The rhythm method, also known as the calendar method or the Knaus-Ogino method (named after Hermann Knaus and Kyusaku Ogino), is a method of natural birth control that involves counting days of a woman's menstrual cycle in order to achieve or avoid pregnancy. A recently developed variant of the rhythm method is known as the Standard Days Method.
Incorrect use of the term
The phrase "the rhythm method" is frequently used, in error, to describe the behavior of any people who have unprotected sex yet wish to avoid pregnancy. While the failure rate of rhythm is very high compared to most other methods of birth control, correct use of the rhythm method prevents a significant number of pregnancies. Statements that calendar-based methods are "not methods of birth control" or "the same as nothing at all" are false.
The phrase "the rhythm method" may also be incorrectly used to describe the practice of observational fertility awareness (FA) methods. This often comes as a source of chagrin to practitioners of FA, because FA methods are significantly more effective than rhythm. Many FA teachers consider the rhythm method to have been obsolete for at least 20 years.
For several decades, especially in the early twentieth century, the rhythm method was promoted by members of the Catholic Church as the only morally acceptable form of family planning. Methods accepted by this church are referred to as natural family planning (NFP) - so at one time, the rhythm method was synonymous with NFP. However, the modern Catholic Church also accepts certain uses of FA, and some sources now use the terms "fertility awareness" and "natural family planning" interchangeably. This overlap between uses of the terms "the rhythm method", NFP, and FA may contribute to confusion.
Description and effectiveness
The following describes use and effectiveness of the method for the purpose of avoiding pregnancy.
Most menstrual cycles have several days at the beginning that are infertile (pre-ovulatory infertility), a period of fertility, and then several days just before the next menstruation that are infertile (post-ovulatory infertility). The first day of red bleeding is considered day one of the menstrual cycle. The formula for the rhythm method requires the woman to know the length of her menstrual cycles.
To find the estimated length of the pre-ovulatory infertile phase, nineteen (19) is subtracted from the length of the woman's shortest cycle. To find the estimated start of the post-ovulatory infertile phase, ten (10) is subtracted from the length of the woman's longest cycle.
A woman whose menstrual cycles ranged in length from 30 to 36 days would be estimated to be infertile for the first 11 days of her cycle (30-19=11), to be fertile on days 12-25, and to resume infertility on day 26 (36-10=26). When used to avoid pregnancy, the rhythm method has a perfect-use failure rate of up to 9% per year.
Standard Days Method
Developed by Georgetown University's Institute for Reproductive Health, the Standard Days Method has a simpler rule set and is more effective than the rhythm method. A product, called CycleBeads, was developed alongside the method to help the user keep track of estimated high and low fertility points during her menstrual cycle. The Standard Days Method may only be used by women whose cycles are always between 26 and 32 days in length. In this system, days 1-7 of a woman's menstrual cycle are considered infertile. Days 8-19 are considered fertile. Infertility is considered to resume beginning on day 20. When used to avoid pregnancy, the Standard Days Method has a perfect-use failure rate of 5% per year.
A software program developed in Germany from 1995 to 2001, Perimon is a stricter variant of the Knaus-Ogino method. It requires a greater period where unprotected sex is not allowed when used to avoid pregnancy, designating a maximum of 10.5 days each cycle as infertile. No clinical studies have been done to determine effectiveness, but the program's developers claim a perfect-use failure rate of 4% per year. The Perimon software requires a paid subscription.
Imperfect use of the rhythm method would consist of not correctly tracking the length of the woman's cycles, thus using the wrong numbers in the formula, or of having unprotected intercourse on an identified fertile day. The discipline required to keep accurate records of menstrual cycles, and to abstain from unprotected intercourse, makes imperfect use fairly common. The actual failure rate of the rhythm method is 25% per year.
Reasons for high failure rate
Even when used perfectly, the rhythm method results in a high pregnancy rate among couples intending to avoid pregnancy. Of commonly known methods of birth control, only the cervical cap and contraceptive sponge have comparably high failure rates. This lower level of reliability of the rhythm method is because its formula makes several assumptions that are not always true.
The postovulatory (luteal) phase has a normal length of 12 to 16 days, and the rhythm method formula assumes all women have luteal phase lengths within this range. However, many women have shorter luteal phases, and a few have longer luteal phases. For these women, the rhythm method formula incorrectly identifies a few fertile days as being in the infertile period.
The rhythm method uses records of past menstrual cycles to predict the length of future cycles. However, the length of the pre-ovulatory phase can vary significantly, depending on the woman's typical cycle length, stress factors, medication, illness, menopause, breastfeeding, and whether she is just coming off hormonal contraception. If a woman with previously regular cycles has a delayed ovulation due to one of these factors, she will still be fertile when the rhythm method tells her she is in the post-ovulatory infertile phase. If she has an unusually early ovulation, the rhythm method will indicate she is still in the pre-ovulatory infertile phase when she has actually become fertile.
