Natural Family Planning Methods Research Articles

Natural Family Planning in the Philippines

The calendar rhythm method of natural family planning (NFP) is one of the most popular contraceptive methods in the Philippines. As a result, the Philippines has one of the highest NFP prevalence rates in the developing world. In recent years, family planning program officials have become increasingly interested in improving the practice of NFP, both by improving the quality of rhythm practice and by introducing newer, more accurate NFP methods. Over the years a substantial body of research data related to NFP practice in the Philippines has accumulated. This paper presents major findings from past research on NFP in the Philippines, discusses their implications for program management, describes current research, and suggests needs for future research.

A prospective multicentre trial of the ovulation method of natural family planning. III. Characteristics of the menstrual cycle and of the fertile phase

Seven hundred twenty-five women of proven fertility recorded the presence of cervical mucus at the vulva in 7514 menstrual cycles. The mean cycle length of the 6472 "normal" cycles was 28.5 days (standard deviation +/- 3.18). The peak day of mucus discharge was the last day of slippery, raw-egg-white-like mucus and occurred on average on day 15 (+/- 2.6). The fertile period was defined as any day on which mucus was reported before the peak day until 3 days after the peak. Its mean length was 9.6 (+/- 2.6) days. The probability of pregnancy was maximal on the peak day and declined on the days before and after the peak.

The Subfertile Couple

When pregnancy is achieved through fertility awareness, there are further long-range benefits to the couple: information which will permit them the choice to avoid, delay or achieve subsequent pregnancies. Thus, the opportunity for responsible parenthood continues. The goal of nursing in subfertility care is to identify factors which may contribute to lowered fertility, and to teach and/or refer appropriately. The most comprehensive single intervention may be to teach the couple awareness of their own fertility through the Billings Method of natural family planning. If conception does not occur, the couple may progress to infertility investigation, knowing that the expense, inconvenience, and possible trauma are justified. Whether pregnancy occurs or not, it is likely that the couple will have had the benefit of clarifying their relationship, further understanding their bodies, and generally growing toward fuller personhood.

Natural family planning: a review.

This review of natural family planning (NFP) focuses on the following: components of the fertile phase; sympto-thermal methods; the history and methodology of NFP (calendar rhythm, basal body temperature, cervical mucus--the Billings Ovulation method); special circumstances--periods of erratic ovulation (puberty, lactation, premenopause, discontinuation of ovulation suppression, cervicitis and vaginitis, ovulation suppression by stress and pharmaceuticals); effectiveness of natural family planning; achieving pregnancy; achieving couple autonomy (confidence in the method, periodic abstinence, dynamics of the learning process, and support systems); problem areas; and delivery systems. The number of users of NFP methods increased from 2.8% of currently married couples in 1973 to 3.4% in 1976. In 1979, 75,000 new clients received training in contemporary NFP, while the number increased to over 100,000 in 1980. NFP is planning for achieving or preventing a pregnancy by the timing of intercourse. A couple can, by observing and recording certain natural symptoms and bodily changes that occur in a woman's menstrual cycle and using the information as a guide, learn to identify fertile and infertile phases in the menstrual cycle. Precise prediction of ovulation forms one of the components of delineation of the fertile phase. Billings pioneered the use of cervical mucus as a single parameter for the prediction of ovulation and its application to NFP. Women are instructed to observe their mucus patterns at the vulva, relying primarily on the sensation of wetness and lubrication, the use of the Kegel exercise, palpation with the finger, a "wipe-through" with toilet paper, or a combination of these observations. In the absence of ovulation, the usual changing mucus pattern is also absent. NFP can be used either to achieve or to avoid pregnancy. When NFP is used to avoid pregnancy, one will encounter method-related pregnancies, teaching-related pregnancies due either to poor teaching or poor learning or both. The major use effectiveness studies are listed in table form, and the results are shown under new headings. To achieve pregnancy, it is the general practice of NFP instructors to teach women to recognize and record their fertility signs and to suggest some months of merely concentrating coitus at the time of maximum fertility. Mastery of NFP calls for both identification of the fertile phase and integration of that knowledge into the couple's sexual decision making and behaviors. Studies are reviewed in terms of the spectre of genetically damaged offspring. NFP instruction is available in nearly every country outside the Soviet bloc.

