Use Of Natural Family Planning Research Articles

Natural family planning and Down syndrome—matching and confounding in a case control study

The journal reported the findings of a case-control study conducted in 1995 by Castilla et al. to determine the association between Downs syndrome and the use of natural family planning (NFP). Researchers collected data on more than 5000 case-control pairs but provided data on only 4925 mothers of malformed infants and 4802 mothers of controls. 6.6% of the former group and 6.0% of the latter were users of NFP. There is considerable potential that sample distortion will result when using the case-control study design one particularly prone to error and bias. The author criticizes Castilla et al. for not defining the source populations exposure category not explaining why data are provided on malformed children when the study objective is trisomy 21 not stating why data are presented on less than 5000 pairs and not explaining the discrepancy between the numbers of cases and controls and how the 476 mothers of babies with Downs syndrome were matched with controls. Castilla et al. also leave it to the reader to make certain calculations provide a chi-square value after writing about 95% confidence intervals with regard to odds ratios and fail to justify a beta of 0.8. Castilla et al.s study and findings should not have been reported in the journal devoid of better analysis and more thorough explanation.

Physician and Nurses’ Knowledge and Use of Natural Family Planning

Perinatal health professionals are in key positions to either promote or dissuade the use of Natural Family Planning (NFP). The purpose of this article is to describe a survey conducted with perinatal physicians and nurses on their knowledge and professional use of NFP. Four hundred and fifty physicians and nurses (150 MDs and 300 RNs) were sent a questionnaire on the use of and knowledge of NFP. One hundred sixty-six (or 37%) returned the completed questionnaires. Fifty-two percent of the nurses who returned the questionnaires and 48% of the physicians indicated they were taught about NFP in basic (generic) medical or nursing school. The average lecture time spent on the subject in either nursing or medical school was less than one hour. The majority learned about NFP through self-education or on-the-job training. Only four (1 RN and 3 MDs) are certified to teach NFP. Fifty-three percent of the nurses and 44% of physicians would not advise the use of NFP to avoid pregnancy. The most frequent reasons given for not promoting the use of NFP to either avoid or achieve pregnancy were that it is not effective, not natural, too difficult to learn, better methods are available, and it only works for highly motivated educated women.

Sexual behavior of natural family planning users in Germany and its changes over time.

For 10 years, a prospective study has been taking place in Germany to examine the use of natural family planning (NFP). As natural methods are behavioral methods, use-effectiveness, acceptability and continuation rates are very much influenced by patterns of sexual behavior. Therefore we performed an analysis of the sexual behavior of NFP users. Out of the data base of 1211 clients and 12,591 cycles we could identify a group of 300 women, all NFP beginners, with 5900 contraceptive cycles, who contributed at least 12 cycles with reliable recording of their sexual activity. Different groups were analyzed with methods of analysis of variance and regression models to find out significant differences in their sexual behavior with respect to sociodemographic structure and time of use. Nearly half of all the women systematically combine the fertility awareness part of NFP with other family planning methods. They use barriers in more than 60% of their cycles. The other half never or only in about 7% of their cycles use additional barrier methods. The latter show a clear decrease in barrier use in the course of time, whereas the frequent barrier users constantly combine the advantages of two family planning methods. Regarding the frequency of intercourse they are the sexually more active ones and show distinct sociodemographic characteristics. We could confirm the existence of three groups of NFP users, which differ significantly in their use of NFP as a family planning method. Despite these differences the low pregnancy rates indicate the conscious and risk-related sexual behavior of the group members.

Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning

OBJECTIVE: Our purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion STUDY DESIGN: To assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days — 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be “optimally timed,” and all other conceptions were considered as “non-optimally timed.” The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods. RESULTS: There were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions. CONCLUSIONS: Overall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.

