How to use natural family planning

(First of two parts)
In one of our medical missions, we visited a poor family living beside the Sta. Mesa railway. They have seven children, all with tuberculosis. The father and mother also have TB. We helped them for a span of six months. The last time I saw them, the mother was again pregnant with her eighth child. She confessed that she doesn’t know how to stop having babies.
A local study listed the preferred methods of family planning used by Filipinos: contraceptive pills (32 percent); ligation for women (19 percent); withdrawal method (14 percent); rhythm method (14 percent); condom (4 percent) and vasectomy (0.2 percent).
The only method approved by the Catholic church is the natural form of family planning, which relies on the couple’s ability to determine whether the woman is fertile or not.
The woman’s fertile period occurs in the middle of the menstrual cycle, from around 72 hours before ovulation (the regular release of the female egg from the ovary) up to 24 hours after ovulation. Highly motivated couples can use this method effectively.
There are four techniques to determine the time of ovulation:
1. Calendar rhythm method can be used by women with relatively regular menses. For a span of one year, record the woman’s shortest cycle and longest cycle. For example, a woman may have 26 days as the shortest and 34 days as the longest cycle. Next, follow this computation strictly: Subtract 18 days from the shortest cycle, and also subtract 10 days from the longest cycle. In this case, the answers are eight and 24, respectively. Therefore, the woman is not safe from days eight to 24 of her cycle. Day one counts as the first day of menses.
Other family planning methods can be used for the unsafe 16 days. (The reason for the constants 18 and 10 have to do with the fact that ovulation occurs 14 days before the start of menses. The extra plus four days are for safety purposes because the sperm can live up to three to four days.)
2. Temperature method. For most women, there is a slight rise in temperature just after ovulation. The woman has to take and record her temperature every morning once she wakes up and before doing anything.
For example, from an average of 36.5oC during non-ovulation period, her temperature can rise 0.3 to 0.5oC during ovulation. For this method, you need to buy a special thermometer called a basal thermometer, or an electronic thermometer.
Remember, the woman is unsafe up to four days after the rise in temperature, and four days before the rise in temperature. Hence, because the temperature will rise only after ovulation, this method is not effective when used alone.
3. Cervical mucus inspection method. Around four days before ovulation (the start of the unsafe period), the woman’s vaginal mucus becomes thin, clear, more profuse and stretchable. The consistency resembles an egg white, which does not break even if you stretch it between your fingers. When this occurs, this means that the woman is ovulating and may become pregnant. On the other hand, when the mucus returns to become thicker and drier, this means that the woman has finished ovulating.
To prevent pregnancy, avoid sexual contact starting from the time the thin, stretchy egg white-like mucus appears until up to four days after the mucus returns to its usual thicker and drier consistency. This technique needs practice but can be effective. (Important tip: For normal couples who want to become pregnant, having sex during the time that the cervical mucus is thinnest and most stretchable can lead to pregnancy in up to two out of three cases.)
4. Combined mucus and temperature method. The most effective natural family planning method is a combination of all these techniques. The woman checks her early morning (basal) body temperature, then inspects her cervical mucus. She may also feel other signs of ovulation like breast tenderness, low backache and pain in the area of the ovaries.

Disadvantages of natural family planning
• It may take up to six cycles (around six months) to learn effectively.
• The periods of abstinence from sex may coincide with the period that the woman has her strongest desire.
• Daily findings have to be recorded meticulously. You will need a calendar, a special chart and a special thermometer. You need to take your temperature and check your cervical mucus daily.
• The parameters used in natural family planning may be distorted by stress, illness, change in sleeping habits and intake of medicine. Hence, it could become unreliable at times.
• Both the man and the woman need to work together and follow safe and unsafe days.
• Based on scientific studies, natural family planning is generally more difficult and less effective (81 to 95 percent effectiveness rate) compared to other methods.

Advantages of natural family planning
• Approved by the Catholic church, the methods are totally natural, do not use chemicals, and thus, have no side effects.
• It’s very cheap, no need to buy pills or condoms.
• When done properly, the combination method of temperature and cervical mucus may reach 95 percent effectiveness rate, which means it can result in only five pregnancies per 100 couples in one year.
• The couple has to coordinate and work together for it to be successful. This can be an advantage because according to Janet E. Smith, PhD, professor of Life Ethics, the divorce rate for couples practicing natural family planning is much lower (less than five percent) compared to couples using artificial methods.
Filipino couples who would like to use natural family planning need to undergo training from a qualified health worker. The government has to spend resources for training, information dissemination and providing the materials needed (calendar, thermometer, charts and pencil) for indigent couples.
Moreover, a certain level of education is required to understand the process of ovulation and fertility. The process may be tedious but it can be done.
In a future article, I will discuss the pros and cons of other methods of family planning.
(To be continued)