Finally, the rhythm method assumes that all bleeding is true menstruation. However, mid-cycle or anovulatory bleeding can be caused by a number of factors. Incorrectly identifying bleeding as menstruation will cause the rhythm method's calculations to be incorrect.
Current utilization of Standard Days method
The Standard Days method (SDM) is increasingly being introduced as part of family planning programs in developing countries. The method is satisfactory for many women and men who find other methods unacceptable; offering it through family planning centers results in a significant increase in contraceptive use among couples who do not want to become pregnant. The low cost of the method may also enable it to have a significant positive impact in countries that lack funding to provide other methods of birth control.
It is not known exactly when it was first discovered that women have predictable periods of fertility and infertility. St. Augustine wrote in the year 388 of periodic abstinence practiced by the Manichaeans, "Is it not you who used to counsel us to observe as much as possible the time when a woman, after her purification, is most likely to conceive, and to abstain from cohabitation at that time...?" One book states that "[The rhythm method] had been recommended... by a few secular thinkers since the mid-nineteenth century". The Catholic Church first recorded official statement on periodic abstinence to avoid pregnancy is from 1853.
However, how this method prevented pregnancy was not understood until the early twentieth century. In 1905 Theodoor Hendrik Van de Velde, a Dutch gynecologist, showed that women only ovulate once per menstrual cycle. In the 1920s, Kyusaku Ogino, a Japanese gynecologist, and Hermann Knaus, from Austria, independently discovered that ovulation occurs about fourteen days before the next menstrual period. Ogino used his discovery to develop a formula for use in aiding infertile women time intercourse to achieve pregnancy. In 1930, John Smulders, Roman Catholic physician from the Netherlands, used this discovery to create a method for avoiding pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, and this was the official Rhythm Method promoted over the next several decades.
Early Catholic doctrine considered complete sexual abstinence to be the most holy state for humans, with marriage being a holy state for those without the fortitude required by an abstinent life. The Manichaeans (the group the early Church father St. Augustine wrote of) believed that it was immoral to create any children, thus (by their belief system), trapping souls in mortal bodies. Augustine condemned them for their use of periodic abstinence: "From this it follows that you consider marriage is not to procreate children, but to satiate lust." In more recent times, an 1853 ruling of the Catholic Church's Sacred Penitentiary addressed the topic of periodic abstinence to avoid pregnancy. Distributed to confessors, the ruling stated that couples who had, on their own, begun the practicing of periodic abstinence—especially if they had "legitimate reasons"—were not sinning by doing so. In 1880, the Sacred Penitentiary reaffirmed the 1853 ruling, and went slightly further. It suggested that, in cases where the couple was already practicing artificial birth control, and could not be dissuaded to cease attempting birth regulation, the confessor might morally teach them of periodic abstinence. However, into the early twentieth century, it was believed by some Catholics that the only licit reason for sexual intercourse was an attempt to create children.
While maintaining procreation as the primary function of intercourse, the December 1930 encyclical Casti Connubii by Pope Pius XI gave the highest form of recognition to a secondary—unitive—purpose of sexual intercourse. This encyclical stated that there was no moral stain associated with having marital intercourse at times when "new life cannot be brought forth." Although this referred primarily to conditions such as current pregnancy and menopause, the Sacred Penitentiary in yet another ruling in 1932, and the majority of Catholic theologians also interpreted it to allow moral use—for couples with "upright motives"—of the newly created Rhythm Method. In 1932 a Catholic physician published a book titled The Rhythm of Sterility and Fertility in Women describing the method, and the 1930s also saw the first U.S. Rhythm Clinic (founded by John Rock) to teach the method to Catholic couples. A minority of Catholic theologians, however, continued to doubt the morality of periodic abstinence, and some historians consider two speeches delivered by Pope Pius XII in 1951 to be the first unequivocal acceptance of periodic abstinence by the Catholic Church.
Humanae Vitae, published in 1968 by Pope Paul VI, addressed a pastoral directive to scientists: "It is supremely desirable... that medical science should by the study of natural rhythms succeed in determining a sufficiently secure basis for the chaste limitation of offspring." This is interpreted as favoring the then-new, more reliable fertility awareness methods over the Rhythm Method.
It has been suggested that unprotected intercourse in the infertile periods of the menstrual cycle may still result in conceptions, but create embryos incapable of implanting. It has also been suggested that pregnancies resulting from method failures of periodic abstinence methods are at increased risk of miscarriage and birth defects due to aged gametes at the time of conception. The most recent research, however, suggests timing of conception has no effect on miscarriage rates, low birth weight, or preterm delivery.
- ↑ Weschler, Toni (2002). Taking Charge of Your Fertility (Revised Edition ed.). New York: HarperCollins. pp. pp.3–4. ISBN 0-06-093764-5.
