls to omit nothing from the saving doctrine of Christ,” Paul VI admonished (HV, no. 29).

The Church makes available to spouses the means of grace which Christ offers in redemption and invites them to have recourse to them with ever renewed confidence. She exhorts them in particular to pray for the gift of the Holy Spirit, which is poured out in their hearts through the efficacy of their distinctive sacrament: this grace is the source of the interior energy they need to fulfill the many duties of their state, starting with that of being consistent with the truth of conjugal love. At the same time, the Church urgently requests the commitment of scientists, doctors, health-care personnel and pastoral workers to make available to married couples all those aids which prove an effective support for helping them fully to live their vocation (cf. HV, no. 23-27).

More Reasons to Decline IVF.

The following article exposes more of the repercussions and evils that are IVF, and ART as a whole.

IVF Turns Families Topsy-Turvy

Troubling Consequences of Artificial Reproduction
Rome, July 23, 2007

- As demand for in vitro fertilization continues to rise, so too are concerns over the clinics and consequences for families. A leading British expert recently had harsh words for the industry, whose methods have long been criticized by the Church.

Robert Winston, professor of fertility studies at Imperial College London, said clinics had been corrupted by money and that doctors were exploiting women desperate to get pregnant, reported the Guardian on May 31. "It's very easy to exploit people by the fact that they're desperate and you've got the technology, which they want, which may not work," he said.

When it comes to the impact on family life, one of the changes introduced is the trend toward older mothers, reported the London-based Times newspaper June 6. The proportion of in vitro fertilization (IVF) patients aged between 40 and 45 has risen from 10% in the 1990s to 15% in 2006, the article noted. Last year a total of 6,174 women in this age group had fertility treatment, compared with just 596 in 1991.

The average age of all fertility patients has also increased by a full year since 1996, from 33.8 to 34.8. The information comes from data published by the Human Fertilization and Embryology Authority.

The Times commented that the success rate of treatments at an older age is much lower. For women aged between 40 and 42, the live birthrate for a first treatment cycle is 9%. Once they are 44 or above it is 1%. Moreover, at 40, the risk of miscarriage is twice what it is at 20, and there is an increased likelihood of ectopic pregnancy, premature birth, stillbirth, neonatal death and birth defects.

Twins at 60
Shortly before the publication of this data, news came from the United States of a 60-year-old woman who gave birth to twin boys, reported the Associated Press, May 23. Frieda Birnbaum gave birth to the boys at Hackensack University Medical Center, New Jersey.

Another case that received attention was that of Spanish mother Carmela Bousada, who gave birth at 67 to twins, reported the Times on Jan. 29. She underwent IVF treatment at the Pacific Fertility Center in Los Angeles.

Meanwhile, the Canadian newspaper the Ottawa Citizen reported April 18 the case of Melanie Boivin, who donated some of her ova to her daughter, Flavie. The daughter, aged 7, is sterile due to a genetic condition. The article commented that if Flavie eventually decides to use the ova and becomes pregnant, she will be give birth to her genetic sister and Melanie Boivin will simultaneously become mother and grandmother. The mother's actions were criticized by ethicist Margaret Somerville, the paper reported. "We have to think about what we are doing when we are running around nature," she said, noting that such a procedure completely overturns the normal transition of life.

Another practice that raises ethical doubts is the increasing use of surrogate mothers from developing nations to bear children for families from richer nations. One of the countries where this is taking place is India, explained an article published by Reuters on Feb. 4. A surrogate mother in the United States would cost a couple anything up to $50,000, Gautam Allahbadia, a fertility specialist, told Reuters. In India, however, it can be done for $10,000-$12,000. The Indian clinics usually charge $2,000-$3,000 for the procedure while the surrogate mother is paid $3,000-$6,000. The article observed that there are no official figures, but it is possible that 100-150 surrogate babies are born each year in India.

Clinics are also starting to offer treatments aimed at the homosexual community. The Los Angeles-based The Fertility Institutes has launched a program for homosexual men who want to become parents, Reuters reported March 14. According to clinic director Jeffrey Steinberg they have already treated about 70 gay male couples while preparing the new service. He also noted that around three-quarters of the homosexual couples pay extra to choose the sex of their baby.

The convoluted parental structures created by IVF techniques also give rise to complex legal problems. A surrogate mother who has no genetic connection to the baby she is carrying does not have to be listed as the mother on a birth certificate, ruled the Maryland Court of Appeals, according to a report by the Associated Press on May 16. The case involved twins born in 2001. The woman carried the twins for a father who used an egg donor, and the surrogate mother had no genetic relationship to the twins.

Another case, still to be decided, involves the fate of a couple's frozen embryos. Augusta and Randy Roman decided to go ahead with treatment to produce the embryos, but just hours before they were due to be implanted in the wife's womb, her husband decided he did not want to go ahead with the procedure, reported the Los Angeles Times on May 30. This took place in 2002 and the following year the couple divorced. Since then they have disagreed over the fate of the frozen embryos and the matter has now reached the Supreme Court of Texas. Randy wants the embryos destroyed or to remain frozen.

The Los Angeles Times noted that so far the top courts of six states have ruled in such cases. In general they have decided that the right of one ex-spouse to not procreate trumps that of the other to procreate.

Not morally neutral
Church has long warned of the problems associated with IVF. In 1987 the Congregation for the Doctrine of the Faith published the "Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation," ("Donum Vitae").

