The July 2019 edition of the WOOMB Bulletin is here. Please check out all the exciting new Billings happenings from around the world.
We recently contacted WOOMB to confirm what we should be quoting when asked about effectiveness studies for the Billings Ovulation Method®.
They sent an interesting document that starts off discussing the need to include the range of published studies that meet the requirements for medical evidence in relation to the design of the study. So, in other words, don’t just look at one study when quoting success rates.
The current standard way of reporting effectiveness rates of contraceptive methods is the Pearl Index. It gives effectiveness rates based on the number of pregnancies expected if 100 women used a given method for a year.
Studies on natural family planning and/or contraception will also refer to both user and method effectiveness. When method effectiveness is cited, it refers to perfect use, meaning users follow a particular method’s instructions exactly.
WOOMB states that the most accurate way of quoting contraceptive success rates is in “initiates.” The document explains, “That is, the first-time use including any learning period. The reason for quoting figures for initiates is that the effectiveness rates will improve the longer a group has been using a method because those who are likely to become pregnant may already have become pregnant and be lost to the study if the initial period is not included.”
The following three international studies of the Billings Ovulation Method® produced method effectiveness rates in initiates:
The World Health Organization (1978-1981)
The Indian Medical Research Council (1996)
The Jiangsu Health Institute in China (1997)
“The studies recruited women who had not previously used the Billings Ovulation Method® and recorded the pregnancy rates for those who became pregnant either during the teaching phase or after.”
Based on those studies, we can cite the Billings Ovulation Method® with a method-related pregnancy rate of 0-2.2 pregnancies per hundred women years in initiates.
All three studies had impressive numbers of women included in their study, living in many parts of the world.
▪ The World Health Organization’s multi-center study took place from 1997 – 1981. The locations included Auckland, Dublin, San Miguel, Bangalore, and Manila. There were 869 women in the study, equaling 10,215 cycles of use. There were 2.2 method-related pregnancies per hundred women years in initiates. (2.8 when the initial phase excluded)
Published: Fertility and Sterility 1981 Vol. 36, p. 152ff, 1981 Vol. 36, p. 591ff.
▪ Indian Council of Medical Research Task Force on NFP (1995) had the states of Uttar Pradesh, Bihar, Rajasthan, Karnataka, and Pondicherry. They had 2,059 women with 32,957 women months of use. The study concluded there were 0.86 method-related pregnancies per hundred women years in initiates.
Published: Contraception 1996, Vol. 53 pp. 69-74.
▪ Jiangsu Family Health Institute, China (1997) Dr. QIAN Shao Zhen. This study had 1,235 women with 14,280 women months of use. No method-related pregnancies in initiates. (5 user-related pregnancies)
Published: Chinese Medical Journal 1998.
Good to note: Evidence-based method-related Pearl Index for Billings Ovulation Method® is 0-2.2 per hundred women years in initiates.
Q. You have such a fascinating history. Would you please take us back to where you lived as a child, including your Jewish roots and how you ended up becoming Catholic?
Life in Vienna was ordinary until March 10, 1938, when Hitler arrived to “take his homeland back into the Reich.” By Passover 1939, there had already been enough persecution of Jews that I was sure that it was time for the Messiah to come.
There was a tradition that a cup of wine at the Seder table would be drained mysteriously the year the Messiah was to come. I was bitterly disappointed that the cup was still full at the end of the Seder. In June that year I was sent to England in a children’s transport.
The family who received me had already been in touch with my parents, so I was far better off than the many who just went into the unknown. My parents had sent me out as they did not know if or when they would get the visa for the United States that they had applied for, and they wanted to make sure I would be safe even if they did not make it out. My English family were members of Church of England, although Mrs. Dodd had recently become a Christian Scientist. In their wonderful reception of me I realized that the Messiah had already come.
In March 1940, my parents were able to sail for New York to try to begin to build a new existence. Their English was from what they had learned in school, but they applied themselves. Father became a cook in a camp in the Adirondacks. He had been a mess sergeant in the Austrian cavalry in World War I. The following September, my mother had collected enough money to pay for a ticket for me to join them in New York.