Current status of natural family planning in Granada (Spain)

In Spain the use of natural family planning (NFP) is limited. In Barcelona, CODIPLAN, an NFP planning center, has offered natural methods to potential users for a number of years. In Granada and Jaén, information provided by health professionals on fertility awareness is now gaining importance. In 1989, a seminar introduced NFP in Granada; the program has been very active since. Two courses were run for teachers and for health personnel, and we took part in the practical training of providers of alternative medical care through two programs organized by the University of Granada. We also gave talks on local radio and television programs, presented updating sessions at daycare centers, and gave health education classes at primary and secondary schools. The international seminar on NFP in March, 1992 was organized jointly by the University and the City Council. The proceedings will be published by the University of Granada. In 1990, under the scientific auspices of the Natural Family Planning Department at the Zaidin Medical Center, we started a program of training and follow-up for NFP users via an on-going seminar on NFP. In Granada and Jaén, NFP methods are now available to the general population and to health personnel.

Evaluation of natural family planning programmes in Liberia and Zambia

Studies to evaluate use-effectiveness and cost-effectiveness of natural family planning (NFP) were conducted in Liberia and Zambia. The Liberian programme provided uni-purpose NFP services to 1055 clients mainly in rural areas; the Zambian programme provided NFP services integrated with MCH to 2709 clients predominantly in urban areas. The one-year life table continuation and unplanned pregnancy rates were 78.9 and 4.3 per 100 woman-years in Liberia, compared to 71.2 and 8.9 in Zambia. However, high rates of loss to follow-up mandate caution in interpretation of these results, especially in Zambia. More women progressed to autonomous NFP use in Liberia (58%) than in Zambia (35.3%). However, programme costs per couple-year protection were lower in Zambia (US$25.7) than in Liberia (US$47.1). Costs per couple-year protection were higher during learning than autonomy, and declined over time. These studies suggest that NFP programmes can achieve acceptable use- and cost-effectiveness in Africa.

Factors related to autonomy and discontinuation of use of natural family planning for women in Liberia and Zambia

From 1983 to 1988, natural family planning programs were conducted in Liberia and Zambia. In Liberia 1055 and in Zambia 2709 women used natural family planning to avoid pregnancy. These users could become pregnant, discontinue use of the method, or become autonomous users. Women who changed intention did not stop use of natural family planning and were not treated as discontinuations. In a multivariate analysis, client's age, breastfeeding status, employment, urban/rural residence, time of registration in the program, and visit intensity were significantly associated with the outcomes. The most consistent association was that women who entered the programs in the later time periods were more likely to become autonomous users and less likely to discontinue use of the method or to experience an accidental pregnancy.

Overview and summary: The interface of breastfeeding, natural family planning, and the lactational amenorrhea method

This session explores the use of natural family planning during breastfeeding and the operational ization of the research findings related to the breastfeeding-natural family planning interface into training programs. Worldwide, the vast majority of women breastfeed their infants; in many countries breastfeeding continues for several months. Studies show that women learning natural family planning during lactation, particularly those whose menses have returned, have an increased risk of unplanned pregnancy. Altered hormonal levels may make interpretation of the signs of fertility return (mucus, and so forth) difficult during this time. The lactational amenorrhea method may be a useful adjunct to natural family planning training.

Natural family planning: Looking ahead

Natural family planning is used by a relatively small number of people worldwide. The Institute's goal is to increase the knowledge, availability, effectiveness, and acceptability of natural family planning. To do so, the Institute is conducting biomedical research in several areas including: (1) the development of a home test kit for ovulation prediction, (2) sperm-mucus interaction, (3) the mechanisms and fertility impact of lactational amenorrhea, and (4) outcome of pregnancies in natural family planning users.

Fertility Awareness: Jet-Age Rhythm Method?

