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A prospective multicentre trial of the ovulation method of natural family planning. Pt. 2. The effectiveness phase.
Fertility and Sterility. 1981 Nov; 36(5):591-98.A 5 country prospective study was undertaken to determine the effectiveness of the ovulation method of natural family planning. 869 subjects of proven fertility from 5 centers (Auckland, Bangalore, Dublin, Manila, and San Miguel) entered the teaching phase of 3-6 cycles; 765 (88%) completed the phase. 725 subjects entered a 13-cycle effectiveness phase and contributed 7514 cycles of observation. The overall cumulative net probability of discontinuation for the effectiveness study after 13 cycles was 35.6%, 19.6% due to pregnancy. Pregnancy rates per 100 woman-years calculated using the modified Pearl index were as follows: conscious departure from the rules of the method, 15.4; inaccurate application of instructions, 3.5; method failure, 2.8; inadequate teaching, 0.4; and uncertain, 0.5. Cycle characteristics included: 1) average duration of the fertile period of 9.6 days, 2) mean of 13.5 days occurred from the mucus peak to the end of the cycle, 3) a mean of 15.4 days of abstinence was required, and 4) a mean of 13.1 days of intercourse was permitted. Almost all women were able to identify the fertile period by observing their cervical mucus but pregnancy rates ranged from 27.9 in Australia and 26.9 in Dublin to 12.8 in Manila. Continuation was relatively high ranging from 52% in Auckland to 74% in Bangalore.
Psychosexual aspects of natural family planning as revealed in the World Health Organization multicenter trial of the ovulation method and the New Zealand Continuation Study.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, DC, December 10-14, 1990, edited by John T. Queenan, Victoria H. Jennings, Jeffrey M. Spieler, Helena von Hertzen. Washington, D.C., Georgetown University, Institute for International Studies in Natural Family Planning, . 118-20.Successful natural family planning (NFP) use depends upon the day-to-day sexual decision making of users. Given the important role of psychosexual factors in this decision making, they are an important influence in both the effectiveness of natural methods as well as in their acceptability as a means of family planning. The World Health Organization (WHO) Multicenter Study of the ovulation method was conducted in Auckland, New Zealand; Bangalore, India; Dublin, Ireland; Manila, the Philippines; and San Miguel, El Salvador with the secondary objective of obtaining psychosexual information to identify factors leading to the successful use of NFP. Findings were reported in 1987. This paper reviews some of the WHO findings and compares them with some preliminary findings of the current study in New Zealand on continuation rates of NFP users following the symptothermal method with the goal of determining rates of continuation and reasons for acceptability. The WHO study found that the more satisfied people were with NFP and the less difficulty they reported with abstinence, the more likely they were to be successful users, as measured by their avoidance of pregnancy. The New Zealand Study, however, indicates that for many couples abstinence may not be the main difficulty in using NFP, and that long-term acceptance is not necessarily influenced by pregnancy. The authors notes that the two studies involved different NFP methods. The challenge for the future of NFP services is to learn more about what leads to acceptability in different countries and cultures, remembering that for a natural method of family planning, success depends very much upon the decisions, attitudes, and resulting behavior of the couple involved.
INTERNATIONAL JOURNAL OF GYNAECOLOGY AND OBSTETRICS. 1989; (Suppl 1):91-8.In 1975, World Health Organization (WHO) Special Program of Research, Development, and Research Training in Human Reproduction carried out a multicenter, cross-cultural evaluation of the ovulation method in 5 countries--El Salvador, India, Ireland, New Zealand, and the Philippines. Clinical studies were also conducted by others. The WHO trial involved 869 women. More than 10% were illiterate; more than 20% had a technical or university education. The study was planned so that a woman's ability to calculate fertile days could be evaluated. The trial was divided into a learning phase of 3 months (extended to 6 for slow learners) and a 13-cycle effectiveness phase. In 3 months, more than 93% of the women learned to recognize their mucus pattern; only 1.3% failed. Self-recognition of mucus changes was learned equally well regardless of education. 45 pregnancies occurred in this phase. 725 women entered the effectiveness phase. In general, the method was well accepted. 130 pregnancies occurred during the effectiveness phase. 121 of these (almost 70%) were caused by conscious departures from the method; only 17 were truly method-related (less than 10%). An overall Pearl rate (per 1300 cycles) was 22.3. It was only 2.2% for method-related failures. As for pregnancy outcomes, live births accounted for 85.9% of the total. Where the child's sex was known, the proportion of males was .58 (81 males; 59 females). It was .61% when coitus occurred 2-5 days before the peak day (PD) and .67 among coitus occurring 2-4 days after PD. The proportion of males among those conceived within 1 day of PD was .55. This does not differ from the typical population value of .51. The WHO study does not support the hypothesis of an increased risk of malformations and spontaneous abortions in women practicing natural family planning (NFP). Partners were less satisfied with the method than women. However, more than 1/2 found no difficulty with abstinence. This indicates proper selection; not a true acceptance rate. The major drawback of NFP seems to be conscious rule breaking. 3 additional trials of the ovulation method were undertaken--1 in Tonga; a multicenter US study; and a Los Angeles study. These trials confirmed the main features of the method.