Since 1987, the technologies involved in IVF have changed greatly, but many of the underlying ethical problems are the same. Science and technology are valuable resources, the instruction readily acknowledged. Nevertheless, it is a mistake to consider that scientific research and its applications are morally neutral. Moreover, the Congregation for the Doctrine of the Faith explained, they must be put at the service of the human person and should follow the criteria of the moral law. It is a mistake to consider the human body as merely made up of biological elements, the instruction argued. The human person has both a bodily and a spiritual nature.

As well, when it comes to the question of transmitting human life, it is not permissible to ignore the special nature of the human person. From the moment of conception, the instruction insisted, the life of every human person must be respected. In addition, the gift of human life should be carried out in the context of acts by a husband and wife.

The congregation admitted that the desire for children and the love between spouses who wish to overcome problems of sterility "constitute understandable motivations," behind the use of IVF methods. Nevertheless, the instruction continued, the existence of good intentions needs to be placed alongside the nature of marriage and the need to respect the rights of the child.

The document also commented on how only too often IVF techniques involve the destruction of human embryos. By acting in this manner we place ourselves in the position of imposing "death by decree," the text warned. The regular practice of such acts carries with it the risk of creating a mentality that leads us to a domination over the life and death of fellow human beings, the congregation adverted. A domination that with the passing of time is creating a seemingly unstoppable slide into practices that bring about serious moral and social dilemmas.

Monday, July 23, 2007

Ethical Answers to Infertility 2

The Gift of Infertility Part 2

Dr. Jameson and Jennifer Taylor

Catholic Exchange
July 22, 2007

As we saw in part one of this series, couples who have learned to chart effectively have a 76 percent chance of conceiving during their first cycle of use and a 98 percent pregnancy rate by their sixth cycle. Still, even if natural family planning (NFP) does not work for everyone (us included), artificial reproductive technologies (ART), such as intrauterine insemination (IUI) and in vitro fertilization (IVF), are contrary to the Church's teaching on human sexuality. Not only do IUI and IVF frustrate the unitive aspect of lovemaking, they violate the baby's right to be conceived through a person-to-person, body-to-body communion of husband and wife.

Person to (Doctor to) Person
Just as the person is an integration of the physical and the spiritual, every act of lovemaking should be ordered to the physical and spiritual good of each spouse. The physical goods of intercourse — pleasure and reproduction — need little explanation. The spiritual goods — primarily joy and gratitude — are derived from knowing that your spouse accepts and embraces all that you are. In this acceptance, the person is treated as an end in himself rather than a means to an end.

Couples struggling with infertility often experience an intense bond that comes from enduring the crisis of infertility together. Such intimacy, however, is distinct from the personal communion that only occurs in the conjugal act. Perhaps more than others, infertile couples can appreciate the spiritual benefits of lovemaking. When you are infertile, every act of intercourse is pregnant with the hope that God will work a miracle.

By contrast, techniques such as IUI and IVF entail an intentional decision to bypass the unitive aspect of the marital act. The use of these procedures transforms what is supposed to be a spiritual union between two persons into a merely biological process. Unlike intercourse between animals, though, the marital act requires that husband and wife surrender their entire selves to each other and to God.

This total gift of self, from which the spiritual goods of the conjugal act are derived, is inseparable from the act itself. For this reason, techniques such as IUI and IVF cannot bring about the spiritual goods unique to marital intercourse. Donum Vitae (The Gift of Life) explains: "The origin of the human being thus follows from a procreation that is 'linked to the union, not only biological but also spiritual, of the parents, made one by the bond of marriage.' Fertilization achieved outside of the bodies of the couple remains by this very fact deprived of the meanings and the values which are expressed in the language of the body and in the union of human persons" (II, 4).

The "meanings and values" inherent to the conjugal act are uniquely personal. That is to say, man and wife can only give themselves person to person, not person to catheter to person, or person to petri dish to person. By definition, this union is exclusive. Hence, nothing should come between the person-to-person, body-to-body communion of husband and wife. IUI and IVF are not conjugal acts because they are not extrinsically exclusive. The very possibility that these procedures can produce a baby between two people who have never even met one another indicates that IUI and IVF are not exclusive, and hence, not personal. To claim that they are is to redefine the conjugal act, much as homosexuals want to redefine marriage as a union between any two people who subjectively love one another. The wisdom of the Church's instruction is derived from the recognition that the marital act is designed by God to adhere to certain objective standards.

What About the Baby?
Most people believe that intercourse should be something more than a physical process aimed at making a baby — that the baby himself has a right to be created through the loving union of two persons. This intuition, at least, helps to explain why couples who use IUI and other reproductive technologies continue making love even after the procedure in the hope that their child might be the result of a natural conception — a conception achieved without the intervention of a third party. It also permits the couple to believe that their baby is the product of their conjugal love for one another in spite of their use of a procedure aimed at conceiving a child outside of a specific conjugal act. In effect, these couples presume IUI and IVF are personal acts because they occur within the context of ongoing marital relations. But not every sexual act that may occur within marriage — sodomy, for example — is a personal act.

As suggested above, a personal act harmonizes the spiritual and physical welfare of each spouse. This integration is what distinguishes mere reproduction from procreation — creation that seeks to imitate God in his own generosity and fecundity (cf. CCC 2335). In doing so, the couple extends God an invitation to enter into and bless their sexual union in whatever way He desires. This idea, that a child has the right to be created by God through a specific personal act, is especially stressed in Donum Vitae: "Conception in vitro is the result of the technical action which presides over fertilization. ... In homologous IVF and ET [embryo transfer], therefore, even if it is considered in the context of 'de facto' existing sexual relations, the generation of the human person is objectively deprived of its proper perfection: namely, that of being the result and fruit of a conjugal act in which the spouses can become 'cooperators with God for giving life to a new person.' These reasons enable us to understand why the act of conjugal love is ... the only setting worthy of human procreation" (II, 5).

