Reason and religion in natural family planning.

Dr. John Billings is a world expert on the techniques of Natural Family Planning (NFP). In July 1998 he and his wife Evelyn presented papers at the Lambeth Conference of Anglican Bishops in Canterbury, England. These papers were given at a night session, Dr. Billings writes in a separate letter, one of those outside the plenary session of the conference and open not only to bishops but to others who were attending the conference. Attendance was voluntary. This is the first time that the paper by Dr. John Billings appears in print. He is from Australia and is a Catholic.

The Lambeth Conferences are held every ten years. It was at the 1930 conference that a majority of bishops ruled that contraception was lawfully acceptable when used for serious reasons. Dr. Billings notes that "it was predicted that this would open the floodgates to the use of contraception for any reason at all, both within and outside of marriage, and this prediction has been fulfilled."

The purpose of the lecture was to show that NFP is in itself a most respectable medicial technique in harmony with faith and reason. This is not to say that NFP may be used for any and all reasons. On the contrary, the Church continues to reject contraception outright and approves of NFP only when couples decide they have serious reasons for spacing their children. It is and may not be used as just another birth control method.

For a concise statement on legitimate spacing of children according to the mind of the Church, see Vatican II, the Church in the Modern World (Gaudium et spes) #50, p. 953 Flannery edition. Also consult Humane vitae.

Editor

If the experiments, which I urge, be defective, it cannot he dificult to show the defects; but if valid, then by proving the theory they must render all objections invalid.

Isaac Newton

It is intrinsic to Faith that a believer desires to know better, to understand more deeply, what he believes. Freedom and responsiblity exist when the formation of conscience is assisted by knowledge brought to the intellect. The meaning of the word "conscience" means "with knowledge." Without a foundation of reason, faith would be in danger of being superficial or perhaps sentimental and without influence on reality. Faith could then become subordinate to whatever dominant values prevailed in the current social mentality. It would be a faith that had fallen on stony ground as our dear Lord described (Mk 4:5) or perhaps into thorns, unable to resist the temptations of a consumer society and the corruption engendered by a semblance of legality being given by laws which allow actions which are of their nature evil. To confront the moral disorders of our time, we must first of all recognize and understand them.

Jesus on marriage

Our Lord Jesus Christ spoke to the apostles about marriage (Matt 19:8), telling them something of what marriage was intended to be "from the beginning". Christian people understand that the proper context for bringing new human life into the world is the permanent and exclusive union in which spouses renew the first plan that the Creator inscribed in the hearts of man and woman. In His Infinite Wisdom, God has now decided to reveal more information about "the beginning". It is the fact that when He made the first woman, He made her in a truly magnificent and beautiful way to enable her to fulfil her role of conceiving and bearing children. He has made it possible for the husband and wife to solve such problems as may be occasioned by a rapid succession of pregnancies beyond the physical and economic resources of the couple and their family.

Deeper understanding of marriage

We need to have a deep understanding of that special kind of love that we call conjugal love. This is the unique love which develops between a man and a woman to the extent that they wish to give themselves to each other in an indissoluble relationship as long as they live. The family they form is the fundamental unit of society and the sexual relationship is intended by the Creator to provide the extraordinary privilege of helping to create new human life, individuals who have the destiny to live in God's family throughout eternity.

We are living in a world where there has been relentless and often hysterical propaganda regarding population growth. At the same time all the countries of Europe have a birth-rate below replacement levels and are progressively changing the ethnic structure of their people; similar changes are being observed in other countries as well, including Japan, USA and even Australia, where we have more sheep than people. One of the committees of the United Nations, which has the best reputation for its projections regarding population changes in the future, has stated the possibility, even the probability, that by the year 2030 the population of the whole world will begin to decline.

We have not been persuaded to become very interested in modern demographic predictions, but we are interested in the problems of individual human beings. We now know that we have a solution that is effective, harmless, simple although profoundly scientific, and able to help married people to achieve or to postpone pregnancy. We have also seen that the use of this technique in marriage fosters the love of the husband and wife for each other, promoting happiness, fidelity and peace for the family, promoting an environment eminently suitable for the rearing of children.