A prospective multicentre trial of the ovulation method of natural family planning. II. The effectiveness phase

A five-country prospective study was undertaken to determine the effectiveness of the ovulation method of natural family planning. After successful completion of a teaching phase of three cycles, 725 subjects entered a 13-cycle effectiveness phase and contributed 7514 cycles of observation. The overall cumulative net probability of discontinuation for the effectiveness study after 13 cycles was 35.6%, 19.6% due to pregnancy. Pregnancy rates per 100 woman-years calculated using the modified Pearl index were as follows: conscious departure from the rules of the method, 15.4; inaccurate application of instructions, 3.5; method failure, 2.8; inadequate teaching, 0.4; and uncertain, 0.5.

A randomized prospective study of the use-effectiveness of two methods of natural family planning

The final results of a prospective comparative study of two methods of natural family planning indicate a significant difference in the 12 month net cumulative pregnancy rates between the ovulation and symptothermal methods. These differences are on the order of two to one in favor of the symptothermal method. Pearl pregnancy rates confirm similar differentials between the two methods. Dropout rates for both methods were high. Lack of interest or dissatisfaction with the method was the major reason for dropout during training while pregnancy or desine for pregnancy were the major reasons for dropout during the formal phase of the study.

A prospective multicentre trial of the ovulation method of natural family planning. I. the teaching phase

The percentage of 869 women in five countries capable of being taught to recognize the periovulatory cervical mucus symptom of the fertile period was determined in a prospective multicentre trial of the ovulation method of natural family planning. The women were ovulating, of proven fertility, represented a spectrum of cultures and socioeconomic levels, and ranged from illiteracy to having postgraduate education. In the first of three standard teaching cycles, 93% recorded on interpretable ovulatory mucus pattern. Eighty-eight per cent of subjects successfully completed the teaching phase; 7% discontinued for reasons other than pregnancy, including 1.3% who failed to learn the method. Forty-five subjects (5%) became pregnant during the average 3.1-cycle teaching phase. The average number of days of abstinence required by the rules of the method was 17 in the third teaching cycle (58.2% of the average cycle length). To what extent the findings of this study can be extended to other couples remains to be demonstrated.

Natural family planning: women deserve the truth.

The most recent data on natural methods of family planning, notably on the Billings, or ovulation, method, show statistically significant data on their effectiveness. A study conducted on 1139 couples followed for 2 years has yielded a failure rate of only 1.14%. Another study conducted in 1980 on 55 couples followed for a 2 year period has yielded a similar failure rate. Many experts sustain that NFP methods are not only completely risk-free, but are a creative contribution to a couple's human experience. The 3 NFP methods are the thermal, the sympto-thermal, and the ovulation method. NFP methods are not as well known as they deserve to be; women have a right to know all that is available to them in the field of contraception.

Comparative evaluation of two methods of natural family planning in Colombia

Results of a comparative study of the ovulation method (OM) and symptothermal method (STM) of natural family planning in Colombia are presented. Recruitment of volunteer couples began in August, 1976, and continued through December, 1978, during which time 566 couples were randomly assigned to one or the other of the two methods. The study included 3 to 5 months of training in the method assigned, after which the couples entered the follow-up phase of the study. They remained in follow-up until (1) they dropped out or (2) the study closed in June, 1979. Total dropout rates were high for both methods of natural family planning. One year after entry into the follow-up phase of the study, net pregnancy rates were 24.2% for OM users and 19.8% for STM users. Gross pregnancy rates were 29.2% for OM and 26.1% for STM. Differences in pregnancy rates between the two methods were not statistically significant.

The Ovulation Method—Vulvar Observations as an Index of Fertility/Infertility

Channel formation in dried cervical mucus and the presence or absence of fern formation are correlated. The mean number of channels was 9.2 when the fern was negative 42.8 when the fern was poor positive and 73.9 when the fern was good positive. The difference between the means in the 3 groups was statistically significant (p < .0001). The channel number in dried cervical mucus and the presence or absence of fern formation are correlated with the day of the menstrual cycle in which the specimens were obtained and with the womans observation of the PEAK mucus symptom while using the ovulation method of natural family planning. The data organized itself more clearly when it was related to the womans observation of the PEAK symptom. This has been explained by the fact that the PEAK mucus symptom is essentially an ovulatory event. The reliability of the womans vulvar observations while using the ovulation method was tested against observations of cervical mucus obtained from the level of the endocervix. In those vulvar observations that are considered fertile by the method the channel number and the frequency of good positive ferning were higher than in those observations that are considered infertile. When the vulvar observations that indicate fertility were compared with those vulvar observations that indicate infertility the difference was statistically significant (p < .01). Finally a practical model of human fertility is described using practical experience with the ovulation method the womans vulvar observations while using the method and the channel and fern formation of endocervical mucus. A progressively declining index of fertility is described that is statistically significant.(AUTHORS MODIFIED)

A randomized prospective study of the use-effectiveness of two methods of natural family planning: An interim report

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 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 colleccted 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.

