The All Natural FP Reference Guide

The Department of Health
Republic of the Philippines
All Natural
The
Family Planning
Reference
Guide
Table of Contents
A Natural Family Planning Training Design for Service Providers v

Acknowledgements vi
General and Specific Objectives viii
Methodology ix
How to Use this Training Guide xi
Training Flow xii
Introduction to the Course xiv
The Competency-Based Approach to Training xvi
MODULE 1: Responsible Parenthood 1

Frequently Asked Questions 6
Supplemental Reading 7
MODULE 2: Fertility Awareness 9

Teaching and Evaluation Guide 28
MODULE 3: Basal Body Temperature 31

BBT Charts 41
MODULE 4: Mucus Method 53

MM Charts 66
Autonomous MM Chart 72
MODULE 5: Sympto-Thermal Method 79

Sympto-T Charts 84
MODULE 6: Standard Days Method 100

Table of Contents
Department of Health iii
Reference Guide for Natural Family Planning
Table of Contents

TwoDay Method 117
MODULE 7a: Lactational Amenorrhea Method 121

MODULE 7b: Mucus Method for Breastfeeding Women 131

Breastfeeding Charts 137
MODULE 8: Couple Communication 148

Couple Dialogue Script 148
MODULE 9: Counseling on Natural Family Planning 159

MODULE 10: Mainstreaming NFP for Program Sustainability 165
Annexes
Annex 1 - Participant Information Sheet 170
Annex 2 - Pre/Post Course Questionnaire 171
Annex 3 - Pre/Post Course Questionnaire Answer Key 175
Annex 4 - Birth and Emergency Plan 177
Annex 5 - Human Fertility: Myth of Fact 178
Annex 6 - Daily Learning Journal 179
Annex 7 - Couple Dialogue Script 180
Annex 8 - Case of Monica 181
Annex 9 - Guidelines for Individual Competency Evaluation (ICE) 182
Annex 10 - Action Plan Sheet 183
Annex 11 - Training Evaluation Form 184
References 185
Table of Contents
iv Department of Health
A Natural Family Planning Training Design for Service Providers
Introduction
Mainstreaming Natural Family Planning (NFP) has been a
Philippine Family Planning (FP) program goal for years. However,
a number of factors such as 1) inadequate resources allocated by
the government and the private sector; 2) the need for trainers
and service providers for a simpler technology to teach; 3) the
need for follow up of NFP acceptors to ensure correct use; and
4) the unfavorable attitude of many health program workers
towards an NFP program, contribute to the long wait for NFP
to be mainstreamed. Another equally important concern in the
current NFP program is to institute competency-based training
for FP providers. In line with the above, a streamlined NFP
training for service providers has been designed for program
workers to acquire NFP knowledge and skills in a simplified
manner with less follow-up requirements, thereby encouraging
them to readily provide the service in their respective areas.
In consideration of the family planning situation

in the country, current statistics based on NDHS (National
Demographic Household Survey, 2008) show that 49.3% of
women in union are not using any FP method, and 17% are
traditional method users (withdrawal and periodic abstinence).
NFP offers alternatives for addressing the existing unmet FP
needs of Filipino couples notwithstanding the low percentage
(less than 1%) of couples using modern NFP methods, such as
the Mucus/Billings Method, Basal Body Temperature, and the
Sympto-Thermal Method.
This training aims to provide basic knowledge and

skills on the Mucus Method, Basal Body Temperature, Sympto-
Thermal Method, Lactational Amenorrhea Method and on
the Standard Days Method. Methodologies will emphasize
acquiring skills so that the service provider will feel competent
and confident to teach Natural Family Planning to their clients.
Adopting a simplified competency-based NFP training

is in synch with the DOH decision to make Family Planning one
of its flagship programs on health while placing emphasis on
mainstreaming Natural Family Planning. (DOH Administrative
Order No. 125 Series 2002 signed on June 5, 2002.)

Department of Health v
ACKNOWLEDGEMENTS - IRH/PH
Main writer:
Milagros Serrano-Rivera, BA Psych, BSEd.
Module writers:
Elnora Aquilizan-Duran, BS MedTech, MA Rel Ed.
Marina Magnolia Gallardo-Ninobla, RN, RM, MAN
Rebecca Pastor-Santos, MA MC
Editor:
Bethel Buena Villarta, DrPH, RN
Design and Layout:

Reina Marie Castelo Gastardo, BFA
Secretarial Assistance:
Marilyn Guadamor-Reck, RM, DSS
The following participated in the September, 2009 pretesting

of the manual and the guide, from CHD III:
1. Maricel T. Aquino
2. Clotilde B. Arimboyutan
3. Yolanda S. Baltazar
4. Leidee B. Bada
5. Rodolfo G. Cabungcal
6. Amy Grace S. Cayanan
7. Roy Nelson T. de Roxas, MD
8. Lea L. Escoro
9. Manuel Galapon III, MD
10. Juliet V. Gonzales
11. Justina A. Mauricio
12. Elmer P. Mirafelix
13. Rosalie M. Oga
14. Anita A. Pangan, MD
15. Julieta B. Pascual
16. Imelda C. Pazcoguin
17. Daisy D. Reyes

vi Department of Health
18. Natividad N. Sabado

19. Gemma B. Sabarea
20. Alicia B. Santos
21. Irene O. Serapio
22. Cynthia C. Trinidad
23. Elvira P. Veraya
Lastly, the technical assistance of the following Family

Health Central Office DOH, and CHD III personnel is greatly
appreciated:
Dr. Honorata Catibog
Dr. Lourdes Paulino
Dr. Florence G. Apale
Ms. Onofria de Guzman
Ms. Teresita dela Cruz
Erlinda Maglanque

Department of Health vii
General Objective:
• To develop the competencies of service providers in the
teaching of Natural Family Planning.
Specific Objectives:
• By the end of the 4-day training course, each participant is
expected to be able to:
1. Explain Responsible Parenthood (RP)/Maternal and

Child Health (MCH) as an entry point in discussing NFP
2. Discuss joint fertility as a basic concept for NFP
methods including
2.1 Phases of the menstrual cycle
2.2 Overview of NFP methods: Definition,
Advantages, Disadvantages
3. Identify the different NFP methods
3.1 Basal Body Temperature (BBT)
3.2 Cervical Mucus Method (CMM)
3.3 Sympto-Thermal Method (STM)
3.4 Standard Days Method (SDM)
3.5 Lactational Amenorrhea Method (LAM)
4. Discuss the NFP methods in terms of their:
4.1 Mode of Action
4.2 Effectiveness
4.3 Advantages and Disadvantages
4.4 Guidelines in the Correct Use of the Method
4.5 Identification of the Fertile and Infertile periods
based on chartings
5. Demonstrate basic skills in the following:
5.1 Conducting fertility awareness session
5.2 Providing initial instruction on NFP
5.3 Recording observations on NFP charts
5.4 Analysis and interpretation of NFP charts
5.5 Handling follow up visits
6. Adopt a favorable attitude towards the teaching and
use of natural methods of family planning.

viii Department of Health
Methodology
Field experience has shown that using the competency-
based approach to training providers in Natural Family
Planning yields positive results.
Competency-Based Training (CBT) emphasizes

learning by doing. It focuses on the specific knowledge and
skills needed to carry out specified tasks or activities. In CBT,
the participants observe and practice the job skills they need
to master while being trained.
The CBT approach is scientifically grounded in the

learning theory that an individual’s ability to recall essential
information is greatly increased when the material is learned
through participatory methods rather than passive methods
such as listening to a lecture or reading.
Competency-based training is also based on the

principles of adult learning theory which state that adults
learn best when:
1. the learning environment closely reflects their real-life
context;
2. they have many chances to observe and practice; and
3. they receive immediate feedback on their performance.
Didactic Phase
The training course will use exercises, lecturettes,
demonstrations, supervised practices, practices in charting
and role-playing. Visual aids will be used to facilitate learning.
To achieve competency, much time will be devoted to charting
practice for NFP methods while the GATHER approach for
counseling will be demonstrated and used with Individual
Competency Evaluation.
Practicum Phase
There will be three (3) months practicum at the
participants’ area of assignment. Each participant/service
provider is expected to provide services for at least 3-5 NFP
clients within six (6) months after the training.

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Participants
The participants are service providers who qualify
based on the following criteria:
1. willing to be trained in NFP
2. committed to teach and follow up the use of NFP
methods for couples in the community
3. has the support of the RHU/LGU
Operating Details
• Live-in training for four (4) days
• Approximate number of training participants – 20 to
25
• Training ratio – One (1) trainer to ten (10) participants for
the didactic phase, 1:5 for the Individual Competency
Evaluation
Certification
A certificate of attendance will be awarded to those
who completed the didactic phase and a certification as
NFP provider will be given to those who meet the practicum
requirements.
Cost of Training
Per participant: the cost should cover Board and
Lodging, trainers’ fees (if relevant), participants’ handouts (all
NFP Kit – manual, ovulation thermometer, NFP sample charts
for exercises, and blank charts for users, SDM Job Aids Packet,
SDM colored cue cards, (5) SDM CycleBeads).
Per site: Advocacy Video CD, (1) poster, 5 flyers and 5
brochures per participant.

x Department of Health
HOW TO USE THIS REFERENCE GUIDE
The All Natural Family Planning Reference Guide is a handbook

for Service Providers to use in the counseling of clients in
any of the modern and scientific natural methods of family
planning.
The first two modules Responsible Parenthood and Fertility

Awareness are modules that provide the background for
teaching Natural Family Planning.
Modules 3 to 9 cover the teaching and counseling information

for the different methods of NFP: Basal Body Temperature,
Cervical Mucus Method, Sympto-thermal Method, Standard
Days Method, LAM, Mucus Method for Breastfeeding Women,
Couple Communication and Counseling on NFP.
The last module goes beyond NFP Counseling and looks at

the different aspects of service installation and how to make
NFP teaching sustainable as part of the RP/RH program.
Each module includes the teaching and Evaluation Guide,

Frequently Asked Questions, and Supplemental Reading. Each
method module includes charts as needed. Annexes at the
end of the guide include all forms and documents needed by
the service providers.

Department of Health xi
TRAINING FLOW
DATE TOPIC/SESSION Remarks

1st Day
AM Pretest Sponsoring Agency
8:00 Opening Program – Welcome, Introduction
of Participants/House Rules/Host Teams
Leveling of Expectations/ Course Objectives
Training Flow & Methodology
Introductory Activity
PM Why NFP? Responsible Parenthood/ Lead Trainer
1:00 Maternal and Child Health
Module 1
Module 2 Fertility Awareness with Overview of NFP Training Team
Methods
Module 3 Basal Body Temperature Demonstration
of Guidelines &
Practice Charting
Learning Journal Pax/support staff

2nd Day
AM RECAP of Day 1 By assigned group
8:00
Module 4 Cervical Mucus Method Demonstration of
Guidelines &
Practice Charting
Module 5 Sympto-Thermal Method Demonstration of
Guidelines &
Practice Charting
PM Standard Days Method Case Demonstration
1:00 of Guidelines
Module 6 Supervised Practice

xii Department of Health
DATE TOPIC/SESSION Remarks

Module 7 Lactational Amenorrhea Method Case Demonstration
Mucus Guidelines for Breastfeeding of Guidelines
Practice charting
3rd Day
AM Recap of Day 2 By assigned group
8:00
Module 8 Couple Communication Dialogue/Role Play
Module 9 Counseling Approach to NFP Case demonstration
Preparation for ICE
PM Individual Competency Evaluation (ICE) Case
1:00 demonstrations in
small groups
4th day
AM Recap of Day 3 By assigned group
8:00
Module 10 Mainstreaming NFP: Training, Service Pax with facilitator
Delivery and Reporting System
Action Planning
PM Post test & Evaluation Support staff
1:00
Closing Sponsoring Agency

Department of Health xiii
Introduction to the Course
TRAINER’S ACTIVITIES KEY LEARNING POINTS
Distribute the pre-course The Pre-course questionnaire will provide the training
questionnaire (Appendix B. Give team and the participants themselves with their level of
participants 10 to 15 minutes to knowledge at the start of the training. It will help the training
answer it. team to decide on what points would need emphases during
the training. It will also be a measure of any increment in
Instruct them to put their names knowledge and level of confidence after the training.
and a symbol across their names.
The symbols will be used to keep
their scores confidential when
these are posted.
Expectations and Objective-

Setting
Divide the participants into 3

groups according to how they
are seated. Give the participants
3 cartolinas of different colors.
Ask the groups to write down
their expectations, one group for
expectations from the course,
one from the trainers, and one
from the participants. Give them
5 minutes for the exercise and ask
them to pose their answers up
front. Synthesize the responses
and level with the objectives by
showing the powerpoint on the
training objectives. Show which
expectations will be met through
the training, and show which
ones will not likely be met.
Ask how will we meet these

objectives.

xiv Department of Health
Warm–Up Activity
Conduct a warm-up activity for

introducing the CBT approach.
Invite 8 volunteers up front for a
warm-up activity. Ask the rest of
the participants to be observers.
Ask each volunteer to think of
one activity he/she is really good
at. Each one will state their name
and act out the activity chosen,
without stating what it is. The
next person then states his/ her
name, acts out his activity and
then gives the names and acts
out the activities of all the persons
preceding him/her.
At the end of the activity, ask the Expected Lessons from Warm-up Activity
volunteers and the observers
what made it easy for them What makes it easy for people to remember?
to remember the names and 1. Focusing and Paying attention
corresponding action. 2. Knowing your turn will come to demonstrate
3. Action is easier to remember than words you hear or
you read
4. Repetition
5. Having a reference like the nametags
6. When there is order in presentation
7. Coaching from others
8. Easy and Clear messages
9. Having fun
To apply these learnings to the training: the CBT

approach will be used, that is, skills-focused and learning
by doing. Methodology for the sessions will be interactive
illustrated lectures, demonstrations, repetition, and return

Department of Health xv
demonstrations. Knowledge is specific to the roles that the

participants will assume for nfp after the training.
Confucius said: “What we hear, we forget. What we see, we

remember. But what we do, we understand.”
There are levels of competence that the training addresses:
Level of unconscious incompetence – we think we know it,

but we do not. Many people think that they know NFP until
such time that they admit they do not know much about the
modern scientific natural methods of family planning to bring
them to the next level. It is difficult to help people who remain
on the level of unconscious incompetence.
Level of conscious incompetence – admitting to

one’s having more to learn about something and wanting to
learn it – a good starting point for learning.
Level of conscious competence – knowing that you own the

ability and skill for something, a deliberated performance of
an activity carried out effectively and efficiently.
Level of unconscious competence – few people achieve this

level, a level of mastery beyond proficiency, operating on the
level of subconscious efficiency, “kahit natutulog”.
It is not the objective of this training for trainees to

achieve mastery for the duration of the course, but the skills
gained will improve with practice most especially if these are
immediately put to use, leading to heightened confidence
and deeper commitment to perform better as nfp counselors.

xvi Department of Health
Module 1: Responsible Parenthood
Introduction
Parenting is a 24 hour-a-day, 7 day-a-week job that requires abilities, skills, duties and life
experiences. These attributes are necessary for parents to provide for the physical, emotional,
intellectual, spiritual, and financial needs of the family. Among the skills required of parents is the
ability to make decisions in planning the number and spacing of their children.
The Philippine Family Planning Program is anchored on four pillars. These pillars are:
• Respect for Life, which aims to protect the life of the unborn and therefore maintains that
abortion is not a method of family planning.
• Birth Spacing of three to five years to enable women to recover from pregnancy, improve
their well being, the health of the child and the relationship between husband and wife and
between parents and children.
• Informed Choice and Voluntarism. Couples may choose from all range of methods what they
will use to exercise responsible parenthood. Their choice is based on full information of each
method to include benefits, side effects, advantages and disadvantages. The couple’s decision
is out of their voluntary action to enable them to attain their family goal.
• Responsible Parenthood, which is the will and the ability of parents to respond to the needs
and aspirations of the family.
At the national level, responsible parenthood is seen to be instrumental in the achievement of

the country’s Millennium Development Goals by 2015. Among the specific goals is the reduction of
child mortality to 26 per 1,000 live births and the reduction of maternal mortality to 52 per 100,000 live
births.
Responsible parenthood is critical in the improvement of maternal and child health which
in turn will lead to a reduction in maternal and child mortality. All of us parents have dreams and
aspirations; we can share these dreams with each other in our next activity.

Department of Health 1
Responsible parenthood is the shared responsibility of the husband and wife to determine and
space their children in order to pursue a better quality of life. Responsible parents only want the best
for their families.
Responsible couples are committed to ensure that every member of the family will be able to
develop their capabilities and potentials.
Parenting is a vocation which needs not only personal dedication but also adequate knowledge
and skills.
These knowledge and skills are the parents’ tools in ensuring their child’s/children’s proper
development, upbringing and formation of good character.
Parents, therefore, should be aware of their duties and responsibilities. These are:
• Provision of love and care which starts at prenatal stage
• Development of social skills that make children friendly, happy, responsible and self confident
• Instilling discipline by being the first teachers and role models
• Providing children’s right to education
• Giving the children necessary citizenship training
• Teaching the wise use of money
• Spiritual formation with parents as models in loving, obeying, worshipping God
Possible Answers:
1. excited to be a parent
2. anxious about the new responsibility
3. challenged to prove their capability to become a parent
The excitement of couples to become parents usually comes with anxiety over the new
responsibility. However, the anticipation for the new member of the family can be an experience the
husband and wife can cherish as long as they agree to jointly take the responsibility of caring for their
child.

2 Department of Health
The care of a child starts with conception. Prenatal care is extremely important and visits to a health
facility are advised for:
• Assessment of pregnancy
• Early detection of problems
• Education on child care
• Advise on maternal and child nutrition
• Advise on proper breastfeeding and infant/child nutrition
• Advise on family planning
Counseling in prenatal periods for the pregnant women, her partner and family members
emphasizes preparing for delivery and post natal care. Even while the pregnancy of a woman has been
uneventful, the possibility of a problematic delivery or birthing is always present.
So there is always a need to be ready for emergency. It is critical that the mother is helped in
making a birth and emergency plan. Towards this end, the DOH has prepared a Birth and Emergency
Plan.

BIRTH AND EMERGENCY PLAN
I know that any complication can develop during delivery. I

know that I should deliver my baby in a health facility.
I will be attended at delivery by _________________________.

Name of doctor/nurse/midwife or others. Specify.
I plan to deliver at ____________________________________.