Crossing the Atlantic alone was an adventure in seasickness. The only place I was not nauseated was on deck, where I sat on a drum until I was asked to not sit on the depth charge! I did not see the Statue of Liberty when we entered the harbor, but was so pleased to see lights after living in the blackout, and the big Wrigley’s Chewing Gum sign.
My parents met me in New York and Mother’s scream when she saw me embarrassed me, as I had become very English. I learned later that three ships had left Scotland together, and no one knew who was on which one. One was bombed, one was torpedoed, and only ours, the Cameronia, got through. Once we got over the initial greetings, Mother immediately took me to a beauty shop for a haircut. My hair was too long! Then, we went to meet the great aunt and uncle who had provided the affidavit needed for my parents’ entry to the United States.
By then, my mother had a summer job as a domestic helper with a family in Elberon, NJ. I was allowed to stay with her. The family had advanced some of my fare. I was sent to Long Branch, New Jersey Junior High School where, at age 12, I was put in Grade 9 because of the long list of subjects on my report card from Dr. Williams’ School in Dolgelley, North Wales where we had spent the previous year because the war had begun in England. The list was impressive: arithmetic, geometry, and algebra. But they were so minimal that I never had a proper basis for math. When I decided on a medical specialty many years later, I immediately ruled out therapeutic radiology as I was sure I would never get the dosage properly calculated.
When the New Jersey job ended, Mother found another with a German immigrant family on Staten Island who had come a few years earlier. I attended Avery High School and even got placed in an English honors class, thanks to my British school year.
We met my second cousin, Marlene, who encouraged us to leave New York, which was becoming an enclave of refugees. So, we made a stop in New York in preparation for a
for a move to Louisville, KY. This was prolonged by my coming down with measles and pneumonia, causing me to miss a trimester of grade 9. But we did arrive in Louisville, and my parents set about building a new life for us.
The Jewish Refugee Service was immensely helpful by finding a couple of rooms for us when we arrived and later helping to find jobs for my parents and an apartment. It was all very basic, but we were so happy to be alive. I was sent to the YWCA camp for two weeks the next summer and heard a reading of 1 Corinthians 13. When I got back to Louisville, I bought a Bible at Woolworths for 25 cents and read the whole New Testament in three days. I had no doubt it was true.
Q. Where did medical school come into play? How did you decide to become an obstetrician/gynecologist?
I had seen the lecture hall at the University of Vienna Medical School on a newsreel when I was eight years old, and somehow knew that someday I would be hearing lectures there. Obviously, I did not get to study in Vienna, but the idea of becoming a doctor never left. I liked the idea that in obstetrics, medicine and society met. I was interested in both the scientific and the personal aspects of medicine.
What followed was too personal to write about, but suffice to say that we had a pre-med course at the University of Louisville entitled, “History and Philosophy of Science,” taught by the chairman of the biology department. He taught that there are three kinds of truths: social, scientific, and religious, which were in parallel and never intersected.
As a medical intern, I had a patient who had rheumatic heart disease and was three months pregnant. At that time, the treatment was therapeutic abortion. However, the chief resident in medicine, a convert to Catholicism, would not sign off on it. I was indignant that he was “imposing his religion on science,” but the woman did well with medical management.
We now know that therapeutic abortion is NOT the proper treatment for such situations, thanks to Dr. Samuel Cosgrove, a non-Catholic who was head of the Margaret Hague Maternity Hospital in Jersey City.
In any event, that incident, and meeting a young man who was Catholic, introduced many other considerations. Internship was followed by residency in pathology in Massachusetts General Hospital in Boston. There were wonderful bookshops near the hospital. I picked up the Summa contra Gentiles and could not understand a word of it, so I enrolled in a night course in “Problems in Western Philosophy” at Harvard’s Lowell Institute for $5! I discovered that there were far more ways of looking at truth than my college course had mentioned, such as if truth subjective or objective, absolute or relative, etc.
I also enrolled at the Paulist Catholic Information Center and, after a rather intense year of study and prayer, concluded that the truth was both absolute personal and objective, proved by the One who said He was the truth and proved it with His Life, Death, and Resurrection.
