The new politics of natural family planning

There has been an increase in interest in natural family planning (NFP) in recent years. The Roman Catholic Church and other groups sympathetic to NFP philosophy have pressured the US Agency for International Development (AID) to increase emphasis on NFP, and AID has responded by increasing funding devoted to NFP from US$0.8 to US$7.8 million from 1981-85. In 1985, AID exempted NFP providers from the requirement of providing direct or referral services for other methods, but repealed the exemption in 1986. Several methods fall under the NFP umbrella: rhythm, the estimation of ovulation time by the counting of days elapsed in relation to menstruation; and the more precise cervical musus; basal body temperature; and sympto-thermal methods. Because NFP requires considerable training, recording, and willingness to abstain, recruitment is difficult and dropout rates high. A 5-country World Health Organization study found that 17% of women dropped out during training, and 36% discontinued during the following year. At the 4th International Congress of the International Federation for Family Life Promotion (IFFLP), it was stressed that data on NFP prevalence classed by type of NFP are lacking. Questions raised included whether populations of countries that have achieved or hope to achieve a low birth rate will be interested in NFP; whether NFP can increase the risks of birth defects through fertilization by "aged gametes;" and whether NFP is capable of helping couples to select the sex of the child. The implications of the contraceptive effects of breastfeeding were reviewed. Some problems arise concerning evaluation of effectiveness: NFP advocates often do not consider couples who "break the rules" as acceptors, and when these couples are excluded from data the method appears much more effective. Traditionalists emphasize the increased quality that NFP brings to a marital relationship. Some participants maintained that rigid moral advocacy would deter many couples.     

A new diagnostic aid for natural family planning

Introduction We have studied the use-effectiveness of salivary ferning as a diagnostic testing aid to natural family planning. We used PG/53, a pocket microscope.Materials and methods Use of natural family planning methods was studied in 32 women who used the new technology PG/53 to detect the fertile period. By this means the women observed their menstrual cycles and other markers of fertility, such as basal body temperature and appearance of cervical mucus.Results Of the 32 women participating in this research, 28 women had a good salivary test with positive ferning by the microscope in the same period as other markers of fertility. In 4 cycles the ferning was uninterpretable as there was no correspondence with the cycle phase. Ferning began 1–2 days before cervical mucus appearance, and lasted a mean of 6.2 days. Ferning occurred, on average, 7.2 days before the first day of temperature shift.Conclusions There is a direct correlation between salivary ferning and fertile period. Salivary ferning may be used as a new parameter to aid women to detect the fertile period in combination with other symptothermal methods of ovulation detection. We now need further research in order to improve the use-effectiveness of salivary ferning.

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Resumen Estudiamos la eficacia del uso de la formación de helecho salival como ayuda de prueba diagnóstica para la planificación familiar natural. Utilizamos PG/53, un microscopio de bolsillo.El uso de métodos de planificación familiar natural se estudió en 32 mujeres que utilizaron la nueva tecnología PG/53 para detectar su período de fecundidad. Con este método las mujeres observaron sus ciclos menstruales y otros indicadores de fecundidad, tales como la temperatura corporal basal y la aparición de moco cervical.De las 32 mujeres que participaron en este estudio, 28 tuvieron una buena prueba salival con formación positiva de helecho al microscopio en el mismo período que otros indicadores de fecundidad. En 4 ciclos la formación de helecho no fue interpretable ya que no hubo correspondencia con la fase del ciclo. La formación de helecho comenzó 1–2 días antes de la aparición de moco cervical y duró en promedio 6,2 días. La formación de helecho ocurrió, en promedio, 7,2 días antes del primer día de cambio de temperatura.Hay una correlación directa entre la formación de helecho salival y el período de fecundidad. La formación de helecho salival puede utilizarse como un nuevo parámetro para ayudar a las mujeres a detectar el período de fecundidad en combinación con otros métodos sintotérmicos de detección de la ovulación. Actualmente se necesitan más investigaciones a fin de mejorar la eficacia del uso de la formación de helecho salival.

