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[Unpublished] 1980. Presented at the Second International Congress of the International Federation for Family Life Promotion, Navan, Ireland, September 24-October 1, 1980. 13 p.Results of a research program on puerperium physiology are discussed in terms of their relationship to return of fertility during the postpartum period and possible applications to natural family planning (NFP) during this period. Correlation between nursing and first postpartum menstruation has been found. Of especial importance is the finding of the probability of ovulation occurring during the first 10 postpartum weeks being practically nil (=.0008) and chances of ovulation increasing after 12th week postpartum if full nursing is maintained (=.047). Therefore, in terms of Billings' method, nonnursing mothers or those nursing for less than 28 days must wait until first postpartum menstruation (40-80 days) before learning the method, if abstinence is maintained during the postpartum. Mothers in full nursing can reinitiate intercourse between 25-30 days postpartum. A WHO-sponsored training program of teachers of the Ovulation method in Santiago, Chile, trained 70 couples, and use-effectiveness postpartum was particularly studied. 82 couples were recruited as students. The women were all white and of low socioeconomic class. 51 were fully nursing, 25 partially, and 6 had suspended nursing upon entrance to the program. 82 couples completed 655 months of use during the 16-month study. 4 pregnancies occurred, and 2 couples changed methods. Pearl Index was 7.3/100 years of use. When 130 postpartum amenorrheic months were subtracted, Pearl Index was 9.1. 1 pregnancy was in a user under nonovulatory conditions; 2 were method failures; and 1 was the result of faulty teaching. All of the couples are continuing with NFP, and 97.8% were considered to have learned to recognize mucus patterns during postpartum period.
International Review of Natural Family Planning. 1981 Spring; 5(1):83-90.The second International Congress of the International Federation of Family Life Promotion (IFFLP) held in Ireland in September 24 to October 1, 1980 was conducted to provide a forum for issues relating to natural family planning (NFP). The Congress was divided into 3 components: 1) scientific status, program development, and NFP programs in their cultural contexts; 2) the IFFLP general assembly; and 3) trainer's workshop. 2 NFP effectiveness studies (Los Angeles study and Colombia study) both comparing the ovulation method and the sympto-thermal method were discussed in terms of recruitment, training, dropouts, and conclusions. Recruitment in both studies was very low (2-3% of population in the Los Angeles study, and less for the Colombia study), raising questions relating to the measure of acceptability of natural methods in the population concerned and the nature of the constraints of the study. Dropout rate reached an alarming 70% at the end of a year in both studies, raising the questions of the validity of the life-table analysis presented. The Pearl Index values for both studies were very high: for the LA study, 18.5/100 woman-years for the sympto-thermal method and 32/100 woman-years for the ovulation method; for the Colombia study, 33/100 for the sympto-thermal method and 35/100 for the ovulation method. The following were deemed as important scientific advances in NFP: 1) clarification of the concept of "basic infertile" pattern of preovulatory mucus (unchanged pattern day after day means continuing infertility); 2) use of cervical mucus as one of the most important indices in infertile/subfertile patients and also during lactation and premenopause; and 3) development of methods for measuring levels of estrone-3-glucuronide and pregnanediol-3-alpha-glucuronide to predict start and end of fertile phase. A paper presented on the use of the Billings Ovulation Method by 82 postpartum women followed up for an average of 16 months showed that only 4 unplanned pregnancies occurred (2 method and 2 user failures), and 97.8% of the women learned to recognize their postpartum mucus pattern. The Pearl Index was 7.3/100 woman-years and overall method failure rate was 3.6. Other topics discussed were NFP program services and developments in NFP by zonal groups.
[Unpublished] 1979. Presented at the International Symposium Medicated IUDs and Polymeric Delivery Systems, Amsterdam, Holland, 1979 June 27-30. 23 p.After almost 20 years of worldwide availability and use of IUDs, assessment of their future role for family planning remains difficult. There are differences concerning the success of IUDs in different programs, and there is also wide variation among individual women in the acceptability and utility of the IUD. Successful IUD use seems to depend upon a complex interplay of factors which include the technology of the IUD itself, biological variation among women, individual and cultural differences in tolerance of IUD caused side effects, and the nature and quality of the available medical care and follow-up services. The principal difficulties encountered in IUD use are discomfort and increased bleeding, spontaneous expulsions, increased frequency of uterine and pelvic infection, and pregnancy failures. In the early years of mass programs for family planning in developing countries the IUD was often emphasized. Inadequate data exists to obtain an accurate world picture of IUD usage and demographic impact at this time. IUDs are available in most countries through a number of channels, and figures on distribution and usage through sales and service programs are incomplete. The best measurement of prevalence of use of IUDs comes from special surveys selected in order to provide a representative sample of the nation's or an area's population. The usage of IUDs in China and India is reviewed. When fertility effects on acceptors are examined, the experience with the IUD seems to be favorable compared with other means of fertility control, but the programmatic impact of IUD use has not been so favorable. Many countries have either added additional means of fertility control or switched emphasis to other methods.