To conceive a child through a technological process that replaces the conjugal act is to subject him to the "standards of control and dominion" inherent to the scientific method (II, 4). As such, the baby becomes an object of micromanipulation, rather than the fruit of a personal union sanctified by God.

Christians who approve of IUI and IVF maintain that these "artificial means merely assist the natural process." The Church, however, teaches that these procedures replace the conjugal act. Clarifies Donum Vitae: "A medical intervention respects the dignity of persons when it seeks to assist the conjugal act either in order to facilitate its performance or in order to enable it to achieve its objective once it has been normally performed" (II, 7). In the case of IUI, IVF, and other techniques, "The medical act is not, as it should be, at the service of conjugal union but rather appropriates to itself the procreative function and thus contradicts the dignity and the inalienable rights of the spouses and of the child to be born" (II, 7).

Divine Grace and Human Nature
What is primarily at issue here are the differing views of human nature held by Catholics and Protestants. Catholic doctrine maintains that grace builds on nature. God — and man's — action in the world must thus respect the natural order, which itself is part of the eternal order. Protestant theology believes nature is something low, something to be overcome by grace. For the Catholic, IUI and IVF are immoral because they replace the natural means by which a child should be conceived and, in so doing, subvert the natural ends of marital sexuality. For the Protestant, these natural means (and ends) are much less important than the good intentions and faithful heart that accompany the use of these techniques. As the authors of Empty Arms put it, "One can use 'unnatural' treatments and still demonstrate trust in God." What is important for the Protestant is the belief that God is working through these procedures, apart from whether or not the procedures are performed according to nature.

United in prayer and hope in God's generosity, couples who use IUI and IVF naturally feel as if their struggle with infertility has brought them closer to each other and to God. Yet these couples, albeit inadvertently, are impeding their union as man and wife by enabling a third party to intervene. The Catechism counsels: "These techniques ... betray the spouses' 'right to become a father and mother only through each other'" (CCC 2376). Some couples intuit this fact by acknowledging that masturbation is embarrassing or that choosing IVF was an extremely difficult decision. Nevertheless, these same people will maintain that they don't feel alienated from each other or God. The case is similar to those who justify their use of contraception by saying: "If God wants us to have a baby, we'll still have one." Yet, as the author of life, God "fearfully and wonderfully" begets each one of us "in secret" (Ps. 139:13-16). According to Scripture, this is His right alone (cf. Eccl. 11:5). Sure, God is acting when a man and a woman conceive a child outside of the natural order, but His hand is being forced. In such cases, God is present only permissively, rather than actively. Every baby, however, has the right to be given as a gift, a blessing bestowed according to the natural means established by God in accord with His perfect timing.

This is not to deny that babies produced through IUI and IVF are just as cute, wonderful and loved as any other children. The joy they bring to their parents is also just as real, if not more intense. This happiness, though, comes at the expense of the babies who have been denied the right to be conceived through a personal act. Needless to say, children created through artificial techniques are persons; they have immortal souls. Once conceived they also have a right to be loved and protected by their parents and society. Still, no one would admit that every act that results in the conception of a child is morally licit. Rape, for instance, may also result in the conception of a child.

Likewise, as we will see in part three of this series, not every act that creates life is "pro-life" — or even promotes the dignity of life.

Sunday, July 22, 2007

NFP Awareness Week July 22- 28, 2007

NFP Awareness week's date was chosen based on the Feast on St. Joachim and St. Anne, celebrated on July 26th, as well as the July 25th release of Humanae Vitae by Pope John Paul II. The week's purpose is to spread information and support for NFP through education on its theological basis and methods.

Throughout the week I will be posting articles, and other things, on issues related to Natural Family Planning.

Redeemed Sexuality

Theresa Notare

As Christians we should be grateful beyond words for the gift of our redemption. We believe that Christs action on the cross has changed all things, for all time. We should seek to relate every aspect of our lives to how Christ has redeemed us and our world. When we consider the mystery and contemporary confusion — of human sexuality, it is even more urgent for Christians to ask, How has Christ redeemed human sexuality?

Today our media features topics that not long ago would have been labeled science fiction, or pornography. Cloning, casual sex, getting pregnant by means of reproductive technologies, frozen embryos, adultery — the list goes on. Does anyone in the public square relate these issues to the spiritual? When those of us try to bring God into the equation, we are often told that individual morality must not be imposed on the public. But that should not deter the Christian.

Christs work on the cross has restored all of human life, even human sexuality. That means that human sexuality is not tinged with sin, nor is it morally neutral. Although we can misuse even the best of Gods gifts, that does not change the fact that sex is Gods gift of life and love to us. Specifically, sexual intercourse was never meant to be directed to the individual. Its not a sport or game to be enjoyed on its own. Sexual intercourse is a powerful event of interpersonal communion — it is a sacramental event.

This makes more sense when we realize that Christian marriage is a sign of Christs presence in the world. As Christians we accept on faith that human sexuality is caught up in Christ, uniting a man and woman in a union which reflects Gods love in the world and is directed to others. With that starting point, it makes excellent sense to keep sex in marriage.