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ResuméIntroduction Nous avons étudié l'efficacité du contrôle par le test de la cristallisation de la salive en forme de fougère comme diagnostic aidant au planning familial naturel. Nous avons utilisé un microscope de poche (PG/53).Matières et méthodes L'application de méthodes de planning familial naturel a été étudiée chez 32 femmes qui utilisent la nouvelle technique PG/53 pour déceler la période de fécondité. Les femmes ont observé leurs cycles menstruels et d'autres marqueurs de fécondité, tels que la température basale et l'aspect du mucus cervical.Résultats Chez 28 des 32 femmes ayant participé à cette étude, le test de la salive est apparu concluant au microscope, avec cristallisation positive en feuille de fougère à la même période que les autres marqueurs de fécondité. Pour 4 cycles, la cristallisation n'a pas pu être interprétée car il n'y avait aucune correspondance avec la période du cycle. La salive commençait à se cristalliser 1 à 2 jours avant l'apparition du mucus cervical pendant en moyenne 6,2 jours. Cette cristallisation se produisait en moyenne 7,2 jours avant le premier jour de l'élévation de la température corporelle.Conclusions Il existe une corrélation directe entre la cristallisation salivaire en forme de fougère et la période de fécondité. En combinaison avec d'autres méthodes thermo-symptomatiques de détection de l'ovulation, ce test peut servir de nouveau paramètre pour aider les femmes à déceler la période de fécondité. Il faut dès lors poursuivre les recherches en vue d'améliorer l'efficacité du contrôle de la cristallisation salivaire.

     

Efficacy of a new method of family planning: the Standard Days Method

The Standard Days Method is a fertility awareness-based method of family planning in which users avoid unprotected intercourse during cycle Days 8 through 19. A prospective multi-center efficacy trial was conducted to test, in a heterogeneous population, the contraceptive efficacy of the Standard Days Method. A total of 478 women, age 18-39 years, in Bolivia, Peru, and the Philippines, with self-reported cycles of 26-32 days, desiring to delay pregnancy at least one year were admitted to the study. A single decrement multi-censoring life table analysis of the data indicate a cumulative probability of pregnancy of 4.75% over 13 cycles of correct use of the method, and a 11.96% probability of pregnancy under typical use. This article describes the study and the results. Results suggest that despite its requirement that couples modify their sexual behavior when the woman is fertile, the Standard Days Method provides significant protection from unplanned pregnancy and is acceptable to couples in a wide range of settings.     

Evaluating client autonomy in natural family planning

A critical element for evaluation fo natural family planning (NFP) methods is client autonomy. Autonomy in NFP refers to clients who can identify their fertile days and apply this method without teacher assistance. The results of this study show that clients who are autonomous have a 12-month continuation rate of 96.7% and a pregnancy rate of 1.7% after beginning charting. The non-autonomous clients had a 12-month continuation rate of 34.3% and a pregnancy rate of 24.8% after beginning charting, significantly different from the autonomous clients. Using a bivariate analysis, we found that women 30 years and older who had two children or more, and women in the same age group (30 years and older) who wanted to limit rather than space pregnancy were significantly more likely to become autonomous. These findings have implications for NFP programs and future evaluation efforts.

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Resumen Un elemento crítico para la evaluación en los programas de los métodos naturales de planificación familiar (NFP), es la autonomía del cliente. Esto se refiere a clientes que pueden identificar sus dias fértiles y aplicar el método sin ayuda de un instructor. El resultado de este estudio muestra que clientes autónomas tienen una tasa de continuidad a 12 meses de 96,7% y una tasa de embarazo de 1,7% luego de comenzar el registro. Las clientes no autónomas tuvieron una tasa de continuidad a 12 meses de 34,3% y una tasa de embarazo de 24,8%, luego de comenzar el registro, significativamente diferente a la de clientes autónomas. Usando un análisis a dos variables, encontramos que las mujeres de 30 o más años, con dos o mas hijos y las mujeres en el mismo grupo de edad que deseaban limitar más que espaciar los embarazos, era significativamente mas posible que se convirtieran en autónomas. Estos hallazgos tienen implicaciones para los programas de planificación familiar natural (NFP) y para futuras evaluaciones.

