Natural family planning

From Academic Kids

Natural family planning (NFP), sometimes described as periodic abstinence, is a form of birth control that involves recognizing the natural signs in a woman's fertility. Depending on their goals, couples may choose to time sexual intercourse so that it falls during the infertile phase (to avoid pregnancy) or the fertile phase (to achieve it).

Contents

1 Description

2 Birth Control Effectiveness in General

3 Effectiveness of Natural Family Planning

4 References

5 Measurement

5.1 Observational Methods

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Description

There are several methods for practicing NFP. Reliable forms of NFP, such as the basal body temperature method, the cervical mucus method, and the symptothermal method, have been developed over recent decades. In addition, mothers of newborns can delay the return of their menstrual cycle (and thus, their fertility) by using the lactational amenorrhea method (LAM).

NFP is unique in that it is the only family planning method that:

is free (apart from the purchase of a thermometer and charts)
is natural (introducing no chemicals into the body nor artificial devices to modify the sex act)
is in accord with moral beliefs of Catholics and some others
can also be used to conceive a child (the same knowledge of fertility patterns is used to time intercourse optimally to achieve pregnancy without using invasive or un-natural medical procedures.

Like the Pill and other non-barrier contraceptives, NFP offers no protection against sexually transmitted diseases. NFP methods do require regular, consistent effort to determine when a couple's chance of fertility is low. For many women, the times of high fertility coincide with the time of highest libido. The "scheduling" of sex required can be inconvenient for partners who do not live together and are unwilling to abstain or use non-procreative forms of sex when they are able to spend time together. For these reasons, other methods are more popular than NFP among large sections of society.

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Birth Control Effectiveness in General

The effectiveness of NFP, as of artificial forms of contraception, can be assessed two ways: method effectiveness and user effectiveness. The method effectiveness is the proportion of women correctly using the method who do not get pregnant. User effectiveness is the proportion of women using the method who do not get pregnant. For all forms of contraception, user effectiveness is lower than method effectiveness, due to several factors:

mistakes on the part of those providing instructions on how to use the method
mistakes on the part of the method's users
conscious user non-compliance with method.

For instance, someone using oral forms of hormonal birth control might be given incorrect information by a health care provider as to the frequency of intake, or by mistake not take the pill one day, or simply not bother to go to the pharmacy on time to renew the prescription.

However, when used correctly, accurately, and in the way it is meant to be used, studies have shown NFP to be 99% effective, the same as oral contraceptives

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Effectiveness of Natural Family Planning

The most effective forms of NFP have approximately 99% or higher method effectiveness according to recent studies (e.g., Hilgers, et al., 1998; Ecochard, et al., 1998). User effectiveness is significantly lower.

For instance, in one study, a Creighton method achieved 99.5% method effectiveness but only 96.8% user effectiveness (Hilgers, et al., 1998). In another study, a Creighton method had 17% of users getting pregnant, with a vast majority of these getting pregnant due to lack of correct use, so that only 0.14% of the actual users experienced a perfect-use pregnancy (Howard and Stanford, 1999).

Research conducted by Ecochard, et al. (1998) found that:

NFP users can achieve a 98.9% effectiveness rate under ideal conditions.
Typical NFP users will achieve 93.5% effectiveness rate.

By comparison, the Alan Guttmacher Institute reports a user effectiveness rate of only 92.0% for "the pill" oral contraceptives).¹

The most common reason for the lower user effectiveness is not mistakes on the part of instructors or users, but conscious user non-compliance (Howard and Stanford, 1999; anonymous, 1999), i.e., the couple knowing that the woman is likely to be fertile at the time, but engaging in sexual intercourse nonetheless. An NFP advocate might argue that some of these cases simply constitute a couple's deciding that they are, after all, willing to accept a child as a consequence of intercourse, and hence these cases might not count as failures of NFP, but simply as a decision not to use NFP.

Studies have indicated little or no difference in frequency of intercourse among couples using natural family planning (with such couples thus more sexually active during the infertile phases of the cycle).

