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. 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. Often considered part of alternative or complementary medicine, some of these 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 ovulating, 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 generaly used, natural family planning is a contraceptive choice that is made on individual moral, religious or personal grounds. In other societies, where breastfeeding is not only traditional but is the most economically viable way to nourish a child for the first years of life — a hiatus in childbearing is 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, several 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.

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". "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)

The Billings method depends on careful examination of the cervical mucus. This mucus changes through the cycle according to hormonal influences. Three different cervical fluids are delimited : (1) sticky, tacky, and dry occurring after menstruation, (2) creamy, milky, and smooth, which occurs right before the most fertile period, which is (3) slippery, egg white, stretchable, clear, and yellow /pink or red tinged. Women are taught to avoid intravaginal sexual activity when the cervical mucous reflects the most fertile time." However, these same findings are a rational basis to increase the chance of conception, by preferentially having intercourse at the time of maximal fertility.

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)

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.

External links

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