Natural family planning

This article is about the alternative medical means of contraception, for a general discussion of birth control in human society - see contraception, for surgical means of contraception - see Sterilization (surgical) and for methods using medications and medical devices - see Contraception (medical methods).

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Natural Family Planning is a method of periodic abstinence from, and varieties of, sexual contact between the male and female in a couple who desire to plan the timing of the arrival of their children. Often considered part of alternative or complementary medicine, some natural planning methods have a firm basis in the health sciences. The most sophisticated practices are based on the biological basis of human reproduction, and may be aided by medical tests for ovulation and other tests and examinations derived from medicine and biological science.. By being able to estimate whether on not a woman is likely to be fertile at a given time, the chances of conception can be increased or decreased depending on whether that time period is used for abstinence from, or engagement in, unprotected intercourse. Further, the fertility of men, in terms of sperm count, can be altered by their behavior and, within a restricted range, can be used to make conception more likely. In many traditional societies, family planning is often part of the fabric of everyday life, rather than a conscious strategy to influence pregnancy. For some couples in developed countries where medical contraception is generally used, natural family planning is a contraceptive choice that is made on individual moral, religious, health, political, economic or personal grounds. Breastfeeding is not only traditional but is the most economically viable way to nourish a child for the first years of life, and a hiatus in childbearing can be primarily a side-effect of providing breast milk, rather than the result of periodic sexual abstinence, because the hormonal milieu that favors lactation frequently prevents ovulation.

Fertility in men and women

Men generally are fertile throughout their adult years, and although aging, severe malnutrition, exposure to ionizing radiation, or other environmental factors can change fertility over time, overall, the production of the male contribution to an embryo, the sperm cell, is relatively constant. In women, this is not the case. The female's contribution to the embryo is the ovum, which is always produced periodically instead of constantly, and which is only viable for fertilization for, at most, 2-3 days. The menstrual cycle in women begins its first episodic appearance at menarche and continues until menopause. Natural family planning methods are, by and large, focused on ovulation. Several natural methods of contraception depend on daily examination, of various sorts, in order to recognize that a woman is ovulating. These methods encourage couples to identify "fertile days" and use this knowlege for family planning.

Billings method

"There are many types of NFP, including the Billings Method (the ovulation or mucous method), named for Australian doctors Jon and Evelyn Billings. This method charts the presence and description of cervical fluid". The biological basis for the method relies on the universal attributes of cervical mucus in women, which change in a predictable fashion through the ovulatory cycle according to hormonal influences.

"Cervical mucus is a heterogeneous secretion containing more than 90% water. It has intrinsic properties including consistency, spinnbarkeit (stretchability), and ferning" (the making of a fern-leaf pattern when smeared on a glass slide).(reference:Current Diagnosis & Treatment Obstetrics & Gynecology - 10th Ed. (2007)

In the Billings method, cervical fluids is examined and classed as one of 3 types according to its vusual and tactile qualities.

(1) sticky, tacky, and dry -which occurs early in the cycle, immediately after cessation of menstruation (2) creamy, milky, and smooth, which occurs right before the most fertile period (3) slippery, consistency of egg white, stretchable, often clear, and sometimes yellow, pink or red-tinged, which are signs of fertility.

Couples avoid intravaginal sexual activity when the cervical mucus indicates the possibility of fertility. In the simplest application, abstinence is required from the beginning of menses until 4 days after the last day of fertile-type mucus. Some practice in identifying the fertile mucus is required, as well as detailed knowledge of the rules to apply, and couples usually learn the method from a teacher trained to teach the method. Other variations also identify days after menstruation and before ovulation when the couple can be confident of infertility; this takes more care and practice. The first appearance of fertile-type cervical mucus is not only a sign that ovulation is likely to come within a few days, but the presence of this mucus is also in itself an aspect of fertility, as sperm can live for several days in a woman's body when fertile mucus is present but dies relatively quickly otherwise. So detection of the first fertile mucus can be a sign that the woman's fertile time has begun. The detection of the first fertile mucus in the cycle tends to rely on subtle signs such as a slight feeling of slipperiness at some time during the day, although a few days later the fertile-type mucus may be much more obvious.

The Billings method requires abstinence during days of bleeding, including menstruation. Although for someone who is only keeping track of days of bleeding and not cervical mucus the days of bleeding can be the days one is most confident of being infertile, nevertheless these days do not meet the higher standards of precision of the Billings method. There are two main reasons for considering the days of bleeding to be days of possible fertility. First of all, the Billings method (unlike temperature methods which will be discussed later) does not find positive confirmation that ovulation has occurred. The woman could be having an unusually long cycle, and what is thought to be menstrual bleeding could turn out to be bleeding at the time of ovulation. Even if the woman has had regular cycles for years and has never noticed bleeding at the time of ovulation, she could at any time have an unusually long cycle, and bleeding at the time of ovulation may be more likely in such a long cycle. The other reason for abstinence during days of bleeding is that, especially for women with short cycles, fertile mucus can sometimes begin to appear before the bleeding stops, and would not tend to be noticed when bleeding is also present. A day without bleeding is required for the woman to confirm that there is no slight slippery feeling of fertile mucus.

