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Natural family planning: looking ahead.

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.

Amenorrhea↗

Quality of care among Jamaican private physicians offering family planning services.

The National Family Planning Board is the agency of Government empowered to prepare, carry out and promote family planning programs in Jamaica. The Board has prioritized the expansion and sustainability of family planning services in large part through encouraging the participation of the private sector. To enhance the availability, acceptability and effectiveness of private physician family planning services, information was collected on the service practices of 90% of physicians, through face to face interviews. Bruce's framework was used to evaluate the findings of the study. The study indicated that: A wide variety of contraceptives are available - Basic equipment and adequate supplies are in place for the provision of services - Provider bias, inappropriate contraindicators and process and scheduling hurdles exist. The major recommendations relate to the: Revision of norms and guidelines for all contraceptives - Continuation of contraceptive technology updates for private physicians - Revision of legal/regulatory barriers which restrict access to some contraceptives for certain target groups.

Adolescent↗

[HIV seroprevalence in patients seen at sexually-transmitted disease and family planning centers in Spain, 1995-1996. AIDS Programs of the Autonomic Communities and Network of sexually-transmitted disease, HIV and family planning centers].

BACKGROUND: The sexually-transmitted diseases (STD's) centers are good sentinels for monitoring the sexual transmitting of HIV. This study analyzes the results of voluntary HIV tests run in 1995 and 1996 within a network of STD, HIV and family planning centers in Spain. METHODS: Starting as of 1995, a questionnaire was sent out yearly to said centers for recording the number of individuals found to have HIV the previous year and the number of those who are proven to be HIV positive. A calculation of HIV incidence was based as a function of sex and the main HIV transmission categories. RESULTS: Eighty-one centers answered the survey in 1995, 78 having done so in 1996. Ninety-five percent of these centers ran the HIV test at the request of the interested parties. At the 39 centers which provided data regarding the HIV tests conducted in 1996, a total of 15,964 individuals had been tested. Positive: 4.8% (n = 760) (CI: 4.4%-5.1%). The HIV seroprevalence was higher for males (5.9%) than for females (2.6%; p, 0001). The highest HIV seroprevalence was found among injecting drug users (IDU's) (18.7%). On comparing HIV seroprevalence in 1995 with that of 1996, drops were detected in the number of homosexual/bisexual men from 7.4% to 6.1% (p = 0.049) and in women prostitutes, from 2.0% to 1.3% (p = 0.034). The Sexual partners of IDUs went from 3.4% to 4.6% (p = 0.267). CONCLUSIONS: These results provide a nationwide reference regarding HIV incidence among populations having high-risk sexual relations. The trend therein is favorable among homosexual/bisexual men and female prostitutes.

Adult↗

What nurses should know about natural family planning.

Two common natural family planning (NFP) methods are the ovulation method based on characteristics of cervical mucus and the symptothermal method based on changes in cervical mucus, basal body temperature, and the cervix. Both methods are effective when used correctly. Nurses should understand the principles of NFP and introduce these methods in discussions of family planning options. Interested clients should be referred to a certified NFP instructor for education and supervision.

Body Temperature↗

Measuring university student satisfaction with a campus family planning clinic in Costa Rica.

Family planning clinics for university students play a valuable role in promoting health. This research project, a pilot study among women students who sought family planning services through a Costa Rican university clinic, introduced student evaluation of the family planning clinic, documented services provided in family planning visits, and identified issues for further study. Aged 18-33 years, the 53 respondents (a convenient sample) who completed a self-administered questionnaire were mostly (64%) single; all were sexually active; and 78% wished to have children (or more children) some day. Though all were sexually active at the time of their visit, only 62% were currently using contraception, and fewer than half of these were using effective methods. Nearly all students (96%) reported they learned new information during their appointment, and many received screening tests and examinations. Respondents rated their satisfaction with aspects of clinic service as high, citing the clinic's low visibility on campus as the most important area for improvement. All of the students said they would definitely return (85%) or would consider returning (15%). The results support the continuance of such a clinic on the campus, as well as of the practice of student evaluation. This collaborative study demonstrated areas for future research and stimulated interest in the university clinic as a research setting.

Adolescent↗

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.

Adult↗

Cost-benefit analysis of selective screening criteria for Chlamydia trachomatis infection in women attending Colorado family planning clinics.

Women attending family planning clinics in Colorado during 1988 were screened for Chlamydia trachomatis infection by enzyme immunoassay (EIA, Chlamydiazyme, Abbott Laboratories; Abbott Park, IL). Cervical specimens from 11,793 women attending 22 family planning clinics were analyzed. Patient history and physical exams were used to assess risk factors for infection. A total of 913 individuals (7.7%) had positive culture results for C. trachomatis. Multivariate analysis showed that infection was significantly related to endocervical bleeding, cervical mucopurulent discharge, a new sexual partner in the last 3 months or multiple previous sexual partners (greater than 3) in the last year, pregnancy, the use of oral contraceptives, and age. Increased odd ratios were observed for the combination of endocervical bleeding and mucopurulent discharge and sexual history that included partners over the previous year as well as the most recent 3 months. A combination of these criteria was used to selectively screen women attending Colorado family planning clinics on an ongoing basis. A cost-benefit analysis employing a model reported previously showed a significant financial benefit associated with universal screening over either selective screening or no screening for C. trachomatis in this population.