There are millions of couples all over the world who have, at least from time to time, a serious need for help to regulate the size of their family. Our experience in working in more than a hundred countries gives us the confidence that when they are offered an acceptable, effective, harmless technique which will enable them to fulfil responsible decisions regarding the number of children they wish to have, they will give effect to those decisions by their own actions.

New knowledge about reproductive biology

There have been very remarkable developments in our knowledge of reproductive biology in this century, and particularly in the past three decades, which have completely transformed the whole area of the regulation of birth by Natural Family Planning.

It has been known for centuries that animals and birds have what is called a sexual season, an oestrous cycle, and that this is recognized by natural signs and patterns of behaviour by both the male and female of the species. It is only in this century, indeed within the later half of this century, that human beings, despite their greatly superior intelligence, have discovered that the human female can be taught to recognize the natural signs of her cyclical fertility and the longer times of infertility. Amongst the animals the action of chemical attractants, usually volatile compounds, which we call pheromones, provide the important signals. Although pheromones may exist in humans, if they are odours they may be obscured by various perfumes applied to the skin.

In 1929-30 two great scientists, Knaus in Austria and Ogino in Japan, both gynaecologists, proved by separate lines of research that the occurrence of ovulation in the woman's cycle is related in time to the menstruation which follows and not to the menstruation which marked the beginning of the cycle. The woman is having cycles of fertility and that is why she has menstrual cycles. When she ovulates the ovaries may release one or sometimes more ova, but all of those egg cells are produced on the one day; there is only one ovulation day in any cycle. The ovum has a short life, perhaps 6-12 hours, certainly less than 24 hours, if it is not fertilized, and then the woman will always menstruate about two weeks later. It is the ovulation which causes her to menstruate.

Every healthy fertile woman is aware of the fact that over a few days during her menstrual cycle she observes the presence of a discharge from the vagina, a mucus substance which can be recognized by the sensation it produces on the vulva. She will ordinarily also observe the appearance of the discharge, but this less important though valid visual observation may not be possible if the discharge is scanty.

History of research

We had found in the medical literature occasional references, dating back more than a hundred years before we started our work in Melbourne in 1953, to the fact that when a woman is fertile the cervix of the uterus is producing a special secretion. Earlier in this century some French gynaecologists had taken samples from the cervical canal at the time the woman was ovulating, as was confirmed by hormonal estimations, and studied it in the laboratory so that some features of their physical and chemical characteristics had been defined.

We began to question women who, with their husbands, were anxious to use a natural method to space their pregnancy,s about their observations from day to day within the cycle. The women were generous to a remarkable degree in providing these descriptions. To our surprise, they revealed the fact that they had observed a mucus discharge lasting an average of five or six days during the cycle and, when they recorded the days on which the mucus was leaving the vagina, their menstruation always came two weeks later. We knew then that the women were in fact recognizing the only time in the cycle when it was possible for them to become pregnant. We were soon applying this knowledge to help them to space their pregnancies or alternatively to help the apparently infertile couple to achieve pregnancy, by directing attention to the most fertile day in the cycle, which we were also able to define by the changing pattern of the discharge from day to day.

Professor James Brown

We have been helped by two very great scientists. One of them is Professor James Brown, who came to work in the laboratories of the Royal Women's Hospital within the University of Melbourne in 1962. He is an endocrine chemist who had already established an international reputation for his production of techniques for measuring the level of circulating oestrogen and progesterone from day to day during the cycle. He very willingly agreed to submit this method we had now defined to the evaluation provided by his laboratory techniques. He has worked with us since 1962 until the present day, and he has performed many thousands of these measurements on women in all the different circumstances of the reproductive life, including young girls before reaching sexual maturity and women beyond menopause.