Name of hospital/health center/clinic
This is a Philhealth accredited facility ____ Yes _____ No
The estimated cost of the maternity package in this facility is

P_________ (inclusive of newborn care).
The available transport is ______________________________.
I have contacted __________________________ to bring me

to the hospital/maternity clinic/health center.
I will be accompanied by _______________________________

Name
_____________________________ will take care for my

children/home while I am in health facility.
In case of a need for blood transfusion, my possible donors are:
_______________________ _________________________
Name Address
_______________________ _________________________
Name Address
In case of complications, I will be referred right away to:
Contact person: ______________________________________
Address: ____________________________________________
Tel. No.
_______________________________________________

The pregnant woman together with the midwife should fill out the Birth and Emergency Plan. The
need to give birth in a health facility cannot be overemphasized.
It is just as important to respond to the health maintenance of the mother even if she is not pregnant.
In this connection, the need for the couple to be conscious and careful about another pregnancy until
they are ready for another child in the family is very important.
“Children are blessings and the best way

parents can show their gratitude for these blessings
is to give them special care.”
SUMMARY AND CONCLUSION

The principal pillar of the Philippine Family Planning Program is Responsible Parenthood. This is
because it is considered as critical in the achievement of the country’s Millennium Development Goal
of reducing child and maternal mortality. Parents who are aware of and have taken their responsibilities
seriously are needed to ensure a healthy family, which will contribute to the development of a
progressive nation

FREQUENTLY ASKED QUESTIONS:

Responsible Parenthood
1. In most Filipino homes a child is the center of attention and love. Will this not spoil the child and make
him become a problem as he grows up?
Too much attention or too little attention will both have an effect on the emotional make up of the
child. Parents, therefore, need to balance their attention to avoid giving too much or too little.
2. When a couple needs information on natural family planning, where is the best place to go?
The health center, parish or private clinics, where there are trained service providers who can help, are
the best places to go for information on NFP. They may also be referred to another health facility to address
their specific need.
3. In case a couple decides to practice a natural family planning method but the husband cannot go to the
clinic for counseling because of his work, can the wife go for counseling and communicate information
to her husband?
Of course the wife can go to the clinic for information and share the information she gathered with
her husband. It is ideal however for both the husband and the wife to be present for counseling even for just the
second visit.

SUPPLEMENTAL READING:
Responsible Parenthood and Maternal and Child Health
Parenting can be the most rewarding phase of adult life. Nothing brings more joy and pride than to bring
up a happy, productive, self-confident and loving child. To accomplish this, parents extend to their children the
benefits of moral guidance, self-discipline and religious instruction. They set good examples to their children
constantly and consistently.
Responsible parents recognize and address the unique needs of their children in the various stages of their
development. These stages and developmental tasks, according to human development expert, Erik Erickson, are:
• Infancy – Trust must be developed as his basic needs are met, otherwise the child can grow up mistrusting
people.
• Toddler – The child has to learn autonomy in walking, talking, etc. so that shame and doubt are not
manifested in his behavior.
• Childhood – In play and early schoolwork, the child should develop initiative and industry, otherwise
he/she would always feel inferior and guilty.
• Adolescence – Identity is developed at this stage, otherwise there would be role confusion.
These developments are carried over to adulthood, laying the foundation for the child’s maturity. Every
responsible couple should be aware that every child has intrinsic rights that should be upheld, recognized and
fulfilled by their parents. According to the UNICEF, Declaration of the Rights of the Child (1959), these rights
are:
• to be born well once they are conceived
• to have a nationality and a name
• to develop into a happy, useful and active member of the society
• to have a wholesome family
• to a healthy and vigorous life
• to enrich and strengthen their character through a moral and upright life
• to education and skills development
• to safe and wholesome recreation and activities
• to be protected from anything that will affect his/her development and growth negatively
• to grow up as a free and responsible individual
• to have equal rights and opportunities and have the protection of the government if they are differently-
abled
• to be protected by the government against all forms of abuse
• to enjoy the protection and care of the government if they live in areas of conflict

Like children, parents also have rights provided by law. These rights are:
• The right to the company of their children and in relation to all other persons or institutions dealing with
child’s development, the primary right and obligation to provide for their upbringing
• The rights over the person and property of the child as provided by the Civil Code
• The right to discipline the child as may be necessary for the formation of his/her good character, and may
therefore require from the child obedience to just and reasonable rules, suggestions and advice.
Parents should talk WITH their children. It is a wise parent who listens to what his/her children are
thinking, feeling, or wanting to do. By understanding and accepting them, parents come to respect their children
as human beings.
In the context of any religion or faith, the family is the core social unit. Parents should take into account
that as an institution, the family’s main function is to provide total care for the children, prepare them for adult
roles, provide discipline, and respond to the spiritual needs of children.

Module 2: Fertility Awareness
Introduction
In seeking to include fertility awareness as an integral part of the family planning program of
the Philippines, the Department of Health hopes to be able to promote the reproductive health and
sexual well being of individuals and communities. The focus is not just on women, but on men as well,
and adolescents who would be, in the future, forming relationships for their own families.
What is Fertility Awareness?

It means knowledge of how one’s own reproductive system functions, and the biological and
sociological facts about human fertility. It means the ability to know if a woman is fertile or infertile
to determine if having sexual intercourse on the particular day could result in pregnancy. It is the full
appreciation of one’s own sexuality and procreative power.
Fertility: Myth or Fact Myth or Fact?

A woman can get pregnant on any day of her cycle.
If men do not ejaculate, sperm will collect and lead to
physical or mental disease.
If a woman misses her period, this could mean that she
is pregnant.
Menstruation is the most important event in a woman’s
cycle of fertility.
A man can get a woman pregnant with only one act of
intercourse.
Wet dreams happen naturally.
Sperm cells deposited inside the woman’s body die
instantly all the time.
Menstruation is dirty blood.
Timing of sexual intercourse can be agreed on by both
husband and wife.
Intercourse during the woman’s infertile days can lead
to pregnancy.
The brain is not involved in human reproduction.
A baby can result from intercourse only during the
woman’s fertile days.

What is fertility?
Fertility is the ability of a person to bear children. It is necessary for both a man and a woman
to be fertile in order for them to bear a child. It necessarily focuses on Male and Female fertility, not
separately, but in a joint or combined perspective.
The human capacity to reproduce involves a man and a woman and their contributions in the
conception of a child. A man contributes the sperm cell and the woman, an egg cell.
This picture is the fertilized egg cell. At this point, the sperm cell and the egg cell have united,
in the process called fertilization.
• A mature, viable egg is the ultimate indicator of female fertility while mature, motile and adequate
number of sperms is the indicator of male fertility.
• The fertilized ovum is the most important, if not the ultimate indicator of human fertility.
• Before they unite, the sperm cells remain in the body of the man, and the egg cell, inside the
woman’s body.

Through sexual intercourse, the man and the woman contribute these sex gametes in the conception
of a baby. Specific body parts are designated for human reproductive functions.
• It is also crucial to understand that aside from the male and female reproductive body parts, the
brain is involved in the process of reproduction, not only physically but more so on the decision
making process. A couple can also make decisions when to have children based on their values and
beliefs. This can be translated as responsible parenthood.
Why is fertility awareness necessary?

Men and woman are not only gifted with the ability to have children, but also with the intellectual
ability and capacity to understand and fully appreciate their fertility. Our bodies are already equipped
with the mechanisms for natural management of fertility. We can observe these systems at work in our
own bodies when we know what signs, feelings, and experiences to watch out for.
Knowing one’s body and fertility empowers the person to make a truly healthy, informed and
responsible decision on his/her family life aspirations. This will enable Filipino families to fully benefit
from the Family Planning services offered both by the government and the private sectors.
Let us trace the passageway of the sperm cell in the male reproductive tract, and the passageway
of the egg cell into the female reproductive tract. In this way, we can understand better how fertility
works.

At around puberty, sperm cells begin to be produced

•
Male Reproductive System in the testes.
Vas deferens • The male hormone testosterone directly influences
Seminal vesicles the production of the sperms called spermatogenesis.
Testosterone is also responsible for the secondary
Prostate gland male characteristics. A skin covering called the
scrotum protects the testes.
Cowpers gland • The sperm cells are stored and become mature in the
Urethra epididymis. The sperm cells then are transported
Penis through the vas deferens.
• They are combined with fluids from the seminal
Testes Epididymis vesicles and the prostate gland.
Scrotum
• Together, they form a milky white fluid called semen. The milky white fluid is called semen.
• The fluids nourish and assist the movement of sperms until they are released by the millions from
the man’s body in the process of ejaculation through the penis, the male organ for intercourse.
Within minutes after ejaculation, sperm can reach the Fallopian tube in the woman’s body
and can live for up to 5 days in the woman’s body when she is fertile.
Female Reproductive System • The egg cell on the other hand grows and develops
in the ovaries.
• When a baby girl is born, her ovaries already contain
Fallopian tube
Uterus the number of egg cells. At puberty, the eggs begin to
mature. Once in every cycle, an egg cell fully matures
Uterine lining and is released from the ovary into the fallopian
tube. This process is called ovulation.
Cervix
Ovary
The egg cell survives for about 24 hours in
Vagina the fallopian tube. If a sperm cell is present,
fertilization is likely to occur after intercourse.
• Fertilization is the union of egg cell and the sperm cell.

• The fertilized egg journeys for around 6 days towards the uterus where
it is implanted in the endometrial or uterine lining. Pregnancy takes
place for a period of 9 months and culminates with childbirth. The
cervix, which is known as the neck of the uterus, dilates at childbirth to
allow the emergence of the baby from the uterus through the vagina,
which is also the female organ for intercourse.
• If unfertilized, the egg cell disintegrates and is reabsorbed in the
body. In about 10-16 days, the uterine lining is shed off in the form of
menstruation.
• The man’s fertility is signaled by his first ejaculation during sleep, known as nocturnal emission
(wet dreams).
• A man is fertile everyday of his life starting from puberty and ends at death. This means he
has the ability to father a child (impregnate a woman) for every sexual intercourse that he engages
in from puberty until he dies.
• In the conception a child, the man contributes the sperm.
• The sperm can live up to three to five days inside the woman’s body around ovulation time.
• A woman is fertile when she has the ability to become pregnant. This is signaled by the menarche,
her first menstruation at around 8-12 years of age.

• A woman is fertile only on certain days of each menstrual cycle. These are the days when she
can become pregnant.
• In the conception of a child, the woman contributes the egg cell.
• The egg cell is released at ovulation, which occurs once during each menstrual cycle.
• A woman’s fertility ends at menopause, when menstrual periods have stopped for a year.
• Joint Fertility involves the united and equal contribution of the male and female in the decision
and ability to have a child,
although it is the woman who becomes pregnant and goes through childbirth,
fertility involves contributions from both the male and female;
• The sperm and the egg meet through lovemaking or sexual intercourse.
• Lovemaking can occur anytime throughout the menstrual cycle of the woman
• However, a baby results from lovemaking only during the woman’s fertile days, when she releases
an egg. The sperm unites with the egg to produce a baby.
• At other times, lovemaking will not result in pregnancy.
• It is also crucial to understand that aside from the male and female reproductive body parts; the
brain is involved in the process of reproduction, not only physically but more so on the decision
making process.

• As a classic example, let us compare the woman’s fertility with planting rice.
• Planting during the dry season will not result in growth of the crop. Similarly, lovemaking during
woman’s dry period or infertile time will not result in a pregnancy.
• On the other hand, planting during wet season, when followed by the sun, will produce growth.
Similarly, lovemaking during the woman’s wet period or fertile period time will result in
pregnancy.
Statement Myth or Fact?

A woman can get pregnant on any day of her cycle. Myth
If men do not ejaculate, sperm will collect and lead to
Myth
physical or mental disease.
If a woman misses her period, this could mean that she
Fact
is pregnant.
Menstruation is the most important event in a woman’s
Myth
cycle of fertility.
A man can get a woman pregnant with only one act of
Fact
intercourse.
Wet dreams happen naturally. Fact
Sperm cells deposited inside the woman’s body die
Myth
instantly all the time.
Menstruation is dirty blood. Myth
Timing of sexual intercourse can be agreed on by both
Fact
husband and wife.
Intercourse during the woman’s infertile days can lead
Myth
to pregnancy.
The brain is not involved in human reproduction. Myth
A baby can result from intercourse only during the
Fact
woman’s fertile days.
Knowledge on fertility will make us better understand how pregnancies can be planned. Couples need
to make joint decisions with regard to their fertility intention. This is an important factor to consider
when helping couples choose their family planning options.

The Menstrual Cycle

• Menstruation and the menstrual cycle are part of a woman’s reproductive functions.
• The menstrual cycle starts from the first day of the woman’s menstrual period and ends on
the day before she begins her next menstrual period.
• Since this happens regularly, it is called a cycle.
• The cycle includes the maturation and release of a mature ovum from the ovary up to shedding
off of the endometrium.
• (LMP - is the date of the last menstrual period)
Length of the Menstrual Cycle:

• The length of the menstrual cycle varies for each woman,
• For some the cycle is as short as 26 (or even fewer) days. Others, it is as long as 32 days or more.
Irregular periods are common in girls who are just beginning to menstruate. It may take the
body a while to adjust to all the changes taking place in the body. However, on the average, a
menstrual cycle usually lasts about 26 – 32 days.
Let us examine the cycle length of this woman who had her first day of menstruation on April 10 and
the next menstruation started on May 8.
• If we count the days from April 10 (first day) to May 7 (the day before the next menstruation),
which covers one menstrual cycle, then the cycle length is 28 days.
• Theoretically, a woman is considered to have an average cycle if she usually menstruates every
26-32 days in a month.
• It is important to know that cycle length is the beginning from the first day of menstruation
(LMP) up to the day BEFORE the next menstruation.
!Remember! the four (4) menstrual phases, rather than just 3 as taught in medical school is for teaching
purposes related to natural family planning.

The Menstrual Cycle has four phases. These are:

1. The Menstrual Phase
2. Pre-ovulatory phase
3. Ovulatory Phase
4. Post-ovulatory phase
Menstrual Phase:
• Starts on first day of menses
• Woman observes bleeding
• Bleeding comes from shedding of lining of uterus. It indicates
that there is no pregnancy
• Includes all days of menstrual bleeding, usually 4-6 days.
• Menstrual bleeding is normal and healthy. Bleeding does
not mean the woman is sick
Pre-Ovulatory Phase:
• Bleeding has stopped
• Egg cells begin to develop
• Lining of the uterus starts to thicken
• Mucus forms a plug. This mucus prevents entry of sperms
• Includes all dry days after menstrual bleeding stops
• A woman experiences dry feeling and no mucus
• The pre-ovulatory phase is relatively infertile phase

Ovulatory Phase
• The third phase of the cycle, called ovulatory phase is the
highlight of a woman’s fertility
• One mature egg is released and stays in the tube for about
24 hours
• Endometrium becomes thick of heavy, downy velvet and
has become soft and succulent in preparation for a possible
implantation.
• The mucus plug is gone.
• The mucus becomes watery, stretchy, slippery and clear. It
provides channels that help the sperm to be transported to
the egg. It nourishes and provides channels that help the
sperm to be transported to the egg.
• The mucus also filters abnormal sperms
• If sperms are present at this time, the woman can get
pregnant.
Post-Ovulatory phase
• No egg is present. If there is no fertilization, the egg cell
disintegrates and is reabsorbed by the body
• Lining of the uterus continues to thicken
• The mucus forms a plug again to prevent entry of sperms
• Women experience dry feeling with no mucus at all, if there
is any mucus, it appears to be sticky, cloudy, crumbly or
pasty.
• The post-ovulatory phase is called the absolute infertile
phase because there is no egg present.
• Blood vessels rupture, escape of blood into the endometrial
lining.
• Because there is no pregnancy, the woman will experience
menstruation again and another cycle will begin.

If sperms are present at around ovulation time, then fertilization can occur.
FERTILIZATION is the union of the sperm and mature ovum in the upper portion of the fallopian
tube.
FETAL DEVELOPMENT
• Immediately after fertilization, the fertilized zygote stays in the fallopian tube for 3-4 days.
• During which rapid cell division (mitosis - resulting daughter cells contain double the number
of chromosomes, called diploid division) is taking place.
• The fertilized ovum journeys for around 6 days towards the uterus where it is implanted in the
endometrium or uterine lining.
• Pregnancy takes place for a period of 9 months and culminates with childbirth. The cervix,
which is the neck of the uterus, dilates at childbirth to allow the emergence of the baby from
the uterus through the vagina.
FETAL GROWTH AND DEVELOPMENT

Fetal growth and development is divided into trimesters that is, the whole nine (9) months is
divided into three (3) parts, and with each part having three(3) months.

FIRST TRIMESTER At the end of 12 weeks:

• Weight is about 1/2 to 1 ounce
• Baby develops recognizable form
• Nails start to develop and earlobes are formed
• Arms, hands, fingers, legs, feet and toes are fully formed
• Eyes are almost fully developed
• Baby has developed most of his/her organs and tissues
• Baby’s heart rate can be heard at 10 weeks with a
special instrument called a Doppler
• Placenta is fully developed
• Sex of fetus can be identified
SECOND TRIMESTER At the end of 6 months:

• Internal organs are maturing and the fetus begins to
grow and prepares for life outside the womb
• Eyelids begin to part and eyes open sometimes for
short periods of time
• Skin is covered with protective coating of thick, cheesy
white grease called vernix caseosa
• Soft woolly hair called lanugo will cover its body. Some
may remain until a week after birth, when it is shed.
• Mother begins to feel fetal movement called
quickening
THIRD TRIMESTER At the end of 9 months:

• Weight is about 7 to 7 1/2 pounds
• The lungs are mature
• Baby is now fully developed and can survive outside
the mother’s body
• Skin is pink and smooth
• From 36 weeks onwards, baby settles down into
the mother’s pelvis and lower in the abdomen in
preparation for birth and may seem less active
• Baby is just about ready for birth

CARE OF THE PREGNANT MOTHER

• Pregnant women are encouraged to have monthly pre-natal check-ups to ensure healthy
pregnancy and safe delivery.
• A pregnant woman should be prepared physically, psychologically, emotionally and financially.
Special care is needed before and during pregnancy and after the birth of the baby.
• As soon as the woman suspects that she is pregnant, she should consult a doctor. If pregnancy
is confirmed, regular check-ups are required to monitor the progress of pregnancy and detect
any possible complications
• Women are encouraged to be responsible for her health and the well-being of her baby. She
should avoid substances (alcohol, caffeine, and smoking) that may cause harm to the fetus.
• Pregnant women are encouraged to eat nutritious food, perform exercises that help strengthen
the pelvic and abdominal muscles and be conscientious with grooming and hygiene.
• Sexual activity is only discouraged when the woman feels uncomfortable and is contraindicated
when there is presence of complications (bleeding and premature contractions)
• Men are encouraged to be involved during the care of the pregnant mother and her baby.
Emotional support is as necessary as financial support during the antenatal period.
The Menstrual Cycle And Pregnancy: A Summary

The menstrual cycle has four (4) phases. The menstrual phase is characterized by bleeding. The
pre-ovulatory phase is considered as relatively infertile days. The ovulatory phase is considered as the
fertile phase. The post-ovulatory is considered as absolutely infertile days. If there is no pregnancy, the
woman will experience menstruation again and another cycle will begin.
If intercourse takes place during the fertile phase, pregnancy can result and the woman and her
partner is encouraged to visit the health center to monitor maternal and child well-being.

