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China successfully launching Billings Ovulation Method

Shao-Zhen QIAN
Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 200031, China

This paper was presented at the International Jubilee Conference, 50th Anniversary of Billings Method, UNiversity of Melbourne, Australia, conducted by Ovulation Method Research & Reference Centre of Australia, March 28-30, 2003.

In the 30 years fertile life of women, only a few days in each cycle are fertile and the rest of time infertile. People of insight have long considered making use of this natural phenomenon to regulate fertility. Early methods of natural family planning (rhythm, basal body temperature, symptothermal, etc.) are unsatisfactory for fertility regulation and the Chinese people did not accept them. In the early 60’s, Drs. J.J. and E.L. Billings and their colleagues discovered the interrelationship between the cervical mucus and the cyclic changes in the ovarian hormones and fertility and alleged the use of mucus symptom as the main index of ovulation and fertility applicable to all phases of female reproductive life. This is a milestone in the study of natural family planning.

37,000 BOM teachers trained

2.7 Million fertile couples in regular use

success rate 99%

abortion rate dramatically reduced

32% of infertile couples give birth

Since the official introduction of the Billings Ovulation Method (BOM) into China by the Chinese Ministry of Health in 1995, the method has been distributed to almost every corner of China, including the industrial and agricultural areas and the minority regions. Chinese women of different strata and ethnic groups readily understand the meaning of the mucus patterns described in the Billings books and all of them accept the method. After teaching, most subjects are able to recognize the peak symptom from the first cycle and the rest from the second cycle, except in a few (around 1%) having anovulatory cycles as confirmed by plasma hormonal assay.

Chinese Family Planning workers not only advocate fertility control but also fertility promotion for those without children. The BOM is a bidirectional approach that can be used for both purposes and is becoming one of the most favoured methods in China. Since it is simple to learn, cost free, non-invasive, has no side effects and, in particular, it is the most effective way of fertility regulation in all conditions, as breastfeeding, irregular cycle, pre-menopause, coming off contraceptive medication or during emotional and physical stress.

Fourteen BOM Centres have been established in China at the most strategic areas for fertility regulation and 36,845 BOM teachers have been trained. A certain percentage of the teachers were trained by the Australian Teaching Group led by Drs JJ and EL Billings. Up to date the method has been regularly used in more than 2,686,400 fertile couples for avoiding pregnancy, the overall success rate being around 99%; In addition, there were 14,524 among 45,280 infertile couples (success rate 32.1%) who were overjoyed to obtain their children by the use of BOM. The common people affectionately called these kids the Billings babies. BOM or mucus observation is now the primary treatment for couples presenting at the 14 Centres and neighboring clinics experiencing difficulties in conceiving. Through field trials we also confirmed the fact that mucus observation not only enables the women to understand their fertile status, but is also helpful to their reproductive health. Many women consulted gynecologists for an early diagnosis and treatment, when they observed abnormal mucus symptoms.

Table 1. Artificial abortion rates in Community A and B in 2002

Community	A (BOM widely used)	B (BOM seldom used)	P
Total fertile women	36,240	49,042
Artificial abortion in 2002	221	1992
Abortion rate	0.61%	4.06%	<0.01

In certain localities where the BOM has been widely used, not only the birth rate but also the artificial abortion rate is significantly decreased. In Community A of one municipality, the BOM was widely spread, the yearly artificial abortion rate in 2002 being 0.61% (per 100 fertile women), while in the neighboring Community B, where BOM was seldom used, the rate was 4.06%. which was almost 7 times that of A, the difference being highly significant (P<0.01, Table 1). The basic conditions of the two communities were similar and their artificial abortion rates in the past had been also similar.

The intrauterine device (IUD) is the most popular contraceptive method used in China. We have done a randomized one-year parallel comparison of the efficacy of BOM and TCu220c in avoiding pregnancy. TCu220c is a widely used IUD in China. One thousand five hundred and fifty-six fertile women of different educational levels were enrolled and randomly classified into 2v groups, one using BOM and the other, IUD. From Table 2, it can be seen that both the pregnancy and the discontinuation rates are much lower (P<0.01- P<0.001) in the BOM than in the IUD group. Besides, in the IUD group, there were 15 expulsions and 38 removals due to side effects (pain/bleeding); thus the total use-related discontinuations amounted to 65 cases (12 pregnancies and 53 expulsions and medical removals). In the BOM group only 5 pregnant cases (all use-related) were discontinued and there were no side effects.

Table 2. Gross cumulative 12-month life-table (Tietze) event rates (mean ± SE %)

	BOM	IUD	P
Pregnancy	0.5 ± 0.2	2.0 ± 0.6	<0.01
Expulsion		2.6 ± 0.7
Medical removal		6.3 ± 1.0

Use-related discontinuations	0.5 ± 0.2	10.6 ± 1.2	<0.01
Non-medical discontinuations	3.1 ± 0.9	0.5 ± 0.3
Loss to follow-up	1.0 ± 0.3	1.1 ± 0.3
Continuation rate	96.4 ± 0.6	89.3 ± 1.2	<0.01

Continuation cases	966	587
Women-months of use	9,870	6,299
Total number of cases	992	662

The BOM results in China exerted a big impact on both the Chinese community and the medical circle and there were 48 papers, broadcasting stations, TV stations and 5 journals reported the news of Drs JJ & EL Billings and their wonderful method. In most provinces, the BOM has already been incorporated into the Government Family Planning Programme as one of the methods of choice by the fertile couples.

The method is highly efficient only when a series of precautions and regulations are strictly followed. Inappropriate use would result in higher failure rates, as in preliminary trials in China (1989) and some other places. Drawing a lesson from the early work, we always stick to the authenticated Billings teaching materials. In China only the authenticated BOM materials (Chinese translation, with the approval of WOOMB) are used and nobody is permitted to rewrite, revise or modify them. In China, the BOM book, booklet, wall charts, slide rule, etc. are among the most popular reference materials for family planning. We also provide these materials to Chinese-speaking peoples outside China.

We pay much attention to the Teacher-training course and the women-teaching course, as well as an adequate guidance system and regular follow-up visits to the couples. Such a programme not only imparts scientific knowledge but also provokes and maintains the initiative of the women and their husbands, who are invited to participate in every other follow-up interview. Qualified teachers, the acquisition of BOM knowledge by the participants, the women’s motivation and the husbands’ cooperation are the key points for the successful implementation of BOM.

Conclusions

The BOM is well accepted by different strata Chinese people;
The use-effectiveness of BOM is much higher than that of TCu220c, with significantly lower pregnancy rate and discontinuation rate (P<0.01);
The extensive use of BOM will significantly decrease the artificial abortion rate;
In infertile couples of unknown cause, the BOM is the method of choice in achieving pregnancy.

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