This was the gift of faith, not a philosophical proof. I was received into the Catholic Church on May 8, 1952, in the Paulist chapel on Park Street in Boston. I received the grace to give my whole life to the Lord and, five years later, entered the Medical Mission Sisters. Although I was not drawn to the foreign missions particularly, I knew the Lord had children in need everywhere. Providentially, after pathology, I had trained in obstetrics and gynecology. This training was much needed in the five years I spent at Holy Family Hospital in Rawalpindi, Pakistan, followed by two years in Dhaka, East Pakistan, which is now Bangladesh.
When my mother became blind during my time in Dhaka, I asked to return home. In 1968, I joined the Medical Mission Sisters House of Studies in St. Louis. There I returned to Washington University where I had been a resident physician. When my old chief was replaced by an enthusiastic abortionist, I went across town to St. Louis University, a Jesuit school where I was teaching when Roe v. Wade was imposed.
Q. When did you first hear about the Billings Method™? And what was your initial reaction to it?
Cardinal Carberry, archbishop of Washington, sent the first American edition of The Billings Method to all the Catholic doctors in St. Louis in 1972. It had been published by Msgr. Robert Deegan of the Department of Health and Hospitals for the Archdiocese of Los Angeles. It made more sense than the previous information on the cycle: calendar and temperature rhythm. The book was complicated, but I had just delivered the fifth child of a charismatic couple and they did not want to have any more children, at least not for a while. The couple and I prayed and cursed our way through the book together. In 1973, Roe v. Wade was decided.
My first reaction was to go to parishes to teach about embryonic and fetal development, but that made little impact. Therefore, it made sense to try to prevent abortion by preventing the crisis pregnancy. Obviously, contraception was not the full answer. Even today, 45% of undesired pregnancies are conceived during a cycle in which the women said they were using a contraceptive.
I met Larry Kane, the founder of the Human Life Foundation, when I had occasion to go to Washington. He suggested I meet Mercedes Wilson. The following June, Mercedes stopped in St. Louis and explained the Billings Method™. It was like turning on the light in a dark room. We no longer fell over the obstacles. She talked about the upcoming meeting in Sydney. I was teaching Ob/Gyn at St. Louis University Medical Center at the time, and a group of us had a chance to take over the space of a crisis pregnancy center that was moving from the basement of St. Joseph’s Catholic Church in Clayton, MO. That became the Aware Center. My department sent me to Sydney, Australia, where I met 200-300 Billings Ovulation Method® user couples who were walking statistics, testifying to the success of the method. There had not been much published effectiveness data up to then. The lectures were excellent on the biology of sperm, the hormones controlling ovulation, and the human reactions. On my return to St. Louis, I found myself the local expert on the Billings Method™, except that Sydney was 8,000 miles away. This was before cheap long-distance calling and decades before the internet. One of our group of eight who began the Aware Center was a professional teacher who did the initial instructions. Others did the follow-up and support. The crisis center had maintained a roster for consultations 24/7. We began to do it that way, but discovered that there really was no such thing as an emergency coitus. When in doubt, don’t!
Q. Over the years you became friends with some of the great leaders in our field, including Drs. John and Lyn Billings, Dr. James Brown, and Dr. Kevin Hume, among many others. What are a couple of your most cherished memories of your time with them?
Kevin Hume met my flight when I first arrived in Sydney. He and Peggy were hospitable throughout my stay, even introducing me to Sydney rock oysters, which he assured me were the best in the world. After the meeting I flew to Melbourne and sat with Lyn as she taught beginners, and I sat with Kath Smyth as she did follow-up. After watching Kath for the morning, I said, “I think I can do that.” So, she let me take the lead in the afternoon. Heaven help us! But that’s how we started. Kath was doing the urine estrogen and progesterone assays for Jim Brown. Gradually, the correlations between cervical mucus patterns and the continuum of ovulation were elaborated. That was Jim Brown’s life’s work. The final version was published after Jim died, by Len Blackwell, his long-time collaborator in New Zealand.
