Two different forms of NFP.  Couples need to know that there are two distinctly different forms of natural family planning—ecological breastfeeding and systematic NFP.   

Ecological Breastfeeding (EBF) is the world’s oldest form of natural baby spacing.  It’s the form of nursing in which 1) the mother fulfills her baby’s needs for frequent suckling and her full-time presence and 2) in which the child’s frequent suckling postpones the return of the mother’s fertility.  Ecological breastfeeding is further defined by the Seven Standards of Ecological Breastfeeding; these are maternal behaviors that assure mother-baby togetherness and frequent suckling.  Research-based evidence shows that mothers who follow these norms will experience an average of 14 to 15 months of breastfeeding infertility. 
        Ecological breastfeeding forms an integral part of the information couples deserve to know, and NFP International is currently the only American organization that teaches it as a form of NFP.     

The second form of natural family planning is Systematic NFP.  That refers to all those systems that are designed to determine the fertile and infertile times of the fertility-menstrual cycle.  Systems that teach all the common symptoms such as cervical mucus, waking body temperatures, and physical changes in the cervix are variations of the Sympto-Thermal Method, sometimes called the Cross-Check Method.  Systems that teach essentially only the cervical mucus sign are called variations of the Ovulation Method.  Some systems teach only variations of the original Calendar Rhythm first developed in the 1930s. Some systems also use high-tech tools to estimate the time of ovulation.  These are expensive and are not necessary in the use of NFP.  
        We believe that couples deserve to know all the common signs of fertility and infertility, and that’s why we teach the Sympto-Thermal version of systematic NFP. Only by learning how the common signs work together in a cross-checking way can couples make an adequately informed choice among the morally acceptable systems.

Estimating the date of childbirth.  The single best way to estimate the “due date” uses the temperature pattern associated with ovulation.  It does not require medical tests and expenses.  It is available to all those (but only those) who use the temperature sign.
        We believe that every couple deserves to know this due-date information.  Everyone concerned with reducing the cost of health care should be teaching this.

Motivation.  There are a number of reasons that lead couples to choose natural family planning.  Health.  Avoidance of risks of hormonal birth control.  Low cost and effectiveness.  Morality.  Faith.  All these reasons should be taught in an NFP course. 

John F. Kippley
Sex and the Marriage Covenant
www.NFPandmore.org

Inquirers have asked us to state the substantive differences between what is taught by Natural Family Planning International and what is currently taught by the Couple to Couple League International.  The differences are clear. 

Background.  We founded both organizations—CCL in 1971 and NFPI in 2004.  We brought to the League in 1971 three charisms or perspectives.  This became known as the Triple Strand approach to teaching NFP.
 1.  We taught ecological breastfeeding as a form of NFP.   
 2.  We taught the biblically based covenant theology of sexuality as a way to support Humanae Vitae and to explain the meaning of the marriage act.  This concept can be stated in 17 words.  “Sexual intercourse is intended by God to be at least implicitly a renewal of the marriage covenant.”  This concept easily lends itself to consideration of what is involved when man and wife enter into that covenant.
 3.  We were open to all the signs of fertility and developed different rules for different situations. 
    We directed and guided the League for 32 years.  In late 2003 a separation occurred.  In 2004 the new CCLI management decided to terminate its international activities in languages other than English and Spanish.  Later in 2004 we formed NFP International to support what we had previously started in other European languages and to keep our traditional Triple Strand program alive and well via the internet.  In 2005 we opened the NFPI Website, www.NFPandmore.org, and published our online manual titled Natural Family Planning. 
 
Changes.  In December, 2007 CCL announced significant changes to the traditional program.  CCL titled its announcement an EXTREME MAKEOVER, and the title reflected the changes it made.
 
1.  CCL dropped the teaching of ecological breastfeeding as a form of natural family planning. 
   On the contrary, we continue to believe that that eco-breastfeeding definitely IS a form of natural family planning.  We believe that it is God’s own plan for spacing babies and therefore the world’s oldest form of NFP.  We further believe that couples deserve to learn about breastfeeding not only as part of God’s plan for healthy babies and mothers but also as part of his plan for baby care and natural baby spacing.
    We know from scientific studies that eco-breastfeeding DOES space babies IF mothers follow the natural mothering pattern first described in Breastfeeding and Natural Child Spacing: The Ecology of Natural Mothering.  We also know that there are misunderstandings about breastfeeding’s influence on baby spacing.  Therefore we are doing what we can to provide the proper information and practical help.
 a.  The preceding book (classic 1974 Harper & Row edition) has been republished (Lulu, 2008, quality paperback).
 b.  To help mothers better understand more clearly the baby-care behaviors usually necessary to experience breastfeeding’s natural infertility, Sheila has also written The Seven Standards of Ecological Breastfeeding: The Frequency Factor (Lulu, 2008). 
 c.  In our NFP manual, Natural Family Planning, a chapter is devoted to ecological breastfeeding, and we teach this material in the NFPI three-meeting course.  