- ↑ Kippley, John and Sheila Kippley. The Art of Natural Family Planning. The Couple to Couple League, Cincinnati, OH: 1996. p.154. ISBN 0-926412-13-2
- ↑ 3.0 3.1 Hatcher, RA (2000). Contraceptive Technology (18th Edition ed.). New York: Ardent Media. ISBN 0-9664902-6-6. Unknown parameter
- ↑ Arévalo M, Jennings V, Sinai I (2002). "Efficacy of a new method of family planning: the Standard Days Method" (PDF). Contraception. 65 (5): 333–8. PMID 12057784.
- ↑ "Perimon". 2007. Retrieved 2007-02-11.
- ↑ Weschler, p.48.
- ↑ Kippley, p.111
- ↑ Kalaca S, Cebeci D, Cali S, Sinai I, Karavus M, Jennings V (2005). "Expanding family planning options: offering the Standard Days Method to women in Istanbul". J Fam Plann Reprod Health Care. 31 (2): 123–7. PMID 15921552.
- ↑ Template:Cite paper
- ↑ Gribble J, Jennings V, Nikula M (2004). "Mind the gap: responding to the global funding crisis in family planning". J Fam Plann Reprod Health Care. 30 (3): 155–7. PMID 15222918.
- ↑ 11.0 11.1 Saint, Bishop of Hippo Augustine (1887). A Select Library of the Nicene and Post-Nicene Fathers of the Christian Church, Volume IV. Grand Rapids, MI: WM. B. Eerdmans Publishing Co. pp. On the Morals of the Manichæans, Chapter 18. Unknown parameter
- ↑ 12.0 12.1 12.2 12.3 12.4 Yalom, Marilyn (2001). A History of the Wife (First edition ed.). New York: HarperCollins. pp. pp. 297-8, 307. ISBN 0-06-019338-7.
- ↑ 13.0 13.1 "On the Question of Natural Family Planning". cmri.org. Retrieved 2007-04-01. "Question: Certain married couples, relying on the opinion of learned physicians, are convinced that there are several days each month in which conception cannot occur. Are those who do not use the marriage right except on such days to be disturbed, especially if they have legitimate reasons for abstaining from the conjugal act? Response: Those spoken of in the request are not to be disturbed, providing that they do nothing to impede conception."
- ↑ "A Brief History of Fertility Charting". FertilityFriend.com. Retrieved 2006-06-18.
- ↑ 15.0 15.1 Singer, Katie (2004). The Garden of Fertility. New York: Avery, a member of Penguin Group (USA). pp. pp. 226-7. ISBN 1-58333-182-4.
- ↑ 1 Corinthians 7.8-9, 32-35
cf. St. Jerome, Against Vigilantius
Council of Trent, Session 24
- ↑ 17.0 17.1 17.2 "On the Question of Natural Family Planning". cmri.org. Retrieved 2007-04-01. "Question: (1) Whether married couples may have intercourse during such sterile periods without committing mortal or venial sin? (2) Whether the confessor may suggest such a procedure either to the wife who detests the onanism of her husband but cannot correct him, or to either spouse who shrinks from having numerous children? Response: Married couples who use their marriage right in the aforesaid manner are not to be disturbed, and the confessor may suggest the opinion in question, cautiously, however, to those married people whom he has tried in vain by other means to dissuade from the detestable crime of onanism."
- ↑ "Is Natural Family Planning a 'Heresy'?". rtforum.org. Retrieved 2007-04-01. "Question: Whether the practice is licit in itself by which spouses who, for just and grave causes, wish to avoid offspring in a morally upright way, abstain from the use of marriage – by mutual consent and with upright motives – except on those days which, according to certain recent [medical] theories, conception is impossible for natural reasons. Response: Provided for by the Response of the Sacred Penitentiary of June 16, 1880."
- ↑ Kippley, p.231
- ↑ Gladwell, Malcolm (2000-03-10). "John Rock's Error". The New Yorker.
- ↑ Moral Questions Affecting Married Life: Addresses given October 29, 1951 to the Italian Catholic Union of midwives and November 26, 1951 to the National Congress of the Family Front and the Association of Large Families, National Catholic Welfare Conference, Washington, DC.
- ↑ Luc Bovens (2006). "The rhythm method and embryonic death" (PDF). Journal of Medical Ethics. 32: 355–356. External link in
- ↑ Gray, RH (October 1984). "Aged gametes, adverse pregnancy outcomes and natural family planning. An epidemiologic review". Contraception. 30 (4): 297–309. PMID 6509983.
- ↑ Gray RH, Simpson JL, Kambic RT (May 1995). "Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning". American Journal of Obstetrics and Gynecology. 172 (5): 1567–1572. PMID 7755073.
- ↑ Barbato M, Bitto A, Gray RH; et al. (June–September 1997). "Effects of timing of conception on birth weight and preterm delivery of natural family planning users". Advances in Contraception. 13 (2–3): 215–228. PMID 9288339.
- CycleBeads - A website promoting the Standard Days Method