National Marriage Week
Natural Family Planning and the Effects of Periodic Abstinence on Marital Relationships
By: Michelle Asuncion-Castor
Editor’s Note: In honor of Valentine’s Day this week, we are highlighting a research summary of a 2021 article published by researchers Richard J. Fehring and Michael D. Manhart in The Linacre Quarterly. The study — summarized by Michelle Asuncion-Castor, a former FACTS elective participant — concluded that couples who used natural family planning (NFP) methods had improved self-esteem, stronger marriages, and lower divorce rates than those who relied on sterilization or contraception alone.
Natural family planning (NFP), also referred to as fertility awareness-based methods (FABMs) involves monitoring women’s biological markers of fertility to predict times of fertility and infertility, as well as observe overall ovulation health. NFP methods can be used to achieve or avoid pregnancy. For the latter, periodic abstinence or avoiding sexual relations is exercised during the fertile time. Literature suggests that periodic abstinence within a marriage can help strengthen relationships, improve communication, and aid in personal growth and development. In this two-part article, titled “Natural Family Planning and Marital Chastity: The Effects of Periodic Abstinence on Marital Relationships,” researchers Fehring and Manhart conducted a literature review and analyzed the National Survey of Family growth data.
Part I: Literature Review
The researchers reviewed several studies that discussed the impact of NFP methods and periodic abstinence on marital relationships. According to the article, 60% to 85% of respondents, both men and women across all studies, consistently perceived that the practice of periodic abstinence and NFP helped their marriage, despite acknowledging the occasional difficulties.  The idea of a “shared responsibility” helped improve their overall impression of the marriage. The study done by VandeVusse, Hanson and Fehring in 2003 revealed that 74% of couples expressed satisfaction with using NFPs.
“According to the article, 60% to 85% of respondents, both men and women across all studies, consistently perceived that the practice of periodic abstinence and NFP helped their marriage.”
Couples using NFP also reported higher levels of self-esteem and spiritual well-being compared to couples not using these methods. Additionally, NFP users had lower divorce rates than their counterparts. The study also explored the effects of religion on divorce and found that frequent church attendance and prioritization of religion resulted in lower rates of divorce. The frequency of sexual intercourse for NFP users did not vary significantly compared to those using other forms of family planning, like oral contraception, female sterilization, and condoms. Depending on the type of NFP utilized, couples generally reported 4.05 to 5.5 acts of intercourse per month. This is roughly comparable to the general survey of married Americans that listed a frequency of 1.2 acts of intercourse per week, which is about 4.8 acts of intercourse per month.
“The frequency of sexual intercourse for NFP users did not vary significantly compared to those using other forms of family planning, like oral contraception, female sterilization, and condoms.”
Part II: Research Review
Based on the above literature review, the authors then hypothesized that there would be greater odds of divorce and cohabitation among married women who ever used sterilization, the hormonal pill, or condoms as a method of family planning, compared to women who never used those methods.  Given prior data, the authors also hypothesized that the practice of NFP and periodic abstinence would strengthen marital relationships. Secondary outcomes explored whether or not cohabitation with a member of the opposite sex influenced divorce rates.
Researchers analyzed the National Survey of Family Growth (NSFG) survey conducted by the National Center for Health Statistics/US Department of Health and Human Services from 2015 to 2017. A randomly-selected sample size of reproductive-age women participated in an eighty-minute in-person interview, with an additional computer-assisted interview program for more sensitive questions. The mean age of this data set was 36.8 years. The keywords used to compile data included the use of oral contraception, female sterilization, condom use, NFP methods, oral hormonal contraceptives, and sterilization. Secondary variables included the importance of religion, church attendance, and marital status. This research study utilized 2,582 women who were ever married.
The most common method of family planning was female sterilization. Within the data set, 20% of women reported ever using NFP, with less than 1% currently using it. Divorce rates varied among users of the different methods of family planning. Among couples who used sterilization the divorce rate was 39.4%, for oral contraceptive users it was 28.2%, and for condom users it was 27.7%. These percentages reflect the approximate percentage of people currently using those methods as well. Additional analysis revealed that those who chose sterilization had a 2.05 odds ratio of getting divorced compared to 0.59 for NFP. Church attendance had the lowest odds ratio for divorce at 0.56. Chi-square risk analysis showed that those who ever cohabitated had a 2.44 odds ratio of being divorced, compared to those who did not cohabit with a member of the opposite sex. Women who actively prioritized religion or attended church regularly had 64 to 68% lower odds of ever cohabiting compared to their counterparts.
In alignment with previous data, those who had ever used NFP and/or attended church had lower odds of divorce compared to their counterparts. Odds of divorce were higher in those who were sterilized or had ever used oral contraception. Interestingly, there was no statistical difference between those who had used condoms compared to NFP methods. Those using NFP methods had a 14% divorce rate compared to 39.4% of those utilizing sterilization, and 27 to 39% of women who ever used oral contraceptives. Those who listed “high importance” of religion or had frequent church attendance also had lower odds of divorce. When exploring secondary outcomes of cohabitation, the authors found that those cohabiting had higher divorce rates compared to those non-cohabiting and were more likely associated with female sterilization and the use of oral contraception and condoms. These results were consistent with previous studies.
“Those who had ever used NFP and/or attended church had lower odds of divorce compared to … those who were sterilized or had ever used oral contraception.”
Some of these studies were limited by insufficient requirements on the knowledge of NFPs; some articles’ criteria included having attended only one NFP class. Other limitations included small sample sizes, with one study having only 15 couples. These studies could not distinguish whether couples using NFP methods had inherently stronger relationships compared to non-NFP users. Another limitation the authors noted included newer digital fertility-awareness applications, in which users are often advised to still use condoms or are insufficiently taught to use certain methods. Another limitation includes survey bias. Reproductive-age males in the NSFG surveys were not asked about family planning and were therefore not included. Perhaps collecting the responses of reproductive-age males could provide more insight into the impact of NFP methods on marital relationships. It would also be beneficial to tease out other confounding factors, including age of marriage, length of marriage, and whether these couples had children. Based on the comprehensive literature review and additional data analysis provided by this article, it can be concluded that exercising periodic abstinence in NFP users leads to improved self-mastery, self-esteem, communication, overall marriage strength, and lower divorce rates than non-NFP users.
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ABOUT THE AUTHOR
Michelle Asuncion-Castor, DO
Michelle Asuncion-Castor, DO, is a first-year family medicine resident at Ascension Columbia St. Mary’s Hospital at the Milwaukee campus. She completed the two-part FACTS elective course as a 4th year medical student at the Des Moines University College of Osteopathic Medicine.