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Book Review

John Marshall, Love One Another: Psychological Aspects of Natural Family Planning, London , Sheed & Ward, 1995.

This book holds out the promise of being a major contribution to understanding the Church's teaching on responsible parenthood. By a distinguished medical researcher in natural family planning (NFP), Dr. John Marshall, it is based on correspondence with 10,000 NFP users in the British Isles and Ireland. Dr. Marshall, Emeritus Professor of Neurology, University of London, confirms through this correspondence that natural family planning is a reliable method of birth control that can be and is used by numerous ordinary couples. (The couples in his correspondence are primarily what we would call blue-collar). He cites statistics as well as testimonies to show that many couples find the method both effective and beneficial to their marriage. For example he includes such quotes from women as:

Most months I am quite sure of myself and see the temperature due to ovulation quite clearly. There is the odd time when I am in doubt, but play it safe and take one or two more temperatures. . . . . I must say my husband and I find this form of family planning most satisfactory. (p. 28)


The temperature method has helped my husband and myself to be happier in our sexual relationship than we have been at any time previously in our 19 years of marriage, and consequently the whole of our relationship is more loving. (p. 29)

He also confirms and highlights from the correspondence some of the challenges NFP couples experience such as: sex on a schedule with too much intercourse crammed into one week; the problem of expressing love in the fertile phase; the woman's heightened desire in the fertile phase and lack of desire in the postovulatory phase; as well as the importance of the husband's cooperation. It is not that NFP practitioners are not aware of these challenges but Dr. Marshall shows how critical the psychological aspect is. Much attention has been paid to perfecting the physiological aspects of the method and an equal effort expended on a new theological exposition of the Church's teaching but the psychological aspects have, indeed, been neglected
[1]. Here the book provides a most valuable service.

Given all this why, then, is the book a major disappointment and likely to damage rather than assist the cause of natural family planning? The last chapter provides the answer. Dr. Marshall, because of negative experiences from a number of the couples, recommends that the Church change its teaching on contraception.

The Author's Ambivalence towards NFP

In order to assess the weight of Dr. Marshall's case, it is important to examine first his own long-standing ambivalence towards the Church's teaching which is evident throughout the book. The author was one of the original six members of the Birth Control Commission established in 1964 to consider the question of family planning since it was being promoted by international agencies. Because family planning was seen to cover so many disciplines, the original commission, consisting of two physicians, two sociologists, on economist and a secretary was expanded. Theologians were among those added and they concluded that from the point of view of natural law, contraception could not be classified as an "intrinsic evil." Dr. Marshall accepted this theological evaluation as is evident in the last chapter on "The Ethics of Contraception." Yet he continued to devote enormous amounts of time to natural family planning through the Catholic Marriage Advisory Council in England, personally answering every one of the 10,000 letters from NFP users over the years himself.

Dr. Marshall's ambivalence towards NFP is also shown by his refusal to include European charts in an NFP study because barrier methods were recommended during the fertile phase yet he recommends the Church approve the use of barriers at that time. While describing as spurious the inseparability of the unitive and procreative aspects of sexual intercourse because not every act of intercourse is, in fact, procreative, he also applauds the linking of the unitive and procreative since to separate them has resulted in trivializing sex. Again while he admits that NFP affects the whole person, he cannot see it as a "way of life." Such ambivalence permeates the whole book. Not only is Dr. Marshall ambivalent but he is biased towards the negative and this is evident in the method he employs to present his material.

NFP Method

But first a look at the particular natural method of NFP taught by correspondence. Throughout it is referred to as the BBT (Basal Body Temperature) method. Dr. Marshall says that it includes mucus but he does not appear to trust the mucus sign, especially in the preovulatory phase. In fact he gives an erroneous definition of Peak mucus, describing it as (p. 15) "the day on which the mucus is experienced as maximally slippery and lubricative" instead of the last day of fertile-type mucus before the change[2]. As a result an undue number of couples appear to confine intercourse to the postovulatory phase. Certainly negative comments come conspicuously from such couples.