The optimal use of natural family planning (NFP) requires the daily measurement of basal body temperature combined with examination of cervical mucus to estimate the onset of ovulation. Popularity and efficacy of the method are low mainly because of the required lengthy abstinence from intravaginal coitus; reliance upon the sympto-thermal method of NFP requires an average of 17 days of such abstinence. The accurate measurement of certain biochemical changes however could reduce the required period of abstinence by more than 50% and boost the popularity and use of NFP. Home tests could be used to detect hormonal changes in a womans saliva and urine over the course of her menstrual cycle. Indeed it is now possible to accurately measure the increase in progesterone metabolites in a few drops of urine. The use of two dipsticks to measure estradiol and progesterone levels in saliva would however be ideal. Research and development efforts are needed to that end. This latter approach would require no toxicology US Food and Drug Administration scrutiny should be much shorter than with drugs legal exposure would be minimal and the undertaking is within the technical and financial resources of relatively small diagnostic companies. The level of market demand for such home tests remains undetermined. Women attempting to avoid unwanted pregnancies as well as female athletes flight attendants traversing multiple time zones on a regular basis and professional women postponing childbearing until their late thirties can all potentially benefit from tools capable of increasing their individual awareness of their fertile periods.

Epidemiological studies of natural family planning.

The prevalence of the use of natural family planning (NFP) can be estimated from sample surveys of married women in the reproductive ages (MWRA). Surveys in developed and developing countries during the past decade indicate that the prevalence of NFP use varies from 0 to 11%. In addition, if one considers NFP use in relation to other contraceptive methods, the percentage of all current contraceptors who use NFP varies from 1 to 35%. This suggests that NFP is an important method in certain countries. Pregnancy rates for NFP vary widely, but most reliable studies report 1-year life-table pregnancy rates between 10 and 25/100 woman-years. The Billings ovulation method consistently has higher pregnancy rates than the sympto-thermal method and NFP users generally have among the highest pregnancy rates compared to other methods. The major safety issue concerning NFP is the risk of adverse pregnancy outcomes associated with aged gametes. There are suggestions from a number of investigations that conceptions distant from ovulation have a higher risk of spontaneous abortion and a higher proportion of male births. The findings with respect to birth defects or multiple pregnancies are less consistent, although some studies have reported an increased risk of chromosomal anomalies.

The Provision of Natural Family Planning Services at Public Health Centers in Colombia

The authors report the results of a two-year project to increase the use of natural family planning (NFP) methods in Colombia through the development of a community outreach program for the provision of methods through public health facilities. NFP use increased in both groups in which an effort was made to include this method in family planning services though the total prevalence of at the end of the study was less than two percent of couples in each group. (SUMMARY IN FRE AND SPA) (EXCERPT)

Natural Family Planning: A Comparison of Continuers and Discontinuers

Little research has been done on social-psychological variables related to the use of natural family planning. The objective of this study was to analyze variables that differentiated between continuers and discontinuers of natural family planning (NFP). Questionnaires were obtained from couples who had received instruction in the sympto-thermal method of natural family planning at a large urban hospital. Subjects who were attempting to become pregnant or who were using other methods of contraception in conjunction with NFP were deleted from the analysis, leaving N of 74. With Pearson correlation, variables significantly related (p<.05) to NFP continuance were: religiosity, planning more children, perceived severity of pregnancy, support from spouse and relatives, dissatisfaction with other contraceptive methods, attitudes toward NFP, perceived effectiveness of NFP, attitudes toward abstinence, and importance of intercourse.

Natural family planning in Mauritius, Indian Ocean: utilization patterns and continuance predictors.

