Monday, December 12, 2005

Natural Family Planning and SDM in the Local Church

At the plenary assembly of the Catholic Bishop’s Conference of the Philippines (CBCP) in July 2003, two consensus votes were taken with regard to family planning. The first vote was a no to collaboration with the government’s total family planning program. The second vote, however, was a yes to the diocese’s use of the Standard Days Method (SDM) in its own program of natural family planning (NFP) — without any contraceptive component and without collaboration with government.

The first vote maintained the Church’s critical stance against the government’s population program, which was still perceived to be dictated by a contraceptive mentality. This apprehension among bishops persisted even if the present administration of President Gloria Macapagal- Arroyo, a devout Catholic, had earlier indicated its preference for natural family planning methods.

Indeed, this preference for the NFP methods by government was heightened by the introduction of a new and simpler NFP method, called the Standard Days Method. Ironically, however, objections to SDM came not from government quarters but from several church-related groups, particularly those who were promoting the earlier-recognized NFP methods such as the Basal Body Temperature method (BBT), the Billings Ovulation Method (BOM), and the Sympto-Thermal Method (STM).

For them, SDM was suspect because it was being promoted by government, presumably with some back-up contraceptive methods; the research for SDM was funded by USAID; the method was not yet fully tested; and it was nothing more than the old calendar-rhythm method that had already been discredited as unreliable. Moreover, SDM could not be considered as NFP because it did not involve the daily examination of bodily signs and symptoms.

This then is the significance of the second vote at the CBCP assembly. Notwithstanding these objections, the bishops as a body recognized SDM in itself as a natural family planning method. Provided it is not mixed with contraceptives, is not seen as a government program with its cafeteria approach, and is accompanied with the proper value formation to avoid a contraceptive mentality, the bishops did not voice any objections to the inclusion of SDM in the local church’s program for natural family planning. Indeed, since the CBCP has distanced itself from the government’s NFP program, all the more should the local church promote its own comprehensive NFP program that includes SDM.

What is the Standard Days Method in the first place? SDM is a new calendar-based method of family planning based on fertility awareness. It helps a woman know her fertile days by simply counting the days of her cycle, starting with the first day of menstruation. It identifies days 8-19 of the cycle as the fertile period when pregnancy may occur if there is intercourse. Days 1-7 and the rest of the days after day 19 are identified as non-fertile days.

SDM’s “fertile window” of days 8-19 has been standardized and is applicable only for women whose menstrual cycles range from 26 to 32 days. It is made clear from the outset that SDM is not applicable to all women. In this sense, despite its simplicity, SDM cannot be the exclusive NFP method for the local church to promote; but neither should it be the excluded method.

SDM was developed by the Institute for Reproductive Health (IRH) of Georgetown University, the oldest Catholic university in the United States. It is the result of an extensive research process spanning sic years since the mid-90s, involving pilot sites in Bolivia, Peru and the Philippines. The concept of SDM was first validated through computer simulation of over 7, 600 cycles provided by the World Health Organization from its ovulation method trials. It has since then been clinically tested with a high effectiveness rate of 95.25% in the three countries where almost 500 women were followed up for 13 cycles.

To help women track the days of their menstrual cycle, IRH devised a necklace of cycle beads consisting of 32 colored beads, representing the day of menstruation (red), the fertile days (white), and the infertile days (brown). Hence, couples can easily know the days when they should abstain from intercourse if they wish to avoid pregnancy. Or they may also use the same beads to achieve pregnancy.

Currently, SDM is being introduced in 14 countries, including India, Turkey, and Egypt, and several smaller countries in Africa and Latin America. In the U.S. as well as in other parts of the world, the cycle beads for SDM are being sold over the internet. Following its mandate, IRH-Georgetown continues to test and develop other simplified NFP methods. Earlier, it had developed the Lactational Amennorhea Method (LAM), which is now widely promoted by both government and church agencies. It also continues to streamline teaching aids for BOM and STM promoters.

