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  • Title: Natural family planning: looking ahead.
    Author: Queenan JT, Moghissi KS.
    Journal: Am J Obstet Gynecol; 1991 Dec; 165(6 Pt 2):1979-80. PubMed ID: 1755451.
    Abstract:
    Natural family planning is used by a relatively small number of people worldwide. The Institute's goal is to increase the knowledge, availability, effectiveness, and acceptability of natural family planning. To do so, the Institute is conducting biomedical research in several areas including: (1) the development of a home test kit for ovulation prediction, (2) sperm-mucus interaction, (3) the mechanisms and fertility impact of lactational amenorrhea, and (4) outcome of pregnancies in natural family planning users. The major scientific issues in natural family planning (NFP) are identified in this article. The use effectiveness of NFP has been estimated differently. The Institute for International Studies in NFP has given the figure of 5-40 pregnancies/100 women years for use effectiveness. This is the equivalent of the pregnancy rate for diaphragm use (14%) and condoms (10%). A multicenter WHO study has demonstrated that for couples using the method correctly, it was 97% effective for all sites combined. After a suitable training period of 3 cycles, 94% of women could identify the fertile phase. NFP use among family planning users is 41% in Peru, 23% in the Philippines, and 22% in Haiti, but among all women the NFP rate is less than 5%. 4 mandates of the Institute are provided which specifically relate to the mission to increase the knowledge, availability, effectiveness, and acceptability of NFP for child spacing internationally. The 1st deals with the need to develop a simple home test for predicting ovulation in order to prevent pregnancy. Attention would be focused on unusual situations such as the perimenopause period, irregular cycles, or vaginal infections. The test kit is viewed also as a learning tool for educating about how the body responds to the fertility cycle. The implication for adolescents is that it could provide a positive way to develop fertility awareness and self confidence about sexuality. The 2nd mandate was to identify the parameters of sperm entry and survival. The presence and quality of mucus was investigated as well as molecular level analysis of factors influencing fertilization. The 3rd mandate was to explore the factors regulating the gonadotrophins in lactation and the factors that differentiate fertile from infertile periods in lactation. The safety of lactational amenorrhea method (LAM) is being investigated, particularly promoting exclusive breastfeeding for mothers with nutritional deficiencies. The 4th mandate is to explore the safety of NFP in terms of pregnancy outcome. It is suggested that aging gametes whether pre or post ovulation may contribute to suboptimal pregnancies. Recommendations need to be made based on clear evidence of reproductive risk.
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