Factors associated with discontinuation from an island-wide natural family planning program in Mauritius were examined in 2 stratified random samples of 300 (1976) and 350 (1980) acceptors. The data were gathered through records, educator observations, and field interviews with the 1980 sample. Comparison between those served by the Action Familiale program and characteristics of the Mauritius population as a whole suggests that the natural family planning program serves a somewhat better educated group of couples who have more employment security and smaller families than the general population. Acceptors selected the natural family planning method for reasons such as a desire to have a child according to a plan or to space children (29%), avoidance of the side effects of artificial contraception (21%), or as a result of a recommendation by a friend, relative, or professional (25%). 74% of acceptors in the 1980 sample expressed satisfaction with the method and indicated that their spouse shared this satisfaction. After 3.5-4.5 years of follow-up, 57% of acceptors in the 1976 sample had discontinued use of natural family planning. 9 variables in 4 categories--Administrative, Psychological-Motivational, Educator-Acceptor Relationship, and Family--were predictive of discontinuation. The major factors differentiating discontinuers from continuers were: 1) discontinuers had previously registered at Action Familiale and dropped out; 2) discontinuers placed more emphasis on spacing than on preventing pregnancies; 3) discontinuers discussed fewer topics with their educators; 4) discontinuers and their husbands seemed less interested in the natural method; 5) discontinuers had less family support for natural family planning; 6) educators experienced greater difficulty in teaching discontinuers; 7) discontinuers demonstrated less understanding of the symptothermal method; and 8) educators made fewer preregistration visits to the homes of discontinuers.

Natural family planning: A comparison of continuers and discontinuers

Little research has been done on social-psychological variables related to the use of natural family planning. The objective of this study was to analyze variables that differentiated between continuers and discontinuers of natural family planning (NFP). Questionnaires were obtained from couples who had received instruction in the sympto-thermal method of natural family planning at a large urban hospital. Subjects who were attempting to become pregnant or who were using other methods of contraception in conjunction with NFP were deleted from the analysis, leaving N of 74. With Pearson correlation, variables significantly related (p<.05) to NFP continuance were: religiosity, planning more children, perceived severity of pregnancy, support from spouse and relatives, dissatisfaction with other contraceptive methods, attitudes toward NFP, perceived effectiveness of NFP, attitudes toward abstinence, and importance of intercourse.

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.

Status and Prospects of Natural Family Planning

A 3-day conference on natural family planning held at Airlie House Warrenton Virginia under the joint auspices of the Human Life Foundation and the National Institute of Child Health and Human Development is reviewed. Subject matter included biological rhythms menstrual cycle immature and aged gametes prediction of ovulation detection and control of ovulation psychology of natural family planning and teaching of clients. Biological rhythms are detectable in all living organisms. Those that operate apart from the environment are known as circadian circatidal circamonthly and circannual cycles. The reproductive rhythm of mammals was especially considered. The mechanism underlying reproductive cyclicity appears to operate via catecholamines which stimulate nuclei in the hypothalamus to secrete certain peptides called releasing factors. The peptides pass through the veins to the pituitary. The hormones secreted by the pituitary then act on the ovaries and testes to control reproductive function. The gonads in turn secrete hormones that return to the hypothalamus to help regulate releasing factor production. These activities are constant but oscillations have been shown. Menstrual histories reveal that cycles are not really regular particularly in the periods before age 20 and after age 40. When an ovum is fertilized later than normal subsequent abnormalities in cell division may occur. In vitro studies suggest that fertilization of aging ova is associated with a larger fraction of abnormal births than with normal ova. Both aged and immature spermatozoa also appear to be a liability. The use of natural family planning may increase the probability of fertilization with aging gametes. A prediction of impending ovulation is needed. To be effective it must become positive by 72 hours before ovulation. Current methods indicate only present or part ovulation. Regulation of ovulation by steroid therapy or hormones has been tried particularly with clomiphene. Changes in the physical properties of cervical mucus to be noted by the patients have been advocated as a reliable method of predicting ovulation. Basal body temperature records are often used as the best method available. The mental status of couples has also been considered important. Natural family planning requires abstinence diminishes spontaneity focuses daily attention on functions women often prefer to ignore and is associated with anxiety. It was pointed out that the problems differ in different religious cultural and social groups. Techniques of teaching clients also vary in different countries and at several social levels. Programs appear to develop around effective teachers. Natural family planning was recommended as a feasible method of contraception for couples with sufficient motivation and a willingnes s to accept a measurable risk of pregnancy. Improved techniques are hoped for.