Dear Bishops of Mindanao and FLA Coordinators,
In mid-December, I received a copy of a letter addressed to His Eminence Alfonso Cardinal Lopez Trujillo as Chairman of the Pontifical Commission on Family. The letter has four signatures and purportedly represents the Family and Life Apostolate diocesan representatives in Mindanao. It questions my advocacy for: (1) the Standard Days Method (SDM), and (2) collaboration of the Church with the Commission on Population (POPCOM) and the Department of Health (DOH).
We have indeed discussed a number of these points during our bishops’ recollection meeting in Davao on November 7. Despite the various questions raised, mostly on the scientific reliability of SDM, I was glad to see the openness of most of the bishops with regard to the All-Natural Family Planning program that we had started in Ipil Prelature over the past four years. Let me then make these clarifications as a response to the letter and a continuation of our dialogue for promoting responsible parenthood and natural family planning in Mindanao.
I. On the Standard Days Method
1) In July 2003, at the plenary assembly of the Catholic Bishops’ Conference of the Philippines, all the bishops present, with Archbishop O. Quevedo presiding, had a lengthy discussion on SDM. We passed an affirmative consensus vote, with no objection, 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 “cafeteria” approach of promoting contraceptives. This guideline takes into consideration the words of caution expressed in Cardinal Trujillo’s communication of May 2003. This then is the standing guideline adopted by CBCP, which should be respected by our FLA workers in Mindanao.
2) It was with this guideline in mind that the Prelature of Ipil continued and expanded its program for natural family planning which included not only SDM but all modern, scientific NFP methods. We can summarize this program with the numbers 1-6.
We have one comprehensive All-NFP program to promote Responsible Parenthood through Natural Family Planning. This includes all recognized scientifically-based NFP methods today, and not only SDM. Indeed not all women are qualified to adopt SDM. In this sense, SDM is offered only as an added option. There are two general approaches of family planning that we differentiate – the natural vis-à-vis the artificial. We also point out that it is not a question between “modern contraceptives” and “traditional NFP methods,” but rather that there are modern, scientifically-based NFP methods as well which are equally if not even more effective than contraceptives.
We address the three felt needs of many young couples today – namely, (1) they want to plan their families; (2) they prefer natural family planning; and (3) they want to choose among available NFP methods. In the process we have articulated four pastoral guidelines – namely, (1) we are pro-life as our first principle; (2) we are for responsible parenthood as our goal; (3) we are for natural family planning as our means; and (4) we are for enabling couples to make an informed and responsible choice, based on the formation of a right conscience.
We are following a five-step approach in order to systematize and decentralize the program to reach every kapilya community or barangay. The first step is a parish-level orientation for all leaders. This is followed in step two by a providers’ training. Step three is a kapilya-level orientation followed by individual counseling at the household level (step four). The fifth step is quarterly monitoring at the parish and prelature levels. Finally, we provide information on six modern NFP methods, which include SDM and the Two-Day Method (TDM), another simplified method based on cervical mucus observation. For a fuller exposition of these 1-6 elements, I am attaching my updated article on “Mainstreaming NFP in Ipil Prelature.” (Annex A)
In general, we are heartened by the positive response of almost 1,500 couple-users of NFP in the prelature so far. Two-thirds of these are SDM-users while a fourth are practitioners of the Billings Ovulation Method (BOM). We find that making available information on all NFP methods is a win-win solution: we have gotten more BOM users today than in the past when BOM was presented alone. Indeed, couples learn to combine NFP methods or shift from one method to another depending on their preference.
Our FLA workers also report that three-fourths of NFP users in our tally have actually shifted from contraceptive use. Among the reasons often cited are: avoidance of side-effects to health; cost-free considerations; adherence to the Church’s moral guideline; and their preference for what to them is indeed natural.
3) Is SDM then reliable as an NFP method? When this was discussed at the CBCP assembly three years ago, SDM was still being piloted by some NGOs in limited settings. At this point, however, after extending our All-NFP program as a church ministry to the entire prelature and meeting couple-users of more than one to three years, I can attest that NFP, particularly SDM, is indeed a valid, viable, and vital option for a growing number of couples.
Along with almost 1,000 SDM users, our 250 NFP volunteer providers in Ipil Prelature would agree with this conclusion. They have made the following general observations: Despite initial difficulties, couples learn to handle the 12-day period of abstinence in SDM. They do not combine SDM with any contraceptive method (and our church workers have never counseled them to do so). Many prefer SDM because it is much simpler and easy to follow. Many say that the beads have helped them to communicate better with their spouses. Not a few couples have also remarked that for them the choice was not between SDM and BOM, but rather between SDM and contraceptives, or between SDM and no method at all.