2.  In its “extreme makeover,” CCL dropped the covenant theology of sexuality stated above.  CCL has replaced this with an interpretation of the “Theology of the Body” (TOB) developed by Pope John Paul II between 1979 and 1984.  
    The papal TOB is widely praised and rightly so, but experts recognize that it is huge and difficult to understand.  Our experience is that because the TOB covers so much, it needs careful definition.  Further, unless you are reading the entire Theology of the Body and/or are taking a good course on it, what you hear or learn is someone’s interpretation, not the TOB itself.
    We are pleased to note that when the Pope in 1994 was addressing the laity about the meaning of the marriage act, he incorporated the idea that it ought to be a renewal of the marriage covenant.  “In the conjugal act, husband and wife are called to confirm in a responsible way the mutual gift of self which they have made to each other in the marriage covenant” (Letter to Families, n.12).
    Our experience is that couples can grasp and understand this basic concept almost intuitively once they hear it.  Therefore, we continue to believe that covenant theology of sexuality provides a succinct and very workable way to support and explain the teaching of Humanae Vitae.

3.  In its “extreme makeover,” CCL dropped the concept of having different rules for different situations.  It has replaced this with what they call a single rule, but its modifications for different situations effectively make it into three rules. 
    We continue to think it is useful to have different rules for different situations. 

4.  Also included in its “extreme makeover” is a different perspective about how to convey the teaching of the Church regarding the proper use of natural family planning.  Humanae Vitae uses “serious reasons” in section 10 and “just causes” in section 16 to describe the qualifying reasons for the morally good use of NFP. 
    The CCL Student Guide mentions only “just reasons.” 
    In NFPI we use the phrase “sufficiently serious reasons,” as we have done for many years, to convey the meaning of both of these sections of Humanae Vitae. 

Cost: The CCL 3-meeting course costs $135.00.  The NFPI 3-meeting course suggested donation is anywhere from $45 to $85–depending on what the teaching couple decides to offer by way of books in addition to the Natural Family Planning manual used at the NFPI classes.  Our pastor wanted us to charge at least $100 or $125 for the classes because that was the cost for other marriage preparation programs in our area.  Sheila didn’t feel right about that amount.  The pastor, Sheila and I settled on $70.00.  At our classes, Sheila and I give each attending couple the NFPI manual, and the BD digital thermometer. 
For further details, see our postings in various categories of blogs (upper right corner of website).

John F. Kippley
Sex and the Marriage Covenant: A Basis for Morality
www.nfpandmore.org

In the stated effort to simplify the teaching, the learning, and the use of the NFP method to be taught by the Couple to Couple League, its current management has dropped some of CCL’s traditional rules in favor of what they now call one rule. I challenge that description because it looks like three rules to me. In my last blog I told why I think it is a mistake to abandon the sympto-thermal Rule K as an excellent way to determine the start of Phase Three, postovulation infertility. In this commentary, I want to address the possible abandonment of Rule B and Rule C as well as the concept of one rule for several situations.

Rule C

The “C” in Rule C stood for Cautious and Conservative. For most couples it was excessively conservative. As we stated in the Fourth Edition of The Art of Natural Family Planning, Rule C “requires BOTH three consecutive days of full thermal shift AND four days of drying-up.” I don’t know if it added anything by way of effectiveness to the other sympto-thermal rules, but it was an option that probably gave added confidence to couples with a very serious need to avoid pregnancy. A 3-day full thermal shift crosschecking four days of drying up presents a visually strong indication of postovulation infertility to anyone who is adequately informed.

Rule B

The “B” in Rule B stood for “Billings” in honor of his work, but it was a sympto-thermal rule. That meant that we wanted a sufficient temperature cross-check on the four days of drying-up. At first glance it appears that one of the rules or options in CCL’s new system is identical to Rule B, but that’s not the case. According to what we have heard, the temperature requirement in Rule B is stronger than the option in CCL’s new system.

Dr. Josef Roetzer

The management and staff at CCL claim that their new system is based on that of Dr. Josef Roetzer. That seems to be true. They also claim that the new system has only one rule and that it is therefore easier to teach, understand and use. I have not seen Dr. Roetzer making such claims. I admire his work that started in the Fifties and has continued into the present time. In Austria and Germany he has faced difficulties that may well be worse than what we have faced in the States. We are indebted to him and are grateful for whatever progress he has made in Europe and in the States as well.

One rule or three rules?

As I understand it, the basic Roetzer postovulation rule is a 3 + 3 rule: Phase Three starts on the evening of Peak-plus-3 crosschecked by three days of thermal shift, all above the low temperature level (LTL) with the last one at the High Temperature Level (HTL). That’s the basis for the Rule R (for Roetzer) we wrote into The Art of Natural Family Planning many years ago. Call that Rule One.

The confusion or contention starts when the pattern doesn’t meet both of those criteria. As I understand it from listening to CCL recordings, the Roetzer system has two more options.

In one of them, if the temps are above the LTL but not at the HTL, three days of a closed (not just closing) and firm cervix confirm the three days of drying-up and slightly elevated temps. Call that Rule Two.

