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BMJ. British Medical Journal. 1993 Sep 18; 307(6906):723-6.The Catholic Church approves the use of natural family planning (NFP) methods. Many people think only of the rhythm method when they hear NFP so they perceive NFP methods to be unreliable, unacceptable, and ineffective. They interpret the Catholic Church's approval of these methods as its opposition to birth control. The Billings or cervical mucus method is quite reliable and effective. Rising estrogen levels coincide with increased secretion of cervical mucus, which during ovulation is relatively thin and contains glycoprotein fibrils in a micelle like structure aiding sperm migration. Ultrasonography confirms that the day of most abundant secretion of fertile-type eggs white mucus is the day of ovulation. Once progesterone begins to be secreted, cervical mucus becomes thick and rubbery and acts like a plug in the cervix. Other symptoms associated with ovulation include periovulatory pain and postovulatory rise in basal body temperature. A WHO study of 869 fertile women from Australia, India, Ireland, the Philippines, and El Salvador found 93% could accurately interpret the ovulatory mucus pattern, regardless of education and culture. The probability of pregnancy among women using the cervical mucus method and having intercourse outside the fertile period was .004. The probability of conception increased the closer couples were to the fertile period when they had intercourse (.546 on -3 to -1 peak day and .667 on peak day 0), regardless of education and culture. The failure rate of NFP among mainly poor women in Calcutta, India, equal that of the combined oral contraceptive (0.2/100 women users yearly). Poverty was the motivating factor. NFP costs nothing, is effective (particularly in poverty stricken areas), has no side effects, and grants couples considerable power to control their fertility, indicating the NFP may be the preferred family planning method in developing countries. Prejudices about NFP should be dropped and worldwide dissemination of NFP information should occur.
[The Church, the Family and Responsible Parenthood in Latin America: a Meeting of experts] Iglesia, Familia y Paternidad Responsable en America Latina: Encuentro de Expertos.
Bogota, Colombia, CELAM, 1977. (Documento CELAM No. 32.)This document is the result of a meeting organized by the Department of the Laity of the Latin American Episcopal Council on the theme of the Church, Family, and Responsible Parenthood. 18 Latin American experts in various disciplines were selected on the basis of professional competence and the correctness of their philosophical and theological positions in the eyes of the Catholic Church to study the problem of responsible parenthood in Latin America and to recommend lines of action for a true family ministry in this area. The work consists of 2 major parts: 12 presentations concerning the sociodemographic, philosophical-theological, psychophysiological, and educational aspects of responsible parenthood, and conclusions based on the work and the meetings. The 4 articles on sociodemographic aspects discuss the demographic problem in Latin America, Latin America and the demographic question in the Conference of Bucharest, maturity of faith in Christ expressed in responsible parenthood, and social conditions of responsible parenthood in Peruvian squatter settlements. The 3 articles on philosophical and theological aspects concern conceptual foundations of neomalthusian theory, pastoral attitudes in relation to responsible parenthood, and pastoral action regarding responsible parenthood. 2 articles on psychophysiological aspects discuss the couple and methods of fertility regulation and the gynecologist as an advisor on psychosexual problems of reproduction. Educational aspects are discussed in 3 articles on sexual pathology and education, education for responsible parenthood, and the Misereor-Carvajal Program of Family Action in Cali, Colombia. The conclusions are the result of an interdisciplinary effort to synthesize the major points of discussion and agreements on principles and actions arrived at in each of the 4 areas.
Report on the evaluation of various family life education projects with particular emphasis on youth in the English-speaking Caribbean: general conclusions and recommendations.
