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UN Chronicle. 1998 Winter; 35(4): p..According to the 1998 revised estimates and projections of the United Nations, the world population currently stands at 5.9 billion persons and is growing at 1.33 per cent per year, an annual net addition of about 78 million people. World population in the mid-twenty-first century is expected to be in the range of 7.3 to 10.7 billion, with a figure of 8.9 billion by the year 2050 considered to be most likely. Global population growth is slowing, thanks to successful family planning programmes. But because of past high fertility, the world population will continue to grow by over 80 million a year for at least the next decade. In mid-1999, the total will pass 6 billion-twice what it was in 1960. More young people than ever are entering their childbearing years. At the same time, the number and proportion of people over 65 are increasing at an unprecedented rate. The rapid growth of these young and old new generations is challenging societies' ability to provide education and health care for the young, and social, medical and financial support for the elderly. (excerpt)
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.
Research on natural family planning: the WHO Task Force on Methods for the Determination of the Fertile Period.
In: Ireland. Dept. of Health, World Health Organization [WHO]. International Seminar on Natural Methods of Family Planning, Dun Laoghaire, County Dublin, Ireland, October 8-9, 1979. [Dublin, Ireland, Dept. of Health, 1979]. 146-53.The WHO (World Health Organization) Task Force on Methods for the Determination of the Fertile Period addresses itself to the following topics: 1) the effectiveness of natural family planning (NFP) methods; 2) ways of improving NFP technology and developing new methods for predicting and detecting ovulation and the fertile period; 3) improving the delivery of NFP, particularly by nonphysicians, and 4) the psychosocial and psychosexual aspects of NFP. The WHO Programme is interested in NFP research for the following reasons: 1) political (to pacify such vocal groups as the Vatican, pro-life organizations, ecology-minded people); 2) to obtain objective information on NFP's effectiveness, continuation of use, advantages and disadvantages and limitations since these methods are being promoted and used; 3) the need and a place for non-chemical, non-device, non-invasive and reversible methods within the technology for fertility regulation; and 4) no other intergovernmental or international organization is undertaking research on NFP in developing countries. The research officially began to function in 1974, and the research scope included the prediction, as well as the detection of ovulation, and the determination of the start and end of the fertile period. The problems associated with NFP include accurate identification of the fertile days of the menstrual cycle, the number of days of abstinence required, and the implementation of abstinence if pregnancy is not desired, and the need for daily continued motivation and cooperation of both partners. Studies by the Task Force included those which obtained data on the percentage and characteristics of couples who can and cannot successfully learn and use the methods; reasons for discontinuation; difficulties experienced in recordkeeping; motivation for using NFP and others. Some of the studies show that the effectiveness of the method is affected almost exclusively by the motivation of the couple. The Task Force also aims to develop inexpensive and easy-to-use technology suitable for home use, primarily in developing countries. Further research is being done on 1) factors that affect demand, choice and use of NFP methods; and 2) the psychosociological integrative and disintegrative effects of fertility control methods including their impact on conjugal stability and the psychological significance of the act of coitus in different peoples and cultures.
IPPF Medical Bulletin. 1982 Dec; 16(6):2-3.IPPF does not advise that periodic abstinence be considered an equal alternative to more effective family planning methods because of findings from recent, carefully conducted trials that show unusually high failure and discontinuation rates compared with other methods. Periodic abstinence for family planning depends upon identifying the fertile phase of the menstrual cycle which occurs around the time of ovulation and avoiding sexual intercourse during that time. Abstinence is sometimes necessary during a large part of the cycle because of the difficulty of accurately predicting the fertile phase. In recent major studies, almost 20% of women using the sympto-thermal method became pregnant within a year, as did about 25% of those using the cervical mucus method, compared with less than 5% of those using oral contraceptives or IUDs. The sympto-thermal method appears more effective than the cervical mucus method, but both show wide ranges of pregnancy and discontinuation rates among different groups of women. Nevertheless, family planning associations should familiarize themselves with the periodic abstinence techniques for couples for whom periodic abstinence techniques for couples for whom periodic abstinence is the only choice. Such couples should be clearly informed that the method is not considered an effective method of family planning. Periodic abstinence is better than no method, however, and various other benefits can be obtained, such as knowledge of female physiology. Couples may identify the fertile phase to use barrier methods only on days estimated to be fertile, and it may lead to use of more effective contraception. Methods of detecting ovulation are also useful in diagnosis and treatment of infertility.
