Natural Family Planning Methods Research Articles

Time to pregnancy: results of the German prospective study and impact on the management of infertility.

The likelihood of spontaneous conception in subsequent cycles is important for a balanced management of infertility. Previous studies on time to pregnancy are mostly retrospective and biased because of exclusion of truly infertile couples. The study aim was to present a non-parametric estimation of cumulative probabilities of conception (CPC) in natural family planning (NFP) users illustrating an ideal of human fertility potential. A total of 346 women was observed who used NFP methods to conceive from their first cycle onwards. The couples practising NFP make optimal use of their fertility potential by timed intercourse. The CPC were estimated for the total group and for couples who finally conceived by calculating Kaplan-Meier survival rates. A total of 310 pregnancies occurred among the 346 women; the remaining 36 women (10.4%) did not conceive. Estimated CPC for the total group (n = 340 women) at one, three, six and 12 cycle(s) were 38, 68, 81 and 92% respectively. For those who finally conceived (truly fertile couples, n = 304 women), the respective pregnancy rates were 42, 75, 88 and 98% respectively. Although the numbers of couples in both groups were similar, the impact of age on time to conception, as judged by the Wilcoxon test, was less in the truly fertile than in the total group. Most couples conceive within six cycles with timed intercourse. Thereafter, every second couple is probably either subfertile or infertile. CPC decline with age because heterogeneity in fecundity increases. In the subgroup of truly fertile couples, an age-dependent decline in CPC is statistically less obvious because of high homogeneity, even with advancing age.

Die Effektivität von Zyklusmonitoren zur Bestimmung des fertilen Fensters

Können Zyklusmonitore wie die Temperaturcomputer Babycomp/Ladycomp, Cyclotest 2 Plus, Bioself 2000, der Hormoncomputer Persona, die Speichelmikroskope PC 2000, PG 53, Maybe Baby und die symptothermale Methode (STM) der natürlichen Familienplanung (NFP) effektiv das fertile Fenster im Zyklus der Frau feststellen?

Couples' views of the effects of natural family planning on marital dynamics.

Natural Family Planning (NFP) requires periodic abstinence and partner cooperation to prevent pregnancy. The aim of this study was to learn about the effects of modern NFP methods on marital relationships. Descriptive survey. Questionnaires were mailed to 1,400 randomly selected couples known to use NFP and residing in the United States of America; 334 couples (24%) responded. Content analysis was used to identify meanings and themes. Numeric analyses were used to determine frequencies. Nearly two-thirds of the qualitative comments were positive. Four themes were identified in the positive responses: relationship enhancements, knowledge improvements, spirituality enrichments, and method successes. Three negative themes were identified: strained sexual interactions, worsened relationships, and method problems. Although about one-fourth of the comments indicated that NFP presented challenges, the majority (74%) found it beneficial, often resulting in stronger bonds, better communication, and improved knowledge. NFP had more positive than negative effects and its use warrants further consideration.

Factors influencing the choice to use modern natural family planning

A discrepancy exists between the interest in modern methods of natural family planning (NFP) and their actual use in developed countries. To explore reasons for this discrepancy, we analyzed data from a questionnaire administered to postpartum women in Berlin (n = 223) and Cracow (n = 233). Knowledge of NFP, past use of NFP and expected effects of abstinence on the partnership were independently associated with interest in using NFP, but not the choice to do so among those interested. Desire for future pregnancies, importance of religious belief and location in Cracow were independently associated with the choice to use NFP among those interested. Perceived accuracy of observation to identify the fertile time and acceptance of own body were independently associated with both interest in and choice to use NFP. Frequency of intercourse had no effect on interest. These results suggest that increased access and cultural support would likely lead to a higher prevalence of NFP use in developed countries.

Eine Studie zur Kenntnis und Einschätzung der natürlichen Familienplanung

Purpose: There is a discrepancy between the interest in Natural Family Planning (NFP) and its actual use. The supposedly high level of knowledge about NFP in Germany and a low prevalence of use has been interpreted as proving that there is no demand for NFP in the population, However, in previous research we found a low level of knowledge of modern NFP methods among Germans that we studied. They also had a number of biases against its effectiveness. This study was undertaken to verify these findings. Material and Methods: In the Autumn 2000 a survey was conducted by a written questionnaire in a maternity ward in Berlin. 200 questionnaires were distributed, 134 (67%) were returned and suitable for the analysis. The demographic characteristics of the respondents were very similar to the corresponding population. Results: 82% of the respondents knew about at least one NFP-method; however, the modern methods were nearly unknown. 17% knew about mucus observation, and 4% about the symptothermal method. The temperature method as well as the mucus observation were both considered ineffective, clearly less effective than condoms. Despite this, 13% of the women mentioned NFP as one of the methods they would probably use in the future. Conclusion: The relatively low prevalence of use of NFP-methods in Germany does not coexist with a high level of knowledge of modern NFP-methods, but with a pronounced ignorance about them. Regarding the effectiveness of the NFP-methods there is a much disinformation. The hypothesis of a well-informed decision against the use of modern NFP-methods is to be rejected. The explanation for the discrepancy between the relatively high interest in and the relatively low prevalence of actual use of NFP may be due to a deficit of information about NFP. Further studies should address this possibility.