In the 1970s, we discovered another great scientist, Professor Eric Odeblad, both a gynaecologist and a physicist, who had been studying the physical properties of the secretions in the cervix during the cycle, using very modern apparatus for analyzing these properties and some of the chemical constituents of biological substances, including the mucus formed by the cervix.

The work of both Prof. Brown and Prof. Odeblad independently provided complete confirmation of the basic principles and guidelines of what we had called the Ovulation Method and which later came to be called the Billings Ovulation Method (BOM) or just the Billings Method. The eponymous title was recommended as a synonym of the Ovulation Method by a committee of the World Health Organization.

Professor Eric Odeblad

Professor Odeblad's research began in the early 1950s, but it was not until about 1970 that we became aware of it; after this we developed a close working relationship with him, by visits between Melbourne and Sweden, where he was Professor of Medical Biophysics in the University of Umea.

He has demonstrated that there are four types of mucus produced in the cervix during the cycle. Immediately after menstruation the cervix becomes closed by a thick, viscous mucus impenetrable by the sperm. When a group of follicles in each ovary begins to develop, they secrete oestrogen and this causes the formation of a fluid mucus whose discharge the woman may feel and see. This is an indication to her that she is coming towards ovulation and that now the sperm can enter the uterus and may be kept in a healthy state there for perhaps two or three days. As the oestrogen level continues to rise, another type of mucus is formed which facilitates the entrance of the sperm into the uterus.

Now the woman is able to define all the phases of the cycle--menstruation, days of infertility before the fertile phase, the commencement of the mucus pattern indicating the beginning of the fertile phase, the peak of fertility and the time of ovulation, the commencement of the days of infertility after the ovum has come and gone; and she is able to predict the onset of her next

menstruation.

The teaching, therefore, involves helping the woman to understand a natural phenomenon with which she is already familiar, having observed it in every fertile cycle ever since she became sexually mature. There need be no surprise therefore to know that illiterate women living in severe poverty are able to be instructed to understand their cycles in this way with relative ease. Even the presence of a vaginal infection does not prevent recognition of the fertile phase of the cycle. The woman now is recognizing both infertility and fertility, those days on which it is impossible for an act of intercourse to result in pregnancy, those days on which intercourse may cause pregnancy, and those days when intercourse is most likely to result in conception.

We often point out that Natural Family Planning is not contraceptive. The word contraception is a contraction of the term "contra-conception." In the use of the natural method there is no action taken to prevent conception. Added to that, there is no contraception that can assist couples to have a child of their own.

The basic fact to be acknowledged is that the Creator has implanted messages in the woman's body which He now intends her to recognize and understand. The woman's cycle is a manifestation of God's creative intent at any particular time. During the days of infertility an act of intercourse will not result in conception. During the fertile phase it is the intention that an act of intercourse may result in conception. Recognizing God's dominion in the creation of human life is therefore a fundamental element of a natural method.

Desirable effects

The BOM has many desirable effects upon women s health, apart from allowing women to escape the complications of chemical contraception, the intra-uterine device (IUD), and surgical operations including tubal ligation and abortion. It is necessary to recognize that health is not only physical health, but there are also important psychological, emotional, spiritual and social elements which require promotion of the dignity and fundamental rights of all women. Adequate health care must include reference to female reproductive health, which means preservation or restitution of the ability to conceive and bear a child, what is called in the Universal Declaration of Human Rights the obligation to give "special care and assistance to motherhood." This means that all women should have access to competent obstetric and gynaecological services, which include appropriate care of the child in the uterus and assistance to establish breast-feeding of the child after birth.

The woman will also benefit from a deeper understanding of her own menstrual cycle, which results from instruction in the BOM. This gives her a diagnostic reference of normality when disorders develop such as certain ovarian cysts, vaginal infections, cancer of the cervix and of the body of the uterus, and less common conditions such as hypopituitarism, hyper-prolactaeima and so on.

