A year ago, things looked bleak for John Bruchalski, M.D. Still recovering from a debilitating illness, and with a burgeoning practice in obstetrics and gynecology, Bruchalski needed to find a partner, fast. No problem—except that Bruchalski needed a physician who shared his belief that natural family planning (NFP) is the only moral and healthy child-spacing method to offer patients. The well of like-minded physicians kept coming up dry.
But Dr. Bruchalski doesn’t give up easily. In his words, “God works with the simple.” Bruchalski, following his conscience and the social teaching of the Catholic Church, simply forged ahead. His faithful assent to God finally paid off in the form of Dr. Marie Anderson.
But why was it so hard? Where the demand is high for physicians cast in the Bruchalski mold, why is the supply so low? Why aren’t there more Bruchalskis? Indeed, the national directory of NFP-only physicians is mighty thin. Only a handful of NFP-only OB/GYNs are practicing—in fact, most NFP-only physicians, according to the NFP group One More Soul, are in family practice, not obstetrics.
More than 1.5 million American women practice natural family planning (48% of them Catholic), according to the Natural Family Planning Center. But only thirty-two obstetrician/gynecologists nationwide serve them, according to Steve Koob, founder of One More Soul. For those women who seek family practice physicians for their OB/GYN needs, the pool of NFP-only physicians increases to around 157 nationwide. As a result, large pockets of faithful Christian women around the nation do not receive the proper medical care they both need and deserve.
Monstrous obstacles stand in the way of Catholic OB/GYNs following the simple dictates of conscience. A wide array of medical institutions—all responsible for the formation of physicians—form a collective roadblock. Medical schools, academic journals, professional associations, health management organizations (HMOs), and pharmaceutical companies, along with the professional and social pressure of peers, control money and respect in the medical world. The fear of losing money and respect—commodities without which medical practices die—makes thin the NFP-only physician directory, while hundreds of thousands of women are left without complete and respectful obstetric and gynecological care.
Medical Roadblock
A glimpse into the world of medical school reveals all. With very few exceptions, NFP is not taught at all, or only barely and in a dismissive fashion as a “religious thing” not necessary to medical training. Natural Family Planning Center executive director and George Washington University Medical Center OB/GYN associate professor Dr. Hannah Klaus explains that in medical schools, the female reproductive system, ovulation, and contraception are taught as a unit. Likewise, the male reproductive system and sterilization are taught as an inextricable match. While Klaus praised an exception—Georgetown’s inclusion of NFP in its OB/GYN curriculum—even there it is not given exclusive treatment. Klaus criticizes an “elitist” attitude among medical school faculty imposing the belief that men and women are not capable of abstaining from sex. Klaus hopes to right the wrong-headed ideas regarding the science of NFP. Despite the compelling results of her research, only a trickle of support exists in the academic medical world for her work.
“This is the thing you’re being trained to do. If you don’t [prescribe contraceptives], you won’t have any income and you won’t be serving your patients,” explains One More Soul director Koob concerning the medical school perspective. The lesson to students: You will fail if you follow the Church’s teaching. It is difficult for motivated achievers (the type who tend to go to medical school) to go against the mainstream, and tough penalties are exacted should a student choose to follow his conscience. As Koob points out, it is largely a matter of professional respect: “We all want to be considered the best in our profession.” The folks responsible for professional advancement in this case view NFP-only physicians as practicing on the “fringe.”
What can an NFP-only medical student expect should he or she choose obstetrics and gynecology? The American College of Obstetrics and Gynecology (ACOG) “tolerates us,” says Klaus. After much urging, ACOG produced one educational pamphlet on NFP among more than 100 dealing with birth control. Even this one is highly flawed, and needs rewriting. Klaus expresses no surprise at this, and has been pushing for a rewrite for quite a while. Yet this professional association to which 90% of OB/GYNs belong is charged with keeping physicians updated on new issues and defining professional and clinical standards for all OB/GYNs. Simply put, they confer peer respect, and NFP physicians are not getting their due.