The redeemed nature of marriage was understood by the Church from our earliest history. Following up on Jesus own words on the indissolubility of marriage, St. Paul likened Christian marriage to Christs relationship with His Church. As Christ loved the Church . . . so the husband should love and cherish his wife as he cherishes his own body; for husband and wife are one body, as Christ and the Church are one body. This is a great mystery (Ephesians 5:21-33). St. John Chrysostom (347-407) taught that the one flesh of the spouses is not an empty symbol. They have not become the image of anything on earth, but of God Himself (Homily 12).

The love of spouses, says the Catechism, requires of its very nature, the unity and indissolubility of the spouses community of persons, which embraces their entire life (#1644). The root of this indissolubility is found in God Himself, who taught us of His fidelity through His covenant with Abraham. It is found finally in Christ, who united Himself with His Church.

In this age of continuous assaults on Gods design for life and love, it would do the world good if Christians reclaimed our rich heritage. Before we can do this we need to return to the mystery of our faith and meditate on who Jesus is, what He did for us, and how this has changed all life for all ages.

Theresa Notare, MA, is Assistant Director of the Diocesan Development Program for NFP, A program of the United States Conference of Catholic Bishops Committee for Pro-Life Activities.

Saturday, July 21, 2007

Phillip's New Dieu

Here are the requested pictures of Phillip's new kneeler - assembled by yours truly.

Thursday, July 19, 2007

A Vanishing Line

The following article calls into question the blurred line between sufficient prenatal care and eugenics in the secular field of obstetrics.

The question I pose is where do you halt your curiosity to maintain clear judgment in regards to your unborn child? This boundary, I'm sure, is different for everyone and difficult to be sure of until placed in a similar situation, however, I think it does deserve previous contemplation and spiritual preparation.

As an example, to completely circumvent any temptation of abortion in the event of tragic news concerning their unborn child, I know some who avoid all intrauterine testing including sonograms. Others may find the total hands off approach to be extreme, but that stance truly prevents any possibility for Doctors to suggest termination due to a diagnosed birth defect. Moreover and undeniably the process of procreation has become so intrusive as technology and science have progressed. In the fast approaching future, I don't doubt that, through In vitro fertilization
, parents will be able to choose their baby's sex and other distinguishing characteristics such as height and intelligence level. In fact, as part of the currently ongoing embryonic pre-screening done for IVF, embryos with an affinity for certain cancers and other fatal diseases are deemed unacceptable and are therefore never given a chance for implantation. What these practices really come down to is that yet again man is attempting to take on the identity of God, and we all regretfully know where those actions lead.

When Expectant Parents Hear “Bad News”

Elias Crim

Catholic Exchange
July 18, 2007

Like many other laypeople who found a new ministry, Monica Rafie first had to undergo a personal trial by fire. On her website,, she recounts what happened at the clinic in suburban Chicago in June 2001, when her second child, Celine, was 22 weeks along.

The OB left us in the exam room for a very long time. I don't know whether she had ever delivered bad news before. I wonder what must have raced through her mind when she looked over the ultrasound. Eventually she did return to the little room where I sat with legs dangled over the examination table and my husband bobbed our squirmy ten-month old son on his knees...We were told that our baby had hypoplastic left heart syndrome, a condition incompatible with life.

A few days later, Monica and her husband talked with a maternal-fetal specialist and were given the same options: termination, comfort care, surgeries or transplant. "By then we had done some research and had a better understanding of the situation. We knew by then that 'incompatible with life' was not entirely accurate. We also knew that if our baby would survive, it would require that we fight for her. We didn't know yet exactly what we would do, although termination was out of the question."

Next, something fairly common in prenatal counseling occurred: these parents discovered that the first diagnosis was wrong. The baby had hypoplastic right heart syndrome, a very rare defect and one with a somewhat better prognosis than the first. When their daughter was born, she showed symptoms of heart failure within hours and required her first open-heart surgery at just barely one week old.

Many months of "fighting for her" followed, with little Celine doing a good deal of fighting herself, with two more surgeries to follow, and the unpleasant post-surgical experience which included dehydration, suture pain, IVs, chest tube removals, poking and prodding, not to mention simple boredom in the hospital bed. But, as her mother maintains, it was a matter of trading temporary discomfort in exchange for her very life.

Today, Celine is a normal five-year old with excellent heart function and no developmental delays. She may have a pacemaker in her future but her slapstick sense of humor gives no hint of discouragement.

During this experience, Monica's search led her to online sites that featured "termination message boards", where nobody was really allowed to offer hope or support. "They were little chambers of doom" she reports, places where parents were trying to cope with the advice to "say goodbye early."

Many women, she discovered, are willing to take the practitioner's advice at face value, "usually out of fear." One physician remarked to a mom with a difficult pregnancy that "it would be selfish and cruel to have this baby"! Such episodes are evidence of the degree to which eugenic thinking has seeped into American medicine today. Pediatricians are very familiar with the quest for the "perfect baby", the option to terminate and "try again". Many families, when caught up in the urgency and shock of the crisis, never think to question the authority of physicians who go beyond the medical realm to offer arbitrary assessments of the "worthiness" of a life, sometimes in stunningly insensitive language.

Monica's research also revealed that on numerous occasions ultrasounds and other prenatal technology can lead to misdiagnoses and over-diagnoses — which then lead not only to unfortunate decisions about terminating the baby's life, but also the emotional trauma of knowing it was all a terrible mistake.

She also discovered that there were very few websites devoted to collecting stories of women who had the courage to defy the experts, be they Catholic women or otherwise. After some advice from her husband, who owns a web development company, the BeNotAfraid website — a glossy, sleek-looking effort — was launched.

