The Natural Family Planning Page

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The Natural Family Planning Page

Natural Family Planning (NFP) refers to several methods for spacing, postponing, avoiding or enhancing the possibilities of conception, without any chemical or physiological alterations of the reproductive system (female or male).

Contemporary methods, which are the focus of this page, are sometimes referred to as 'Fertility Awareness' since they are ultimately based on awareness of natural symptoms of fertility that are readily recognizable by any woman. As such they are distinct from older 'calendar' methods such as Ogino-Knaus (the so-called 'rhythm').

NFP Research

NFP has extensive support in the medical literature since the 'seminal' article appeared in the 'Lancet' in 1972. A select bibliography will eventually be available here. Meantime much of it can be found by consulting the Billings, Nature's Method and CCL sites. Good sources for NFP bibliography are recommended in this note from Dr Joe Stanford of the University of Utah.

NFP methods in brief:

Primary symptom: sensation of wetness/dryness due to changes in cervical mucus that indicates the time of ovulation
Methods include (or are variously named): Billings (Ovulation) Method -see here also; Creighton Model NFP
Sympto-Thermal Method.
Reliability: 97.5-99.5% method-effectiveness in extensive clinical trials.
Side-effects: None.
Cost: initial training usually $10-120, though it is frequently provided free of charge; maintenance costs are practically nil.
Involves: Corresponsibility of the couple; periodic abstinence; motivation.
Works for: everyone, including post-partum and pre-menopausal women, illiterate women; women with irregular cycles, etc.
Uses: postponing or spacing births; achieving conception in couples with marginal fertility.
Humanitarian advantages: it respects the natural ecology of the body; it is in harmony with the customs and ethical requirements of all major cultural and religious traditions (including the Catholic and Moslem faiths)

The Billings Ovulation Method of NFP

It is a method of family planning which takes advantage of the biological fact that women are infertile more often than fertile throughout their reproductive years. Couples can use the knowledge of their fertility to achieve or avoid a pregnancy.

How does it work?

The Billings Ovulation Method is based on the following facts:

Ovulation occurs only one day in each cycle.
The ovum lives in the fallopian tube for less than 24 hours if not fertilized.
Sperm need fertile mucus to survive.
Sperm without fertile mucus die within a short time.
Sperm with fertile mucus may live 3-5 days.
fertility depends on ovulation and satisfactory mucus.
Shedding the lining of the uterus (menstruation/period) occurs 10-16 days after ovulation.
Couples wishing to achieve a pregnancy may wish to have intercourse at the fertile time.

Couples wishing to avoid pregnancy refrain from intercourse or sexual contact at the time of fertility.

How do a couple know when they are fertile?

For several days before ovulation a woman's body produces mucus from the cervix (the opening of the uterus). This mucus gives early awareness of fertility. It is essential for sperm survival and transport. A couple learn to identify their fertility and infertility through the woman's observation of this mucus and the sensations accompanying it. This mucus is apparent at the vulva (the external opening of the vagina) and, in the course of her ordinary activities, a woman may be aware of sensations indicating the presence of the fertile mucus.

Can the Ovulation Method be used if you have irregular cycles?

Yes. As the Billings Ovulation Method is based on identifying fertility or infertility on a day to day basis, all women can learn the method regardless of their cycle length or irregularity. Women who are ovulating irregularly, or not at all, can use the method to identify infertility or periods of infertility.

Once learned, the method can be applied to all variations throughout a woman's life:

Regular cycles
Irregular cycles
Anovular cycles (no ovulation)
After childbirth
While breast-feeding
After contraceptive medication
Approaching menopause
Low fertility

Does the Billings Ovulation Method have any medical side-effects?

No. The Ovulation Method is harmless. It does not depend on pills, devices, invasive examination or surgical procedures.

All in all modern Natural Family Planning (NFP) is safe, healthy, 99% effective in avoiding pregnancy, as well as in achieving one,a good marriage builder, is reversible, morally accepted, and cheap. You can accurately gauge your fertility through easily observable signs and choose to increase or greatly decrease your fertility while getting to know your body better.