My own experience of the intimate side of marriage has yet to be fully satisfactory, and I put this down to the fact that we must remain virtually aloof for the greater part of the month, and then have to pack a whole month's love-making into the last eight days or so. (p. 62)

One knows that there is just this one week in the month when one can live a normal married life and things always seem to be conspiring to threaten it. (p. 69)

Presentation of Material

In Dr. Marshall's book the negative experiences are given either equal or greater weight than the positive experiences although a prospective study he, himself, conducted from 1965-68 on the psychological aspects of the BBT method, which he summarizes in the book, show otherwise. In that study only 8 to 9 percent of both men and women felt that the BBT method "had hindered" their marriage, while about 74 to 75% felt it "had helped." As many as 69 percent of men and 61% of women appreciated intercourse more after the abstinence phase while only 9 percent of men and 13 percent of women appreciated it less. When it comes to specific aspects such as effect on spontaneity, the majority--more than 50 percent said it did not affect while less than a third said that it did. Again three quarters of women and two-thirds of men found the method satisfactory while only 22 percent of men and 17 percent of women did not. Any way these statistics are interpreted the majority of NFP users in the study, about three quarters, found the method satisfactory and helping their marriages. With regard to the letters on which the book is based, Dr. Marshall's method was to extract comments, place them on cards and file in categories. Unlike the prospective study, such a method could not provide any percentages between satisfied and dissatisfied users. Yet he dismisses the significance of percentages and instead gives equal weight to both negative and positive comments. (p.34)

A further bias in presentation can be seem from the relative space devoted to negative and positive comments. Negative comments are generally longer and with more pages devoted to them. This is particularly noticeable in the chapter on "spiritual aspects." Only one page is devoted to positive comments and five to negative. By placing the negative after the positive in almost all cases, it tends to negate or diminish the impact of the positive comments.

Dr. Marshall's method of extracting comments also means that it is not possible to assess the context in which they were written nor evaluate the general adjustment of the couple's marriage. There seems to have been no follow-up when the couples were having difficulty with their sexual relationship (See page 37-38). While the NFP teacher's role is not to tell the couple how to behave during the abstinence phase, as he says (p. 96), it is appropriate to refer couples who are having sexual or psychological difficulties for additional counseling, just as it would be to refer them for a medical diagnosis if there were an unusual physical discharge.

Inadequacy of Concepts

Nowhere in the book does Dr. Marshall cite other psychosocial studies, such as those by Robert Jonas, Sr. Peter McCusker, Grace Boys, Denise Desmarteaux, Gunter Freundl, Notker Klann and Thomasina Borkman and Mary Shivanandan. An important aspect of these studies, limited though they may be, is the development of concepts related to the practice of natural family planning. His analysis does not even match that of the primarily descriptive McCusker study in 1976. While some of the testimonies he cites refer to stages in integrating NFP into the couple's relationship, Dr. Marshall makes no attempt to examine this phenomenon. The same couple, as Klann shows, may experience NFP as negative at one phase of their life and positive at another[3]. Borkman and Shivanandan found two distinct stages, one the primarily physiological and the other the psychological and relational. Couples who remain at the physiological stage tend to have more negative experiences than those who have reached the relational transformative stage. At the transformative stage, couples often view NFP as a "way of life [4]." One woman in the book referred to this:

Actually, I still think of it as family planning, when it's really our WAY OF LIFE! Something now, quite naturally integrated into our happy relaxed relationship. (p. 29)

