Effective use of natural family planning (NFP) requires both skill and motivation by a couple, which means adequate counseling and training must be available.
In a guidebook on NFP, the World Health Organization (WHO) describes NFP services as "primarily educational, and a competent teacher is the key to success in delivering such services." The guidebook says good teachers can include people who do not have formal health-care training, but they must have good communication skills to discuss with a couple the importance of refraining from sex during fertile periods.1 To teach NFP, a provider typically needs four meetings with a client over several months.
The first step in NFP training should be fertility awareness, helping women and men to understand their reproductive system, menstrual cycles and fertile periods. Interviews with experts from several successful NFP programs illustrate other ways to approach or improve NFP training:
- In Nairobi, Kenya, the NFP Training and Medical Services Center works with women, including many in slums who cannot read. The center uses an exercise book with small squares that women color to help them keep track of their fertility signs. "In slum areas, the women have no privacy, so the Billings (cervical mucus) method is their usual choice. It is easier to track with the coloring books without using a thermometer," says Sabina Mwaulu, who directs the program. Provider training takes six to eight weeks, she says, depending upon the background of the nurses, who must pass a government exam to be certified as NFP teachers.
- In the United States, one program combines group sessions with individual counseling. "We have worked over the years at developing a curriculum for teaching clients that is cost-effective but will not compromise the quality of learning," says Barbara Kass-Annese of the Los Angeles Regional Family Planning Council, which uses two 90-minute group sessions to teach the menstrual cycle, fertile period, rules of NFP and how to apply them, followed by two individual sessions during a woman's next two menstrual cycles.
- A study coordinated by the Twin Cities Natural Family Planning Center in Minnesota, USA, compared two training approaches: one that used a group approach and another that emphasized individual counseling. Individual counseling cost 50 percent more than group training, yet no significant differences were found in continuation or pregnancy rates for the two approaches. Group training also involved more men in learning to use NFP. The five group sessions, held monthly, included time for private discussions with individual couples as needed.2
- A study of NFP programs by Catholic groups in Bangladesh, India, Kenya, South Korea and the United States concluded that socioeconomic backgrounds, previous family planning experiences and educational level did not appear to be associated with a client's willingness or ability to discuss NFP.3 However, another analysis of these users in Bangladesh, Kenya and South Korea found that older ages and better educational levels were associated with lower rates of unplanned pregnancy, as was previous family planning use.4
- Some family planning programs do not have the resources to train staff in NFP. Experts say a more practical option may involve referring clients to existing NFP services, sending one person to be trained at a nearby NFP service, or having a person on staff who gives only general advice about NFP.
-- Sarah Keller and William R. Finger
References
- World Health Organization. Natural Family Planning: A Guide to Provision of Services. Geneva: World Health Organization, 1988.
- Kramer D, Tix P, Cleary J, et al. Ovulation method program format effectiveness. Int Rev Nat Fam Plann 1989;13(1-2):117-33.
- Klaus H, Labbok M, Barker D. Characteristics of ovulation method acceptors: a cross-cultural assessment. Stud Fam Plann 1988; 19(5):299-304.
- Labbok MH, Klaus H, Barker D. Factors related to ovulation method efficacy in three programs: Bangladesh, Kenya and Korea. Contraception 1988:37(6):577-89.
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