For people who are trying to avoid pregnancy there are only 3 methods of 100% effective avoidance of pregnancy:

Total abstinence
Removal of the ovaries (NOT tubal ligation)
Castration (NOT vasectomy)

All of these method has a pregnancy rate, including NFP. Though it readers must bear in mind that the information stated on this page is not rally an adequate one. You are suggested to refer to more books and professional organization for a thorough study. The information given here is solely the opinion of the authors and not any NTP organizations.

Below are somewhat little information gathered by the authors on the basics of the said method.

EFFECTIVENESS FOR AVOIDING PREGNANCY

The most surprising advantage of NFP to some is that, to avoid pregnancy, it is actually more effective than most forms of artificial birth control.

For comparison, below is the approximate method effectiveness (percentage of couples of normal fertility who go one year without getting pregnant, using each method properly).

No birth control method	20%
Calendar Rhythm (Ogino-Knaus)	87%
Withdrawal	91%
Ovulation (or Billings) method	96%
Diaphragm with spermicide	97%
Foam	97%
LAM (breastfeeding) (first 6 months)	98%
Condom	99%
I U D	99%
Pill	99.7%
Sympto-Thermal method	99.8%
Tubal Ligation	99.6%
Vasectomy	99.85%
Castration, removal of ovaries, abstinence:	100%

This data was reported by the U.S. Dept. of HEW, and various respected medical journals. The references are in "The Art of NFP" (ANFP) book. Two studies actually showed a zero STM pregnancy rate, but realistically ALL methods, even tubal and vasectomy, have a surprise pregnancy rate (except the last 3).

The most effective reversible birth control method is a version of the Sympto-Thermal Method that allows intercourse only after the rules determine ovulation. Most couples don't want to follow such a strict regimen and are willing to accept a small risk of pregnancy, so they choose a variation that suits their needs. The effectiveness is really your choice.

A recent but typical study found "...natural family planning can be extremely effective in the Third World. The study was of 19,843 predominantly poor women in Calcutta...The pregnancy rate was similar to that with the combined contraceptive pill --0.2 pregnancies/100 women users yearly." (British Medical Journal, Sept. 18, 1993, by R.E.J. Ryder.)

User rates for all methods are lower. The user rate is the actual rate in practice by couples who sometimes misuse a method (forget a pill, diaphragm in wrong, condom without spermicide, misinterpret NFP rule, etc.). Another reason for lower user rates is that some studies had only limiters and others only spacers. Limiters intend to limit family size; spacers generally want kids "soon" and are apt to use more liberal rules and take chances, and will eventually use NFP to increase their fertility. Lumping in spacers, some studies have shown NFP effectiveness as low as 85%, which is most often quoted in literature designed to sell artificial contraception. However, artificial methods also have low effectiveness rates if not used carefully.

You can reach the "99%" effectiveness level (better than artificial methods) if you learn NFP properly and practice it according to the rules. It is NOT contingent on your having regular cycles. You can also use NFP to help get pregnant when desired, and pay attention on your daily nutrition to increase your fertility. Additional information substantiating the excellent effectiveness of NFP can be found at the CCL and Family of the Americas web pages.

HEALTH

Natural methods do not interfere with a person's health in any way. In fact, you get to know your cycles so that you know when something's not totally right. And if your cycles are really weird, NFP can be used, but it alerts you and your doctor.

By using NFP, women learn things about their individual bodies which can be useful when trying to acheive pregnancy. NFP doesn't have side effects that can reduce fertility in the long-term, as some artificial birth control methods can.

MARRIAGE BUILDING

NFP users generally reports a positive impact on a relationship. It operates a totally different way from contraception, which acts as a barrier (physically and emotionally) between you. Because NFP is a cooperative system, it helps you to love, respect, appreciate, and communicate better. You learn it together, interpret the charts together, and decide to postpone or seek pregnancy together. The divorce rate among NFP users is far less than the average partly because of this.

