Talk:Fertility awareness/Archive 1

Old Talk

I don't think these should all be redirected into each other. It's generally better form to keep them separate, especially if there's reason to think something can stand as its own entry, and most of these can. Anyone else care to weigh in? --TheCunctator

Uh, what is it that shouldn't be redirected into each other? What topics are being combined? --Wesley

---

From the Recent Changes:

The following were combined into this entry

• Lactational amenorrhea method
• Symptothermal method
• Cervical mucus method
• Basal body temperature method
• Calendar method
• Rhythm method

Actually, looking at the edits more carefully, the Epopt created each of the above as redirects. So at some point someone might want to split them up, but it's not like anyone redirected earlier entries. --TheCunctator

---

"Very effective"? If I understand the statistic correctly (and it's not detailed), that means nearly one in 10 women using it *as described* will get pregnant in any one year of using the method continuously (and, if I've done my sums right, that gives a sexually-active woman who doesn't want a child less than a 1-in-10 chance of making it 20 years without an unwanted pregnancy). IIRC every modern mechanical or chemical contraceptive performs better than this. --User:Robert Merkel

• The statistic quoted (vague as it is) refers specifically people who strictly use the calendar method. Since the other methods of NFP are much more precise (relying on signals that a woman's body sends as her fertily changes), it's misleading to apply that statistic to the whole NFP article. I realize that the way to counter this is to come up with some better statistics, and cite them. I'll ask my wife tonight. We've used NFP throughout our seven years of marriage, and it's helped us get pregnant when we wanted to and space our pregnancies out when we wanted to. --DGJ

I would say at least as effective rather than very. If you read the numbers on various types of the pill they suffer from what is euphemistically knowns as 'break through ovulation' (i.e., sometimes women ovulate anyway), especially with the more recent (post 1985?) lower dosage pills; condoms, of course, have a failure rate only anecdotally available - and the anecdotes put them between 5 and 10% of total times used, which is higher than 10% per annum. Oh - and, we have to talk about statistics in actual use vs. statistics in studies. 'Breakthrough Ovulation' is probably partially dosage levels and partially dosage irregularity. I'm sure implanted hormonal birth conrtol is much more regular, but it has plenty of unpleasant side effects that lead people to seeking other methods. Natural Family Planning users joke that their biggest statistical problem is that the people who use natural family planning want more children than the typical average, so they don't tend to show the kind of volume control zero-population growth people would like to see. I tend to agree - I don't think you'll find many people who actually practice any form of NFP who actually want only one child. I think they could do it, but that's not what they're after; they're looking to usefully or carefully space 5 or 6 or 8 children. --User:MichaelTinkler, godfather of a 3rd child in a 5 child family and a 4th child in a 4 child family.

oh, and now I've gone and looked at some planned parenthood pages (the most important U.S. advocate for all sorts of family planning) and contributed a little to oral contraceptives talk. Condoms and birth control pills don't look a lot better than nfp unless 'perfectly used'. Depoprovera is undoubtedly another thing entirely. User:MichaelTinkler

Hmmm. Looking at (presumably the same) planned parenthood statistics, it seems that if performed perfectly, the natural family planning methods, mostly beat condoms under the same conditions. The exception is, the calendar method, which under ideal conditions seems to have a failure rate of 9%. The chemical methods are still quite a bit more effective if taken reliably. Might I also point out that comparing the pill under "typical" conditions with nfp under optimum conditions isn't accurate either. --User:Robert Merkel

• Good points, Robert. --DGJ

yep - all these 'rates' are in ideal situations, and if you start looking they all refer to a fairly limited range of studies. This is why the subcutaneous implanted types of chemical birth control were invented, to get around the randomness of human pill-taking regimes. I'm not contributing any of this to the entries; I'm hoping that someone who understands more will make sure that no one makes claims for oral contraceptives or condoms that can't be supported. By the way, in the land of anecdote, I know a woman for whom the surgical methods didn't work - talk to almost any O.B.-Gyn and you'll hear about women who get pregnant after 'tube tying' and men whose vasectomies spontaneously reversed themself! --MichaelTinkler

"Very effective"? If I understand the statistic correctly (and it's not detailed), that means nearly one in 10 women using it *as described* will get pregnant in any one year of using the method continuously (and, if I've done my sums right, that gives a sexually-active woman who doesn't want a child less than a 1-in-10 chance of making it 20 years without an unwanted pregnancy). IIRC every modern mechanical or chemical contraceptive performs better than this. --User:Robert Merkel

Robert you are forgetting the fact that people who use the Natural methods often overlap them. Since they do not cause any interaction problems and to be "extra sure". I think you should research it some more before making such harsh comments. Also, the statement is not about natural vs unnatural birth control. The point is that doing it the natural way (can) and IS a very effective method. [except sometimes in the case of the calendar method for women who's cycles are irregular, but this can't be helped and there are still other ways to do it naturally] Nothing is 100% (besides not having sex) and as someone else mentioned, other birth control methods (eg condoms) have a failure bracket but are still deemed very effective. Because it is a fact that they are very effective. This also brings me to another few points- that condoms can also be used as well as fertility calculations to make it probably one of the most effective and side-effect free birth control/contraception methods you will find. Women may not rely on condoms for birth control but may still use it for protection against diseases. All of these can be used together and do not take long. That takes me into point 2 (see below, it belongs in another section) Papa leaf 22:27, 3 October 2005 (UTC)

---

I believe that part of the reason some chemical reasons achieve their effectiveness is their little-advertised second line of defense. If breakthrough ovulation does occur and an egg becomes fertilized, the contraceptives have also irritated the uterus so that the fertilized egg (embryo?) does not get implanted in the wall of the uterus. That's fine for avoiding pregnancy if that's all you're after, but if you happen to be among those who think that life begins at conception, then you would have to call what happens then an abortion. That would mean that the contraceptive acted more like an abortifacient in that instance. Perhaps NFP's success rate should be compared with other methods of abortion as well? Wesley

I think you might be right WRT implantation prevention for chemical contraceptives, but surely discussing it belongs on the oral contraceptives page. The only relevance here might be in the context of why a couple might choose to use nfp for moral reasons - they object to the possibility that taking chemical contraceptives might cause an "abortion" (though medicine wouldn't regard it so) of a successfully-fertilised foetus. I don't think I've ever heard that argument advanced. --user:Robert Merkel

I think you're right about where this belongs; I just added it to the oral contraceptives page. I have seen this argument advanced in Catholic literature; might have been something put out by the Couple to Couple League. At any rate, it's a logical consequence of the premise that human life begins when sperm fertilizes egg. Wesley

The argument in fact is fairly commonly advanced. In fact, one way that some people become opposed to artificial birth control is because they find out that oral contraception works some of the time by preventing implantation, i.e., by killing the embryo, and hence conclude that oral contraception is immoral. And this in turn makes a number of pro-life folk reassess their whole attitude towards contraception and can lead them to NFP (besides, even on non-moral grounds such as effectiveness, a choice between NFP and barrier methods might well be won by NFP). Medicine does not regard this as an abortion, because abortion is defined as the termination of a pregnancy, and current medical terminology considers a pregnancy to start at implantation, not at conception. But according to many pro-life ethicists, this is a merely terminological point, since what they believe makes abortion wrong is not that it terminates a pregnancy, but that it terminates a human life--which the prevention of implantation does, too. user:Pruss

---

Someone added 'The "scheduling" of sex required is highly impractical for single women or those who do not live with their partners.' Why is it "highly impractical"? Are there unpredictable times when "single women or those who do not live with their partners" go into heat and absolutely must have sex? Are they biologically incapable of saying "no, it's the wrong time of month?" Unless someone can justify this remark, I will delete the implication that such women lack free will. the Epopt

Would "inconvenient" be a more appropriate word? "Incompatible with their lifestyle"? As you undoubtedly know, many women who are not involved in a regular live-in relationship a) like to have sex, b) have schedules that don't revolve around their menstrual cycle, and c) don't wish to get pregnant at this point in their lives. --Robert Merkel

"Inconvenient" might work. How about "women who don't want to use this system will find this system is not one they want to use"?