Dr. Marshall clearly does not see it as a "way of life." (p. 57) Yet the transformative potential of NFP is one of its greatest assets.
Dr. Marshall's limited approach can best be seen in the chapter on spiritual aspects. The quotes refer mainly to the couples' attitudes towards Church teaching, building up to his own ultimate rejection of the Church's teaching. Three women appear to enjoy spiritual benefits over and beyond obeying the Church's teaching but most of the others are still at the rule stage of religion/spirituality with the majority chafing at the restrictions. (pp. 84-90) Part of Dr. Marshall's problem may be due to his view of difficulties with abstinence as always a negative experience. Dr. Thomasina Borkman, professor of sociology, George Mason University, faced with her own negative views of sexual abstinence when she first studied the experiences of NFP couples, found herself impelled to rethink her position. How could couples both say that abstinence was difficult and yet describe it as benefiting their marriages? The dictionary gave her the answer, ascribing two meanings to the word, "difficult," one a challenge and the second deprivation. In Dr. Marshall's 1965-68 study about 8-9 percent found NFP unequivocally a deprivation, the same percentage as the couples in the Shivanandan/Borkman study. Not to make this distinction is seriously to misinterpret the experiences of NFP couples. Every worthwhile venture poses some challenges. While these may not be welcomed at the time, the rewards can outweigh the difficulty of the effort. One has only to think of the struggle involved in mastering any sport.

Experiential Learning

Dr. Marshall places strong stress on experience together with scientific observation as the ultimate arbiter of the validity of the Church's teaching on responsible parenthood. (p. 118) Yet there is no evidence he understands the process of experiential learning. Experience is, indeed, important in the integration of NFP into the couple's relationship but it is a dynamic not a static process. In its medical aspects, NFP involves what is called "head knowledge," i.e. the couples must learn the basics of the method and charting. But in its psychological aspect it calls for behavior modification and this involves experiential learning. Dr. Borkman, one of the leading experiential experts nationally and internationally[5], describes experiential learning as a process that involves the whole person, spiritual, psychological and physical. It proceeds by way of trial and error with many falls along the way. For example, there are two ways of looking at the tendency of couples to caress each other to orgasm during the abstinence phase, (1) as part of the process of sexual mastery and (2) as a fixed condition. In the one case the couple is striving for sexual integration and in the other they have settled for a spurious abstinence[6].

While the basics of NFP can be taught by correspondence, it is much more difficult to teach the couples how to integrate it into their marital relationship. A surprising number have succeeded, which says much for the potential of the method itself, but sociological research shows that certain conditions facilitate the integration. One of these is witness by other couples. Sharing their personal story of struggle and reward acts as a spur to couples going through a similar experience. The couple's frame of reference is also important. For example one couple quoted in the book sees sexual intercourse as a gift from God that should not be restricted while another is "sufficiently realistic to think that the perfect sexuality described in novels does not exist in reality." Obviously such attitudes affect their experience of a method that requires periods of abstinence. On this score Dr. Marshall's book itself with its overemphasis on negative experiences and an inadequate theological framework is likely to discourage couples from even trying the method let alone persevering if they run into difficulties.

The Ethics of Contraception

Dr. Marshall is not a theologian, let alone a moral theologian. His justification for attempting an ethical appraisal of the Church's teaching is based on his "scientific" understanding of the nature of sexual intercourse and the experience of couples. The first part of this review has shown the danger of basing theology on experience without a full understanding of the nature of experience and experiential learning. It is equally hazardous to base moral theology on a limited physical understanding of sexual intercourse. That, indeed, is biologism or physicalism.

First of all it is incorrect to say that the Church did not recognize as early as the 1930s that not every act of intercourse is physically open to generation[7]. Pius XI did describe contraception as "intrinsically against nature" because it deprives sexual intercourse of its "natural power[8]." His condemnation was set within the living tradition of the Church from earliest times. Dr. Marshall finds fault with this argument from "against nature," citing several meanings to "nature. First let it be said that NFP proponents do not reject artificial aids for determining the fertile period. Contraception is opposed not because it makes use of science but because it is against (contra) life (conception).

Both Paul VI and John Paul II uphold their predecessor's view of the law of nature as in essence divinely ordered since God is the author of nature and God has linked the generation of life to sexual intercourse[9]. The third meaning of nature as according to human reason and will is developed both by Paul VI in Humanae Vitae and John Paul II, especially in Love and Responsibility[10]. Their arguments are very different from the limited interpretation of Dr. Marshall. Reason and will belong to man's spiritual nature and love can only exist when they dominate the physical and psychological drives. Contraception makes the domination of the sexual drive in the service of life and love irrelevant. It elevates the physical side of marriage at the expense of the spiritual. It is physicalist in its truest sense.

