Natural Family Planning and the Fertility Awareness Method

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Natural Family Planning (NFP) refers to a group of methods that can be used to avoid pregnancy. Because these are the methods of family planning endorsed by the Roman Catholic church, some people mistakenly assume that they are the same thing as the 'rhythm method', which is not the case. Instead, NFP is a collection of methods that use different clinical signs and algorithms to tell when a woman is fertile or infertile, with the most commonly used signs focusing on observations of cervical mucous, basal body temperature, cervical position, and hormone levels. Most (but not all) NFP methods involve some level of
charting - keeping track of fertility signs so that 'fertile' and 'safe' days can be ascertained.

Natural Family Planning (NFP) is sometimes referred to as the "Fertility Awareness Method" (FAM), especially by those who are into it for non-religious reasons and those who choose to use barrier methods rather than abstain during fertile days. Increasing numbers of women are turning to FAM because they see it as a healthier alternative to hormonal contraceptives, because they like the idea of being more 'in tune' with their reproductive systems, and even because they see it as a way of empowering women. FAM most often refers to the sympto-thermal (STM) method described later below, but can theoretically be used with many of the methods described.

Because NFP methods can be used to predict when women are at their most fertile, they're also often used as a method to increase the chance of conception. Sometimes a woman's charts over time from NFP use can help a health care professional pinpoint whether some common fertility problems should be explored, such as anovulatory cycles and short luteal phases. However, the focus of this entry will be on using NFP methods to avoid pregnancy, not achieve it.

Methods - a Finite Selection from an Infinite Sample

There are a large and ever-growing number of NFP methods available to women today, each with its own benefits and disadvantages. As it would be impossible to detail each of them here, this entry will cover a representative sample and include the more commonly used methods.

Counting Methods - It's All in the Numbers

Of all NFP methods, these are the ones that come closest to the 'rhythm methods' of old. These methods can only be used effectively in women who have relatively regular cycles of 'average' lengths. For example, the Standard Days method is only conisdered appropriate for women whose menstrual cycles are usually between 26-32 days in length. In this method, couples abstain on days 8-19 of the woman's cycle - this means that every couple using this method will need to abstain for 12 days each cycle, regardless of fertility signs.

Basal Body Temperature Method

The Basal Body Temperature (BBT) method involves determining fertile vs infertile days solely from basal body temperature. For optimum effectiveness, temperature needs to be taken every morning upon arising using a basal thermometer either orally, vaginally, or rectally. This method is based on the fact that women's temperatures tend to rise very slightly just after ovulation. Because this rise can be less than a degree Fahrenheit and a person's body temperature tends to increase over the course of the day, taking the temperature at about the same time each day is important for this method.

Paragraph HERE about coverlines, thermal shifts, etc.

While there are several electronic gadgets on the market designed for this method, there do not appear to be any organizations that advocate this as a first-line option, in part because of concerns that the efficacy is lower than for other NFP methods.

Mucous Only Methods

Mucous-only methods involve checking for cervical discharge repeatedly over the course of the day. This type of method truly cannot be learned from a book alone - relatively subtle changes differentiate between the many mucous types to be charted, and couples really need to work with a well-trained instructor. One advantage over temperature-based methods for some women is that there is no need to wake up at the same consistent time each day with a mucous-only method.

The most commonly used mucous-only method is probably the Billings Ovulation Methods (BOM), but growing in popularity is the Creighton Model (CrM) FertilityCare System. There are differences between the two in how mucous is assessed and charted - BOM involves developing an ongoing awareness of the sensations that the mucous generates, and CrM involves checking with toilet paper with each visit to the restroom. The Ovulation Method (OM) is a spin-off of BOM; the method itself has remained very largely the same, with the main changes being in how the method is taught.

The Creighton Model FertilityCare System has more resources and tools for dealing with women's reproductive healthcare as a whole than any other method discussed here. Many women first seek out a FertilityCare Practitioner not to learn family planning, but because they are struggling with infertility or menstrual abnormalities.

Symptothermal Methods - Putting it All Together

The Sympto-Thermal Method (STM) uses temperature, mucuous, and in some cases cervical position to distinguish between a woman's fertile and infertile periods.

There are several variations on this method, including --
Couple to Couple League (CCL)
Take Charge of Your Fertility (TCOYF) (will need to find a page of this link that will be kosher)
Northwest Family Services (NWFS)

If you're not entirely sure where your cervix is or what it looks like, you might find it helpful to actually examine it visually to begin with, by doing a self pelvic exam.

Hormone Measurement Methods - Science to the Rescue!

It's not uncommon for women who are trying to avoid pregnancy to be reluctant to trust their own observations to ascertain their fertility status on a day-by-day basis. Other women struggle with symptom-based methods because of irregularities in their body temperatures and/or cervical signs. For these women and their partners, methods that involve actually measuring hormones to determine fertility can be more effective and less stressful.

Marquette Method

Lactational Ammenorrhea - The Role of Breastfeeding in NFP

Lactational ammenorrhea (LAM) is the medical term for the way in which breastfeeding can delay a woman's return to fertility after pregnancy. A woman who is not breastfeeding can theoretically conceive again within weeks of giving birth. Breastfeeding can extend this period up to six months, but only under certain conditions:

  • The woman must be exclusively breastfeeding - this means that the infant isn't receiving any bottles or solid foods.