San Francisco, San Francisco Press, 1974. 292 p.Despite its high effectiveness, lack of side effects, ease of use, and low cost, condom utilization has declined in the U.S. from 30% of contracepting couples in 1955 to 15% in 1970. The present status of the condom, actions needed to facilitate its increased availability and acceptance, and research required to improve understanding of factors affecting its use are reviewed in the proceedings of a conference on the condom sponsored by the Battelle Population Study Center in 1973. It is concluded that condom use in the U.S. is not meeting its potential. Factors affecting its underutilization include negative attitudes among the medical and family planning professions; state laws restricting sales outlets, display, and advertising; inapplicable testing standards; the National Association of Broadcasters' ban on contraceptive advertising; media's reluctance to carry condom ads; manufacturer's hesitancy to widen the range of products and use aggressive marketing techniques; and physical properties of the condom itself. Further, the condom has an image problem, tending to be associated with venereal disease and prostitution and regarded as a hassle to use and an impediment to sexual sensation. Innovative, broad-based marketing and sales through a variety of outlets have been key to effective widespread condom usage in England, Japan, and Sweden. Such campaigns could be directed toward couples who cannot or will not use other methods and teenagers whose unplanned, sporadic sexual activity lends itself to condom use. Other means of increasing U.S. condom utilization include repealing state and local laws restricting condom sales to pharmacies and limiting open display; removing the ban on contraceptive advertising and changing the attitude of the media; using educational programs to correct erroneous images; and developing support for condom distribution in family planning programs. Also possible is modifying the extreme stringency of condom standards. Thinner condoms could increase usage without significantly affecting failure rates. More research is needed on condom use-effectiveness in potential user populations and in preventing venereal disease transmission; the effects of condom shape, thickness, and lubrication on consumer acceptance; reactions to condom advertising; and the point at which an acceptable level of utilization has been achieved.
Injectable progestogens - officials debate but use increases. Les progestatifs injectables : les autorites en debattent, mas l'usage s'en repand.
Population Reports. Series K: Injectables and Implants. 1975 Mar; (1): p.A report on the status of the injectable contraceptive agents, Depo-Provera (depot medroxyprogesterone acetate) and Norigest is presented. Depo-Provera is distributed in 64 countries, though it is not available in the U.S., the United Kingdom, and Japan. The drug is usually administered in single 150 mg injections every 3 months, and doses of 300-400 mg every 6 months have been studied. The contraceptive effect of Depo-Provera is primarily through its ability to inhibit ovulation. Norigest exerts its effect by altering the cervical mucus. The suppression of ovulation is most likely caused by action on the hypothalamus-pituitary axis, resulting in inhibition of the luteinizing hormone surge. Depo-Provera causes an atrophic endometrium, while Norigest has varying endometrial effects. The reported pregnancy rates for Depo-Provera are usually less than 1%, while those for Norigest are slightly higher. Most method failures occur either shortly after the 1st injection or at the end of an injection interval. Menstrual disorders have been the primary reason for discontinuation. The injectables can cuase shorter or longer cycles, increased or decreased menstrual flow, and spotting. Depo-Provera users experience increased amenorrhea with continued use, while normal cycles increasingly reappear in Norigest users. Cyclic estrogen therapy has been effective in treating excessive or irregular bleeding and amenorrhea. Long-acting estrogen injections have been administered in combination with Depo-Provera or Norigest, though the studies are limited in number. Weight gain of up to 9 pounds has been reported for users of Depo-Provera. Some researchers have found that Depo-Provera raises blood glucose levels, while others have reported it does not. No adverse effects have been reported for injectables on blood clotting, adrenal or liver function, blood pressure, lactation, and metabolic or endocrine functions. The continuation rate for Depo-Provera is reportedly higher than that for oral contraceptives. Generally, 60% of the acceptors will use the method for at least 1 year. Effective counseling on the menstrual alterations resulting from injectables can increase continuation of the method. The return of fertility in Depo-Provera users usually requires 13 months from the time of the last injection, while the afertile period in Norigest users is about 6 months from the time of the last injection. Instances of fetal masculinization as a result of Depo-Provera use have not occurred. The possibility that Depo-Provera can cause cervical carcinoma in situ has not been substantiated by the evidence; doubt about this possible association has prevented its approval as a contraceptive method in the U.S. Although Depo-Provera and Norigest have caused breast nodules in laboratory animals, there is no evidence to suggest that this effect would occur in human. Despite the advantages of injectables, family planning officials have been reluctant to permit its unrestricted use, primarily because it cannot be withdrawn guickly enough if problems arise and because the actual effect on fertility is not yet known. Nonetheless, the use of Depo-Provera has increased in recent years. The IPPF and the U.N. Fund for Population Activities currently supply the drug.