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[Unpublished] . 11 p.This glossary, prepared by the Task Force on Methods for the Determination of the Fertile Period of the World Health Organization (WHO) Special Program of Research, Development and Research Training in Human Reproduction, defines 79 terms and concepts central to the understanding of family planning based on periodic abstinence. The glossary was the result of awareness that the absence of standardized terminology has resulted in misunderstandings regarding the teaching and practice of natural family planning methods, errors in the overall interpretation of data and evaluation of effectiveness, and communication difficulties between family planning programs and investigators. The glossary is primarily intended to provide technical language for the natural family planning instructor as a tool for communication with couples who intend to practice family planning based on periodic abstinence. Efforts were made to use simple and precise language, and it is expected that the glossary will be translated from English and adapted to local vernacular and cultures. The glossary in not intended to replace a manual of instruction on natural family planning planning.
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.
[Lactation-induced amenorrhea as birth control method] Lactatieamenorroe als geboorteregelingsmethode.
NEDERLANDS TIJDSCHRIFT VOOR GENEESKUNDE.. 1998 Jan 10; 142(2):60-2.In 1966 WHO published a document on improving access to quality care in family planning, which who pronounced to be a fundamental human right. According to this document, despite the assortment of reliable contraceptives worldwide 350 million people have unmet need for contraception because of lack of access or availability. Adequate reproductive health depends not only access to contraceptives, but also on adequate screening and treatment of anemia, sexually transmitted diseases, and cervical carcinoma. Among 8 groups of birth control methods studied, the lactational amenorrhea method (LAM) was dealt with in detail. The underlying mechanism lies in the stimulation that breastfeeding brings about and in breastfeeding's suppression of the release of gonadotropin- releasing hormone and of dopamine (the prolactin inhibiting factor). A 1974 investigation in Rwanda demonstrated that 50% of rural women who breast fed their children frequently got pregnant within 23 months of childbirth and that 50% of city women became pregnant 9 months postpartum. The Bellagio consensus has stated that LAM provides 98% protection against pregnancy in the first 6 months postpartum as long as breast feeding is the exclusive feeding method practiced. A 1992 analysis of 9 prospective studies reported that 6 months postpartum only 0.7% of the women using LAM became pregnant. LAM still plays a crucial role in Africa, where the average number of children per woman is 6. Without breastfeeding the estimated figure would be 10.
International Planned Parenthood Federation medical and service delivery guidelines for family planning.
London, England, International Planned Parenthood Federation [IPPF], 1992. xviii, 169 p.The International Planned Parenthood Federation has developed these guidelines to help persons working in family planning services and education ensure adequate levels of quality of care. The guidelines conform to the three dimensions of technology assessment needed for any project: it must be scientifically, socially, and operationally sound. Providers should adapt the service delivery guidelines to local realities. They should consider the needs and resources of the various sites in which the guidelines will be applied. The guidelines can also be developed into educational and training materials. They serve as a guide to the delivery of family planning services, a reference document for assessing quality of care, a training instrument, and a tool for supervision. The first chapter addresses the rights of the client, ranging from the right to information to the right of opinion. The second chapter is dedicated to contraceptive counseling, while chapter 3 is dedicated to family planning training. Chapter 4 discusses hormonal contraception (combined oral contraceptives, progestagen-only pills, service management, progestagen-only injectables, and the subdermal implants, Norplant). IUDs are covered in detail in chapter 5. The barrier methods addressed in chapter 6 include condoms, diaphragms, cervical caps, and spermicides. Chapter 7 covers both male and female voluntary surgical contraception. Natural family planning methods are addressed in chapter 8 entitled Periodic Abstinence. These methods include the basal body temperature method, the cervical mucus method (Billings method), the calendar or rhythm method, and the sympto-thermal method. The guidelines conclude with a detailed statement on diagnosis of pregnancy and a list of suggested reading material.