In Cagayan de Oro Archdiocese, where I am now based, we have started the All-NFP program in five pilot parishes, after a series of orientation talks to our clergy, religious sisters, and family life workers. Another seven parishes have scheduled the step one orientation talk before they begin their providers’ training. I am particularly glad to see the active involvement of the Catholic Women’s League in the All-NFP program, in coordination with our Christian Family and Life Apostolate (CFLA).
4) The scientific bases for SDM are summarized in the briefing paper furnished by the Institute for Reproductive Health-Philippines (IRHP). (Annex B) Biological factors relative to a woman’s fertile period, variations within the average woman’s cycle defined as 26 days varying up to 32 days, and computer simulations of over 7,600 actual cycles provided the theoretical bases for standardizing the length of the fertile window. This was followed by pilot studies and clinical trials in three countries, including the Philippines. In short, the science of statistical probability was used to determine a standardized fertile period that could be applicable to a large segment of the target population – in this case, women whose menstrual cycles range from 26 to 32 days. It is estimated that three-fourths of all women are within this cycle range. From the clinical trials, SDM has scored a high effectiveness rate of 95.25%.
In this sense, the standardized days of SDM are quite different from the customized days of the calendar rhythm method which requires the individual woman to make repeated calculations based on her six previous cycle lengths. Even the allegation that SDM users may use condoms during the fertile period is an oblique admission that the calculation itself is accurate. The scientific study of SDM has been accepted by the World Health Organization; it is now recognized as a modern fertility awareness based (FAB) method of family planning.
In Ipil Prelature we have only 3-5 verified cases of method failure. Other cases of failure or drop-outs were attributable to the users not following strictly the rules for SDM adoption.
II. On Collaboration with Government
Last December 6 at the National Population Congress in Manila, the Commission on Population launched its Responsible Parenting Movement and new policy directions to promote only natural family planning. This was in response to a directive of President Gloria M. Arroyo who had made known her preference for NFP since the start of her administration. Prior to this launching on October 24, upon invitation of CBCP President Archbishop Angel Lagdameo, DOH Secretary Francisco Duque III and POPCOM Executive Director Tomas Osias came over to the CBCP office. They explained this new program and solicited the support of CBCP from the three bishops present, namely Archbishop Lagdameo, Archbishop Paciano Aniceto, Chairman of the Episcopal Commission on Family and Life, and myself as CBCP Vice-President. At a follow-up meeting on November 10, members of the Permanent Council were also present. All the bishops expressed their appreciation for this new policy direction. However they deferred any decision and suggested that the proposal for church-government collaboration on NFP be discussed first at the next CBCP plenary assembly in January 2007.
It was at this point that I suggested that we already try out in pilot dioceses the joint promotion of NFP by government agencies and the local church. This would give us a more realistic frame of reference for the discussions in the coming CBCP plenary assembly. In addition to Cagayan de Oro, it was suggested that Jaro and San Fernando, Pampanga, could also be suitable sites for piloting.
Back in Cagayan de Oro, we then prepared a draft memorandum of agreement with the Region X DOH and POPCOM offices. This draft memo was discussed extensively with the clergy and family-oriented organizations. However, in deference to the precautions expressed from various quarters, I encouraged the Catholic Women’s League as a religious lay organization to be a signatory to the MOA instead of the archdiocese itself. (Three years ago, the Couples for Christ had entered into a similar agreement with the national DOH office to promote NFP.) This memo was signed by the CWL archdiocesan president and the regional heads of DOH and POPCOM on December 19, with myself as witness and consultant.
In our collective discernment among NFP promoters in CWL and in pilot parishes, there were four major reasons for entering into this agreement with regional government agencies.
(1) This is a new national policy that dovetails with the concerns of the Church with regard to responsible parenthood and natural family planning. It is articulated by the Chief Executive herself and translated into operational guidelines by the national and regional DOH and POPCOM offices. It also reflects a new sensitivity towards cultural and religious values among government offices – i.e., that population management can be attained through responsible parenthood, and that responsible parenthood in turn is practiced through natural family planning. (Among the present Commissioners of POPCOM are Mrs. Geraldine Padilla, Chair, Committee on Women, Couples for Christ, and wife of the CFC founder; and Dr. Jose Sandejas, Presidential Adviser on Family Matters and a close adviser too of Archbishop Aniceto.) Despite strong objections from pro-contraceptive legislators, the executive branch of the national government is pursuing this NFP-only approach – probably the only one of its kind among developing countries today. (See PDI news items in Annex C.)
Perhaps at no other time has the church and government agreed more fully on the goal of responsible parenthood and the means of natural family planning. The availability of modern simplified methods can also accelerate the promotion of NFP. If the church is serious in mainstreaming NFP as a pastoral program to reach many more couples beyond the less than one percent indicated in national surveys, the offer of working with the support of government resources should not be downplayed. This is similar to the situation of our Catholic schools availing themselves of public funds to carry on the mission of Christian education.