The reason most people who avoids pregnancy refuses to try NFP is probably due to the periodic abstinence from sexual relations that is required. We turn that around and count it as an advantage instead. It prevents the partners from developing a pattern where one person is always desirous of intimacy and the other is always seeking more space, by creating times when both people feel strong desires. A "courtship" and a "honeymoon" each month helps keep a marriage from getting stale. It also forces you to develop different aspects of your relationship at different times.

Couples trying to achieve pregnancy can feel there is no pressure on them during most of the month, when they know what part of the month they're fertile. Charting fertility signs can let people know whether they're pregnant or not, much sooner than they would otherwise know, thus reducing uncertainty and anxietyboth for those seeking and avoiding pregnancy.

COST

Classes, books and materials are anywhere from free to $60, and after that it takes a $3 book of charts per year. You save the cost of home preg. tests, fertility specialists and drugs, birth control pills, doctor visits & surgery. This really is a disadvantage, making NFP instructors hard to find because, unlike the huge contraceptive industry, they cannot advertise due to low cash flow.

CYCLES: BASIC FERTILITY AWARENESS

In a typical menstrual cycle, a woman has several days of bleeding, followed usually by a few infertile days, then several days during which fertile cervical fluid is produced, then ovulation. About 2 weeks after ovulation the cycle ends and the bleeding of the next cycle begins.

If you have intercourse when no fertile cervical fluid is being produced, (and this usually includes the days of bleeding), the sperm quickly die, and pregnancy is highly unlikely. When fertile cervical fluid is present, the sperm gradually dies but can still live in it for up to 6 days. Therefore you are fertile when fertile cervical fluid is being produced, even several days before ovulation. The egg lives only about one day. Ovulation may occur again up to a day later, and that egg dies a day later. After that, it's impossible for you to become pregnant for the rest of that cycle.

The different parts of this cycle are usually determined using two main symptoms. The first is basal body temperature, an easy and reliable indicator that ovulation has occurred. The woman's temperature is taken immediately upon waking, at the same time every morning. It only goes up about a half degree Fahrenheit, which is most accurately read with a basal body temperature (BBT) thermometer. It generally stays up for 2 weeks (the "luteal phase"), then might dip just before menses starts again.

The second symptom is observation of the quality of the cervical fluid itself. This takes more experience than just reading a thermometer, but most people with good instruction are doing well after 3 to 4 cycles. The fertile cervical fluid lasts around 3 to 7 days, and is like stretchy egg white. The less fertile cervical fluid is tacky, opaque, and generally less abundant.

In the usual cycle, cervical fluid builds up to a peak, ovulation occurs, then the cervical fluid dries up and BBT goes up. However, ovulation can be delayed due to a number of things, or a cervical fluid patch may start then dry up, then start again; you just wait for the BBT rise to signal ovulation. Postpartum cycles (including nursing, which prevents ovulation temporarily) and menopause are normal things that can be successfully charted.

Several different rules for finding the relatively fertile and infertile times have been developed and fine tuned over the years, based on thousands of charts and much medical research. You can choose each cycle whether to seek or avoid pregnancy, and how conservative to be. We haven't told you everything you need to know to interpret the cervical fluid or temperature signs. That's something we're leaving to adequate instruction (books or class).

AVOIDING PREGNANCY

Since men are normally always fertile, NFP methods depend on finding out when the woman is fertile or possibly fertile, and having intercourse only on days when she is known to be infertile.

CALENDAR RHYTHM

The now obsolete Calendar Rhythm used each woman's past cycle history to predict future cycles. Its method effectiveness, up to 87%, was similar to that of its competitors in the 30's and 40's. The Calendar Rhythm method, practiced correctly, uses the shortest and longest cycle in the past year or two to design rules for each woman. If a woman has a cycle much shorter or longer than her normal length, she can then get pregnant. Unfortunately, it was taught and practiced haphazardly, resulting in much worse effectiveness.

Instead, modern NFP assumes women are not perfectly regular. It accurately gauges your fertility as it happens, using readily observed symptoms.