In: Annual technical report, 1992, [of the] World Health Organization [WHO]. Special Programme of Research, Development and Research Training in Human Reproduction. Geneva, Switzerland, WHO, 1993. 95-106. (WHO/HRP/ATR/92/93)This 1992 Annual Report of the Task Force on the Natural Regulation of Fertility of the World Health Organization's Special Programme of Research, Development, and Research Training in Human Reproduction describes the principal objectives of the Task Force as 1) improving understanding of the mechanisms and factors that influence the duration of lactational infertility, 2) developing and evaluating methods to detect ovulation, and 3) improving and evaluating the effectiveness of natural family planning methods based on periodic abstinence. In the area receiving most of the Task Force's attention, three research lines are being supported to determine 1) the relationship between breast-feeding practices and the duration of lactational amenorrhea, 2) the biological mechanisms of ovarian suppression during lactation, and 3) the "interface" between relying on lactation for fertility regulation and the use of other methods. Ovulation detection research includes 1) a multicenter study to assess whether women can measure changes in cervico-vaginal fluid volume with a simple device to identify the fertile period and 2) evaluation of methods for home-based assays of urinary estrone and pregnanediol glucuronides to monitor cyclical changes. In the area of natural family planning, preparations are being made to conduct research into the calendar/rhythm methods commonly used. The Task Force works in close collaboration with the international organizations which are active in the field and distributes information about Task Force activities through scientific publications and conferences.
Lancet. 1995 Jul 22; 346(8969):233-4.Natural family planning (NFP) tends to be considered as a matter of chance resulting in unplanned pregnancies and large families. A World Health Organization (WHO) multicenter trial of the ovulation method of NFP was undertaken during 1975-79 with the primary objective of determining what proportion of women of many different cultures could be taught to recognize changes in the cervical mucus around the time of ovulation. The conclusions were that: a) irrespective of cultural, educational, or economic background, over 95% of fertile women could recognize the mucus signs of fertility; b) the fertility rate was 22.6 pregnancies per 100 woman years; c) the preovulatory and postovulatory days designated by the ovulation method of NFP rules as infertile were indeed infertile, as the pregnancies in this phase were 4 per 1000 acts of intercourse. The knowledge gained through the WHO trial and subsequent experience has given NFP organizations and teachers a much greater understanding of the fertile and infertile phases, so that total pregnancy rates have been steadily falling. Of the 11 NFP studies so far reported in the 1990s, the 3 that had total pregnancy rates greater than 5 per 100 woman years were trials of atypical NFP approaches or teaching methods. The results can be compared with reported pregnancy rates of between 0.18 and 3.6 for artificial contraceptive methods in well-motivated couples. One criticism of NFP is that the necessary periods of abstinence may be detrimental to the marital relationship. It is suggested that the sexual revolution of the last 20-30 years has caused marital and family breakdown on a massive scale, thus NFP might be the antidote. Since women are potentially fertile for no more than 6-8 days in the cycle, these easily recognized symptoms empower women through the knowledge they impart regarding their state of fertility. All women are entitled to this simple and fundamental information.
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.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, D.C., 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 Family Planning, . 94-5.The World Health Organization (WHO) is a leader in the promotion and support of the development of an integrated approach to maternal and child health and family planning programs, including natural family planning (NFP). WHO has no specific policy related to individual family planning methods, including NFP, but due consideration, support, and information are nonetheless being provided to help program managers introduce NFP in countries' family planning programs. Technical, financial, and educational support is being provided at the country, regional, and global levels, while collaboration is being strengthened with the various UN and nongovernmental organizations. The Program of Maternal and Child Health and Family Planning is preparing a series of technical and managerial guidelines on various contraceptive technologies. A guide to the provision of NFP services is included in the series, synthesizing the knowledge and experience of experts and programs in NFP from around the world. A brief explanation is also provided of the current NFP methods. A brochure on NFP containing essential messages in the form of simple questions and answers is also being prepared from family planning providers and users. It will be richly illustrated and will propose simple answers in common language to the most commonly asked questions about NFP. Finally, WHO has prepared a brochure in collaboration with UNFPA and various nongovernmental agencies on breast feeding and child spacing.
