Pope Francis will visit here next year, and 2018 will also mark the 50th anniversary of Humane Vitae,
the missive by Pope Paul VI which enforced the Church’s prohibition of
all forms of artificial contraception.
In this document, the Pope
suggested that “medical science should, by the study of natural rhythms,
succeed in determining a sufficiently secure basis for the chaste
limitation of offspring”.
Limitation of offspring, chaste or otherwise, is practised by the vast majority of sexually active people in Ireland
today.
Indeed, with the most recent data from 2010 showing that more
than 94 per cent of sexually active people in Ireland use some form of
contraception, it’s difficult now to recall the days of a blanket ban on
contraception.
In those days, natural family planning, or condoms
smuggled from England, were all that couples had to avoid an unwanted pregnancy.
The same 2010 study showed that
roughly 3 per cent of people were using a natural method of
contraception, such as Billings or the calendar method.
Yet failure
rates for such methods vary wildly, as there are multiple factors
involved in using them perfectly.
And nowadays they are being
increasingly used for the opposite of what they were originally
intended, as couples employ them to enhance their chances of conceiving.
Dr Deirdre Gleeson,
a specialist in occupational health who is also a course director with
the Natural Family Planning Teachers Association of Ireland (NFPTAI), is
the first to admit these methods aren’t for everybody.
“You have to be realistic: a
natural method won’t work for everyone, but those it does work for are
delighted and wish they had come to it sooner. But they need to be very
motivated and disciplined. The main reason it will not work is lack of
motivation, or if the woman’s husband or partner is not supportive.”
She estimates that roughly 5 per
cent of couples are using these methods, and attributes this to a
“resurgence” in interest in the natural approach.
“Natural family
planning fell off the proverbial cliff for about 20 years – people
didn’t want to know about it. But we have seen a growing interest in
recent years. There are very devout Catholic couples, but there are also
people with no religious affiliation whatsoever who are looking for a
green or eco approach to family planning.”
Green method
According to Gleeson, natural
family planning is the traditional “Catholic method” which relies on
abstinence during the fertile phase, while fertility awareness is the
“green method” for couples who are against hormonal and other artificial
contraceptives but will accept the use of barrier contraceptives such
as condoms or the diaphragm during the fertile phase.
“I like to refer to the groups as
the ‘holies’ and the ‘hippies’ . . . and they all get on very well,” she
laughs. Gleeson admits to having “a foot in both camps”, as a member of
the Irish Catholic Doctors’ Association.
The NFPTAI is secular, however,
and has members of all faiths and none, she explains. “We teach it from
the scientific aspect, and then you can take it or leave it. The point
of it is to identify as accurately as you can the beginning and end of
the fertile phase.”
The association uses a combination
of the three classic natural family planning methods: calendar, body
temperature, and Billings, in the symptom-thermal double-check method
they teach.
It is an education-based method
and requires three or four sessions of one hour’s duration in training
for the woman or couple, although Gleeson explains there are now lots of
smartphone apps available which make this slightly easier “and much
more interesting”.
“If a woman wants the pill, or the
coil, or the implant, they just go to their GP and submit to the doctor
and have something inserted or a prescription written. This method is a
lot more holistic and is a lot more woman-centred and couple-centred.
The knowledge of your cycle is empowering whether you chose to use
natural family planning or not.”
According to Gleeson, studies have
shown that couples who use natural family planning have far more sex
than couples who use artificial methods. “You do have abstinence for
about a week each month, but we think they make up for lost time.”
As knowledge of the fertility
cycle improves, modern methods have evolved greatly from original
efforts at natural family planning, notes Gleeson.
“The older rhythm method was based
on a regular 28-day cycle, which didn’t work for an awful lot of women.
There were jokes like ‘what do you call a couple who use natural family
planning? Mammy and Daddy’.”
Research carried out by Swedish biophysicist Erik Odeblad
in the 1960s and 1970s changed this, however; he found that the cervix
is as responsive as the pupil of the eye and his work on changes in the
cervical mucus forms the basis of the Billings method.
Ita McDonnell of Naomi-Billings
Ireland explains that the organisation has been running pre-marriage
courses for more than 35 years, and says their services are as popular
as ever.
“There is such choice out there in
terms of contraception but we are finding a huge lack of knowledge,
just of the very basics of what is happening. Most people don’t even
know that the egg only lives for 24 hours. At the moment we find that
the age profile has risen – the couples we speak to now are around 33 or
34.”
McDonnell asserts that the method
is highly sensitive and says that not only is it effective in delaying
pregnancy, hundreds of couples have been able to plan their families by
using it.
