Paula Aiton, one of a small group of women turning to natural family planning (NFP), has been practicing the birth control method since her wedding last September. She and her husband, Loren, are confident that not only will they be able to prevent pregnancy but that they will be able to conceive at the appropriate time.
When Paula, 20, began considering birth control options last fall, her major concern was finding an effective method that presented a minimum of health risks.
The Aitons, practicing Roman Catholics, settled on NFP and are pleased that it falls within the guidelines of the church's teachings, which forbid the use of any artificial means of birth control.
Split Among Advocates
However, NFP advocates are divided over whether the practice should be considered a contraceptive or merely "fertility awareness."
Because NFP pinpoints when ovulation occurs--based on bodily secretions and temperature--health officials say at least half of the new NFP converts are learning the method to achieve pregnancy.
Although a form of NFP was introduced in the early 1950s by Drs. John and Evelyn Billings of Australia, only in the last 10 years has NFP been widely promoted.
The Billingses' ovulation method requires that a woman recognize mucus at the vaginal opening, the theory being that mucus develops in response to the same hormones that direct the ripening of the egg in the ovary, therefore predicting ovulation.
Another method, basal body temperature, involves measuring the temperature of the body at rest, usually in the morning upon awakening. Because progesterone is secreted after ovulation occurs, causing an increase in temperature, a sustained rise in temperature would indicate that ovulation has occurred.
A combination of these two methods is referred to as sympto-thermal monitoring. Proponents of symptothermal say the process takes five minutes in the morning--to take your temperature--and five minutes at night--to record the appearance and consistency of the day's cervical mucus. They say the procedure becomes as routine as remembering to take a birth control pill daily.
NFP's effectiveness is a matter of debate among practitioners. Theoretically, all sides agree, it is 99% effective, as high as the more popular birth control pills.
However, in a 1979 study at Cedars-Sinai Medical Center, the symptothermal method proved to be only 89% effective in preventing pregnancy, the same as the diaphragm. The ovulation method was ranked at a poor 74%, below condoms at 85%.
That study sparked strong criticism because some subjects were allowed to have intercourse during fertile periods if they used barriers such as condoms, foams and jellies. Proponents of the ovulation method also questioned the motivation and commitment of test subjects, who were required to fill out daily reports charting changes in mucus and temperature.
Dr. Thomas W. Hilgers, an associate professor in the department of obstetrics and gynecology at Creighton University in Omaha, Neb., conducted another test in 1980 and found the ovulation method to be 94% effective in pinpointing ovulation. (The study did not consider pregnancies a failure of the method.)
The method should be taught, and couples should decide whether they want to use it as a contraceptive or for achieving pregnancy, Hilgers said.
300 Teachers Trained
The medical school at Creighton University is believed to be the only U.S. school that has a division of natural family planning within its department of obstetrics and gynecology. The center, which promotes the ovulation method, has trained more than 300 teachers in seven centers throughout the country.
Hilgers said he believes that the ovulation method is more effective than basal body or even sympto-thermal because there are many factors that could affect the body temperature. He said when both temperature and mucus are charted, the tendency is to rely on the temperature.
All three methods are attractive to women who do not want to use artificial methods of birth control.
"Many women are developing physical problems because they are using artificial contraceptives and they are recognizing the danger," said Phyllis Jones, a registered nurse who teaches NFP at Quo Vadis Family Center in Torrance, a nonprofit counseling center sponsored by the Sisters of Social Service, a Catholic religious community.
"The majority of the women I see are leaving other birth control methods because they are frightened by the knowledge that they can be harmed," said Jones, who has taught the method to more than 200 woman at Quo Vadis since 1980.
NFP practitioners said one reason the method is not more widely used is because people often confuse it with the outdated rhythm method, which predicts ovulation will occur 14 days before the menstrual cycle begins.
"That, of course, didn't work because women's menstrual cycles can vary from person to person and from month to month," said Carmen Minervini, a former NFP instructor at Quo Vadis. "My generation of women used rhythm and they all have large families."
Many doctors and other health care practitioners are dubious about NFP's effectiveness, and do not recommend it as a birth control method if other artificial methods can be tolerated.
Dr. James Moran, head of the obstetrics and gynecology department at St. John's Hospital and Health Center in Santa Monica, cautioned that various factors could affect the quality of mucus as well as body temperature. Because the method requires about a six-month training period and a strong commitment from both partners, there is much room for error, he said.
"The Pill is still the most acceptable, and it is safer than a lot of people have thought," Moran said. "The Pill is the most effective (contraceptive), other than total abstinence."
The fact that other birth control methods are so convenient also works against more general acceptance of NFP, said its promoters.
"We are used to high technology," said Barbara Kass-Annese, coordinator of the NFP program for the Los Angeles Regional Family Planning Council. "We are used to taking an aspirin for a headache rather than meditating. NFP is no different. For people to get excited about knowing their body and using that knowledge for family planning is very foreign. They would rather take a pill or use something that sounds scientific.
"(NFP) has not enjoyed the major advertising backed by pharmaceutical companies that other forms of birth control have enjoyed," she continued. "In addition there has been so much misinformation in the community and in the health care community that even the limited media coverage, by and large, has not been positive."
Planned Parenthood and church-related organizations like Quo Vadis are trying to change that situation by promoting and teaching NFP.
The Pope and the Roman Catholic Archdiocese of Los Angeles have gone on record in favor of NFP. Msgr. Charles Fortier, associate director of the Family Life program of the Los Angeles Archdiocese, said some priests still are reluctant to promote NFP because of past bad experiences in advocating the rhythm method. But the message is slowly being sent, he added.
"It is not easy for people to learn a new technique," he said. "It is so easy to get the Pill or the IUD. But I think through our courses in preparation for marriage we can promote natural family planning."
Some churches, such as American Martyrs Church in Manhattan Beach, conduct classes in NFP at the parish. Charles and Nancy Wuller of Manhattan Beach teach the monthly classes where couples initially meet twice a month to learn how to chart temperature and mucus. After that, meetings are held once a month, usually for six months. The cost for the course is $30.
(At Quo Vadis cost is based on a sliding scale. Planned Parenthood offers the course for $50.)
The fertility awareness method using artificial devices is opposed by church-related groups but is offered as an alternative by secular groups. "Some people just feel they can't abstain," said Sandra Rodriguez, a health educator with Planned Parenthood of Los Angeles. "If that's the case, they should be using something. We don't promote one way or the other. It is our business to make sure people understand everything there is to know about fertility, and then let them decide what is best for their needs."