International Planned Parenthood Federation's policy and support for periodic abstinence: rationale and future plans.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, D.C., 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 Family Planning, . 93.The International Planned Parenthood Federation (IPPF) is comprised of 107 autonomous family planning associations (FPA) and is governed by its volunteer membership. Policies on family planning methods, which apply to the affiliated FPAs, are formulated from statements written by IPPF's International Medical Advisory Panel (IMAP), a group of internationally recognized physicians active in family planning. IMAP statements are reviewed by the Central Executive Committee and become policy, if approved. IPPF has had a policy on periodic abstinence since 1982, with the original statement amended most recently at the November 1990 IMAP meeting. The federation acknowledges the importance of periodic abstinence-based family planning methods and encourages its members to make those methods available to increase family planning options. Couples who choose those methods should be informed of the advantages and disadvantages, including failure rates, and appropriate counseling and follow-up should be provided.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, D.C., 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 Family Planning, . 91-2.The UN Population Fund (UNFPA) has neither policy for any specific method or approach to family planning, nor preference for any particular method. UNFPA's judgement on particular methods is based upon public assessments and UNFPA's perception of its appropriateness and effectiveness. General policies regulating UNFPA support to population programs rest upon a set of fundamental principles related to the type of relationship maintained with governments of the UN member states and to ethical and human rights implications. The UNFPA supports natural family planning (NFP) as one of many viable family planning options for use in a comprehensive national program. NFP methods are methods of choice for couples who are able to abstain methodically for sufficient periods of time, are capable of following specific instructions, and are able to communicate effectively with each other. A natural constituency therefore exists for NFP. Moreover, UNFPA believes in the educational value of natural methods. NFP helps couples to understand basic features of their reproductive physiology and to develop capacities for self-observation. This educational component of NFP helps improve women's status within the family, in relation to their partner or spouse, and in society overall. UNFPA looks forward to the time when NFP becomes an active and dynamic part of national family planning programs everywhere.
In: Natural family planning: current knowledge and new strategies for the 1990s. Proceedings of a conference, Part II, Georgetown University, Washington, D.C., 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 Family Planning, . 82-3.Natural family planning (NFP) is being practiced in several countries throughout Latin America, with a significant number of reported acceptors initiating and maintaining the practice of the method through International Planned Parenthood Federation (IPPF) Western Hemisphere Region (WHR) family planning associations (FPAs). IPPF/WHR has taken advantage of a recent updating and simplification of its service statistics system to incorporate NFP listed as a distinct method just like the others offered by the FPAs. The FPAs were therefore credited with providing NFP. This explicit inclusion of NFP in the service statistics forms and in the accompanying IPPF Service Statistics Manual will likely prompt FPAs to register NFP acceptors. More FPAs will also probably consider offering this method to clients. To incorporate NFP into a multimethod data system, family planning programs are recommended to use the power of demonstration, provide reporting space in statistical forms, and gather, tabulate, analyze, and publicize results.
BMJ. British Medical Journal. 1993 Oct 16; 307(6910):1003.An author of an article about natural family planning (NFP) in an earlier issue of the British Medical Journal contends that NFP and modern contraceptive methods (e.g., oral contraceptives [OCs]) provide comparable effectiveness against pregnancy. He uses data from a WHO multicountry study and a study of 20,000 women in Calcutta to support his position that NFP is safe, reliable, and effective. IPPF staff agree with the author that health professionals would accept another inexpensive, reliable, and safe family planning method. The author misrepresented the studies' findings, however. He says that the pregnancy rate for the WHO study group was 1.5%. Yet, the women who participated in the study and conceived included not only the 1.5% but also another 19.4% who did not identify their fertile cycle or did not abstain as called for by NFP guidelines. The author failed to mention these women in his review. The actual NFP failure rate for the WHO study group was 20.9%--a much higher rate than that for modern contraceptive methods. The Calcutta study did not present enough information on the methodology or selection of cases to allow comment. When both partners are very motivated, when the woman can always recognize signs of her fertile period, and when the couple can truly avoid intercourse according to NFP guidelines, periodic abstinence is an effective family planning method. Otherwise the woman is at great risk of conceiving. Many couples gamble and do not abide by the guidelines. In reality, the author's assertion that NFP is as effective as OCs is clearly false. IPPF considers NFP as one of many family planning choices. Couples choosing NFP should be told of its real failure rates, the need to totally follow the abstinence rules, and the risk of pregnancy when those rules are not followed.
