Re-viewing the Standard Days Method: Eight Perspectives. Archbishop Antonio J. Ledesma, S.J., D.D. Archbishop of Cagayan de Oro

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1 1 Re-viewing the Standard Days Method: Eight Perspectives Archbishop Antonio J. Ledesma, S.J., D.D. Archbishop of Cagayan de Oro As a recently developed method of natural family planning, the Standard Days Method (SDM) has been the subject of much discussion and debate among church circles and lately even among some government agencies. One group favors SDM because it is simple and works and can reach out to many more couples. Others question SDM because for them it is not scientific, is not reliable for women with irregular cycles, and does not involve the daily observation of bodily signs. Still others object to SDM as an NFP method because it includes the use of back-up contraceptives and is promoted by government agencies in this way. In order to weigh and balance all these contentions, it would be helpful to examine eight perspectives on SDM. 1) SDM as a Fertility Awareness-Based (FAB) Method This is the scientific description of SDM as developed by the Institute for Reproductive Health of Georgetown University, and as classified by the World Health Organization in its listing of birth regulation methods. Awareness of a woman s fertility cycle can be determined by various indicators e. g., through basal body temperature, cervical mucus secretions, the start of the menstrual cycle, etc. One of the earliest attempts to predict the fertile period was the calendar rhythm method pioneered separately by Kyusaku Ogino in Japan and Hermann Knaus in Austria in the late 1920s. This was based on the individual woman s recorded observations of her past menstrual cycles. In contrast to this customized calculation of the woman s fertile period which proved to be cumbersome, SDM provides a simplified and standardized formula based on computer simulations of more than 7,000 actual menstrual cycles. This makes it applicable to women with an average menstrual cycle ranging from days. Its effectiveness rate is reported at 95.25%. Approximately four-fifths of all women have this average cycle, which actually allows for variations within a six-day range. 2) SDM as a Natural Family Planning Method Practically speaking, fertility awareness-based methods can be equated with NFP, but with the crucial assumption that abstinence and only abstinence is observed during

2 the fertile period to avoid pregnancy. The option of the couple for abstinence from marital intercourse is seen as part and parcel of any NFP method. The length of the abstinence period varies with each NFP method e. g., 8-9 days for the Billings Ovulation Method, 12 days for SDM, and as long as 17 days (!) on the average for the Basal Body Temperature method. Any NFP method, and not only SDM, it should be noted, could be compromised by the mixing of back-up contraceptives during the period of abstinence. Thus any NFP method, with its estimated duration for abstinence, will entail some sacrifice and discipline from both partners. Every NFP method, moreover, will also have its own manner of calculating the fertile and infertile period e.g., by daily observation and charting of mucus secretions, daily temperature-taking, counting of beads, etc. Any of these methods may or may not appeal to one or both of the spouses. In this light the adoption of a particular NFP method is best left to the judgment of the couple themselves. 3) SDM as an FAB method with back-up contraceptives Some family planning organizations and some government workers have promoted SDM with the suggestion of combining it with a back-up contraceptive method during the abstinence period. Practically speaking, this would mean resorting to the use of condoms (but not pills, which would disrupt the length of the menstrual cycle). IRH-Georgetown, in its own research addressed to westernized readers, states that SDM is a fertility awareness-based method of family planning in which users avoid unprotected intercourse during the fertile period. Apparently, the authors have adopted this double-negative phrase as a technical description to include within the potential scope of SDM even non-nfp adherents. On the other hand, IRH spokespersons have pointed out that this does not preclude faith-based organizations from including SDM in their natural family planning programs by simply advocating for complete abstinence during the fertile period. Indeed the original objective of IRH was to address the need for a simplified NFP method. The fact that the research for developing SDM was funded by USAID does not negate the scientific validity of the method. On the contrary, it manifests the readiness of Georgetown University, the oldest Catholic university in the U.S. and USAID to seek ways to standardize the calendar method for a larger group of potential users, and to meet the requirements of faith-based organizations. 4) SDM as part of an AII-NFP program 2

