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Studies in Family Planning. 1984 Nov-Dec; 15(6/1):253-66.This paper critically analyzes claims for the effectiveness of the Billings method of natural family planning and raises questions about the wisdom of actively promoting this method. The Billings method, developed in Australia, is based on client interpretation of changing patterns of cervical mucus secretion. Evaluation of the method's use-effectiveness has been hindered by its supporters' insistence on distinguishing between method and user failures and by the unreliability of data on sexual activities. However, the findings in 5 large studies aimed at investigating the biological basis of the Billings method provide little support for the claims that most fertile women always experience mucus symptoms, that these symptoms precede ovulation by at least 5 days, and that a peak symptom coincides with the day of ovulation. Although many women do experience a changing pattern of mucus symptoms, these changes do not mark the fertile period with sufficient reliability to form the basis for a fully effective method of fertility control. In addition, the results of 5 major field trials indicate that the Billings method has a biological failure rate even higher than the symptothermal method. Pearl pregnancy rates ranged from 22.2-37.2/100 woman-years, and high discontinuation rates in both developed and developing countries were found. Demand for the method was low even in developing countries where calendar rhythm and withdrawal are relatively popular methods of fertility control, suggesting that women of low socioeconomic status may prefer a method that does not require demanding interaction with service providers and acknowledgment of sexual activity. The Billings method is labor-intensive, requiring repeated client contact over an extended time period and high administrative costs, even when teachers are volunteers. It is concluded that although natural family planning methods may make a useful contribution where more effective methods are unavailable or unacceptable, many of the claims made for the Billings method are unsubstantiated by scientific evidence.
In: International Planned Parenthood Federation [IPPF]. Male involvement in family planning: programme initiatives. London, England, IPPF, . 177-83.The International Labor Organization (ILO) has enlarged its traditional concern and responsibility for labor welfare to encompass the worker's welfare not only at the workplace but also in his living environment. The purpose of this paper is to introduce the ILO's Population/Family Welfare Education Programme. The basic objective of this program is to improve the quality of life of workers and teir families through educational activities aimed at creating an appreciation of interrelations between family income and expenditure, family budgeting and determining of priorities for various needs of the family, including family size. The program is implemented at country level through labor ministries, employers' groups, trade unions, or co-operatives. The program is designed for workers in the organized sector; its content and approach are refined for 4 main sub-groups: male workers, young workers undergoining vocational training, young unmarried female workers, and plantation workers and cooperative members in rural areas. In all cases the ILO program uses existing welfare and educational institutions, and is presented in terms of family level relationships. Once the inter-relationships of needs and resources within the context of the family is considered, it becomes apparent that needs are predominantly determined by family size. To the extent that couples are prepared to regulate their fertility, this decision may be influenced by family decision making. On the other hand, the potential for influencing family resources is limited. Family well-being can thus be seen in terms of family needs, resources and decision making. Workers must therefore be shown that they can determine their family size. This is the basic family welfare education message. It has a distinct ILO flavor about it and has proved to be acceptable to governments, employers, trade union leaders and members.