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, . 9.The World Health Organization has two sections which work in the field of natural family planning: the Division of Family Health through its Maternal and Child Health and Family Planning Program (MCH), and the Special Program of Research, Development, and Research Training in Human Reproduction (HRP) through its Task Force on methods for the Natural Regulation of Fertility. The MCH focus upon education and services complements the HRP's efforts in biomedical research. The long-term objective of task force research is to improve the performance of methods used for NFP. The main research areas are lactation, indices of the fertile period, and NFP, with primary emphasis given to lactation and its contribution to the natural suppression of fertility. Lactation is receiving high priority because breastfeeding makes an important contribution to infant and maternal health, and to birth spacing. Moreover, breastfeeding is the only form of birth spacing available to many women in the developing world.
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, . 52.The Family Life Movement of Zambia's (FLMZ) five-year demonstration program to provide natural family planning services was the first of its kind and scope in Africa. In the absence of available textbooks and picturesque volumes, FLMZ developed its own training materials over time as the practical needs of the trainers, trainees, and users became evident. The World Health Organization (WHO) Family Fertility Learning Resource Package was later introduced and adapted to meet local needs, with instructor training objectives based on the WHO package objectives and taught effectively with chalk and blackboard. Teachers in the field use very simple materials and do not need much in addition to anatomy charts and cardboard thermometers for instruction purposes. In the Zambian experience, however, imported, elaborate colored charts and teaching aids were considered inappropriate. Teacher involvement in evaluating the teaching aids lead to the creation of more acceptable and appropriate materials.
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, . 53-4.The Human Life Foundation and the US Department of Health and Human Services in collaboration with the International Federation for Family Life Promotion (IFFLP) in 1974 began developing a training guide in natural family planning (NFP). A task analysis of NFP programs and teachers in the US and Canada found that teachers need to have sufficient and accurate knowledge and skills in fertility awareness to effectively teach ovulation and symptothermal methods to couples. Teachers also need to provide follow-up services until couples reach autonomy. Training materials were therefore developed for NFP teachers including four modules of instructional guides with specific knowledge, attitude, and performance training objectives stated; eight objective, multiple-choice tests, with two versions for each module; and a rating scale to measure the required initial skill level for teaching NFP to client couples under supervision. Training objectives were revised after review by national and international NFP experts. Reliability of the multiple-choice tests proved to be 0.93-0.95 for all versions of each of the eight tests. Field testing of the modules with more than 200 NFP teachers in the US and Canada found the average score for each of the four modules to be 85%; a postinstructional mastery level of 90% was subsequently established as the passing score to become an NFP teacher in the US. Attitude scales were also developed and used primarily as an attitude/surfacing tool. In 1976, the US affiliate of the IFFLP formally revised and validated the objectives, and developed tests to measure their achievement. At the same time, the World Health Organization (WHO) used the same task-based, original objectives as a basis for developing the Family Fertility Learning Resource Package. The final version of the WHO package was field tested in five countries, published, and distributed by 1981. USAID-funded NFP demonstration programs were conducted in Zambia and Liberia over the period 1983-90 to study the use, methodology, and cost-effectiveness of establishing a national NFP service delivery system. The author points out that a number of the lessons learned by the IFFLP over the past 17 years can be applied universally: teacher evaluation is improved with valid, reliable, and objective testing tools; testing instruments must reflect the realities of the situation in which NFP is to be taught; evaluation must be integrated into the total training approach; and translation of technical evaluation tools requires precision and accuracy to maintain the discriminant functions of each item and overall test efficiency.
The promotion of the lactational amenorrhea method and child spacing through breastfeeding advocates, Contract No. OR-HO-001.
