Thursday, February 9, 2012
NFP, Covered by Insurance?
Recently all the talk about the HHS mandate for contraceptives to be made free of co-pay to all insured women has made me reflect on Natural Family Planning. It seems to me that the appeal of having free contraceptive services will make some women (and girls) turn to chemical contraception when they might have otherwise stuck with something else, like condoms. I've been struck by the way this has been billed as a "health" issue, as though it is really a healthy thing for women to screw around with their hormones for a couple of decades (approx. ages 15-35, based on some of my friends from high school) before they decide to have kids (and then can't always get pregnant...and need fertility services to achieve pregnancy).
Now, of course, pregnancy does bring on certain health issues, sometimes exacerbating pre-existing conditions and sometimes creating temporary health problems (like constant acid reflux, in my case!). But pregnancy is not a disease, and getting pregnant doesn't make a woman "unhealthy" any more than not being pregnant makes a woman "healthy." My sister the midwife has said before that she works at a hospital--but not with sick people!
Of course Catholic institutions object to having to cover contraception, not simply because it is against Church teaching, but, as arguments from liberal Catholics (Vince Miller, E.J. Dionne, Commonweal, etc.) have shown, this is about conscience more than contraception. But what if we could get all insurance companies to cover Natural Family Planning with no co-pay?
Of course, some people might see this coverage of natural methods as coercive, trying to get women to use NFP. And that's basically what I just said above about providing the pill (etc.) free of charge; it might lead women to chemical contraceptives that would otherwise have chosen something else. But, unlike all those other methods, NFP does absolutely nothing to mess with a woman's health. Studies, moreover, show it to be just as effective (if not more effective) than contraceptive methods at avoiding pregnancy.
Now, there are a lot of misconceptions about NFP, one of which is that it's simply the "rhythm" method, based on the length of a woman's cycle and supposed leutal cycle. It's not, however, and is almost surprisingly accurate. I once had NFP described to me by someone who had gone to a one-time info session thus: "Basically, the woman does all this work and then says, 'No, honey, not tonight.'" And it is true that some methods of NFP have a steep learning curve, but even in the seven years since I learned the Couple to Couple League's Sympto-Thermal method via a homestudy course, NFP has become ever more convenient, with such things as online charting, or the Petite Sophia basal body thermometer, which has an alarm to remind you to take your temp and charts your cycle for you based on those temps.
More recently, I've been using the Clearblue Easy Fertility Monitor, which is definitely the easiest, most convenient method of NFP I've ever used. Based on a morning urine test (not for the whole cycle, just about ten days), it actually informs you of "Peak" day, i.e. the best day to get pregnant. Prior to that you can get 5+ days of high fertility, which are abstinence days for those postponing a prengancy. Especially for that difficult time of return to fertility after childbirth, the monitor turns fertility into a no-brainer.
The downside to the monitor, and the reason I shunned it for the first six years of my marriage, is that it costs a lot of money (which we didn't have when we were both grad students!). The monitor itself is $140, which wouldn't be bad if that were the only cost, but the boxes of strips are somewhere between $30-50 depending on where you buy them; each stick costs at least $1. And because each cycle requires sticks from the same box, sometimes those sticks end up getting wasted.
I'm sure these items would count for health insurance flex spending, and I realize they are not prescription medication, like the pill, nor a surgical procedure, like sterilization. But I think Catholic institutions should pay for these expenses. In fact, I think all places that provide insurance to employees should have to pay for this.
I don't want to coerce women into learning about their fertility cycles, per se. But I am convinced that most women have absolutely no clue about it. Conversations with NFP-practicing friends on the topic, however, often end up in the area of TMI: exactly how easy it is to tell the cervix is open (thus fertile), the amazing stretching length of cervical mucus, getting the fertility window narrowed down to seven days, the surprising delayed ovulation due to stress at work, the possibility of low progesterone indicated by that really short leutal phase, detection of endometriosis because of mid-cycle bleeding, lack of ovulation in the first few post-partum cycles, etc. Wow! Women can really know what's going on with their bodies if they try! Just basic observation can provide clues that medical doctors would never know. In fact, a friend of mine who is a medical doctor told me that not once were the observable changes in cervical mucus taught to them in med school.
This same friend said that she thinks people are hesitant to embrace NFP because they don't "get" the concept of abstaining: "What do you mean I can't have sex for a whole week?" Granted, in special situations (like the post-partum return to fertility), abstinence can extend much longer than a week. But for a woman with a regular cycle 7-9 days would be all the required abstinence. Now, some will say that this is unfair to the woman because it's when she most desires to be intimate. That may be true, but it does not necessarily limit the enjoyment, and can actually build anticipation and desire. Moreover, to quote a friend of mine that was on the pill: "The pill worked great for us not getting pregnant...because I never wanted to have sex!" The pill can kill libido; NFP doesn't. Some may say that abstaining for a week will greatly decrease the number of times a couple will be intimate, but again, the studies don't support that. There are still roughly 15-20 days per cycle available. And, again, to quote a different friend of mine that was on the pill, "Sometimes I think that people judge those of us on the pill as though we're sex-crazed, indulgent people who just want to have sex every night. But honestly, we don't have sex that much, no more than people who are using NFP."
If it sounds like I've turned into an evangelist for NFP and the Clearblue Easy fertility monitor, then you're probably interpreting me correctly. I don't think chemical contraception is healthy for women, and the fact that it's the most commonly prescribed medication to women of a certain age doesn't testify to its being good for them, physically or psychologically; it's not some kind of super-vitamin. But there are times that a couple might want or need to postpone a pregnancy for health or other reasons, and NFP can make that possible. There may be a greater necessity of discipline, and self-control in sexual matters is definitely not hip in our society, so it will undoubtedly be hard to sell.
And that's why I suggest that as a first step toward encouraging women to find out about their fertility, items like the Petite Sophia and Clearblue Easy monitor (plus sticks!) should be offered to women completely free of charge. Everyone covered by insurance should have to chip in to pay for those women who choose NOT to alter their body's chemistry in order to avoid pregnancy.