Fertility Indicators
37.6
37.4
37.2
37
36.8
36.6
36.4
36.2
36
1
4
7
10
13
16
19
22
25
28
31
There are various signs, which will tell a woman when she is fertile and not fertile. These are fertility
indicators and include the following:
1. Changes in a woman’s body temperature at rest.

2. Changes in her cervical mucus
3. Temporary infertility of fully or nearly fully breastfeeding woman with accompanying
conditions/criteria.
4. Tracking the first day of menstruation and a woman’s cycle lengths to determine the
fertile window period.
Note: There are other signs, such as mood changes, and feeling of heaviness at the pelvic area, and
breast tenderness, and unusual craving for foods, that need to be correlated with the more significant
observations.
These scientific indicators have served as the scientific bases for the development of the natural
methods of family planning or fertility awareness-based methods.
Through the knowledge of the basic facts about fertility and fertility awareness, we can use this
technology to practice natural family planning (NFP).

THE DIFFERENT NATURAL FAMILY PLANNING METHODS
Natural Family Planning or NFP is an educational process of determining the fertile and infertile
periods of a woman:
• By observing and recording the signs and symptoms of the menstrual cycle
• So that lovemaking can be timed
• In order to achieve or avoid pregnancy
• NFP is also known as the Fertility Awareness Based methods since it utilizes principles involved
in human fertility awareness
Fertility Awareness Based Methods that utilize the physiological changes within the menstrual cycle to
determine the period when a woman is fertile and infertile:
The NFP Methods are:
• Basal Body Temperature
• Mucus Method
• Sympto-Thermal Method
• Lactational Amenorrhea Method (LAM)
• Standard Days Method (SDM)
1. BASAL BODY TEMPERATURE (BBT) is based on a woman’s resting body temperature, which
is lower before ovulation until it rises to a higher level beginning around the time of ovulation. Her
infertile days begin from the FOURTH day of the high temperature reading to the last day of the
cycle. All days from the start of the menstrual cycle up to the THIRD high temperature reading are
considered fertile days.

2. MUCUS METHOD (MM) is based on the daily observation of what a woman sees and feels at the
vaginal area throughout the day. Cervical mucus changes indicate whether days are fertile or infertile
and can be used to avoid or achieve pregnancy.
SYMPTO-THERMAL METHOD
The Sympto-Thermal Method is based on the combined

technology of the Basal Body Temperature & Mucus
Methods i.e. the resting body temperature and the
observation of mucus changes at the vaginal area
throughout the day together with other signs (e.g.,breast
engorgement, unilateral lower abdominal pain) which
indicate that the woman is fertile or infertile.
3. SYMPTO-THERMAL METHOD (Sympto-T) is based on combined the technology of the

Basal Body Temperature and the Mucus Method i.e. the resting body temperature and on the
observations of mucus changes at the vaginal area throughout the day together with other signs
(e.g. breast engorgement, unilateral lower abdominal pain) which indicate that the woman is fertile
or infertile.

4. LACTATIONAL AMENORRHEA METHOD (LAM) is the use of exclusive breastfeeding as a

temporary family planning method.
Lactational means exclusive breastfeeding
Amenorrhea means not having menstrual bleeding
Method is used when her baby is 6 months or less.
A woman uses LAM when:

• Her baby is exclusively breastfed on demand and without offering any supplemental feeding
• Her menstrual period has not yet returned;
• Her baby is less than 6 months old.
5. STANDARD DAYS METHOD (SDM) is based on the woman’s menstrual cycle. It identifies cycle
days 8-19 as the woman’s fertile period. It works for women with menstrual cycles of 26-32 days.
SDM makes use of CycleBeads™. These are colored beads used to help the woman keep track of her
fertile and infertile days.

Advantages of Fertility Awareness Based Methods:

• Can be used either to avoid or achieve pregnancy;
• No health related side effects associated with their use;
• Very little or no cost;
• Immediately reversible;
• Increases self-awareness and knowledge of human reproduction and can lead to a diagnosis
of some gynecologic problems;
• Enhances self-discipline, mutual respect, cooperation, communication, and shared
responsibility of the couple for family planning;
• Acceptable to couples regardless of culture, religion, socio-economic status, & education;
• Not dependent on medically-qualified personnel, the technology can be transferred by a
trained autonomous user;
• Once learned, may require no further help from health care providers;
• NFP can be provided as a separate service or as one of the services of an established health
and family planning community agency.
Disadvantages of NFP or FAB methods:

• Require a high level of diligence from both partners;
• May inhibit sexual spontaneity;
• Except for SDM – need extensive training – takes about two to three cycles to learn to
accurately identify the fertile period and how to effectively use it;
• Require consistent and accurate record keeping and paying close attention to body changes;
• Require periods of abstinence from sexual intercourse;
• Require rigid adherence to daily routine of awakening at fixed time, without enduring any
disturbance before taking the temp;
• May be difficult to practice for some women with multiple sex partners;
• Offer no protection against STI/HIV/AIDS

All NFP methods are Fertility Awareness Based methods, and these are methods that utilize
the physiological changes within the menstrual cycle to determine the period when a woman is
fertile and infertile.
NFP methods are NO DIDO methods :

• No Drugs
• No Injections
• No Device
• No Operations

The key to successful FP/NFP counseling is based on a sound understanding and appreciation
of the male and female reproductive system, human fertility, and the different FAB methods. FAB
methods can be learned and are not difficult to teach if one is properly trained to do so. FAB/NFP
methods are safe and effective methods, based on evidence and research.



Fertility Awareness &
Modern Natural Family Planning Methods
1. Why is the woman’s fertile period longer than one day when the egg cell can only be fertilized for
24 hours?
The woman’s fertile period is determined by 3 factors: the timing of ovulation which cannot be
determined specifically, the lifespan of the sperm cell in the woman’s body during her fertile time, and the
lifespan of the egg cell.
2. Why do we say that men are fertile for life when they become less sexually active with age?
For as long as men ejaculate, the sperms may be viable and capable of fertilizing the egg cell.
3. Is modern natural family planning only for highly educated couples?

Studies show that couples worldwide, whatever their economic or educational status can use
modern Natural Family Planning methods successfully if they are properly trained and highly motivated.
2. Do modern natural family planning methods really work?

Modern natural family planning methods can be effective if practiced correctly and consistently.
In a study of the cervical mucus method, only 3 percent of women who used the method correctly and
consistently became pregnant in one year.
3. Is it true that only women with regular menstrual cycles can use modern Natural Family Planning
methods?
Studies show that most women, regardless of cycle regularity, can use modern natural family
planning methods such as the Mucus Method or BBT Method.
4. Can most men accept abstinence during a woman’s fertile period?

Studies show that for most couples who choose to practice modern natural family planning, the
men have reported that they are find it self-rewarding eventually. The required abstinence during their
partner’s fertile period instills discipline in sexual matters. However some couples report choose to use
backup methods whenever abstinence becomes too difficult for them.
5. Is withdrawal a modern natural method of family planning?

Withdrawal or coitus interruptus is not a method of family planning. It is a practice, and a bad
practice at that. Withdrawal is not effective at all and makes intercourse unsatisfactory for the couple.

6. What is the rhythm method?

The rhythm method is considered a traditional method of family planning. It is not a modern
method and is therefore not being recommended for couples to use. The rhythm method involves counting
the days before and after menstruation each month. Women try to estimate the fertile and infertile
days using some trial and error calculation and this has been proven as ineffective practice, resulting in
surprise pregnancies.
7. Is there a different passage for the woman’s urine?

Yes , a woman’s urine, unlike the man, passes through another opening, the urethra. Besides the
vagina, the woman’s external genitalia include the labia majora and the labia minora, and the clitoris, which
is the primary organ for physical sexual stimulation. It is important also to note that the secretions due to
sexual stimulation are produced by the action of the Bartholin’s glands and the Skein glands, and not the
cervical glands which produce the mucus.

Module 3: Basal Body Temperature Method
Introduction
The Basal Body Temperature Method (BBT) is a Natural Family Planning Method wherein a
woman’s basal body temperature is taken upon waking up after at least 3 hours of continuous sleep
and before doing any physical activity.
The method is based on the tendency of women to have lower temperatures before
ovulation, and higher temperatures afterwards. This is known as a biphasic pattern.
The temperature is taken using an ovulation or BBT thermometer.
Basal Body Temperature Method

The method entails daily taking & recording of a woman’s temperature
• with an ovulation thermometer
• after 3 hours of continuous sleep
• before any activity
• at approximately the same time with the use of an ovulation/BBT thermometer.
• The basal body temperature is the temperature at rest after at least 3 hours of continuous sleep.
• The natural family planning method that makes use of basal body temperature readings and
recordings within a woman’s menstrual cycle is the Basal Body Temperature Method.
• Effectiveness rate: 99%
Temperature Changes
• The basal body temperature (BBT) of a woman is lower before ovulation, until it rises to a higher
level beginning around the time of ovulation.
• After ovulation, her BBT typically rises slightly and stays in a slightly higher range until her next
period begins. This slight increase in BBT, from ovulation until menstruation, is a sign that she
ovulated during this cycle. The rise is due to the action of progesterone.
Fertile and Infertile Days

• The changes in a woman’s BBT particularly the apparent shift during the ovulation period are
the bases for determining the fertile and infertile periods in her menstrual cycle.

Women who can use the BBT method:

• Women with menstrual cycles of any length
• Women willing to take their basal body temperature daily and record them and interpret their
temperature patterns.
• Women who are able to have at least 3 hours of continuous sleep everyday at almost the same
time.
• Couples who can avoid sexual intercourse several consecutive days each cycle.
• Couples who can talk about the timing of their sexual intercourse.
• Couples who are at low risk of STI/HIV-AIDS
BBT or Ovulation Thermometer
The highest temperature reading in a BBT thermometer is 38˚C. It has wider gradations than the
clinical thermometer and is therefore easier to read.

The temperature readings are recorded on a BBT chart and the changes in the woman’s basal
body temperature particularly the shift during the ovulation period are the bases for determining the
fertile and infertile period in her menstrual cycle.
Effectiveness rate: 99%

Blank BBT Chart
Sample Completed BBT Chart

BBT Chart
• Cover line is the point of reference for determining the thermal shift that occurs during
ovulation (highest temperature on days 6-10)
• Thermal shift is indicated by the three (3) consecutive temperatures above the cover line
• Vertical line is drawn between days 2 & 3 of the thermal shift
• Fertile days are days to the left of the vertical line
• Infertile days are all days to the right of the vertical line
The basal body temperature is the temperature at rest after at least 3 hours of continuous sleep. The
natural family planning method that makes use of basal body temperature readings and recordings
within a woman’s menstrual cycle is the Basal Body Temperature Method.
It entails the taking of a woman’s temperature:

• After at least three hours of continuous sleep
• before doing any activity
• at approximately the same time of the day
• with the use of an ovulation/BBT thermometer.
Initial Instructions for the BBT Method

1. Use a BBT or ovulation thermometer.
2. Shake the thermometer to 35˚C or below in the evening and place it at the bedside.
3. Starting on the first day of menstruation, take the temperature upon waking up every morning
before any activity after at least 3 hours of continuous sleep.
4. Take the temperature by placing the silver bulb under the tongue or the armpit for 5 minutes.
The temperature should be taken in the same manner/site throughout the menstrual cycle.
5. Read and record the temperature immediately after taking it.
How to Record the temperature readings:

1. Using a BBT chart, place a dot in the center of the box that matches the temperature printed on
the left side of the chart.
2. Connect the dots daily by drawing a straight line from the previous day’s reading to the present
day’s reading. A temperature pattern will be seen.
3. If the temperature is between two readings, record the temperature of the higher reading e.g.
between 36.3˚ and 36.4˚, record 36.4˚.

4. Ideally, the husband records the temperature but if he is not around, the woman can do it
herself.
5. Record any illnesses of the client that may contribute to a rise in temperature on the chart. These
changes can affect the BBT and must be taken into account when interpreting the temperature
pattern.
Recording Temperature
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
36.7 ● ●
36.6 ● ●
36.5 ● ● ●
36.4 ● ● ● ●
36.3 ● ● ● ●
36.2
36.1 ●
36.0
I. Determining the cover line based on WHO guidelines:

The cover line is the point of reference for determining the thermal shift that occurs during ovulation.
The thermal shift is represented by 4 consecutive readings above the cover line.
1. Take the BBT daily starting on the first day of menstruation and record it on a BBT chart.
2. Connect the temperature readings daily and find the highest temperature from days 6-10.
Disregard any temperature that is abnormally high due to illness.
3. Upon reaching the 10th day, draw a horizontal line on the highest temperature from days 6
to10 across the whole chart. This is the cover line.
4. Continue to take and record the temperature readings until the day before the next menstrual
cycle.

Cover line
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
36.7 ● ●
36.6 ● ●
36.5 ● ● ●
36.4 ● ● ● ●
36.3 ● ● ● ●
36.2
36.1 ●
36.0
II. Determining the thermal shift based on WHO guidelines:

1. Watch for 4 consecutive temperature readings above the cover line.
• This indicates that ovulation has taken place.
• Henceforth, the temperature will remain at a high level until the day before the next
menstruation.
• The temperature will return to a lower level at the onset of the next menstrual cycle.
2. Count these 4 consecutive temperatures above the cover line and mark them as days
1, 2, 3, 4. This is the thermal shift.
3. Draw a vertical line between days 3 and 4 from top to bottom of the chart.
4. Label the days to the left of the vertical line as the fertile days and all the days to the right
of the vertical line as the infertile days.

Thermal shift
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
36.7 1 ● ●
2 3 4
36.6 ● ●
36.5 ● ● ●
36.4 ● ● ● ●
36.3 ● ● ● ●
36.2
36.1 ●
36.0
Sample BBT Chart showing the Coverline and Thermal Shift

Precautions when using BBT:

1. Disregard any high temperatures due to illness. (Mark/label them on the chart)
2. Women who forget to take their daily BBT will have to use another method or wait for another
cycle to start BBT observations again.
BBT Rules for Postponing Pregnancy

1. For couples who wish to space/limit pregnancy, only infertile days of the post-ovulatory phase
(days to the right of the vertical line) are available for lovemaking
2. Intercourse is available from the fourth day of the thermal shift until the end of the cycle.
These days are absolute infertile days.
3. The first day of menstruation up to the third day of the thermal shift are considered fertile days
and couples are advised to abstain from lovemaking in order to postpone pregnancy.
BBT Rules for Achieving Pregnancy

1. Observe the signs and symptoms of the menstrual cycle for at least one cycle.
2. Abstain for a day or two between sexual intercourse so that the partner’s semen will have the
maximum number of sperm cells needed to increase the probability of conception.
3. As much as possible, plan lovemaking just before the thermal shift. The couple needs to
approximate this based on previous charts.
4. Take the BBT daily. If the temperature remains elevated for a longer period than the previous
menstrual cycle, the woman may be pregnant.
Return visit for BBT Users

• Ask the client to come back when the thermal shift has been identified.


Highest temperature on days 6 - 10 to determine the

Cover line is: 36.5 ˚C.
Thermal shift: Cycle days 18 - 21
Fertile days: Cycle days 1- 20
Infertile days: Cycle days 21 - 31
Lovemaking days: Cycle days 21 - 31
Advantages:
• Almost all of the advantages of NFP apply to the BBT method
• Confirms that ovulation has taken place. Two weeks after, menstruation will occur.
Disadvantages:
• Woman has to take her temperature daily and keep records of the signs and symptoms of
fertility
• Not recommended for women who are not willing to take and record their temperatures daily
• Cannot be used by women who are in situations that may not permit them to follow the rules
e.g. women working on shifts or are taking certain medications
SUMMARY/CONCLUSION
The Basal Body Temperature (BBT) Method is a fertility awareness based method of family
planning. It involves the daily taking and recording of the woman’s temperature after three hours of
continuous sleep. It is effective for spacing as well as for achieving pregnancy.










Basal Body Temperature Method
1. What is the right route for taking the woman’s Basal Body Temperature?
The recommended route is either oral or axillary, but the same route has to be used for the whole cycle.
2. Should the temperature be taken at the same time each day?

Not necessarily at the same time, but more or less. What is important is that it is taken after at least
3 hours of continuous sleep.
3. How long is the infertile period of a woman using BBT?

A woman’s post-ovulatory absolute infertile period is constant at 10 to 16 days from the closest day to
ovulation.
4. How does BBT help a woman achieve pregnancy?

By determining the day before the thermal shift, a couple is able to time intercourse at the most fertile
time. A woman is able to detect if she is able to maintain the fertilized ovum for implantation if she has a good
luteal phase of at least 10 days. This is very important especially in cases where a pregnancy is difficult to
achieve.
5. Is there another way of determining the rise in temperature due to ovulation besides the coverline?
Yes, by watching out for 3 consecutive higher temperature recordings immediately following 6 previous
lower recordings.
6. How do we deal with factors that affect the temperature such as illness, infections, or alcohol intake?
The general rule to be followed is to disregard any temperature recordings that are due to these factors.
Continue taking the temperature and see if it will go down or up the temperature level before or after ovulation.

Basal Body Temperature Charting
Fertility Awareness is a means of understanding your reproductive system by observing and writing down
fertility signs. These signs determine whether or not you can become pregnant on a given day. You are actually
fertile during only about one-fourth of your menstrual cycle. It is a great way to learn more about your body.
What is the Basal Body Temperature Method?

Worldwide, the basal body temperature method is the oldest and most widely practiced of the fertility
awareness methods. Every woman is different and your temperature may vary, but most women ovulate (release
an egg from the ovary) at about day 14 of their menstrual cycle, plus or minus 2 days. The egg is viable for about 1
day, and sperm can live for 2-3 days.
How do I chart my basal body temperature?

Make a chart like the one pictured below. Keep a daily calendar record of your temperature using a regular
thermometer placed under the tongue for 3 minutes. Take your temperature after you wake up in the morning but
before you get out of bed. On the same record, chart your menstrual cycle, beginning with day 1 as the first day of
your period. If possible, chart your temperature pattern for a few months before relying on it.
Sample Basal Body Temperature Chart

When can I have sex using this method?

If you don’t want to get pregnant, it is safe to have sex after your temperature rises above your normal
temperature for 3 days in a row. This indicates that ovulation has occurred and the egg has already passed.
When am I most fertile?

If you want to get pregnant, your most fertile days are those just before your temperature begins to rise
during ovulation. It’s difficult to predict this time, so practice the temperature method until you know your
pattern.
Advantages:
• The basal body charting method is free.
• This method does not involve taking pills.
• No foreign object is put into your body.
• There are no side effects.
• You and your partner rely on each other for mutual support and commitment to make this method work.
• If used correctly every time, the failure rate of this method is 1%-9%.
Disadvantages:
• Fertility Awareness Methods do not protect you from HIV/AIDS or other sexually transmitted infections.
• This method is not a good choice if:
• your periods don’t come at a regular time each month;
• your temperature pattern is different each month;
• you just stopped taking birth control pills;
• you just started having periods;
• you are close to menopause;
• you can’t keep a calendar chart; or
• you don’t like going without sex for at least 2 weeks.
Where can I learn more about basal body temperature charting and other Fertility Awareness Methods?
Some clinicians and family planning clinics can help you. Two good books include: Taking Charge of
Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement by Toni Weschler, or
Fertility Awareness Handbook by Barbara Kass-Anese.