Um, I a) like to have sex, b) have a schedule that doesn't revolve around my menstrual cycle, and c) don't wish to get pregnant at this point in my life YET I am not single and do live with my partner -- so I'd strongly agree with Epopt's suggested deletion. A possible replacement would be "NFP requires significant self discipline and attention to detail on the part of it's users to be effective." -- this could say "not for you" without insulting single people or people who use NFP. --Saracarl

I think that generally the advocates of NFP are quite willing to say that NFP works best within a committed relationship. Since most of us advocates of NFP appear to tend to be opposed to pre-marital sex, we don't think this is a serious defect. --user:Pruss

This is totally outrageous. One should probably abstain in the early days of trying out the methods (as with the pill) but only for the reason of being comfortable with making calculations and trusting (learning) about their body. All a woman needs to do is test herself in the morning and take a few notes, it would not even take 15 minutes. It can be done when she is in bed (temperature,microscope etc) or when she is up and getting ready in the morning (mucus, microscope, any other calculating methods) It is rude and presumptuous, doesn't even seem to have any basis. Nothing of this sort should be mentioned, and if a woman looks further into using a particular method, she will realise herself if her schedual is just far too unstuitable to use it effectively. Though I seriously doubt how it could be. Like an earlier poster mentioned, once a woman knows what days are fertile days and "safe days" to have sex she will make the decision to have or abstain from sex based on what the calculations show and what her wishes are (to try for a child or intercourse not resulting in pregnancy). -reply to Robert again..what exactly are you trying to imply or what sort of strange point are you trying to make? Because you don't seem to know much about it yet are arguing that it is a bad method. Papa leaf 22:27, 3 October 2005 (UTC)

---

Here is a table I assembled from http://www.fda.gov/fdac/features/1997/babytabl.html and from www.plannedparenthood.org/BIRTH-CONTROL/CONTRACHOICES.HTM -- perhaps someone can make NPOV use of it.

Method	FDA	Planned Parenthood
None	15%	15%
Continuous Abstinence		100%
Withdrawal (coitus interruptus)		81-96%
"Outercourse" (sex play without vaginal intercourse)		nearly 100%
Male Latex Condom	86%	86-98%
Female Condom	79%	79-95%
Diaphragm with Spermicide	80%	80-94%
Cervical Cap with Spermicide	60-80%	80-90% for women who have not had a child 60-80% for women who have had a child
Sponge with Spermicide	60-80%
Spermicides Alone	74%	72-94%
Oral Contraceptives (combined pill)	Over 95%	95-99.9%
Oral Contraceptives (progestin-only minipill)	95%
Emergency Contraceptives	75%	IUD within five days: 99.9% effective "morning after" pill within 72 hours: 75-89%
Injection (Depo-Provera®)	Over 99%	99.7%
Implant (Norplant®)	Over 99%	99.95%
IUD (Intrauterine Device)	98-99%	97.4-99.2%
Periodic Abstinence	About 75% (varies, based on method)	75-99%
Surgical Sterilization	Over 99%	99.5-99.9%

---

Moved from main page:

(Note: Where do the above statistics come from, and where is the support for the comparison to "optimally-used hormonal contraceptives"? A Catholic agency (which would presumably be biased in favor of NFP) or a study funded by a pharmaceutical company (which would presumbably be biased against it)? Regarding the context of the statistic quoted above... even a "precise" use of the calendar method is not the best NFP method possible, so the above comparison seems unfair. The calendar method alone is about ten times more effective than chance, but most people who use NFP don't rely simply on counting days. A World Health Organization study reportedly found that when couples used NFP properly, the failure rate was 3% or less; this compares favorably to that of several artificial methods. But statistics quoted by various Catholic sources claim 99% effectiveness; yet statistics compiled by companies that sell artificial methods of contraception describe anyone who has ever abstained from sex in order to avoid pregnancy as a "user of NFP," regardless of whether that person has actually been trained in one of the NFP methods described here. OK, end of digression.)

In response, please examine the discussion above.

• Yes, much discussion has been added since I added the above (or some earlier version of the above).

Some of the statistics might well be worth adding to the main page, but essentially I think the basic conclusions are "calendar is not great", "other NFP methods, strictly followed, are probably better than condoms under the same conditions but not as good as hormonal contraceptives, IUDs etc", and "the statistics are less clear than one might like for this discussion". are valid. --Robert Merkel

• Robert, I think that some language like what you just suggested above ought to go back in the space where that paragraph was removed.

---

Removed from main page:

NFP is philosophically attractive to some feminists (because both partners participate equally), naturalists (because it in no way interferes with the body's natural functions) and men (because they get advance warning of the onset of their partner's PMS).

Hmmm. Not the feminists I've read.

• Maybe you should read these.
  • http://www.csun.edu/~hbnur004/nfpfem1.htm
  • http://dispatches.azstarnet.com/features/1999/1208-944682416.htm
  • http://www.udallas.edu/phildept/smith/publications.htm

In fact, access to contraception and abortion was one of the key issues of 1960s feminism (and still is in countries where it's not readily available). I think stating what's a minority position as "some" is kinda misleading. --user:Robert Merkel

• And I think that removing the whole section, and thus turning the "some" who voice these views into "none," is kinda unfair. If you remove the observation about feminism because you haven't read those feminists, what's the justifictaion for removing the comments about naturalists and men?

WRT to the feminist view, as far as I can tell, the policies of mainstream feminist organisations are that women should have the right to choose any contraceptive method they feel appropriate. You might also notice that they heavily advocate the availability of drugs for women to control their own reproduction (notably RU-486). Nor is NFP discussed when information on contraception is presented. NFP's close connection with the Catholic Church and thus anti-abortion activism generally pits such groups on opposite sides of the political fence on related issues. Draw your own conclusions.

Remember that there are women and men who consider themselves feminists but who are strongly opposed to abortion. See, e.g., http://www.feministsforlife.org. Of course this is not mainstream feminism nowadays (even if a number of the famous feminists of the 19th century apparently held such views--see http://www.feministsforlife.org/history/foremoth.htm), but to claim that it is not feminism at all would be dubious, and indeed an expression of a particular POV on what feminism is supposed to be. And it would not be surprising if some of these kinds of feminists might be opposed to artificial birth control (e.g., Janet Smith (see, e.g., http://www.aodonline.org/aodonline-sqlimages/SHMS/Faculty/SmithJanet/Publications/FeminismWomenFamily/FeminismMotherhood.pdf), a Catholic moral philosopher, thinks of herself as a feminist, and is opposed to artificial birth control). Moreover, the claim under discussion is that some feminists find NFP philosophically attractive. Doesn't that claim seem to be logically compatible with a belief that abortion and artificial birth control are morally acceptable and should be legal? If so, then NFP could be attractive to some pro-choice feminists as well. It is a fairly standard part of feminism to have a suspicion of a generally male-run medical system. Moreover, NFP could be attractive in that it involves a woman's gaining a more thorough understanding of how her body works. This would seem like something that could be attractive to a number of feminists. - User:Pruss

WRT academic feminism, I don't follow the developments in academic feminism beyond what gets reported in the popular press. Somebody with a women's studies might wish to comment on perspectives from there. I suspect, but have no particular evidence for, that NFP advocacy would be very much a minority position there as well.

WRT men, the comment about PMS struck me very much a throwaway line and hardly a serious reason to advocate NFP.

As to naturalists, that aspect makes sense.

Oh, by the way, while Planned Parenthood might be argued to be in favour of chemical contraception, I find it highly doubtful that the FDA is some kinda of advocate for the Pill. That's why I removed the reference to them as proponents of chemical contraception (though obviously on the Planned Parenthood article you'd make that point).

Why would it be highly doubtful that the FDA would be in favor of the Pill? As a government agency, they are at least potentially vulnerable to lobbying dollars like anyone else. NFP doesn't present nearly as much of a profit center as most artificial contraceptives, so there are less hypothetical lobbying dollars on its side. This is pure speculation as far as I know, but it doesn't strike me as being at all unreasonable to suppose that the FDA would favor drug companies. A similar factor is at work in reporting the health benefits of breastfeeding compared to formula feeding: formula manufacturers spend lots of money promoting their product, but there are no "breastfeeding manufacturers" with comparable resources to promote it. Wesley

Because its a government bureacracy whose job isn't to advocate anything. Its job is to evaluate foods, drugs, cosmetics, and the like to find out whether they are acceptably safe and effective. It's not a lobby group. --Robert Merkel

yes, it's a government agency. I hope I didn't say it's a lobby group; I certainly didn't mean that. The fact that it's a government agency doesn't make it automatically neutral, or non-partisan, or benevolent. It doesn't make it automatically corrupt either. Any government agency that regulates a lucrative industry is going to be subject to a certain amount of pressure from industry lobby groups, both directly and from elected presidents and congressmen who themselves are lobbied. Both the FDA and FCC fall into this category. It's just a fact of life. And it's next to impossible for them to avoid at least the appearance of bias in at least some cases, whether that bias appears to be in favor of consumers, large corporations, or whomever.