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Resumé Un élément critique pour l'évaluation des méthodes de planning familial naturel est l'autonomic des intéressées. En termes de planning familial naturel, l'autonomic concerne les femmes qui savent identifier leurs jours de fécondité et appliquer la méthode sans l'assistance d'un personnel compétent. Les résultats de létude présentée montre que les clientes qui sont autonomes ont un taux de poursuite à 12 mois s'élevant à 96,7% et un taux de grossesse de 1,7% après avoir commencé à enregistrer leurs dates. Les femmes non autonomes ont fait preuve d'un taux de poursuite à 12 mois de 34,3% et un taux grossesse de 24,8% après le début de l'enregistrement, ce qui représente une différence significative par rapport au groupe autonome. En procédant à une analyse doublement orientée, nous avons constaté que les femmes âgées de 30 ans ou plus ayant eu deux enfants au moins et les femmes de la même tranche d'âge (30 ans ou plus) qui souhaltalent limiter plutôt qu'espacer les grossesses étalent, de facon significative, plus susceptibles de devenir autonomes. Ces constatations entraînent des retombées pour les programmes de planning familial naturel et pour les efforts d'évaluation qui seront faits ultérieurement.

     

Pregnancy complications in natural family planning users

A multicenter cohort study was designed to assess pregnancy outcome among natural family planning (NFP) users, and provide the opportunity to address complications in NFP users by planning status and by timing of conception with respect to day of ovulation. There were 877 singleton births in this sample. Complications evaluated were abnormal vaginal bleeding, urinary tract infection, vaginal infection, hypertension of pregnancy, proteinuria, glycosuria, and anemia.There was no significant difference in the mean age, number of prenatal visits or birth weight among optimally and non-optimally timed pregnancies or for planned and unplanned pregnancies. There were higher incidences of "parity 2 or more" and current smokers in the non-optimally timed pregnancies and lower incidences of prior pregnancy loss and "currently employed" in the non-optimally timed pregnancies. There was little difference in pregnancy complications with respect to pregnancy timing, with the exception of a significant increased risk of vaginal bleeding late in pregnancy among non-optimally timed conceptions (11.5%) compared to optimally timed pregnancies (5.2%, RR = 2.2, 95% CI 1.3-3.7).More differences were observed in pregnancy complication rates by planning status. Unplanned pregnancies were associated with significantly more late pregnancy bleeding, vaginal infections, proteinuria, glycosuria and medication use than planned pregnancies. Unplanned pregnancies had lower incidences of maternal anemia.Complications of pregnancy were low in this NFP population, irrespective of planned versus unplanned status. Women with planned pregnancies had even fewer complications during pregnancy than women with unplanned conceptions, suggesting that women using NFP to plan their reproduction may be at particularly low risk.     

Who uses natural family planning?

This study examined the characteristics and attitudes of 132 married couples who had received training in use of the symptothermal method of natural family planning (NFP). 61% of respondents were 20-30 years of age and over 2/3 had completed college; 59% were Catholic. The largest group of subjects (35%) became aware of NFP through friends, neighbors, and relatives. 71% said they were drawn to NFP because it represented a safe and healthy alternative to other methods of birth control; only 17% gave moral or religious reasons for learning about NFP. 42% of the sample were using NFP at the time of the survey, 32% had discontinued use, and 25% were using fertility awareness in conjunction with barrier methods (combination-continuers). There was a significant difference between these 3 groups in church attendance: 48% of combination-continuers and 67% of continuers compared with 41% of discontinuers attended church once a week or more. The combination-continuer group had more Catholics (50%) than the discontinuer group (37%) but less than the continuers (76%). No significant differences were found between the 3 groups in terms of age, education, or regularity of menstrual cycle length. Over 3/4 of continuers had been married for less than 5 years compared with about 1/2 of those in the 2 other groups. 69% of continuers believed that NFP is extremely effective compared to 13% of discontinuers and 40% of combination-continuers. Spouses encouraged each other in the use of NFP in 88% of combination-continuer couples and 86% of continuer couples, but only about half of discontinuers received such encouragement. Although most NFP advocates emphasize a nonsexual form of abstinence during the fertile period, the vast majority of respondents in this study defined abstinence to include the possibility of orgasm. Combination-continuers, positioned between continuers and discontinuers or both dissatisfaction with other methods and with abstinence, warrant more attention in future NFP research.     

