Kambic, R. T., Wesley, R., & Lanctôt, C. A. (1994). Trial of a new method of natural family planning in Liberia. Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception, 10(2), 111-119. https://doi.org/10.1007/BF01978104
Kambic RT, Wesley R, Lanctôt CA. Trial of a new method of natural family planning in Liberia. Adv Contracept. 1994;10(2):111-119. doi:10.1007/BF01978104
Kambic, R. T., et al. "Trial of a new method of natural family planning in Liberia." Advances in Contraception : the Official Journal of the Society for the Advancement of Contraception, vol. 10, no. 2, 1994, pp. 111-119.
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African Federation for Emergency Medicine0489p2588
Planned Parenthood Association of Liberia01a81w125
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RRM Academy Synopsis
Liberian Modified Mucus Method users had low unplanned pregnancy rates
Unplanned pregnancy rates were low in both groups: 6.6 per 100 woman-years with the Modified Mucus Method (MMM) and 1.5 with the sympto-thermal and ovulation method (ST/OM). The difference was reported as not significant. The Monrovia, Liberia, study followed 154 MMM acceptors and 399 ST/OM acceptors. The cost per couple year of protection was similar.
Study at a glance: Unplanned pregnancy rates were low with a new mucus method. Source: Kambic RT et al., 1994, PMID 7942258.
Key Findings
Unplanned pregnancy rates were 6.6 per 100 woman-years among 154 MMM acceptors and 1.5 among 399 ST/OM acceptors, a difference reported as not significant.
Personal discontinuation was 27.3 per 100 woman-years with MMM and 3.2 with ST/OM (p < 0.005); total discontinuation with MMM was 44.0.
The cost per couple year of protection was $55.80 for MMM and $56.10 for ST/OM.
MMM acceptors more often had attended school (75.3% versus 62.9%) or used family planning before (55.2% versus 32.8%), and less often were housewives (35.1% versus 59.5%).
The authors describe the MMM unplanned pregnancy rate as comparable to the 7.3% and 10.0% reported in two other studies and similar to the rates of barrier methods.
Interpretation
The report compares two groups of service clients registered in one area of Monrovia between January 1987 and March 1988, using life tables for twelve-month rates. The MMM was offered at selected sites during the last third of a five-year demonstration program. The authors note that their MMM clients were educated and middle-class. The method was designed for poor and illiterate women, and the authors recommend further study of the method.
RRM Context
The Modified Mucus Method relies on home visits, simple rules and no charting, and it was designed for poor and illiterate women. Fertility awareness-based methods teach women to recognize their own fertile signs. Restorative reproductive medicine uses the same cycle observation to understand reproductive health. The paper adds evidence from Liberia on how women accepted and used these methods and what they cost.
Our editorial summary of this paper, not the article's abstract.
Abstract
This paper describes the evaluation of a new method of natural family planning (NFP) in Liberia. The Modified Mucus Method (MMM) was developed to address the need for a simple method of charting for poor and illiterate women. The acceptance, use, and cost-effectiveness of the MMM were compared with standard NFP methods, the sympto-thermal and ovulation method (ST/OM), used in the same population. The personal discontinuation rate of MMM users was 27.3 per 100 women per year compared with 3.2 among ST/OM users. Unplanned pregnancy rates were low for both MMM and ST/OM, 6.6 and 1.5 respectively. The cost per couple year protection (CYP) for MMM was $55.80 and for ST/OM $56.10. There were differences in characteristics between MMM and ST/OM clients. The MMM clients were more likely to have attended school and to have used a family planning method previously, and were less likely to be housewives. We conclude that the MMM in Liberia was provided to an inappropriate sample of women, educated and middle-class rather than poor and illiterate. The MMM users were dissatisfied and discontinued at the rate of 44 per 100 women entering per year. This is an unfair evaluation of the MMM because of the unsuitable study population. It is our opinion that the MMM needs more study to become part of the inventory of birth spacing methods.
