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Natural Family Planning: A Safer Alternative

JANUARY/FEBRUARY 2004 VOLUME 20 J PHARM TECHNOL 3 Breast-feeding mothers who wish to avoid pregnancy need a safer alternative than hormonal contraception. Although ecological breast-feeding can reduce the incidence of pregnancy to 1% during the first 6 months after giving birth,1 not all mothers are able to adhere to the frequent feeding schedule it requires. Consequently, many women seek another method to help avoid pregnancy during this time and may assume that hormonal contraceptives are the safest and most effective choice. However, the medical literature indicates otherwise. Appearing in this issue of jPT is the first2 in a series of 3 articles reviewing the effects of various drugs and drug classes in breast-feeding. Although many agents pose little or no risk to nursing infants, the safety of others is less certain. In their review of the available literature on hormonal contraceptives taken during breast-feeding, Nice et al. found conflicting study results, descriptions of breast milk irregularities, and reports of adverse effects in nursing infants. Clearly, hormonal contraceptive use by mothers places their breast-feeding children at some degree of risk. But the good news is that this risk can be avoided through an often overlooked or misunderstood alternative to hormonal contraception called natural family planning (NFP). By using simple, reliable criteria to identify a woman’s fertile times, NFP provides an effective, affordable, and natural way to avoid pregnancy while posing absolutely no risk of adverse drug events to nursing infants or their mothers. NFP is actually not one single method, but identifies a handful of methods of varying complexity and effectiveness used to discern when ovulation occurs during a woman’s monthly cycle. In one of the simplest forms of NFP, known as the Billings, ovulation, or mucus-only method, daily cervical mucus secretions are observed and charted to identify periods of fertility. Another common variation, the temperature-only method, predicts fertility based on shifts in morning basal body temperatures. The most reliable form of NFP, the sympto-thermal method, combines daily mucus observations, basal body temperature measurements, and assessments of cervical positioning to yield a triple-cross-checked system with reliability comparable to or exceeding that of any contraceptive method. In terms of avoiding pregnancy, the Billings method, temperature-only method, and full sympto-thermal method are 92.6%, 96.1%, and 99.6% effective, respectively.3 Common misconceptions about NFP often dismiss it from consideration as a worthwhile alternative to contraception. Perhaps the most prevalent misunderstanding is that NFP is simply a euphemism for the so-called rhythm method of avoiding pregnancy. In fact, the two differ both in means and ends. The antiquated rhythm method attempts to predict fertility from records of previous cycle lengths. Its retrospective nature, however, makes it inherently unreliable in the face of a woman’s ever-changing physiology. Conversely, NFP’s simple morning self-assessments provide real-time data, automatically adjusting to unexpected variations in cycle length that would render the rhythm method ineffective. Another common misconception is that NFP is overly complex and that few people can persist with the daily