Your Right to Know: A Universal Core for NFP Instruction

This is my plea for bishops, priests and informed laity to help ordinary couples know and live according to the teaching of Humanae Vitae.  I am not just politely suggesting; I am begging those with teaching authority in the Church to do two things relevant to Humanae Vitae.  1)  Require that every engaged couple take the right kind of NFP course as a normal part of preparation for marriage.  2)  Insist that every required course teach a universal core that includes all the common signs of fertility, ecological breastfeeding, Catholic morality regarding love, marriage and sexuality, and some additional things stated below.  I believe that the Church-related NFP course should be an exercise in evangelization, not just non-contraceptive birth control.

I accept the teaching of Jesus that being his disciples involves taking up our cross daily, and I believe this applies to his teaching about love, marriage and sexuality.  I also believe that his words in Luke 11:46 apply to those who have teaching responsibilities in the Church today.  “Woe to you also, scholars of the law, for you load men with burdens hard to bear, and you yourselves do not touch the burden with one of your fingers.”  Thus I believe that bishops, priests, deacons and informed laity are called to do what they can — both to affirm the teaching and to provide the practical help to live it.

Couples have a right to know enough about the intellectual and practical help available so that they can make a well informed choice among the available options.

Engaged and married couples have a God-given right to learn—

  • All the common signs of fertility and infertility—mucus, temperature and cervix and how to use these in a cross-checking way for confidence and effectiveness.
  • Ecological breastfeeding as a form of natural baby spacing that maximizes all the health benefits of breastfeeding for both mother and baby, maintains the milk supply, and delays the return of fertility for an average of 14 to 15 months.
  • The moral teaching of the Catholic Church relevant to love, marriage, sexuality, generosity in having children, and birth control.
  • This teaching in the context of God’s revelation and the marriage covenant.
  • The relative effectiveness of the different systems.

I believe that this right to learn and to know is indisputable.  After all, who can argue that anyone, Catholic or not, does not have a right to learn all of this?

The current situation, however, does not facilitate that right to learn the options.  Many of the NFP services offered by diocesan offices are variations on the mucus-only approach.

  • They teach only the external mucus sign.
  • They exclude teaching the internal observations of mucus and the cervix.
  • They exclude any teaching of the temperature sign.
  • They do not teach ecological breastfeeding.
  • They do not teach Catholic morality as a normal part of their instruction.

Among those who teach the cross-checking signs, no one except NFP International teaches ecological breastfeeding.  Others may teach about breastfeeding as a healthy practice, but they do not teach the seven standards of ecological breastfeeding, the only kind associated with extended breastfeeding infertility.  Withholding this information unfairly restricts the freedom of couples to choose.

Some dioceses try to compensate for this by offering more than one program.  That would be satisfactory if the couples knew enough to make an informed choice between the different programs, but they don’t.

Why does this happen?  I think it is a matter of salesmanship.  The mucus-only programs are run mostly by women who are nice people.  They have sold their product to the diocese and not infrequently have been hired as the diocesan NFP coordinator or director.  They are liked by their bosses who are happy to have someone taking on this task.  It is quite natural for them to think that their particular program is the best or at least completely adequate, and the idea of offering couples a real choice seems quite foreign.  After all, the leaders of their respective programs have said that the temperature sign, the internal observations, and the cervix sign aren’t needed.  It may be that the diocesan NFP coordinator has never experienced ecological breastfeeding.

All of this is understandable, and all of it makes for harmony in the chancery office, but is it fair?

What is needed is a minimum universal core in every NFP program that  is recognized in any way by the diocese.  It would respect the God-given rights of couples to know what God has made available:

  • All the common signs of fertility and infertility—mucus, temperature and cervix and how to use these in a cross-checking way for confidence and effectiveness.
  • Ecological breastfeeding as a form of natural baby spacing
  • The moral teaching of the Catholic Church relevant to love, marriage, sexuality, generosity in having children, and birth control.
  • This teaching in the context of God’s revelation and the marriage covenant.
  • The relative effectiveness of the different systems.

This can be done with relative ease.  There is no good reason why every program cannot teach Ecological Breastfeeding.

Adding the temperature sign to current mucus-only instruction will not be difficult to teach, but there may be resistance to change.  I am not saying that everyone has to chart temperatures.  No.  What is necessary is that couples are given sufficient information so that they know that the temperature sign can be used in a crosschecking way and has other significant advantages listed in my commentary on the temperature sign.  They should learn how to chart if they so desire.

Speaking of resistance to change, I understand that an American doctor-promoter of Calendar Rhythm went to his death sill believing that nothing more was needed.  I am grateful that in 1935 Father Wilhelm Hillebrand used the temperature-based research of Dr. T. H. van de Velde and insisted that an elevated temperature pattern was needed to cross-check the rhythm calculations, thus correcting the weakest part of the Calendar Rhythm system.  What motivated Father Hillebrand was not any sort of doctor-based dogma but simply wanting what would best help his parishioners.  I think he provides an example for our bishops and priests today.

