Advances in contraception : the official journal of the Society for the Advancement of Contraception最新文献

Conceptions involving aging gametes are of relevance to natural family planning (NFP) because women using NFP to avoid pregnancy abstain from intercourse during the fertile time of the cycle. To help verify the safety of pregnancies occurring among NFP practitioners, our group has, since 1986, conducted a large cohort study involving six experienced NFP centers. Timing of conception was determined from NFP charts, in which women recorded days on which intercourse occurred. The number of days from the most probable conception intercourse to probable day of ovulation was first determined, and used as an estimate of the time gametes remained in the genital tract before fertilization. Several studies have already been completed, cohort as well as case-control in nature.

Distinct means have been developed to answer an increasing demand and need for methods that can accurately predict and detect the fertile phase of the menstrual cycle and fit various indications and changing situations of women's reproductive life. Methods based on the detection of direct fertility markers, such as hormonal tests and ultrasound, are more objective and accurate than traditional markers based on indirect markers, but cost and dependence on supplies limit their application. Nevertheless, these methods could be used during a few cycles either as support in the teaching phase or in difficult cases and for specific indications. Likewise, some new devices designed to facilitate recording and calculation of fertility signals could be combined with clinical methods to improve prediction and detection of the fertile phase. Besides the search for new fertility markers and the development of new methods, the possibility of combining already existing methods would certainly improve use-effectiveness and acceptance.

Alterations in the expression of the human genome, or interference with its products, can be induced in the male reproductive system by chemicals mimicking or antagonizing naturally occurring hormones. Opportunities exist for disruption at the hypothalamus, pituitary and testis levels. Recent concerns generated by the increased incidence of testicular cancer, congenital anomalies of the male genitalia and possible alterations in human semen quality have been linked to the environment. The report by Carlsen in 1992 [1] suggested that semen quality has deteriorated over the past six decades. More recent reports suggest that the decline may be globally non-uniform and regional in nature. The effects of any such declines upon overall pregnancy rates are generally unknown, although some studies have attempted to address them. A preliminary review of the impact of a small decrease in sperm concentrations suggests that a directly measurable reduction in fecundity does not occur, but that future problems could be anticipated. Decrements in semen quality will alter the epidemiological probabilities of pregnancy due to coitus on different cycle days and may thereby change the duration of the fertile time. Current understanding of the implications of altered semen quality on relative fertility is not sufficient to change our current teaching and practice of NFP.

The International Conference on Population and Development (ICPD) served as the international launchpoint for a broadened reproductive health agenda, bringing global attention to a variety of underlying issues that impact on women's health and well-being, and highlighting the need to redress imbalances in gender equity that have had negative health and social consequences in particular for women and girls. To meet the challenges of the ICPD, programs must assess, prioritize and implement an expanded set of reproductive health interventions within an environment of diminishing resources. This paper argues that hidden social and health costs that particularly affect women must be included in the assessment and prioritization of reproductive health interventions. In addition, it argues that issues of gender and sexuality cannot be separated from the delivery of appropriate family planning and reproductive health care if we are to have a significant impact on improving the reproductive health of current and future generations.

Social marketing applies commercial sector ideas to programs to change behavior. It involves a mindset that is customer-focused; a process that starts with customers and continually returns to them for validation; and concepts to make change happen. Customer behavior models guide strategy. One useful model is based on stages of change and four behavioral influences: perceived benefits, perceived costs, the influence of others, and perceived behavioral control.

This paper synthesizes a six year collaboration between a natural family planning (NFP) non-governmental organization (NGO) and the National Health Service of the Emilia Romagna region in Italy. It also compares the public program experience with NFP services provided in the private sector in the adjacent region of Veneto. Midwives provided NFP services in government family health clinics while in the private sector NFP was taught by non-health laypersons in a church-based facility. The populations served by these two programs were different. Women in the public sector were slightly older and two-thirds were married. Forty percent of the clients had chosen to use NFP to achieve a pregnancy. The private sector client, recruited in part through premarriage counseling programs, was equally divided between married and single women, though the majority came for advice on avoiding or spacing pregnancies. In both regions NFP users were more highly educated than the general population.

Despite the recognized benefits for clients and programs of providing natural family planning (NFP) services, few family planning programs offer NFP and few provide fertility awareness education. Furthermore, many non-governmental organizations (NGOs) that provide only NFP actually reach a very small percentage of the potential NFP users in the areas they serve. This paper discusses the results of interviews with selected family planning providers that were conducted to explore reasons why NFP and fertility awareness education are not offered in their programs, and with NFP providers to get their opinions on how to improve service delivery. The interviews were structured around some of the lessons learned from the successful incorporation of the lactational amenorrhea method (LAM) into several multimethod family planning programs. There is agreement that the need for NFP services* is far from being met and that most clients lack the information and skills they could learn through fertility awareness education. The providers interviewed also acknowledged that offering these services would improve the quality of reproductive health services in general. Presented here are some ideas about why these services are not offered, as well as suggestions for integrating NFP and fertility awareness education into existing family planning programs.

A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14870 cycles, 28 unintended pregnancies were studied. Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During "perfect use" the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most unforgiving for imperfect use (unprotected intercourse in the fertile phase). However, it is extremely effective when either abstinence or protected intercourse is used in the fertile phase.

Fertility awareness-based methods of family planning are rarely offered through reproductive health services in Latin America, despite evidence that many women use them. Providers state that clients do not want these methods, but provider-bias is evident. Providers overestimate the difficulty of learning and using fertility awareness-based methods, and they underestimate their efficacy. Both providers and clients have difficulty dealing with sexuality (which is central to fertility awareness-based methods). Many providers lack gender sensitivity, 'worsening' the unequal relationship between providers and clients. Experience has shown that when fertility awareness-based methods are well provided, they can have a positive effect on sexuality, self-understanding, and equality in the couple's relationship.

The Reproductive Health Awareness model developed by Georgetown University Institute for Reproductive Health is responsive to the elements of quality of care articulated by Judith Bruce in 1989. The model encourages self-choice regarding family planning options, informed choice and flexibility to change family planning options with changing circumstances, and inclusion of men and the family. Providers utilizing the model must know the stages of behavior change and how to program care based on the client's knowledge and readiness, and how to communicate with clients such that they are facilitating care rather than prescribing it.