When really tested, medical authorities do not even tolerate NFP-only OB/GYN practice. Baltimore’s St. Agnes Hospital OB/GYN residency program lost its accreditation because it would not train students in contraception, sterilization, and abortion.
Residency hammers in the lesson further. “Residency is set up a lot like the military,” says Dr. Anderson, Bruchalski’s new partner. “If you cause problems, they can make your life miserable.” And should you make your moral views concerning artificial contraception an issue? “They tell you, ‘Are you sure you want an OB/GYN residency?'” The tough reality is that fifty to sixty percent of most OB/GYN practice involves contraception or sterilization.
Indeed, OB/GYN residency is boot camp for anyone who morally opposes these practices. If your beliefs are not fully formed, your conscience may drift. If you are uncompromising, however, you could see lots of extra time “on call,” and large doses of scorn from those who have to pick up the slack—prescribing contraception and performing sterilizations and abortions.
According to Klaus, NFP-only residents miss out on some aspects of training. For example, Klaus’s own training included only three cesarean section deliveries because so many of these procedures involve tubal ligation (sterilization) surgery immediately following delivery. The pressure to succumb to the procontraception opinion in order to get through residency is great.
Any faithful Catholic medical school student considering an OB/GYN residency must be extremely well grounded. One University of Tennessee medical student graduating this spring counseled by Koob was told that he would be the only NFP-only resident at any of the schools under his consideration for OB/GYN residency. Another has decided first to study theology in order to strengthen her pro-NFP position. Such students must prepare themselves for isolation.
Publish and Perish
According to Johns Hopkins researcher Robert Kambic, the lack of funding for publishable research promoting NFP can largely be blamed for NFP’s lack of credibility in medical schools and in the practice of medicine as a whole.
Since the advent of modern contraceptive methods, academic journals have egregiously underpublished the persuasive scientific underpinnings of NFP. While some progress has been made of late, it takes a long time for the old guard to come around. The old guard—physicians and medical academics at their prime when the Pill hit the scene in the ’60s—were exposed to almost no scientific data to support NFP. At the same time, the science behind the Pill and other artificial methods was well-funded and promoted by pharmaceutical companies and advocacy organizations like Planned Parenthood.
These physicians and academics trained the new generation in OB/GYN practice. As a result, teaching and practicing NFP is a fringe activity only for the few, proud, and the faithful who learn the science and practice of NFP only after graduating from medical school and going through their residencies. Some, like Dr. Bruchalski, experience a conversion after they see the destruction contraception inflicts upon women and their marriages. As he puts it, “It is a matter of the heart.” Stout hearts are required to carry these physicians through financial struggles as well.
The sheer quantity of cash pumped into the development and promotion of artificial contraception as compared with natural means is astounding. Well over $75 billion has been spent by American taxpayers on national and international population activities since 1968. Of that, a minuscule 0.5% has been spent on natural methods. Most of this tiny amount is spent on education in less-developed countries; NFP tends to catch on better in societies less consumer-driven than the United States. Some federal foreign aid was won in 1985, which helped establish the Georgetown-based International Institute for Natural Family Planning.
After almost three decades of scrambling for money to support research and promotion of natural family planning through mostly volunteer organizations, physicians graduate from medical school with next to no knowledge of NFP. While there is some headway being made in the publication of articles in academic journals, the medical establishment, through social and professional pressure, keeps these scientific developments generally channeled to “acceptable” areas such as helping women achieve desired pregnancies.
Then consider the billions of dollars spent in the development and promotion of contraceptives by drug companies. Pharmaceutical companies aggressively market the use and acceptability of their products. There are power and money behind contraceptive research, and there is no interest in developing the science behind a product they can’t sell—the inner resources of couples to track their fertility.
“NFP stands for Not For Profit. . . . You can’t sell a woman her own mucus,” says Klaus, referring to a conspicuous sign of a woman’s fertility. NFP-only physicians all point to the omnipresence of the drug companies in the OB/GYN world. At conventions and at home, physicians are wined and dined to woo their loyalty. Companies do what they must to develop and sell contraceptives to physicians whose financial success depends upon prescribing contraceptives. Further, the drug companies cast themselves—and are seen by most—as simply providing what women want and need.