[Unpublished] . vii, 44 p. (HON-05)In Honduras, a decreasing prevalence of exclusive breast feeding, with over 50% of infants given supplemental liquids during the first 30 days, was causing health risks for the infants and pregnancy risks for the mothers (with 49% at risk within a year of giving birth). Therefore, La Leche League Honduras (LLLH) conducted an operations research study in the Las Palmas neighborhoods of San Pedro Sula to evaluate whether the combination of medical personnel and mother support groups trained in lactation and the lactational amenorrhea method (LAM) for child spacing would increase prevalence and duration of exclusive breast feeding, amenorrhea, and the reported use of LAM at 6 months postpartum over that found in a community served only by trained medical personnel. This project received financing in the amount of US $20,250 from Georgetown University and technical assistance from the Population Council. Specific objectives were to train at least 50 physicians, provide updated information to at least 50 nurses through a workshop, train and certify at least 36 community mothers to serve as breastfeeding advocates (BAs) with specific information on LAM and the ability to make referrals to complementary family planning (FP) services, and initiate at least 6 mother support groups which would meet monthly throughout the year-long study period of 1991. A nonequivalent pre/post-test design was used with the experimental group receiving BA training and support groups and both the control and experimental groups receiving identical training of medical staff. A July 1990 survey of the 6,794 households in the project area revealed 1083 mothers of babies less than a year old and 630 pregnant women. 848 women from this group were interviewed at baseline and 922 at endline to determine socioeconomic status, health system affiliation, reproductive history, breastfeeding and infant feeding practices, contraceptive use, and LAM knowledge and attitudes. Focus groups were held after 3 months of service delivery for qualitative evaluation, interviews were conducted, and 4 mother support groups were observed. BAs were given record-keeping forms, and referral stubs were collected. This report described the implementation of project activities and the impact of the intervention in great detail. The results suggest that training health professionals was partially successful in improving breastfeeding practices and that use of LAs was effective in promoting exclusive breast feeding and use of compatible FP methods and increasing LAM knowledge. However, analysis of women using LAM as a FP method revealed that only 6.5% correctly met all criteria. Lessons learned from this evaluation are cited and the following suggestions are made for further research: 1) develop materials to teach LAM to low-literacy women; 2) examine the role of provider bias and influence of exclusive breast feeding prevalence on LAM acceptance; 3) discover the relative effectiveness of LAM promotion by LLLH vs. FP agencies; 4) test the effectiveness of strategies which segment a target population for LAM education; and 5) determine whether LAM leads to subsequent use of other FP methods.
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.
BRITISH MEDICAL BULLETIN. 1993 Jan; 49(1):182-99.Lactational amenorrhea by means of the natural contraceptive effect of breastfeeding is a valuable tool to space families and control fertility in developing countries. In most developed countries, postpartum women are advised to initiate artificial contraception at about 4 weeks postpartum to prevent conception. However, this approach to postpartum contraception is not appropriate in many countries. Although breastfeeding does inhibit fertility, particularly during lactational amenorrhea, it is still unreliable for family planning. Data from prospective studies showed that the cumulative probabilities of ovulation during lactational amenorrhea were 30.9% and 67.3% at 6 and 12 months, respectively. When ovulatory cycles associated with adequate luteal phases were considered, the corresponding figures were 13.8% at 6 months and 37.5% at 12 months. On the basis of data from 13 studies in 8 countries, the Bellagio consensus statement concluded that breast-feeding provides more than 98% protection from pregnancy during the first 6 months postpartum if the mother is fully breastfeeding. It has been suggested that lactational amenorrhea alone would be a more practical strategy for lactating women in many countries, providing acceptably low cumulative pregnancy rates of about 3 and 6/100 women at 6 and 12 months, respectively. In the 5-center study of the ovulation method of natural family planning carried out by WHO, 94% of the women were able to carry out the method correctly, which yielded a pregnancy rate of 3/100 women-years. In a study, the home ovarian hormone monitor has been used by 37 women over a total of 55 woman-years for pregnancy avoidance. The ovarian hormone monitor gave 5 or more days' warning of ovulation in 99% of cycles and allowed intercourse to be resumed 1-3 days after ovulation in 88% of cycles. The WHO multicenter study of the ovulation method has shown that if the method is used correctly there is a first year probability of failure of 3.4%.