Adolescent↗

Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT Program in California, 1997-1998.

OBJECTIVES: The California Family Planning, Access, Care, and Treatment Program was implemented in 1997 to provide family planning services for uninsured, low-income women and men. We estimated the impact on fertility of providing 500 000 women with contraceptives. METHODS: Paid claims and medical record review data were used to estimate pregnancies averted. Pregnancies women experienced while enrolled in the program and pregnancies they would have experienced given methods used before enrollment were modeled as a Markov process. RESULTS: One year of Family Planning, Access, Care, and Treatment services averted an estimated 108 000 unintended pregnancies that would have resulted in 50 000 unintended births and 41 000 induced abortions. CONCLUSIONS: Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California.

Abortion, Legal↗

Family planning in Isparta, Turkey.

Family planning practices were reported by 491 married women, aged 15-49, who applied to the Family Planning Centre in Isparta, Turkey. Eighty-four percent of the women used contraception, the IUD being used most frequently. Almost half of the women married before age 18 years.

Adolescent↗

Family planning in the balance.

Family planning has long been acknowledged as an effective public health intervention. In recent years, however, family planning has come under increased scrutiny from conservative politicians and constituents. National US policies instituted since 2001 are resulting in cutbacks in family planning programs worldwide. In the long run, these conservative initiatives may set back several decades of progress in reproductive health and reproductive rights. In promoting an ideologically driven approach to sexual and reproductive health, the recent policy developments threaten to subvert ethical standards of medical care and the principle of evidence-based policy.

Abortion, Induced↗

Circular on family planning, 11 July 1987.

This Circular on family planning is summarized as follows: "The circular points out that recently there have been successive cases of hampering and sabotaging family planning work in various parts of the province. Family planning work personnel have been beaten up and abused in revenge, and there have been instances of illegally removing intra-uterine devices, obtaining money by deceit, and harming women mentally and physically. These have hampered the smooth progress of family planning. To protect the enthusiasm of the family planning personnel and ensure the smooth progress of family planning in Guizhou, the Circular demands that the public security organs at all levels fully play their part in cracking down on crime and serving the four modernizations. They must provide full support for the family planning departments in carrying out their work in a normal fashion, and protect and support the cadres and masses in the frontline of family planning work. In cases of threatening, beating up, and taking violent revenge against family planning personnel, the public security organs must work with the departments concerned to investigate and deal with the matter promptly. Cases of illegal removal of an intra-uterine device, obtaining money by deceit, abusing women, and other instances of sabotage of family planning must be promptly investigated and dealt with according to law."

Asia↗

The measurement and utility of the opinion leadership concept for family planning programs.

The objectives of family planning educational programs often include information diffusion as well as attitude and behavior change within a target population. This paper suggests that working with opinion leaders might be one possible means of fulfilling these objectives. But in order to work with opinion leaders, it is necessary first to identify them. For family planning studies, the operational indicators used in past studies do not appear to be adequate. These indicators do not accurately identify persons who will take an opinion leadership behavior in the future, do not measure knowledge by the opinion leader, do not distinguish positive from negative opinion leaders, and do not take account of the bi-directional flow of information and advice both to and from the opinion leader. Drawing upon data from a family planning study in Baltimore, various examples for inadequate opinion leadership indicators are given. The paper suggests the need to revise these indicators and then outlines a simple and inexpensive program that might be used to channel the energies and activities of family planning opinion leaders towards the fulfillment of program objectives.

Attitude↗

Sex ratio associated with timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of natural family planning.

This was a multicentred, prospective study of pregnancies among women using natural family planning. The women maintained natural family planning charts of the conception cycle, recording acts of intercourse and signs of ovulation (cervical mucus changes, including peak day and basal body temperature). Charts were used to assess the most probable day of insemination relative to the day of ovulation and length of the follicular phase of the cycle. The sex ratio (males per 100 females) for 947 singleton births was 101.5, not significantly different from the expected value of 105. The sex ratio did not vary consistently or significantly with the estimated timing of insemination relative to the day of ovulation, with the estimated length of the follicular phase or with the planned or unplanned status of the pregnancy. Although these findings may be affected by imprecision of the data, the study suggests that manipulation of the timing of insemination during the cycle cannot be used to affect the sex of offspring.

Family Planning Services↗

Asian women's use of family planning services.

Detailed research on the family planning needs of Asian women is extremely important in informing public policy in the new purchaser-provider environment of the National Health Service (NHS), which was introduced in 1991. In depth interviews were conducted with Asian women of Indian, Pakistani and Bangladeshi backgrounds in the South and West Regional Health Authority area, to investigate their family planning behaviour and use of family planning services. This research shows significant diversity in the knowledge and use of contraception between married professional women, married non-professional women and unmarried women. This paper examines the different family planning service implications for each group of women. The results show that professional married women and unmarried women are able to meet their family planning needs by utilising existing family planning services. However, married non-professional women experience significant difficulties in using family planning services largely due to communication problems with health professionals and their low levels of personal autonomy. Most Asian women in this study showed a strong preference for a female GP and a non-Asian GP for sexual health and contraceptive services.

Adolescent↗