Add the pressure of for-profit health management organizations, and the lock tightens. As private practices become increasingly difficult to sustain, HMOs are taking over medical management. This does not bode well for the future for NFP-only OB/GYNs: For-profit HMOs are too risk-averse to chance losing their contracepting clients. Dr. Lorna Cvetkovich, an OB/GYN in Wichita, Kansas, says that not only is there “no place for Catholic physicians to go and be trained as Catholics,” but “our own Catholic HMOs won’t accept them.”
She has little doubt about the reason. She recounted a story where a Catholic hospital in Louisiana had, in order to attract an OB/GYN to town, guaranteed him a generous salary. Upon learning that he was an NFP-only physician, his guaranteed salary was cut in half. But Dr. Cvetkovich is most concerned about the lack of support in the Church for the vocation she and her colleagues have chosen. This concerned is echoed by all facets of the NFP movement.
She points to the five Catholic medical schools and expresses dismay that none provides a training ground for faithful Catholic OB/GYNs. Each one of the schools defies Church teaching when it trains physicians to contracept and sterilize. Without the Church’s active promotion of her teaching on every level, the philosophy of openness to life cannot compete with the cash or the professional pressure behind the contraceptive movement. Dr. Cvetkovich and others in the NFP movement say many in the Church willfully refuse to see the beauty of the Church’s teaching or promote her full expression.
Promoting the Culture of Life
Teresa Notare, director of the Diocesan Development Program’s NFP program, is the self-termed “hub of the wheel” when it comes to promoting NFP to Catholics. She achieves incredible results with the resources she has. Each of the 187 Catholic dioceses in the United States has an NFP coordinator or contact person providing NFP services. But these programs are charged with the mission to reach every Catholic couple. Notare’s minuscule budget and staff, given her mission, would make Planned Parenthood laugh. Turning the issue around from what some consider a fringe ideology to an accepted building block of marriage would require major money to rival the pharmaceutical research and advertising, as well as Planned Parenthood’s savvy legislative and public relations campaigns. According to Notare, the blitz would need to begin with Catholics in charge. While in a great number of cases leaders are active NFP experts, many are lackluster in their commitment, and some are “actively hostile,” according to Notare.
What physicians do get is the supportive network of enterprising organizations like the Pope Paul VI Institute, the U.S. bishops’ Human Life Foundation, The Family of the Americas, Human Life International, and several others. These groups have provided some significant spiritual, scientific, and promotional counterpressure to the vast contraceptive movement. Without their activity, the Church teaching articulated in Humanae Vitae would be a dead letter in the United States.
Only courage and patience and faith have propelled NFP-only physicians like Dr. Bruchalski through the road-block the world of medicine puts in the way of physicians who want to follow their consciences. The obstacles are indeed monstrous, so why do it? Does it really matter from the patient perspective whether her physician believes in contraception or not? As long as Catholic couples learn effective NFP methods somewhere, shouldn’t they be fine?
Dr. Anderson says of the faithful Catholic women going to physicians who do not support them, “I think they’re going to a place that doesn’t look at the whole person. You’re a body, a soul, a heart, a spirit, and you’re only having your body treated. That’s not what we’re about here. I think that’s doing only half the job, and it will show up at some point.”
What NFP-only physicians are about is something much larger than money or human respect. “This is not just about contraception; it’s about children,” says Bruchalski. Are they blessings or little self-fulfillment pills? The group One More Soul sprang, as its mission statement says, from the “hope that through the grace of God and their efforts one more soul would be created for the kingdom of God. Since the creation of a soul is more awesome than the creation of the universe, one soul would more than justify any amount of effort.”
Dr. Bruchalski can breathe a little easier now. He has a capable new partner, and he believes that as more and more doctors follow their consciences, their number will increase to match the increase in patients. “God works with the simple. . . . If you step out an inch, God gives you back much more.”