In the first part of the menstrual cycle, after bleeding stops and before the first fertile mucus is observed, the Billings method for avoiding pregnancy restricts intercourse to alternate evenings. Evenings are used because the woman has a better chance of noticing the presence of fertile mucus while awake and active during the day. If a woman who has been taught to notice the signs and is carefully watching for them doesn't notice any signs of fertile mucus throughout the day, that suggests that she is infertile that evening -- but that confidence does not extend to the following morning, since fertile mucus might begin during the night and not be noticed. The day after intercourse, the presence of seminal fluid makes it difficult to tell whether fertile mucus is present, so the couple needs to wait until the end of the second day before again being confident of continuing infertility.

Prospective studies of women who checked cervical mucus daily have indicated that "the probability of most fertile type mucus by day of the menstrual cycle increased from values <20% outside of days 10-17 to a peak of 59% on day 13." (Scarpa B. Dunson DB. Colombo B. Cervical mucus secretions on the day of intercourse: an accurate marker of highly fertile days. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 125(1):72-8, 2006 Mar 1. UI: 16154254)

These same findings are a rational basis to increase the chance of conception, by preferentially having intercourse at the time of maximal fertility.

Standard days method

Midwives who advocate natural family planning claim that "the Standard Days Method is appropriate for women with most menstrual cycles between 26 and 32 days long. Women using this method are taught to avoid unprotected intercourse on potentially fertile days 8 through 19 of their cycles to prevent pregnancy."(Germano E. Jennings V. New approaches to fertility awareness-based methods: incorporating the Standard Days and TwoDay Methods into practice. Journal of Midwifery & Women's Health. 51(6):471-7, 2006 Nov-Dec. UI: 17081938)

Breast feeding and lactation

The hormonal balance that occurs when a woman is actively breastfeeding is one that tends to suppress ovulation. In this way, whether by happenstance or design, breastfeeding, alone, tends to be an efficacious manner of "timing" children, at least when breastfeeding is the sole means of nourishment for the baby. According to current obstetrics, "in the first weeks or months following birth, provided there is little or no supplemental feeding for the infant, breast-feeding will provide 98 percent contraceptive protection for up to 6 months. At 6 months, or if menses return, or if breast-feeding ceases to be full or nearly full before the sixth month, the risk of pregnancy increases."(Gabbe: Obstetrics - Normal and Problem Pregnancies, 4th ed. Copyright © 2002 Churchill Livingstone)

Lactional amennorhea is cited as a major factor in birth control in many areas of the world, particularly poorer and more rural areas in subSaharan Africa (ref for rural- Audu BM. Yahya SJ. Bassi A. Knowledge, attitude and practice of natural family planning methods in a population with poor utilisation of modern contraceptives. Journal of Obstetrics & Gynaecology. 26(6):555-60, 2006 Aug. UI: 17000506)

Increased fertilty: practices that increase the chance of conception

Sometimes a child is very much wanted, but pregnancy does not come. Although there are medical ways to increase the chance of pregnancy, natural family planning can be used to tilt the odds towards conception. Interestingly, in some traditional cultures, customs that are based on religious edicts actually translate into effective methods for increasing the chance that a child will be born.

Jewish law & fertility

In rabbinic Judaism, Jewish law molds and guides the practices of daily living. These traditional practices were formulated in pre-modern societies, long before modern biology would explain ovulatory cycles or measure sperm counts. Nevertheless, such practices constitute, in effect, a form of natural family planning. If implemented properly, Jewish laws could serve to regulate the timing, potency and frequency of marital relations so as to maximize reproductive outcomes.

Specifically, Jewish tradition would increase the potency of sperm by prohibiting male masturbation. In addition, Jewish laws limit the potential timing of marital relations so as to synchronize with the menstrual cycle. The frequency of martial relations, moreover, is governed by Jewish laws concerning the husband's positive commandment to bear children and fulfill his spouse's marital needs. In sum, Jewish laws arguably act together so as to favor a married couple sharing a bed just at the time of ovulation, after a period of physical separation.

Jewish law (halakhah) prohibits male masturbation. As a result, observant Jewish husbands would be expected not to ejaculate prior to marital relations. In men, the sperm count- that is the number of sperm in each ejaculate, is directly correlated with fertility. This sperm count can be increased if several days pass without ejaculation, and can be decreased with very frequent ejaculation. For most men, the sperm count is high enough so that even with frequent ejaculation, impregnation is possible. However, an increase in the sperm count can be important for men who have relatively low numbers of high quality sperm in each ejaculate. Sex within marriage is encouraged in traditional Jewish life, but there are proscribed periods when husband and wife are not to have any physical contact, not to see each other undressed, and not to share the same bed. When there is menstrual bleeding ( actually, any vaginal bleeding) a woman is not to be touched by her husband, and she and he do not change this status until 7 days after the last blood is seen, at which point she will submerge in the ritual bath (the mikvah). Then, physical contact-including intimacy, is allowed. If the couple follow the rules of orthodoxy, this means that they will, monthly, find themselves together in the marital bed after 10 plus days of separation, when his sperm count is likely to be quite high, and her follicles are likely to be mature, with ovulation imminent.

Christian perspectives

Natural Family Planning is the method of Family Planning recommended by the Roman Catholic Church, but is also used by non-catholics and is incorporated in some form by other religions and by traditional cultures.

External links

• National Fertility Awareness and Natural Family Planning Service for the United Kingdom [1]
• The Natural Family Site, BYG Publishing [2]

• An explanation of the Jewish marital laws during a woman's month cycle, from Nishmat, the Jerusalem Center for Advanced Study for Women: http://www.jewishwomenshealth.org/article.php?article=12