Pontifical council for family--note on the natural regulation and methods of observing fertility.
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The actual effectiveness rates of natural and barrier methods of family planning are lower than the theoretical ones. If couples accurately defined the limits of the fertile phase and used barriers at that time, then actual effectiveness might increase. A randomized, controlled clinical trial was initiated to determine the effectiveness of the contraceptive sponge used only during the fertile time and to compare this with sponge use at every intercourse. Recruitment problems and discontinuation forced the early termination of this study, but qualitative information about compliance and acceptability was collected. Common sponge problems were reported as were misuses of the sponge, but problems and misuse were not related. Determination of the fertile phase was reportedly easy, but complaints of and discontinuation for inconvenience occurred. For unplanned pregnancies, contraceptive behaviors around the time of conception are presented.
In order to determine the effectiveness of the ovulation method in spacing or achieving pregnancy as well as couple satisfaction with the method, the Natural Family Planning Program of St. Vincent Hospital, Green Bay, WI, studied 453 couples who had participated in the program. The program's director reports that the study results suggest the method provides a safe, effective approach to birth control and assists some women to become pregnant who have not succeeded prior to using this method.
Five programs of instruction in the ovulation method (OM) in diverse geographic and cultural settings are described, and characteristics of approximately 200 consecutive OM acceptors in each program are examined. Major findings include: the religious background and family size of acceptors are variable, as is the level of previous contraceptive use. Acceptors are drawn from a wide range of socioeconomic and religious backgrounds; however, family planning intention was similarly distributed in all five countries. In sum, the ovulation method is accepted by persons from a variety of backgrounds within and between cultural setting.
Natural methods of fertility regulation are acceptable in most cultures. Many couples worldwide do not wish to use contraceptives or do not have access to them but wish to limit their family size or lengthen the time between births. Barriers to expanding use of natural family planning (NFP) methods include a lack of providers who can teach NFP and a lack of time to teach and follow couples during the initial months of NFP use. If simple yet effective methods of NFP are available, then NFP could be introduced to a wider audience. Recently, calendar rules have been revised that use a set interval to identify fertile days. These new rules provide better coverage of fertile days and require less abstinence than the rules traditionally used with the calendar method. One of these new rules is being field tested in a pilot study in Brazil. Couples are asked to abstain from day 9-19 (inclusive) of the menstrual cycle, using a beaded necklace (the 'collar') as a mnemonic device. Focus groups with the teacher-monitors and in-depth interviews with female and male users were carried out to evaluate the acceptability of the 'collar' method. A preliminary analysis of these focus groups and interviews from the first site is presented.
Since 1989 an international multicenter prospective study to evaluate the effectiveness and acceptability of natural family planning (NFP) methods in Europe has been conducted by the NFP Research Center at the University of Düsseldorf in collaboration with the European Zone of the International Federation for Family Life Promotion (IFFLP). Fourteen NFP-organizations from nine European countries participate in the study. Cycle data from women in the fertile age group are transferred to a special standard computer sheet by the respective organizations and forwarded at three-monthly intervals to the study center for analyses. To date, 10,045 cycles from 900 women aged between 19 and 54 years have been analyzed. This paper presents the pregnancy rate for the women aged between 19 and 45 years of age, who contributed 9284 cycles. In the analyses the cycles were subdivided into two categories consequent to sexual practices during the fertile phase: group I (NFP only--4277 cycles) use only NFP to avoid a pregnancy; group II (FA/mix--5007 cycles) where barrier methods or coitus interruptus during the fertile phase, at least in some cycles, were used to avoid a pregnancy. The women used different clinical indicators such as basal body temperature (BBT), cervical mucus, calculations, cyclical cervical changes or combinations of these to determine the beginning and the end of the fertile phase necessitating a further division into four subgroups, A, B, C, D, and different efficiency rates for each of these groups. In group A (symptothermal method, double check) 15 unintended pregnancies (UIP) occurred in 7404 cycles, giving a pregnancy rate of 2.4 Pearl Index (PI); in group B (muco-thermal method) there were 12 UIP in 1352 cycles with a pregnancy rate of 10.6 (PI); in group C (mucus to detect the beginning and mucus and BBT to determine the end of the fertile phase) there was one UIP in 434 cycles, and in group D (mucus method only) there was one IUP in 70 cycles. The numbers in group C and D are too small to calculate a pregnancy rate (PI). No pregnancy was observed in women over 40 years of age. Our conclusion from these preliminary results is that in the continent of Europe, the symptothermal method when used with periodic abstinence (NFP only = group I) and fertility awareness with the use of barriers during the fertile phase (FA/mix = group II) are effective methods of family planning.(ABSTRACT TRUNCATED AT 400 WORDS)
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Natural family planning (NFP) methods can be effective if taught well and practised by well-motivated couples. Midwives should be able to give couples an understanding of the basic principles of the methods. The observable signs of the fertile cycle are changes in basal body temperature, in the consistency of cervical mucus and in the texture and position of the cervix. Practised properly the ovulation method can have a failure rate of as little as 2.2 pregnancies per 100 woman-years. The ovulation method is a suitable method for mothers who have breastfed to detect the onset of ovulation.