Medline search

Why can't people simply do a bit of a medline search? Here's some recent data. I'm including everything that has effectiveness data subject to the following restrictions: omit everything before 1998, include only articles with "natural family planning" in the title, and omit studies with less than 100 participants, studies involving fertility monitoring devices (other than simple thermometers), studies which estimate pregnancy probabilities on semi-theoretical grounds (based on cycle day conception probabilities, say), and articles with no abstracts on medline. All effectiveness figures are per woman per year unless noted otherwise.

1. Arevalo M.; Jennings V.; Nikula M.; Sinai I.: "Efficacy of the new TwoDay Method of family planning", Fertility & Sterility. 82(4):885-92, 2004 Oct. Sample size 450. Locations: Guatemala, Peru, Philippines. Correct use efficacy: 96.5%. Overall efficacy (including incorrect use): 86.3%.
2. Che Y.; Cleland JG.; Ali MM. "Periodic abstinence in developing countries: an assessment of failure rates and consequences", Contraception. 69(1):15-21, 2004 Jan. This is a survey of 15 national surveys. No distinction made between correct and incorrect use, and the abstract says that most of the users are using simple calendar rhythm (rather than the more sophisticated NFP methods). Overall efficacy: 74%. (Remark: Not very useful for assessing NFP as opposed to rhythm.)
3. Howard MP.; Stanford JB. "Pregnancy probabilities during use of the Creighton Model Fertility Care System" Archives of Family Medicine. 8(5):391-402, 1999 Sep-Oct. Sample size: 701. Location of study: Houston TX. Per 100 couples, the following were observed. 0.14 couples got pregnant despite perfect use. 2.72 couples got pregnant due to user/teacher error. 12.84 couples got pregnant because they had sex at a time at which they knew themselves to be fertile. 1.43 couples had "unresolved pregnancies". (Remark: So perfect use pregnancy is not at all likely given NFP, but if you have sex while knowing that you're fertile, you might well get pregnant.)
4. Anonymous(!). "European multicenter study of natural family planning (1989-1995): efficacy and drop-out". Advances in Contraception. 15(1):69-83, 1999. Overall sample size: 1328 women. All data is over 12 cycles, not over a year (though the two are pretty close). Double check methods: Unintended pregnancy rate: 2.61% over 12 cycles. Drop-out rate: 3.9%. Lost-to-follow-up rate: 3.1%. Single check methods: Unintended pregnancy: 8.5%. Drop-out rate: 3.0%. Lost-to-follow-up rate: 23.4%. Additional information: "Most pregnancies occurred because of deliberate unprotected intercourse in the fertile phase". (Remark: I have no idea why Medline lists this as anonymous, but it is published in what I assume is a refereed journal.)
5. Hilgers TW.; Stanford JB. "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness." Journal of Reproductive Medicine. 43(6):495-502, 1998 Jun. Overall sample size: 1876 couples. Location: U.S. Perfect use effectiveness: 99.5%. Actual use effectiveness: 96.8%. Discontinuation rate: 11.3%.
6. Ecochard R.; Pinguet F.; Ecochard I.; De Gouvello R.; Guy M.; Huy F. "Analysis of natural family planning failures. In 7007 cycles of use". Fertilite Contraception Sexualite. 26(4):291-6, 1998 Apr. Sample size: 626 couples, mostly French, some Swiss and Belgian. Method effectiveness: 98.9%. Method+user effectiveness: 93.5%. (Remark: My guess based on the abstract only is that this number is what we get if we drop the people who quit using NFP during the study or something like that and then calculate the pregnancy rate in the remaining population, while the next number is the overall number.) Overall non-pregnancy rate: 82.42%. (Remark: I suspect this includes people who quit using the method. It's hard to tell from the abstract.) -User:Pruss

---

By the way, something worth mentioning somewhere in the article is the way that NFP users can adjust the amount of abstinence to obtain the effectiveness they want, by adding additional "safety days" on both sides of the identified fertile period. Strong anecdotal evidence suggests that once one adds enough of these, the chance of pregnancy becomes close to that which one gets in the case of sterilization. This is up to the individual couple. The methods normally presented to users are a bit of compromise between effectiveness and not having too much abstinence. But in cases where there is a strong enough need to avoid pregnancy, strong anecdotal data suggests that extremely high effectiveness (perhaps rivaling sterilization) can be achieved by adding enough safety days. It's a rather nice thing about NFP that one can tailor the amount of abstinence to get the effectiveness one wants. For instance, if one abstains except on one very carefully chosen day each cycle, I suspect one can probably ensure that the chance of conception is effectively nil. I don't think there really are any studies in these extensions, because of difficulties in compliance I expect. -User:Pruss --- Can someone take a look at the edits by 214.13.4.151? I was going to revert them, but some of them are actually legit, and a few I really don't know enough about to want to touch. --InShaneee 15:47, 18 May 2005 (UTC)

I've done quite a bit of editing on this page and hope to do some more, as my time allows. My thought (if the Wiki community allows it) is to move most of this article (not the Religion section) over to the title 'Fertility Awareness Method' (the article currently there is not as comprehensive as this one) and to create a new article for Natural Family Planning, describing the things unique about it (as opposed to the broader category of FA) and perhaps expanding a bit on the religion section. --Lyrl 30 Aug 2005

FA vs NFP

I just reverted an edit that removed almost all of the information in this article. This article started out as a NFP article, but the general topic changed to FA, so it was renamed. This FA article is significantly different from the Fertility Awareness Method article, enough so that they should be merged instead of one being simply deleted. If someone wants to create a new article to cover NFP, that would be a great idea. But this article covers too much info that's not in the FAM article for all of that information to simply be deleted in an effort to return this article to it's NFP origin. Recap: A new NFP article would be more than welcome, but I disagree with the editor who simply deleted all the info in this article that's not about religious attitudes toward FA/NFP. --Icarus 23:11, 1 September 2005 (UTC)

I agree that merging is the right thing to do. Pasting one article onto another was against the Wikipedia rules. Does anyone have content in the FAM article they think should be preserved? To me, it seems like a shorter, less comprehensive article (or was before my inappropriate edit). It also does not have much editing history. Perhaps a redirect should just be created at that location, pointing to this article? (I have deleted my request for a move) Lyrl 15:57, 4 September 2005 (UTC)

Religious/Christian

Why is it that this page is shown as a religious/Christian thing? No doubt the Pope and his religion have strong views on it, but it is not a strictly religious thing and ought to be changed to say that it exists, and certain religions and the Pope are very much in favor of this method due to their beliefs. The piece about the Pope can still be mentioned but shouldn't be so prominantly featured, if you feel the need, put it in it's own section(if there isn't one already) or put a link to a page with more information. I hope someone will fix this soon because I'm afraid I will mess up the article, but will do it myself if need be. Papa leaf 22:27, 3 October 2005 (UTC)

The article mentions FA's role in certain Christian sects, but is pretty much focused on the practical aspects instead of the religious ones. If you want to add a little info on other motivations for using FA, feel free. But seeing how important it is to certain Christian sects, it would be wrong to not include the little that's already there. --Icarus 06:19, 4 October 2005 (UTC)

Sorry I was refering to this bit: "Natural Family Planning (NFP) is the set of pregnancy avoidance methods permitted by the Catholic Church. Though many people assume the ineffective Rhythm Method is the only form of NFP, several types of NFP have very high effectiveness rates - above 99% per year" then it goes straight on to talk about Catholics and the whole page is practically about religion. (I meant to say Catholic above) I'm not sure what's going on with the talk page, I think I may have posted it in the wrong area. I was on the Natural Family Planning page and when I clicked on discussion and posted everything it was fine. But when I go back to the article it changes to Fertility Awareness. (and that paragraph isn't there) I'm confused. Papa leaf 01:39, 6 October 2005 (UTC)

