Friday, February 24, 2006

Mainstreaming Natural Family Planning in Ipil Prelature

During the first weekend of February 2006, I joined a training seminar on natural family planning methods in Roxas City. This was sponsored by the Archdiocese of Capiz which was interested to know more about our All-NFP program for Responsible Parenthood in Ipil Prelature. Hence, three trainors from the prelature teamed up with two Manila-based trainors from the Institute for Reproductive Health to give the intensive 2½-day seminar on all NFP methods. In all, there were 62 participants representing 29 of the 33 parishes of the archdiocese.

Some participants had already been teaching the Billings Ovulation Method in pre-Cana seminars. Only a few, however, had heard about the Standard Days Method. And no parish at all had a monitoring system to follow up actual users. Everyone agreed that much more needed to be done to mainstream NFP and to reach out to as many couples as possible. It is in this light that the Capiz parishioners were interested to know more about our pastoral experience in Ipil Prelature in promoting an All-NFP program over the past 3½ years.

I. Pastoral Situation

From a national perspective, the latest Philippine demographic and health survey indicates that only 33% of currently married women are using modern contraceptives, 16% are using traditional methods, and less than one percent are adopting modern NFP methods. Conversely, 51% of all couples do not have any family planning method at all.

Despite more than three decades of government-sponsored promotion of practically free contraceptives, the question can then be raised why only one-third of all couples have accepted contraceptive use. Is it because the other two-thirds of Filipino couples are still looking for a family planning method that is safe, reliable — and natural?

On the other hand, a similar question can be raised why less than one percent of currently married women are adopting modern NFP methods. Has the government – as well as the church – failed to promote NFP? Or are the earlier NFP methods too difficult to adopt?

From our pastoral experience in Ipil, we realize that the majority of couples today have three felt needs:

They want family planning – i.e., to plan the size of their family and to space births;

They prefer natural family planning, if given adequate information on fertility awareness and NFP methods; and

They want to choose among NFP methods – to suit their own circumstances and preference.

Our biggest challenge then 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.

II Vision and Pastoral Guidelines

This then is our vision: to mainstream NFP by reaching out to the majority of Filipino couples who are looking for a family planning method that is effective, suited to their own circumstances, and in consonance with the Church’s moral guidelines.

The objectives for our NFP program include the following:

To adopt a proactive pastoral approach to address the felt needs of couples for family planning;

To offer an All-NFP program by making available information on all modern, scientific NFP methods; and

To promote the value formation that is integral to our Family Life Apostolate and to enable couples to make an informed and responsible choice, based on the formation of a right conscience.

In the light of these vision and objectives, we have adopted four pastoral guidelines for our All-NFP program in the prelature (cf. Fig 2).

We are pro-life. This is our first principle. We are at the service of life from the moment of conception. Hence, we are against abortion, which is also proscribed by our Constitution.

We are for Responsible Parenthood. This is our goal – to help parents to be aware of their rights as well as their duties in the procreation and education of their children. Planning one’s family in order to adequately care for every child that comes into the world is the right and responsibility of Christian parents.

We are for Natural Family Planning. This is our recommended means in consonance with the moral teaching of the Church. NFP means the practice of periodic abstinence according to the natural fertility rhythm of the human body. Our promotion of NFP should include all modern, scientifically-tested NFP methods.

We are for enabling couples to make an Informed and Responsible Choice. Within the context of a secular and pluralistic society, the government’s focus is to refrain from coercion and to provide information on all family planning methods that it deems legally acceptable for couples to make an informed choice. On the other hand, the church’s focus should be to provide information on all NFP methods and to help couples form a right conscience so that they are able to make not only an informed but also a responsible choice.

For the majority of couples who are not using any family planning method at all, the question can be raised whether or not these couples are forced by circumstances to make uninformed and irresponsible choices in a matter that is crucial to their family life. Ultimately, neither the government nor the church can make this choice for couples. It is their inherent right and duty as responsible parents and citizens to have this freedom of choice for themselves. This is the goal of Responsible Parenthood that both Church and State subscribe to.