Natural family planning: The contribution of fertility awareness to body‐person integration

The issue of family planning is not one a gynecologist can avoid yet the posture of the majority of the members of this profession -- one of providing whatever the patient requests with some explanation of the physical risk factors -- hardly adresses any of the basic issues. First fertility is not a disease yet the medical model for coping with its untoward effects is used. Secondly all contraceptive methods whether medical or surgical have some unplanned pregnancies associated with their use. Much education has been aimed at sexual responsibility yet its focus has been on encouraging full sexual expression while separating sex from procreation. The reality is that pregnancy is the normal of coitus. Although the outcome can be controlled to a greter or lesser extent by technology there are many men and women who will not adopt these means to prevent what is freely admitted as unwanted pregnancy. Often classical denial operates among adolescents. For adolescents there often is a need to find out if the powers of the body are truly there. In work with fertility acceptance methods of natural family planning (NFP) there have been many couples who had previously used any or all of the technological contraceptives and had for a variety of reasons -- religion ecology fear of oral contraceptives feminine assertiveness or personal taste -- decided that they wanted to try to understand their body language in respect to their cyclic fertility and to control family size by confining intercourse to the known infertile phase when pregnancy was not desired. The discovery of the significance of the cervical mucus by Billings ushered in a new era. Users of NFP methods in the US and outside the USSR-China areas generally use either the Billings method solely or combine the mucus observation with basal body temperature and sometimes other symptoms such as cervical changes breast tenderness backache. It takes several cycles of observation before most couples are proficient in observing their fertility signs. Follow-up is built into all successful programs. While learning begins in the area of cyclic fertility the understanding of the mood changes accompaning the estrogen-progesterone cycle is helpful to the couple. When couples can become totally vulnerable about their desires their emotions and face the risk of openness to life which is inherent particularly in the use of NFP they perforce have had to develop a deep trust and commitment. Consideration in the sexual sphere spills over into all areas of the couples relationship.

Natural Family Planning

A better understanding of reproductive anatomy and physiology has led to newer methods of natural family planning, including the ovulation method and the symptothermal method. Studies have shown that 1 percent of couples who consistently and correctly use either of these methods conceives during one year of use. However, in the absence of standardized interpretation of study results, use-effectiveness data of these methods vary widely. The lactational amenorrhea method may be used in selected patients during the first six months postpartum, and its effectiveness in avoiding pregnancy is reported to be as high as 98 percent. Advocates of natural family planning promote these methods as inexpensive and safe ways to determine periods of peak fertility and point to the potential benefit of increased communication in a relationship.

Fertility Awareness: Four Methods of Natural Family Planning

A desire for naturalness and fears of damaging side effects from artificial methods of birth control have stimulated public interest in natural family planning. Congress has responded to the public interest by requiring inclusion of information and counseling on the methods in federally funded family planning programs. Four methods of natural family planning are recognized: calendar rhythm, basal body temperature, ovulation, and symptom-thermal, the latter two being the most popular. A scientific basis exists for the natural methods and deserves consideration by nurses who deal with clients seeking family planning information. The natural methods, or fertility awareness, do not attempt to correct all the ills of family planning; they ofer an alternative for clients who want to avoid or must avoid artificial contraceptives.

The Art of Natural Family Planning.

This self-education manual on natural family planning (NFP) is divided into 2 parts. Part 1 explains why a couple should use NFP and part 2 explains the of the sympto-thermal method of NFP. The primary method taught in this book is the full sympto-thermal method which married couples it is claimed can use at the 99% level of effectiveness to either avoid or postpone pregnancy. The method is also useful in helping couples achieve pregnancy even when their mutual fertility is marginal. Part 1 argues that couples should choose NFP because it is cost-effective promotes physical health does not have the side effects attributed to other birth control methods (pill IUD sterilization) and is always reversible. Some less tangible arguments include the getting in touch with your own body rhythms and increased self-awareness. Arguments centering around the morality of NFP are aired. The final argument for using NFP is that it will bring marital couples closer together because NFP is a process requiring mutual decision-making teaches a more spiritual satiation opens the lines of communications between couples and promotes nongenital ways of expressing affection. The how-to section discusses the signs of ovulation (changes in cervical mucus ovulation pain and temperature rise) guidelines for interpreting symptoms of ovulation (including discussions of cycle variations) surprise or unwanted pregnancies return of fertility after childbirth and how to put NFP into practice in your day-to-day life (including various testimonials from couples using NFP).