Ah, thanks for the clarification. What happened was that for a while, the NFP article redirected to the FA article. (It's actually a little more complicated, but that's the short of it.) There's now a separate NFP article (again... like I said, it's a little complicated), but the talkpage still redirected to this talkpage even though the article no longer redirected to this article. I've fixed that. I'm also going to try to add something to the beginning of the NFP article to direct people looking for a more secular (or just non-religious or non-Catholic) approach to the FA article. --Icarus 06:19, 6 October 2005 (UTC)

Billings Method

There are entire books written to teach people fertility awareness - two of the ones referenced by this article are over an inch thick. Including specific instructions for one particular method (Billings, Creighton, CCL sympto-thermal, FAM sympto-thermo, Doering, etc., etc.) seems a little out of the scope of an encyclopedia article. I'm also afraid it would encourage couples to try to avoid pregnancy based on information in this article alone. I'd like to remove most of the Billings method instructions added by 216.123.247.18 Lyrl 22:42, 4 November 2005 (UTC)

The level of detail in the Billings section is not substantially different from the Sympto-Thermal information. It would make the article unbalanced to preferentially remove Billings information while retaining information on other methods.Wanfactor 17:07, 5 November 2005 (UTC)

No information is given on the sympto-thermo method (for example, how to cross-check signs for greater accuracy, when it is OK to overrule fertile observations from one sign with more convincing infertile signals from another, etc.). Rather, each individual sign is described by itself, with the note that they may be combined, or each may be used alone.

The Billings Method is a CF-only method, and information in the Billings section is duplicated in the CF section. CF: "The production of fertile cervical fluid is caused by the same hormone (estrogen) that prepares a woman’s body for ovulation" Billings: "During the days leading up to ovulation, (the fertile time period), the increase in estrogen levels causes the cervix to produce a mucus that helps sperm survive."

The rest of the information in the Billings section is duplicated elsewhere in the article. From EFFECTIVENESS OF FERTILITY AWARENESS: "The cervical fluid-only methods have a method failure rate of 3% per year" Billings: "According to proponents, the Billings Ovulation Method has a 99% method effectiveness rate and 95% user effectiveness rate."

From DESCRIPTION: "FA can be used by all women throughout their reproductive life, regardless of whether or not a woman is having regular cycles, is approaching menopause, or is breastfeeding." Billings: "This effectiveness applies regardless of whether or not a woman is having regular cycles, is approaching menopause, or is breast feeding."

Again, from DESCRIPTION: "Avoiding pregnancy by use of FA requires abstinance from sexual intercourse for at least 8-10 days each cycle - achieving the highest effectiveness rates can require even more abstinance. However, studies have indicated little or no difference in frequency of intercourse between couples using fertility awareness and those using oral contraceptives. (Couples avoiding intercourse during the fertile phase of the cycles are thus more sexually active during the infertile phases of the cycle.)" Billings: "In addition, properly trained couples trying to avoid pregnancy rarely need to abstain from marital relations for more than two weeks."

If you have information you can add to the article (such as modifying the CF section to more broadly cover different method's descriptions of CF, or citing the studies for Billings effectiveness in the EFFECTIVENESS section), please do so - that's how articles like this get better. But I think the information currently in the Billings section does not contribute to the article and should be removed from its current location.Lyrl 02:04, 6 November 2005 (UTC)

The terminology used in the article appears to be method specific. eg; cervical fluid is a term coined by Toni Weshler and not used by other methods, sympto-thermal often uses the terms 'stretchy' or like 'egg-white' to describe mucus while Billings would use 'stringy'. In addition, the approach to interpretation is quite different betweeen different methods, and I think there is an implicit interpretation (or bias) of fertility within the document. eg. you claim that you have seen 'too many pregnancies resulting from dry days', however, this is a subjective interpretation of an observation. There is significant scientific data which demonstrates that conception cannot occur without cervical mucus capable of sustaining sperm survival. Thus, the most likely reason that these pregnancies occurred is that cervical mucus was present, but was not observed.

On the topic of conception without cervical mucus - it is true that sperm will typically die within twenty minutes in a vagina without cervical mucus. But sperm do not wait for ovulation in the vagina: as demonstrated by the work of sperm psysiologists such as Dr. Joanna Ellington, sperm take 15-45 minutes to travel from the vagina to the fallopian tubes. In the fallopian tubes, sperm can live quite well for many days without any cervical mucus.

NFP teachers from the Couple to Couple League have written that they believe conception sometimes occurs without cervical mucus. Some speculate that an unusually large volume of semen, for example (from multiple acts of intercourse) can change the environment of the vagina sufficiently to allow sperm time to travel through the cervix.Lyrl 16:16, 20 November 2005 (UTC)

That being said, I do think the Billings section does need some work.Wanfactor 02:50, 6 November 2005 (UTC)

I agree with Wanfactor that the article is currently biased in favor of one school of fertility awareness. It would benefit from edits suggested by Wanfactor such as changing the Ms. Weshler-specific term 'cervical fluid' to the term used by most teaching schools 'cervical mucus.' I would like to see the article kept as an overview of the different schools - with each section 'description', 'effectiveness', etc. addressing all the schools - rather than breaking each method out into its own section.Lyrl 20:48, 6 November 2005 (UTC)

If the term cervical mucus is used instead of cervical fluid, it should be used because 'mucus' is a more scientifically accurate term than 'fluid'. Other language or viewpoint changes should occur, not to slant the article towards the majority view held by most methods (even if such a thing should exist), but because the changes would reflect a more scientific or accurate picture of fertility, as would be appropriate to a fertility overview. I think each method should be free to choose their own language to describe their method, but I do not think a 'tyranny of the majority' should be the basis for choosing the language in the sections that are not method specific. With the qualification that the article remain readable. Wanfactor

I contest the definitions of FAM and NFP. I do not believe that these definitions are objective. Please refer to the discussion on the NFP page for my reasoning. Wanfactor 17:01, 5 November 2005 (UTC)

Side effects of fertility awareness

I think the claim that the claim that FA has no side effects should be cited. User:Ben Standeven as 70.242.135.236 16:41, 5 December 2005 (UTC)

I'm not sure where to find a source that addresses the issue of side effects (or lack of) related to paying attention to what's on one's toilet paper, or to taking one's temperature. I'm having a hard time imagining any possible side effects from these activities. Perhaps I'm misunderstanding Ben Standeven's dispute with the statement?Lyrl 23:43, 5 December 2005 (UTC)

Agreed. Joie de Vivre 22:31, 3 December 2006 (UTC)

The claim that FA has no side effects should apply only to the non-invasive methods of FA; ie. exluding the cervix check, since an internal exam alters the physiology of the vagina. Wanfactor

One could posit that inserting a penis into a vagina stands as least as much of a chance of disrupting the environment as inserting fingers would. If a woman is using FA for birth control, it'd be almost impossible to determine whether the fingers or the penis were causing a change. Plenty of women regularly masturbate with fingers inserted vaginally, or allow partners to masturbate them with fingers inserted vaginally. I think the current mention of possible environmental changes through digital penetration is enough. I say, don't cite it. Joie de Vivre 22:31, 3 December 2006 (UTC)

Accuracy dispute?

I just noticed this article is in the category "Accuracy Disputes". Does anyone know what the dispute is about? Maybe it's an old tag that's been corrected - if so, can it be removed?Lyrl 03:03, 21 December 2005 (UTC)

mucus observation

The changes I made to the mucus observation were meant to clarify the science and physiology behind the sign, and to eliminate the 'interpretational' information that appeared to be method specific. Since there is a dramatic difference between the ways that different methods determine the end of fertility, I think it would be better either to cover each method separately, or none of them at all. Wanfactor 03:04, 5 January 2006 (UTC)

Breastfeeding infertility

Should the section on this stay in the FA article (as-is, or summarized)? Or should all the information be moved to the LAM article? Lyrl 19:58, 8 January 2006 (UTC)

vatican roulette

Anyone else notice that 'vatican roulette' redirects to fertility awareness? Or that if you type 'wikipedia billings ovulation' into Google, the first result is this fertility awareness page, and the second result is 'vatican roulette'? I have to say I find this rather insulting. Wanfactor 02:17, 12 January 2006 (UTC)

LAM not contraception?

