Frequently Asked Questions

Natural Family Planning – What is it?

The World Health Organisation’s definition is “methods of planning or preventing pregnancy based on the observation of naturally occurring signs of the fertile and infertile phases of the menstrual cycle. People who use NFP to avoid or delay pregnancy, abstain from sexual intercourse on potentially fertile days. Those wanting to achieve pregnancy use NFP to identify the fertile phase and hence maximize the probability of pregnancy.” WHO (1988)

NFP, therefore, has two components

  1. The observation and recording of the signs of fertility which lead to a knowledge of the current probability of conception.
  2. Modification of sexual behaviour according to the aims of the couple.

If it is necessary to avoid conception, the couple do not have sexual intercourse during the fertile phase. And, conversely, when attempting to achieve pregnancy, the observation of the signs allows them to choose the most fertile time of the cycle.

Another WHO document (1995) notes that some authors “have expanded this definition to include the identification of other times when observing natural signs can indicate the returning signs of ovarian activity after prolonged periods of infertility such as during breastfeeding or the pre-menopause.”

What is the Effectiveness of NFP?

The Pregnancy Rate is taken from various sources and is the Method Effectiveness (percent of women who unintentionally conceive in the first year of use)

  1. Total abstinence 0%
  2. Post ovulation infertile phase only 0%
  3. Female and Male sterilisation <1%
  4. Sympto-thermal (pre and post ovulation) 0 – 2% (World Health Organisation Multicenter Study1981)
  5. Billings Ovulation Method 0 -2% (World Health Organisation Multicenter Study 1981)

These methods are more reliable if the users learn the methods before becoming sexually active.

The Sympto-thermal method is very effective for women with irregular cycles, and when breastfeeding and in the pre-menopause.

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What about the Abstinence?

The ovum lives 24 hours but is only fertilisable for 12 of those 24 hours.
The sperm live 5-6 days in a welcoming environment.
This is a joint fertility of 6-7 days.

All methods of NFP ask for extra days of abstinence on both side of these 7 days. However some couples who have recorded and charted for a long time know their own fertility and reduce the abstinence accordingly.

Before NFP became known 70 years ago, couples who had completed their family were faced with years of abstinence. NFP is a great leap forward for couples, especially for those with serious health problems, because they can chose to wait for the time of absolute certainty, after ovulation.

Abstinence from sexual intercourse in the fertile phase is an integral part of NFP as part of an agreement by the couple to avoid pregnancy. For successful integration of sexual abstinence into a relationship, sexual control has to be balanced by fulfilling the needs of intimacy. This is related to an active building and maintenance of the relationship by non-genital means.

The expression of love takes many forms. If sexual intercourse is the only time that affection is expressed the rest of the relationship remains immature and static. The fertile phase is an opportunity for couples to enhance their relationship-trust over their individual desires. It becomes a sign of generosity and respect for the Other and the joint decision originally made by them both. There is a great increase in the sense of self-worth. The research into sexual self-control is very sparse. The researchers have focussed mainly into abnormality e.g. lapses leading to rape, pornography and paedophilia and also into areas of excess sexual control as in frigidity. (Wiederman 2004)

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Sympto-thermal?- Have you ever heard of it?

It is really strange that the reliability and usefulness of the Sympto-thermal Method, although it is recognised by the World Health Organisation (WHO), is not actively promoted by many national health authorities (except for Germany, and Malta) even though the STM empowers couples to increase their sexual and reproductive health, and is a financial saving for the exchequer.

“Sympto-thermal” means that at least two indicators are used to define the fertile time.

  1. The “Symptom” is the mucus which reveals the onset of ovarian activity and the start of the fertile phase.
  2. The “Thermal” is the temperature rise in the cycle. It indicates that the ovum has been released into the fallopian tube, which is the end of the fertile phase.

By recording the temperature each day and the changes in quality and quantity of the mucus, it is possible to determine the beginning and end of fertile and infertile days of the menstrual cycle.

A third optional sign, checking the lower opening of the uterus, the cervix, can be another useful indicator of ovulation, as also breast tenderness and abdominal pain. These can be very useful during breast feeding, the menopause and times of illness when the temperature is fluctuating.

Each woman has her own pattern of fertility which, although very similar each cycle, does in fact change slightly due to the activity and stresses of daily life. She must chart her signs of fertility every day. Very quickly, with some guidance, it is possible to learn to record and interpret the chart and be confident of knowing the infertile and fertile times and so to choose to achieve or avoid pregnancy.

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Do couples using the Sympto-thermal Method have less sex?

It would seem so at first glance, but many studies, especially those done in the USA, have shown that NFP couples have more sex and for longer time in their life. They develop greater intimacy because they collect and interpret the information together, they develop greater intimacy in all areas, emotional as well as spiritual. They have greater harmony. They come to a more closely shared vision of their relationship.