Billings natural family planning in Shanghai,China

With cervical mucus, or Billings, method of family planning, a woman learns to recognize the characteristics of her cervical mucus that identify the fertile phase in her menstrual cycle. She and her partner abstain from sexual activity during a period from the first indication of mucus until four days after the mucus peak day, which includes ovulation. They also abstain during menses, because mucus can be confused with menstrual bleeding. This method of family planning is used widely, worldwide, by couples seeking a natural, reliable method of family planning.Between July 1988 and May 1990, 688 couples of child-bearing age, most of whom were parous, used the Billings method for contraception. Five hundred and fifty of these couples used the method for more than 12 months. Efficacy, continuation rates, and discontinuation rates were analyzed using life-table analysis for 10 175 woman-months of data collected. The net cumulative discontinuation rates per 100 women at 12 and 18 months were 19.85 and 34.58, respectively, resulting in continuation rates of 80.15 and 65.42. The discontinuation rates per 100 women for method-related reasons at 12 and 18 months were 1.61 and 2.84, respectively, while the discontinuation rates for unintended pregnancy were 1.02 and 1.18. During the study, 67 subjects volunteered to have vaginal smears taken from the upper part of the vaginal wall for cytologic examinations, and among them serum and urine LH levels were measured in 10 subjects and urinary estrogen and progesterone were assayed in 35 cases. These tests related other indications of the menstrual cycle to the ability of the women to judge ovulation by cervical mucus. Our research suggests that further investigation of the Billings method is warranted and that careful planning and organization are needed to disseminate the method more broadly.

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Resumen Con el método de planificación familiar del moco cervical, o de Billings, la mujer aprende a reconocer las características del moco cervical que identifican la fase fecunda de su ciclo menstrual. Ella y su compañero se abstienen de tener actividad sexual durante cierto período desde la primera indicación de moco hasta cuatro días después del día de moco máximo, que incluye la ovulación. También se abstienen durante la menstruación porque el moco puede ser confundido con el sangrado menstrual. Este método de planificación familiar es ampliamente utilizado en el mundo entero por parejas que desean recurrir a un método de planificación familiar natural y seguro.Entre julio de 1988 y mayo de 1990, 688 parejas en edad de procrear, que en su mayoría habían tenido hijos, utilizaron el método anticonceptivo de Billings. Quinientas cincuenta de estas parejas utilizaron el método durante más de 12 meses. La eficacia, las tasas de continuación y las tasas de abandono se analizaron mediante el análisis de tablas de vida de 10.175 meses-mujer de datos recopilados. Las tasas acumulativas netas de abandono por cada 100 mujeres a los 12 y 18 meses fueron del 19,85 y 34,58, respectivamente, dando tasas de continuación del 80,15 y 65,42. Las tasas de abandono por cada 100 mujeres por motivos relacionados con el método a los 12 y 18 meses fueron del 1,61 y 2,84, respectivamente, y las tasas de abandono por embarazo no intencional fueron del 1,02 y 1,18. Durante el estudio, 67 mujeres se ofrecieron a que se les tomaran muestras vaginales de la parte superior de la pared vaginal para análisis citológicos, y en estas muestras se midieron los niveles de LH en orina y suero en 10 mujeres, y el estrógeno y la progesterona en orina se analizaron en 35 casos. Estos análisis relacionaron otras indicaciones del ciclo menstrual con la capacidad de las mujeres de juzgar la ovulación por el moco cervical. Nuestra investigación sugiere que es necesario realizar más estudios del método de Billings y que se requiere una planificación y organización cuidadosas para una mayor difusión del método.

