Counseling clients in natural methods of family planning.
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The lactational amenorrhea method is a natural method of family planning for women who breastfeed their infants. The underlying physiology results in a natural suppression of ovulation, and the concomitant amenorrhea, induced by exclusive (or almost exclusive) breastfeeding. This in addition to the infant's age of 6 months or less and specific feeding pattern are the parameters used to identify the possible return of fertility. The lactational amenorrhea method provides at least 98% protection against pregnancy. Data from a recent multicenter study of breastfeeding support the use of the lactational amenorrhea method as a natural family planning method. The lactational amenorrhea method can be incorporated into natural family planning programs and teaching.
Methods of natural family planning are sometimes difficult for women to use during lactation. When this is so, the lactational amenorrhea method may prove useful. Researchers agree that a fully breastfeeding woman who is amenorrheic is 98% protected from pregnancy for up to 6 months after delivery. The fertility status of 74 users of natural family planning during the time they would have been protected by the lactational amenorrhea method is examined. Underlying hormonal profiles show that there was little ovarian activity during this time. Eight ovulatory events occurred during the period of protection by the lactational amenorrhea method, of which four fulfilled minimum criteria for adequacy; there were no pregnancies during this period. However, some women did report experiencing fertile mucus symptoms during this time that were often unrelated to estrogen production. Using the lactational amenorrhea method rather than natural family planning allows them to avoid unnecessary abstinence.
Early methods of natural family planning (calendar rhythm, basal body temperature, and symptothermal) are briefly mentioned and dismissed as unsatisfactory for fertility regulation at our present state of knowledge of female reproductive physiology. Cervical mucus patterns, which reflect ovarian hormone levels, are shown to be accurate markers of the fertile and infertile phases of a woman's menstrual cycle. Interpretation of these patterns forms the basis of the Billings Ovulation Method of natural family planning. Extensive laboratory and clinical studies have shown this method to be on a sound scientific footing, that it is applicable to all phases of a woman's reproductive life, and that women readily understand and are able to teach other women the meaning of these patterns as experienced by changing sensations at the vulva and changing characteristics of any visible mucus. The simple rules which have been formulated for postponing and achieving pregnancy are given. Field trials of this non-invasive method for fertility regulation in both developing and developed countries show that the rules are readily understood by participants. In the most recent trials, it has been shown that the method-related pregnancy rate is less than 1 per 100 woman years, which compares more than favorably with other contraceptive techniques.
This study was designed to determine the efficacy of the symptothermal method of natural family planning during lactation. Although the method appears to give a reasonable reflection of fertility potential over time, it overlaps with the profound influence of lactation in both ovulation suppression and the delay of luteal phase adequacy. Further analysis is planned to attempt to identify those particular mucus signs and symptoms that are helpful during the transition from lactational amenorrhea to normal cycling.
Participants in courses of natural family planning methods were questioned regarding sociodemographic characteristics, previously and last used family planning methods and their motivation for course attendance. The method used most often previously was the 'pill' (47.6%), natural family planning came next with 35.8%. Among the methods used last, natural family planning dominated with 38%, followed by the pill (27.1%). The main motives given by both men and women for attending the course were 'quest for an alternative method' (36.1%), 'considerations about health' (31.4%).
Throughout Germany, 851 women who were instructed in natural family planning participated in a prospective study. Of these, 255 women with 3174 cycles used only natural family planning for family planning and 274 women with 3995 cycles occasionally used barrier methods in the fertile phase. For natural family planning--only users, the Pearl rate for unplanned pregnancy was 2.3 and for mixed-method users 2.1. Most pregnancies resulted from unprotected intercourse during the fertile phase, and the use of barrier methods does not reduce risk-taking.
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Data accumulated to date from the Los Angeles study indicate that the total termination rate for 12 months from the beginning of the training period and from formal entry into the study was high for the ovulation method (OM), and symptothermal method (STM). Voluntary withdrawal was the highest single reason for termination in both methods. The 12 month voluntary withdrawal rate, measured from formal entry into the study, was significantly higher for OM users. Pregnancy rates measured from both the beginning of training and formal entry into the study were significantly higher for OM users than for STM users. Complete analysis of the data collected during the study is currently in progress. It is anticipated that some of the causes for the differences in pregnancy rates and withdrawal rates between the two methods can be identified.
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A total of 1,267 women in the F.R.G., aged from 15 to 45 years, were interviewed about their family planning behavior and the importance of natural methods of family planning (NFP) in a representative demographic study. It was found that 19.6% of the respondents were not sexually active. The others used various methods, as follows: pill, 38.4%; IUD, 10.3%; condom, 5.9%; diaphragm, 2.1%; spermicides, 0.8%; withdrawal, 3.4%; NFP methods, 3.9%. The main reason for rejecting a method was a possible medical risk. Of the responding women, 73% had some previous knowledge about NFP; 47% of them found such methods to be interesting, and approximately 20% indicated a high probability of the use of NFP methods in the future.
Some indirect relationships between contraception failures and offspring with a pathological condition are reviewed, and a causal connection between them is suggested. This hypothesis is supported by the decreasing incidence of Down syndrome (DS) in general in recent years, and the increase among the younger maternal age categories as well as the effect of birth order. A more than doubled incidence of DS children among young Catholic mothers and the fact that conceptions of children with DS are preceded by unusually long periods of abstinence are emphasised and discussed. These data offer circumstantial evidence that the conceptions that occur despite application of the so called "natural" family planning methods in particular are at high risk. The impact of reproductive biological failures ("nature") and of reproductive behaviour ("nurture") on the human gametes can be disentangled by thorough studies of the epidemiology of major and minor congenital anomalies.
In a group of 55 unmarried women, mean age 25 years, attending a family planning clinic and having minor gynecological complaints, the correlation between Chlamydia trachomatis (CT) antigen, CT antibodies, vaginal colonization by Candida or bacteria and the method of contraception was investigated. The correlation between CT antigen and CT antibodies (IgG) was significant in oral contraceptive users (p = 0.003), as was the correlation with vaginal colonization by Candida and potential pathologic bacteria. In the group using the natural family planning method, a statistically significant correlation was found between CT antigen, IgG (p = 0.002), IgA (p = 0.02) antibodies, and vaginal candidiasis (p = 0.002), but not with bacterial colonization (p = 0.90). The discrepancy between CT antigen and antibodies is discussed. Differences in the prevalence of Chlamydia trachomatis infection were found among groups using different birth control methods, indicating an association between Chlamydia infection and the contraceptive method used.