Last Update: 12/13/2005

© Emory University

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Module 4: Cervical Mucus Method (CMM)
Introduction
Doctors Evelyn and John Billings originally developed the Cervical Mucus Method which is
internationally known as the Billings Ovulation Method. It is used to determine the fertile and infertile
periods of a woman using the changing properties of cervical mucus. The method is based on the
observation that there are days wherein the mucus is watery, elastic, and clear; days when it is sticky;
and other times when there is little or no mucus production.
The Cervical Mucus Method has been scientifically tested and is endorsed by the World Health
Organization (WHO). If properly used it is as effective as the other modern methods of family planning.
It is one of the best ways to determine a woman’s fertile and infertile periods.
Ovulation
• Changes in color, consistency and amount of her cervical mucus tell a woman when she is about
to ovulate.
• She also observes the feeling of dryness or wetness in her vaginal area.
• These observations will help her identify the days during each menstrual cycle when pregnancy
can or cannot occur.
• Effectiveness Rate: 97%
• The Mucus Method has been scientifically tested and is endorsed by the World Health Organization
(WHO).
• If properly used it is as effective as the other modern methods of family planning.

Mechanism of Action
• On days nearing ovulation, cervical mucus is thin and

copious and is conducive for sperm penetration, survival, and
subsequent fertilization of the egg cell.
• During the woman’s fertile period, she feels wet and sees
slippery, stretchy, watery, and clear mucus. This type of
mucus nourishes and provides channels for sperms to swim
and reach the egg. If a sperm unites with a mature egg cell,
pregnancy occurs.
Fertile Period
• Sperm survival and transport is not possible because of the

mucus plug.
• During the woman’s infertile period, there is no mature
egg cell. The mucus forms a plug that prevents sperms from
entering the cervix. The woman feels dry and she may either
see thick, scanty mucus or no mucus at all. Pregnancy cannot
occur at this time.
• By observing changes in the cervical mucus, the woman
can learn when she is fertile or infertile. This information can
Infertile Period help her and her partner to plan their lovemaking in order to
achieve or avoid pregnancy.

Who can use the Mucus Method?

• Women with normal cervical mucus secretions
• Women willing to observe and record changes in their cervical mucus secretions and interpret
the records
• Couples who can avoid sexual intercourse several consecutive days each cycle
• Couples who can communicate on the timing of their sexual intercourse
• Couples who are at low risk of STI/HIV-ADS
PRACTICE OF THE CERVICAL MUCUS METHOD
MUCUS OBSERVATIONS
WHO observes the mucus?

The woman
WHAT does she observe?

1. What she feels (wetness or dryness)
2. What she sees (appearance of mucus)
WHERE does she observe?

Around vaginal area or “puwerta”
WHEN does she observe?

1. everyday from the first day of menstruation
2. Throughout the day while standing, walking around, or going through daily chores
3. Before or after urinating
HOW does she observe?

1. Observes her feeling in the vaginal area (wet or dry)
2. Checks mucus in her underwear. If none, she passes a tissue around her vaginal area and checks
if she sees anything.
3. She does not need to touch or inspect the mucus internally.

RECORDING OF MUCUS OBSERVATIONS
WHO records the observations?

The couple because both should be aware of the fertile and infertile times and both should
agree on the timing of their lovemaking.
WHAT is recorded?
1. What the woman feels
2. What the woman sees
• If woman has no mucus in the morning and then notices a small amount of mucus in the
evening, she should record the most fertile observations of the day: mucus is more fertile
than no mucus.
WHERE are the observations recorded?

On the blank Cervical Mucus Method Chart
Blank Cervical Mucus Method Chart

WHEN are the mucus observations recorded?

• At the end of the day
• in the evening before going to sleep.
HOW do they record the mucus observations?

By using symbols that represent
• what the woman sees
• what the woman feels.
R - “Regla” or menstruation; spotting

D - Dry with no mucus
X - Wet, with slippery, stretchy, clear, or watery mucus
- Peak day; last day of wetness or wet mucus
M - Dry with sticky, pasty, or crumby mucus
1, 2, 3 - Post Peak Days
- Lovemaking Days
OBSERVING RECORDING
WHO? Couple
1) Feeling at vaginal
area (wet/dry)
WHAT?
2) Appearance of
Cervical Mucus
WHERE? Mucus Method Chart
(puwerta)
In the evening,
WHEN?
before going to sleep
Use chart symbols:

HOW?
R, D, X, ,
1, 2, 3, M, v

Blank Cervical Mucus Method Chart
Sample Completed Cervical Mucus Method Chart

IDENTIFYING THE PHASES OF THE MENSTRUAL CYCLE ON A CMM CHART
A. Menstrual Phase
• Observation starts on the first day of the menstrual cycle, that is, the first day of a woman’s
menstruation. Observation begins on January 18, 2008 the first day of her menstruation
• She feels wet
• She sees blood
• She knows that her menstruation has stopped because bleeding has stopped and she feels
dry.
• Her menstrual phase is from Jan, 18-22, 2008.
• The symbol used for the menstrual phase is “R”
B. Pre-Ovulatory Phase
• She feels dry.
• She sees no mucus; there is no more blood or spotting.
• Cycle Days 6 to 10 are from Jan 23 – 27, 2008. Symbol used is “D”
• This is the Pre-ovulatory Phase. This is a relatively infertile phase.
C. Ovulatory Phase
• She does not expect to feel dry all the days after her menstrual phase or menstrual bleeding.
• After the dry days, she would feel wet and see mucus.
This is considered to be the Ovulatory Phase, which are cycle days 11 to 20 or
Jan 28 – Feb 6, 2008.
• The change from days of dryness and no mucus to days of wetness and mucus is a very
significant change in the menstrual cycle. The presence of mucus signals the impending
fertile days or the release of a mature ovum.
• The woman should be seeing the build-up of mucus which changes in appearance and
consistency during the ovulatory phase.
• She should be watching out for the Peak Day or the Last Day of Wetness or
Last Day of Wet Mucus.
The symbol for the wet days is “X”
• She would recognize her Peak Day because the next day she would experience dryness
with no mucus or dryness with sticky mucus.

• Feb. 3, 2008 or cycle day 17 is her Peak Day in this chart because the next day, she felt dry.
The symbol used is .
• The ovulatory phase includes the three post-peak days which are cycle days 18-19-20 or
Feb. 4,5,6, 2008 in the chart. These are fertile days.
D. Post-Ovulatory Phase
• Cycle days 21-30 or Feb. 7-16, 2008 are the days in the Post-ovulatory Phase.
• The woman feels dry and sees no mucus or may see sticky, pasty, crumbly mucus.
• These are absolute infertile days
• The application of certain rules will help a couple effectively use the Cervical Mucus Method
in order to either achieve or avoid pregnancy.
• These are the Peak Day Rule and the Early Days Rule.
1. Peak Day Rule
• Count 3 days after the Peak Day
• During the Post Peak Days, the woman will feel dry and see sticky mucus or no
mucus at all
• On the 4th day after the Peak Day, lovemaking is available to the couple night or day
until the next menstruation without resulting in pregnancy.
2. Early Days Rule (EDR)
• On dry days following menstruation, lovemaking will be on alternate evenings only.
• If there are no dry days following menstruation, EDR cannot be applied.

MUCUS METHOD RULES

1. Avoid lovemaking during menstruation.
2. Avoid lovemaking during the pre-ovulatory period or dry days following menstruation until the
Early Days Rule (EDR) is learned.
• On dry days following menstruation, a couple can have lovemaking on alternate evenings only.
• EDR applies only to women who have dry days after menstruation.
• Some women with shorter cycles may not have dry days after menstruation and cannot apply
the Early Days Rule. Instead, they abstain until the Peak Day Rule is applied.
3. Avoid lovemaking on all days and nights when the woman experiences wet feeling or has wet
mucus.
4. Wait for the LAST day of wetness or wet mucus.
5. Apply the PEAK Day rule:
Count 3 days after the Peak Day. During these Post Peak Days 1, 2, 3, the woman will feel dry and
see no mucus or sticky mucus, if any. On the 4th day after the Peak Day, lovemaking is available
to the couple night or day until the next menstruation without it resulting in a pregnancy.
NOTE: Remember that the charts shown are only sample charts. Cycles vary from woman to woman
and from cycle to cycle.
TIPS FOR THE SUCCESSFUL USE OF THE CERVICAL MUCUS METHOD

• The successful use of the Mucus Method depends on the commitment and cooperation of both
the wife and her husband.
• It is important for the couple to see and feel the mucus for one complete cycle with NO lovemaking
or until the Peak Day is identified by the Service Provider. This helps them to understand the
woman’s mucus pattern without other secretions and without risking pregnancy.

Cervical Mucus Method Practice Chart
Answers to Practice Charting I

Fertile days: cycle days 11-20
Absolute infertile days: cycle days 21-31
Menstrual Phase: cycle days 1-5
Pre-ovulatory Phase: cycle days 6-10
Ovulatory Phase: cycle days 11-20
Post-ovulatory Phase: cycle days 21-31
Lovemaking days: cycle days 21-31
Lovemaking on alternate evenings only: days 6,8,10

Cervical Mucus Method Answer Chart
Cervical Mucus Method Practice Chart II

Advantages:
Almost all of the advantages of natural family planning are applicable to the Cervical Mucus Method.
Detection of infections
• It provides opportunities for deeper sexual communication between husband and wife
Disadvantages:
1. Requires daily observation and recording of the cervical mucus.
2. Can be tedious during the early stages of knowing and establishing the woman’s menstrual
cycle.
3. Discharges due to infections can be confused with the natural mucus secretions.
Follow-up Visits:
• The woman should come back for the next visit when her peak day/post peak days have been
identified.
• She meets with her service provider for three times, specifically once for each cycle.
• The goal is that by the 3rd cycle she can autonomously use the Cervical Mucus Method without
needing the service provider. If the client is not yet autonomous by the 3rd visit, ask client to
come for another visit until she can satisfactorily meet all the criteria for autonomy.

At the end of the learning period which is usually 3 cycles, the client is taught how to use the
autonomous user’s chart. Colors can be introduced so descriptions can now be dropped or not written
out.
SUMMARY/CONCLUSION
The Cervical Mucus Method is one of the more popular Natural Family Planning Methods. This is
because a relatively easy way of learning its proper use has been developed. Its rate of effectiveness
is also high at 97%. Another factor that has contributed to its popularity is the shortened period
of abstinence as compared to the Basal Body Temperature Method since it allows lovemaking on
alternate evenings on dry days following menstruation (i.e. Early Days Rule). As in other NFP methods
however, the main challenge remains to be the handling of abstinence when the woman is fertile. This
is reported to be self-rewarding over time for the couple as individuals and for their relationship.
In all the above concerns, the role of the Service Provider is critical: ensuring the accurate
understanding of the method rules as well as guiding the couple in its correct practice.












Mucus Method
1. Is observation of the mucus secretion difficult?

Most women have noticed this secretion, but do not know its relation to fertility. Once it is explained,
most women say they have seen and felt the secretions. What is important is the daily observation in relation
to the menstrual cycle. It is also important to keep a daily record of the observations so that women don’t rely
on memory alone.
2. Why is it important for the man to be involved in the recording of the mucus observation?
Husbands should be aware of the part of the cycle his wife is in, so that he is able to discipline and
psyche himself in terms of their sexual intercourse. It is also important for him to understand that there are
certain days when intercourse will probably result in pregnancy, and more days when it will not result in
having a baby. The mucus observations done by the wife tells him that she values their joint fertility and that
she is doing her part to meet their fertility intentions. Thus it is necessary for the couple to decide jointly what
their fertility intention would be at this time of their relationship. Sexual harmony is more easily achieved
when there is mutual consent from each partner.
3. Many women report that around ovulation time, or when they are experiencing their mucus secretions,
they feel more amorous and romantic and therefore enjoy sexual intercourse more. For couples who are
avoiding a pregnancy, will this not make abstaining or waiting too difficult?
It is statistically true that most women experience sexual urges at the peak of their fertility, around
ovulation time. This is due to the cervical mucus secreted by the cervical glands. However, it is important
to know that a different pair of glands, which are the Bartholin’s Glands, secretes sexual lubrication fluids.
When a couple has waited out the fertile time to meet their fertility intentions, sexual intercourse during the
infertile period can be just as or more satisfying because of the delayed gratification and the anticipation, plus
the mutual consent to start with. It is also important to note that nature does favor conception, and this is how
the reproductive systems work. However, a higher ideal or purpose for responsible parenthood helps couples to
go through the waiting time.
4. Why do some women report seeing and feeling secretions all the time throughout the cycle?
There may be several reasons for this: First, it is important that the woman keep a chart of her
observations so that this can be validated. Second, there should be a pattern of menses, dry feeling, followed by
slippery, wet mucus, and again, an experience of dryness at the vulva. If this pattern is not experienced, then it
would be worthwhile to refer the woman for a check-up. This is especially true if the woman experiences itchiness
and secretions are yellowish and may have some odor. She may be experiencing cervical infections which can be
a common occurrence. Thirdly, ruling out the first two, check if the woman is experiencing continuing sexual
arousal throughout the cycle.

5. Are there factors that influence the production of cervical mucus secretions?
The cervical mucus secretions are influenced by the intake of hormones, such as contraceptive pills. The
mechanism of action of some contraceptive pills is that the mucus plug does not transform into slippery, watery
mucus since ovulation is suppressed.
6. Why is intercourse not advised on menstruation days, when it is absolutely sure that these days do not
coincide with the woman’s ovulation?
For methods that do not require a prescribed cycle range, it is important to note that women with short
cycles may get pregnant from intercourse during the later menstruation days since most of their cycles may have
no dry days. Because sperm can live up to 5 days, and can hide in the cervical crypts, pregnancy can occur. This
is advised for women with short cycles who find difficulty achieving a pregnancy.
7. If there is intercourse on the night of the last dry day, followed by a wet day, can a woman get pregnant
since sperm live up to 5 days inside her body?
Remember that the woman feels dry the whole day because there is a cervical mucus plug that cannot
be penetrated by sperm cells and this causes them to lose their viability.
8. Why does the EDR allow for intercourse only in the evenings, and why alternate?
Because the woman is in her pre-ovulatory phase which is a relative infertile phase, meaning she
does not know when her mucus will begin, intercourse is available only at night because she relies on her
observation throughout the day. Intercourse is available on alternate evenings only because post-coital fluid
from intercourse on the night before results to a wet feeling in the woman’s genital area up to noon the next day.

Mucus Method
Odeblad, Erik. Science of Mucus (in Fertility Awareness).
Cervical mucus is of great significance in determining the fertile and infertile days in a woman’s menstrual
cycle. Odeblad has classified the mucus secretions found in the cervix during the different phases of the menstrual
cycle. Vaginal secretions produced by the Bartholin glands direct sperm towards the cervix.
In summary, the cervical secretions are the G, L and S. With the rise in the estrogen level, a woman feels
the S and L mucus secretions while the increase in progesterone during the post-ovulatory phase brings about the
feeling of dryness due to the predominance of the G-mucus. These important physiological processes within a
woman’s body are the basis for the Mucus Method of Natural Family Planning.

Module 5: Sympto-Thermal Method (Sympto-T)
Introduction
The Sympto-Thermal Method (Sympto-T) is a combination of the Cervical Mucus Method and
the Basal Body Temperature Method. Since it uses two sets of indicators of fertility, it is considered
more effective than the Cervical Mucus Method and Basal Body Temperature Method when used
singly. This module reviews the observations and recordings made in the Cervical Mucus and Basal
Body Temperature Methods as well as the need to guide a couple’s practice of natural family planning.
The Sympto-Thermal Method (Sympto-T) combines the observations made of the cervical
mucus, temperature readings, and other signs and symptoms of ovulation to determine the fertile and
infertile days in a woman’s menstrual cycle.
• It combines the technology of the Cervical Mucus Method and that of the Basal Body Temperature
Method.
• Effectivity: 99%
The following can use the Sympto-Thermal Method of natural family planning:
• Women willing to take their basal body temperature daily and record them and interpret their
temperature patterns as well as observe and record their cervical mucus changes.
• Women with normal cervical mucus secretions.
• Women who are able to have at least 3 hours of continuous sleep everyday at almost the same
time.
• Couples who can avoid sexual intercourse several consecutive days each cycle.
• Couples who can talk about the timing of their sexual intercourse.

Blank Sympto-Thermal Chart
Sample Completed Sympto-Thermal Chart

• Since this is the same technology as BBT and MM, the same steps in observing and recording
are followed. Rules pertinent to the two methods are also applied.
If the post-ovulatory phase of the 2 methods are not the same, what should be followed?
• The post-ovulatory phase is determined by following the infertile period of the

method that comes later (either thermal shift of peak day)
• Are there bonus lovemaking days for Sympto-T?
Bonus lovemaking days are available on dry days following menstruation but on alternate evenings
only. (Early Days Rule)
Sympto-Thermal Method Guidelines

1. The first fertile day is identified on the first onset of mucus following dry days after menstruation.
Follow the EARLY DAYS RULE.
2. On dry days following menstruation, lovemaking will be on alternate evenings only.
3. If there are no dry days following menstruation, EDR cannot be applied.
4. The post-ovulatory phase is determined by following both BBT and MM Rules. However,
when there is a difference, follow whichever comes later, whether peak day or the thermal
shift.

Sympto-thermal Practice Chart

Advantages and Disadvantages are the same as the MM and BBT methods.
• The biggest advantage of the sympto-thermal method is the use of 2 indicators which
makes it more effective.
• This however is also considered as a big disadvantage to those who do not like to chart
observations of 2 indicators i.e. temperature and mucus changes.
SUMMARY/CONCLUSION
The Sympto-Thermal Method uses both the Cervical Mucus Method and the Basal Body
Temperature Method. It proves to be as effective as any of the methods mentioned when used singly.
It can be used by women with any menstrual cycle length and like the other natural family planning
methods, it requires couple cooperation for the success of its use. It does not protect the couple from
sexually-transmitted infections and requires more work for the woman since she has to observe and
record two fertility indicators.











1. Why would a double indicator be needed to track a woman’s fertility?

There is actually no need for two indicators of fertility such as the temperature and the mucus secretions
to track down a woman’s fertility. However, since knowledge of the two indicators can be very intriguing, some
couples opt to observe these two indicators. We know by now that the BBT can only tell us the post-ovulatory
infertile phase, so combining it with mucus observations can give couples a bonus for sexual intercourse during
the pre-ovulatory infertile phase. This is a motivating factor. Likewise, seeing the graphic rise that confirms
ovulation is a plus factor for couples, particularly men, since mucus observations can be quite subjective.
2. What is the reason for the guideline on following whichever comes later to identify the post-ovulatory
infertile phase?
This is purely a matter of precaution. Based on charts of women using the Sympto-thermal method,
the mucus guideline would precede the thermal shift but occasionally, this changes. So it is best to follow the
guideline: “Whichever comes later.”
3. What was discovered first, the temperature or the mucus secretions?

