Evaluation of natural family planning programmes in Liberia and Zambia

Gray RH; Kambic RT; Martin MC; Wesley R; Cremins R; Lanctôt CA

doi:10.1017/s0021932000020538

Fertility Awareness Effectiveness

Evaluation of natural family planning programmes in Liberia and Zambia

Gray RH, Kambic RT, Martin MC, Wesley R, Cremins R, Lanctôt CA

Published April 1993 Journal of Biosocial Science, 25(2), 249-258

DOI 10.1017/s0021932000020538 PMID 8478373

RRM Academy Synopsis

Natural family planning can work acceptably in Liberia and Zambia

A 1993 evaluation of demonstration projects in Liberia and Zambia suggests that natural family planning programs can reach acceptable effectiveness and cost in Africa. Women avoiding pregnancy enrolled in both: 1055 in Liberia and 2709 in Zambia.

Key Findings

Women in Liberia progressed to autonomous use of the method more often than women in Zambia: 58.0% compared with 35.3% (p<0.001).
Cost per couple-year protection was US$47.1 in Liberia and US$25.7 in Zambia (1983 dollars). Costs were higher during learning than during autonomy and fell as each project matured.
Among women avoiding pregnancy, the one-year life table rate of unplanned pregnancy was 4.3 per 100 woman-years in Liberia and 8.9 in Zambia, a significant difference.
Among women avoiding pregnancy, one-year life table continuation was 78.9 per 100 woman-years in Liberia and 71.2 per 100 woman-years in Zambia.
Liberia ran a uni-purpose program in mainly rural areas. Zambia integrated natural family planning with maternal and child health care, mainly in urban areas.

Interpretation

The report evaluates two demonstration projects with life table methods and program accounting records. Teachers trained women in the symptothermal method and the ovulation method. The authors place the unplanned pregnancy rates within the range reported for several other natural family planning programs. They note high rates of loss to follow-up, especially in Zambia, and advise careful reading of the continuation figures. The authors state that loss to follow-up does not bias the cost estimates, because they rest on mean duration of use, including use before loss or discontinuation.

RRM Context

Fertility awareness-based methods teach women to chart cervical mucus and basal body temperature and to recognize their own fertile days, an expression of body literacy. In this evaluation, trained teachers instructed urban and rural women. Women who could not read charted with symbols. Husbands attended at least one teaching session in about 60% of cases, which brings the couple into the method.

Our editorial summary of this paper, not the article's abstract.

Abstract

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.

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Fertility Awareness Methods Compared

Topics

Fertility Awareness › Effectiveness › Typical and Perfect Use · Cost and Access › Population and Global Health › Low Resource Settings · Contraception › Comparative Studies › Contraception Versus Fertility Awareness

Ronald H Gray

Ron Gray, R Gray

PMID 8478373 8478373 DOI 10.1017/s0021932000020538 10.1017/s0021932000020538 Gray et al. 1993, Gray 1993

Evaluation of natural family planning programmes in Liberia and Zambia

Natural family planning can work acceptably in Liberia and Zambia

Key Findings

Interpretation

RRM Context

Abstract

Read the guide

Topics

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