OVULATION METHOD

In the Ovulation Method (OM), also known as the Billings method, the woman not only observes when she is bleeding, but also observes when she's producing fertile cervical fluid. Many women are keptical that they can really observe their cervical fluid, but after daily charting and the guidance of a qualified teacher, they get to be pros after a few cycles. Thus the fertile time is determined with good accuracy.

The days of bleeding are days of low probability of being fertile; one isn't quite sure on those days. Without the confirmation of ovulation, bleeding which otherwise seems to be menstruation could really be bleeding at the time of ovulation, or bleeding for some other reason. So they're called "days of bleeding" rather than "menstruation," and require abstinence. Also, in a very short cycle, fertile cervical fluid may begin to be produced before menstruation has finished, and it may be difficult to observe in the presence of bleeding.

The OM is much more effective than rhythm was, because the actual fertile time is detected. If there's an unusually long or short cycle where the rhythm method would fail, the OM nevertheless requires abstinence during your fertile time, as detected by the cervical fluid pattern. An added advantage is that the OM allows intercourse from the end of bleeding all the way up to the time that your fertile time begins, which happens when the sperm-sustaining fertile cervical fluid appears.

SYMPTO-THERMAL METHOD

Using cervical fluid observations like the OM but crosschecking them by temperature is called the Sympto-Thermal Method (STM), and is more accurate than using either sign alone. Occasionally there's more than one cervical fluid patch, but ovulation occurs only after the last one. Without the temperature crosscheck, you would assume ovulation was after the first cervical fluid patch.

The Sympto-Thermal method uses daily temperature measurements, taken upon waking in the morning at the same time every day. It also relies on symptoms of fertility, most commonly the presence of fertile cervical fluid, and the position of the cervix. Around the fertile time, the cervix withdraws further into the body and its opening widens.

At the time of ovulation, temperature starts to rise about half a degree Fahrenheit. Crosschecked with the other symptoms, this provides confirmation that ovulation has occurred and determines the infertile time following ovulation. The precise sympto-thermal rules require waiting 3, 4 or more days, depending on the situation, after the first sign that ovulation seems to have occurred, while continuing to collect information to confirm it. This also allows for multiple ovulations.

The infertile time in the early part of the cycle is less certain, but can still be found with effectiveness rates that compare well with other methods. The version with the lowest effectiveness rate allows intercourse up to the last day that is free of fertile signs such as cervical fluid. This rule is similar to the Billings Method. Stricter rules are available for those who want them; these rules involve beginning abstinence a few days before the first fertile signs are expected.

In the STM intercourse is often allowed during menstruation. Unlike the OM, you can tell that bleeding is really menstruation, because the rise of temperature in the previous cycle confirms that ovulation has occurred.

A possible new approach is examining dried saliva or cervical fluid with a magnifying lens. The crystallization patterns theoretically change depending on whether the woman is in the fertile part of her cycle. But user experience and medical studies have not yet shown this to be easily used or effective, as the other symptoms are.

LACTATION AMENORRHEA METHOD

Recently, researchers have defined what they call the "Lactation Amenorrhea Method" (LAM). Used since the beginning of humanity, breastfeeding still prevents more pregnancies than all artificial methods of birth control put together.

After giving birth, a woman normally experiences a time of infertility until her body is ready for another pregnancy. If you don't breastfeed, it's usually quite short. If you exclusively breastfeed your baby, without pacifiers, bottles, babysitters, or schedules, the average length of infertility is 14 months. It varies a lot, though, from a few months to several years. If fertility returns during the first 6 months while breastfeeding a lot, it usually starts with menstruation before the first ovulation. That provides a warning that fertility is returning.

The rules for LAM are simple: If a woman has given birth in the last 6 months, is fully breastfeeding her baby (no formula, solid food, etc.) and has not yet menstruated, she can assume she has 98% family planning effectiveness from breastfeeding alone.

You can achieve higher effectiveness by following guidelines of "ecological mothering": nursing on demand, nursing at night, nursing in a lying-down position for naps and at night, no bottles or pacifiers. The longest time between feedings each day may be the strongest factor leading to the return of fertility, so if the baby stops nursing during the night, the return of fertility becomes more likely.