Far from neglecting love in the marital relationship, as Dr. Marshall charges, Pius XI in Casti Connubii (On Christian Marriage) gave a greater recognition to love in the marital relationship than any of his predecessors[11]. Paul VI further developed the role of love and John Paul II categorically states that it is love that coordinates the two meanings of marital intercourse, the unitive and procreative[12]. But love is an act of reason and will first, then it finds its expression in sexual intercourse. Periods of abstinence help to ensure the primacy of agapic over erotic love. It facilitates self-mastery. Sexual intercourse is a sign of total self-giving. A person can only make a complete gift of self if he is in full possession of himself including his sexual drive. Dr. Marshall has ignored these more profound insights into the place of love and sexual intercourse in marriage.


Other inadequacies of Dr. Marshall's book could be noted, such as his neglect of breastfeeding; the role of NFP in achieving pregnancy and in encouraging an openness to children, his superficial historical review of the birth control movement "to safeguard the health of the mother," and the complete absence of any negative effects of contraception on the woman, the couple's relationship or society.
But most of all, it is regrettable that a man of Dr. Marshall's stature and apparent dedication to natural family planning should fail so signally to understand much less promote the Church's teaching on responsible parenthood. The testimonies themselves provide invaluable information on the practice of NFP. No serious NFP advocate can afford to overlook the very real struggles and difficulties of some couples in its practice. In this aspect Dr. Marshall has made a substantial contribution. The danger is that his interpretation and conclusions will be accepted as gospel truth and further undermine the credibility of NFP especially among those who could do most to promote it such as pastors and doctors.

Mary Shivanandan, MA, STD


1. Louis P. LaBarber, "Psychosocial Aspects of NFP Instruction: A National Survey," International Review of Natural Family Planning, 14 (1) (Spring 1990): 34-53.

2. Professor Erik Odeblad, renowned expert on cervical mucus, says that "it is very important to know that the quantity of mucus is usually not at its maximum on the Peak Day. The quantity and also the stretchiness are greater on the day preceding the Peak." "The Discovery of Different Types of Cervical Mucus and the Billings Ovulation Method, Bulletin of the Natural Family Planning Council of Victoria, 21 (3) (September 1994): 3-34.

3. Notker Klann et al. "Psychological Aspects of NFP Practice," International Journal of Fertility Supplement, (May 1988): 65-69.

4. Thomasina Borkman and Mary Shivanandan, "The Impact of Natural Family Planning on Selected Aspects of the Couple Relationship," International Review of Natural Family Planning, 8 (1) (Spring 1984):58-66

5. Dr. Borkman, professor of Sociology, George Mason University, has studied the process of experiential learning in natural family planning as well as other areas where behavioral change is implicated such as recovery from an addiction. As applied to NFP see especially: "A Social-Science Perspective of Research Issues for Natural Family Planning," International Review of Natural Family Planning, 3 (4) (Winter, 1979): 331-355.

6. See John Harvey, "
Expressing Marital Love during the Fertile Phase," International Review of Natural Family Planning, 4 (4) (Winter 1980): 279-296.

7. Ramón García de Haro, Marriage and the Family in the Documents of the Magisterium: A course in the Theology of Marriage, (San Francisco: Ignatius Press, 1993), 133. See Also Humanae Vitae, no. 11.

Ibid., 131.

Humanae Vitae, no. 12, and Familiaris Consortio, no. 33.

Humanae Vitae, no. 9 and Karol Wojtyla, Love and Responsibility (San Francisco: Ignatius Press, 1993), 21-24.

11. Pius XI, On Christian Marriage (Boston, MA:
St. Paul Books & Media, n.d.), 14.

Copyright ©; Mary Shivanandan 2003

This Version: 11th February 2003

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