NFPS-821 Fertility File 17

NATURAL METHODS OF FERTILITY CONTROL

A PROSPECTIVE STUDY BY CAMEN. MILAN, ITALY

M. Barbato & G. Bertoletti

INTRODUCTION

In the last few years in Italy, the number of couples using natural methods to plan their families has increased for religious, cultural and medical reasons.

A recent study confirmed that 16% of fertile couples used "periodic abstinence" but that only a small percentage of these received any instruction or were using the most efficient methods of natural family planning - i.e.

the ovulation method (Billings),
the temperature and calculation method
the sympto-thermal method.

The majority used some version of the Rhythm method (Ogino and Knauss).

The biggest problem concerning the use of natural methods is the low continuation rate.

Camen has carried out research in different Italian cities with the aims of verifying:

the true efficiency of each method and
the percentage of women who continue to use natural methods to control their fertility.

There is still opposition from many members of the medical profession and in our experience, only well-educated couples are strong enough to choose a natural method for moral or cultural reasons in face of this.

DESCRIPTION OF STUDY

Participants in the Study had to fulfil the following conditions:-

Attend a course of instruction and agree to abstain from sexual intercourse during the fertile phase
Be of proven fertility.
Agree to keep a daily chart and fill in the questionnaires presented to them.

Particular attention was paid to the motivation of the couples joining the study.

AUTONOMY

Experience showed that the couples required supervision for six months before reaching autonomy in the use of natural methods.

PREGNANCY

Following conception each couple was asked to state whether the pregnancy was planned or unplanned in the case of an unplanned pregnancy it was necessary to determine the cause :-

A misunderstanding of the rules
A deliberate breaking of the rules
A method failure

RESULTS

I. ANALYSIS OF PARTICIPANTS

Age of the Women
Age	%
younger than 20	9.7
21-40	79.6
older than 40	10.6
Table 1

Number of Children per Couple
Number of Children	%
0	62.6
1	23.3
2 or more	14.1
Table 2

II. STUDY DATA

Number of Couples	460
Number of Cycles	8096
Average Number of Cycles per couple	17.6
Table 3

Method	No. of Couples	%
Temperature & Calculation	167	36.5
Sympto-thermal	293	63.6
Table 4

III. PREGNANCIES

Planned Pregnancies	130
Unplanned Pregnancies	25
Total	155
Table 5

Cause of Unplanned Pregnancies	No. of Couples	Pearl Index
Method Failure	3	0.44
Misunderstanding the Rules	10	1.47
Resulting from Sexual Intercourse in the Fertile Phase	12	1.76
Table 6

Cause of Unplanned Pregnancies According to Phase of Cycle	No. of Couples	Pearl Index
Pre-ovulatory Infertile Phase according to Ogino Calculation (Shortest cycle - 19, gives the last infertile day.)	0	0
On a Dry Day in the pre-ovulatory Infertile Phase	10	1.47
During the Fertile Phase	13	1.92
Before the Third High Temperature was Recorded	2	0.29
After Recording the Third High Temperature	0	0
TOTAL	25	3.68
Table 7

Unplanned Pregnancies	Number of Couples	Pearl Index
Limiters	0	0
Spacers	25	3.68
Table 8

IV. CONTINUATION RATES

After Two Years
Couples Continuing	376	81.94
Couples who Abandoned the Method	10	2.18
Couples Lost to Follow up	74	16.08
Total	460	100
Table 9

Analysis of 25 Couples who had Unplanned Pregnancies
Category	No.	%
Couples Continuing to use the Method	20	80
Couples who Abandoned the Method	1	4
Couples Lost to Follow up	4	16
TOTAL	460	100
Table 10

Analysis of 130 Couples who had Planned Pregnancies
Category	No.	%
Couples using Method Subsequently	82	63
Couples who Abandoned the Method	1	0.7
Couples Lost to Follow up	47	36.2
TOTAL	130	100
Table 11

DISCUSSION

These natural methods allow well informed and motivated couples to avoid pregnancy.

On this question of efficiency the results justified our confidence in these methods, in spite of the fact that some couples take risks.

During the learning phase our instructors identified couples who were likely to take risks.

These results are possible if couples accept NFP as a way of life which also provides a method of birth control.

In this "way of life", the following points are particularly important :

the couple must accept life as a gift, must live their love with a total respect for the other person, with feelings of tenderness and an interest in discovering new ways of expressing their feelings

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