International Review of Natural Family Planning. 1982 Fall; 6(3):290-8.This article summarizes the experiences of the author, a priest, in teaching natural family planning, (NFP), for the past 7 years in the rural areas of Central America, the Caribbean, Ghana, and Mexico, including his participation in a multicentered WHO study. He 1st points out that it is important to use information that people already know. The article contains a sample illustration which relates the fertile period of growth that accompanies rain in the natural environment to the period of ovulation. The WHO study included 900 women from India, the Philippines, Ireland and New Zealand, in addition to the author's parish in El Salvador. Illiterate women in El Salvador learned to identify the fertile times in their cycles with the same facility as the women of New Zealand, who had an average of 12 years of education. The study also found that the method had a theoretical effectiveness of 98.2%, although the participants in rural El Salvador got pregnant at a rater higher than anywhere else. This was not due to a failure of the method, but instead could be attributed to user related pregnancies. That is, the women that got pregnant didn't follow the rules of the method. He states that people in rural areas learn the natural method of birth control easily because it costs nothing and because of their reverence for nature, it seems natural. In addition to the child spacing advantage, the beneficial effects of natural methods include the discipline of periodic abstinence and the education of children about the beauty and dignity of sex. The author stresses the need to educate rural people that artificial methods of birth control, especially sterilization, have harmful and evil side effects.
In: Jeffcoate SL, ed. Ovulation: methods for its prediction and detection. Chichester, England, John Wiley, 1983. 33-47. (Current Topics in Reproductive Endocrinology Volume 3)This chapter reviews certain recognizable biological effects that occur due to the major changes in the circulating blood levels of estrogen and progesterone and discusses the ongoing use of these biological signals for the self detection of ovulation and the fertile phase of the cycle. These biological changes include the basal body temperature, changes in the cervix and its mucus secretion, mittelschmerz, and the menstrual cycle molimina. The calculation or calendar method is the oldest technique for determining the fertile period and followed the work of Ogino (1930) and Knaus (1933). The fertile phase of the cycle was identified from the records of the previous 6-12 menstrual cycles. The potential fertile period was then calculated on the following basis: define the shortest and the longest menstrual cycle over the preceding 6 and preferable 12 cycles; the 1st day of the potentially fertile phase is the longest cycle minus 11 days. For a women whose menstrual cycles have varied between 26-31 days, the potential fertile period would be days 8-20 of the cycle. The greatest weakness of the calendar calculation is that it depends on a prediction, based on the menstrual history, of what is likely to occur and not on what is actually taking place. Very rapid electronic thermometers are now available which offer considerable advantages over the clinical thermometer. The daily taking and charting of the basal body temperature (BBT) is the simplest and most widely used method for detecting ovulation. To overcome the drawbacks of the calendar method and the BBT method for identifying the fertile period, John and Evelyn Billings of Melbourne in the early 1970s developed the ovulation method. Self recognition of cervical mucus symptoms provides the woman with a simple means of detecting the fertile phase of her cycle and the likely time of ovulation. Individual cycle variation in the preovulatory duration of the symptoms limits the position of the prediction, yet the "peak" day correlates better with the time of ovulation than the shift in BBT. In addition to effects on cervical mucus, estrogen also changes the morphology of the cervix. The preovulatory rise in estrogensoftens the tissues of the cervix and opens the cervical os. The softened cervix and gaping os with a cascade of clear mucus is a sign of optimal estrogen response and of imminent ovulation. A World Health Organization (WHO) multicenter study of the ovulation method provided a substantial amount of information of the normal menstrual cycle of a large number of women of proven fertility in the age group 18-39 years whose cycles were not influenced by the use of hormonal or other contraceptive methods.