Natural family planning in 1985: a status report

The current status of natural family planning (NFP) was reviewed. There is renewed interest in NFP, and many couples who find other methods unacceptable for medical, safety, or personal reasons are turning to NFP methods. The percent of contraceptive users who rely on behavioral methods in developing countries in 35% in Peru, 20%-25% in Haiti, Philippines, and Sri Lanka, and average 7.5% for the remaining 23 developing countries. IN the US about 4.7% of all contraceptive users rely on behavioral methods. Worldwide, rhythm is the most commonly used form of behavior fertility control, but this method is not promoted by most NFP programs. The 3 modern methods of NFP are 1) the basal body temperature method, 2) the cervical mucus, or Billings method, and 3) the sympto-thermal method. All these methods rely on physical signs and symptoms to detect ovulation and require sexual abstinence during the fertile phase of the menstrual cycle. The basal body temperature method requires women to detect the slight rise in temperature which occurs at the time of ovulation. The method is 94%-97% effective if intercourse is restricted to the postovulatory phase of the cycle. Disadvantages of the method are that intercourse must be restricted to only 7-13 days of the cycle, women must take their temperature daily, the method cannot be used during fever episodes, and the method is inappropriate for use during lactation or near menopause. The cervical mucus method is based on observing cervical mucus changes during the cycle. These changes signal the fertile and infertile phases of the cycle. According to a World Health Organization study, 93% of the women instructed in the method were able to detect mucus changes, and illiterate women were as adept at identifying these changes as university graduates. Findings also indicated that the method was 97% effective if abstinence was practiced during 15 days of the cycle, but use-effectiveness was only about 80%. This method has the advantage of not requiring ovulatory regularity. The sympto-thermal method uses a combination of symptoms including temperature shifts and mucus changes to detect ovulation. Some studies indicate that the combined method is more effective than those methods based on only 1 symptom, but many individuals find the combined method difficult and confusing. The advantages of NFP methods are that they require no medical supervision and that they have no side effects. Family planning providers often have negative attitudes toward NFP and many programs do not provide NFP services. Many providers maintain that the methods are ineffective and difficult to apply and that there is little demand for NFP. Research should be undertaken to determine if these opinions are valid. The major source of funding for NFP programs and projects is the US Agency for International Development (USAID). The agency is currently supporting 22 NFP projects under USAID grants and another 16 bilateral NFP programs. The research undertaken in connection with these projects should provide needed information on NFP advantages, disadvantages, effectiveness, and demand.