Tuesday, January 8, 2002.
By Colleen Carroll
Of The Post-Dispatch

NATURE'S COURSE

* Natural Family Planning is gaining in popularity. Couples are finding that it not only works but puts them in harmony with fertility cycles and each other.

Debbie Muckler, 29, always assumed she would take the birth control pill when she married. Then she and her fiance heard about Natural Family Planning when they attended a marriage preparation class for Catholic couples.

"We really associated it with the rhythm method," Muckler said, referring to the calendar-based method that is notoriously unreliable because it can fail to account for irregularity in a woman's ovulation cycles. NFP, as it is known, purports to use scientific precision to read a woman's body signals and predict her fertility.

The more the Mucklers learned about NFP, the more they were convinced it would work for them. Five years later, the Ferguson couple have two children and pronounce the method "100 percent effective." They used NFP to avoid pregnancy in the early years of their marriage, then used it to plan their two pregnancies.

They're not alone; the number of people who use NFP is growing in St. Louis and nationwide.

Diane Daly oversees area NFP classes for the Archdiocese of St. Louis. She has seen the number of program participants -- which include non-Catholics -- grow by 23 percent from 1998 to 2000, and 247 new couples signed up in 2001. When couples who came back for refresher courses were included, last year's tally jumped to 605 couples.

Supporters praise NFP as a family planning method that is cheap, natural and free of side effects. Most are Catholics who want to observe the Catholic Church's prohibition on artificial birth control. But people outside the Catholic faith also are embracing the method because it works in harmony with their natural fertility cycles.

The number of NFP users is still minuscule when compared with other birth control methods.

The National Center for Health Statistics estimates that only 1.6 percent of American women of childbearing age use some form of periodic abstinence, and even fewer - 0.2 percent - use NFP. Among the reasons for the low numbers:

* NFP fails to protect against sexually transmitted diseases, making it an unlikely choice for women who have multiple sexual partners.

* Couples using NFP must diligently track the woman's ovulation cycle, communicate often about the possibility of pregnancy and abstain from sex during fertile times.

NFP advocates say the greatest obstacle to use is lack of awareness - something that is starting to change because of information available on the Internet and proselytizing NFP users.

"This is really such a well-kept secret," Daly said. "I think women are looking for alternatives." Daly also credits increased publicity and physician awareness for the rise in NFP interest here.

The search for an alternative - and a billboard on Interstate 170 - led Wanda Sams of St. Louis to an Natural Family Planning program last year. Sams, 39, and her husband had tried for nine years to conceive before she became pregnant with her son, now 4 months old. Sams underwent surgery for scar tissue and used NFP to avoid in-vitro fertilization. She conceived naturally. Since her pregnancy, she has continued to use the method.

"It was a calming feeling," said Sams, a Baptist who eschews artificial contraception out of health concerns, not moral qualms. "The natural aspect appeals."

Using NFP, a woman monitors observable changes in her body - such as fluctuating temperature, for example - to find out when she is fertile. On fertile days, she and her partner must decide to avoid or engage in sexual intercourse, depending on whether they want to try to conceive.

Many NFP couples say that sexual abstinence takes them back to former patterns of courtship, and forces them to communicate differently.

"The abstinence has actually been a huge benefit to our relationship," said NFP user Brian Niebrugge, 29, of Maplewood. "It ignites a passion and an appreciation of one another in a way that wouldn't necessarily be there otherwise."

In three years of marriage, Niebrugge and his wife have used NFP successfully to avoid pregnancy. Soon they plan to use the method to conceive. Like many NFP users, Niebrugge credits the method with bringing him closer to God and to his wife, because it has given him a fuller understanding of human fertility.

"That has brought into our lives this love for life and also for children," Niebrugge said. "It just feels like it fits to have children. I am excited about it."

Many NFP couples have large families - a fact that critics say proves the method's high failure rate. Clinical studies have shown modern NFP posting effectiveness rates of better than 99 percent when used perfectly, but human error - and risk-taking by amorous couples who ignore signs that they should abstain from sex - can significantly lower the odds of avoiding pregnancy.

Mary Kogut, director of health services for Planned Parenthood of the St. Louis region, said NFP was perfect for couples who have a strong, monogamous relationship, good communication skills and the dedication it takes to chart fertility and to abstain when necessary.

"But for those who would find pregnancy to be very frightening, they tend to use a method that has a higher success rate," Kogut said. She said Planned Parenthood refers NFP clients who want more information about fertility awareness methods to NFP programs. "This is just not a method that is sought after by the vast majority of our clients," she said.

Nor does NFP get much attention from doctors. Physicians often use aspects of NFP to gauge a woman's fertile times and aid conception. But few encourage their patients to use NFP as a primary method of family planning.

Dr. Michael Dixon, a family physician in south St. Louis County, is an exception. He eschews artificial methods of contraception in favor of NFP only. He said his interest in natural methods sprang from a combination of religious conviction and medical research.

"It really makes sense to me," said Dixon, a Catholic who first received NFP training in 1979. While religious people tend to be attracted to methods that respect a woman's natural fertility cycle, Dixon said, "NFP really transcends religion. It's simply, overall, a very healthy way to approach one's body."