Following the rules for LAM greatly decreases the chances of ovulation occuring. Preventing ovulation prevents conception. I thought that was the definition of contraception? Lyrl 03:02, 28 January 2006 (UTC)

It could be the definition for some people. But for others, it's not, so I just removed ambiguity. See also here. For Catholics (orthodox ones, at any rate!) such as Sheila Kippley, who did a lot to promote LAM, the word "contraception" carries connotations of thwarting and frustrating nature. The Couple to Couple League, co-founded by Sheila Kippley, is against contraception, but promotes Natural family planning, of which LAM is one method. Anyway, as far as I can see, my edit removed something that might be disputed, but didn't introduce anything that would be disputed. Hope that helps. AnnH ^(talk) 07:48, 28 January 2006 (UTC)

To elaborate a little on the above — those who advocate charting fertility signs or ecological breastfeeding as a means of spacing birth, especially when it's for religious reasons, tend to avoid calling it contraception. The "contra" in contraception suggests it's against something. It's like the difference between eating salads if you want to lose weight and eating chocolate cake and then deliberately vomiting. In one case it's taking advantage of something which is in harmony with nature (the fact that lettuce doesn't have many calories); in the other case, it's acting against nature. So knowing you're infertile on day X of your cycle, and taking advantage of that is not considered to be thwarting what God built into nature. Similarly, taking advantage of the fact that you're infertile while practising a special kind of breastfeeding, which Sheila Kippley believes was the original kind, is again not considered to be thwarting what God built into nature. I realize a lot of people would shrug and say, "Oh, it's the same thing." But since it's very much disputed, and since supporters of NFP and Ecological Breastfeeding would be against "contraception", I thought it was better not to say that LAM is a form of contraception. AnnH ^(talk) 18:50, 28 January 2006 (UTC)

CCL promotes ecological breastfeeding, which is different from LAM. Ms. Kippley developed the rules for ecological breastfeeding. She did NOT develop LAM (see here). Point taken that contraception is a disputed description in some circles, though. I've changed the wording a bit to hopefully keep the possibly disputed word out, but still make clear what LAM is. Lyrl 18:57, 28 January 2006 (UTC)

Yes, I know ecological breasfeeding isn't exactly the same as LAM, and that Sheila Kippley developed the former, but not the latter, although they're similar. (I have all the Kippleys' books — John and Sheila.) I just worded my post a little sloppily because I was more concerned with explaining the objection to using the word "contraception" than I was with who developed what and what the two practices are. Thanks for the link. It looks interesting. I'll read it later. Cheers. AnnH ^(talk) 19:04, 28 January 2006 (UTC)

LAM is somewhat different from the observational methods of fertility awareness as fertility is altered by the hormones produced during breastfeeding. However, since the purpose of breastfeeding is nurishment of the baby, and the resultant infertility is a secondary result (even if it is desired) it is not contraceptive in the way the Pill is contraceptive. It is more similar to pregnancy, where ovulation is suppressed as well. Obviously, pregnancy is not contraception either.Wanfactor 02:00, 30 January 2006 (UTC)

Agreed. I can't imagine anyone breastfeeding (especially the kind of unrestricted breastfeeding involved here) with the primary intention of suppressing fertility and the secondary intention of nourishing the baby. AnnH ^(talk) 02:06, 30 January 2006 (UTC)

Confined to contraception?

This article seems pretty focused on fertility awareness as a contraception method. In my limited experience, it seems to be used more often as a conception aid. Note that TTC (for "trying to conceive") directs readers to look at this topic for more. Does anyone know more about using it for conception, and can they balance out the article a bit to reflect that usage? moink 21:13, 8 February 2006 (UTC)

Excellent idea. Maybe next month I'll look into it, if someone else doesn't beat me to it. AnnH ^(talk) 21:25, 8 February 2006 (UTC)

Comparing use rates for oral contraceptives with ideal or near rates for FA

The section labeled "effectiveness of fertility awareness," lists the use rates (and only the use rates) of oral contraceptives while inviting readers to compare these rates to FA under ideal or near ideal conditions. Is this really an accurate and unbiased point of comparison? C. Rowan, 5/9/06.

rhythm method and embryo death

• 'Rhythm method' may kill off more embryos than other methods of contraception
• The rhythm method and embryonic death — Omegatron 13:25, 27 May 2006 (UTC)

The author assumes that most Rhythm failures are caused by unusually long sperm or egg life. Actually, most Rhythm failures are caused by incorrect calculation of ovulation - whether due to unusually early or late ovulation, or to a woman with an unusually short or long luteal phase. So this assumption is incorrect, and is inflating his estimates of embryos "killed" by Rhythm.

The author's lack of biological knowledge also comes across in things like his belief that embryos implant immediately after conception (they actually implant 6-12 days after ovulation), and in his unreferenced statement that 50% of embryos never implant. Although IVF cycles have implantation rates around 40%, studies of couples with normal fertility using CF-only methods of fertility awareness have shown pregnancy rates of 67-80% in the first cycle of trying (see "Achieving pregnancy" section), suggesting implantation rates in couples of normal fertility are much higher than 50%. So this incorrect assumption is also inflating his estimates.

His choice of method (Calender Rhythm) is also inflating his estimates. When used correctly (i.e. not having sex on days the method identifies as fertile), it has a 10% per-year failure rate. Most observational FA methods have a less-than-1% per-year failure rate. The Dry Day Rule has a 3-6% per-year failure rate.

The theory that embryos created from aged gametes are more likely to be defective is also called into question by research that shows no difference in miscarriage rates between optimally timed intercourse and non-optimally timed intercourse [1].

In short, I don't believe this is a good article. The concept does seem important to many people, though, and it seems appropriate to cover the possibility of increased embryo death in the "Scientific basis" section.

This FA Wikipedia article is not an ethics article, though, it is focused on describing the method. I don't believe this article should be mentioned in the introduction.Lyrl 14:28, 27 May 2006 (UTC)

Factual accuracy

I've found a discrepancy in the Effectiveness section;

"(i.e. abstaining from intercourse from menstruation until after ovulation) have a method failure rate of 1% per year."

This doesn't make sense, as the said time period is the infertile phase; ergo abstinence during that phase would not have any significant effect as a contraceptive method. Does anyone else agree? To my knowledge, an egg cannot be fertlised BEFORE ovulation, can it? I mean, there's no egg there.

Let me know. TydeNet 09:09, 30 May 2006 (UTC)

Ova typically live 6-12 hours, with a rare egg capable of surviving 24 hours without fertilization. Sperm typically live 3 days, with up to 5 days considered normal and at least one documented case of pregnancy from intercourse eight days before ovulation. An egg cannot be fertilized before ovulation. However, intercourse before ovulation can certainly result in pregnancy, because of long sperm life. Due to the short life span of human ovum, however, intercourse after ovulation is unlikely to result in pregnancy. Lyrl 22:51, 30 May 2006 (UTC)

merge proposal

How is this different from Natural family planning and natural birth control? See discussion at Talk:natural family planning.--Andrew c 22:15, 13 June 2006 (UTC)

Proposed Infobox for individual birth control method articles

Let's all work on reaching a consensus for a new infobox to be placed on each individual birth control method's article. I've created one to start with on the Wikipedia Proposed Infoboxes page, so go check it out and get involved in the process. MamaGeek (Talk/Contrib) 12:12, 14 June 2006 (UTC)

Typical use failure

Typical use failure is currently listed at 25% per year. That number is from the National Surveys of Family Growth, a survey that included 7,643 women. Because only 1% of Americans (i.e. 76 women in the survey) use any form of FA or NFP, that survey did not obtain enough data to break down failure rates by method. 0.2% of American women aged 15-44 use one of the observational methods of NFP. 0.7% use the Rhythm Method - three times as many. So the FDA failure rate is heavily skewed toward the failure rate of the Rhythm Method.

This is what is in The Art of Natural Family Planning on that subject:

...references lump together all methods of 'period abstinence' as if they were the same. This is because the data were derived from the National Surveys of Family Growth. Therefore, the average of 20 surprise pregnancies per 100 couples per year is not based on published prospective studies, but only based on questionnaire-generated data. The number of users of different NFP methods was too small to allow analysis of separate types of NFP. This is where confusion can occur in any publication regarding effectiveness rates.