As reported in my commentary on relative effectiveness, the US Bishops sponsored a scientific study by independent researchers that concluded, “Results of this study show the STM to be superior to the OM of NFP in terms of use-effectiveness.”  Then, almost all the couples who had been in the OM side of the study asked to be trained in the STM,  and they were trained.  It seems to me that the bishops should be making sure that couples today have that same opportunity.

I have no objection whatsoever to a couple choosing to use a single-sign system after they have been adequately taught how to use additional signs in a cross-checking way.  That is their right.  I insist only that they receive adequate instruction so that they are truly free to choose one way or the other.

We are all familiar with the saying of Jesus in John 8:32, “If you continue in my word, you are truly my disciples, and you will know the truth, and the truth will make you free.”  While it is certainly true that he was speaking about himself, that latter phrase can also be applied to many areas.

In urging a universal core, I am urging only that these words, “and the truth will make you free” apply to the science and art of natural family planning.  Couples deserve to know the full truth so that they can exercise their Christian freedom to choose, among morally valid alternatives, what they believe is best for them and their babies.

Near the top of this commentary, I quoted Luke 11:46:  “Woe to you also, scholars of the law, for you load men with burdens hard to bear, and you yourselves do not touch the burden with one of your fingers.”

In providing the full truth, bishops and their collaborators certainly will be helping to lift the burden of living the truths affirmed by Humanae Vitae.  In fact, great numbers of couples who accept and live out the full truth that includes generosity and ecological breastfeeding will find that the whole package is much more of a blessing than a burden.

JFK, September 29, 2013

Your Right to Know: Spacing effectiveness of breastfeeding

You certainly have a God-given right to know the spacing effectiveness of breastfeeding, and you also need to know the differences between the different forms of breastfeeding.

Cultural breastfeeding has almost no effect on the return of fertility.  In other words, fertility returns almost as fast as it does with bottlefeeding.  That’s because Westernized cultural breastfeeding generally entails nursing according to a schedule, regularly using pacifiers and bottles, leaving the baby in the care of others, and trying to get the baby to sleep through the night as soon as possible.  All of these practices reduce the frequency and the amount of nursing, the length of nursing sessions, and generally the months of breastfeeding.  This form of breastfeeding certainly provides some benefits to baby and mother alike, but it should not be expected to delay the return of fertility.

Exclusive breastfeeding is also called the Lactational Amenorrhea Method (LAM).

This form of breastfeeding can have a very high spacing effectiveness for the first six months postpartum if three Standards are followed.

  1. The baby is exclusively breastfed.  The baby receives only his mother’s milk directly from her breasts for his nourishment.  He does not receive any other food or liquid.  His mother’s milk is his only food and liquid.  Exclusive really does mean exclusive.
  2. The mother has no menstrual bleeding after the first 8 weeks postpartum.
  3. The baby must be younger than 6 months of age.  Thus the LAM applies only for six months.

Research has shown that the LAM has a 98% spacing effectiveness during the first 6 months.  During the first 8 weeks postpartum, any bleeding may be ignored as a sign of fertility according to the LAM research.

A problem with LAM is that only about half the mothers doing exclusive breastfeeding will experience natural infertility for six months.  That is, they will have a period before six months.  That’s because many mothers doing LAM do not nurse frequently enough.

Ecological breastfeeding (EBF) means breastfeeding according to the Seven Standards of ecological breastfeeding as follows:

  1. Breastfeed exclusively for the first six months of life as in LAM above.
  2. Pacify or comfort your baby at your breasts.
  3. Don’t use bottles and don’t use pacifiers.
  4. Sleep with your baby for night feedings.
  5. Sleep with your baby for a daily-nap feeding.
  6. Nurse frequently day and night and avoid schedules.
  7. Avoid any practice that restricts nursing or separates you from your baby.

Mothers who care for their babies according to the Seven Standards will experience, as a group, an average of 14 to 15 months of breastfeeding amenorrhea (no periods).

The return of menses with EBF follows a normal distribution curve.  In our two studies—

    •   7% had a first period before 6 months,

    • 56% were without menstruation at 12 months,

• 34% were still in amenorrhea at 18 months. 

    • The average duration of amenorrhea was 14.5 months. 

Research by Doctors Remfry (1895) and Prem (1971) showed that only 6% of nursing mothers actually became pregnant before they had their first period, and those studies occurred before women had learned to identify the return of fertility from the presence of cervical mucus and/or changes in the cervix.

Besides the natural baby spacing benefit, the other great blessing of ecological breastfeeding is that its frequent suckling maintains the milk supply and thus maximizes the many health benefits of breastfeeding for both mother and baby.  For a list of the 21 benefits to babies and 8 benefits to mothers, see pages 103-104 of Natural Family Planning: The Complete Approach.  And the full list of benefits grows every year.

Because of both the spacing benefits and the health benefits, we think it is highly appropriate to refer to ecological breastfeeding as God’s own plan for spacing and baby care.  It is difficult to understand why anyone who is interested in the welfare of babies and mothers is not making every reasonable effort to promote and teach ecological breastfeeding.