3 Since the start of their discussions on SDM, Catholic bishops have noted this ambiguity in the adoption of SDM with or without back-up contraceptives. Thus, during the CBCP Plenary Assembly in July 2003, the body passed a consensus vote that SDM without any of the contraceptive component... could be used by a diocese in its program of Natural Family Planning. It was in this light that the Prelature of Ipil baptized SDM and included it in its AII-NFP program. Subsequently, All-NFP carried three connotations: (1) the program included all modern, scientifically-based NFP methods; (2) it would reach out to all barangays and kapilya communities; and (3) it would promote NFP all the way i.e., without any backup contraceptives. As a pastoral approach of the local church, the inclusion of SDM has noticeably quickened the pace of NFP promotion. From the mid-70 s to the turn of the century, the records of family life workers in Ipil indicated a yearly average of only 20 new couple-users of NFP methods. Over the past few years, on the other hand, the numbers have increased by the hundreds, and have now reached more than 2,000 users. After hearing about SDM for the first time, not a few couples have mildly chided our FLA workers by asking, Why only now? In effect, couples have expressed their sentiments that they have a right to information regarding all NFP methods, including simplified ones like SDM. It is in this light that the prelature has considered the inclusion of SDM in an All-NFP program as a pastoral Imperative. In interviews of young couples about to be married, our family life workers have come to realize that most couples today have three felt needs: (1) They want to plan their families e.g., in terms of family size and spacing of births; (2) They prefer natural family planning if they are given enough information about the what, why, and how of NFP; and (3) They want to choose among available NFP methods. Couples appreciate the stance of the local church that they have a choice of any NFP method that best suits their circumstances with the provision that they follow carefully the requirements inherent in the particular method. Included in these requirements is the practice of complete abstinence during the identified fertile period, i.e., if one wishes to avoid pregnancy for the time being. 5) SDM as a pedagogical approach The teaching of natural family planning starts with fertility awareness. However, according to our NFP trainors a considerable number of married persons are not even aware of the fertility cycle of the woman s body. Although the determination of the days when a woman is fertile or not fertile has been fine-tuned by the daily recording of body 3

4 temperature levels or cervical mucus secretions, this may have only added to the difficulty of many couples in comprehending the natural rhythm of the human body. As a simplified method, SDM has been more readily understood by first-time adopters of NFP. With the visual use of colored beads as a pedagogical tool, SDM has also become eye-catching, and even a subject of jokes an effective way of communicating with regard to culturally-sensitive matters. Starting from the simple to the complex has been a cardinal principle of teaching from kindergarten pupils to adult couples. From the experiences of our NFP trainors, SDM as a first step has enabled them to explain more readily the other NFP methods like the Basal Body Temperature (BBT) method or the Billings Ovulation Method (BOM). On the other hand, if SDM is presented last, it enables the trainors to summarize concisely all the various methods as ultimately based on fertility awareness. One trainor has remarked that it takes her only five minutes to explain SDM, in contrast to the five hours needed to explain BOM. With this in mind, several couples have started to combine NFP methods one to serve as a back-up to the other. It is not unusual to hear from couples that they have moved from SDM to BOM or vice-versa, while retaining the earlier method as a countercheck. In the same way that the Sympto-Thermal method (STM) combines the temperature and mucus methods, some couples are now beginning to adopt an SDMmucus method. Ultimately, our NFP counselors are finding out that the inclusion of BOM in an All-NFP program is a win-win solution. It reaches out to more NFP adopters by increasing SDM users as well as more users of BOM and other NFP methods. Our current All-NFP programs have recorded a marked increase of BOM users compared to the earlier numbers when BOM alone was being promoted. The competition is not between SDM and BOM. Rather the choice for many couples is either: SDM or contraceptives; SDM or no NFP method at all; or, worse still, SDM or abortion. Excluding SDM from an NFP program would result in a loss-loss situation for potential NFP users and for the local church s ministry for family and life. During the ad limina visit of the Mindanao bishops to Rome last February 2011, I presented to the Holy Father in a private audience our trainors manual for All-NFP along with a reader on NFP and SDM. I mentioned to him our inclusion of simplified methods like SDM. Pope Benedict s immediate remark echoed the pedagogical approach we have adopted: Yes, simplified methods are good for simple people. 4