They then have a table with actual failure rates from a number of studies:

• Liberia 1990 - 4.3% (life table)
• Zambia 1990 - 8.9% (life table)

Gray RH, Kambric RT, Lanctot CA; et al. (April 1993). "Evaluation of natural family planning programmes in Liberia and Zambia". Journal of biosocial science. 25 (2): 249–258. PMID 8478373. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Multinational 1981 (U.S., France, Canada, Columbia, Mauritius) - 7.2% (1% perfect use) (life table)

Rice FJ, Lanctot CA, Garcia-Devesa C (1981). "Effectiveness of the sympto-thermo method of natural family planning: an international study". International Journal of Fertility. 26 (3): 222–230. PMID 6118343.{{cite journal}}: CS1 maint: multiple names: authors list (link)

• U.S. 1981 - [From Kippley: 11.2% (0% perfect use) (life table)] [From PubMed abstract: 13.7-16.6% STM, 34.9-39.7% OM (Pearl Index)]

Wade ME, McCarthy P, Braunstein GD; et al. (October 1981). "A randomized prospective study of the use-effectivness of two methods of natural family planning". American journal of obstetrics and gynecology. 141 (4): 368–376. PMID 7025639. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• U.S. 1981 - 14.4% (life table)

Kambic R, Kambic M, Brixius AM; et al. (November 1981). "A thirty-month clinical experience in natural family planning". American journal of public health. 71 (11): 1255–1257. PMID 7294271. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Australia 1978 - 16% (life table)

Hatcher, RA (1994). Contraceptive Technology (Sixteenth Revised Edition ed.). New York: Irvington Publishers. ISBN 0829031715. {{cite book}}: |edition= has extra text (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

• Columbia 1980 - 19.8% STM, 24.2% OM (life table) [26.0% STM, 33.8% OM (Pearl Index)]

Medina JE, Cifuentes A, Abernathy JR; et al. (December 1980). "Comparative evaluation of two methods of natural family planning in Colombia". American journal of obstetrics and gynecology. 138 (8): 1142–1147. PMID 7446621. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• Germany 1991 - 2.3% with abstinence, 2.1% with barriers during fertile phase (Pearl Index)

Frank-Herrmann P, Freundl G, Baur S; et al. (December 1991). "Effectiveness and acceptability of the sympto-thermal method of natural family planning in Germany". American journal of obstetrics and gynecology. 165 (6 Pt 2): 2052–2054. PMID 1755469. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)

• U.K. 1991 - 2.7% (Pearl Index)

Clubb EM, Pyper CM, Knight J (1991). "A pilot study on teaching natural family planning (NFP) in general practice". Proceedings of the Conference at Georgetown University, Washington, DC. {{cite conference}}: Unknown parameter |booktitle= ignored (|book-title= suggested) (help)CS1 maint: multiple names: authors list (link)

• Europe 1992 - 2.4% STM; 10.6% muco-thermo (Pearl Index)

"European Natural Family Planning Study Groups. Prospective European multi-center study of natural family planning (1989-1992): interim results". Advances in Contraception. 9 (4): 269–283. December 1993. PMID 8147240.

• Italy 1986 - 3.6% (Pearl Index)

Barbato M, Bertolotti G (1988). "Natural methods for fertility control: A prospective study - first part". International Journal of Fertility. 33 Suppl: 48–51. PMID 2902027.

• U.K. 1976 - 23.9% (Pearl Index)

Marshall J (August 1976). "Cervical-mucus and basal body-temperature method of regulating births: field trial". Lancet. 2 (7980): 282–283. PMID 59854.

Those studies were all of sympto-thermo or Billings.

I went ahead and typed up the references so I have them available here (I originally posted this on Talk:Natural family planning). I also found the following while poking around on PubMed:

• Germany 1997 - 2.2% (life table) (perfect use - 0.63% with abstinence, 0.45% with barrier during fertile phase)

Frank-Herrmann P, Freundl G, Gnoth C; et al. (June–September 1997). "Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study". Advances in Contraception. 13 (2–3): 179–189. PMID 9288336. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: date format (link) CS1 maint: multiple names: authors list (link)

Lyrl 02:48, 25 June 2006 (UTC)

NFP paragraph

Saying "actually refers to" is POV, in that it seems like wikipedia is taking a stance on what is the more proper use of the term. I prefered the previous version that said "NFP can generally refer to..." and "however NFP can also more specifically refer to...". I think mentioning abstinence is very imporant in describing how NFP works as BC. However, as seen on other articles, Joie feels otherwise. I don't see how the changes helped, or what problems they were trying to address. Let's discuss.--Andrew c 21:12, 11 October 2006 (UTC)

This paragraph has become wordy. any use of FA methods and One of these methods is a religiously-motivated practice of FA, and although.. seem like they can be cut completely. I don't see how this latest version is an improvement on what we had before. Could we specifically state what was wrong with the old version, so maybe we can address those issues. Because I really am not fond of some of the phrasing used in the current version. There is probably a better way to communicate what we need to say.--Andrew c 23:18, 27 November 2006 (UTC)

I think the wordiness is an attempt to satisfy my complaint about implying FA was the only NFP method. Joie de Vivre seems to have some enormous objection to saying that the Catholic version of NFP includes stastical and LAM methods. As far as I can tell, whatever this objection is has not been articulated. I also do not see the current version as an improvement, but (sorry!) would be bothered by just cutting the phrases you mentioned because of FA/NFP conflation. Lyrl ^Talk _Contribs 00:29, 28 November 2006 (UTC)

I have addressed the wordiness (which also bothered me), while trying to maintain clarification about NFP as it relates to fertility awareness. The original concern about referring to NFP as "a religiously based form of FA" has been addressed by clarifying that NFP refers to "a set of several" methods. It is clear that NFP is more than just a religiously-based form of FA. Anyone who wants to learn more about exactly which methods the Vatican has deemed morally appropriate is free to visit the article detailing those methods. A link to the NFP main article is in the paragraph. Joie de Vivre 21:08, 28 November 2006 (UTC)

In regards to this diff, I preferred the older version better (though I like the changes made in the birth control article). Lyrl ^Talk _Contribs 19:45, 2 December 2006 (UTC)

External links organization

I'm not sure about the recent complete dissociation of secular vs. Catholic sites in the "External links" section. I see where it is beneficial to the "Descriptions", as secular sources may have very different views than pro-NFP sources.

But I think seperating the teaching organizations may be detrimental to people looking for a teacher, and possibly misleading. First, it makes readers look in two different places - seperated by three headings and twelve links - for teaching organizations.

Second, it strongly implies that all teachers in the "Catholic" section include religious content in their classes. While this is true of some NFP organizations (CCL, for example), others (Billings, Creighton) do not have religious content in their classes. Billings will even license teachers without any religious beliefs; the owner of the Justisse site listed in the external links is licensed by the Billings organization. Just because a religious organization licensed a teacher, does not mean classes from that teacher will have religious content.