A study of the knowledge, perceptions, and behavioral intentions of physicians regarding periodic abstinence (PA) methods was undertaken in Mauritius, Peru, the Philippines, and Sri Lanka. Most respondents considered PA to be useful, although even the PA providers prescribed mainly non-PA methods. Detailed knowledge of PA methods was not evident, but most physicians were willing to initiate general discussion about PA with patients. Physicians favored methods perceived as "scientific" and "modern," which primarily prevent pregnancy and secondarily avoid other health risks. When carefully presented as "scientific" and "modern," methods presented to medical audiences may find acceptance and be more likely to result in referral.
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All natural family planning (NFP) methods are based on the determitnation of a woman's fertile period so that a couple may abstain from sexual relations or use a mechanical means of birth control during that time. Researchers are seeking more accurate methods of predicting the onset of ovulation in order to increase the effectiveness of NFP. A new device developed by Dr. Gebhard F.B. Schumacher, a fertility specialist at the University of Chicago who serves on FHI's Technical Advisory Committee, and Dr. Stepen J. Usala, a former medical student at the University's Pritzker School of Medicine, holds the promise of providing a new, cheap, and relatively simple way of predicting ovulation. Called a volumetric vaginal aspirator, the instrument allows women to measure their own vaginal fluid on a daily basis. In early studies of 7 women carefully studied over 18 menstrual cycles, a striking 3 fold to 30-fold increase in the volume of vaginal fluid occurred a few days before ovulation. Results from 12 more women for a total of 26 cycles confirmed the earlier studies. Blood samples were taken in order to measure the levels of estrogen, known to increase prior to ovulation, and luteinizing hormone, which peaks sharply on the day of ovulation, in the women studied. These confirmed that ovulation typically had occurred after the fluid volume increase. In addition, participants recorded their basal body temperature (BBT) upon awakening. Although the BBT does not predict ovulation, it frequently increases by 1/2-1 degree Fahrenheit after ovulation thus serving as an indicator of the end of the fertile period. The prototype of the vaginal aspirator is a disposable plastic syring marked at .05 milliliter intervals so that fluid levels can be easily measured. After the manufacturing process for the aspirator is perfected so that the instrument can be mass produced, Dr. Schumacher hopes that largescale clinical trials will be initiated in the US and abroad. The larger studies and an endocrine study are needed in order for effective rules to be developed for applying the method in either birth control or fertility enhancement. The vaginal aspirator could be useful not only for preventing unplanned pregnancy but also for aiding couples experiencing infertility to pinpoint the time that conception is most likely to occur. As an aid in birth control, the aspirator should have a success rate similar to or better than that of a diaphragm, Dr. Schumacher believes. Although the women testing the vaginal aspirator were ablet to use it without assistance, Dr. Schumacer emphasizes that some patient education will be necessary if it becomes commercially available. Fertility awareness teachers could incorporate it into their courses. Research on the volumetric vaginal aspirator has been supported by FHI and by Mothers' Aid Research Fund of Chicago Lying-In Hospital.
The hospital-centered trend that has dominated medical culture and the management of health care during this entire century has, in the last few years, undergone a reversal in Italy. Conditions in other countries suggest that similar changes have or will become increasingly common. The family physician today manages many of the functions previously handled by hospitals and specialists. In the field of reproductive health, family physicians are responsible not only for diagnosis and treatment, but also for prevention and education. The present study considers this new context with the objective of investigating the knowledge and behavior of Italian family physicians in the field of women's health, with particular regard to family planning (including natural family planning), through (1) a qualitative study (focus groups) of a small group of family physicians and (2) a questionnaire sent to 500 family physicians throughout Italy. The results of the focus group are summarized in the form of obstacles that the family physician finds in providing family planning services and proposals for change. The results indicate that because of their holistic approach, the family physician is an appropriate provider of family planning services although continued use of specialists' services, changes in logistics of the family physicians' practice, increased gender sensitivity, and additional training and information are necessary. The results of the questionnaire (121 responses, 24.2%) indicate that the Italian family physician currently lacks certain important information about family planning and would require logistical support to provide these services but is interested in acquiring information and is an appropriate family planning provider. An additional challenge for encouraging family practitioners to provide natural methods is that they favor a "medical" approach rather than a "behavioral" one in their treatment preferences for several other conditions.
BACKGROUND: Intercourse results in a pregnancy essentially only if it occurs during the 6-day fertile interval ending on the day of ovulation. The strong association between timing of intercourse within this interval and the probability of conception typically is attributed to limited sperm and egg life times. METHODS: A total of 782 women recruited from natural family planning centres in Europe contributed prospective data on 7288 menstrual cycles. Daily records of intercourse, basal body temperature and vaginal discharge of cervical mucus were collected. Probabilities of conception were estimated according to the timing of intercourse relative to ovulation and a 1-4 score of mucus quality. RESULTS: There was a strong increasing trend in the day-specific probabilities of pregnancy with increases in the mucus score. Adjusting for the mucus score, the day-specific probabilities had limited variability across the fertile interval. CONCLUSIONS: Changes in mucus quality across the fertile interval predict the observed pattern in the day-specific probabilities of conception. To maximize the likelihood of conception, intercourse should occur on days with optimal mucus quality, as observed in vaginal discharge, regardless of the exact timing relative to ovulation.
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