As a method, the Basal Body Temperature method was first used in Europe, until Drs. John and Lyn
Billings researched on the mucus method and made it known worldwide. It provided for an easier and less
cumbersome natural method of family planning.

This supplemental reading explains how a woman can learn to identify her fertility signs and symptoms.
Women wishing to use the Sympto-Thermal Method to avoid or to achieve a pregnancy are advised to contact a
qualified Natural Family Planning Instructor.
The Sympto-Thermal Method consists of observing more than one indicator of the woman’s fertility. Most
couples that use a combined or Sympto-Thermal approach use cervical secretions and Basal Body Temperature to
identify the fertile time. Some women also check the position and feel of their cervix or use a calendar calculation
as a “double-check” against cervical secretions to identify the start and end of the fertile time. Other minor
indicators include noting ovulatory pain (mittelschmerz) or breast tenderness. Ovulatory pain refers to lower
abdominal pain or cramping some women feel around the time of ovulation.
Basal Body Temperature (BBT)

The BBT is the body temperature of a healthy person on awakening. The BBT rises under the influence
of progesterone. Most ovulatory cycles demonstrate a biphasic BBT pattern: lower in the first part of the cycle,
rising to a higher level beginning around the time of ovulation, and remaining at the higher level for the rest of the
cycle. By taking her temperature on a chart each day of her menstrual cycle, a woman can retrospectively identify
when she may have ovulated. However, because the BBT does not give adequate advance warning of ovulation,
it cannot be used to identify the start of the fertile time. Therefore, it is of limited use for a woman who wants to
achieve pregnancy.
Figure 1. Temperature variations during a menstrual cycle

Figure 1 (above) illustrates the BBT variations during a model menstrual cycle of 28 days. In reality, the BBT may
rise more suddenly or more gradually. The typical pattern of a lower temperature before ovulation, followed by a
higher temperature immediately before, during, and after ovulation, can be disrupted by illness, stress, travel, or
interrupted sleep.
To use the BBT to determine the post-ovulatory infertile time:
1. Take your BBT every morning at the same time before getting out of bed (after at least 3 hours of sleep).
A special calibrated thermometer makes temperature reading easier. Take the BBT orally, rectally, or
vaginally, but take it at the same site each day so changes in BBT can be detected accurately.
2. Record your BBT readings daily on a special NFP chart (similar to that in Figure 4). Connect the dots for
each day so a line connects dots from day 2 to day 3, and so on.
3. Your temperature will probably rise at least 0.4° F around the time of ovulation and remain elevated until
the next menses begins. Your actual temperature and maximum temperature are not important, just the
rise over the baseline (pre-ovulatory) temperatures.
4. If you have 3 days of continuous temperature rise following 6 lower temperatures, you have ovulated
and your post-ovulatory infertile time has begun. To see the baseline and rise clearly on the chart, draw a
line just above (0.1 degree line) the lower (pre-ovulatory) temperatures. When you record 3 continuous
temperatures above this line and the last temperature is 0.4 degrees higher than this line, your post-
ovulatory infertile time has begun.
5. If you cannot detect a sustained rise in BBT, you may not have ovulated in that cycle. A true post-ovulatory
BBT rise usually persists 10 days or longer.
6. Some women notice a temperature drop about 12 to 24 hours before it begins to rise after ovulation,
whereas others have no drop in temperature at all. A drop in your BBT probably means ovulation will
occur the next day.
7. To conceive. It is not possible to predict fertile days using BBT. By the time the rise is detected, you
are probably in the infertile phase of your menstrual cycle and have missed the opportunity to become
pregnant. A biphasic temperature pattern, however, can let you know you are probably ovulating normally.

1. To avoid pregnancy. Because the ovulation may occur as early as day 7 of the menstrual cycle, assume
you may be fertile from just after menses (if your cycles are no less than 25 days in length) until your
temperature has remained elevated for at least 3 consecutive days. The most effective way to use BBT
charting when avoiding pregnancy is to avoid intercourse all through the first part of your cycle, until the
temperature rise indicates you have ovulated.
Note: Because BBT does not provide information about the beginning of the fertile time; it is rarely used as the
only fertility indicator by a woman who is using NFP.
Changes in cervical secretion signal the beginning and end of the fertile time, even among those who have irregular
cycles. Observe your cervical secretions by “the look, touch, and the feel”:
• Look at the secretions on your undergarments, fingers, or toilet paper to determine its color and
consistency.
• Touch the secretions to determine their stretch and slipperiness.
• Feel how wet the sensation is at your vulva when you are walking.
When they first appear, the secretions may be scant but sticky and thick with a cloudy color. Highly fertile
secretions are clear, stretchy, wet, and slippery. Ovulation most likely occurs within 1 day before, during, or 1 day
after the last day of clear, stretchy, slippery cervical secretions. When you are observing your cervical secretions, do
not douche, because it can wash out the secretions, making it very difficult to notice changes.
Figure 2. Cervical secretion variations during a menstrual cycle.
Use your cervical secretions to identify the beginning and end of the fertile time:
1. Observe your cervical secretions every day, beginning the day after your menstrual bleeding has stopped,
and record them daily on a special chart (see Figure 2). To help you avoid confusing cervical secretions
with semen and normal sexual lubrication, some counselors advise complete sexual abstinence throughout
the first cycle.
2. Check secretions each time before and after you urinate by wiping (front to back) with tissue paper. Note
and record the color and appearance (clear, or cloudy) and consistency (thick, sticky, or stretchy) of the
secretions, and how they feel (dry, wet, or slippery). Record how much they stretch when pulled between
your thumb and index finger. Also, note and chart the sensations of dryness, or wetness at your vulva.
Always record the “most fertile” observations you see during the day.

1. Note the typical pattern in the cervical secretions:

• During menstruation, blood masks any other sensations of wetness or secretions.
• After the menstruation, the vagina may feel moist a few days, but not distinctly wet. There usually are
no observable secretions. (Some women do not have any of these dry days, especially if they have very
short cycles.)
• Next may come secretions that are thick and sticky, cloudy. The vagina still does not feel distinctly
wet. This can last for several days. Consider these days as fertile.
• As ovulation nears, your secretions usually become more abundant, and you will have an increasingly
wet sensation. Secretions become clear and slippery and can stretch 2 to 3 or more inches between
the thumb and forefinger. The peak or last day of wetness or clear, slippery secretions is assumed to be
about the time of ovulation.
• After ovulation, the secretions become thick, cloudy, and sticky or disappear until the time of the next
menstrual period.
2. Douching, vaginal infection, semen, foam, diaphragm jelly, lubricants, medications, and even the normal
lubrication of sexual arousal may interfere with the ability to notice a clear-cut secretion pattern.
To conceive: Have intercourse when cervical secretions are present. The probability of conception is greatest
when the secretions are clear, stretchy, and slippery.
To avoid pregnancy: Check for secretions as soon as your menses are complete. (Some counselors recommend
avoiding intercourse during menses because it is difficult to detect secretions when they are mixed with menstrual
blood.) You can have sexual intercourse on pre-ovulatory days if no secretions are present. (Some counselors
recommend abstaining the next day and night following intercourse to allow time for bodily fluids to drain out of
your body so you will not confuse semen and arousal fluids with cervical secretions. The following day, check your
cervical secretions.) The fertile time begins when cervical secretions are first observed until 4 days past the peak
day (the last day of clear, stretchy, slippery secretions.)

See Figure 3 (below) for an example of a chart completed by a woman using BBT, cervical secretions, cervical
position and feel, and other minor indicators.
Figure 3. Symptothermal variations during a model menstrual cycle
Learning about their fertility is important for men and women, regardless of which family planning
method they use or whether they choose to use family planning at all. Information about their fertility and the skills
to apply this information to oneself is called “fertility awareness.” Fertility awareness increases peoples’ knowledge
of their reproductive potential and enhances self-reliance. Some couples like the active involvement required of
the male partner, who learns about his own and the woman’s fertility and then abstains from intercourse when the
woman is fertile. Fertility awareness information can be used for a number of purposes:
To conceive: Couples have intercourse on days the woman is potentially fertile. These include the days she observes
cervical secretions or notes that her cervix is relatively soft and open. The chances of achieving a pregnancy are
greatest when the woman observes clear, stretchy, slippery secretions. Conception is most likely to occur within 1
or 2 days of peak mucus (secretions).
To detect pregnancy: A post-ovulatory temperature rise (see the section on “Basal Body Temperature Charting”)
sustained for 18 or more days is an excellent early indicator that pregnancy is under way.
To avoid pregnancy: For maximum effectiveness, couples should abstain from intercourse during the entire
fertile time as indicated by the NFP method.

To detect impaired fertility: Charting fertility signs costs relatively little and can aid in diagnosing and treating
fertility problems due to infrequent or absent ovulation. Women who do not ovulate tend to have a meandering
BBT pattern throughout the cycle, rather than the typical biphasic pattern (lower in the first part and higher in
the second).
To detect a need for medical attention: Changes in cervical secretions, abdominal pain, and other signs may
indicate the need for medical attention.

Module 6: The Standard Days Method
Introduction
The Standard Days Method (SDM) identified days 8 to 19 as the average woman’s fertile
days, if her cycles are anything from 26 to 32 days.
With the use of a tool called CycleBeads™, the practice of NFP becomes easy. This module discusses
the SDM and how it can be used effectively by couples and taught easily by providers. This helps the
couple track fertile and infertile days.
STANDARD DAYS METHOD (SDM)

• The Standard Days Method is based on the woman’s menstrual cycle. It identifies cycle days 8th
to 19th as the woman’s fertile period.
• It works for women with menstrual cycles of 26-32 days. Colored bead/CycleBeads™ are used to
help the woman keep track of her fertile and infertile days.
• Recall that there are certain days during woman’s menstrual cycle when she can become
pregnant.
• The SDM is based on these facts of woman’s fertility.
• Effectiveness Rate of the SDM is 95.25% based on an efficacy study done by IRH, Georgetown
University in accordance with international research standards.
Source: WHO Medical Eligibility Criteria 3rd Edition 2004 listed as FAB Method
• For women with cycles of 26-32 days, days 8-19

Day 8 Day 19
have been identified as their fertile window, based
on averages of statistical probabilities. This 12–day
Fertile Window
fertile window includes the life span of sperm cell,
5 days 12-24 hours
ovulation time, the life span of egg cell and the six-
day variation in the cycle range
• To use the SDM, the woman identifies days 8 through
Menses Probable timing of ovulation
Menstrual Cycle 19 of her cycles and avoids sexual intercourse on

these days.

The CycleBeads™
THE CYCLEBEADS™
• The CycleBeads™ represents the woman’s menstrual cycle. Each bead represents a day of her
cycle.
• The RED bead marks the first day of menstruation.
• The WHITE beads represent the days when a woman can become pregnant.
• The BROWN beads are the days when a woman cannot become pregnant.
• The CHOCOLATE BROWN bead and the BLACK bead (barrel) are indicator beads. These determine
if the woman is within the required cycle range.
A woman can use this method if her cycles are between 26-32 days. To use it effectively, the couple
needs to abstain from intercourse during the days when she can become pregnant.

HOW TO USE THE CYCLEBEADS™

1. On the first day of menstruation, place the rubber ring on the red bead.
2. Mark the first day of menstruation on the client card.
3. Every morning, move the rubber ring to the next bead moving from the narrow portion of the
band towards the wider end.
4. Move the rubber ring even on days of menstruation.
5. On the day when menstruation starts again, move the rubber ring to the red bead. A new cycle
has started.
6. Abstain from intercourse on white bead days for those who wish to avoid pregnancy. Have
intercourse on white bead days for those who wish to achieve pregnancy.
7. To check if the bead was moved already, check client card for the date when menstruation
began. Count the days since this date and then move the rubber ring to the corresponding
bead.
How to Use the CycleBeads ™
1. On the first day of 2. Mark the first day on the

menstruation, place the client card
rubber ring on the RED bead
3. Move the band every Always move the band from

morning, to the next bead narrow to wide end of bead

Warning Signs and Precautions

1. Take note of the number of menstrual cycle days.
• If you start your period before you get to the dark brown bead, you have had a short
cycle – less than 26 days.
• If you get to the last bead and do not start your period by the next day, you are having
a long cycle – more than 32 days.
2. The first time this happens, take note and mark the client card.
3. The second time this happens within a 12-month period, go back to the service provider for
further counseling on use of another method.
• If the cycle is 42 days or over, have a pregnancy test. If the result is positive, refer for prenatal care,
if negative, advise another method.
Who Can Use the SDM:

• The World Health Organization, in its publication “Medical Eligibility for Contraceptive Use”,
states that the SDM, like other fertility awareness-based methods, poses no adverse risk to
women who choose to use it.
• The SDM is intended for women who meet certain criteria:
1. Women with cycles of 26-32 days.
2. Women who are using family planning for the first time.
3. Couples who can communicate and abstain during fertile days.
4. Couples not at risk of STIs.
5. Contraceptive shifters may also use the SDM provided the following criteria are met.
Tools/aids in SDM counseling:

• Provider Calendar – a 12-month calendar to help calculate the length of the woman’s menstrual
cycle. A provider must ask the client’s previous menstrual cycle (PMP) and the last menstrual cycle
(LMP). The provider will guide the client in calculating the PMP and the LMP.
• Follow-up Visit Cue Card – a job aid that helps the provider determine if the couple/woman still
meets the criteria for using the SDM.
• CycleBeads™
• CycleBeads™ Cue Card – this job aid reminds the provider of the key points to discuss when
providing counseling.
• Tell participants how to use the CycleBeads™.

Month First Day of Menstruation

January 27 Jan-Feb: Cycle 1 _______
February 24 Feb-Mar: Cycle 2 _______
March 26 Mar-Apr: Cycle 3 _______
April 25 Apr-May: Cycle 4 _______
May 21
Average cycle length: 26-32 days

Long cycle length: more than 32 days
Short cycle length: less than 26 days
Special cases for use of SDM:

Contraceptive shifters may also use SDM provided criteria to qualify are met, as follows:
• Postpartum and/or Breastfeeding

- monthly menstruation has returned
- has completed at least 1 cycle with 26-32 days
- expects current cycle to be within 26 and 32 days
• Who recently used contraceptive pills?
- menstrual cycles were within 26 to 32 days before pill use
- expects current cycle to be within 26 to 32 days
• Who recently used injectables?
- at least 3 months have passed since the last injection
- menses have returned
- cycles were within 26 to 32 days before injection
- last menstrual cycle was within 26-32 days
• Who recently used IUD?
- IUD has been removed
- menstrual cycles while using the IUD are within 26-32 days

Case Study samples:
Case # 1:
• Tricia has been breastfeeding her daughter for the past 18 months. For the past year she had
her menstruation every month, about the same time. Her last menstruation started November
5 and she expects her next period on the first week of December, probably the 2nd or 3rd.
Case # 2:
• Vina stopped using birth control pills 4 months ago. Her menstruation returned right away and
seems to be normal just like it was before. The first day of her last menstrual period was October
25. She expects her next period on November 22. Her period before started September 25.
She remembered this because it was her wedding anniversary. Today is October 29.
Case # 3:
• Today is August 25. Sheila would like to start on SDM use but her last Depo-injection was March
24 and was due for injection last June 24 but she did not have the shot. While using injectable
her menses was lighter and sometimes she did not get her period.
Case # 4:
• Aling Lora visited the clinic to find out if she can switch to SDM as a family planning method.
She is on IUD use for almost a year now. She gets her monthly menses at exactly the same time
every month at about 27 days interval from onset of her menses.

Case # 1 Answer:
• Tricia can use the SDM even if she is breastfeeding. She meets the criteria for breastfeeding
mothers which is at least 4 menstrual periods and that her cycle was 26 – 32 days. Her expected
current cycle is either 27 or 28 days, from Nov. 5 to either Dec. 2 or 3.
Case # 2 Answer:
• Vina can use the SDM because she meets the criteria for previous pill users, which is that her
cycles were 26 to 32 days before she started taking the pill and that her current cycle is 26 to 32
days. Her last cycle was 30 days from Sept. 25 to Oct. 24, and she expects her cycle to be 30 to
31 days from October 25 to either Nov. 24 or 25.
Case # 3 Answer:
• Although more than the required 3 months have passed since her scheduled injectable shot,
Shiela cannot use the SDM yet because there is no information whether her menses have
returned. She does not meet the criteria for injectable users to have the return of menses and if
the cycle is between 26 to 32 days.
Case # 4 Answer:
• Aling Lora can use the SDM because she meets the requirements for the cycle length. However,
part of counseling may be to assess couple communication to practice abstinence during the
white bead days.
ADVANTAGES OF SDM
• No need for counting or charting since the SDM makes use of beads for tracking the cycle days.
• Can be used either to avoid or achieve pregnancy;
• No health related side effects associated with their use;
• Very little cost
• Provides opportunities for enhancing the couple’s sexual life
• Not dependent on medically-qualified personnel the technology can be transferred by a trained
autonomous user
• Once learned, may require no further help from health care providers.

DISADVANTAGES OF SDM
• Can be used only by women whose cycles are within 26-32 days.
• Can become unreliable for women who have conditions that change the menstrual length.
RETURN VISITS
• SDM counseling can generally be provided in one client visit. However, each program and provider
may determine if a follow-up visit is required for additional information and services as appropriate.
IMPORTANT:
• Tell the client to return within 7 days of her next menstrual period and ask her to bring her
CycleBeads™, client card and if possible, her partner.
• Ask client to return to the clinic for any problems or warning signs that may come up.
Confirm understanding of the method using the following questions

1. Why do you plan to use the method? (Confirm fertility intention)
2. What do you do when you get your menstrual bleed?
3. When do you move the rubber ring?
4. Do you move the rubber ring on days of menstrual bleeding?
5. What do the brown beads mean? What do the white beads mean?
6. How will you prevent pregnancy?
7. What will you do if your partner wants to have intercourse on a white bead day?
8. What should you do if you get your period before moving the band to the chocolate brown
bead?
9. What should you do if a day has passed since you moved the band to the black bead?
10. How do you feel going home with this method?


SDM offers a simple, effective, natural and modern method of family planning. It is easy to
teach, learn and use. Being natural, it goes with the modern health trend. It is free from side effects. It
is best for couples who can communicate and express their care for each other through the timing of
their lovemaking.
In Summary: SDM
üSimple
üNatural
üSafe
üEffective
üEasy to use
üModern method
üPromotes partner communication





Standard Days Method
1. Can anyone use CycleBeads™?