PROGRESS IN HUMAN REPRODUCTION RESEARCH. 1992; (22):8.The WHO Special Programme on Research, Development and Research Training in Human Reproduction and diagnostic companies conduct research into the development of a simple, accurate, robust, home based method which predicts ovulation. A prolonged rise in the excretion product of estradiol in the uterine indicates that ovulation will soon follow A similar rise in serum estradiol levels also occurs several days before ovulation. Researchers in Melbourne, Australia have created an uncomplicated tool to measure the most plentiful estradiol excretion product, estrone glucuronide, and the progesterone excretion product, pregnanediol glucuronide, whose rising levels indicate the end of the fertile period. In 1991, WHO and the Australian researchers began a multicenter studying comparing this instrument with the sign and symptoms observed in traditional natural family planning methods. As of mid 1992, results were not yet available. The ability to determine the beginning and the end of the fertile period makes this potential tool especially promising. WHO is supporting another multicenter study testing for a decline of the enzyme guaiacol peroxidase in cervical mucus as a marker of approaching ovulation. It is difficult to test for forthcoming ovulation in premenopausal women, because they do not always ovulate their menstrual cycles. A WHO study looked at the association between ovarian hormone secretion an symptothermal indicators of fertility in 36 premenopausal women (177 menstrual cycles). Around 33% of the women regular menstrual cycles that may have been fertile, around 19% experienced no hormonal changes indicating fertility during their cycles, and the rest of the woman had a combination of both. Further traditional symptothermal markers could not distinguish the 2 different types of cycles.
Switching back: an experimental intervention of family planning client remotivation and clinic staff retraining: impact upon reacceptance and continuity.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 73-82.In 1990, the Mauritius Family Planning Association presented educational sessions for former clients allowing them to meet f amily planning personnel and other women with similar experiences. It used audiovisual aids to discuss use of modern contraceptives and the advantage of scientific family planning, to dispel myths and rumors, and to explain how different methods could be used to meet their and partners' needs. At the same time, 10 service providers from the experimental clinic underwent a 6 week sensitization and retraining program emphasizing organization for efficiency, counseling skills, and skills to build client self esteem. Researchers observed both the control and experimental clinic for 9 months in 1991. 36 remotivated clients (73% return rate) and 29 mainly former clients who did not attend a session reaccepted a contraceptive method at the experimental clinic. As for the control clinic, 24 remotivated clinics (46% return rate) and 7 mainly former clients reaccepted a method. Both clinics' staff said that the extra clients returned because the 93 remotivated clients recommended or referred them directly to the clinics. The 2 interventions therefore had a spread effect. The experimental clinic did have a much better retention rate than the control clinic (46 client vs. 28 clients), however. Further it had higher continuity rates throughout the study period. At the end of the study, the continuity rate was 93.8 for the experimental clinic and 53.8 for the control clinic. The researchers concluded that the improved clinic services of the experimental clinic due to staff retraining in skills and attentiveness were responsible for the superior retention record and rates of return and continuity. Thus IEC programs that attend to former and potential clients' needs and develop skills and attentiveness of providers improve acceptor and continuity rates.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 54-72.Researchers arranged for interviews with 300 female discontinuing clients at 2 maternal and child health/family planning (MCH/FP) clinics in Mauritius and followed 230 of them to explain what happens to women who discontinue coming to the MCH/FP clinic. 26% of all women in the sample stopped using MCH/FP clinic services for fertility related reasons. The 2 leading reasons were desire for pregnancy (15.2% of all women) followed by husband absent or sexually inactive (5.2%). Further 30.1% switched to a competing contraceptive provider, especially a factory based provider (11.3%). They tended to switch providers because the new provider was more accessible or they were either dissatisfied with the quality of services at the MCH/FP clinic or the new clinic had an advantage over the MCH/FP clinic. 43.9% switched from scientific family planning methods to either natural or traditional family planning methods. These women tended no to wander out of the house and to be poorly educated, of an ethnic minority group, and >35 years old. In fact, 26.1% used natural family planning because of dissatisfaction with either the contraceptive methods themselves or the quality of services provided. Much attendance discontinuity was determined by misperceptions about ongoing or long term contraceptive use. This indicated that clinic counselors should become more sensitive to and fully address the problems and side effects of contraceptive method use. In conclusion, the MCH/FP clinics should focus their information, education, and communication efforts on the women who switched to unscientific or natural methods.