New York, New York, United Nations Fund for Population Activities [UNFPA], 1984 Nov. xii, 39,  p.Most family life education (FLE) projects included in this evaluation have the longterm objectives of reducing the incidence of teenage prognancy, and promotion of self-reliance and positive, responsible behavior among youth. The immediate objectives and project strategies are also very similar across projects, e.g., in-school and out-of-school FLE, comprehensive youth services, including family planning (FP) and training. The evaluation shows that project design has improved over the years (clearer and measurable formulation of objectives, more comprehensive workplans and better explanation of budgetary items) and projects have moved from addressing a wide variety of broad issues to a more focused consideration of adolescent fertility. However, the Evaluation Mission in concerned that due to the similarities in project design, country-and-time-specific factors have not always been adequately taken into consideration. Other concerns include the lack of systematic needs assessment and use of baseline data to guide implementation. All the projects evaluated have contributed to the training in FLE/FP of a large number of family life educators, teachers and nurses and have thus significantly strengthened professional national capability. Nevertheless, training needs still exist in motivational/attitudinal variables, sex roles, teaching/learning technics. The projects have made a significant contribution to the introduction of FLE into schools and teacher training institutions. The focus at present should be the institutionalization of FLE within the in-school sector, including the development of a policy approving FLE in schools. The development of community-based health centers was often the central activity of the out-of-school FLE component of the projects. These centers have contributed to shaping the countries' attitudes by creating an awareness of teenage pregnancy, by developing an acceptable strategy, by providing a focal point for discussing sensitive issues, and by becoming a mechanism for community mobilization. The projects have also contributed to making FP services available and specialized services for adolescents are being established. The emphasis has been more on education and awareness creation than on contraceptive distribution to adolescents. At present the need is to strengthen the service delivery components. The limited availability of data suggests that adolescent pregnancy remains an urgent problem in the region. Sustained and more focused FLE/FP program efforts directed to adolescents continue to be needed in the region. The most important general lesson learnt from the programs is that programs in adolescent fertility can be started and implemented in countries even prior to declaration of policy by governments. However, at a certain stage of implementation the programs cannot be carried further without explicit government policies and control.
Socio-economic development and fertility decline in Costa Rica. Background paper prepared for the project on socio-economic development and fertility decline.
New York, New York, United Nations, 1985. 118 p. (ST/ESA/SER.R/55)This summary of information on the development process in Costa Rica and its relation to fertility from 1950-70 is a revision of a study prepared for the Workshop on Socioeconomic Development and Fertility Decline held in Costa Rica in April 1982 as part of a UN comparative study of 5 developing countries. The report contains chapters on background information on fertility and the family, historical facts, and political organization of Costa Rica; the development strategy and its consequences vis a vis the composition of the gross domestic product, balance of trade, investment trends, the structure of the labor force, educational levels, and income; the allocation of public resources in public employment, public investment, credit, public expenditures, and the impact of resource allocation policies; changes in land tenure patterns; cultural factors affecting fertility, including education, women and their family roles, behavior in the home, women and politics, work and social security, and race and religion; changes in demographic variables, including nuptiality patterns, marital fertility, and natural fertility and birth control; characteristics and determining factors of the decline in fertility, including levels and trends, decline by age group, decline in terms of birth order, differences among population groups, how fertility declined, and history and role of family planning programs; and a discussion of the modernization process in Costa Rica and the relationship between demographic and socioeconomic variables. Beginning with the 1948 civil war, Costa Rica underwent drastic changes which were still reflected in national life as late as 1970. The industrial sector and the government bureaucracy have become decisive forces in development and the government has become the major employer. The state plays a key role in economic life, and state participation is a determining factor in extending medical and educational resources in the social field. The economically active population declined from 64% in 1960 to 55% in 1975 due to urbanization and migration from rural to urban areas, but there was an increase in economic participation of women, especially in urban areas. Increased educational level of the population in general and women in particular created changes in traditional attitudes and behavior. Although there is no specific explanation of why Costa Rica's fertility decline occurred, some observations about its determining factors and mechanisms can be made: the considerable economic development of the 1950s and 1960s brought about a rapid rise in per capita income and changes in the structure of production as well as substantial social development, increased opportunities for self-improvement for some social groups, and a rise in expectations. The size of the family became an aspect of conflict between rising expectations and increasing expenses. The National Family Planning Program helped accelerate the fertility decline.
[Unpublished] 1982. Paper prepared for Conference on Vasectomy, Colombo, Sri Lanka, Oct. 4-7, 1982. 21 p.Discusses the factors responsible for the decline of male acceptance of vasectomy over the past decade. The Association for Voluntary Sterilization (AVS) is a nonprofit organization working in the United States which helps funding of similar programs in other developed and developing countries. Reasons for the decline of vasectomy acceptance include the lack of attention paid to male sterilization in countries with family planning programs, the introduction of new technology for female sterilization, the introduction of new effective methods of contraception, and the exaggerated sexual role of the male and the need to protect his virility. The author reviews successful vasectomy programs and finds that, to be successful, a program should have strong leadership, a focussed design, clinic hours that would not interfere with patients' working schedules, and should pay attention to the needs of men, e.g., emphasizing that vasectomy does not cause impotency. The program should also have a community-based orientation, since all the services are not hospital-based and can be brought to the client's home, thereby emphasizing the minor nature of the surgery. AVS believes that vasectomy as a means of family planning can be effective. It is safe, inexpensive, simple, and deliverable. A special fund was allocated in 1983 to stimulate the development of several pilot and demonstration projects in a variety of countries.