There was great interest aroused by this article and on 16th October the BMJ published nine letters all strongly critical of Dr Ryder's enthusiasm for natural family planning.

James Trussell of the Office of Population Research at Princeton University criticised the data quoted by Dr Ryder, stressing the wide gap between failure rates from perfect use and from imperfect use of the ovulation method during the WHO trial: "it is extremely unforgiving of imperfect use", although he admitted that imperfect use was not very common.

A letter from representatives of the International Planned Parenthood Federation took issue with the same study, similarly stressing the strict requirements of perfect use, while another criticised the method for requiring "a level of control over sexual behaviour that many people have not got".

John Guillebaud also criticised the use of the Calcutta and WHO studies, expressed doubts about the ability of the majority of users to apply the method perfectly, and also opined that the desire for sexual intercourse is "strongest post-menstrually leading up to ovulation", though one would have liked him to quote a reliable source for that fact.

Another letter (from a man ! ) bemoaned the poor prospects for a method which relies on the co-operation of men: "It does not matter how well a woman understands the signs of ovulation if she has to submit to her partner's demands". Anne Jewell also saw NFP as an unfair burden on the female partner where motivation to abstain at the fertile time is unbalanced within the couple.

Meghana Pandit wrote to say that a method of periodic abstinence is unfair to poor people living in crowded housing whose limited privacy may already be depriving them of opportunities for intercourse.

A letter from the Margaret Pyke Centre called for the Catholic Church to condemn artificial infant feeding in the same terms as artificial birth control, since more breastfeeding would mean fewer unwanted pregnancies world-wide, and another from the same centre attacked the whole idea of periodic abstinence as "unnatural".

A few weeks later in the issue of 20th November the editor updated the debate by printing the "extraordinary" letters of support for Dr Ryder received by the BMJ, saying: "This correspondence ... has changed what may have been a prejudice on my part against natural methods of contraception."

Some of these letters countered the objections raised. Dr Ryder himself replied to the unease about "insufficient information" in the Calcutta study, defending his Pearl index calculation of 0.35 for all pregnancies.

John Kelly pointed out to John Guillebaud that "arousal depends on many factors irrespective of the time in the cycle", and an obstetrician pointed out Kinsey's findings that most women experience maximum sexual responsiveness immediately before or just after the menses. Others wrote of the gap between failure rates for perfect and imperfect use in other methods. There were also calls for well-funded large scale studies to establish a clearer and more credible picture of the method's true reliability status.

Cecilia Pyper focused attention on studies other than those criticised in the earlier letters, namely sympto-thermal research in Italy and Germany, and her own practice's pilot study, while another letter cited a Chinese study with excellent effectiveness and continuation rates.

Gavin Jarvis questioned the morality of developing contraceptive policy on the basis that "men are mere brute beasts ... driven by an urge over which they have no control ... Such attitudes reduce sexuality to a mere reflex."

Dr Kelly also suggested that behind the profession's resistance may lie the fact that "scientific natural family planning depends on consumers rather than providers", and Dr Clift made this same point: "Could it be that people want to promote the use of expensive drugs ?", calling for the NHS to invest in developing the method.

Colleen Norman also deplored the lack of availability of a natural method, "rarely offered by family planning clinics, even to couples requesting it", despite the fact that even the most critical correspondents had acknowledged that there are couples who choose natural methods and use them very effectively.

Professor Odeblad wrote to express appreciation for the use made of his research by the Billings method.

Many correspondents who wrote in support of Dr Ryder cited the emotional and psychological benefits of natural methods in deepening relationships, sharing responsibility and promoting co-operation and mutual respect.

But the interest engendered by Dr. Ryder’s article was not confined to readers of the BMJ. Articles appeared in the National Press, the Tabloids and in Women’s Magazines. Dr Ryder was in demand for interviews and lectures.

This welcome publicity for Natural Methods of Family Planning has maintained the increased demand on the NFP Service from Clients and from Health Service Personnel and we are grateful for co-operation of the work of those in all organisations who teach Natural Family Planning.

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