Natural Family Planning teachers number over two thousand in the United States (as counted in the most recent survey by the U.S. Bishops' Diocesan Development Program for Natural Family Planning). They offer a variety of methodologies in Natural Family Planning (NFP), and a wealth of knowledge and experience about marriage and sexuality, to married or engaged couples who are seeking to achieve pregnancy or avoid pregnancy. The teacher is regularly expected by clients to offer advice on breastfeeding and parenting, and to know the names of appropriate professionals if referral is needed: NFP-friendly physicians, lactation consultants, and marriage counselors. Couples' questions about the ethics of certain infertility treatments often come to the NFP teacher first. The advantage of having a human teacher instead of trying to learn NFP from a book is flexibility and experience: clients expect the teacher to help them resolve any question they may have about observations and the application of rules in using NFP. This presents a huge challenge to the teacher, but it also means that NFP teachers in any diocese can be a valuable resource for marriage preparation programs and family life offices.
Who can be a Natural Family Planning teacher? Teachers, usually either women or couples, are trained through a variety of programs run by dioceses or such organizations as the Couple to Couple League. To qualify for certification by the Diocesan Development Program (DDP), both the program and the teacher must meet certain standards (available at www.usccb.org/prolife/issues/nfp/standard.htm). The standards cover the practicalities of teaching and using NFP and the theological foundation for periodic abstinence as a method of family planning. This assures couples, at least in the United States, that the instruction they will receive is medically accurate and in conformity with Church teaching. Teachers are expected either to practice NFP themselves, or to accept it philosophically if they are not in a position to practice it (for instance, single people who are teachers). They must also support the Church's teachings on family life and responsible parenthood.
Couples come to NFP classes expecting to learn how to live in harmony with their fertility, using periodic abstinence to avoid pregnancy or achieve pregnancy. Conveying the basic information needed to practice NFP is the primary goal of the instructor, though she also needs to be realistic with her class about success rates in both achieving and avoiding pregnancy. Infertile couples are very vulnerable, and they need to understand that in some cases NFP may only give them a vocabulary to discuss their fertility problems with appropriate professionals. Couples avoiding pregnancy need to know that the unintended pregnancy rate for NFP is comparable to that of artificial methods of contraception. Couples coming to the class from a marriage preparation program should already have a theological understanding of Church teaching so that the instructor may start immediately with the pragmatic details of using NFP.
Most programs provide a detailed outline to the teacher that will cover, for example, anatomy and physiology of the male and female, followed by details of the menstrual cycle and the events of ovulation and conception. Instructors have an obligation to present this clearly and accurately, because clients who understand these basic concepts tend to be able to use NFP more successfully, whether to achieve or avoid pregnancy. How to make observations and interpret them is usually covered over the course of several classes, as are special circumstances such as breastfeeding or discontinuing steroidal contraception. Individual follow-up is usually done in a private session at the end of the course. The couple may stay in touch with the teacher for years after the class, or they may decide they are autonomous and need no further help.
Besides accurate and complete information, the teacher owes her clients confidentiality. In a class of several couples, the teacher may try to foster an atmosphere of informality and, simultaneously, anonymity by introducing herself by first name only and asking the members of the class to do the same. In fact, clients will frequently share more information about themselves as the class progresses, especially if it is extended over several sessions, but some couples will guard their privacy very carefully. This can shift the dynamic of the class -- the other couples may feel foolish if they share their concerns and get no response from their peers. The teacher has to be sensitive to this possibility, welcoming any questions and responding fully to them.
Because NFP has two goals, avoiding pregnancy or achieving pregnancy, an even more difficult issue arises in class when couples do not wish to share their purpose in taking the class with anyone else. Infertility especially is fraught with emotion for the couple: first acknowledging that this may be a problem for them, and then accepting that they need help. Taking an NFP class is sometimes the first step toward seeking professional help, but should never be seen by either clients or teachers as a substitute for medical evaluation. The client intake form may be the first time that some clients actually state that they are seeking pregnancy, and how long they have been doing so. Since the other couples may be taking the class to avoid pregnancy, the teacher must walk a fine line between the two goals without revealing anyone's purpose in taking the class unless that person discloses it first. Seeking pregnancy does not mean simply reversing the rules for avoiding pregnancy, and should not be dismissed as "the easy part" of NFP. For some couples, it is far from easy. Achieving pregnancy must be treated as a distinct facet of using NFP.
Sensitive issues can arise when the NFP teacher realizes that there may be a problem with a couple's fertility before the couple does. Information from the intake form may reveal a medical condition that affects fertility, or may show that the couple has been trying to conceive for over a year. The couple's charts may show that the woman is not ovulating, or that her luteal phase is too short to sustain a pregnancy. The couple may not even be trying to conceive at this point, but they want to use NFP. A short luteal phase will be a problem because it leaves too few usable days at the end of the cycle for the couple currently avoiding pregnancy, and a lack of any clear ovulatory event will leave no usable days at the end of the cycle. Even without other symptoms, this warrants a referral back to the physician, as do cycles that consistently are too short (under twenty-one days) or too long (over forty days). Physicians are notoriously skeptical about the effectiveness of NFP as a family planning method, but they will sometimes advise their patients to chart temperatures to see if they are ovulating: a patient who has already done several months of charting has cut several months off the wait for diagnosis and treatment. In any case, it is the task of the physician, not the teacher, to discuss a diagnosis of fertility or infertility with the couple.
In fact, helping infertile couples constitutes a disproportionately large part of the NFP teacher's mission. It is also, in many ways, the most difficult part. The emotional cost to the teacher can be high as she learns more about her clients and their dreams of a family. She may need to learn how to set boundaries around her own feelings and her privacy, especially if she has a family of her own. The label "infertile," which comes after one year of "unprotected intercourse" without conceiving, is devastating to some couples, especially in our world of Assisted Reproductive Technology (ART). Those couples may seek information and reassurance from someone they feel they know well: their NFP teacher (who is generally easier to reach than their physician). Many of the ART's are not available to Catholics who wish to follow Church teaching, and those which are neither forbidden nor endorsed by the Church can be confusing. The NFP teacher may find herself being asked specific questions about the morality of certain methods: can we use GIFT? How about IUI? Why can't we use IVF?
In vitro fertilization (IVF) is a good example of the kind of question that infertile couples may bring to their NFP teacher. The Church has stated clearly that IVF is not allowable. It introduces a third party (the doctor) who replaces the marital act between husband and wife by fertilizing an egg outside of the mother's body, then transferring the embryo back into the mother's womb. This bypasses the unitive aspect of the marital act, and disrespects the human dignity of the embyro. And yet, the infertile couple points out, God allows babies to be born this way, so it must be right! They may even feel that God has not lived up to his end of the bargain if they have been charting for a long time without success. The average NFP teacher is not trained to deal with these questions and may ultimately have to refer the client for counseling either from a spiritual advisor or even a therapist. Some couples who have reached this stage of bargaining are no longer helped by monitoring their fertility, and it is the obligation of the teacher to point this out. Some infertile couples prefer to continue, however, feeling that this means they are doing everything possible to aid conception.
Ultimately, NFP teachers have to learn to let go of "their couples." Whether their clients are seeking or avoiding pregnancy, the goal is always to bring couples to autonomy, letting them make their own judgments based on the best information possible. It becomes the responsibility of the NFP user to decide how to act on that information, including the decision to seek medical help or to come back to the teacher for a refresher course.