[Population growth, development work, and family planning (the church's experience in the third world)] Bevolkerungswachstum, Entwicklungsarbeit und Familienplanung (kirchliche Erfahrung in der Dritten Welt).
In: Probleme und Chancen demographischer Entwicklung in der dritten Welt, edited by Gunter Steinmann, Klaus F. Zimmermann, and Gerhard Heilig. New York, New York/Berlin, Germany, Federal Republic of, Springer-Verlag, 1988. 308-15.This paper approaches the problem of population growth, development and family planning from the point of view of Christian church activities in the 3rd World. It is an oversimplification of the situation to believe that development policy in a country can be guided only by population considerations. The challenge of population growth must be seen in the context of many barriers to development in the 3rd World which are closely associated with population trends. Thus, birth control measures will succeed only when they are part of a unified multi-sector development aid that is integrated into the life of the country taking into consideration cultural and ecological factors. The author traces the evolution of viewpoints among development specialists since the Bucharest conference of 1974 in which contraception was no longer accepted as the basic principle in development aid, unless it is integrated into a complete system of satisfying the basic needs of a population. The target group for this strategy is primarily the family, representing as it does the smallest unit of human society in village and urban communities. The author lists and discusses a number of general criteria for acceptability of methods of contraception. Development leaders trained in the western churches can accept methods of natural family planning (NFP) such as rhythm methods but in many societies local cultures unquestionably accept richness in children as a blessing. The use of NFP requires the acceptance of a new life style by both husband and wife.
Washington, D.C., Georgetown University, School of Medicine, Institute for International Studies in Natural Family Planning, 1989 Jul. 15,  p. (USAID Cooperative Agreement DPE-3040-A-00-5064-00)Natural family planning (NFP) is a technique for determining a woman's fertile period to regulate childbearing. There are many methods in NFP including rhythm or calendar, basal body temperature, cervical mucus, modified mucus, and sympto-thermal. All of these methods use the natural signs and symptoms of a woman's fertile and infertile periods of the menstrual cycle. The rhythm or calendar is still the most widely used method, and women keep track of the lengths of previous menstrual cycles to determine the days of fertility. The cervical mucus method uses changes in the characteristics of the mucus during the fertile period. The basal body temperature method uses the change in resting temperature to determine the fertile period. The sympto-thermal method uses a combination of body temperature, cervical mucus, and breast tenderness to determine the fertile period. Breast feeding provides a period of about 6 months after birth when there is a delay in the return of ovulation. The advantages of natural family planning include the following: little contact with medical personnel and procedures, it is less expensive, it may provide a method in agreement with religious or ethical beliefs, and it can help couples understand how their reproductive system works. In a World Health Organization study, the effectiveness of NFP was shown to be 78% overall, and the continuation rate was 65%. Many other studies have shown rates between 70-90% effectiveness over a 12 month period. In a recent African study over a 5 year period, unplanned pregnancy rates were 4.3% and 9.6% in Liberia and Zambia respectively.
Geneva, Switzerland, WHO, 1988. vi, 82 p.There are 4 natural family planning (NFP) methods: rhythm, cervical mucus (Billings), basil body temperature, and symptothermal. The rhythm method is one in which cycle history of last 6-12 months is used to estimate the possible days of fertility. In the cervical mucus method a women must be able to detect changes in the cervical mucus discharge during the cycle. The basil body temperature method uses the difference in temperature that occurs after ovulation, and can only be used to detect the infertile time after ovulation. The symptothermal method combines the mucus method and the basil body temperature methods. In addition it uses other physiological indicators such as breast tenderness, pain, bleeding, and abdominal heaviness. The use of natural planning methods demands the cooperation and motivation of both partners to be successful. The methods can be taught by midwives, nurses doctors and other health care professionals. NFP teacher training is the cornerstone of the NFP programs and service. Teachers must have the technical ability and practical experience to carry out training programs. NFP programs can only be successful in areas that are receptive to NFP and have high literacy rates. To plan and implement NFP services, one must take into account community needs, resources available, and the structures needed to deliver these services. It is important to evaluate the effectiveness of the program, including formal evaluation of the teachers, monitoring of the users, and getting feedback from both.
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.