No. The Standard Days Method, on which CycleBeads™ are based, works very well for women who
usually have menstrual cycles between 26 and 32 days long. Women who often have cycles shorter than 26 days
or longer than 32 days are not good candidates for this method. Also, women who would not be able to avoid
unprotected intercourse on the days they might get pregnant are not likely to be successful using this method.
Like any method of family planning, SDM isn’t for everyone.
2. How many women have cycle lengths that are between 26 and 32 days long?
According to data from the World Health Organization, about 80% of cycles are between 26 and 32
days long and most women have most of their cycles within this range.
3. What if I’m using CycleBeads™ and I start my period before I get to the darker bead?
If you start your period before you get to the darker bead that means you have had a cycle that is less
than 26 days long. CycleBeads™ work best for women who usually have cycles between 26 and 32 days long. If
you have more than one cycle less than 26 days long in a 12-month period, CycleBeads™ will not work well for
you and you should use another alternative to meet your family planning needs.
4. What if I’m using CycleBeads™ and I start my period before I finish all the beads?
This is what will happen most of the time. As soon as you start your period, just skip over any remaining
beads and put the ring on the red bead. Then continue moving the ring one bead per day.
5. What if I’m using CycleBeads™ and I get to the last bead, but I still haven’t started my period?
If you move the ring to the last bead and you don’t start your period by the next day that means you
are having a cycle that is more than 32 days long. CycleBeads™ work best for women who usually have cycles
between 26 and 32 days long. If you have more than one cycle that is more than 32 days long in a 12-month
period, CycleBeads™ will not work well for you and you should use another alternative. If you move the ring to
the last bead and you don’t start your period within a week, you should consult your doctor.
6. What should I do if I forget to move the ring?

It is best to always mark the day that you start your period on a calendar. If you know the date you
started your period this cycle, you can go to your calendar and count the days between that date and today.
Then count the same number of beads on the CycleBeads™, beginning with the red bead. Just move the ring to
the correct bead and continue moving the ring every day. If you are unable to determine what day you started
your cycle, wait until your next period to begin using CycleBeads™.

7. If I start my period late at night or early in the morning, what should I do about moving the ring?
You should move the ring to the red bead on the day that you start your period. If you know that you
started your period anytime before midnight, move the ring to the red bead that day. The next morning (or
whenever you normally move the ring) you should move it to the following bead. If you started your period
during the night and are not sure what time it started, move the ring to the red bead when you wake up and
consider that day to be Day 1 of your menstrual cycle. You will then move the ring the following day.

Standard Days Method
The Clinical Scenario

A 24-year-old newlywed comes to you for advice on natural family planning, as requested by her husband’s
family. Her menses are regular. She asks you if there is a more scientific method of doing natural family planning
and what are the probabilities of getting pregnant.
Clinical Bottom Line

With the Standard Days Method, the couples modify their sexual behavior when the woman is fertile and
it provides significant protection from unplanned pregnancy if it is used correctly. The probability of pregnancy
with this method is 5% if correctly used, but with typical use the rate is 12%. The typical use rate must be seriously
considered before recommending this method of family planning to couples. There is more than a one out of ten
chance of pregnancy with typical use of the Standard Days Method.
Citations
Marcos Arevalo, Victoria Jennings, Iris Sinai. Efficacy of a new method of family planning: the Standard Days
Method, Contraception 65 (2002) pp. 333-338.
Corresponding Author’s Name and Contact Information

Victoria Jennings, E-mail: [email protected] (V. Jennings). Fax: +1-202-687-6846
Search Terms Standard Days Method, Contraceptive Efficacy, Pregnancy Rate
Level of Evidence 2b: Individual Cohort Study of Harm
Three-Part Do women using the Standard Days Method have the same pregnancy rate or probability
Clinical of pregnancy as compared to other user-controlled methods currently available (such as
Question cap, condoms, diaphragms, and spermicides)?
The Study Patients

A total of 478 women (married or living with a stable partner) from 5 sites in Bolivia (Trinidad), Peru
( Juliaca and Lima) and Philippines (La Trinidad and Tuba) between 18 and 39 years old who had regular cycles
of 26 and 32 days long desiring to delay pregnancy at least 1 year were admitted to the study.

Exposure of Interest: Standard Days Method

The Institute of Reproductive Health at Georgetown University proposed a fixed formula among women
who typically have menstrual cycles of 26 to 32 days and consider themselves fertile during days 8 to 19 days of
their cycles. To prevent unplanned pregnancy, they avoid unprotected intercourse on those days.
The Outcome: Pregnancy Rate Methodological Issues

Subjects in the Standard Days group and the comparison groups were defined and found similar in other
important ways. The exposures and outcomes were not measured objectively nor measured blind because of the
nature of the methods. Follow-up was adequate and complete.
The Evidence
Comments:
1. In the table, the “No” group in the method used (not SDM) includes all those study participants who
did not use the SDM correctly, those who used protective devices during fertile dates, and those who had
unprotected sex.
2. This trial showed the Standard Days Method (SDM) is an effective method of family planning, when
used correctly. With a pregnancy rate of 5% with correct use, it is comparable to male condoms (5%) and
even better compared to other user-controlled barrier methods (spermicides – 6%, cap- 9%, diaphragm-
6%). The SDM is simple to teach, learn and use.
1. The chance of pregnancy using the Standard Days Method is 12% with typical use and therefore
the method shares the handicap of all user-controlled methods in that their effective use depends
on user (the couple’s) behavior. The typical use rate should be acknowledged when reviewing this
family planning method option with couples. Most pregnancies occurred during the first cycles of
the method use (42% of pregnancies occurred in the first three cycles) and very few in the latter
cycles (only three pregnancies in the last five cycles).
One has to make 26 couples use methods other than SDM for a year, to save one pregnancy.

Answer to Clinical Scenario

As with Natural Family Planning methods, the couple must follow the instructions during counseling
closely to achieve maximal efficacy rates. With a pregnancy rate of 5% with correct use, it is comparable to male
condoms (5%) and even better compared to other user-controlled barrier methods (spermicides – 6%, cap- 9%,
diaphragm- 6%). SDM is simple to teach, learn and use. However, with typical use, it is clear that SDM has its
flaws. With typical use, there is a 12% probability of pregnancy — not reassuring to couples who desire a very
reliable method of fertility control.
A Publication of the Philippine Evidence-Based

Reproductive Medicine Network
A Study Group of The National Institute of Health
Evidence is published by The Philippine Evidence-Based
Reproductive Medicine Network.
To learn more about our organization, please write or call:
The Philippine Evidence-Based Reproductive Medicine Network
This publication was made possible through support provided by

the United States Agency for International Development (USAID),
under the terms of contract #492-C-00-02-00019-00.
The opinions expressed herein are those of the author(s) and
do not necessarily reflect the views of USAID.
A Publication of the Philippine Evidence-Based
Reproductive Medicine Network
Day Day
8
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Module 6: TwoDay Method Supplemental Reading
TwoDay Method
The TwoDay Method is a natural family planning method developed and tested by the Institute for
Reproductive Health, College of Medicine, Georgetown University, Washington, USA. Effectiveness Rate is
96%.
The TwoDay Method is one of the best ways to predict and determine when ovulation occurs. Couples
who can avoid sexual intercourse several consecutive days each cycle (mean # of days of abstinence is 12 + 1 day)
and who are at low risk of STI/HIV-AIDS are eligible to use this method.
Advantages
TwoDay method helps the woman become aware of her body and her own fertility. It does not require
distinguishing among different types of cervical secretions, as compared to the Mucus Method. Women of any
menstrual cycle length can also use it.
Furthermore, it allows the couple to reassess and re-evaluate their fertility goals and provides a more
meaningful interaction between the husband and the wife. Thus, using the TwoDay method helps enhance the
loving relationship of husband and wife by promoting couple communication
Finally, the the TwoDay Method is easy to teach, learn and use.
Disadvantages
The TwoDay Method requires daily observation and recording of the cervical mucus. Does not protect
against STIs and HIV-AIDS.
STEPS OF THE TWODAY METHOD

1. Identify secretions
a. Are the secretions normal?
• Have you ever noticed secretions at one time or another?
• Have you noticed secretions recently?
• What are your secretions like?
• Have you ever experienced secretions that smell bad or is accompanied by itchiness or pain?
b. Can the woman focus attention on her secretions several times a day everyday?
• Can you remember to check your secretions everyday?
• Can you do this several times a day?
• Can you record in your client card if you had secretions or not?

c. Special Circumstances:
• Post-partum or breastfeeding – should have at least 4 menstrual periods after delivery
• Recent use of 3-month injectable – 4 months should have passed since the last injection and should
have at least 1 menstrual period after the 4 months
• Recent use of pills – should have stopped taking the pills and should have had her menstrual period
after stopping the pills
• Recent use of IUD – should have had her IUD removed
• Recent miscarriage or abortion – make sure that bleeding associated with the loss of the baby has
ended and should have had at least one menstrual period after the miscarriage
2. Use the algorithm:

TwoDay Guidelines
To know when you can get pregnant, you should be aware of your secretions everyday. If you had secretions
TODAY or YESTERDAY, you can get pregnant. Abstain from sexual intercourse today to avoid pregnancy.
When you are menstruating or did not have secretions YESTERDAY or TODAY, it is an infertile day. You can
have sexual intercourse without fear of pregnancy.
When does a woman experience secretions?

After menstruation, there may be some days without secretions. After which, a little secretion may be
noticed. At the start, it is little in amount, and later increases in quantity.
When does a woman experience secretions?

After some days with secretions, days without secretions follow. Later, menstruation will come again. This
happens every month. Once it starts, secretions continue to appear for several consecutive days.
Can you say what secretions are like?

Secretions are not always the same. Because it is little at the beginning, the woman has to pay more
attention to be able to see it and feel it. Later, it will increase in quantity and is easier to see and feel it.
Can you say what secretions are like?

Even if secretions change in quantity or look different, all secretions indicate that you can get pregnant.
To avoid pregnancy, avoid sexual intercourse when you experience secretions.
How can a woman pay attention to her secretions?

A woman can observe for secretions by paying attention to her secretions several times a day, starting from
midday until before going to sleep:
a. Looking at it/checking secretions when in the toilet (wiping oneself with tissue before passing urine)
b. Looking at underwear
c. Touching the genital area with clean fingers
d. Feeling in the vulva without interrupting daily activities
e. Feeling of dampness or not
How does a woman keep a record of her secretions to be able to identify her fertile days?
The client card helps the user keep a record of her secretions to be able to identify her fertile days.

TwoDay Method Client Card

Write the date of the first day of menstruation. Look for the day of the week on the card on which the
method was started. Fill in the corresponding mark on that day.
MARK: - for days with menstruation

O - for days with NO secretions
X - for days with secretions
Determine if today you can get pregnant or not. When your menstruation comes, start marking on a new card.
Remember to mark your card every night before sleeping.
3. Communicate with Partner

For the management of Fertile Days, ask yourself these questions: How would you or your husband feel
if you cannot have sexual intercourse for several days in a row? What do you think would you do during the
fertile days to avoid having sexual intercourse? Are you as a couple able to communicate openly about wanting
to have sexual intercourse and how to avoid it?

Module 7a: Lactational Amenorrhea Method
Introduction
The Lactational Amenorrhea Method is a natural technique of spacing children that was
developed for breastfeeding women. It is based on the temporary natural infertility that happens after
the mother has given birth and from exclusive or nearly exclusive breastfeeding. However, three (3)
important criteria must be present for this method to be effective. These criteria together with the
advantages and disadvantages of using this family planning method are discussed in this module.
• Does breastfeeding prevent pregnancy?

• How many have you heard that breastfeeding mothers don’t get pregnant? Do you know any
lactating mother who got pregnant? What about a lactating mother who was able to space her
children?
• What maybe the reasons why some breastfeeding mothers get pregnant while others don’t?
• We will park your answers and we can review them after the session
LACTATIONAL AMENORRHEA METHOD

• Women who are fully or almost fully breastfeeding and have no menstruation yet can use
breastfeeding as a family planning method within the next six months after delivery.
• The Lactational Amenorrhea Method (LAM) is a modern, temporary family planning method that
has been developed as a tool to help support both breastfeeding and family planning use. It is
based on the temporary natural infertility resulting from certain patterns of breastfeeding.
• “Lactational” means related to breastfeeding;

• “Amenorrhea” means not having menstrual bleeding;
• “Method” means a technique for contraception.

Training Manual for Natural Family Planning
L - actational
• Is the production of milk by a mother’s breasts
• In order to produce contraceptive effect, the breastfeeding has to be either exclusive/fully
breastfeeding or almost exclusive/almost fully breastfeeding
• Exclusive or fully breastfeeding means that no other liquid or solid food is given to the infant
except breast milk;
• almost exclusive or almost fully breastfeeding means that the infant is being given vitamins, a
little of mineral water or juice may be given aside from breastmilk;
• feeding interval should not exceed four (4) hours during the day and six (6) hours at night
A - menorrhea
• means having no menstrual bleeding
• the breastfeeding woman’s menstruation has not yet returned (this does not include the
spotting that occurs 56 days postpartum)
M - ethod
• means a technique for contraception
• LAM has been proven to be more than 99.5% effective if woman meets the 3 criteria established
for use of method, namely:
Criteria to be considered when using LAM:

1. She is fully or nearly fully breastfeeding her infant
2. She is amenorrheic (i.e., her menstruation has not returned)
3. Her infant is less than 6 months old

Physiology of Lactational Amenorrhea Method

• LAM is a method which is based on the physiology of fertility and lactation
• The more the baby suckles, the more the body produces prolactin, which is responsible for milk
production. Prolactin in the woman’s body is known to suppress ovulation.
• These are the reasons why the three (3) criteria must be met in order to keep the woman
producing milk; and keep the prolactin continuously high in her body.
Physiology of LAM
When can LAM be initiated?

• LAM can be initiated at any time during the first six months postpartum
• The best time to begin counseling a woman about LAM and other family planning methods
is during the antenatal period to allow her to make an informed choice about which method
she wishes to use following the birth of her baby.
• LAM can be started immediately postpartum. The health care provider can help prepare the
woman to begin breastfeeding immediately after birth and, if the woman has decided to use
LAM, verify that she understands the criteria for LAM use.

Advantages of LAM
• LAM is universally available to all postpartum breastfeeding women
• LAM has been proven to be 99.5% effective
• The use of LAM does not require a physical examination
• With LAM, protection from unplanned pregnancy begins immediately postpartum
• There are no family planning commodities required while client is using LAM
• The use of LAM contributes to improved maternal and child health and nutrition
• LAM serves as a bridge to the use of other family planning methods; the use of LAM during the
immediate postpartum allows a woman time to consider which long-term method is best for
her
Disadvantages of LAM
• LAM is considered as a temporary, short-term method which is effective only for a maximum
of six months
• If a mother and child are separated for extended periods of time because of work outside the
home, LAM effectiveness may decrease
• Full or nearly full breastfeeding may be difficult to maintain for up to six months due to a variety
of social circumstances
• Like all other NFP methods, LAM does not protect a client from STDs and HIV/AIDS


LAM is a natural family planning based on the temporary infertility created by full or almost full
breastfeeding. It’s typical use-effectiveness of 98% and use-effectiveness of 99.5% is comparable with
other family planning methods. To ensure effectiveness, all three criteria must be present, i.e., the the
woman must be: (1) fully or almost fully breastfeeding; (2) menstruation has not yet returned; (3) baby
is less than 6 months or below.
It is also important to note that the woman should be counseled on using a reliable FP method
if any of the three criteria no longer applies to her.
Optimal breastfeeding practices include exclusive breastfeeding for the first six months and
breastfeeding with appropriate complementary feeding for two years or more. LAM is a family planning
method which supports improved breastfeeding health child pacing, child survival, and woman’s
health.




Lactational Amenorrhea Method
1. What is the difference between LAM, breastfeeding, and amenorrhea?

LAM is a contraceptive method, based on the physiology of breastfeeding. LAM is a method of
contraception that a woman consciously chooses to use to reduce her chance of becoming pregnant by adhering
carefully to the three criteria.
Breastfeeding is a feeding practice.
Amenorrhea, or the absence of menstrual bleeding, reflects a reduced risk of ovulation, but neither
breastfeeding nor amenorrhea is a family planning method.
2. How does LAM work?

The infant’s suckling suppresses the production of the hormones that are necessary for ovulation.
Without ovulation, pregnancy cannot take place.
3. How many return visits are needed by LAM users?

At the very least, a client needs to return for a visit if she perceives any breastfeeding difficulties or as
soon as any one of the LAM criteria changes.
An additional follow-up visit at five to six months postpartum is essential to determine the client’s
plans for switching to another contraceptive method and for introducing complementary foods when her baby
is six months old. Whenever possible, the health care provider should schedule the visit when the client brings
her baby for assessment or immunization, in this way saving the mother time by reducing the total number of
visits to the clinic.
4. What contraceptive methods can be used after LAM?

Women who are breastfeeding and who switch to another method should be advised on contraceptive
options. Combined oral contraceptive pills (COC) and combined injectables are not recommended before six
months postpartum because they contain estrogen, which may decrease the quantity of breastmilk. After six
months postpartum, a woman who is breastfeeding can use any method of her choice as long as she is properly
screened and meets the eligibility criteria.
5. Can a woman who is separated from her baby use LAM?

A woman who is separated from her baby regularly for more than four to six hours cannot expect a
high level of contraceptive protection from LAM, even if she expresses milk during the separation. Expressing
breastmilk is definitely not effective as suckling at the breast in suppressing ovulation, and for this reason a
woman who expresses her milk may not rely on LAM.

Scientific Basis of Lactational Amenorrhea Method
To understand what creates the state of infertility that occurs among postpartum breastfeeding women,
it is important to understand the changes that occur in the menstrual cycle. Scientists have studied the return
of fertility among breastfeeding women and compared this with the cycles of non-pregnant, non-lactating
women. In non-pregnant, non-lactating women, hormones from the pituitary gland, which are regulated by
the hypothalamus, initiate a series of other hormonal changes that cause the development and maturation of an
ovarian follicle containing an ovum or egg cell. The follicle secretes estrogen and eventually ruptures, releasing
the egg cell. The ruptured follicle forms a temporary gland known as the corpus luteum and begins to secrete
progesterone in addition to the estrogen. The estrogen and progesterone cause the lining of the uterus to thicken
in preparation for the implantation of the egg cell should it be fertilized. If the egg cell is not fertilized or if it does
not implant, the uterine lining is shed during menstruation.
This cycle of events is sometimes modified, as when a woman becomes pregnant or breastfeeds. When
a woman breastfeeds, the stimulation of the nipple by the infant’s suckling sends nerve impulses to the mother’s
hypothalamus, which responds by changing the production of the pituitary hormones. As described earlier, these
hormones are needed to stimulate ovulation. Without this stimulation, the ovaries do not produce a ripe egg
or prepare the uterus for pregnancy. Therefore, there is a time when breastfeeding women do not ovulate or
have menstrual periods. Hence the term, “lactational amenorrhea” — which is a lack of menses resulting from
breastfeeding. As we will discuss later in the presentation, the lack of menses is usually a sign of temporary
infertility.
The infant’s suckling is the stimulus that initiates the state of lactational amenorrhea for breastfeeding
women. Women choosing to use LAM for contraception maintain lactational amenorrhea and infertility by
breastfeeding intensively.