In October 2003, a training workshop for NFP-SDM providers was hosted by Malaybay Diocese and opened to other dioceses in Mindanao. Five dioceses sent participants. The majority came from seven pilot parishes in Bukidnon, including the parish of Phillips. Spanning three decades since the mid-70’s, Camp Phillips had hosted the interdiocesan training program on the earlier-known NFP methods. This was sponsored periodically by the Episcopal Commission on Family and Life.

In their sharing, the participants saw the usefulness and need for a simplified method like SDM to be included in the church’s NFP program—particularly for those who found it difficult to keep daily records of body temperature or mucus characteristics. This assessment of SDM was reinforced during their field visits to two pilot barangays where SDM had been introduced over the past two years with the help of a non-government organization.

In one site, SDM was found to be widely acceptable not only among Catholics but also among couples of other religious affiliations. A notable number of couples had chosen to shift from the use of contraceptives to SDM. In the other site, a mother described how SDM was now being passed on to the next generation: her own 16-year old daughter was the one reminding her to move the cycle beads everyday.

Moreover, in other parts of Mindanao, Muslim couples have also expressed their interest in SDM as an NFP method. During the first quarter of 2004, two more training workshops for NFP-SDM providers were hosted by the local churches of Basilan and Sulu for their family life workers, including several Muslim women. The participants were enthusiastic about SDM as a practicable method that could easily be taught to both Christian and Muslim communities.

It is in this light that all these participants were perhaps simply reflecting the sentiments of Fr. Vicente San Juan, S.J., former ECFL executive secretary, and prime mover for many years of the NFP training course in Phillips. Although now in semi-retirement, Fr. San Juan had no qualms in endorsing SDM as a new NFP method, remarking that the principal criterion should be “what a method does to a couple’s life.”

In the Prelature of Ipil, we have included SDM as an added option in our natural family planning program under our family life apostolate. Even as we continue to promote the earlier-known methods, we note that the couples themselves have found SDM a much easier method to learn. “Why did you not teach this to us earlier?” has been a common reaction. We have also devised a less expensive string of “vertical beads” to help couples track the days of the menstrual cycle.

However, because the practice of NFP entails a way of life, our family life workers have made sure to include formation life values in the promotion of NFP-SDM. Part of this value formation is to enable couples to choose NFP as a truly human and Christian option, without combining it with other artificial contraceptives. The rule-of-thumb criterion for NFP is made clear: “no DIDO,” i.e. “no drugs, injections, devices, or operations.” Compared to the earlier NFP methods that our family life workers have been teaching over the past two decades, we find that the rate of acceptance of SDM in our pilot parishes over the past two years has increased markedly.

Indeed, couples themselves who have shifted from contraceptives to SDM tell us that the main reason they did so was SDM is natural. In this light, the prelature has included SDM in the array of modern NFP methods that we are making known to couples—first, as an added option for couples in their desire to follow the moral guidelines of the church; and secondly, as a pastoral imperative for the local church, to enable couples to make an informed and responsible choice with regard to family planning. Over all, in our 19 parishes, as of June 2004, our family life workers have tallied 366 current users of natural family planning methods: 261 with SDM, 102 with BOM, and one each with BBT, STM, and LAM.

“The future of humanity,” points of Pope John Paul II, “passes by way of the family.” The same thing can be said of the population issue confronting developing countries like the Philippines today. Population management cannot be done by government alone; ultimately it rests on countless couples exercising responsible parenthood through family planning. For Catholic couples, this means natural family planning. And the more NFP options we can make available to them, the more we can empower them to exercise responsible parenthood.

In commemorating last year the 40th anniversary of the encyclical, Pacem in Terris, Pope John Paul II reminds us his predecessor’s teaching that every human right involves a correspondingly duty. The same reminder can be made with regard to the whole area of family life. Couples should exercise their rights as well as their responsibilities of parenthood.

Going beyond structures to reach out people, the Holy Father invites us to engage in “gestures of peace” in our present-day world. Couples adopting NFP methods, including SDM, are hopefully among those who manifest these gestures of peace—and development—for the good of their families and the common good of their nation.

Natural Family Planning--Dream or Reality?