I'm wondering if combining the teaching sections - but putting notes by ones that definitely or might have religious leanings - would better inform readers interested in that type of information? Lyrl ^Talk _Contribs 00:59, 1 November 2006 (UTC)

All of the organizations now listed under the single Catholic heading have pronounced religious leanings. I have cleaned up the list a bit for the following reasons:

- Couple to Couple League: mentions "building 'healthy marriages'", has extensive religious content under Links and elsewhere

- Creighton FertilityCare: refers to "bonding 'your marriage'", links to the Pope Paul Institute which apparently is the "home of FertilityCare"

- Fitch Fertility Centers: refers to "marital life"

- Primer on NFP (NFP Files) refers to the method as "moral" and "marriage-building", and is run by a local chapter of the heavily Catholic CCL (above)

- and the last link is another Creighton (Vatican-affiliated) group

Looking at these more closely, it becomes apparent that these links don't belong in this article. They have been removed. Joie de Vivre 20:28, 16 November 2006 (UTC)

What is the rationale for:

• Reverting my corrections to the infobox "date first use"? I have the sources I used for the new date cited in the Rhythm Method article.
• Changing "Teaching organizations" to "Teaching resources"? There are dozens of FA teachers in the U.S., and likely hundreds worldwide. Wikipedia is not a collection of links. It is better to link to places that are collections of links (i.e. organizations of teachers) than to try to link directly to all teachers' websites here.
• Deleting teaching organizations with religious associations? Their FA rules are just as good as anyone else's, and they are likely to be the only teachers nearby most Wikipedia readers. Having to choose between religious instructions or attempting to figure things out on one's own is not a great choice. But it's better than no choice at all, which is what removing links to those organizations would seem to try to impose on readers.
• Removing the descriptions of the teaching organizations? I don't feel so strongly about this, but I thought it interesting to note, for example, that all Creighton teachers are physicians, and most CCL teachers are couples.
• Removing all external descriptions of both FA and NFP? I see the statements about removing NFP descriptions because they "have pronounced religious leanings" therefore "don't belong in this article". I'm not sure I disagree with that, but would like more explanation, and that doesn't explain the removal of FA descriptions.
• Removing two of the software links?
• Listing fertilityuk as a Catholic organization? I was under the strong impression that was a branch of NIH, the government-run health ministry in Great Britain, and had no association with the Catholic Church.
• Listing PalmNFP as Catholic software? The FAQ cites Taking Charge of Your Fertility (an entirely secular resources) and also Couple to Couple League - but warns about the morality content, implying the site owner doesn't necessarily agree with CCL.

Lyrl ^Talk _Contribs 02:24, 17 November 2006 (UTC)

People who go to the organizations previously listed will be taught that sex outside of marriage, use of birth control, and masturbation are immoral. Many people who wish to learn how to use FA will be sexually active and unmarried, or will intend to use condoms or other barrier methods during the fertile period, or will plan to engage in other sex acts during the fertile period, all of which will clash mightily with the Catholic organizations' beliefs and methods. The FA external links section is not an appropriate place to list organizations which preach moral doctrine while educating about women's sexuality and health. FA and NFP are differentiated right at the top of this article, and anyone who seeks more info about NFP itself is free to view that article. If one can verify that an organization teaches a method of FA which does not have the religious content of NFP, they may be listed here. That would uphold the distinction between FA and NFP. The links which are currently in this section are specific to FA, let's keep it that way. Joie de Vivre 22:56, 20 November 2006 (UTC)

If FA teachers were common, I would agree with you. But because so many locations have only NFP teachers (if they have any at all!), I believe they are an important resource for women and couples seeking to learn fertility awareness. I think adult women and couples are perfectly capable of taking an NFP class, learning the scientific information, and ignoring the religious content.

Thank you for your response, and your edit today. I'm going to repeat some of my previous questions, as I still have concerns related to them.

• Did you have an objection to the 1929 "Date first use" in the infobox?
• Did you have a reason for including the website for a single teacher (Katie Singer - Garden Of Fertility) when all other links in that section are to organizations?
• What was the rationale for removing two of the software links (Aware! and Bloodays)?
• Why was FertilityUK deleted? Here it talks about "NHS fertility awareness practitioners" and a "Reproductive Health Consultant & NHS Primary Care Career Scientist" - as NHS is a branch of the UK government, I'm strongly led to believe FertilityUK is run by the UK government. I've never seen anything on their site that links them to the Catholic Church.

Lyrl ^Talk _Contribs 00:41, 21 November 2006 (UTC)

I agree. The UK link specifically talks about FA, where the Billings method page doesn't use the term FA. I would support including the former, but not oppose removing the latter.--Andrew c 01:01, 21 November 2006 (UTC)

No problem, Lyrl. First, my answers:

• Objection to first use: yes, but I'm unprepared to answer this for another few days.
• Single teacher: The other two happen to be organizations, currently there is only one single teacher's web site listed -- feel free to add more.
• Removal Aware!/Bloodays: They are both of very poor quality. In Aware! the GUI doesn't even show a single line to demonstrate the basal body temperature; it shows a series of disconnected dashes. It uses cryptic icons and abbreviations, all the information is visually cramped together and difficult to interpret; it's just badly made. Bloodays: the site consists of a single page, written in broken English. It provides no FA support, it's just merchandise for sale. The calendar claims to provide a "baby gender predictor" -- I can't find any scientific evidence this is even possible. There are many other software options listed, all of which provide higher quality and full customer support.
• FertilityUK reason for removal: I don't remember, I'll add it, pending further research.

In regards to including the Catholic-affiliated NFP institutions, I do not agree that inclusion on this page is merited. If someone wishes to learn about FA from a teacher but is unable to find an FA teacher in their area, they are free to locate NFP teachers and take what they will from them. But we should not assume that people necessarily want a teacher, or that if they do, they are willing to go to NFP teachers. We certainly should not predicate listing of NFP organizations in this section on these assumptions. Many women don't even want to avail themselves of a teacher for such a personal activity; they read about it, learn about it, and teach themselves. A supposed lack of FA teachers does not mean that NFP teaching organizations should be listed as a substitute -- they're still incorrectly categorized. Joie de Vivre 04:03, 21 November 2006 (UTC)

"Methods and characteristics" comments, and "Date first use"

The Two-Day Method was also developed by Catholics. At least, I'm assuming that based on the fact that Georgetown University is a Catholic university. I'm almost certain the sympto-thermo method was also developed by Catholics (all of the researchers at the time that method was developed appear to have been Catholic), and don't have enough information on the temperature methods to form an opinion either way.

What is the rationale for noting which methods were developed by Catholics? I'm not seeing how the origins of a method are relevent in the "methods and characteristics" section (though addition of a history section would be interesting).

I eagerly await your comments on the "Date first use" field of the infobox. Lyrl ^Talk _Contribs 23:11, 21 November 2006 (UTC)

Any update on the "Date first use" discussion?

Also, any response on my question about why Creighton and Billings were singled out in the article for their Catholic origins? I'm leaning towards deleting those statements until someone gets around to doing a "History" section where they would be more appropriate. Lyrl ^Talk _Contribs 19:54, 2 December 2006 (UTC)

None yet, been busy. Comments deleted, it was clunky phrasing anyway. History section is a good idea. Joie de Vivre 22:23, 3 December 2006 (UTC)

BOM, CM, and religious bias

I do not understand why we have to exclude certain methods because they were developed by Catholics. There is nothing about the general term "fertility awareness" that means "anti-religion". We have sources that specifically call these two methods fertility awareness (just do a google search). The fact that we may personally think it is wrong to consider these 'Catholic' methods FA is trumped by our sources. I personally believe there is nothing wrong with mentioning these two methods in this article, and I question the motivation behind removing valid content just because of the religion of the developers of these methods. Do we have any source that specifically says these methods are absolutely not FA (because we have sources saying that they are)?--Andrew c 21:41, 4 December 2006 (UTC)

First, glossary terms for anyone just joining: BOM=Billings Ovulation Method, CM=Creighton Model.

Andrew c, it's not that these methods are "absolutely not FA", it's that they are "absolutely NFP". It's misleading to provide links to the Creighton Model in this section, because they include religious content on their website that is totally irrelevant to the practice of FA. Many women who are unmarried use FA for birth control, yet the CM website expounds on the virtues of their method as helping to 'bond your marriage' - see #11 in this list. Also, not all women who use FA will abstain from sex during the fertile period; many will happily use condoms or barrier/spermicide methods. However, #12 in that same list appeals to users with the claim that their method is "morally acceptable to you and your spouse". This language is explicitly specific to Catholic NFP, and it's likely to be offensive to those who don't share their views.