Trends in Contraceptive use among Catholics in the United States: 1988-1995

been a rapId decline in the use of natural methods of family planning; a sharp rise and slow decline in the use of oral contraceptives and, in the past ten years, a major reliance on surgical sterilization for contraception. Information from these national surveys has provided useful information for contraceptive providers, policy makers, and religious groups. The method of avoiding and achieving pregnancy that is promoted and encouraged by the Roman Catholic Church is natural family planning. Since natural methods are the only methods sanctioned by the Catholic Church, an assumption could be made that contraceptive practices among Roman Catholics in the United States would substantially differ from contraceptive use by the general population. The purpose of this article is to describe the use of contraceptives by Roman Catholic women between 1988 and 1995 and to compare contraceptive use by Catholics with national trends. Information on trends in contraceptive use among Catholic women is of interest to Catholic health care providers and policy makers, natural

A new simplified calendar-based method of natural family planning

A new simplified calendar-based method of natural family planning

A fixed formula to define the fertile window of the menstrual cycle as the basis of a simple method of natural family planning

A significant number of women worldwide use periodic abstinence as their method of family planning. Many of them use some type of calendar-based approach to determine when they should abstain from unprotected intercourse to avoid pregnancy; yet they often lack correct knowledge of when during their menstrual cycle they are most likely to become pregnant. A simple method of natural family planning (NFP) based on a fixed formula to define the fertile window could be useful to these women. This article reports the results of an analysis of the application of a fixed formula to define the fertile window. A large existing data set from a World Health Organization study of the Ovulation Method was used to estimate the theoretical probability of pregnancy using this formula. Information about the variable probability of pregnancy on different cycle days relative to ovulation also was considered in the analysis. Results suggest that a fixed formula in which days 8–19 of the menstrual cycle are considered to be the fertile window would provide the appropriate basis of a simple, effective, family planning method.

Physicians’ knowledge and practices regarding natural family planning

Objective: To assess physicians’ knowledge and practices of modern methods of natural family planning. Methods: A questionnaire was mailed to 840 physicians selected randomly from Missouri state licensing records for obstetrics-gynecology, family practice, general practice, and general internal medicine. Results: The response rate was 65%. A total of 375 physicians (69% of respondents) saw women for reproductive issues. About half (46%) of physicians reported that they mentioned natural family planning to at least some women when discussing family planning issues. Observing vaginal discharge of cervical mucus was discussed by 40% of physicians in the context of avoiding pregnancy and by 36% of physicians in the context of helping a couple achieve pregnancy. Twenty-two percent of physicians estimated the best possible effectiveness of natural family planning to avoid pregnancy to be greater than 90%, and 35% estimated the actual effectiveness to avoid pregnancy to be greater than 70%. (The threshold rates of 90% best possible effectiveness and 70% actual effectiveness were chosen to be somewhat less than those reported in medical literature.) Physicians who gave higher estimates of effectiveness of natural family planning and physicians who were aware of an instructor in their community were more likely to provide women with relevant information about natural family planning. Conclusion: Most physicians, especially those unaware of availability of instructors in their areas, underestimate the effectiveness of natural family planning and do not give information about modern methods to women.

The twoday algorithm: a new algorithm to identify the fertile time of the menstrual cycle

Women who monitor their fertility signs and recognize when they are fertile can use this knowledge to conceive or to avoid pregnancy. Studies have shown that there is a rather small fertile window of several days during each menstrual cycle. Established methods of identifying the fertile window, such as the Ovulation and the Symptothermal methods of Natural Family Planning, can be very effective in helping couples avoid pregnancy. A new algorithm for identifying the fertile window has been developed, based on monitoring and recording of cervical secretions. The TwoDay Algorithm appears to be simpler to teach, learn, and use than current natural methods. A large existing data set from a World Health Organization study of the Ovulation Method, along with Natural Family Planning charts from women using the Ovulation Method and the Symptothermal Method, were used to determine the potential effectiveness of the TwoDay Algorithm in identifying the fertile window. Results suggest that the algorithm can be an effective alternative for low literacy populations or for programs that find current Natural Family Planning methods too time consuming or otherwise not feasible to incorporate into their services. Further studies are needed to determine the efficacy of the TwoDay Algorithm in avoiding pregnancy and to assess its acceptability to users and providers.

The frequency of coitus during breastfeeding.

