Marquette Model of Natural Family Planning and Fertility Awareness Based Method

Marquette Model of Natural Family Planning (NFP)

Background & Goals

Survey studies consistently show that women prefer safe, easy to use, and effective forms of family planning. At the turn of the 21st century, women and couples who wished to use non-medical methods of family planning i.e., natural family planning (NFP), also sometimes called fertility awareness-based methods (FABM), only had the choice of natural methods that were developed 40 to 60 years ago, including calendar-based (rhythm) methods and cervical mucus and basal body temperature systems to monitor fertility. These methods were often not effective in helping women avoid pregnancy, are cumbersome to use, and not easy to provide. Furthermore, they were not effective in helping women avoid pregnancy during the postpartum transition to fertility or the transition to menopause.

The challenge was to develop a system of NFP/FABM that was easy to use, easy to teach and provide, and that was effective not only among women with regular menstrual cycles but also women who were postpartum or who were approaching menopause.

The main developer of this new system, Richard J. Fehring, researched several devices that were designed to help women and couples monitor the fertile days of the women’s menstrual cycle for the purpose of achieving or avoiding pregnancy or monitoring their reproductive health. These devices included electronic thermometers, miniature microscopes to view salivary ferning patterns, and electrical resistance measures of saliva. In consultation with a reproductive endocrinologist at Loyola University, he learned about a new electric hormonal monitoring system that was developed to measure changes in estrogen and luteinizing hormone (LH) to help women to achieve pregnancy.

Fehring decided to integrate this new electric hormonal fertility monitor (EHFM) into a new NFP/FABM system to avoid or achieve pregnancy. The first system was used in conjunction with cervical mucus monitoring as a second check for estimating the fertile phase. The algorithms and protocols for the new system called the Marquette Model (MM) was launched in 1999. The MM is a modern easy to use, effective system of NFP that integrates the newest hormonal monitoring technology.  In 2000, an online MM NFP teacher training program at Marquette University was developed for health professionals that included a NFP theory course and MM NFP practice course.  A MM NFP medical application course was added in 2008.  

Program Description

Old systems of NFP/FABM (i.e., basal body temperature and cervical mucus changes) are based upon subjective and often imprecise indictors of fertility. Subjective and imprecise indicators result in lengthened estimates of the fertile phase of the menstrual cycle and poorer efficacy. Both cervical mucus and basal body temperature changes are due to fluctuations of the reproductive hormones, estrogen, LH, and progesterone. The ability to self-measure and track out reproductive hormones is the latest advancement in menstrual cycle monitoring.

Newer hormonal monitors (e.g., MIRA, PREMOM, Oova, and Inito) provide quantitative levels of the key hormones of the menstrual cycle. These newer monitors also utilize the smart phone to measure the hormone and provide an app that graphs out the results. The newer hormonal monitoring systems also are better diagnostic tools that help in the interpretation of the women’s menstrual cycle as a vital sign for health. Women who use these monitors indicate that they provide objective indicators of fertility, are easier to use, and provide more confidence in using NFP/FABM for achieving or avoiding pregnancy. MM researchers have conducted and published several comparative and satisfaction studies to back these claims.

The MM has several cohort multisite effectiveness studies and the only randomized comparison effectiveness studies of NFP methods since the early 1980s. The MM also has special evidenced-based published protocols for tracking fertility during the postpartum transition to fertility and the first six menstrual cycles postpartum. It is during the first three menstrual cycles postpartum that women/couples become pregnant not intending to. The MM involves educating women about their menstrual cycle as a vital sign for health and empowers them to use body symptoms for avoiding or achieving a pregnancy or for women’s health management. A recent (2022) study published in the Journal of Women’s Health showed no significant changes in the parameters of the menstrual cycle by users of the MM pre and post a Covid vaccine injection.

Evidence of Success

The model’s postpartum unintended pregnancy rates are based on both cycles of use and months of use – which is the latest method of calculating postpartum pregnancy rates – and our rates range from 6-8 per 100 women. (Note that the hormonal pill has a pregnancy rate around 8 per 100 women over 12 months of use.). Other major providers of NFP/FABM (e.g., the Couple-to-Couple League International) often refer their postpartum women/couples to a MM provider.

Women who are postpartum from other NFP/FABM systems often seek out MM providers. About 75% of our women/couple clients are postpartum up from around 33% in 2008. Hundreds of MM health care professionals throughout the US, Canada, and other countries utilize these protocols. It should also be noted that our online MM teacher training program and our protocols for helping women/couples achieve pregnancy who have difficulty doing so was featured at a 2018 Office of Population Affairs Title X experts meeting in Washington, DC.

Additional Resources

Marquette University Institute for NFP and the MM Teacher Training Program

Marquette Model NFP Provider List and Map

Marquette Method Professionals Association

For More Information Contact:

Richard J. Fehring, PhD, RN, FAAN

Mary Schneider, PhD, APRN, FNP-BC

Susana Crespo, BSN, RN, NFPI

MaryLee (Kiene) Barron, PhD, APRN, FNP-BC,

Qiyan Mu, PhD, RN

Thomas Bouchard, MD, Family Medicine

Kathleen Raviele, MD, Ob/Gyn

For More Information Contact:

Drs. Richard Fehring and Mary Schneider
Past and Current Director
Marquette University
College of Nursing
Institute for Natural Family Planning