“It can be used to monitor your
reproductive health, and that is a new area for us. Somebody who has
been charting with us might note something slightly different and know
that it isn’t what they should be seeing in that particular part of
their cycle. Reproductive health is quite a big area with the use of the
Billings method. For example, we can tell someone who is having
difficulty in that perhaps their fertile phase is a bit short, and then
they can go into their consultant with that information.”
Failure rates
Billings is based on changes in
the cervical mucus, and McDonnell says the method becomes intuitive
after some time. “Women get to know their developing, changing patterns,
and that the cervix is now open. Couples can show love in other ways
during this time. The cervix then closes after ovulation has occurred
and the couple can have intercourse as much as they want during the next
phase.”
Naomi-Billings have been collecting statistics since 1972 and the latest trial, carried out in China, showed a zero pregnancy rate. Ireland was part of a WHO trial during the 1970s, along with El Salvador, India and New Zealand, and the failure rate here was shown to be 2.8 per cent. Other studies have shown much higher failure rates, however.
“Billings are very honest about
their figures but it may be that the couple have decided to instead go
for a pregnancy,” says McDonnell.
On the reverse side, trials in
couples with proven subfertility have shown significant success – 34 per
cent of couples involved in one trial in Rome had become pregnant
within 3-6 months, and in another trial 78.3 per cent became pregnant in
between four and seven months.
“We can’t help everybody because
some people might have another problem, but we will pick up polycystic
ovaries and help with diagnosing endometriosis. Because we can monitor
clients’ reproductive health, it may mean that they get the help they
need a little bit sooner.”
Naomi-Billings sees a few hundred
couples each year, on average, says McDonnell. “Couples may come back
after three or four years to ‘brush up’ on the method. We work on the
premise that we would upgrade our training every few years.”
The organisation receives no funding from the Catholic Church.
“We have never asked the Church for anything because Billings taught
that this method is for every woman. We would never ask anyone what
religion they are. It is so popular but the thing is that there is no
money in it. We are supported by the HSE so our services are completely
free to people. There is that mentality out there that if something is
free then it is not worth anything. But we don’t want to charge anything
because we feel this is knowledge that everyone should know and every
couple should know.”
Diaphragms and coils
Dr Shirley McQuade is medical director of the Well Woman clinics, which have about 30,000 consultations every year.
She explains that while it is
several years since someone sought advice on natural family planning,
there is a certain proportion of women who will only request
non-hormonal methods of contraception, such as diaphragms and copper
coils.
“We often get people coming in to
say they have googled non-hormonal methods and copper coils are what
came up so they want one.”
McQuade lectures medical students in University College Dublin
on contraception.
“That does include natural family planning methods
but there is very much a Cinderella aspect to it – students need to know
it is there, but in practical terms, the the vast majority of doctors
are never going to need to use it.”
She explains that the Persona
system has been around for a few years now. This is a system that uses
urine sticks, and gives a red, amber or green light for intercourse
based on the “safety” of the timing.
“Quite a few women use that as a fertility monitor, which is the opposite of what it’s supposed to be used as,” she says.
A new fertility monitor called
“Daysy” uses body temperature as a guide, harnessing new technology to
provide an algorithm based on more than a million women’s menstrual
cycles.
At almost €300, it isn’t cheap, and McQuade adds that she is not confident in the use of body temperature as an indicator.
“In the second half of the cycle
after ovulation happens, progesterone goes up and body temperature goes
up by 0.6 degrees. You can plot this out and note the rise but the
problem is that the rise may not coincide exactly with ovulation. Also,
your temperature needs to be taken before you get up in the morning, so
before you even get out of bed. If you’ve had a late night the night
before, that will upset the reading, or if you have a cold or anything,
that too.”
Women can have quite regular
cycles most of the time, but for several reasons their cycle can change.
This is typically stress-related, such as the many college students
that McQuade sees. She adds that women in their 40s will also encounter
problems with natural family planning methods, as their cycles begin to
change and vary.
McQuade keeps a chart in her
consultation room based on recent research carried out in the US that
looked at the failure rates of all contraceptive methods. To see in
black and white that the failure rate of the pill with typical use is 9
per cent often startles women. With condoms, that jumps to 18 per cent.
“All contraceptive methods are
really good in laboratory circumstances but once you take them out into
the community, they aren’t as good. The best are those that have no user
input, such as the coil, and the implant – those work. But everything
else, where a person is involved who has to make a decision as to
whether they do something or take something – the real-life use is very
different.”
McQuade agrees that there are
problems with natural family planning methods, much as there are with
other contraceptive options. “Your choice of method depends on what
stage you are at in your life and how big of a disaster a pregnancy
would be.”