5 A week later, his Assistant Secretary of State, Abp. Fernando Filoni, wrote to me conveying the pope s message: The Holy Father has asked me to thank you for the Natural Family Planning manuals which you gave to him. He appreciates the sentiments which prompted this gesture. His Holiness prays that you will be sustained in your episcopal ministry and filled with grace and peace. 6) SDM as part of the government s NFP program During the last quarter of 2006, the Director of the Commission on Population and the Secretary of the Department of Health approached the CBCP Permanent Council regarding the possibility of church-government collaboration on natural family planning for the country. From the side of government, this was a response to a directive from President Gloria M. Arroyo to promote only natural family planning a preference she had enunciated since the start of her administration. Since then, POPCOM has launched its nationwide Responsible Parenting Movement that includes values formation modules that approximate the Church s outlook on personhood, human sexuality and responsible parenthood. DOH on its part has now recognized SDM as an NFP method. Under the previous DOH administration, SDM was considered only an adjunct NFP method that was still considered experimental. Church leaders responses to the overtures from the executive branch of government have, on the one hand, been praiseworthy of the NFP direction being charted, but noncommittal in terms of collaboration. This hesitation is partly explained by the historical context. Older family life workers recall that in the early 70 s, church and government joined forces to promote NFP. Government and USAID funding helped support NFP training seminars for church workers. The earlier-known temperature and Billings mucus methods were at that time being propagated. By the mid-70 s however, church leaders decided to cut off the collaboration because of the introduction of contraceptive methods, with major support coming from foreign funding organizations. Throughout the 80 s and 90 s, dioceses on their own continued their efforts at NFP promotion. Perhaps, the most notable among these was the series of inter-diocesan summer workshops on family life values and NFP promotion conducted in Camp Phillips, Bukidnon, by Fr. Vicente San Juan, S.J., and his team from the Episcopal Commission on Family and Life. On the whole, however, based on national surveys, NFP has so far barely reached one percent of married couples of reproductive age. It is this enormous need and challenge that confronts both government and church groups if they wish to promote NFP separately or in collaboration with each other. 5

6 The availability of simplified NFP methods like SDM and, more recently, the Two-Day Method (TDM), can be the crucial factor in mainstreaming NFP in Philippine society. On the other hand, there is also need for the church s values formation to ensure that NFP methods, including SDM, are not mixed with back-up contraceptives. When SDM was first introduced in the Philippines in the early 2000 s, it was the Prelature of lpil that first included it in its NFP program, long before the local government agencies took cognizance of it. It is this pastoral experience spanning more than nine years now that has made the All-NFP program in Ipil credible to government officials and, ironically, incredible to some church observers. Meanwhile, in the Archdiocese of Cagayan de Oro, the local governments of the city and the two provinces of Misamis Oriental and Camiguin have asked for our training manuals and seminars on All-NFP. In response, we have positively engaged with them by teaching and sharing our modules on NFP, including values formation as an integral part. Consequently, over the past three years, these LGUs have issued executive decrees with budgets to promote solely All-NFP. They have also invited our NFP trainors to help monitor and evaluate their NFP programs, which include the teaching of SDM without back-up contraceptives. WhiIe keeping our own NFP program separate as a church ministry, these LGU s have given the example that government agencies do not necessarily mix NFP methods with back-up contraceptives and that information on NFP can be mainstreamed and reach many more couples through their barangay health workers. 7) SDM in actual church programs The All-NFP program in Ipil Prelature (now a diocese) was started in mid-2002 and has covered 20 of its 21 parishes, with resident NFP providers in more than half of all the chapel communities. Upon my transfer to Cagayan de Oro Archdiocese, a similar program was introduced since August 2006 in nine pilot parishes. After a year of piloting with encouraging results, the program has been opened to other interested parishes and now extends to four-fifths of the archdiocese s 60 parishes and chaplaincies. As these pastoral programs continue in both areas, it would be good to clarify some disinformation being spread around about the All-NFP program being carried out by our family life workers: 1. We do not promote SDM only. Rather, we present all NFP methods and let the couples decide, according to their circumstances and preference. 6