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Resumé Par la méthode de planning familial de l'observation du mucus cervical (méthode de Billings), une femme apprend à reconnaître les caractéristiques du mucus qui signalent la phase de fécondité de son cycle menstruel. Elle s'abstient alors d'avoir des rapports sexuels avec son partenaire durant une période allant de la première indication du mucus jusqu'au quatrième jour après les pertes les plus abondantes, lorsque l'ovulation se produit. Ils s'abstiennent également durant les règles, car le mucus peut être confondu avec l'écoulement menstruel. Cette méthode de planning familial est largement utilisée dans le monde entier par des couples qui cherchent une méthode naturelle et fiable.Entre juillet 1988 et mai 1990, 688 couples en âge de procréer, ayant pour la plupart des enfants, ont utilisé cette méthode de contraception. Parmi eux, 550 l'ont appliquée pendant plus de 12 mois. Les taux d'efficacité, de poursuite et d'abandon ont été analysés en fonction des tables de survie sur la base de données recueillies correspondant à 10.175 mois-femme. Les taux nets cumulés d'abandon pour 100 femmes à 12 et 18 mois se sont élevés respectivement à 19,85 et 34,58, soit par conséquent des taux de poursuite de 80,15 et 65,42. Les taux d'abandon pour des raisons liées à la méthode ont été respectivement, à 12 et 18 mois pour 100 femmes, de 1,61 et 2,84, tandis que les taux d'abandon pour cause de grossesse inattendue ont atteint, 1,02 et 1,18. Durante l'étude, 67 voluntaires ont accepté de se soumettre à des frottis de la partie supérieure de la paroi vaginale pour examens cytologiques. Chez 10 d'entre elles on a mesuré les niveaux de LH sériques et urinaires; chez 35 autres on a dosé l'oestrogène et la progestérone urinaires. Ces tests ont permis de définir d'autres caractéristiques du cycle menstruel grâce auxquelles les femmes peuvent déterminer le moment de l'ovulation d'après le mucus cervical. Notre enquête laisse penser que la méthode de Billings mérite une étude plus approfondie et qu'il est nécessaire de planifier et d'organiser soigneusement la manière de répandre davantage cette méthode.

     

Lactational amenorrhea as a method of family planning in Egypt

Because of the potential importance of the lactational amenorrhea method (LAM) as a family-planning option in Egypt, we analyzed data from the 1995 Egyptian Demographic and Health Survey (EDHS) to study breastfeeding practices, use of contraception, reproductive history and sociodemographic factors for 5504 mothers with children under 3 years. According to the EDHS data, about 80% of Egyptian women breastfed for at least 6 months, and 40% breastfed for 15-18 months. Over half of breastfeeding mothers used no additional contraception. Thirty-six percent of mothers breastfeeding children younger than 6 months who reported using no additional contraception were exclusively breastfeeding and amenorrheic, but only 4% reported relying on breastfeeding for family planning. We also held eight focus group discussions with breastfeeding mothers from urban and rural Upper and Lower Egypt on their use of contraceptive methods, breastfeeding, lactational amenorrhea and LAM. Participants showed strong recognition of the contraceptive effects of breastfeeding but differed widely in their understanding of lactational infecundability and knowledge of LAM as a method. These results suggest that LAM would be widely acceptable to Egyptian women, but that an educational program about the method is needed.     

A Catholic hospital and natural family planning

Instituting a natural family planning program in a hospital setting is a challenge that the Catholic medical community is bound to accept. Natural planning methods, taught by appropriate and well-trained instructors, can help clients become more conscious of their fertility and more able to accept responsibility for their life decisions.     