III Towards an All-NFP Program

Since the mid-70’s, the Prelature of Ipil, which was then a Jesuit Mission District of the Archdiocese of Zamboanga, has been a pilot area for the earlier NFP methods – such as the Basal Body Temperature method (BBT) and the Billings Ovulation Method (BOM). However, with the dissociation of the church from the government’s family planning program and the end of outside funding by the mid-80’s, the NFP program reached a plateau and slowed down.

In October 2001, some of our prelature workers visited Impasugong, Bukidnon, where a new NFP method, called the Standard Days Method (SDM), was being piloted among small farmer couples. Because of its simplicity in teaching fertility awareness with the aid of a string of cycle beads, practically all the parishes agreed to include SDM in, what we now call, the All-NFP program for the prelature.

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 estimated that three-fourths of all women are within this cycle range. Hence, 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 six years since the mid-90’s, involving pilot sites in Bolivia, Peru and the Philippines. It has been clinically tested with a high effectiveness rate of 95.25%.

To help women track the days of their menstrual cycle, IRH devised a necklace or 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.

In July 2003, at the CBCP plenary assembly, the bishops passed a consensus vote recognizing SDM as a method that “could be used by a diocese in its program of Natural Family Planning,” provided it was not combined with contraceptives and it was not seen as part of the government’s total Family Planning Program for population control. [1] In effect, the bishops as a collective body gave their Nihil Obstat to SDM, but its Imprimatur was left to the local ordinary of each diocese.

IV A Five-Step Approach

Meanwhile in the prelature, All-NFP training seminars were conducted at the vicariate level and in some parishes. However, the approach was still haphazard, leaving the task of covering all the 19 parishes to a few prelature workers. After a series of consultations, by June 2004, the prelature designed a five-step program for each parish. This would systematize and decentralize the All-NFP program to reach every chapel community (kapilya) or barangay.

Fig. 3 delineates this step-wise progression from the parish to the kapilya and household levels. The five steps comprise: (1) an orientation talk on responsible parenthood and NFP for parish leaders and kapilya representatives; (2) a providers’ training on All-NFP methods for kapilya representatives; (3) an orientation talk on All-NFP for the kapilya community; (4) individual counseling of couples by the provider at the household level; and (5) periodic reporting from the kapilya to the parish up to the prelature levels.

In September 2004, our NFP parish coordinators underwent a four-day refresher course on all NFP methods, given by the staff of the Institute for Reproductive Health (Phil.), an affiliate of Georgetown University which had developed SDM and other simplified NFP methods. Starting with an overview of fertility awareness, the IRH staff went on to discuss the distinctive features of each method to enable the participants to have a comprehensive view of NFP. This has been the content of the providers’ training seminars being given at the parish level ever since. A total of 367 participants, including 68 couples, have taken the training so far. They are now servicing 182 kapilyas or 29% of the total number of 626 chapel communities.

V Progress reports

What then have been the results of our All-NFP program so far? Table 1 gives the breakdown of providers and continuing users in our 19 parishes. As of December 2005, there were 1,125 continuing users. Of these, 742 (or 66%) are SDM users, while 295 (or 26%) are BOM users. There are also 77 breastfeeding mothers, while eleven prefer the temperature method or its combination with the mucus method.

Although the number of NFP users is still a small percentage of the total number of couples, it is a promising figure for a program that has reached out so far to only about a third of the total number of chapel communities. Prelature and parish workers have also been advised not to fast-track the program – to make sure that seminar participants are properly trained to become service providers with values formation and that each couple receives adequate counseling.

Our All-NFP program has been greatly facilitated and sustained by our Basic Ecclesial Communities at the chapel and neighborhood cell levels. Indeed, our pastoral experience in Ipil Prelature indicates that natural family planning is a valid, viable, and vital option for a growing number of couples.

For more information, contact Sr. Ana Lea Pielago, FLA-NFP Coordinator:

Bishop’s Residence Tel.: (062) 333 2266
Prelature of Ipil Fax: (062) 333 2574
Ipil, Zamboanga Sibugay E-mail:
[1] CBCP, Selective Analytical Index, Plenary Assemblies 1945 – 2003, Manila, 2004, p. 62 & 131.

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