Results showed high rates of use effectiveness and relatively low cost.
Additional benefits are helping couples with difficulty conceiving to achieve pregnancy and assisting young women to understand their own sexual development better.
In the Oxford area, natural family planning (NFP) was being taught by
trained teachers in a voluntary organisation.
The demand for this service was increasing and could not be met by the teachers available.
To determine how best to meet this demand, a study was conducted to
assess
In this community-based study, NFP instruction was given to clients by a practice nurse supported by two doctors.
An initial interest session was arranged for small groups of women or couples.
Couples were encouraged to attend, but the majority of women came without their partners.
The study participants, that is, those women who wished to learn a
natural method, were offered five educational sessions at monthly intervals.
The participants were taught fertility awareness by the symptothermal method
(1),
which combines the daily observation of the cervical
mucus symptom with the recording of the basal body temperature.
Those couples wishing to avoid pregnancy were advised to have sexual intercourse during the infertile phases of the cycle and to abstain from intercourse during the fertile phase; but couples wishing to use barrier contraception during this time were free to do so.
Couples wishing to achieve pregnancy were taught fertility awareness,
aiming to identify the days of maximum fertility.
The teaching time was recorded to evaluate the time taken for each woman to reach autonomy (according to the criteria of the programme) and hence the cost of teaching natural methods in general practice.
The women received instruction in small groups.
Every effort was made to form groups of women / couples of similar age
and educational background, and also according to their fertility status
(for example, women of normal fertility avoiding pregnancy,
breast feeding mothers, and women during the pre-menopause).
Women with problems of infertility were seen individually, preferably
with their partners.
All interested women were accepted, irrespective of age or state
of fertility.
Of 208 accepted women, 102 completed fertility charts for one cycle
and expressed a wish to continue charting.
(Of the remaining 106, 64 were interested only in learning fertility
awareness, and 42 attended only the initial sessions).
The 102 participants formed the main study sample and were asked to
provide at least twelve fertility charts for the purpose of the study.
Of the four women with other reasons for charting their cycles,
three had suffered from disturbing symptoms thought to be pre-menstrual,
and one woman had suffered chronic ill-health with bouts of pyrexia.
These women were not using their knowledge of fertility awareness as
a family planning method, but information on their charts helped to
diagnose the cause of their symptoms.
Many of the women, a number of whom were looking for an alternative
method because of medical advice, had previously used other methods
of contraception.
There were two failures, one a method failure and one a user failure.
Thus, pregnancy rates were 2.7, calculated with the Pearl Index.
No pregnancies resulted from couples who at times used barrier methods
of contraception during the fertile time.
Of the twenty-six women who wanted to become pregnant, nineteen
succeeded during the two years.
The majority of these women learned to identify the fertile phase
of the cycle by recognition of the cervical mucus symptom and became
pregnant within three to four months.
Two women who had recently stopped using hormonal contraception took
eleven and fourteen months before normal cycles were charted and
pregnancies were achieved. Seven women were attending the fertility clinic.
Increasing awareness of the fertile time allowed more accurate timing
of intercourse, particularly valuable for two of the women who had very
long and irregular cycles and were thought to have had a history of miscarriage.
One thirty-nine year old, who discontinued her course of fertility
drugs on consultant advice, conceived several months later using her
knowledge of fertility awareness.
During this study, two general practitioners acted as medical advisors
when problems arose, but were not involved in the routine teaching
of the method.
In costing other methods of family planning, the general practitioners'
fees and the practice nurse's salary were included with the cost
of pills or devices.
The average teaching time per client for women avoiding pregnancy was four hours.
Group teaching and audio-visual programmes
The audio-visual programme on NFP, which explains the scientific basis
for natural methods and describes the symptothermal method in detail,
was shown to all women at the first session.
Other programmes for women during lactation and for women in the
premenopause age group were shown as appropriate.
The majority of women expressed a need to avoid pregnancy when they
entered the study; the remainder were actively planning pregnancy.
The majority of women in this study chose to use natural methods for
reasons of ecological preference or for moral reasons.
Results
Three conceived following education about how to identify the most
fertile days, although the cause of their infertility was never found.
Three women conceived while taking fertility drugs.
Two were on clomiphene and one on bromocriptine.
These women felt their increased understanding of fertility had played
some part in helping them to time intercourse to achieve pregnancy.
The cost of teaching NFP in general practice was calculated.
(See Tables I & II)
The cost of teaching NFP in general practice, whether to women of
normal fertility or to women in special circumstances,
compares favourably with other methods over a two-year period even
though there are high costs during the first year.
Women of normal fertility took less time to teach than those in
'special circumstances',
ie. lactating women, pre-menopausal women, and women experiencing
delayed return of normal fertility following the use of oral contraceptives.
| Family planning nurse's salary (4 hours) | £17.60 |
| Cost of thermometer | £3.50 |
| Cost of charts / year | £1.20 |
| Total first-year cost | £22.30 |
|
(as at 1990) for Family Planning in U.K. | ||||||||||||
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NFP should be offered by family planning clinics and by general practitioners who give a family planning service as an alternative to artificial methods of contraception.
This small study taught the symptothermal method and produced an
overall efficacy rate of 2.7 on the Pearl Index.
This rate is comparable to the intrauterine device (IUD) (1-5) or barrier methods (3-6).
Only the combined pill and injectables (less than 1) and the progestogen-only pill (1-2) are more efficient reversible methods (2).
The majority of the women in the study chose a non-invasive method of family planning, frequently citing unwanted side effects as reasons for turning away from artificial methods.
There are other positive aspects to giving education in fertility.
For example, in England, where one couple in eight has a fertility problem,
education was all that was needed to achieve pregnancy in the majority
of cases in this study.
Education in fertility awareness was appreciated by women who wanted this information but did not plan to use NFP immediately.
From the questionnaires, it emerged that the women were helped to understand their developing sexuality, physically and emotionally.
They felt better prepared to make responsible decisions about relationships and their choice of a method of family planning.
In this two-year pilot study on teaching NFP in general practice,
it has been shown that the STM can be an efficient and cost-effective
method of family planning.
|
Dr Michael Woolridge of the Department of Child
Health at Bristol Maternity Hospital for his help in planning this study. |
|
Dr Laurence Villard, the Department of Community Medicine
and General Practice, Oxford, for his help in preparing this paper. |
| Professor John Bonnar of Trinity College, Dublin, for his help in preparing this paper. |
| The Family Research Trust who provided the financial support which made this research project possible. |
|
The Royal College of General Practitioners, who provided the financial support which made this research project possible. |
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