EFFECTS OF BREASTFEEDING ON OVARIAN ACTIVITY
The above is a graph which illustrates the importance of maintaining an intensive breastfeeding pattern
if a woman, desires to use LAM. It shows a low level of progesterone, which indicates that normal ovulation is
not occurring and pregnancy is not possible. This low level of progesterone is typical for women who maintain an
intensive, sustained, high frequency pattern of breastfeeding.
Source: Contraceptive Technology and Reproductive Health Series (Family Health International)

Module 7b:
Mucus Method for Breastfeeding Women
Introduction
Breastfeeding alone does not exempt a woman from pregnancy. However, even a breastfeeding
mother experiences changes in her body that she can observe to determine if ovulation will be taking
place soon. The Mucus Method for Breastfeeding Women utilizes the Cervical Mucus Method of family
planning discussed earlier. It is recommended for breastfeeding women who do not meet the criteria
for the use of the Lactational Amenorrhea Method anymore.
The Mucus Method allows a breastfeeding woman to recognize her infertile period even if she is
not ovulating.
As we have learned in the LAM or Lactational Amenorrhea Method, a woman who fully
breastfeeds her baby, has not had her menses yet and her baby is 6 months old and below experience
a physiological infertility. However, if any of the 3 conditions is absent, LAM is no longer applicable and
the Mucus Method for Breastfeeding women or LAM Interface may be introduced to them.
Effectiveness Rate: 99%
Mechanism of Action
• Women who breastfeed usually exhibit a basic infertile pattern (BIP) of no mucus or sticky,
pasty mucus with a feeling of dryness in the vaginal area.
• During the breastfeeding period, the woman may feel one or a few days of wetness with
sticky mucus. This may herald impending ovulation.
• Observation of these mucus changes and sensations in the vaginal area can help a woman
postpone/avoid pregnancy.

Training Manual for Natural Family Planning
Module 7b: Mucus Method for Breastfeeding Women
The following may use the MM for Breastfeeding or LAM Interface:

• Breastfeeding women whose menses have not returned yet
• Women with long cycles
• Women willing to observe and record changes in their cervical mucus secretions and interpret
the records
• Couples who can avoid sexual intercourse several consecutive days each cycle
• Couples who can communicate on the timing of their sexual intercourse
Guidelines for the Mucus Method for Breastfeeding Women or LAM Interface:
1. Observe secretions for two (2) weeks following guidelines of Mucus Method on observing
and recording. The purpose of this is to determine the basic infertile pattern (BIP).
2. The pattern may be either dry (NO mucus seen or felt) or dry but having sticky, pasty mucus
(that is unchanging mucus day after day after day) for fourteen (14) days is seen. Abstain
during this time.
3. If either of these patterns continues, apply Early Days Rules (EDR). Lovemaking is available
on alternate evenings only.
4. If there is a change in the mucus secretions from dry to wet, abstain on all days of mucus
changes and on all days when wet mucus is seen or felt. Then, wait and see, count one,
two, three more days after the changes end before applying EDR again. Do NOT apply the
Peak Day Rule.
These guidelines also apply for women with very long cycles.

Blank Breastfeeding Chart

Answers to Charting Exercises:
1. Completed Chart
• The Basic Infertile Pattern is from Cycle Days 1-14 or Jun 2-15, 2008
• Lovemaking Days are available on Cycle Days 15, 17, 25, 27, 29, 36, 38, 40 or Jun 16, 18, 26, 28,
30 and July 7, 9, 11, 2008.
Sample Completed Breastfeeding Chart

2. Practice MM for BF chart

• The Basic Infertile Pattern is from Cycle Days 1-14 or Dec. 5 -18, 2007.
• Lovemaking days are available on Cycle Days 15, 17, 25, 27, 29, 36, 38, 40 or Dec. 19, 21, 29, 2007
and Jan 2, 9, 11, 13, 2008.
Practice Breastfeeding Chart

Advantages:
• Allows a breastfeeding woman to determine her fertile and infertile periods
• Can be used by women with long cycles
Disadvantages:
• Requires daily observation and recording of the cervical mucus.
• It is tedious because it entails the daily observing and recording of the mucus changes until
ovulation returns.
• There may be long periods of abstinence especially when establishing the Basic Infertile Pattern.
SUMMARY/CONCLUSION
The Mucus Method for Breastfeeding Women or LAM Interface Method of Family Planning is
used by lactating women who do not meet any one or all of the criteria for the Lactational Amenorrhea
Method. With this method, the woman observes the daily cervical mucus changes and sensations
in her vaginal area. Like any natural family planning method, the Mucus Method for Breastfeeding
Women or LAM Interface Method helps the woman become aware of her body and her own fertility.











LAM Interface
1. How does breastfeeding affect a woman’s mucus secretions?

Breastfeeding, first of all, affects ovulation. It is the production of the milk that suppresses ovulation.
And it is the infant’s suckling mechanism that makes the mother produce more milk. Having the 3 LAM
conditions makes a woman experience temporary physiological infertility. Once any of the three conditions is
lost, there is a probable return to fertility. However this is not absolute. A woman who is breastfeeding may
experience that ovulation is likely returning but not quite. Sometimes she can go on for months or even a year
without experiencing menstruation. Keeping track of her daily mucus secretions can be the basis for knowing
when she is ovulating, whether she has menstruated or not. Mucus can either be absent completely or can
appear as dry pasty and unchanging. This would be her Basic Infertile Pattern (BIP). Thus only when she
experiences changes in the infertile pattern of her mucus would her body be warning her that she is nearing
ovulation. The guidelines then would need to be carefully followed throughout this time.
2. Who can most likely follow the Breastfeeding/Mucus guidelines?

Naturally, a previous user of the Mucus method would find using the Breastfeeding /mucus interface
easier than someone who has never observed her mucus before. However, documented successes of women who
use the method without any previous knowledge of the mucus method are available worldwide. Effective use of
the method is made easier by the husband’s cooperation and the fact that more than ever, at this time of a recent
delivery, the couple is highly motivated to prevent a surprise pregnancy.

Postponing Pregnancy During Breastfeeding
The Ovulation Method is particularly suitable for the woman who is breastfeeding because it enables
her to recognize natural periods of infertility. After the birth of the baby, there is a natural period of infertility.
This can be prolonged for months or even years if a mother breastfeeds her baby. It is nature’s way to space babies
and help the mother care for her little infant without the stress of another pregnancy. However, a mother must
be aware of what it means to be totally breastfeeding: the baby depends entirely on the breast for nutrition and
liquids, is allowed to suckle frequently and on demand, and uses the breast as a pacifier.
Suckling stimulates the production of a hormone (prolactin) that suppresses ovulation, thus delaying the
woman’s return to fertility. Suckling frequently, on demand, and using the breast as pacifier or comforter usually
delays the onset of ovulation.
Once the need for milk diminishes, as when supplemental food is added or the baby is weaned, this
hormone is decreased and the woman returns to fertility.
By careful observation a woman can learn to recognize the Basic Infertile Pattern (BIP), which occurs while
she is breastfeeding. The BIP is a time of infertility, which manifests itself in the woman by either a sensation at the
vulva of dryness or by an unchanging discharge present at the vulva. Any change from the BIP is the indication
that the return of fertility is approaching.
A woman begins charting after childbirth when blood discharge (lochia) begins to stop, usually around
three weeks. Abstinence is recommended until the BIP is established, and confirmed by the instructor, then the
Early Days Rules are applied to postpone pregnancy. These rules are designed to enable the woman to recognize
the return of fertility, the beginning of the fertile phase and the identification of the Peak.

Module 8: Couple Communication
Introduction
Communication is crucial in a couple’s intention to plan their family the natural way. Open
communication between partners enables them to express their love and achieve intimacy without
relying on external means or going against their life principles.
This module is designed for health service providers with a guide on how they can assist couples
to effectively communicate with each other in order to successfully practice Natural Family Planning.
COUPLE DIALOGUE SCRIPT
(Husband making amorous gestures)
Wife: Hmmm…ano naman yan? Pwede ba, saka na yan?
Husband: Ikaw naman…bakit, may dinaramdam ka ba?
Wife: Wala naman. Kaya lang ayaw ko pang mabuntis. Wala pang dalawang taon si Baby.
Di ba marami pa tayong gustong marating para sa atin, lalo na sa mga bata.
Husband: Alam ko. Di ko nalilimutan ang mga pangarap natin.
Wife: Yon naman pala. Eh di…diyeta muna.
Husband: Pano naman ako. Puro kayod sa trabaho…diyeta pa.
Wife: Pareho lang naman tayo, eh. Ramdam ko rin yang nararamdaman mo. (a little pause,
then) Ano kaya kung magtanong tayo sa clinic tungkol sa family planning para malaman
and dapat nating gawin?

Husband: Buti pa nga. Okay ba kung bukas na bukas din ay magpunta tayo? Anong oras ba
nagbubukas ang clinic?
Wife: Maaga, mga alas-8 lang bukas na, kaya matulog ka na para magising nang maaga.
Husband: Sige, pahalik na lang sweetheart. Pakikamot mo na rin ang likod ko hanggang makatulog
ako.
The above dialogue ended well because both the husband and wife agreed to ask for
information.
Birth spacing, which is one of the pillars of the Philippine Family Planning Program is a joint
decision of the couple. To arrive at a decision, they have to openly communicate to express their
feelings and aspirations for themselves and for their children and the whole family.
Couple Communication
Communication is crucial in a couple’s intention to plan their family naturally. Good
communication allows couples to express their love and achieve intimacy without relying on external
means. To arrive at a decision, they have to openly communicate to express their feelings and aspirations
for themselves and for their whole family.
NFP based on responsible parenthood is rooted on the framework that a child is a gift as well
as, a responsibility.
When parents take their responsibility, they show their love to their children who become a source of
joy for them and the family.
The value framework for the NFP in the context of responsible parenthood starts with the SELF,
moves toward SPOUSE, CHILDREN, and COMMUNITY.

RESPONSIBILITY TO ONESELF - is
RESPONSIBILITY TO
expressed in the attainment and
maintenance of ONESELF
n Is expressed in the attainment and
maintenance of:
• Self-worth – Every individual must q self-worth
recognize and accept his/her worth as a q self-respect
human being. This entails a good look q healthy lifestyle
at oneself to identify his/her weaknesses q personal growth
and strengths. This acceptance should q spirituality
lead one to exert effort to transform

his/her weaknesses into strength and
further enhance one’s strength.
• Self-respect – This emanates from a person who lives by his principles and relates well his fellow
beings. A self-respecting individual is an asset to his/her family and community.
• Healthy lifestyle is required of an individual to avoid health hazards and diseases that may affect
the performance of his/her responsibilities to the family and the community.
• Personal growth is a human need that is addressed as one is given the opportunity to develop his/
her potentials in order to be a more productive person.
• Spirituality – We are physical beings. We are intellectual beings. But we are also spiritual beings.
As such, we should never allow ourselves to be spiritual vacuum.

RESPONSIBILITY TO SPOUSE is
demonstrated through Couple Dialogue
• Companionship. A husband or wife n Initial Choice of Method

may not always be around when needed n Continued Use of Method
but moments to enjoy each other’s
company must be provided despite
one’s busy schedule or workload. Even
physical distance can be bridged by
modern communication facilities to
maintain a couple’s emotional bond.
• Love is the bond that should tie a couple together. Love is expressed in various ways. The expression
of this feeling strengthens the bond; lack of expression may erode the relationship.
• Attention to one’s spouse is an intimate expression of concern and care. It provides means of
sensing particular needs of the partner that may have to be addressed immediately.
• Respect is something that is earned. Hence, in any relationship respect must be the main fabric
into which all other feelings and sentiments are woven.
• Fidelity is the expression of a spouse’s commitment to his/her partner. Neglect or violation of this
commitment often leads to distrust that weakens the relationship.
• Physical intimacy/sex is the ultimate expression of love between couples. More than just an
answer to a biological need, this intimacy needs to be nourished for the gratification of both
partners encouraging tenderness in total self-giving.
• Open communication is the key to maintaining a harmonious relationship. Its absence in any
relationship can lead to a range of negative feelings such as insecurity, jealousy, distrust among
others. Open communication means the line on both ends should always be available for sending
and receiving messages.
• Time when given to somebody one cares for is more precious than any material thing. Giving one’s
spouse the gifts of time deepens their love for and commitment to each other.

• Care of the home. The home is the love nest of a couple. This is where they gather with their
children and other family members at the end of a busy day. No matter how humble one’s home
is, it should always be warm with positive feelings and care for the family.
RESPONSIBILITY TO CHILDREN is shown by:
• Provision of basic needs – In present society the provision of basic needs of the family is a joint
responsibility of the husband and the wife. Children need proper nutrition for their physical growth
and development. However, growing children have other needs to be able to fully develop their
potentials.
• Spiritual guidance is needed by children in their formative years. Parents should be able to instill
moral values by being God-fearing and God-loving role models.
• Relationship building/social skills should imparted to children as part of their development.

These will ensure their ability to relate with other people, the practice of which will be carried on
to their adult years.
• Love and care. Children who felt the lack of love and care in their early life often grow up with
emotional and social problems. It is therefore parents’ responsibility to make sure that their children
are never wanting in love and care. Spacing the birth of children through the practice of natural
family planning expresses a couple’s love and care for their family.
• Time and space. Children need their parents’ time but too much of it may stifle their growth
and independence. They also need privacy and space for their own discovery of knowledge that
stimulate their intellectual growth.
• Open communication strengthens parent-child relationship and should always be encouraged

early between parents and children and also among the siblings.
• Response to individual needs. At different stages of their development, children have different
needs. Parents need to understand and respond to these specific needs of their growing children.

RESPONSIBILITY TO THE COMMUNITY is

shown through:
RESPONSIBILITY TO THE
COMMUNITY
• Being a responsible/involved citizen n Being a responsible/involved citizen
who participates in activities for the n Contributing to the community
n Modeling for the community
improvement of his community and
relates well with the members of the
community.
• Contributing to the community by

sharing his ideas, skills, time and other
resources that may be needed in the
conduct of activities for the development of the community.
• Modeling for the community by playing their role as responsible parents who bring up their
children with love and care.
To attain what the couple has set as the family goal they should work within an agreed value
system. The role of communication in arriving at an agreement as well as in strengthening their
partnership is very vital. Couples who value their fertility as a gift to one another recognize the need to
agree when to time lovemaking either to achieve or prevent pregnancy.
A couple’s agreement to time lovemaking takes into consideration other values such as self-
discipline, respect for each other, and honesty. This fosters positive communication between the
couple.

Waiting time during the fertile period is made easier by going back to a mutual decision that is
arrived at before the practice of NFP itself.
One partner must not just decide on his or her own, but instead the couple talks about their
choice of method.
If their decision is to avoid a pregnancy at this time, then the discipline of NFP calls for strategies to
manage the fertile time. “Managing the couple’s fertile days springs from their genuine desire to attain
their family goal.”

Managing Fertile/Infertile Days Managing Fertile/Infertile Days

n To attain what the couple has set as the n A couple’s agreement to time
family goal, they should work within an lovemaking takes into
agreed value system common to both consideration other values such
partners. as self-discipline, respect for
n Couples who value fertility as a gift to one each other, and honesty.
another recognize the need to agree when to n This fosters positive
time lovemaking either to achieve or prevent communication between the
pregnancy. couple.
Some Strategies Some Strategies

n Engaging in tiring physical activity n Express love in
n Avoid going to bed and waking up at the creative way
same time n Avoid seductive
n Keep the children in bed clothes, looks, and
with you touches
n Keep bedroom doors
unlocked § Talk about problems and solutions
§ Focus on the children as a couple
Some suggested strategies from successful NFP users during the fertile days are:
• Engaging in tiring physical activity
• Avoid going to bed and waking up at the same time
• Keep the children in bed with you
• Keep bedroom doors unlocked
• Express love in creative ways
• Avoid seductive clothes, looks, and touches
• Talk about problems and solutions
• Focus on the children as a couple

Lovemaking is the ultimate physical intimacy between couples. It is the time for total self-
giving as an expression of love. As such, the act should be meaningful and satisfying to both. Hence
mutual consent is needed for sexual harmony. There are ways by which the couple can achieve the
full meaning and mutual satisfaction in their lovemaking. NFP can keep the couple’s love life exciting,
mainly because of the waiting time in anticipation of their next lovemaking. Popular advice given
to couples who are not ready for a child is to make frequent use of the infertile days for intercourse,
making it into an art:
Before lovemaking:
• Ensure mutual consent
• Ensure privacy
• Be special for your partner, focus on his/her needs
• Prepare the room and the bed
• Make the children sleep early
During lovemaking:
• Give time for caring touches and foreplay
• Be generous in giving and receiving pleasure
• Exercise muscle control
After lovemaking:
• Thank partner
• Evaluate the lovemaking
• Allow and continue to give caring touches
• Set the next lovemaking availability

Benefits
n NFP can keep the couple’s lovelife exciting,
mainly because of the waiting time in
anticipation of their next lovemaking.
n Popular advice given to couples who are not
ready for a child is to make frequent use of
the infertile days for intercourse, making it
into an art.
Dialogue between the couple should go beyond the initial choice of the method and should
be maintained for its continued use. This is part of their total self-giving and expression of love in their
relationship. For mature couples, FAMILY comes first.
Remember…
The measure of the partners’ cooperation
lies on their ability to abide by their
agreement and their willingness to make a
plan for their NFP practice.
The measure of the partners’ cooperation lies on their ability to abide by their agreement and
their willingness to make a plan for their NFP practice.

A critical element to ensure successful practice of NFP is open communication between
husband and wife. Firstly, they have to communicate their fertility intentions to their partners, whether
to achieve, postpone or avoid pregnancy. And then more importantly, they have to continuously
communicate the fertile days when they have to avoid sexual intercourse as well as the infertile days
when the couple can give themselves fully to expressing their love for their each other.


Couple Communication
1. Who should initiate couple dialogue, the husband or the wife?

There is no rule on who should initiate couple dialogue. Either the wife or the husband can start the
dialogue. The important thing is to keep the communication line open on both ends and whatever is the issue
at hand is discussed and resolved.
2. What considerations should be regarded by couples who value fertility as a gift to one another?
Couples who value their fertility as a gift to one another need to agree when to time their lovemaking.
This agreement takes into consideration other values such as self-discipline, respect for each other, and honesty.
3. Why is communication important in the relationship of a couple?

The kind of communication that goes on in the relationship determines how one relates to the other.
The relationship may either be strong or weak depending on the pattern of communication the couple observes.

Couple Communication and Partner Involvement
Basic to the relationship between husband and wife is the marital or couple communication process that
exists in the relationship. The kind of communication that goes on in the relationship determines how one relates
to the other. The relationship may either be strong or weak depending on the pattern of communication the
couple observes.
For communication to be effective, the couple must mutually be emphatic listeners and speakers. This
entails the ability to listen without considering one’s personal thoughts and feelings. Focus is on the thoughts and
feelings of the spouse. THINK WITH the spouse and FEEL WITH the spouse to understand where the spouse
is really coming from.
As a listener, the spouse tries to understand the partner’s concern by exploring from his/her personal
world and perspective. As a speaker, the focus of sharing is on the I- messages. This means sharing one’s feelings,
experiences, thoughts and behavior on the situation or issue at hand and how these affect the person without
making the other feel guilty or defensive.