Q. As the founder/developer of Teen STAR, please tell us how it came to be and what it is.
At the second international Billings Method™ meeting in Melbourne in 1978, Dr. John Billings asked me to have a look at the teens, as no one was doing anything with or for them. The beginnings were providential. During a meeting of the Human Life & Natural Family Planning Foundation board meeting, Kay Ek introduced me to her sister, Mary Thormann, Ph.D., a professor of child development at Marymount College in Fairfax, VA. We talked about the need, and somehow she managed not only to support our endeavor but introduced me to Eunice Kennedy Shriver, with whom she did Meals on Wheels at Our Lady of Victory Parish in Washington. Mrs. Shriver was the executive director of the Joseph P. Kennedy Jr. Foundation for the prevention of mental retardation. At a meeting which the Kennedy Foundation sponsored at the National Institutes of Health, her husband, Sargent Shriver (founder of the Peace Corps), laid out the case for prevention of teen pregnancy as a long-range prevention of mental retardation, as teen mothers often delivered prematurely and had more mentally handicapped babies. On that basis, our research proposal for offering fertility awareness to teens was accepted. It was warmly advocated by Dr. Robert Cooke, scientific advisor to the Kennedy Foundation, who felt that it was dangerous to give contraceptive steroids to adolescents when no one knew their long-range effects. Bob Cooke was a Presbyterian and former chairman of pediatrics at Johns Hopkins. When we found that in our pilot group of 200 girls, the pregnancy rate was 0.44% compared with 12% in the population at that time, we felt that we could begin to train teachers. Teen STAR (Sexuality Teaching in the context of Adult Responsibility) evolved gradually. Mary Lou Bryant led one of the girls’ groups. Being an experienced teacher, she did not follow my medical outline but went into the class and asked, “Do you want to talk woman talk?” She recorded their questions, which became the basis of the content and sequence of the high school girls’ curriculum. We always met with parents before and midway into the program. Soon, the mothers were asking for a similar program for their sons. The current curriculum for young men was written by Fr. Don Heet, O.S.F.S., Ed.D. He wrote it after he had taught it for five years at Pope Paul VI High School in Fairfax, VA. Later, the grade school curriculum was added by Mary Lou. I added the holistic sexuality lecture/discussion sequence, and the postpartum sequence was done by Sr. Nora Dennehy, RGS, Ph.D., and the late Sr. Ursula Fagan, MMS, MSW. We have always insisted on behavioral outcome evaluations and reported them in the scientific literature. All curricula include experiential learning of the woman’s fertility patterns. Boys record their emotions.
Word about Teen STAR spread. Canada was our first international site, then Chile, UK, and France. Many others have followed. We now have an International Teen STAR Federation. Dr. Pilar Vigil, M.D., Ph.D., is the current president. At least 15 countries have autonomous programs, meaning they can train their own teachers. Dr. Vigil reports that we have programs in 56 countries, including places where there is only one teacher.
Q. How long does a training take, and do you still help with trainings?
The initial training requires 35 hours. Part of that can be done online. That is followed by a year of practicum where the teacher is supported in their first-year experience. After two years of teaching, teachers become eligible to be trained as trainers of teachers. Recertification is required every three years. Since last November, we have a new interim executive director, Deacon Santiago Molina (a trainer and supervisor of Billings teachers for BOMA-USA). He has assumed responsibility for the program.
Q. What do you see the future holding for us in the Natural Family Planning field?
As people become more aware of the harmful effects of contraceptive steroid hormones, many more are seeking natural methods. The use of natural methods requires couple communication. This in turn may help heal the culture, which is currently separating sex not only from procreation, but from relationship. It’s going to be a long haul.
Q. If you could give a piece of advice to Billings teachers, what would it be?
My own bias is to focus more on the time of puberty, when the hormonal changes demand so much from the teen, and teach fertility awareness then. Waiting to teach adults is too late, in view of the huge effort to insert LARCs, long-acting reversible contraceptives (IUDs and implants) into any teen who can be persuaded (or coerced). By then, brain maturation, which peaks between the ages of 10-15, may already have been damaged. Obviously, we should continue to teach anyone who desires to learn, but I think we need to focus on the teens.
Although the basic science of NFP is already settled, more is constantly being added. It’s all God’s work. Hang on to Him.
BOMA-USA provides education and training for The Billings Ovulation Method® which is a natural method of fertility management that teaches you to recognize the body's natural signs of fertility.