Spotlight: Montserrat Ayala-Ramirez, M.D., MPH

​Q.  Tell us about your family and where you grew up.
 
I was born and raised in Guadalajara, Jalisco, also known as the “City of Roses” and the cradle of many iconic things associated with Mexico such as the mariachis, tequila, the Mexican Hat Dance, and the sombreros. My father was an army surgeon, and my mom was a biochemist; I only have one brother who is a computer engineer.  We grew up having both of our parents work full time, so my dear aunts and grandma often helped, and I became very close to them. I think on those days and immediately smell my grandma’s kitchen and hear the beautiful voices of ten people talking about their daily activities. 
 
When I got older and moved to Mexico City to pursue my career, I was very fortunate to not only accomplish professional dreams but to find the extraordinary person with whom I have walked, ran, and flew for the last 21 years.  At that time, Fernando was a general surgeon resident, and currently, he is an ear, nose, and throat physician. As in any marriage, we have many stories to tell, and the best of all is about welcoming our three children: Sofia, Jose Fernando, and Natalia.
 
Q. How old were you when you knew you wanted to become a physician? Where did you study medicine?  
 
Because of my father, I was exposed to medicine from an early age. He worked in a public hospital in the evenings, and in the mornings, he had his medical consult in our home. So, quite often, I booked appointments and greeted his patients. I first had a hint of becoming a physician/researcher when I was 14 years old. My grandmother, who was like a second mother to me, was diagnosed with a rare variant of lung cancer. I remember the day when she came back from a doctor’s appointment, and she asked me to read her the pathology report. Since I had no clue what it meant, I searched for the terms in a book. What I read was devastating! I remember telling her that everything was going to be all right, even though I had a knot in my throat. She died within a year after diagnosis. Four years later, I was accepted to the University of Guadalajara, School of Medicine, and later, I moved to Mexico City to do my specialty in Internal Medicine.
 
Q. How did you end up in Durham, NC?
 
It started around 16 years ago when we started a subspecialty at the University of Alabama. At the time, I was 36 weeks pregnant with our second child, and all our belongings were inside four suitcases. We were coming only for two years, but two years became four, and so on. Because of my husband’s job, immigration policies, and educational opportunities, we have had to move several times, making Durham, NC, our most recent move, but not the last one. We are pleased to share that we are moving to Houston, TX, in a few weeks, and we hope that this will be the last one!
 
Q. How do you mix your Catholic faith with being a physician/scientist?
 
To me, being Catholic is part of who I am. It sets the values and standards that guide me. It was that feeling that inspired me to take the Certificate in Bioethics offered by the National Catholic Bioethics Center a couple of years ago. It was beneficial and a great learning experience. I appreciate having the benefit of Catholic sources to guide me in making informed decisions following the values that I cherish.
 
Q. When did you first hear about the Billings Method™, and what led you to become a teacher of Billings?
 
I heard about the Billings Method™ for the first time when I was a 4th year medical student. At that time, we were required to teach contraception to our patients. Because that conflicted with my Catholic faith, I decided to explore the methods of natural family planning that were available. That way, I could speak with my patients about these natural methods as well. The Billings Ovulation Method® caught my eye, not only for its simplicity but for the science behind it. Therefore, I decided to take the course at my home parish, and I loved it! While I did not teach the Method at that time, I talked about it to my patients. I remember women getting excited and surprised to know that a reliable, natural, and healthy method of family planning, such as the Billings Ovulation Method (BOM), existed.
 
In 2013 the priest of my local parish in Virginia invited me to teach NFP. It was at that time that I came across with the Billings Ovulation Method – USA Association (BOMA-USA). I took the teacher training course. Since then, I have been involved in different levels within the association: as a Board Member (now finishing my 3-year term), as part of the Education Committee, and as Chair of the Hispanic Committee.
 
Q. Why do you think medical students typically are not taught about NFP?  And, what can be done to change that?
 
I think there are many factors at play. Usually, among the scientific community, NFP methods are seen with skepticism and underestimated because they are perceived as unreliable and ineffective. This misconception might be due to the lack of knowledge of the various NFP methods, their differences, and their effectiveness rates. For example, the CDC, in one of its pages, lumped together all the Fertility Awareness-Based Methods and, in another, gives an incomplete and vague description of them. At least they have recently updated their website and now mention a current systematic review about the effectiveness of NFP1. That’s a small milestone! Also, within the CDC, the National Center for Health Statistics conducts the National Survey of Family Growth. This organization estimated that only 0.2% of “all women” were “current” users of NFP between 2011-2015 2; however, upon careful reading of the survey, it seems they only included users of the Sympto-Thermal method 2. These are just two examples of how the information about NFP is represented to clinicians, scientists, and the public. Misconceptions need to be clarified, so that accurate evidence about NFP is used. More well-designed research studies about NFP published in peer-reviewed journals will translate to more evidence being accessible to clinicians and the scientific community, in general.  
 
Q. As a member of the Education Committee and Chair of the Hispanic Committee, you have a lot going on in addition to your life as a wife, mother, and physician. Tell us about some of the plans the Hispanic Committee has in the works.
 
Navigating current times has been challenging, but it has opened opportunities for adaptation and growth both in professional and personal life.
 
As part of the Education Committee, and in our efforts to build evidence-based information, we have been putting together a focus group study on women users of the Billings Ovulation Method through the University of North Carolina, Chapel Hill.
 
Concerning the Hispanic Committee, it has been a unique and fulfilling experience coordinating it. We are a small committee born about 18 months ago in response to the needs of the growing Hispanic community within BOMA-USA. Since we had our first meeting, we have reviewed translated materials, training sessions, and worked to implement best practices. We are also working hard to get to know our community via fellowship hours and webinars. Currently, we are happy to be working on the first Spanish Remote Training that began on July 25. As a new committee, we have many other projects and goals that we would like to achieve and will do so one step at a time. We hope we can keep growing and getting more people interested in joining the committee.
 
 
 
 
1 Peragallo Urrutia R, Polis CB, Jensen ET, Greene ME, Kennedy E, Stanford JB. Effectiveness of fertility awareness-based methods for pregnancy prevention: A systematic review external icon. Obstet Gynecol 2018;132:591-604
2 Centers for Disease Control and Prevention. (2017, July). National Center for Health Statistics. National Survey of Family Growth. URL: https://www.cdc.gov/nchs/nsfg/key_statistics/n.htm#natural