"Our site is not actually not about abortion, it's about what happens when you choose life", Monica explains. "And it's not just for faithful Catholics, although there are many great Catholic medical ethics resources which we selectively prefer", she adds, "nor is it a grief site" (it is full of incredible stories of hope and joy, in fact). "It's really for anyone open to — or even just willing to be open to — the idea that carrying the baby and facing whatever comes after with trust and gratitude to God is really the right way to go."

Then there's all the valuable information families will find on the site. With all the ill effects of the Internet, we can be grateful for its invaluable laser-like power to search out highly specific and needed information of this kind.

For example, in the pull-down list of some two dozen genetic problems covered on Monica's website, Pallister-Killian syndrome is one of the more obscure, with only some 200 known cases worldwide at the moment. Yet someone — possibly after an experience such as Monica's — has founded to serve these families.

In addition to personal testimonies from families who have chosen to put aside their fears, the BeNotAfraid site contains a message board, where parents may find posted, say, the contact information for the best specialist physicians treating a certain condition. The board also serves for posting prayer requests, prayer support and other spiritual (mostly Catholic) resources.

Finally, the site's Resources area has a very extensive collection of links on topics like medical/financial assistance, groups specializing in a particular prenatal problem, fetal surgery, grief resources, future planning, and many more.

In some ways, this site for twenty- and thirty-somethings may typify the new face of the pro-life movement, especially in the fact that politics does not appear anywhere on it. "I'm interested in helping and supporting families who arrive at their own decision for life", Monica reflects. "There is a time and a place for discussing legislation and the awful injustice of abortion, but that's not what our outreach is about. I think that's one reason why some medical professionals feel comfortable sharing the outreach with parents."

Perhaps most importantly, all these stories end in joyful victory, even when a child is lost. If you've ever wondered what the statement "suffering is salvific" might mean, go to the site and read the story "Anouk" (under "Anencephaly") that begins: "On the 18th July 2000, our fourth child, Anouk, was born. Thirteen hours later she died. Today, I will try to write down what we lived through with her."

The visitor will find here many beautiful and extraordinary stories of harrowing fear finally overcome by joy. As one father states it, "We could choose to love this child (no matter what) or choose to be afraid of the future, of how this person would change and affect our lives. In choosing to have the baby, we did not think that God would magically 'rescue' us from difficulties now or in the future, but that He would give us the courage to learn how to love more deeply through whatever the future may hold."

Elias Crim is a publishing consultant who writes from Valparaiso, Indiana.

Monday, July 16, 2007

The Abortion and Breast Cancer Connection

Breast Cancer and Abortion: Is There a Link?

Germain Kopaczynski

Ethics and Medics
May 1995
Volume 20 Number 5

The statistics are cause for grave concern: according to the American Cancer Society, there are 182,000 cases of breast cancer diagnosed each year and 46,000 woman die annually of the disease. Why has there been such a high rate in the incidence of this type of cancer? And why especially in the United States? Since the cancer rates are higher among well-educated than among poor women, some have opined that the reason for this may well be lifestyle factors such as diet. Other studies seize upon another possibility; reproductive decisions.

Recent Studies
The catalyst for the spate of recent interest in the number one killer of American women was a recent study. "Risk of Breast Cancer among Young Women: Relationship to Induced Abortion" written by Janet Daling and appearing in the Journal of the National Cancer Institute 86 (1994), 1584-1592. While Daling's article may be the most recent, it is certainly not the first to study this purported link. In the medical literature, we find that as far back as 1957, researchers in Japan were discussing the increased risk from breast cancer following both spontaneous and induced abortions. Anyone who consults MEDLINE, an online bibliography, will see a steady stream of recent articles in medical journals ever since, including that of H.L. Howe et al., "Early Abortion and Breast Cancer Risk Among Women Under 40," International Journal of Epidemiology 18 (1989), 300-304.

Before Daling's 1994 article, perhaps the most famous and oft-cited was that of M.C. Pike et al., "Oral Contraceptives Use and Early Abortion as Risk for Breast Cancer in Young Women," British Journal of Cancer 43(1981), 72-76, which concluded that a first-trimester abortion before a woman has had her first full-term pregnancy was associated with a 2.4-fold increase in breast-cancer risk. What is important to note here is that the first pregnancy when taken to full-term affords a woman an appreciable measure of protection against breast cancer; an induced abortion of a first pregnancy places a woman at a much greater risk for the dread disease.

Studies on the link between the rise of breast cancer and the incidence of abortion have been so numerous and so persistent that in January of 1994, the Washington-based National Women's Health Network [NWHN] felt obliged enough to come out with an opposing fact sheet entitled "Abortion and Breast Cancer: The Unproven Link." However, the accumulating evidence supports the opposite assertion, viz., that there well may be a link, as we shall see.

How Abortion May Generate Breast Cancer
One of the most intriguing of the studies linking breast cancer and abortion is that by J. Russo and Carcinogenesis: Pregnancy Interruption as a Risk Factor," American Journal of Pathology 100 (1980), 497-512. Using rats in an experiment, the authors attempt to explain how the link between abortion and breast cancer comes about in a physiological sense.

The NWHN document referred to earlier is not unaware of the Russo study and what it may mean:

Biological evidence from animal studies demonstrates that there is a plausible explanation for an association between breast cancer and abortion. When a pregnancy is interrupted, as in abortion, the mammary glands contain some areas with completely differentiated structures and other areas of immature cells. (Russo, 1981). Thus the breast is more susceptible to the initiation or promotion of cancer. Studies to this effect in rats are useful since rats' breast tissue is similar to humans.