I don't see any major distinction between the methods used in the CM/BOM and those of any other FA methods; they both seem to be teaching basic concepts of FA that are widely available elsewhere. I don't see there being a good reason why these two methodological organizations should be singled out as the standard, especially but not only because of the religious leanings in the CM's language. These two methods are essentially brand-names for a generic method that is not owned by anyone. I relate it to how people might call a sticky bandage a Band-Aid, that so-called Band-Aid might be a generic version of the same thing. It's the same with FA. There are many other organizations, teachers, and resources that teach the same method, many without involving moral admonitions. It's not appropriate to refer to the CM or the BOM (or any specific brand name) as the standard. Joie de Vivre 22:36, 4 December 2006 (UTC)

I'm not suggesting we refer to them as the standard. Just simply mention in passing their existance. I do not find your reasoning persuasive enough to not include this information. So what if these methods are aimed towards married couples? So what if the creators are Catholic? Just because something may 'offend' a non-Catholic is not a reason (according to any wikipedia policy that I have read) to not include content. It seems like you have a very specific idea of what is or isn't FA, however we have to acknowledge our sources that do not agree with you. I think we have to admit that there is some overlap between the two concepts (NFP and FA). And I believe strongly that wikilinking these two methods in this article can only help, not hurt. Perhaps a good compromise would be to qualify the sentence, something along the lines of: Cervical mucus observation - this method relies on identifying the slippery, stretchy type of mucus produced near and during ovulation. The Billings Ovulation Method and Creighton Model are two examples of such methods, although typically considered forms of natural family planning. I think there are three parts in this issue 1) there is no article on general cervical mucus observation methods 2) the terms FA and NFP are not black and white and 3) I personally find religious motivations not a good enough reason to not include content. I'll reiterate, I feel that linking to these two methods can only help user understanding, and that we can probably qualify the terms to point out that they are also considered NFP methods as well.--Andrew c 22:59, 4 December 2006 (UTC)

I have been an active participant in Ovusoft, a community of women using FA, for three years. I've been practicing the method and avidly reading everything about it I can get my hands on for four years.

Billings method relies very heavily on vaginal sensation. It teaches awareness of vaginal sensation in an in-depth way no other organization does. Many users of Billings never actually look at their cervical mucus, relying entirely on how fertile they 'feel'.

Creighton Model relies very heavily on the visual appearance of cervical mucus. It provides students with large numbers of pictures - many more than any other organization - of every different way cervical mucus appears, so users can always 'match' their mucus with a picture of specified fertility level.

These methods are very different from each other, and also from symto-thermo methods which tend to basically gloss over cervical mucus because they have to spend time teaching about basal temps. Each different type of method has advantages for different types of women and couples. Every secular teacher I am aware of teaches the sympto-thermo method. Removing information on the CM-only methods is censorship and does a disservice to Wikipedia readers.

There are many women in the Ovusoft community who have taken classes from teachers of these two methods, and they all report that the information on cervical mucus is much more helpful than that from teachers of the sympto-thermo method. None of them have ever commented on religious content in the classes. Unlike the Couple to Couple League, these organizations are not in-your-face with their religion.

And even the Couple to Couple League is a great resource for women and couples interested in FA. Its information is very extensively documented, and it extremely thorough - I learned tons from their book that is simply not covered in TCOYF. But I suppose that that book, with information unavailable from any secular source, should also be censored from this article. Lyrl ^Talk _Contribs 00:20, 5 December 2006 (UTC)

As far as the claims of religious content, Taking Charge of Your Fertility, a supposedly secular book, says on p.123 of the Revised (Second) Edition that Ideally, then, the method would be most effective if you only have intercourse when you're infertile. Actually, while it may seem difficult to do, many users of natural birth control feel that this creates a "courtship and honeymoon" effect... By choosing to postpone sex rather than use a barrier method during the fertile phase, people often feel they're living in harmony with their fertility, rather than fighting it.

Hmm. Ms. Weschler is claiming the honeymoon theory, widely used by NFP enthusiasts as the method by which NFP will "bond your marriage". She's promoting abstinence during the fertile period, not only for the secular reason of effectiveness, but also because of the honeymoon effect, and because it's good to "live in harmony with your fertility". Smacks of some kind of new-age religion to me. I think mentions of TCOYF should be included in any ban of religious versions of FA.

Furthermore, while Catholicism is the only religion to allow NFP and nothing else, large numbers of Protestants believe in the sanctity of human life from fertilization, and that possibly abortifacient methods of birth control like hormones and IUDs are immoral (Beginning of pregnancy controversy). In a country (the U.S.) where two-thirds of contracepting couples are on hormones or are sterilized, this pro-life belief can severely reduce the perceived reversible contraceptive options of a couple; FA is one of the remaining methods. That Creighton (a U.S.-based organization) is "morally acceptable" could equally apply to this pro-life group, as to Catholics. Lyrl ^Talk _Contribs 01:29, 6 December 2006 (UTC)

From what you've said, it sounds like the author is reporting anecdotes about what individual users of the system have experienced. "people often feel... etc". That's not religious, that's a feeling that she reports some people as experiencing, with results varying for other users. I don't see any kind of theological system in there. One crucial difference between what she said and what the NFP proponents say is that you didn't mention her as making any claims of her system being more 'moral' or 'correct' than other forms of BC. It's not so much the religious content of the NFP sites that bothers me, as it is the judgemental words and tone they use. Joie de Vivre 19:34, 9 December 2006 (UTC)

My point was that the language on the Creighton website about bonding your marriage was no more religious than the most popular secular book on the subject, and that the contents of the list were not specific to a Catholic POV. Lyrl ^Talk _Contribs 14:55, 10 December 2006 (UTC)

See, now, this is really useful information. I had no idea that Creighton and Billings were so different. You sound knowledgable about the differences; maybe you could include a better description of each one, with a disclaimer that religious content may be included in the classes. Joie de Vivre 19:34, 9 December 2006 (UTC)

I really appreciate your response on this. Much of my information is anecdotal, but this document has some good comparison information (biased, it has a "we (Billings) are better than you (Creighton)" tone, but illistrative nonetheless). Lyrl ^Talk _Contribs 14:55, 10 December 2006 (UTC)

Cervical mucus observation

The current statement in the article: Cervical mucus observation - this method relies on identifying the slippery, stretchy type of mucus produced near and during ovulation.

• Not all women, or all cycles, experience the eggwhite type of cervical mucus. Creamy, watery, and even sticky mucus are equally important observations. The eggwhite type of mucus should not be so heavily emphasized in a description.
• Vaginal sensation is also an important aspect of cervical mucus methods, and should be mentioned equally with the visual observation of the mucus.
• "near and during ovulation" is misleading, for two reasons. First, "near" implies both before and after, while mucus is primarily produced before ovulation - up to seven days before is considered normal. Second, while ovulation happens most frequently on the last day of mucus observation, it frequently happens a couple of days before, or a couple of days after - or even three days before or after (PMID 724176). In the case of ovulation happening a few days after Peak, no mucus is being produced during ovulation.
• Different schools of CM-only methods have very different rules. The Two-Day Method, for example, begins infertility on PK+2, while Billings and Creighton both begin infertility on PK+4. The different emphasis on visual observation of mucus vs. the sensation it causes in the vagina and vulva are also important. Point being, there is more than one kind of CF-only method.

I would prefer either shortening the statement to "Cervical mucus observation", and leaving the description entirely for the "observational methods" section, or having something more along the lines of these methods rely on identifying the cervical mucus and vaginal sensations particular to the several days leading up to ovulation. Lyrl ^Talk _Contribs 01:10, 5 December 2006 (UTC)

Descriptions of various FA methods

Lyrl has mentioned, above, that they are experienced and knowledgeable about the differences between the BOM, CM, and the sympto-thermal methods. If they have time, I want to request that they might create a table which describes the differences between these FA methods. Joie de Vivre 14:05, 27 December 2006 (UTC)

Some of the differences aren't very helpful without longer explanations. The difference between coverlines taught by Toni Weschler and by the Couple to Couple League, for example - Ms. Weschler's rule is in my opinion simpler, but the CCL coverlines (they draw a "lower coverline" (LCL) and a "higher coverline" (HCL)) enable them to have post-o rules that address specific situations left up in the air by Ms. Weschler's method. What specific situations? Then you get into this article being an instruction manual rather than a description.

Even simple descriptions of differences (Billings and Creighton determine infertility at PK+4, Two Day Method determines infertility at PK+2 days) can seem like instructions. Actually texts on FA are hundreds of pages long. Classes typically take six hours. And I'm hesitant to put too much instruction-like material in this article for fear people will misunderstand it, attempt to use it to avoid conception, and end up with an unwanted pregnancy.

I'm unsure if I'm explaning myself intelligently, but I don't currently feel comfortable making such a table. Maybe if someone else with some knowledge on the topic comes around to bounce ideas back and forth, but not by myself. Lyrl ^Talk _Contribs 00:17, 28 December 2006 (UTC)