Perhaps it isn't surprising that my wife and I weren't familiar with Catholic teaching on artificial contraception — we came back to the Church just before marrying in 1975.

We didn't know what to do, so we did what everyone else was doing — we got on the pill, and we did it three months before we married. As serious Christians, we waited until we were married, but we had no qualms about using the pill.

About a year later we came off the pill to try to start our family. The first month we tried, son number one was on the way. We now have six wonderful children, and my wife is on her way to being a saint.

The joys and sorrows of raising a family got us thinking about how to live our lives. My wife was into breast-feeding and our children were spaced about two years apart, using breast-feeding alone. I was a medical student, a resident at the time, and I began looking into the physiology of spacing children that way.

Then I discovered that the Couple to Couple League had been promoting this for years. So we looked into natural family planning, which they also promote.

After that we also read Pope Paul VI's 1968 encyclical on the regulation of birth, Humanae Vitae, for the first time. When I asked patients, relatives and friends if they had read it, I found out that most had never heard of it.

We read it from cover to cover and our response was: “This is beautiful. Why didn't anyone tell us about this?”

Humanae Vitae says: “Direct interruption of the generative process already begun, and above all, directly willed and procured abortion — even for therapeutic reasons — are to be absolutely excluded as licit means for regulating birth. … Equally to be excluded, as the teaching authority of the Church has often declared, is direct sterilization, whether perpetual or temporary” (No. 14).

The concept that temporary sterilization should be avoided, like abortion, was new to me. Reading further, one finds that there isn't any way to limit births by using artificial contraception that's licit in the eyes of the Church.

When we read that and prayed about it, we committed ourselves to never use artificial contraception again. We found peace and wisdom in that decision. But now I was living a double life — personally committed to living Catholic teaching, but professionally willing to do what I had been trained to do in a Catholic hospital: prescribe contraceptives.

In my profession, prescribing the pill is the current approach to many different cases. It's reminiscent of how everyone switched to bottle-feeding in the 1950s for no good reason.

One day I received a phone call from a patient's husband that forced me to think more deeply. He put his question bluntly: “Do you prescribe artificial contraception?”

“My wife and I use natural family planning,” I replied.

“But what do you prescribe? Will you answer my question please?”

“Well, I have my reasons for what I do,” I said.

“Give me one.” “Well, if I don't prescribe contraceptives for them, then all my patients will get sterilized. I'm thinking the lesser of two evils,” I admitted.

“That particular moral approach has been entirely drummed out of orthodox Catholic teaching,” he informed me, not too gently.

His call pricked my conscience and spurred more study. I read a statement from the Canadian bishops: “When doubt arises due to a conflict between my views and the magisterium, the presumption of truth lies with the magisterium. This must be carefully distinguished from the teaching of individual theologians and individual priests, however intelligent or persuasive they may be.”

Another patient, who was probably praying for me, gave me the phone number for a Dr. Kim Hardy. I called Dr. Hardy at 10 p.m. in New Orleans and talked for an hour, probably the biggest phone bill I've ever had.

I asked him how he managed to make the change to recommending natural family planning only. He said, “Well after I made the decision to stop prescribing contraceptives, my practice disappeared. I had to move cities and go to a Catholic parish that was alive and on fire for God.”

I hung up, told my wife, and she said, “Oh, no!” We realized it was a big decision to put our financial stability on the line.

Losing Everything

Now I studied more diligently. Professor Janet Smith was very helpful. So were Pope John Paul II's writings on the theology of the body.

In Familiaris Consortio, he speaks of “the inseparable connection between the unitive and procreative meanings of human sexuality” (No. 32), and says that contraception contradicts the expression of total self-giving of the husband and wife.

Pope John Paul II is telling us that if you say, “I give my whole self to you, but not my ability to have children and I won't let you give me yours,” then the act of love between a husband and wife becomes degraded.

After studying all these things, my first change was to try to talk people out of using contraceptives. If I couldn't, I would write the prescription. After all, I reasoned, I wasn't the one doing it.

But I was still cooperating.

I considered refusing to give prescriptions to single women. I even encouraged some to abstain. But others only got mad, and besides, the Church says that's not where the line needs to be drawn.

In November 1997, I went to the Catholic Medical Association's annual conference in Toledo and met five Natural Family Planning-only physicians in one night. One speaker discussed the fact that the pill causes abortions at times. If contraceptives cause abortions — and I saw it was possible — how could I justify prescribing them for one more day?

I got down on my knees and prayerfully resolved to change, and went to confession where I received God's forgiveness.

I came back and said to my partners, “I'm a new man. I'm not going to prescribe any more contraceptives.” They responded, “Okay, what are you going to do with your 9 p.m. patient?”

Dear Patients …

My decision led to a few interesting talks the first week, but finally I sent out a letter to my patients.

Several other local gynecologists and pediatricians joined me in my decision to conduct Natural Family Planning-only practices. We also began supporting those teaching Natural Family Planning locally.

When I made the change my wife said, “I was wondering when you would do this. It's about time.”

I now speak to all of my pregnant patients about Natural Family Planning and natural spacing of children. Many have had a “failure” with their artificial methods and are very open to a better method.

Women now hear from their friends, “Dr. Fleming won't give me the pill.” I don't get these patients anymore; but I have a lot more who are praying for me, helping me be the best Catholic doctor I can be.

Dr. Phil Fleming is a gynecologist practicing in Ann Arbor, Mich.

Kate Ernsting contributed to this article.