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Natural family planning including breast-feeding.

Bonnar J
In: Mishell DR Jr, ed. Advances in fertility research. Vol. 1. New York, Raven Press, 1982. 1-18.

This discussion of natural family planning (NFP) focuses on the following: calculation of the calendar method; the basal body temperature method; the ovulation method; sympto-thermal methods; international studies on NFP; effectiveness of NFP; breastfeeding and birth spacing; psychological and psychosexual aspects of NFP; and research and development of new methods to determine the fertile period. The calendar method, the oldest technique for determining the fertile period, involves the identification of the fertile time from the records of the previous 6-12 menstrual cycles. The temperature or thermal method depends on the identification of the rise in the basal body temperature (BBT) from a relatively low level during the follicular phase to a relatively higher level during the luteal phase of the menstrual cycle. The basis of the ovulation method is that the cervical glands are highly sensitive indicators of the estrogen level in the blood and thus accurately reflect the follicular maturation in the ovary. In order to use the ovulation method, the woman must learn to recognize the sequence of changes in the quality and quantity of her mucus and the associated sensation at the vulva. The sympto-thermal methods incorporate several markers of ovarian function in order to define the infertile period with greater accuracy. From the perspective of fertility control, it should be recognized that traditional breastfeeding has a central regulating role in the spacing of births and is of considerable importance where methods of fertility control are either unacceptable or unavailable. Couples who follow the rules of NFP methods have a highly effective means of fertility regulation with method failure rates of 0.5-3.0 pregnancies in 1300 cycles. In general use, the methods are around 80% effective. The major advantage of NFP is that no hormones or chemicals are introduced into the woman's body. The couple oriented method promotes both self knowledge and self reliance. NFP calls for an education rather than a medical delivery system, and it aims to make the users both autonomous and potential educators of other users. The major problem with NFP is the modification of the sexual behavior involved and the extent of motivation necessary for successful use. Easy to use and inexpensive tests that identify the fertile period and ovulation would be useful for fertility control, and the World Health Organization task force is currently at work on the development of new technology in this field.

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