7 2. We do not include back-up contraceptives with the use of SDM. Throughout the training, we stress that complete abstinence during the fertile period is integral to the meaning of natural family planning. 3. We do not find SDM ineffective. SDM is the most widely accepted by couples in our semi-annual reports, ranging from 40 to 60%. There have been reports of couple failures i.e., by couples not following the SDM protocol. But, surprisingly, our NFP counselors have not received any report of method failure i.e., due to the method itself. 4. We do not present information on artificial contraceptives. On the contrary, we point out the health risks of contraceptives principally through the sharing among participants about their current family planning methods. 5. We do not receive any USAID funding for our NFP promotion. We have received rather some assistance from individual donors and church- related support agencies, like Misereor and Catholic Relief Services, for the training seminars and lec materials. But the bulk of NFP promotion is done by hundreds of volunteer counselors who reside in chapel communities. 6. We do not force parishes to join the AII-NFP program. We start with orientation talks for all the clergy and diocesan family life workers. Then we wait for invitations from individual parishes to start a six-step implementation plan for the All-NFP program to reach out to as many of the chapel communities as possible. As with the whole NFP program itself, we find that the principle of attraction, rather than condemnation, has gained more solid adherents to the program. The archdiocese has also gone beyond its parishes to pilot All-NFP in three other areas involving Muslim, indigenous people, and Iglesia Filipina Independiente communities. The feedback from these communities has been very appreciative. 8) Bishops consensus statements on SDM and All-NFP On January 21, 2009, at the end of the bishops seminar on peace-building at Pius XII Catholic Center in Manila, Archbishop Angel Lagdameo, CBCP President, convened a dialogue meeting on Natural Family Planning and the Standard Days Method. The dialogue was opened to all the bishops. Twenty-nine bishops attended or roughly half of all those who had just finished the peace-building seminar. These included Archbishop Lagdameo and bishop members of the Episcopal Commission on Family and Life. Bishop Gabriel Reyes of the Commission on the Laity facilitated the dialogue. The dialogue group first listened to the impressions of bishops whose dioceses were already including SDM in their NFP program i.e., Cagayan de Oro, lpil, lsabela (Basilan), 7

8 Job, Digos, and Cotabato. In general, the bishops did not find anything objectionable with SDM being included as an added option in the local church s NFP program, except that there might be need for more training and monitoring. The group then listened to objections and reservations brought up against SDM as an NFP method e.g., that it was not natural and appeared too mechanical with the use of beads; that the information on the internet included the use of back-up contraceptives; that it was as ineffective as the old calendar rhythm method. The third part of the dialogue consisted of a general discussion and clarifications that led towards the formulation of the consensus statement. At the CBCP Plenary Assembly three days later on Jan. 24, the consensus statement was included in the report of Archbishop Paciano Aniceto, ECFL Chairman. The consensus statement was drafted and read by Bishop Reyes. This was distributed to all the bishops. After some discussion on the floor of the assembly, this consensus statement was affirmed and left unchanged by the body. This is now part of the minutes of the CBCP Plenary Assembly. As I review the consensus statement, three salient points can be noted: 1) Recalling their earlier consensus vote in July 2003, the bishops merely reiterated their view that SDM in itself, without mixing with contraceptives, is consistent with the moral teaching of the Church. 2) The statement asserts the responsibility of each bishop to decide whether or not to include SDM in his diocese s pastoral program at the present time. 3) On the other hand, it also asserts the right of a couple in any diocese to adopt SDM as an NFP method. Pope John XXIII s statement aptly describes the spirit of the bishops dialogue and consensus statement: In whatever is necessary, unity; in whatever is doubtful, liberty; in everything, charity. More recently, on July 9, 2011, at the start of the CBCP Plenary Assembly, Archbishop Aniceto as Chairman of the Episcopal Commission on Family and Life and I were requested by our brother bishops to prepare a joint statement on SDM and NFP. This proposal arose from the floor of the Assembly to summarize the results of a consultation attended by 33 bishops two days earlier and to articulate the current stand of the bishops in terms of providing a positive alternative to the Reproductive Health Bill. It was also meant to dispel any further doubts about the inclusion of SDM in a church-sponsored program for NFP. (Perspectives 4, 7, and 8). The full text of this joint statement is presented in Appendix A. 8

9 9 Meanwhile, it is good to keep in mind that Catholic dioceses and church-based organizations in other countries have started to include SDM in their ongoing NFP programs. Among these are India, Honduras, Rwanda, Zambia, East Timor, etc. Concluding Remarks After examining these eight perspectives on SDM, particularly the bishops consensus statements, NFP advocates may find themselves in the same posture as the man who holds a tiny bird in his hand and asks his audience, Is the bird dead or alive? SDM is that bird which we can either allow to fly as a new NFP method or crush to death. Ultimately, we can ask ourselves the same question that the late Fr. San Juan raised when asked about SDM: Does it help the couple or not? It is in this light that we can make four calls with regard to the SDM issue: (a) A call for self-examination by first asking ourselves how effective our present NFP programs are in reaching out to actual users; (b) a call for openness on the part of the clergy and family life workers to the possibilities of new NFP methods; (c) a call for dialogue, not debate, among those for and against particular perspectives on SDM; learning to listen and respect contrasting views can be the characteristics of a church in via; and (d) a call for actual observation or testing in a pilot parish or diocese. Talking and listening to actual users of SDM and other NFP methods can give us a more realistic assessment of the eight perspectives. In this regard, let me reiterate an open invitation for any interested and serious observer of NFP programs to attend our training seminars or to visit our pilot parishes in the local churches of Cagayan de Oro and Ipil. Seeing for one s self should be the first step before judging and acting. Likewise, over the past three years, more than 20 dioceses in Mindanao, Luzon, and the Visayas have undergone training seminars on All-NFP and started their own programs. With the inclusion of SDM as an added option in the NFP programs that are said to be already ongoing in all other dioceses, the Church in the Philippines can indeed present a united and positive alternative to the RH Bill. Then perhaps we can become the first country in the world to truly promote a widespread Culture of Natural Family Planning that is integral to a Culture of Life.