(2) The MOA includes adequate safeguards for the Church’s concerns. It has explicit provisions that “Natural Family Planning methods will not be combined in any way with artificial means of birth regulation”; that the NFP program will be delivered as a distinct and separate program; and that there will be “joint supervision and monitoring of the program.” Moreover, as consultant, the bishop or his representative is given a significant role in the design of the Regional NFP Program Plan. The MOA may also be modified by the parties and is effective for one year, subject to review.
(3) DOH and POPCOM have asked to use our training manuals and the services of some of our trainors. This is in line with the spirit of the MOA that provides for “the sharing of resources – financial, material, human and technical.” In this sense, the government would like to replicate our ongoing All-NFP program. In the joint trainings that have already been conducted, we are glad to see that a more wholistic view of NFP is being presented that is in consonance with Gospel values.
The limited funding for this program does not come from foreign governments, but from the national budget. In this partnership, CWL and the church side are taking the lead role and are actually contributing more to the common effort of NFP promotion rather than becoming dependent on government funding.
(4) A final consideration for us is the challenge of evangelization in the market place – i.e., engaging government agencies in the common objective of promoting responsible parenthood and NFP to address the felt needs of couples. Without a MOA, government agencies will continue to pursue NFP as its declared program at any rate – but without the guidance and value formation that only church-based groups could provide. Indeed in initial discussions and joint trainings with government members, we find much good will and openness for the involvement of church groups in NFP promotion. Many government workers are Catholics and mothers who prefer NFP to other methods. In the spirit of Vatican II, this would be a concrete way for the church to dialogue with the world. For religious lay organizations like CWL, signing the MOA would be seen as a form of principled collaboration – where moral principles are highlighted as a frame of reference.
Vis-à-vis the offer of collaboration with government in NFP promotion, the local church can focus on any of these three directions: (1) to continue to criticize and remain suspicious of government because of its earlier pro-contraceptive stance; (2) to work separately from government on NFP promotion; or (3) to critically collaborate with government in promoting NFP. We have actually tried the first two approaches – with minimal results as far as figures of actual NFP users are concerned. Trying out the third approach may incur some risk of failure and misuse; but perhaps the greater risk is not to try at all. In addressing the felt needs of couples today, are we driven more by the “fear of government” or by the “love of NFP”?
Natural family planning, I would submit, is the positive alternative and the most effective answer the Church can give to the stark realities of unwanted pregnancies, abortions, and use of contraceptives in Philippine society today. A more inclusive approach – that includes simplified NFP methods and critical collaboration with government – can spell the difference between focusing on only one “saved” sheep or reaching out to the other 99% that are still “lost.”
III. An Invitation
Even as we enter into dialogue with government regarding NFP promotion, it would also be good to continue the dialogue among ourselves within church circles. Before making sweeping statements about the efficacy or mis-use of simplified NFP methods without much evidence on the ground, may I extend an invitation to other dioceses to send observers to Ipil Prelature to examine its ongoing All-NFP program. Interviewing actual NFP users and providers can give us a more realistic picture of the situation. When it comes to acceptability among various NFP methods, we cannot make the best the enemy of the good. Indeed, whatever is acceptable to a particular couple under their own circumstances can be said to be the best for them.
When I mentioned the Ipil experience in NFP promotion during my talk to the DOPIM bishops and clergy last November, there were inquiries and general interest about the program. Last May, a group of FLA workers from Digos did visit Ipil Prelature; now they have started a similar All-NFP program in five pilot parishes. Earlier this year, the archdioceses of Capiz and Jaro have had trainings on All-NFP and are starting their own programs. Likewise, the local churches in Basilan and Jolo have had their own trainings as well as some parishes in Malaybalay. Several other bishops in the Visayas and Luzon have also signified to me their intention to review their FLA-NFP programs and include modern simplified NFP methods.
Whether or not we wish to work with government on NFP promotion, it is imperative that the local church activate its own NFP program to address the felt needs of many couples today. Otherwise, we may reach the awkward situation where it is the government alone that strives to promote NFP while the church stays on the sidelines. There is no need for acrimonious debate or ascribing arcane designs on the efforts of other dioceses to promote All-NFP.
As a local ordinary, I am mindful of my responsibilities towards the Christian community, particularly with regard to family life issues. There is indeed need for pastoral prudence, but also some pastoral innovation (Duc in altum!) if we wish to be relevant and responsive to the needs of many couples today. Some may look at the risks involved; but I would rather look at the hope – of personalizing responsible parenthood by means of promoting a culture of natural family planning throughout the country.
For your ministry in the new year, may I invoke the threefold Christmas blessings of Light, Love, and Life – which also encapsulate the spirit of All-NFP promotion in Filipino homes today.
+ Antonio J. Ledesma, S.J., D.D.
Archbishop of Cagayan de Oro