Your fertility will return eventually, of course, and you can delay subsequent pregnancy by watching for the return of fertility. If you've practiced NFP before your pregnancy this is easy. Otherwise, you need the guidance of a qualified teacher.

Not only is breastfeeding good birth control, it is highly beneficial to your baby`s physical and emotional health by providing nutrients, antibodies, and nurturing. Birth control pills adversely affect nursing and milk nutrients, but you need not stop nursing; you simply don't need the Pill.

UNICEF has estimated that each year, 1.5 million babies die worldwide because they weren't breastfed. Use of LAM provides an additional incentive and source of support for breastfeeding.

GETTING PREGNANT

Conception occurs right after ovulation, as the egg enters the fallopian tubes. With good timing, sperm will be waiting there to fertilize it. The egg only lives a day or so, but sperm can live several days in the fertile type cervical fluid. So achieving pregnancy is a matter of timing coitus just before ovulation.

If the woman has very short cervical fluid patches (assuming she knows what to look for), this could adversely affect her fertility. Dry-up drugs like antihistamines, or not drinking enough water, can reduce the amount of cervical fluid. Improved nutrition and guaifenesin (e.g., Robitussin cough syrup) can sometimes help to generate more.

Finding exact ovulation time is impossible without a laparoscope, but you've got a few days of sperm life to work with. Possible signs of ovulation are:

A temp dip toward the end of cervical fluid pattern
First day of cervical fluid dryup
First day of temp rise (usually too late)

ESTIMATED DATE OF CHILDBIRTH

Pregnancy doesn't "begin" at the last menstrual period (LMP); that's the basis of the old-fashioned Naegele's Rule. The time between menses and ovulation can vary, and a woman may even have breakthrough bleeding when she is expecting her next period. The EDC by the Prem rule is the first day of temperature rise minus 7 days plus 9 months. (That's 38 weeks after conception, not LMP.) 65% of deliveries will be plus or minus one week from EDC; 90% +/- 2 weeks; 95 +/-3 weeks; 99% +/-4 weeks.

FERTILITY FACTORS

Fertility varies widely, and about 10% of couples have fertility problems. Talking with NFP teachers (or reading books) may reveal a better picture of what your fertility is, and what your prospects for improving it are. It depends on a lot of factors, and self-awareness of your cycles is the first step. There is a lot you can do without resorting to expensive, ineffective fertility clinics and drugs.

Your charts, properly interpreted, show what your cycles are like. Look for anovulatory cycles, length of cervical fluid patches, breakthrough bleeding, delayed ovulation, or symptoms of approaching menopause. Short luteal phases or unusually low BBT (around 97.2 degrees or lower) may be related to infertility and can often be treated with vitamins and other nutrients, or changes in lifestyle.

A gradual decrease in fertility occurs with age, but until menopause there's still a chance. An MD told a friend of Jim and Mary that over 40, women don't ovulate, but they have 60 charts that show otherwise.

The hormone contraceptives (Pill, Norplant) can have unwanted permanence, and previous IUD use can cause repeated miscarriages. Another good reason not to use them.

Your health and nutrition is important. Drugs, tobacco, alcohol, and caffeine use affect fertility. Stress and excitement can result in anovulatory cycles. Improving your diet and/or taking certain vitamin and mineral supplements can improve fertility; for example, the father must have sufficient vitamin C in hisdiet or the sperm can't swim. For the woman, too much exercise or not enough body fat (min. 20%) can reduce fertility.

If you have low fertility due to low sperm production, irregular cycles, or low cervical fluid there may be additional (and cheap) things you can do to correct these problems.

Before using high-tech infertility treatments, charting the women's cycles can help determine what is causing the infertility, and thus provide a guide as to what techniques may be useful. For example, if charting shows that the woman is actually getting pregnant but is having very early miscarriages, then In-Vitro Fertilization won't be much use, but other medical treatments may help. Short luteal phases, unusually low basal temperatures or lack of fertile cervical fluid are different conditions that can be related to infertility and that have different nutritional or medical treatments.