10 10 Appendix A: All-Natural Family Planning as a Pastoral Imperative 11 July 2011 Dear Brother Bishops, Family Life Coordinators, and Pro-Life Advocates, ln our CBCP Pastoral Letter of 30 January 2011, we expressed our rejection of the Reproductive Health Bill because of its promotion of artificial methods of family planning. On the other hand, we also said that we are pro-life and for the responsible and natural regulation of births through Natural Family Planning. Hence, the active and widespread promotion of NFP becomes a pastoral imperative for all our dioceses. Several dioceses have started to implement a serious and systematic program on NFP. In particular, the Archdiocese of Cagayan de Oro over the past five years has implemented an All-NFP program. This All-NFP program has three meanings: (1) We teach all modern, scientific methods of NFP, including the Billings Ovulation Method (BOM), and the Standard Days Method (SDM); (2) We reach out to all parishes and kapilya communities through volunteer resident NFP counselors; and (3) We promote NFP all the way i.e., without back-up contraceptives. Despite the evidence-based results achieved by the program (e.g., there are now more than 4,500 NFP couple-users as of June 2011), we still hear some disturbing reports about some individuals claiming to be the diocesan coordinators of the Family Life Apostolate or representing the Episcopal Commission on Family and Life. They allege that SDM has not been approved by CBCP and that the Archdiocese of Cagayan de Oro promotes SDM with back-up contraceptives. It is in this light that we wish to reiterate the Consensus Statement that we bishops made in January 2009: (1) The Standards Days Method, provided it is not mixed with contraceptives, is a natural family planning method and is consistent with the moral teaching of the Catholic Church. This was earlier affirmed by Cardinal Alfonso Trujillo of the Pontifical Council on the Family during the bishops ad limina visit in (2) While acknowledging the individual bishop s pastoral discernment to promote SDM or not in his diocese, he may not prohibit any couple in his diocese from using SDM as their method of natural family planning. (As Archbishop of Cagayan de Oro, let me state categorically that our All-NFP program has never included back-up contraceptives. Neither have we promoted only SDM, but have rather included six modern NFP methods. We have also not received any USAID

11 funding, but have depended mostly on local resources and a two-year grant from Catholic Relief Services. Abp. Aniceto has visited our NFP pilot sites in 2008 and listened to actual testimonies from appreciative NFP users.) We appeal to all our brother bishops, family life coordinators, ECFL members and prolife advocates to heed the Consensus Statement of CBCP on SDM. By eliminating the traces of in-fighting among NFP advocates, we can present a united and positive alternative to the RH Bill. Looking ahead, Hapag-Asa, the supplemental feeding program of Assisi Foundation, as well as Caritas-Manila, have both organized All-NFP training seminars for their workers and have started to integrate NFP in their existing social action programs. Likewise, the Catholic Women s League national board has offered the services of their diocesan chapters in helping promote All-NFP in their areas of responsibility. All they need is the gosignal of the local bishop. In a consultation meeting on NFP among bishops on 7 July 2011, Cardinal Gaudencio Rosales of Manila, Ambassador Howard Dee of Assisi Foundation, and Dr. Zenaida Rotea of the Catholic Women s League expressed their full support for the widespread promotion of All-Natural Family Planning. On the part of the Archdiocese of the Cagayan de Oro, we are ready to share our All-NFP training seminars and manuals with any interested diocese. Sincerely in the Holy Family, 11 +Abp. Antonio J. Ledesma, S.J., D.D. (sgd.) Archdiocese of Cagayan de Oro +Abp. Paciano B. Aniceto, D.D. (sgd.) Chair, Episcopal Commission on Family and Life Archdiocese of Cagayan de Oro Archbishop s Residence Fernandez St., Brgy. 1 P.O. Box Cagayan de Oro City Tel. No: (088) Fax No: (08822) acdo_chancery@yahoo.com