A third alternative is used when Rule Two does not apply. In this alternative, once again Peak Day plus 3 is not confirmed by an adequate temperature rise. In this third situation, you wait until Peak Day plus 4. If on P + 4 there are four days of temps above the LTL by any amount, you can consider the evening of P + 4 the start of Phase Three. Again, that means that if on Peak + 4 you have four temps that are only one-tenth of one degree F above the LTL, you could apply this rule. Call that Rule Three.

The need to make distinctions

My concerns are twofold. One has to do with merchandising, the other with methodology.

When Dr. Prem and Sheila and I were the dominant influences at CCL, we made distinctions. When two situations were clearly different from one another, we gave them two different names. It seems to me that in the options above, there are three different situations. I am not at all persuaded that clarity is well served by saying they are all examples of the same rule but just different adaptations. In short, the “one-rule” language looks to me like mere merchandising. In the old CCL we had four sympto-thermal Phase Three rules that were clearly distinguished on the basis of the strength of the temperature pattern and the days of drying-up. We now call this the Kippley-Prem system to distinguish it from whatever CCL is doing or will do. In the K-P method or system, When the temperature pattern is very strong, fewer days of drying-up are needed as a crosscheck. We give these four situations four different labels to distinguish between them. I can still recall one of my college philosophy teachers telling us repeatedly, “bene docuit qui bene distinguit” — “he teaches well who distinguishes well.”

Thus I find it confusing to recognize three different situations and then to group them together and call it just one rule. This has nothing to do with the merits of any of the three rules, just the terminology.

My concern about methodology is illustrated by Figure 14.6 in the Fourth Edition of The Art of Natural Family Planning. It is an unplanned pregnancy chart that is confused by the fact that the couple did not follow the rules at either end of the fertile time. That is, the couple apparently ignored four of the standard Phase One practices, but they still stopped marital relations once the wife began recording mucus. The last marriage act in Phase One was on Day 8, mucus recording started on Day 9, and Peak Day was Day 12. On Days 14,15, and 16, the temperatures were all two-tenths of one degree F. above the LTL. Day 16 was Peak + 4 cross-checked by three days of temps above the LTL, but no temp had reached the HTL. The couple engaged in the marriage act on Day 16. They became pregnant. Did the pregnancy result from the marriage act on Day 8 or on Day 16? We simply do not know. Researchers have told us that ovulation sometimes occurs as early as Peak Day minus 3 and as late as Peak Day plus 3. Pregnancy could have resulted from the marriage act on Day 8 or Day 16 without taking any sort of small miracle to explain it.

The couple who submitted the chart in Fig. 14.6 knew that in their previous cycles the temperature shift was a clear four-tenths to six-tenths of one degree F above the LTL. They knew the temperature pattern by Day 16 was not like their previous experience, but they were not motivated to avoid pregnancy.

Rule B and Dr. Roetzer

In this case, the CCL Rule B would require them to wait two more days for a temperature reading at the HTL. We are told that Dr. Roetzer has had excellent experience with the rule calling for P + 4 crosschecked by a minimal rise in temps, but I have not seen any research published on it. I am also told that Dr. Roetzer tells couples to interpret the current cycle in terms of their previous cycle experience. If that were followed here, the couple would have waited two more days. So, the rule may not be so simple as it appears at first. Maybe the rule really is that you can use P + 4 with a mininimal rise in temps IF you have established from previous cycles that this is your common pattern. I would have no problem with that, and we addressed that situation in Figure 5.5 of the Fourth Edition of The Art of Natural Family Planning. So we will have to wait to see if CCL attaches the same qualifier that Dr. Roetzer apparently uses. (By the way, in the text for Figure 5.5 we note that we have never seen a shift of only two-tenths of one degree F above the LTL. That means a sustained thermal shift of the kind used for making decisions. Of course we have seen partial shifts on the way up to the high temperature level.)

Abandonment of Rule B and other CCL rules

And if that is the case, what sense is there in abandoning Rule B? If we understand what CCL is doing with its allegedly simplified, streamlined system (to use their marketing adjectives) it’s much ado about nothing or a lot of fuss over having less. It appears that CCL teachers are being asked to accept the loss of Rule C, the loss of Rule B, and the loss of Rule K with their clear distinctions. In return they are being asked to accept a basic rule that is essentially Rule R, another rule that is something like Rule B but lacks its high temperature requirement, another rule that accepts a low temp rise when there are three days of closed cervix to crosscheck the days of drying-up, and to call all of these a streamlined one-rule sytem.

The Kippley-Prem system

Our friends in the Czech Republic and Slovakia have been “competing” with the Roetzer system for some years. They have great respect for Dr. Roetzer and his teachers, but they have not been persuaded to adopt that system. They intend to keep what we now call the Kippley-Prem system. They are aware of a situation where some CCL-trained teachers were retrained in the Roetzer system and then wanted to return to the Kippley-Prem system. In our friends’ experience, couples who are acquainted with both systems are very happy with the clear distinctions and rules in the K-P system.

John F. Kippley
Author, Sex and the Marriage Covenant: A Basis for Morality (Ignatius, 2005)
Natural Family Planning: The Question-Answer Book, a short, free, downloadable e-book available at the home page of www.NFPandmore.org.