  • Breastfeeding is occurring on demand, rather than on a set schedule.

  • The infant is being breastfed at least once during the night.

In these circumstances, LAM can be used intentionally as a form of NFP - the effectiveness of this has even been documented by the World Health Organization (WHO). While a woman may go for longer than 6 months before seeing menstruation - or may continue to skip periods even if the above criteria are not met - LAM is not considered an effective form of NFP in these situations.

ADD MORE HERE about time limits for LAM, effectiveness, warnings about pacis, and importance of watching for return of fertility during breastfeeding.

Gadgets and Technology

Can there be a role for technology in Natural Family Planning? Definitely - there a wide variety of gadgets and software programs on the market that can help a couple determine and keep track of a woman's fertile periods.

Low-Tech Options - Keeping it Simple

CycleBeads (with glow in the dark feature) - based on Standard Days Method, problems with keeping track of date --

Saliva testers and 'ferning'

Electronic Gadgets - Have You Been Probed Yet Today?

Ladycomp/Babycomp - temp based only, (can't find a non-commerical link)
Pearly - temp based only, like Ladycomp but smaller, less expensive, and without extra features like glow in the dark indicators.
Persona Contraceptive Fertility Monitor - urine/hormone based, not available in the US? -

Fertility monitors designed for achieving pregnancy
Clearplan Easy Fertility Monitor
Bioself - temp based only --
Ovacue - saliva with optional vaginal probe -

Software - How Much Does Your Computer Know About Your Sex Life?

Ovusoft -
CycleSense -
web-based, like FertilityFriend -
PDA versions

Efficacy and Effectiveness - Will it Work?

ADD PARAGRAPH HERE on efficacy vs effectiveness, typical use vs perfect use, etc

Research Studies

According to the World Health Organization, NFP methods are somewhat more effective than most barrier methods, and somewhat less effective than hormonal or surgical methods.

Combining NFP/FAM with Other Methods

how it works with lactational ammenhorrhea (Often combined with the lactational amenorrhoea method in the first 6 months postpartum. Only effective if mother is exclusively breastfeeding.)

how using barrier methods (rather than abstaining completely) during fertile periods changes effectiveness rates

Yes, But Will it Work for Me?

Populations in Which NFP Methods are Especially Effective

Populations in Which NFP Methods are Less Effective
drugs that affect cervical mucous, and can make the ovulation method more difficult/less effective:

WHO page that lists groups for which NFP will be less effective, however, it doesn't clearly differentiate between mucous-based methods and temperature-based methods: (broken link, find new one)

Motivations for Using NFP or FAM

There are a variety of reasons why a woman and her partner might decide to use Natural Family Planning...

Religion - Using NFP as part of God's Plan

It's not a coincidence that so many of the organizations dedicated to teaching and advocating NFP are explicitly Catholic - the Roman Catholic Church's position against contraception (including both hormonal and barrier methods) leaves NFP as the only morally licit way for Catholic couples to try to space their pregnancies. From the Catholic perspective, NFP isn't considered contraception, as each sexual act is still completely 'open' to the possibility of life, with husband and wife giving fulling of themselves. Even NFP isn't viewed by the Church as something that should be used in every situation, however - it's only considered acceptable when the couple has serious or grave reasons for avoid conception at that time.

However, Catholicism isn't the only religion that has directed families towards Natural Family Planning.

NFP and protestants website:
(some of the information is extremely biased)

NFP and orthodox christians website:
Most orthrodox denominations seem to currently accept artificial contraceptives that do not have abortifacient potential (i.e., barrier methods ok, hormonal methods no ok), but encourage NFP as the ideal. They also make it clear that preventing conception is only considered acceptable under certain circumstances (i.e., it needs to be a non-selfish decision).

NFP and latter-day saints website:

NFP is also sometimes encouraged among Islamic and Jewish believers as well.

Health and Wellbeing

Other Motivations

cost, accessibility, independence, cooperation with partner, positive impact on relationship, increased self-knowledge and empowerment.

Getting Started and Keeping Going

Value of having a teacher and/or mentor

There are several ways to find a class or a teacher. Natural Family Planning classes are sponsored by the Catholic Church in many communities - if this is something that might work for you, a call to your local parish or diocese could help you find a convenient class. Many of the organizations associated with the NFP methods listed above have teachers who offer both group classes and private tutorials; some offer couples the option of a religion-based or a secular curriculum.

Fertility Awareness Method classes are offered by some Planned Parenthood clinics, and also by individual instructors who may or may not be associated with larger organizations like the Fertility Awareness Network, TCOYF, or Justisse. If your community has a feminist health clinic, they may offer FAM instruction, as do some midwives.

Women who are using NFP will often find that they can benefit from talking to other women - this kind of support can help with everything from finding the best method for a couple, getting in touch with good learning resources, advice on charting and recognizing different fertility signs, to dealing with the issues related to periodic abstinence. There is a popular online support group, and while the NFP discussion board is largely a Catholic group, couples who are using or considering NFP for any reason are welcome.

Still to be sorted:

Handout on NFP from American Academy of Family Physicians

Information from Johns Hopkins University, also has links to WHO medical eligbility criteria for other forms of birth control

There are supposedly some WHO resources and studies -- find those and link

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