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References

¹Source: Alan Guttmacher Institute, Facts in Brief, First Year Contraceptive Failure Rates (http://www.agi-usa.org/pubs/fb_contr_use.html). Retrieved May 10, 2005.

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Measurement

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An average length menstrual cycle lasts between 24 and 35 days. It starts with a menstrual bleeding. Ovulation takes place 11 to 16 days prior to the end of a fertile cycle. Ova die if not fertilized within 24 hours of ovulation. Spermatozoa are able to fertilize an ovum for a period of up to five days after they have been ejaculated in the presence of fertile cervical mucus, but die within a few hours if there is no cervical mucus.

The period from the start of menstruation to ovulation lasts a variable amount of time. Menstruation typically lasts less than seven days. In an average length cycle, there will likely be a few days of infertility after menstruation while the ovaries are inactive and the cervix is closed. At some point in the cycle, the ovaries will become active and start producing estrogen. The cervix responds to the elevated estrogen levels by producing a mucus which is capable of causing sperm survival. At this point the woman is potentially fertile. After ovulation the egg can survive for up to 24 hours. After the egg is dead, the woman is infertile for the rest of the cycle. Menstruation follows 11 to 16 days after ovulation in a fertile cycle.

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Observational Methods

NFP methods which not only keep track of the woman's menstrual cycle, but also make observations about the state of a woman's body, offer additional information for couples to use when considering having intercourse.

The basal body temperature method is based on the fact that two or three days after ovulation, hormonal changes cause a rise in body temperature between 0.3 and 0.9C (0.5 and 1.6�F) that lasts at least until the next menstruation.

The cervical mucus method (or Billings method, or Ovulation method, or Billings ovulation method) involves observing the sensation at the vulva and looking at any discharge that may be present. When a woman is not fertile, the pattern of sensation and discharge is unchanging. Fertility is recognized as a changing pattern of discharge and sensation. During the days leading up to ovulation, (the fertile time period), the increase in estrogen levels causes the cervix to produce a mucus that helps sperm survive. Very close to ovulation, the woman may notice a discharge that looks clear and feels slippery at the vulva.

The sympto-thermal method combines the techniques discussed above. Some women may also check the position and feel of their cervix, and note breast tenderness or ovulatory pain (mittelschmerz), the lower abdominal pain or cramping some women feel around the time of ovulation. According its proponents, the symptothermal method can achieve a 99% effectiveness level for a well-instructed and well-motivated couple.

The saliva method involves examining saliva under a microscope for fern-like structures that indicate ovulation.

The lactational amenorrhea method (LAM) of contraception makes use of the natural infertility which occurs through breastfeeding. It is 99% effective during the first six months postpartum in about 90% of women who:

Breastfeed their infants exclusively
Pacify their infants at the breast, not with pacifiers or bottles
Breastfeed often
Sleep with their infants
Are not separated from their infants for more than three hours a day
Take daily naps with their infants

Obviously, this method is only practical for women whose lifestyles allow for it (though this can be said of all methods of birth control.)

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Religion

Total abstinence and NFP (including observational methods and rhythm) are the sole methods of birth control permitted by the Catholic Church.

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Citations

Anonymous (1999) "European multicenter study of natural family planning (1989-1995): efficacy and drop-out", Advances in Contraception 15(1):69-83
Ecochard, R.; Pinguet, F.; Ecochard, I.; De Gouvello, R.; Guy, M.; and Huy, F. (1998) "Analysis of natural family planning failures. In 7007 cycles of use", Fertilite Contraception Sexualite 26(4):291-6
Hilgers T.W. and Stanford J.B. (1998) "Creighton Model NaProEducation Technology for avoiding pregnancy. Use effectiveness", Journal of Reproductive Medicine 43(6):495-502
Howard, M.P. and Stanford, J.B. (1999) "Pregnancy probabilities during use of the Creighton Model Fertility Care System", Archives of Family Medicine 8(5):391-402

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