INTERNATIONAL REVIEW OF NATURAL FAMILY PLANNING. 1987 Winter; 11(4):319-25.To determine whether the degree of satisfaction experienced by a couple in the practice of the Ovulation (or rhythm) Method of natural family planning was related to the required duration of sexual abstinence, data from the 13-cycle effectiveness phase of a WHO study involving 725 women subjects in 5 countries (New Zealand, India, Ireland, the Philippines, and El Salvador) was analyzed. For both subjects and partners the length of the fertile phase was significantly longer in those expressing poor satisfaction than for those in whom satisfaction was classified as good, very good, or excellent. A similar correlation existed between the number of days of abstinence and satisfaction, whereas the total duration of the infertile phase was less strongly related to the degree of satisfaction. Length of fertile phase is the most significant determinant of the degree of satisfaction.
Copenhagen, Denmark, WHO Regional Office for Europe, 1987. 58 p. (ICP/MCH 518; RM/79/P05 (UNFPA); EUR/HRA target 15)A teachers' training workshop on natural methods of family planning in a nonreligious context was convened by the Regional Office for Europe of the World Health Organization (WHO) in August 1986 anttended by participants from 14 countries. This was the first WHO European Region workshop on natural family planning, which is increasingly accepted as a positive, effective means of controlling fertility. The workshop was organized to create a greater awareness of the natural methods of family planning as an appropriate health technology that can be used to identify the fertile phase of the menstrual cycle to aid couples in avoiding or achieving pregnancy and as the basis of education about fertility. A major recommendation of this workshop was that the term "natural family planning" should be replaced with the term "fertility awareness methods" in order to correct the implication that other contraceptive methods are unnatural and bad. To suit the variety of individual needs and preferences, family planning professionals should offer fertility awareness methods as one option in an extensive repetoire of possibilities. The cervical mucus or cervical palpation methods are more appropriate for postpartum or premenopausal women than the basal body temperature method, since the latter is not very effective when ovulation is irregular. Fertility awareness should also be promoted as a back-up when other contraceptive methods are not available and as a means to help infertile couples achieve pregnancy. The teaching of fertility awareness methods in a nonreligious context should address other forms of sexual activity and the possibility of using barrier methods on fertile days. The teaching of fertility awareness should be integrated into all health and education curricula aimed at youth and adults, professionals and nonprofessionals. Since these methods require cooperation on the couple's part, a special curriculum should be designed for men.
International Family Planning Perspectives and Digest. 1978 Winter; 4(4):125-6.Carefully controlled studies conducted by the World Health Organization (WHO) found 2 of the most modern natural family planning (NFP) methods--the ovulation and the symptothermal methods--to be "relatively ineffective for preventing pregnancy." The 2 methods were compared in a randomized study in Colombia and the ovulation method alone was evaluated in 5 countries. Centers with natural family planning experience were selected and only motivated volunteers were recruited, all of whom were given personal instruction, yet in Colombia 16-22% of the women became pregnant within the 1st year of use. In 5 countries 19 pregnancies/100 woman years occurred. A problem with rhythm methods may be the lack of knowledge of the events surrounding conception, the report notes. In 1976, a comparative study of the ovulation and symptothermal methods of NFP was begun under WHO auspices. Women were admitted to the study after they agreed to be randomly allocated to 1 of the methods. All were aged 18-39 and had a history of regular menstrual cycles. They were given 3-5 months of training. Before entering the effectiveness phase of the study, the volunteers were required to have practiced the method correctly during the last 2 months of training. As of August 1978, there were 439 couples in the study. During the 1st year of participation in the study, life table analysis showed that 16% of couples using the symptothermal method and 22% of those using the ovulation method had unwanted pregnancies. In El Salvador, India, Ireland, New Zealand, and the Philippines, centers with experience with the ovulation method and with qualified teachers available participated in the WHO study, which began in 1975. As of October 1978, 890 women had contributed 2685 cycles to the study; 40 women had become pregnant, i.e., 19.4 pregnancies/100 woman years of use. According to WHO, the high rate of failure was not due to the inability of the women to learn the method but to couples "taking a chance" during the fertile phase. 1 reason for the method failures of periodic abstinence may be that the life span of sperm in the female reproductive tract may be longer than was previously believed. WHO is continuing to develop teaching and educational materials for the ovulation and symptothermal methods in the hope that they might help reduce user failure with these methods.