How does this link come about? Researchers are turning their gaze to the issue of cell growth to find an answer. In a recent article appearing in the Journal of the National Cancer Institute 85, no. 24 (December 15, 1993) "Does Abortion Increase Breast Cancer Risk?" Troy Parkins mentions the Daling study (which had not yet been published) as tending to the conclusion that there is a 50% to 90% increase in breast cancer risk for women who have had an abortion before the age of eighteen, and tries to explain the findings by putting forward a hypothesis by Leon Bradlow, M.D., Director of the Laboratory of Biochemical Endocrinology at the Strang-Cornell Cancer Research Laboratory in New York who said, in effect, that a full-term pregnancy confers a protective benefit upon women, helping them avoid breast cancer. Parkins paraphrases Bradlow's argumentation:

Numerous scientists believe the protective benefits of pregnancy arise from having differentiated breast cells because breast cancer arises in undifferentiated cells. During the first half of pregnancy, increased concentrations of estrogen stimulate the mother's breasts to grow. During the second half of pregnancy, breast cells differentiate to allow milk production. There is substantial scientific evidence that estrogen increases breast cancer risk. If a pregnancy is cut short by spontaneous or induced abortion, the woman experiences high estrogen concentrations without differentiation. Some doctors say this explains studies that show an increase in breast cancer risk among woman who have had a spontaneous or induced abortion. Bradlow feels strongly that these studies should be publicized.

Ideology Meets Science
What makes this issue so volatile, of course, is the abortion connection. The NWHN fact sheet, while aware of the pertinent scientific studies attempting to establish the link between breast cancer and abortion, especially of a first pregnancy before the age of eighteen, concludes: "There is currently no scientifically acceptable reason for women to factor an increased risk of breast cancer into their decision whether or not to continue a pregnancy." I find this statement odd because the very studies cited by NWHN lead to the opposite conclusion. What is going on here? Why such an incongruity when dealing with an issue of life and death for so many women? While conceding that women should have as much information as possible about all the factors which may contribute to breast cancer risk, the last paragraph of the NWHN may give the explanation: the group "supports all reproductive rights, including the right to abortion." Is this concern for women's health or is this feminist ideology at work?

Researchers like Daling, while they may be personally pro-choice, believe that this information should become part of the total package of women's right to know everything pertinent about their bodies and the possible harmful effects of the abortion procedure (See Daling's remarks in "Do Abortions Raise the Risk of Breast Cancer," Time Nov. 7, 1994, p.61).

The Sacred Cow Meets the Smoking Gun?
The NWHN may well be right in saying that the link between breast cancer and abortion of a first pregnancy has as yet not been established without any trace of scientific doubt. No researcher, as far as I can tell, is saying that abortion is the only factor responsible for the rapid rise in breast cancer rates among American women. It is one factor, nothing more, nothing less. When the NWHN and other groups take the ideological approach that they do, is it my imagination or are they, in fact, emulating the tactic employed by tobacco companies discounting the purported link between lung cancer and smoking? If abortion is not the smoking gun, neither should it be regarded as a sacred cow.

Feminist Adrienne Rich once wrote: "Abortion is violence: a deep desperate violence inflicted by a woman upon, first of all, herself" (Of Woman Born: Motherhood as Experience and Institution {New York: Bantam Books, 1977}, pp. 268-269). In the tortured prose of this passage, and in the light of the medical studies on the topic we have consulted, Rich may be saying much more than she knows.

Germain Kopaczynski, O.F.M. Conv.
Director of Education
Pope John Center

The Abortion-Breast Cancer Link

Angela Lanfranchi

Ethics and Medics January 2003
Volume 28 Number 1

Thirty years ago when Roe v. Wade was decided, I was a third-year medical student at Georgetown University. The third year is when medical students leave the classroom and go into hospitals to do their clinical rotations. The ruling had an immediate effect on the practice and ethics of medicine. No longer would my obstetrics professor tell his students that his was a unique specialty, that he always had two patients to consider, mother and child. Now only when the mother wanted the child did we treat two patients. When the mother didn't want the child, no consideration would be given to the unborn's humanity. It was no longer a child but a blob of tissue, a "product of conception," a parasitic entity or whatever the mother chose to call "it." For the first time, every doctor in every state could legally kill another human being. On my pediatric rotation that year, I helped to resuscitate a child who was born four months prematurely crying aloud, struggling to breathe. She was the result of a failed abortion. She was wizened and burned from the hypertonic saline used to try to kill her on the hospital floor just below the nursery. I can still see her clearly in my mind's eye.

One and a half years after Roe v. Wade, when I graduated something else very profound had happened. The Hippocratic Oath we took, that had stood medicine in good stead for twenty-four hundred years, had been changed. The part about refusing to give a woman a pessary to induce an abortion had been deleted.

Ten years after Roe v. Wade I watched my mother fight and lose her battle with breast cancer. Added to her physical torment was her mental anguish at the thought of leaving my youngest brother before he was fully grown.

Twenty years after Roe v. Wade, I was settled into a surgical practice devoted to breast cancer. I found that breast cancer risk was no longer one out of twelve women, as I had learned in medical school, but had increased dramatically to one out of eight. Not only that, but the women with breast cancer were no longer postmenopausal grandmothers, but young thirty-year-old mothers with toddlers. I knew from my own painful experience what they would face.