The woman will always know the day in the cycle when she conceives a child. This will provide an accurate calculation of the expected date of delivery from the date of conception. This is a more reliable reference for the expected date than the commencement of menstruation in the cycle in which she conceived. Even in the presence of a vaginal infection, associated with a chronic discharge, the woman can still learn to identify the days of possible fertility and the day of maximum fertility in the cycle, with the help of a competent teacher. The accurate determination of the expected date of delivery of a child is protective of both the mother and child, helping to prevent misguided interference with pregnancy following the diagnosis of post-maturity arising from unreliable calculations. A woman's cycle manifests what nature is telling her about each day in the cycle. She soon learns that this sequence recurs in every fertile cycle, whether the cycles are regular or not, and thus gains complete confidence in t his simple way of regulating fertility and infertility.

Enhances dignity of women

There have been continuing observations among people of different cultures and religions, different economic statuses and education in more than a hundred countries in which BOM Centres have been established. When the woman has obtained this deep perception of her dignity as a woman and the man learns the extraordinary information about her fertility and its recognizable bodily signs, they both develop a new appreciation of their fertility and of the respect to which the woman is entitled. The husband then thinks more about the love and care he wishes to give her and their child. He knows that the child will be the product of their love for each other, and that the conception was the result of a responsible decision they made together.

The security and the freedom that nature is providing occupies their minds more and more as their friendship and love mature and deepen. This is encouraged by the improved communication and understanding between them, and the generous acceptance of the gentle discipline of the method requiring some days of waiting without any genital contact at all, if it is their intention to avoid pregnancy. This discipline demonstrates their ability to be faithful to one another if some temporary separation should occur and is a powerful protection against sexually transmitted diseases.

The husband comes to understand more fully the dignity and the role of the man in this relationship, recognizing himself as the guardian of his wife and child, his responsibility to protect them, to provide somewhere for them to live, to make sure that they are properly nourished and that the child receives a good education to the extent that he sees in a new way the dignity of manhood. He recognizes now that he must contribute, as a matter of justice, to making sure that real equality between men and women exists in every area of society.

It has been widely observed in countries where the BOM is taught, for example, in the United States of America, Guatemala and Nigeria, that there is less marriage breakdown and divorce amongst those who use the BOM than amongst other couples using commercial contraceptives. The couples recognize that with a natural method their actions determine the result that follows, and this engenders sexual responsibility which increases their self-respect, as well as their respect for each other.

The future of marriage

We have worked in many countries where women do not receive the respect to which they are entitled. Men and women must unite to promote the dignity and the rights of women, including the provision of proper health care.

We are born to the vocation of love, first to love God with all our strength and second to love our neighbour as ourself. For the married person it is the spouse who is the first neighbour to whom this duty is owed. Natural Family Planning is a message of love and it has an appeal to the heart of every human being because we are all made to love, in the image of God. In marriage there are many reasons to return to St. Paul's wonderful passage in which he told us, "Love is patient, is kind...does not brood over an injury; takes no pleasure in wrongdoing, but rejoices in the victory of truth; sustains, believes, hopes, endures to the last" (1 Cor 13:4-7). If there are times in marriage when anger or selfishness intrude, we must be ready to admit our failures and apologize. If we have suffered from the spouse's anger or selfishness, we must be ready to forgive. Many wise and holy people have said to us that the most difficult of all virtues is forgiveness; it is the one human virtue that is mentioned in the Lor d's Prayer, the prayer which Jesus himself taught us.

In all of these considerations there lies a buried truth, a treasury of love and an everlasting promise: This is the child. The child holds the key to our return to sanity and to love. Those of us who love the child know this to be true. It is this Love which gives the vital message to marriage, and it is honoured in the sexual act. We who are convinced of this have an obligation to teach and to illumine this truth with love.

Abridged version of a paper given at the Lambeth Conference of Anglican Bishops, Canterbury, England, July 1998.

Editor: We want to thank Mrs. Ann Tanner of Walkerton, ON, a recently retired Family Studies teacher who taught 29 years in four public high schools, for bringing the Billings paper to the attention of Catholic Insight. She herself is now an accredited NFP-Billings method instructor.