Natural Family Planning International

Rose Gioiosa wrote me in 1988 reminiscing about her work and promotion of natural child spacing. By then a nun with the Sisters for Christian Community, she recalled her marriage preparation work starting in 1980 in Boston.  She coordinated the program which reached 1,000 couples during the first three years.  The fourth year she restricted the program to 26 churches (Personal letter, August 2, 1988).

There were three sessions with the best time set on Sundays from 2 to 5 PM.  At the first session, a priest talked about Church teaching on marriage as a sacrament, human sexuality and responsible parenthood, and communications and adjustments in marriage.   Natural family planning slides were shown at this time.  The second session was on similar topics but the presenters were married couples.  Interestingly, these presenter-couples had to have experience with natural family planning and natural child spacing by breastfeeding.  The third session was on the spirituality of marriage.  It ended with the Holy Sacrifice of the Mass, the blessing of the engagement rings, and with engagement promises.  Educational booklets and books were offered for sale.  Natural family planning classes followed and couples were encouraged to attend these classes.  Sister Gioiosa’s reflected that there were many different kinds of marriage preparation programs in those days “with not too much input on natural family planning or breastfeeding  and natural child spacing.”(Ibid)   She retired at the end of 1984.

How did she feel about the marriage preparation programs in general when she wrote me back in 1988?   Here is her response:  “I feel that a few sessions on marriage preparation are only a beginning.  Our couples need the backing and good example of their own parents, relatives and other married couples, as well as good follow-up by their own parish churches and clergy, to support them and to continue this ‘beginning.’ ”

Rose Gioiosa was untiring in her promotion of breastfeeding and its effect of natural child spacing.  Thanks to La Leche League, she reached many mothers through her Child & Family article.  She also reached many couples through her marriage preparation work.

Our 6th anniversary for blogging occurs during this week.  We have done almost 400 blogs during those six years.

Next week:  Life of Dr. Otto Schaefer

Sheila Kippley
Breastfeeding and Catholic Motherhood
The Seven Standards of Ecological Breastfeeding

Influential Persons

In preparing this blog, I thought about people who advocated natural child spacing, who published their research, whose work went beyond the medical journals, and who influenced me in the earlier years of my life.  Their work and their message reached the common person. In a sense, their “natural spacing” work became an active apostolate for them.  I want to call special attention to Rose Gioiosa, RN and Otto Schaefer, MD.  These two persons were pioneers with their breastfeeding infertility work.  They were involved with natural child spacing well before I became actively involved with this topic.  Both pioneers are now deceased, and I am grateful for the correspondence I had with both of them.

Rose Gioiosa

In the spring of 1953 Rose Gioiosa conducted a study among breastfeeding mothers at the Catholic Maternity Institute in Santa Fe, New Mexico.  Her purpose was to show that a mother could “space her babies naturally without the use of rhythm, basal temperature methods, fertility testor, or other family planning techniques” (“Breastfeeding and Child Spacing,” Child & Family, 1964).  After all, in other countries where prolonged breastfeeding of two or three years was the culture, breastfeeding was valued for the spacing it provided before the conception of another child.

In 1955 Miss Gioiosa’s Santa Fe research was published.  (“Incidence of Pregnancy during Lactation in 500 Cases,” Am. J. Obstetrics & Gynecology, 70:1, July 1955).  She concluded that nine months of breastfeeding is a natural means of spacing babies with an interval of 18 to 24 months, that 95% of American nursing mothers would not conceive during the first nine months postpartum as long as the nursing mother did not offer “additional supplementary or complementary formula” during that time, and that the other 5% of nursing mothers who conceived during the nine months postpartum were weaning or offering “supplementary or complementary feedings” (p. 173).

In 1961, the La Leche League Board sent a survey to its members.  Part of the survey asked questions to determine if breastfeeding spaces babies (Child & Family, 1964).  Rose Gioiosa did a comparison study between the results of the La Leche League survey and her own published study; this resulted in her previously mentioned article (Child & Family, 1964).  This article, “Breastfeeding and Child Spacing,” was published in pamphlet form and distributed widely among La Leche League mothers.  When I was interested in the natural spacing mechanism of breastfeeding, this article found its way into my hands through my La Leche League contacts in the mid-1960s.  In her comparison study, Gioiosa reached the same conclusion:  “The early use of other milks or formulas or solid foods in the infant’s diet automatically decreases the demand on the mother’s milk while she is breastfeeding.  There is a subsequent decrease in the supply of milk available, and this tends to diminish the amount of time afforded by the natural spacing mechanism” (Child & Family, 1964).     Rose Gioiosa’s work in the early Fifties and again in the Sixties with the La Leche League survey is probably one reason why La Leche League stated and continued to state in its manual the following:

“While a mother is wholly breastfeeding (no solids or
supplements), she will most likely not menstruate at all.
In fact, the average nursing mother will not have a period
for about seven to fifteen months after giving birth.  When
she does begin to have menstrual periods, at least one and
often several of these will be without ovulation, or sterile, in
most cases.  Only a fraction of 1% of women are likely to
conceive while wholly breastfeeding before having any
periods” (The Womanly Art of Breastfeeding, 1963, p. 49; boldface
not in the original).