Last September 2005 at the BEC National Assembly in Cebu, I shared with the participants “A Formation Program on Natural Family Planning for BECs in Ipil Prelature.” A number of delegates expressed their interest to adopt a similar NFP program in their areas.

To date, our Responsible Parenthood—NFP program has tabulated an encouraging total of 1,025 NFP users throughout the prelature. So far, we have covered a fourth of our 626 kapilya communities. A distinctive aspect of our program is that we provide information on all modern NFP methods, including the Standard Days Method. This is what we now call our All-NFP program.


Unfortunately, there continue to be some apprehensions about SDM as an NFP method. At the Mindanao regional meeting of Family & Life coordinators in Malaybalay in mid-September, these apprehensions were raised once more. Allow me then to clarify some issues based on our pastoral experience in Ipil.

1. On SDM as a natural family planning method:

In our consensus vote at the CBCP plenary assembly in July 2003, we all agreed that SDM in itself was a natural method and could be included in the diocese’s own NFP program, provided it was not mixed with contraceptives and was not seen as part of a government program that promotes contraceptives. Archbishop P. Aniceto reiterated this CBCP stand at the Malaybalay meeting.

In the prelature, we have included SDM in our All-NFP program, even before government workers became aware of this new method. Integrated in the program is our value formation which advocates for abstinence and precludes any use of back-up contraceptive methods during the fertile period. As a rule of thumb, we stress to couples that NFP means no DIDO—i.e., no drugs, injections, devices, or operations. We have also adapted and translated our own NFP training manual, which includes modules on value formation.

2. On the effectivity of SDM:

Among our 675 SDM users, we have had only a handful of complaints regarding the failure of the method itself. This is expected since no method is perfect. Among starting users of any of the NFP methods that we advocate, there have indeed been some drop-outs, but these have been due mostly to the wrong use of the method, lack of interest, or planned pregnancy, and not principally due to the failure of the method itself.

On the whole, SDM users in the prelature have been adopting the method for one to three years now because they have found it to be simple, effective, and practicable.

3. On SDM as a “recycled rhythm method”:

The earlier calendar rhythm method was a customized method, based on the individual woman’s calculation of her shortest and longest cycles from six previous recorded cycles. This then involved some cumbersome computations to determine the first and the last fertile days of the next cycle.

SDM on the other hand, is a standardized method, based on computer simulations of statistical probabilities which make it applicable to a large segment of the population—in this case, women with average regular cycles of 26 up to 32 days. Starting from the first day of menstruation, days 8-19 are identified as the fertile period. The effectivity rate of 95.25% has been validated through clinical field trials in three countries where almost 500 women were followed up for 13 cycles.

It is good to keep in mind that the original calendar rhythm method developed from the pioneering work of Ogino and Knaus is still recognized by the Church as a morally valid method. Pastorally, however, its reliability has been questioned because of the meticulous calculations involved on the one hand and the inaccurate popularizations of the method on the other.

It is this same principle of using a calendar that has been simplified in a scientific way in SDM to make it practicable and reliable for a wider number of women. In the prelature, we find that about two-thirds of NFP users prefer this standardized method because of its simplicity and ease of learning.

4. On SDM as a method that is “bound to fail and promote the use of contraceptives”:

One reason for our All-NFP program is to give couples the widest latitude in choosing the NFP method that for them is suitable, reliable and not “bound to fail.” Indeed, many couples tell us that they choose SDM because they themselves want to move away from contraceptives.

Several couples told us that the 12-day period of abstinence in SDM did create difficulties for them for the first few months. But they have eventually learned to cope with this. Not the least of the factors behind this is their understanding of sacrifice in a truly Christian marriage. What is also equally important for them is that now they are surer in determining the fertile and infertile periods. A number of “traditional rhythm” practitioners, using their own homemade formula of fertile and infertile days, have shifted to SDM without much difficulty. Moreover, in addition to SDM, almost a third of our NFP users are adopting the Billings Ovulation Method.