Integration of NFP into the relationship takes place in three stages. Firstly,the couple start with a stable period when they learn the method itself. Secondly, there often follows a time of coming to terms with the demands of the method, the expectations, the needs and the wishes of the individuals. Thirdly, successful adaptation leads to another stable phase where the advantages are greater than the difficulties. (Klann, Frank-Herrmann and Sottong.1993)

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What is the effect of NFP on the relationship of the Couple?

Couples accept sexual intercourse as a very special and intimate body language in which both express their total, reciprocal self-giving. This total self-giving includes every aspect of a couple’s personhood their physical, psychological and spiritual realities. NFP not only makes it possible to live this vision of love. It actively nurtures a couple’s affection and knowledge of each other as they give of themselves in every act of love. Both the advocates and opponents of Fertility Awareness Based Methods talk about the positive and negative effects on the happiness, sexual satisfaction and commitment of the relationship.

Hundreds of studies have been published, and books and articles written. They vary in quality because of there are so many factors involved, but nonetheless they show valid indicators. NFP because of more frequent communication about intimate sexual matters, increases the relationship skills of love and affection – the expression and experience of love, warmth, and mutual attraction between the couple. It increases personal validation – praise and acceptance of the other. It increases mutual trust- the certainty that one can tell the other about secrets and fears. It encourages self-disclosure. (Hook et al. 2003)

Use of NFP greatly increases the survival rate of couples’ relationship i.e. fewer divorces.

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How Fertile is Fertile?

Humans are not very fertile compared with other mammals.
Horses,sheep and cattle conceive at almost every impregnation.
A human couple having intercourse at the fertile time has only a 1 in 10 chance of becoming pregnant. Having regular sexual intercourse, the couple have an 80% chance of becoming pregnant in a year. If still not pregnant the couple should seek help.

Women and men have hormonal cycles which determine both when a woman can achieve a pregnancy and when a man is most virile. The female cycle can repeat itself every 21-40 days, but the male cycle is variable. A man can normally produce sperm every day from puberty until he dies, but the quantity and quality of the sperm deteriorates with age. The testes, under the influence of testosterone, produce around a hundred million 100,000,000 sperm each day from precursor cells in the testes. It takes about 42 days for a sperm to develop from the germ cell to when it is ready to leave the testes. Even then, it is not developed enough to fertilise the ovum.

In women the average age of the start of the menstrual cycles in England is 13 years (The Age of the Menarche in Contemporary British Teenagers,a survey of girls born between 1982-1986. (Professor Wincup et al. BMJ2001; pp.1095-1096 May 5th). The article notes that 1 in 8 girls reaches the menarche while still in Primary School. In the first year about 80% of cycles are anovulatory (no ovulation). These anovulatory cycles also occur after childbirth and during the pre-menopause.

When a female child is born, her ovaries already contain approximately two million immature 2,000,000 ova. (so that this mother is the grandmother to the children born from these ova which have developed inside her body). Most of these gradually disintegrate throughout the woman’s reproductive life. By the time a woman becomes reproductively mature following the onset of menstruation only 400,000 ova are still present and only 400-500 will be stimulated to full maturity by the woman’s hormones. Each cycle one or more ova will develop to be released at the same time.

Women’s fertility peaks around the age of 19 -24 and starts to decline after 30.

  1. At age 30, 75% will get pregnant within one year and 91% within 4 years
  2. At age 35, 66% will get pregnant within one year and 84% within 4 years
  3. At age 40, 44% will get pregnant within one year and 64% within 4 years

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How many couples worldwide use Natural Family Planning?

32 million couples approximately.
The figures concerning worldwide prevalence of NFP are of course incomplete. The best available data is from the United Nations 2006 on periodic abstinence methods but they do not distinguish between the several types of NFP.

United Nations 2000 – % married women using NFP 2005 – % married women using NFP
World 2.6 2.9
More developed regions – 4.6
Less developed regions – 2.6
Africa 3.2 3.7
Asia 2.1 2.1
Europe 4.3 5.7
Latin America 4.9 4.9
Northern America 2.1 2.1

According to these figures, about 2.9% of women worldwide, living in marriage or another form of union, use some form of NFP, which means approximately 32 million couples, assuming a total of 1.1 billion women included in the analysis (United Nations, 2006) Among European countries the largest prevalence of NFP is in Poland 19.3%. The figure for USA (from1995) is 2.3%.

In 1971 Mother Theresa taught 20,000 very poor couples in Calcutta. The resulting pregnancy rate for these couples was 0.2%. When reported in the British Medical Journal the ensuing correspondence persuaded many doctors of the efficacy of the method.

2004 The China Project reported that there were 48,000 Chinese Teachers of NFP, and 3,600,000 user couples. The pregnancy rate was 0.61%. Also 15,000 sub-fertile couples conceived i.e. one third of subfertile couples who learned and used the knowledge of their fertility achieved conception.

For comparison, worldwide use of Oral Contraception is 15.9%, Condoms 14.3%, and Female Sterilisation 20.5%. (United Nations 2006)

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