New mothers and clinicians would benefit from an understanding of typical sexual behavior during breastfeeding. Unfortunately, little information is available about both the typical length of time to resumption of coitus and the frequency of sexual relations during breastfeeding. This paper describes the commencement and frequency of coitus among breastfeeding women in a variety of settings. The analysis draws on data from two separate research studies. The first was undertaken in three sites (Birmingham, United Kingdom; Montreal, Canada; Sydney, Australia), the purpose of which was to correlate natural observations of fertility with the underlying hormonal profile among breastfeeding women using the symptom-thermal method of natural family planning. The second was a clinical trial of the lactational amenorrhea method of family planning conducted in Manila, the Philippines. Coital frequency reported by these populations of breastfeeding women appears to be lower than that reported in other studies for married women in general. As other research demonstrated, we found coital frequency and postpartum resumption of coitus to be associated with age, but not with the number of children in the household. A better understanding of the level of sexual activity among breastfeeding women could inform and improve programs that offer postpartum support and counseling about family planning.

Implementing reproductive health awareness: progress to date.

This paper describes the experience of various institutions in integrating a reproductive health awareness (RHA) approach into different health, school and community-based programs. RHA, an educational approach that evolved from the Institute's client empowerment approach to natural family planning and fertility awareness, is based on helping women and men to participate actively in their own family planning and reproductive health care by developing skills in self-observation, communication and self-advocacy. In addition to providing the Institute with an avenue for responding to the Cairo and Beijing mandates, RHA has also provided a means to introduce family planning, particularly natural methods of family planning, into programs and institutions. RHA has continued to evolve and strengthen during the process of field testing its contributions to existing reproductive health programs.

Fertility awareness and natural family planning

Information about fertility awareness helps to fulfil the broader definition of the services many family planning clinics offer. Although information about natural family planning is requested by a small number of clients seeking family planning advice, many more clients benefit from information about fertility awareness. Fertility awareness is far more than just basic reproductive anatomy and physiology; fertility awareness involves understanding basic information about fertility and reproduction, being able to apply it to oneself, and being able to discuss it with a partner or with a health professional. Fertility awareness is fundamental to understanding and making informed decisions about reproductive health and sexual health. If clients have a better understanding of fertility awareness, they are in a stronger position to make informed decisions about how they wish to manage their reproductive and sexual health, for example: (1) Fertility awareness information is used to help couples to plan pregnancies as well as to avoid them. This can be helpful to couples who are having difficulty conceiving, for the timing of intercourse or for the timing of some of the sub-fertility investigations. (2) The information is also useful when helping couples to understand how each method of family planning works--how the family planning method interrupts normal fertility, how the method will fail if not used correctly, and how fertility returns when the method is discontinued. (3) Women who are fully breastfeeding value the knowledge about reduced fertility, as do women during the perimenopausal years who value being given clear information about their declining fertility. (4) When counselling couples about the importance of avoiding sexually transmitted diseases it is important they understand sexually transmitted diseases may damage their fertility. (5) Couples who choose only to use a barrier method during the time they think the woman is fertile are a group who do not readily identify themselves to family planning providers. These couples often do not have adequate information about fertility awareness. Advances in technology and the understanding of ovulation, ovum and sperm survival have confirmed that the guidelines used to teach fertility awareness and natural family planning effectively identify the fertile phase of the menstrual cycle. Serial ultrasound studies on the ovaries during the menstrual cycle have confirmed the accuracy of the hormonal assays in pinpointing the likely time of ovulation. Ultrasound studies have also shown that subjective observations of the alterations in cervical mucus and the basal body temperature rise are accurate indicators of the fertile phase. Research on the chances of conception on each day of the menstrual cycle, using hormonal assays to estimate the time of ovulation, was carried out in 1994 by Weinberg and Wilcox. Their results showed that the timing of sexual intercourse, in relation to ovulation, strongly influences the chance of conception. Conception only occurred during a 6-day interval that ended on the estimated day of ovulation. The chances of conception fell to zero 24 hours after ovulation. Several different methods of natural family planning are taught; some methods depend on only using one of the indicators of fertility, others are based on two or more indicators. The main indicators of fertility are: observing the cervical mucus, recording the basal body temperature, palpating the cervix and a calculation based on the cycle length. Research studies performed using a combination of the indicators of fertility show that the failure rate using a combination is less than most of the studies which use a single indicator. In each case the method failure is far lower than the user failure. (ABSTRACT TRUNCATED)

Simplifying NFP: preliminary report of a pilot study of the 'collar' method in Brazil.

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.

Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study.

A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14870 cycles, 28 unintended pregnancies were studied. Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During "perfect use" the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most unforgiving for imperfect use (unprotected intercourse in the fertile phase). However, it is extremely effective when either abstinence or protected intercourse is used in the fertile phase.

Main-streaming NFP into the Department of Health of the Philippines: opportunities and challenges.