The Roe v. Wade ruling not only changed the Oath I took at graduation, but also my practice. We all know someone, either personally or through friends and family, who has had breast cancer. Breast cancer is the only major cancer that continues to rise. Most of this increase has occurred in members of my own generation, those women who were twenty-five to thirty-nine when Roe v. Wade was decided.

Epidemiological Evidence
Abortion is a risk factor for breast cancer. I see it every day in my practice. Thirty percent of my breast cancer patients who are in their thirties do not have a family history of cancer, but have had an abortion. It is estimated that an additional ten thousand cases of breast cancer occur each year because of abortion.

The abortion-breast cancer link (ABC link) is supported by the published epidemiological studies, the physiology of the breast, and the experimental studies done in mammals. Epidemiological studies overwhelmingly support the ABC link; however, to put them into proper perspective, one must understand why some have referred to epidemiology as a "pseudo-science."

Epidemiology can be defined as the study of disease in large populations. These studies can never be taken as proof positive that any risk found is causal. For example, large studies would probably show unequivocally that more people with lung cancer carry matches in their pockets than those without cancer. This would not mean that matches cause lung cancer, even though large studies were done well, were statistically significant, and were reproducible. Biology has shown that it is the carcinogens in match-lit cigarette smoke which causes lung cancer. Similarly, without the support of the well-known breast physiology and experimental data, the studies documenting an abortion-breast cancer link would be inconclusive.

Let us look at the epidemiology first, and then the supporting data. Epidemiologists have defined five criteria which should be largely satisfied before a risk factor can be considered a potential causal risk.

1. The patient must be exposed to the risk before the cancer develops.

2. There must be similar findings in many studies. One or two studies can never be taken to prove anything. In the case of the ABC link, twenty-eight out of thirty-five worldwide studies show a link between abortion and breast cancer. Thirteen out of fifteen studies done in the U.S. show a link.

3. There must be statistically significant increases. Scientists need to show with ninety-five percent certainty that their results could have not occurred by chance alone. There are seventeen statistically significant studies that show a link between abortion and breast cancer and eight were done in the U.S.

4. There should be a dose effect, that is, the risk should be higher with more exposure. In the case of cigarettes and lung cancer, the more cigarettes one smokes, the greater the risk of lung cancer. In the case of abortion, the longer one is pregnant before the abortion, the higher the risk of breast cancer. This was shown in the 1994 Daling study commissioned by the National Cancer Institute.(1)

5. There should be a large effect observed. In the case of abortion and breast cancer there are subsets of women with very high risk. For example, in the 1994 Daling study, all the teenagers who had abortions at eighteen or younger and had a family history of breast cancer developed breast cancer by the age of forty-five. The risk could not be calculated and was reported as infinity.

Now even having satisfied these criteria, the ABC link would still not be proven unless there was a sound biological basis for this risk. All the studies in the world showing that lung cancer occurs most frequently in people who carry matches in their pockets does not mean matches cause lung cancer. I believe that the biological basis for the ABC link is the most powerful and persuasive argument supporting it.

The Biological Basis
The same biology that accounts for ninety percent of all risk factors for breast cancer accounts for the ABC link. Simply stated, the biology rests on two principles.

1. The more estrogen a woman is exposed to in her lifetime, the higher her risk for breast cancer.

2. The younger a woman's breasts mature from Type 1 and 2 lobules to Type 3 and 4 lobules, the lower her risk.

If a woman starts her menstrual cycles early, e.g., at age nine, and continues to menstruate into her late fifties, she is at higher risk because she has more years exposed to monthly estrogen elevations. Through a large, recent, well-publicized study, women became aware that the estrogen in their hormone replacement therapy increased their breast cancer risk. In a similar way, birth control pills elevate breast cancer risk.

Type 1 and 2 lobules are known to be where cancers arise. Type 3 and 4 lobules are mature and resistant to carcinogens. When a child is born, she has only a small number of primitive Type 1 lobules. At puberty when estrogen levels rise they form Type 2 lobules. But it is only through the hormonal environment and length of a full-term forty-week pregnancy that there is full maturation to Type 3 and 4 lobules. This maturation protects a woman and lowers her risk of breast cancer. This is why women who undergo a full term pregnancy have a lower risk of breast cancer and why women who remain childless have a higher risk of breast cancer. It is the interplay of these two principles, estrogen exposure and breast lobule maturation, that accounts for the fact that abortion can cause breast cancer. Within a few days of conception, a woman's estrogen level rises. By the end of the first trimester estrogen levels have increased by two thousand percent. Every woman notices her breasts get sore and tender because the estrogen stimulation results in the multiplication of Type 1 and 2 lobules. It is only after thirty-two weeks that her breasts stop getting larger and mature into Type 3 and 4 lobules in preparation for the breast feeding of her child.

If abortion ends her pregnancy before full maturation of her breasts, she is left with an increased number of the immature Type 1 and 2 lobules. She now has a greater number of breast lobules where a cancer can arise. This causes her to be at greater risk for breast cancer. It is through this same biologic mechanism that any premature birth before thirty-two weeks more than doubles breast cancer risk.
Suppression of Data?
The question now arises, if it is true that abortion increases breast cancer risk, why would organized medicine not support the data? One reason is fear of the results of peer pressure. In my own case, I have worried that I would lose referrals from ob-gyns who do abortions when I have lectured on this topic. Even a family doctor who would refer numerous patients said to me, "You don't tell my patients that, do you?" I worried about my practice. I was also worried about being labeled a pro-life zealot or an anti-choice fanatic. I can understand why a Harvard professor of risk assessment at a Boston cancer institute would tell me privately that she knew abortion was a risk factor for cancer but would not bring it up in her talks on risk. She might lose her job. I have a colleague who did lose an appointment at a New York medical school just because he was quoted in The Lancet giving credence to a study supporting the ABC link.