Improving marital relationship through communication may be achieved through:
• Establishing friendship in marriage. Mutual affirmation, support and praise build each other’s sense of
self.
• Be the best friend of your spouse and trust each other unconditionally.
• Spend time together and talk as best friends do.
• Nurture the relationship by acceptance of differences and separateness as a person and oneness as a couple.
Both husband and wife are involved in making decisions about whether to have a child or not, when to
have a child, and how many children to have. As a couple, they must agree on their fertility intentions.
The more a couple discusses and agrees on their fertility goal, the more likely that they will be able to
achieve it. If they work together to use their NFP method of choice, they will be able to achieve their fertility
intentions.
A woman can help her partner understand why she says NO on fertile days. She can also make her partner
understand that she is not rejecting him. She just should not get pregnant yet.

Module 9: Counseling on Natural Family Planning
Introduction
Family Planning Counseling is an interactive communication process between the health
service provider and the client. It enables clients to make voluntary, informed decisions about their
fertility plan. At the same time, the face-to-face process gives the health provider time to counter fears
and clear doubts of clients.
Service Providers are accountable for providing accurate and clear instructions to women
and couples who are learning about natural family planning.
Family Planning Counseling is the interactive communication process between the health
service provider and the client. It enables clients to make voluntary, informed decisions about their
fertility plan. This give the health provider time to counter fears and clear doubts of the clients.
Counseling also enables clients to apply information to their particular circumstances and make
informed choices. During this two-way communication between client and counselor, each spends
time talking, listening, and asking questions.
In the communication process, three types of Family Planning activities are used. These are:
o INFORMATION GIVING provides facts that raise a person’s awareness of a certain subject
matter which may be done individually or in groups. The full, complete and accurate information
received by a client is the basis of his/her free and informed choice.
o MOTIVATION (sometimes called promotion) aimed at influencing behavior in a particular

direction. As a process, it arouses or induces people to action and helps them sustain the activity in
progress.

o COUNSELING goes beyond just giving facts. It goes deeper into enabling clients to apply
information to their particular circumstances and make informed choices.
As a process, counseling involves two-way communication between client and counselor during which
each spends time talking, listening, and asking questions. Because counseling includes a discussion
of the client’s personal circumstances, feelings and concerns, it is important that it be done in a private
atmosphere.
• Counseling is a helping process which uses interview as a major tool in the solution of an
individual’s problem or a change in his/her attitude or behavior. Its main concern is to help a
client make sound and rational decision based on an examination of alternatives.
• Counseling on natural family planning is unlike medical advice because it involves healthy
individuals and does not prescribe a particular course of action.
The six basic steps known as GATHER is the approach used

in counseling for natural family planning.
The acronym, which is easy to remember, assures the counselor that all the steps to help a client make
an informed decision have been followed.
These steps are:

1. GREET clients in a friendly and helpful way. Introducing oneself is important. Once rapport has
been established, two-way communication is facilitated.
• Ensure confidentiality.
• Offer a seat for the client and open the conversation lightly. Important demographic data as
well as the need of the client may be taken during this step.
• If the client shows interest in learning more about Natural Family Planning, the counselor
moves on to the next step.
2. ASK/ASSESS is the second counseling step during which the counselor asks clients questions
about themselves and assess their knowledge and needs related to natural family planning.
• Ensure privacy.
• Assessing the client’s reproductive intention is the key step in counseling.
• Assessing is done by asking questions.
• Assessing the family planning knowledge of a client is important because it:

o enables the counselor to focus on the client’s needs;

o determines what the client already knows and how the counselor will carry out the
remaining counseling steps;
o saves time of client and counselor
• Before moving to next step make sure that you know the client’s reproductive needs (short,
long term or permanent).
3. TELL is the third step in counseling in which the counselor TELLS clients about Fertility Awareness,
all Family Planning methods and the different Natural Family Planning Methods.
• To make clients understand how natural family planning works, they have to understand first
how the male and female reproductive system works. The client needs this information to
understand how a natural family planning method works.
• Tell client how each method works, its advantages and disadvantages, and possible side effects.
• Debunk old myths, rumors, and misconceptions the client may have.
4. It is during the HELP step in GATHER that the Service Provider asks about the problems they
anticipate and HELP them think of solutions. Sharing with them how other couples changed their
behavior and practiced NFP have successfully managed the fertile and infertile days of the woman’s
cycle can be a big help.
• Visual materials can help clarify questions, reinforce what is said, keep client interest and explain
concepts. These visual aids, to be effective, must contain accurate information, use language
that clients can easily understand and should not be too technical.
5. In the E or EXPLAIN step of GATHER, the counselor explains how to use a particular natural family
planning method chosen by the client.
• explain how to use the method.
• emphasize the importance of recording and use of charts, beads or thermometer.
• confirm client’s understanding of what has been said by asking him/her to repeat what has
been said.
• give the client information material on the method if available.
• describe warning signs, if any.
In the explain step, clients need only information about how to use the method they have chosen.
Information they have already received in the telling step need not be repeated.

6. Clients make Return Visits for different reasons such as:

• to complete a routine follow up
• to ask questions
• also includes Recording, Reporting and Referral when necessary
• Whatever is the reason for the return visit, counselors should always give it importance and
proper attention.
• Natural Family Planning methods clients may need reassurance if there are doubts on how
instructions are followed.
The norms which a counselor should follow include:

• providing a comfortable setting that ensures privacy and confidentiality
• giving client full attention
• placing the client’s needs first
• respecting the client’s socio-economic status, educational level or religion
• never making judgmental remarks about the client.

Counseling is a helping process. In natural family planning, it is the process of giving information,
asking questions, clarifying doubts and misconceptions, and helping clients to make choices and
decisions. The GATHER approach is designed to facilitate the conduct of counseling in natural family
planning. “All throughout the counseling session, be mindful of the client’s rights.”

Counseling Questions
There are three types of questions that can be used in counseling. These are:
1. Closed questions are those that can be answered by yes or no, a number, or a few words.
These may be used at the beginning of the session to break the ice and get information such as
medical history.
Example: Are you using a family planning method?
How many pregnancies have you had?
2. Open questions have many possible answers. These are useful in learning about the client’s
feelings, thoughts, knowledge and beliefs.
Example: What do you know about NFP method?
How does your partner feel about your decision to use NFP method?
Asking questions that begin with WHY may be

intimidating or may sound judgmental. It is therefore,
preferable to use phrases such as “What are your reasons for?”
3. Probing questions help the counselor clarify the client’s responses to open questions.
Example: Can you tell me how your friend’s experience has made you decide to shift to an
NFP method?

Skills for Effective Counseling
RELATING is a basic skill. It calls for certain personal qualities of a counselor – warmth, friendliness, sincerity,
approachability, sensitivity, concern for others, tact, etc.
OBSERVING calls for perceptiveness, being observant of facial expression, behavior, reactions, gestures and use
of eye contact.
LISTENING means listening carefully to what the client says and does not say; making relevant, appropriate
response to assure client he/she is listening
ASKING QUESTIONS. Using the right tone and manner, asking leading questions rather than very direct
questions.
TALKING means having a clear purpose for saying what you say; being encouraging and reasoning.
INTERPRETING involves giving meaning and appropriate explanation to client’s words, statements, expression
and behavior, being very objective and aware of one’s self.
HANDLING PAUSES, brief stops or breaks that are normal occurrence in any counseling session. The counselor
must understand that a pause is needed to rest from the talking or think of what and how to say next.
HANDLING SILENCE. Silence occurs when a pause becomes prolonged or when a client completely stops
from participating in the interaction. The counselor can help the client to move on by asking a question, making
a comment or rephrasing/repeating the last word the client said. If client is unable to continue, offer to see him/
her again by setting an appointment.

Module 10:
Mainstreaming Natural Family Planning
Introduction
Natural Family Planning has long been on the sidelines of the Philippine Reproductive and
Family Planning program, and efforts are now directed towards making the NFP methods a viable
choice of couples. The benefits of Natural Family Planning make it a preferred choice among the many
methods available.
The basic protocol for mainstreaming NFP services has been developed over the years from the
experience of natural family planning service providers. Its purpose is to ensure that NFP follows certain
key steps to be followed by users, providers, and managers. These components for mainstreaming NFP
include training, service delivery or integration into program, including reporting and promotions.
Some indicators that NFP is being mainstreamed into the program could be:
• Couples know about it as a choice
• Misconceptions are corrected
• More NFP users especially among those who are not using any FP method or are relying on
ineffective traditional methods
• Providers have been trained and are providing counseling services on NFP
• Supplies are available
• Positive general attitude towards NFP

Module 10: Mainstreaming Natural Family Planning
A. Training
Service providers must undergo training on NFP to be able to provide the methods to clients
correctly and effectively, since the basic protocol focuses on the provision of the methods using a
counseling approach. While it is not required to have the husband with the woman client on the first
visit, it is highly recommended that the service provider encourage the client to have the husband with
her when she comes around again. Handling male clients is also a necessary skill. When the husband
is involved and is convinced, learning is facilitated. Experience also shows that the woman is able to
explain the methods to her husband and this is found to be very empowering for the woman. The
provider should be able to pass on the required NFP technology and strengthen the client’s value
framework that goes with successful use of NFP.
B. Method Service Delivery – is a client-centered protocol. It ensures the provision of counseling

service to clients until such time that the client becomes autonomous, or able to use the method
successfully on her own.
C. The FP Reporting System

As service providers, recording and reporting is one your basic functions. Its importance is that
the documents serve a legal purpose, for continuity of service, it is a basic tool for planning, and a tool
for monitoring the progress of our work.
An example of the forms used in the reporting system of government family planning workers are:
• Target client list
• Family planning form 1
• FHSIS forms
• CDLMIS forms
Examples of forms will vary from other workers depending on the organization they belong to and if
they are currently reporting the users.
It is important to know the standard terms for reporting users, as this lack of statistics reported is one
of the challenges that mainstreaming NFP must face.

Here are some of the most important terms:

• NA – New to the program, have not used any method before
• Other acceptors – clients that have used FP methods before and are shifting to NFP or changing
clinic
• Dropout – anytime clients do not return on scheduled follow up or validated by staff
• For LAM – dropout if anyone of the criteria is absent.
• SDM – recorded as NA on the day client is give instruction and tool on SDM use
• BBT/CM/STM – recorded as NA or other acceptor as early as the second return visit after
checking chart if client can follow charting instructions correctly. Service provider has the
authority to decide whether or not client can be recorded already as NA. If after 3 or 4 return
visits and the client cannot yet chart correctly, explain that she may not be able to use NFP
successfully so offer other methods.
• LAM – one (1) month after delivery to be sure that the 3 criteria for LAM are in place.
Schedule of return visit after initial instruction

• SDM – within 7 days of the next menstrual cycle
• BBT – when thermal shift has been identified
• CM – when peak day rule has been identified
• STM – when thermal shift and peak day rule have been identified whichever came later
Review of Instructions on how to fill up the government TCL / FHSIS forms

• FPI based on the clinical standards manual
Follow the formula

CU – CU beginning of month (which is the CU end of previous month) plus NA of previous month
plus other acceptor of present month minus dropout of present month.
Flow of Reports
• End of month – midwife prepares report and submits to RHU within the first week of the
following month (done monthly).
• RHU consolidates report quarterly and submits to PHO/CHO on the 2nd week of the 1st month
of the month.
• PHO/CHO submits reports to the region on the 3rd week of the 1st month of the quarter.

Organizing for Sustainability

In addition to delivering the method to clients, service providers play an important role in
ensuring that the services are sustained. Service providers can help ensure that NFP services are offered
in his/her community in order to sustain couples’ practices of NFP. The satisfied NFP user usually is
enthused enough to go out of her way to share her family planning method to other couples who are
interested. It is best that these satisfied users be given training when the occasion arises.
Possible ways of sustaining the couples’ practice and service on NFP:

• Information giving in groups, or one on one, husbands’ sessions
• Setting up of NFP people’s organizations for NFP couples
• NFP users’ meetings in the community
• Ask them to volunteer for NFP activities
• Availability of NFP follow-through reading
• Materials
• Integrating NFP in other existing services
• Involve them in mentoring new users of NFP
• Holding NFP orientation sessions for LGU officials, schools, hospitals, NGOs, Faith-based groups
etc.
Below is an example of an action plan to be filled up for mainstreaming NFP.


Natural Family Planning calls for commitment and dedication and can be very rewarding for
both providers and couples who use it. A culture of Natural Family Planning can arise from its correct
and enriching use. NFP can definitely contribute to meeting the nation’s unmet family planning need
while instilling discipline and responsibility among couple users, the providers, and determination
program managers.

Annex 1 - Participant Information Sheet
Annexes
Annex 2 - Pre/Post Course Questionnaire
Annexes
Annexes
Annexes
Annexes
Annex 3 - Pre/Post Course Questionnaire Answer Key
Annexes
Annex 3 - Pre/Post Course Questionnaire Answer Key
Annexes
Annex 4 - Birth and Emergency Plan
Annexes
Annex 5 - Human Fertility: Myth or Fact
Annexes
Annex 6 - Daily Learning Journal
Annexes
Annex 7 - Couple Dialogue Script
COUPLE DIALOGUE SCRIPT
(Husband making amorous gestures)
Wife: Hmmm…ano naman yan? Pwede ba, saka na yan?
Husband: Ikaw naman…bakit, may dinaramdam ka ba?
Wife: Wala naman. Kaya lang ayaw ko pang mabuntis. Wala pang dalawang taon si Baby.
Di ba marami pa tayong gustong marating para sa atin, lalo na sa mga bata.
Husband: Alam ko. Di ko nalilimutan ang mga pangarap natin.
Wife: Yon naman pala. Eh di…diyeta muna.
Husband: Pano naman ako. Puro kayod sa trabaho…diyeta pa.
Wife: Pareho lang naman tayo, eh. Ramdam ko rin yang nararamdaman mo. (a little pause,
then) Ano kaya kung magtanong tayo sa clinic tungkol sa family planning para malaman
and dapat nating gawin?
Husband: Buti pa nga. Okay ba kung bukas na bukas din ay magpunta tayo? Anong oras ba
nagbubukas ang clinic?
Wife: Maaga, mga alas-8 lang bukas na, kaya matulog ka na para magising nang maaga.
Husband: Sige, pahalik na lang sweetheart. Pakikamot mo na rin ang likod ko hanggang makatulog
ako.
Annexes
Annex 8 - Case of Monica
Annexes
Annex 9 - Guidelines for Individual Competency Evaluation (ICE)
Annexes
Annex 10 - Action Plan Sheet
Annexes
Annex 11 - Training Evaluation Form
Annexes
References
REFERENCES
RESPONSIBLE PARENTHOOD
Handbook on Parenting of Adolescents. Commission on Population, 2007.
Philippines Clinical Standards Manual on Family Planning, The. Department of Health, 2006.
Responsible Parenting and Natural Family Planning Facilitator’s Guide. DOH Commission on Populartion, 2007.
Responsible Parenting Handbook. DOH Commission on Population, 2007.
Ricasio, Jana. Philippines Progress Report on the Millennium Development Goals (MDGs). A paper presented at
the Workshop to Review Frameworks and Logframes UNFPA on Feb 4-6, 2003.
Training Guide on Effective Parenting of Adolescent, A. Plan Philippines, 2005.
MUCUS METHOD
Ovulation Method of Birth Regulation: The Latest Advance for Achieving Pregnancy Naturally, 1980.
Related Readings: The Ovulation Method. Master Teacher Institute, Natural Family Planning, 1993.
Science of Mucus. Missing Link in Fertility Awareness, 1991.
Teaching the Billings Ovulation Method,1995.
SYMPTO-THERMAL METHOD
Getting Started on the Sympto-Thermal Method. Institute for Reproductive Health.

http://www.irh.org/resources-SymptothermalMethod.htm. Date Retrieved: November 4, 2008.
COUPLE COMMUNICATION
Service Providers’ Training Manual (For Faith Based Organizations). Prism Project, USAID Philippines.
Training Guide on Effective Parenting of Adolescents, Plan Philippines.
Wilson, Mercedes Arzu. Love and Family – Raising a Traditional Family in a Secular World.
BASIC REFERENCE
Basic Reference: All Natural Family Planning Manual of the Institute for Reproductive Health, Philippines, 2005.
References

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The Department of Health

Republic of the Philippines

A Natural Family Planning Training Design for Service Providers v

MODULE 1: Responsible Parenthood 1

MODULE 2: Fertility Awareness 9

MODULE 3: Basal Body Temperature 31

MODULE 4: Mucus Method 53

MODULE 5: Sympto-Thermal Method 79

MODULE 6: Standard Days Method 100

Supplemental Reading 114

MODULE 7a: Lactational Amenorrhea Method 121

MODULE 7b: Mucus Method for Breastfeeding Women 131

MODULE 8: Couple Communication 148

MODULE 9: Counseling on Natural Family Planning 159

MODULE 10: Mainstreaming NFP for Program Sustainability 165

In consideration of the family planning situation

This training aims to provide basic knowledge and

Adopting a simplified competency-based NFP training

A Natural Family Planning Training Design for Service Providers

Design and Layout:

The following participated in the September, 2009 pretesting

A Natural Family Planning Training Design for Service Providers

18. Natividad N. Sabado

Lastly, the technical assistance of the following Family

A Natural Family Planning Training Design for Service Providers

1. Explain Responsible Parenthood (RP)/Maternal and

A Natural Family Planning Training Design for Service Providers

Competency-Based Training (CBT) emphasizes

The CBT approach is scientifically grounded in the

Competency-based training is also based on the

A Natural Family Planning Training Design for Service Providers

A Natural Family Planning Training Design for Service Providers

HOW TO USE THIS REFERENCE GUIDE

The All Natural Family Planning Reference Guide is a handbook

The first two modules Responsible Parenthood and Fertility

Modules 3 to 9 cover the teaching and counseling information

The last module goes beyond NFP Counseling and looks at

Each module includes the teaching and Evaluation Guide,

A Natural Family Planning Training Design for Service Providers

DATE TOPIC/SESSION Remarks

Learning Journal Pax/support staff

A Natural Family Planning Training Design for Service Providers

DATE TOPIC/SESSION Remarks

A Natural Family Planning Training Design for Service Providers

TRAINER’S ACTIVITIES KEY LEARNING POINTS

Expectations and Objective-

Divide the participants into 3

Ask how will we meet these

Introduction to the Course

TRAINER’S ACTIVITIES KEY LEARNING POINTS

Conduct a warm-up activity for

To apply these learnings to the training: the CBT

Introduction to the Course

TRAINER’S ACTIVITIES KEY LEARNING POINTS

demonstrations. Knowledge is specific to the roles that the

Confucius said: “What we hear, we forget. What we see, we

There are levels of competence that the training addresses:

Level of unconscious incompetence – we think we know it,

Level of conscious incompetence – admitting to

Level of conscious competence – knowing that you own the

This is a Philhealth accredited facility Yes _ No