A (relatively) new fertility awareness method (FAM) being touted by family medicine practitioners and even by college students across the country as an “authentic language of women’s health and fertility” may actually be causing more harm than help in the contraceptive world.
The Creighton Model (CrM), developed by Dr. Thomas Hilgers, was first launched by the Pope Paul VI Institute in the mid-1980s. It is a variation of the Billings Ovulation Method – that is to say, it is a method of FAM that relies solely on blood / cervical mucous observations to determine ovulation. Other forms of FAM, such as the sympto-thermal method, use body temperature and cervical position in addition to cervical mucous observations to pinpoint ovulation.
While the Institute claims CrM is not a “contraceptive system,” it is prescribed by practitioners not only to address fertility-related issues and to achieve pregnancy, but also to prevent pregnancy – the very definition of a contraceptive.
Unfortunately, learning to avoid pregnancy by charting cervical mucous the Creighton way comes with a heavy dose of ever-so-slightly sexist teachings.
For instance, the Institute proclaims that, “The [Creighton Model] finally allows a woman to unravel the mysteries of her menstrual cycle!” a theme that is oft-repeated throughout course materials – as if women before CrM were too stupid to understand what was happening within their own bodies.
In addition, the Institute places a large emphasis on the fact that CrM is a “shared” method, and that, “responsibility for its use is placed equality on both” partners. How precisely charting cervical mucous places any sort of responsibility for contraception on a male partner other than what should be his standing agreement to not have sex with his partner unless she says it is okay, however, is beyond my ken.
The Institute also attempts to shame users of other contraceptive methods for their choices through statements such as: “Unlike contraceptives, CrM treats fertility as a normal and healthy process,” “spontaneous intercourse involves the submission to emotional impulses while selective intercourse submits itself to choices evaluated and implemented through the incorporation of the intellect, the will and the values that the couple shares,” and “[non-NFP] systems are built upon the notion that…cooperation does not or may not exist. In this latter approach, the a priori premise precludes the development of cooperation in this important aspect of the married couple’s life. The preclusion can lead to stress, tension, resentment and, eventually, destruction of the relationship.”
Apparently not only are contraceptive users unintelligent, valueless wild animals with an inability to control their sexual urges, who treat fertility as abnormal and unhealthy, contraceptives themselves can actually destroys relationships! Oh, the things you learn spending a few hours on the Pope Paul VI website…
Further, as with many other methods of FAM that do not permit users to rely on barrier methods during fertile periods, CrM requires women to abstain from sex during the point in their cycle when they will naturally find sex most enjoyable due to a surge in estrogen and testosterone, while placing no similar restrictions on men as men’s enjoyment of sex does not ebb or wane based on monthly hormonal fluctuations.
In addition to these philosophical objections to the Creighton Model, there are practical hurdles to its use as a contraceptive method to consider.
First, and perhaps most importantly, while Creighton Model supporters are quick to point out that their method has a 99% success rate in pregnancy avoidance, those numbers appear to be just a tad skewed.
Why are the numbers skewed? Because nearly all of the studies evaluating CrM have been commissioned by the Pope Paul VI Institute and/or have been conducted by researchers certified in the Creighton Model. Why is this fact significant? Because CrM-certified researchers are taught to use a completely different analysis of contraceptive failure rates for CrM than that used for any other contraceptive method.
For example, in a comprehensive review analyzing the effectiveness of natural family planning methods, Robert Kambic of The Johns Hopkins School of Hygiene and Public Health stated that:
“Hilgers’ definition of unplanned pregnancies results in almost no unplanned pregnancies, and pregnancy rates which use this definition of unplanned pregnancy cannot be compared with rates using the standard definition.”
Kambic’s analysis is confirmed by statements made by the Institute:
“Users of the [Creighton Model] know their fertility status on any particular day and are given the freedom to utilize that information as they so choose. Those who use a day of fertility to achieve a pregnancy are successful users and not failures. A pregnancy can legitimately be observed as a result of the system’s successful use.”
In other words, the only time the Institute considers a pregnancy by CrM users to be a contraceptive failure is if it occurs during a period when a woman is supposedly not fertile. For all other contraceptive methods, contraceptive failures are measured by pregnancies that occur when a woman INTENDS to use a particular method for pregnancy avoidance, whether or not that method is actually used or whether it is used correctly.
As an example of just how skewed the numbers can get, a re-analysis of a previous study on the Creighton Model found that while the study boasted a 96.2% effectiveness rate, when the data was analyzed using standard statistical analysis and not the Hilgers method, the actual effectiveness rate was 67%, meaning the Creighton Model has a typical use failure rate of 33%, a rate higher than for any other form of contraception.
Finally, it must be noted that you cannot participate in the Creighton Model unless you attend at least eight sessions of a training course, conducted by a CrM-certified instructor, over the course of the first year and then have follow-up training sessions every 6 months or so after the first year. You are required to pay for each of these sessions, as well as for the course materials. At a cost of anywhere from $40 to $100 per session based on your locale, using the Creighton Model as a contraceptive method can be one of the most expensive forms of contraception a woman could choose, particularly since it is not covered by the ACA as it does not involve an FDA-approved contraceptive device. What makes the cost of CrM even more shocking is that other FAM methods using even more biomarkers to determine fertility (for example, the sympto-thermal method) can be accessed for free.
In sum, while certain forms of fertility awareness methods can be used effectively both to achieve pregnancy and as a form of contraception, the Creighton Model fails on both philosophical and efficacy grounds. Women should feel free to choose the contraceptive method they feel is right for them, but they should not feel shamed into using a particular method, nor should they be deceived as to that method’s effectiveness.
Till next time,