In 1994, the Department of Health (DOH) of the Philippines issued a circular which reaffirmed natural family planning (NFP) as one of the basic services to be offered in all government family planning service sites and urged family planning workers to develop competence in teaching NFP methods. Although the circular represented a major policy breakthrough for the main-streaming of NFP it found the department without the capability or experience to directly provide NFP services. The two approaches the department is taking to respond to this new policy initiative are described in this paper. The selection of these approaches was influenced by the devolution of central government authority to local government units. The approaches include developing department capability in NFP training, service provision and service installation and creating a supportive program and policy environment. DOH partnership with an NFP non-government organization (NGO) has been critical in developing NFP capability within the government sector, particularly in NFP training and service installation.

Field trial of Billings Ovulation Method of natural family planning

There are couples with unmet family planning needs and couples who do not use any modern method, yet they desire to space or avoid pregnancies. Many of them look for safe and effective options like the natural family planning methods. The Billings Ovulation Method based on single index cervical mucus parameter is one such option. The present multicentre trial conducted in India has shown an encouraging use-effectiveness of the method, indicating method failure as low as 1.5±0.3 and use-failure 15.9±0.8 per 100 users at 21 months. The method continuation rates have also been as high as 88.3 100 users at 6 months and 52.0 100 users at 21 months.

Sexual values and family planning among charismatic and Pentecostal movements in Brazil

This paper analyses beliefs about sexuality and the use of family planning among Pentecostal Protestants and charismatic Catholics in Brazil. Many have assumed that these new churches are conservative, if not fundamentalist, in their views on these issues. This study shows that both groups tend to evaluate sexuality in a positive way, separating it from reproduction. Although they agree that sexual life is permitted only within marriage, they differ in their attitudes and values in relation to the use of family planning. More charismatic Catholics use natural methods of family planning than any other religious group studied while Pentecostal Protestants opt almost entirely for modern methods. The more flexible Pentecostal position offers religious support to poor women who want to control, or feel that the conditions of their lives force them to control, their fertility. While both religious movements grant women moral authority and strengthen their self-esteem in some ways, both also reinforce gender imbalances through the quest for sanctification.

Natural family planning in the 1990s

Natural family planning (NFP) tends to be considered as a matter of chance resulting in unplanned pregnancies and large families. A World Health Organization (WHO) multicenter trial of the ovulation method of NFP was undertaken during 1975-79 with the primary objective of determining what proportion of women of many different cultures could be taught to recognize changes in the cervical mucus around the time of ovulation. The conclusions were that: a) irrespective of cultural, educational, or economic background, over 95% of fertile women could recognize the mucus signs of fertility; b) the fertility rate was 22.6 pregnancies per 100 woman years; c) the preovulatory and postovulatory days designated by the ovulation method of NFP rules as infertile were indeed infertile, as the pregnancies in this phase were 4 per 1000 acts of intercourse. The knowledge gained through the WHO trial and subsequent experience has given NFP organizations and teachers a much greater understanding of the fertile and infertile phases, so that total pregnancy rates have been steadily falling. Of the 11 NFP studies so far reported in the 1990s, the 3 that had total pregnancy rates greater than 5 per 100 woman years were trials of atypical NFP approaches or teaching methods. The results can be compared with reported pregnancy rates of between 0.18 and 3.6 for artificial contraceptive methods in well-motivated couples. One criticism of NFP is that the necessary periods of abstinence may be detrimental to the marital relationship. It is suggested that the sexual revolution of the last 20-30 years has caused marital and family breakdown on a massive scale, thus NFP might be the antidote. Since women are potentially fertile for no more than 6-8 days in the cycle, these easily recognized symptoms empower women through the knowledge they impart regarding their state of fertility. All women are entitled to this simple and fundamental information.

Natural family planning effectiveness in Belgium

The aim of the study was to check, in a European environment, the practical efficiency and the acceptability of a recent natural family planning (NFP) method. This method includes a double check to detect the beginning as well as the end of the fertile phase of the menstrual cycle. Up to now, 71 women of reproductive age have been registered. They agreed to provide their symptothermal charts and related information. Average age is 32 years. Average fertility is 2 children/woman. Fifty-nine percent of the participants have a professional occupation. The same percentages are found in those accepting a contraceptive method (oral contraceptives or intrauterine devices). Until today 1240 cycles (103 women-years) of experience have been gathered. The average participation was 17.5 cycles/woman. No method failure has been reported. One unintended pregnancy due to unprotected sexual intercourse during the fertile phase occurred (user failure). Overall Pearl Index (PI) was 0.96. In 84% of the cycles, no protected intercourse was reported (NFP only). According to PI, practical efficiency of the NFP method analyzed was 1.31. Sexual abstinence during the fertile phase was found in 71.4% of the cycles.