Rose Gioiosa’s work on natural child spacing helped to inform mothers that pregnancy could best be postponed by nursing for the first nine months and waiting six months before beginning solid food.  Her work supported the bold-faced statement above.  In those days—the 1960s and early 1970s—there was very little support for natural child spacing except through La Leche League International. The main Child & Family article by Rose Gioiosa bolstered the idea, especially among Catholic mothers, that breastfeeding has something to contribute to the natural spacing of babies.

Gioiosa’s work to be continued next week.

Sheila Kippley
Breastfeeding and Catholic Motherhood
The Seven Standards of Ecological Breastfeeding

The Need

“After contraceptive use, breastfeeding duration is the major determinant of the birth interval length…  In many countries the duration of breastfeeding is more important in determining the length of birth intervals than is contraceptive use.” (Becker, Rutstein, & Labbok, “Estimation of Births Averted due to Breastfeeding and Increases in Levels of Contraception Needed to Substitute for Breastfeeding,” J. Biosocial Science, 2003, 35: 559, 560)

It is noteworthy that these researchers did not stress that the best way to have a good birth interval was to practice systematic natural family planning (NFP).  By systematic NFP, I’m referring to the natural method whereby couples use the bodily signs of the woman’s cycle to determine the fertile time.  What the researchers are telling us above and what other researchers have been telling us for years is that breastfeeding can be an excellent way to space babies.  (Past research is available at this website.)  Breastfeeding is the strongest natural influence in spacing babies in an individual family and in maintaining a slow rate of population growth.   As the researchers above stressed, in developing countries where contraceptive use is low it is rare to have birth intervals of less than two years, thanks to breastfeeding.  They add:  “Today [2003], it is clear that breastfeeding, as a major biological determinant of fertility return postpartum, contributes significantly to this interval” (Becker, Rutstein & Labbok, p. 559).

I am disappointed when the breastfeeding aspect of NFP is ignored at natural family planning events.  When I attended an NFP conference in 2002, I picked up the literature from the various NFP groups and found that none of them taught anything about the spacing benefits of breastfeeding.  The only organized programs I know of that give any serious attention to the form of breastfeeding that normally delays the return of fertility for over a year postpartum are those organizations founded by my husband and myself and now the Catholic Nursing Mothers League founded by Pam Pilch.

With systematic natural family planning, the couple deals with fertility on a regular basis with their cycles.  Many of these couples abstain during the fertile time of each cycle to avoid pregnancy.  With breastfeeding the couple deals with infertility.  Breastfeeding couples usually enjoy a year or more of infertility, and thus abstinence is not an issue.  Breastfeeding Catholics might practice abstinence for spiritual reasons during Advent and Lent or periodically at other times, but abstinence is not normally required for spacing purposes when a couple breastfeeds properly.

The key phrase here is “when a couple breastfeeds properly.”  “Properly” means that the mother and baby are doing “ecological breastfeeding” that I will describe later.  I use the term “couple” because a mom who is doing ecological breastfeeding definitely needs the support of her husband in a bottle-feeding culture.

What we need in our Church and in our society is a strong emphasis on breastfeeding and natural child spacing.  Wouldn’t it be a teaching moment to have a conference on natural child spacing with speakers who have experienced this aspect of breastfeeding in their professional work or in their personal lives?  There are still countries or areas where breastfeeding is a primary factor in family size.  Couples from these countries would have much to share with us.   At the 1994 Family Congress in Rome, a man from Africa told us at one of the workshops that the women in his area rely primarily on breastfeeding to space their babies.

Dr. Roger Short from the Department of Physiology at Monash University in Melbourne, Australia contributed to the United Nations symposium report on Nutrition and Population Links – Breastfeeding, Family Planning and Child Health (Nutrition Policy Discussion Paper No. 11, May 1992). Dr. Short concluded:
“Since the dawn of civilization, we have been interfering
with breastfeeding.  The rearing of infants on artificial foods
has been the largest uncontrolled clinical experiment ever
undertaken, and it is still going on, despite the disastrous conse-
quences.  It has brought untold suffering, disease and death
to countless millions of babies.  The erosion of breastfeeding’s
natural contraceptive effect has been a major factor in bringing
about the recent explosive growth of the human population.
There is no cheaper or more effective way of improving
maternal and infant health and lowering fertility, than the
promotion of breastfeeding.” (Ch. 4: Breastfeeding, Fertility and
Population Growth, p. 11; my emphasis in the quote)

While breastfeeding should be promoted for its many health benefits to mother and baby, in these series of blogs, I will direct my attention to the natural child spacing benefit of breastfeeding.

Sheila Kippley
Breastfeeding and Catholic Motherhood
The Seven Standards of Ecological Breastfeeding