Janet Daling, an adamantly pro-choice epidemiologist, told me she refused to speak on the topic anymore because she was tired of having rocks thrown at her. I learned what it felt like first-hand when I presented a research project in a poster session at the San Antonio Breast Symposium in December 2001. Although the abstract had been accepted six months earlier and had the word "abortion" in the title, the program director angrily accused me of using his meeting as a platform to hand out anti-abortion literature. Most troubling is that several years ago the then-president of the American Society of Breast Surgeons told me that her board did not want to have a speaker on the subject at their meeting because they felt it was "too political." I argued that it was also medical, but to no avail. The director of the Miami Breast Cancer Conference also felt it was "too political." He returned a check I had given him so that our Breast Cancer Prevention Institute could not even have an exhibit table. I am waiting for a response from the American College of Surgeons. I hope they too will not deem this topic "too political." What is so telling is that not one authority in the field of breast cancer that I have spoken to directly has said that the data is not true or that I was wrong about the science.
Perhaps another reason physicians have not acknowledged the link is the Semmelweiss Phenomenon. In 1840, forty years before the germ theory was known, a resident in obstetrics noted that there was a twenty-five percent mortality rate from childbed fever on the doctors' ward. On the midwives' floor, where there was frequent hand washing, the mortality rate was only two percent. When at his suggestion an experiment was done by having doctors wash their hands, the infection and death rate on their own ward was greatly reduced. Instead of rewarding Semmelweis and promoting hand washing to reduce mortality, he lost his job and was vilified. It seems that it was easier for doctors to let women die than change their own practices. They would have to acknowledge that the midwives had provided better care and that professors had been corrected by a lowly resident.

Women's groups such as the National Organization for Women have not brought this information out. The idea of safe and legal abortion is the foundation of their cherished reproductive rights. What if it became known that abortion is not safe but lethal to some women exercising that right? The abortion industry does not want to lose clients for its billion-dollar industry, so their trade organization, the National Abortion Federation, tries to dismiss it.

Signs of Hope
Public knowledge of abortion as a risk factor for breast cancer will not only help women obtain true informed consent; it also helps women who have had an abortion. Once a woman knows she is at higher risk, she will be more likely to get screened with mammograms. This can increase likelihood of survival should she develop cancer.

Even if someone remains unconvinced of the causal nature of the abortion-breast cancer link, surely no one can feel that there is so little evidence that women should not be informed of the possibility. It is unconscionable that women's lives and health are sacrificed to maintain an attitude of political correctness.

I am glad to report there are signs of hope. This past June the National Cancer Institute took down its inaccurate and misleading fact sheet on the ABC link on its website. Twenty-eight U. S. Congressmen had sent a letter to the NCI's director pointing out the errors. My older textbooks did not even mention abortion as a possible risk. The newer ones do, even if they try to dismiss the data as inconclusive. One very notable exception to this was written by a researcher who is at Georgetown University, Professor Robert Dickson, who first included it in his chapter on the molecular biology of breast cancer more than ten years ago.(2)

The issue is being discussed in the press. Crisis magazine, a Washington, D.C.-based publication, recently explored this issue in a feature article. There have been countless letters to the editor in newspapers all over the country by laymen and doctors. Miss Oregon, Brita Stream, had as her platform the abortion-breast cancer link and went on to the Miss America pageant in Atlantic City this year. This issue has also entered breast cancer research politics. The Coalition on Abortion/Breast Cancer, an international lay organization, has made the public aware of the issue. They have made women aware that the Susan G. Komen Foundation, an organization which raises money for breast cancer research, also gives this money to Planned Parenthood. They pointed out to Komen and its donors that Planned Parenthood caused a significant amount of breast cancer as the nation's largest abortion provider. This has placed pressure on the Komen organization to stop that practice, with some success.

A month ago I saw in my office identical-twin women. One had several abortions as a teenager and was thirty-six years old when she got breast cancer. I was able to reassure her worried sister, who had a child in her twenties, that she did not share the same risks as her twin and that most likely her biopsy would be benign. When the results came back, it was. An analysis of my own patients with breast cancer in their thirties showed thirty percent had abortions but no family history of the disease.

The most important paper concerning the abortion-breast cancer link was the 1996 meta-analysis done by Dr. Joel Brind.(3) His paper prevented someone from saying, "Some studies say yes, some studies say no." See the chart on the following page showing his meta-analysis. All results on the right of the vertical line are the ones that show a link. At the time of publication there were seventeen out of a total of twenty-three. If it had not been published, I would still be in my office wondering why I have so many thirty-year-olds with breast cancer.

When Dr. Brind's study appeared it created a furor. In response, Dr. Stuart Donnan wrote an editorial in which he said, "I believe that if you take a view (as I do), which is often called `pro-choice,' you need at the same time to have a view which might be called `pro-information' without excessive paternalistic censorship (or interpretation) of the data."(4) Dr. Brind likes to add "And that's from an understated Englishman." At the risk of political incorrectness, I would like to add, "God bless them both."

Angela Lanfranchi, M.D., F.A.C.S.
Breast Cancer Prevention Institute
Poughkeepsie, New York