The ovulation method of family planning

The ovulation method of family planning relies on self-recognition of physiological changes occuring around time of ovulation rather than a calendar to enable a couple to avoid sexual intercourse during the fertile period. The most practical signs are elevated basal body temperature, changes in the amount and physicochemical properties of cervical mucus, and ovulation pain. The basal body temperature rises about .3 degrees C following ovulation. The problem with this method is that it is retrospective. The mucus symptoms, as described by Billings and associates in Melbourne, Australia, are: 1) a variable number of days with no vaginal discharge following menstrual bleeding; 2) onset of mucus symptoms characterized by increasing quantities of 'cloudy' or 'sticky' secretion; 3) a clear, slippery lubricative mucus having the characteristics of raw white of egg (spinnbarkeit), which is an immediate forwarning of ovulation; 4) a variable period of thick, opaque, diminished volume discharge followed by dry days. The clear 'peak symptom' mucus lasts 1-2 days; in a study of 22 women followed for 27 cycles this symptom occurred .9 days +3 or -2 days before ovulation. The problem is that 2 of the 22 cycles reported in detail had ovulation 3 days after the peak symptom and 1 had ovulation 4 days after. Intercourse on the 4th day, therefore, would have had a significant risk of pregnancy. Weissman and associates collected data on 282 women on the Pacific island of Tonga who used the mucus symptoms alone to control conception. In the 2503 cycles there were 53 unplanned pregnancies, 25.4 per 100 woman-years using the Pearl formula. 50 resulted from the couples 'taking a chance,' 2 misunderstood the method, 28 abandoned the method because they wanted more children, and 1 woman became pregnant even though she thought she understood the method. Field trials with groups who are more motivated than those in the Tongan trial are needed.     

A thirty-month clinical experience in natural family planning.

A Natural Family Planning service was evaluated at the end of a 30-month developmental phase. There were 444 women taught and 322 method acceptor of which 248 intended to avoid pregnancy. NFP clients were older (mean age 26.9 vs 22.4 and 23.7 for comparison groups), and a larger percentage were married (83.1 per cent vs 23.0 per cent for the comparison group). After one year of use, the unplanned pregnancy rate was 14.4 per cent and the total dropout rate was 37.6 per cent by life table analysis.     

The demand for family planning: a new approach

A new "supply-demand" measure of family planning demand is compared with others commonly used to target prospective family planning clients. In analyses of data from six cross-sectional surveys the new measure consistently explains past contraceptive use better than the others. Time series analysis for two countries yields similar results. Family planning program officials may wish to consider exploring the use of this measure to target prospective clients.     

Assessment of a new approach to family planning services in rural Pakistan

OBJECTIVES: In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas. METHODS: A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account. RESULTS: Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio = 1.74; 95% confidence interval = 1.11, 2.71). CONCLUSIONS: After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded.     

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.

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Resumen En España, el uso de la planificación familiar natural (PFN) es limitado. En Barcelona, el CODIPLAN ofrece desde hace algunos años métodos naturales a las usuarias potenciales. En Granada y Jaén, la información que proporcionan los servicios sanitarios relativa al período de fecundidad cobra creciente importancia. En 1989, un seminario presentó la PFN en Granada y, desde entonces, el programa se aplica activamente. Se celebraron dos cursos para profesores y para personal sanitario, y participamos en la capacitación práctica de proveedores de atención médica alternative a través de dos programas organizados por la Universidad de Granada. También dimos charlas en programas locales de radio y televisión, presentamos sesiones de actualización en centros de atención diurna y dimos clases de educación sanitaria en escuelas primarias y secundarias. Un seminario internacional de PFN celebrado en marzo de 1992 fue organizado conjuntamente por la universidad y la municipalidad. Las actas serán publicadas por la Universidad de Granada. En 1990, bajo los auspicios científicos del Departamento de Planificación Familiar Natural del Centro Médico Zaidin, iniciamos un programa de capacitación y seguimiento de usuarias de este método mediante un seminario permanente sobre la PFN. En Granada y Jaén, los métodos de PFN se hallan ahora disponibles para la población en general y el personal sanitario.

