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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.
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.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
People. 1980; 8(3):18-20.In Kenya there are now 10,000 women's groups which are officially registered by the government and thus eligible for assistance from the Women's Bureau. A visit to the local group of 60 women in Kambu provides an example of both the courage and the potential of these groups. Initiated in 1976, the group's 1st effort was to plant coffee trees for each member. The next activity was making pottery and growing vegetables and meeting every Thursday afternoon. In 1979 the group applied to the Women's Bureau for assistance and was given over $1,000 to build a pigsty and buy some pigs. This was followed by a shop built for 6,000 shillings from which to sell the sisal baskets and mats which the group makes. The current objective is to raise about 30,000 shillings for a meeting hall, with a store, office and canteen. Family planning was not at the forefront of this group's activities. Nyeri, 1 of the best developed districts in Kenya, is also the site for the 1 experimental project where family planning information and services have been introduced simultaneously with income generating activities to several women's groups. The objective is 3-fold: to promote family planning by integrating it with other activities from the start of the project; to include voluntary motivational work by members of the groups; and to improve the status of members. 10 groups are involved in the project, part of the International Planned Parenthood Federation's worldwide program for Planned Parenthood and World Development. After 1 year of operation, family planning practice had increased markedly, with over 70% of women under 45 using contraceptives in 3 of the villages. There was much evidence showing that many members were actively promoting the family planning idea among their friends and neighbors. The integration of activities has been shown to have increased family planning acceptance. The problem is that with over 5000 requests for help in 1981, The Women's Bureau is only able to provide resources to some 600. At present, the Women's Bureau only has $1 million to spend.
In: Molnos A, ed. Social sciences in family planning. (Proceedings of the Meeting of the IPPF Social Science Working Party, Colombo, Sri Lanka, June 10-13, 1977). London, International Planned Parenthood Federation, 1978 Dec. 9-14.Kenya has a fairly well developed family planning program at the official government level along with an active voluntary Association. It is estimated that over 50,000 women are visiting family planning clinics annually, but as many women drop out of the program in each given month as are recruited. This discontinuation rate presents a major problem for family planning programs, and the underlying causes need to be determined. It is believed that, with the exception of those women who are highly motivated to use contraceptives on a continuous basis, the majority of women, particularly in rural areas, will fail to use contraceptives for long periods of time if the significant others in their lives do not support the idea. It is also probable that many women drop out of family planning programs due to the lack of reliable transport, high transport costs, varying weather conditions, and the family planning program policy which, with the exception of the IUD, provides only sufficient contraceptives to last for 3 months. There are several other reasons why a woman might want to stop using contraceptives: 1) a desire to become pregnant; 2) social pressure to withdraw from the family planning program; 3) the side effects of her method and without a suitable alternative method; 4) difficulty in obtaining contraceptive supplies; and 5) reaching menopause. A family planning campaign which ignores the men is destined for failure in Africa, for the women do not make many of the important decisions. The male must be persuaded to participate in decision-making concerning the use and non-use of contraceptives. Family planning programs should deliberately reduce their drop-out rates even if that means lowering acceptor rates.
In: Diczfalusy, E. and Borel, U., eds. Control of human fertility. Proceedings of the Fifteenth Nobel Symposium, Sodergarn, Lidingo, Sweden, May 27-29, 1970. New York, Wiley, 1971. 39-51.A drug delivery system providing for a controlled release of progestogen and affecting ovulation and steroidogenesis minimally would deal effectively with some of the problems associated with contraception. 2 systems being developed which fit these criteria are the primary topics of discourse in this article. In 1 system an implant consists of a polymer membrane of polydimethylsiloxane (PDS) and contains the progestogen in crystalline form. Major problems with the PDS implants include a lack of intraindividual constance of release and interindividual variation in the slope of the decay in release. In the second system the implant consists of a lipid-steroid membrane containing a steroid. In this implant the concentration of the steroid in the membrane and the nature of the lipid phase may be important in determining the pattern of release. In vivo metabolic studies with lipid-steroid pellets are limited, but the patterns of output may be similar to those seen with PDS implants. Because of rate problems, a shorter regime slow-release implant seems more feasible than a longer lasting system. Surgical difficulties associated with the implantation and removal of the PDS implant make the choice of a lipid-steroid micropellet preparation more feasible for a short-term regimen. The discussion, following the main body of the article, focuses primarily on problems associated with implants.