Looking to Ditch Your Birth Control Pills?

If you and your husband wish to postpone pregnancy, you have several contraceptive options available. One approach—natural family planning (NFP)—has many advantages, yet receives little attention in popular media or the medical community. What's the reason for this lack of awareness? Often it's the common but mistaken impression that any method of postponing pregnancy that doesn't involve medical technology is unreliable or even haphazard. However, studies indicate when couples are taught to use natural family planning methods consistently, NFP is as effective as oral contraceptives and easily surpasses the effectiveness of condoms, whose failure rate is widely considered to be as high as 10 to 15 percent per year. And natural family planning poses no moral or ethical dilemmas for those concerned about the use of other contraceptive technologies.

What are NFP's basic principles?

All forms of NFP involve identifying a woman's "fertile" days, then abstaining from sexual intercourse on those days or engaging in intercourse if a baby is desired. The original calendar or "rhythm" method, devised in the '30s, was based on the knowledge that the time between ovulation (when the ovary releases an egg) and the beginning of menstruation is nearly always two weeks. Women with regular menstrual cycles are most successful with this method since they can predict the timing of their next period, then count back two weeks to determine their fertile days. Unfortunately, at least 25 percent of women don't experience cycles with clockwork regularity, and even those who do might have an unexpected change caused by stress, illness, or other factors.

More recent NFP methods can better pinpoint a woman's fertile period. In 1964, Australian neurologist John Billings and his wife, Lyn, a pediatrician, described a method of predicting fertility that involves a daily self-check of cervical mucus. When a woman nears ovulation, her mucus becomes increasingly clear, watery, and elastic, like egg white. Before and after these fertile days, the mucus is thicker, stickier, and virtually impenetrable, an effective barrier to sperm.

A key time in the cycle is the arrival of the "peak day," after which the mucus begins to revert to its former thick, sticky condition and/or disappears. The peak day correlates with ovulation. Couples who want to postpone pregnancy avoid intercourse when the mucus becomes thin and clear, and abstain for three days after the peak day. Even though an unfertilized egg lives only twelve to twenty-four hours, ovulation can take place two or even three days after the peak day. Abstinence is also necessary for a few days prior to the peak day because sperm survive for two to three days in the cervix when the mucus starts to thin. Here's an easy rhyme from an organization that teaches the Billings method to help you remember it: When mucus is wet, a baby you may get. When mucus is dry, the sperm will die.

Another NFP approach based on the Billings method is the symptothermal method. Couples not only assess cervical mucus but also a woman's basal body temperature, which consistently rises about a half degree when ovulation occurs. A woman takes her temperature every morning before arising with a special thermometer and marks the results on a basal body temperature chart, making it possible to see when ovulation takes place.

Couples using this method also note other symptoms to help them identify ovulation, including midcycle ovarian pain with ovulation, vulvar swelling, or abdominal bloating. None of these symptoms are reliable by themselves, but they can help confirm whether your estimate of fertile days is accurate.

What are NFP's advantages?

With NFP, no drugs, devices, or procedures are involved—thus, there are no side-effects or medical risks, such as future infertility. Here are some other benefits:

Cost is minimal. Aside from the charge for NFP materials and the price of a basal body thermometer, there are no ongoing expenses.

NFP can enhance partnership in marriage. Because both you and your husband must share responsibility in order for these techniques to work, communication in marriage, especially regarding sex, is usually improved.

NFP methods are also useful to couples who want to become pregnant. When intercourse is accurately timed to ovulation, the odds of conceiving are increased. If you and your husband have had difficulty becoming pregnant, your knowledge of your menstrual cycles, basal body temperatures, and cervical mucus is useful if a medical evaluation for infertility becomes necessary.

What are NFP's drawbacks?

Natural family planning requires consistency and ongoing self-discipline to succeed. If your husband won't cooperate, or if he resents the abstinence required each month, other methods may be more appropriate. Here are other factors to ponder:

Do you have a long, reliable track record with this method? If not, NFP isn't advisable if you must not become pregnant for medical reasons.

NFP methods may not work well in certain situations. These include if you have abnormal mucus production, little temperature rise with ovulation, or certain medical problems (such as polycystic ovaries) in which your hormonal patterns are abnormal or extremely unpredictable.

Where can I get more information?

For the Billings ovulation method, contact the Family of the Americas Foundation, Inc., P.O. Box 1170, Dunkirk, MD 20754-1170, 301-627-3346, or the Natural Family Planning Center of Washington, D.C., 8514 Bradmoor Drive, Bethesda, MD 20817-3810, 301-897-9323. For more information on the symptothermal method, contact the Couple to Couple League, P.O. Box 111184, Cincinnati, Ohio 45211, 513-471-2000.

Paul Reisser, M.D., is a family physician in Southern California who serves on the Physician's Advisory Council for Focus on the Family. Dr. Reisser and his wife, Teri, have two teenagers.