5. On the Billings method as the only NFP method to be taught:

For over three decades we have been teaching the Billings Ovulation Method, and continue to do so. However, our family life workers have found the acceptability rate of BOM to be limited, due to the requirements of daily charting and follow-up by a trainor for three to six months. Some women can hardly read or write. Others have expressed their cultural aversion to minute examination of the cervical mucus. We note that the more educated women, like public school teachers, are the ones more likely to stay with BOM. We also find that for many couples the choice is not so much between BOM and SDM, but rather between SDM and artificial contraceptives.

In this light, we find that an inclusive NFP program promoting all modern NFP methods is more acceptable to couples and can reach more households even in the most remote areas. Paradoxically, we have more BOM users today in our All-NFP program than during the time when BOM was being taught alone. It is left ultimately for the couple to weigh the advantages and disadvantages of each method, with the help of individual counseling. Some couples also learn to combine methods, or shift from one method to another. This, we believe, is a more mature aspect of their value formation in responsible parenthood.

6. On the use of SDM cycle beads:

The cycle beads have variously been described as a necklace, a new kind of “rosary” or even as a “satanic” device. Simply put, the cycle beads are only an aid to measuring and identifying the days of the menstrual cycle; they are not the method itself. In the prelature, we have devised a less expensive string of “vertical beads” that serve the same purpose. Couples also tell us that the beads have helped them to communicate better with each other on a matter that is often left unspoken.

7. On the prelature’s promotion of SDM because of outside funding:

Ever since we started our revitalized NFP program three years ago, the Prelature of Ipil has depended mostly on its own limited resources. We have not received any funding from Philippine or foreign governments for our activities. We simply consider these activities part of our Family Life Apostolate to promote responsible parenthood through natural family planning.

We have received some assistance from private donors who believe in NFP to subsidize our training seminars. But we depend mostly on the volunteer services of hundreds of NFP providers in our kapilya communities to sustain and expand the program. This is why we feel optimistic that our experience could easily be replicated by other interested dioceses, particularly through our Basic Ecclesial Community structures.


Whither then, NFP? Is there an urgent need to set up a concrete program for natural family planning in every diocese? From our pastoral experience in Ipil, we realize that the majority of couples today have three felt needs:

1) They want family planning – i.e., to plan the size of their family and to space births;
2) They prefer natural family planning, if given adequate information on fertility awareness and NFP methods; and
3) They want to choose among NFP methods – to suit their own circumstances and preference.

It is in this light that I would plead for openness and dialogue in our discussions and common concern over natural family planning methods. Let us come together to encourage, not disparage, each other’s pastoral program. There is no need for acrimonious debates when we should all be confronting the more urgent pastoral needs of couples. Let us not be afraid to innovate and take risks if we want to address the pastoral needs of a greater number of households.

Regardless of which NFP methods we wish to promote, at the very least, we should be ready to show the actual numbers of NFP users in our localities. For a program without numbers is not a pastoral reality; at best, it remains an advocacy dream.

In my own talks to CEAP educators and religious organizations lately, many have expressed their readiness to work closely with bishops in promoting a concrete NFP program in their localities. Catholic doctors, midwives, and even public health workers have also expressed their readiness to work with the local church in promoting NFP. Perhaps it is time to go beyond just saying “No!” to government programs and to say “Yes!” to our own NFP program.

Our biggest challenge today may not be to confront government or an international conspiracy but rather to address the felt needs of thousands of married couples in our rural and urban poor neighborhoods. For the most part, these are couples who are looking for and are ready to adopt any of the NFP methods that we can show them to be safe, reliable, inexpensive, and practicable.

On the part of the Prelature of Ipil, despite our limitations, may I extend an open invitation for any observers to visit our NFP pilot sites. We also have a training team on all NFP methods that is ready to give seminars upon invitation and to share our NFP pastoral experience in the prelature.

Hoping that you share this vision and this letter with your Family Life coordinators, and with my best wishes and prayers for a dynamic NFP ministry throughout the country.


This is the new blog of Bishop Antonio J. Ledesma, SJ. Talks, reflections and articles will be posted soon.