JFK, September 22, 2013

Next week:  Minimum standards

Your right to know: Relative Effectiveness

As mentioned previously in my comments about cervical mucus, the US Bishops established the Human Life Foundation in 1968 to support Humanae Vitae and to promote natural family planning.  In the Seventies there was considerable debate about the relative effectiveness of the mucus-only “Ovulation Method” (OM) and the cross-checking “Sympto-Thermal Method” (STM) which uses mucus, temperature and previous cycle history.  The Foundation persuaded the National Institutes of Health to run a scientifically sound study in 1976-1978 to compare the use-effectiveness of the OM and STM.

In the formal study, the investigators found an OM imperfect-use rate of 39.7 and an STM imperfect-use rate of 13.7 pregnancies per 100 years of use.  In other words, the OM had an imperfect-use “avoiding” effectiveness rate of 60.3% and the STM had an imperfect-use “avoiding” rate of 86.3%.  The OM group experienced six perfect-use pregnancies; the STM group experienced zero perfect-use pregnancies.  In the words of the final report, “Results of this study show the STM to be superior to the OM of NFP in terms of use-effectiveness.” (Wade et al., “A randomized prospective study of the use-effectiveness of two methods of natural family planning,” Am. J. Obstet. Gynecol. 141:368, 1981, p.375)

Toward the end of the final report, the authors wrote: “It is of interest that after couples were informed in August, 1978 that a statistically significant trend in the pregnancy rate between the OM and STM groups had been found, almost all of the STM volunteers continued in training, and virtually all of the OM volunteers requested to be, and were, thoroughly trained in STM” (376).

In brief, when the relative effectiveness of the mucus-only “Ovulation Method” and the cross-checking “Sympto-Thermal Method” was hotly contested, the US Bishops sponsored a study which found that the STM approach was superior to the OM approach.  Your have a right to know these things.   

 Still, some or many dioceses seem to ignore that part of the science of NFP and continue to promote the mucus-only approach as if there is no difference.

Another comparison.  In the effectiveness comparisons, not much attention has been paid publicly to the differences in the computation of effectiveness rates, and there is a big difference.  The question is this: “How should we count pregnancies that result from not following the rules?”

The terminology has evolved over the years.  In current terminology, “perfect-use” pregnancies refer to pregnancies of couples who became pregnant while following the rules.  “Imperfect-use” pregnancies refer to pregnancies of couples who became pregnant while not following the rules. That seems rather straightforward, and most people in the NFP movement have accepted that standard.

Most is not all.  Dr. Thomas Hilgers, author of the mucus-only “Creighton Model” and “FertilityCareTM” does not accept that standard.  He argues that when a couple engages in the marriage act at a time defined as fertile or possibly fertile according to the rules, the spouses are engaging in “pregnancy-achieving behavior.”  Well, certainly, but that is true for every method.  The rest of the NFP movement counts such pregnancies as “imperfect-use” pregnancies, but Dr. Hilgers does not.  The result is that there are relatively few “imperfect-use” pregnancies in his calculations, and that makes his system appear to be much more effective than it would be if he used the standard accepted by the rest of the NFP movement.

How can we tell?  In 1985, Joanne Doud, a teacher of the Hilgers system, reported a study in which she claimed a very high imperfect-use rate of 96.2%.  Fortunately, she also listed the number of pregnancies that the couples themselves regarded as unplanned.  Using those numbers, the imperfect-use effectiveness was only 67% (Joanne Doud, “Use-effectiveness of the Creighton Model of NFP,” International Review of Natural Family Planning, Vol IX, No.1, Spring 1985).  You have a right to know these things.

For purposes of comparing apples with apples and for credibility, the rest of the NFP movement accepts the statistical method used by the contraceptive birth control movement.  Few in diocesan administration, however, seem to pay attention to the fact that the Hilgers system calculates its user-effectiveness rates in a way that is not accepted or practiced by anybody else in the NFP movement.  Dioceses have paid thousands of dollars to have a single teacher trained in the Hilgers version of mucus-only without any comparative indication that his system is any better than the original Billings system or the cross-checking Sympto-Thermal Method.

What about seeking pregnancy?  There have been no comparative studies about couples using different NFP systems to achieve pregnancy, and thus there is no evidence that any system of observing and recording the mucus sign is any better for achieving pregnancy than that used in any other system.  Fertile mucus is fertile mucus, no matter how observed and recorded.  Further, certain types of impaired fertility may be successfully resolved simply by improvements in nutrition and lifestyle.

On the other hand, when there is a case of difficult infertility, it is good to know that Hilgers-trained doctors may be able to treat certain defects with surgery or other medical techniques in what he calls NaProTECHNOLOGY.  It is also important to know that there are some couples in which one or both spouses are infertile and whose only morally sound hope for a child is the adoption of a baby who needs their loving care.

JFK, September 15, 2013

Next week: Spacing effectiveness of breastfeeding