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Resumé En Espagne, le recours au planning familial naturel (PFN) est limité. A Barcelone, le CODIPLAN offre depuis quelques années aux utilisatrices potentielles des méthodes naturelles. A Grenade et Jaén, l'information fournie par des services sanitaires, relative à la connaissance de la période de fécondité, prend maintenant de l'importance. En 1989, le PFN a été présenté lor d'un séminaire à Grenade et, depuis, le programme se poursuit très activement. Deux cours ont été dispensés aux enseignants et au personnel sanitaire, et nous avons pris part à un stage de formation pratique conçu pour les pourvoyeurs de soins médicaux alternatifs, dans le cadre de deux programmes organisés par l'Université de Grenade. Nous avons aussi fait des exposés pour des programmes radiotélévisés, prenté des séances de mise à jour dans des centres de soins et donné des cours d'éducation sanitaire dans des écoles primaires et secondaires. Un Séminaire international de planning familial tenu en mars 1992 a été organisé conjointement par l'université et la municipalité. Le compte rendu des débats sera publié par l'Université de Grenade. En 1990, sous l'égide scientifique du Département de planning familial naturel du Centre médical Zaidin, nous avons entrepris, dans le cadre d'un séminaire permanent sur le PFN, un programme de formation et de suivi pour les femmes qui ont recours à cette méthode. A Grenade et Jaén, les méthodes de PFN sont maintenant mises à la disposition de la population générale et du personnel sanitaire.

     

Africa: the new family planning frontier

Sub-Saharan Africa will be the family planning frontier of the twenty-first century. Fertility levels and population growth rates are still high, and family planning programs suited to the region are still being developed. Nevertheless, by the end of the twentieth century, fertility transition was under way in Southern Africa and a few countries elsewhere. Successful regional family planning in the twenty-first century will depend upon stronger political leadership, the development of family planning programs that meet the needs of all segments of society and not only currently married women, assistance to the market, and a recognition of the central importance of hormonal methods, especially injectables. Problems include stagnation in economic growth and in child mortality decline, as well as the persistence of the AIDS epidemic.     

Roman Catholic Church-sponsored natural family planning services in the United States

Objectives Our objective was to determine the level and quality of antural family planning service provided by Roman Catholic Diocese-related programs in the United States.Study disign Programs volunteerd quarterly data for five years, using least squares regression we estimated service levels for programs never reporting.Results From 1988 to 1992, 78 dioceses ever reported and 96 never reported. The majority of clients were avoiding pregnancy and receiving follow-up. An average of 18 061 women were taught by these programs each year in the reporting period.Conclusion Without greater commitment of resources, it is likely that NFP will continue to be a marginal method of family planning in the United States.

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ResuméObjectifs Notre objectif était de déterminer le niveau et la qualité du service de planning familial naturel, fourni aux Etats-Unis par les programmes liés aux Diocèses catholiques.Conception de létude Les programmes devaient fournir volontairement pendant cinq ans des données trimestrielles, sur la base de coefficients de régression des moindress carrés; quant aux services liés aux programmes n'ayant pas communiqué de statistiques, nous en avons estmé le niveauRésultats De 1988 à 1992, 78 diocèses ont communiqué des statistiques et 96 n'en ont jamais communiqués. La majorité des intéressées évitaient des grossesses et elles étaient suivies. En moyenne, ces programmes avaient fourni chaque année des conseils à 18.061 femmes durant la période de l'étude.Conclusion Sans devoir faire appel à des ressources considérables, le planning faminlial naturel restera probablement une méthode de planning familial marginal aux Etats-Unis.

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ResumenObjetivos Nuestro objetivo consistió en determinar el nivel y la calidad del serivicio de planficacación familiar natural proporcionado por programas relacionados con diócesis católicas en Estados Unidos.Diseño del estudio Los programas proporcionaron datos voluntariamente durante cinco años y, utilizando la regresión de los mínimos cuadrados, estimamos los niveles del servicio correspondientes a los programas que no proporcionaron datos.Rsultados De 1988 a 1992, 78 diócesis proporcionaron infomatición y 96 nunca lo hicieron. La mayoría de las pacientes evitaban el embarzo y recibieron seguimiento. Mediante estos programas, se enseño en promedio a 18.061 mujeres cada año en el período de información.Conclusión Sin destinar mayores recursos, es probable que el servicio de planificación familiar natural contnúe siendo un método marginal de planificación familiar en Estados Unidos.

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