Calendar Rhythm Users Ofter Make Incorrect Calculations of the Fertile Period

Natural Family Planning
Richard J. Fehring, DNSC, R.N.
Reprinted from "Current Medical Research"
(Summer/Fall 2002), DDP / NFP, USCCB,
Washington, D.C.
Reproduced with Permission

A multi-country focus group study was conducted recently to determine how couples actually use calendar methods, how they determine the fertile phase of the menstrual cycle, what behaviors they use during the fertile phase, and whether they are satisfied with natural methods of birth regulation.1 The study was located in four countries (Hungary, Peru, the Philippines, and Sri Lanka) where a relatively high percentage of couples use natural methods of family planning. Each focus group consisted of 6-12 persons and a moderator familiar with group qualitative research techniques and experience in leading group discussions. The participants were men and women who avoided "unprotected" intercourse during certain days of the cycle to avoid pregnancy, were in stable relationships, were between the ages of 18-45, and who belonged to similar socioeconomic and cultural groups. The focus groups were conducted in community centers and lasted about 2 1/2 hours. In Sri Lanka, there were eight groups involving 32 men and 33 women; in Peru there were 13 groups with 41 men and 59 women; in the Philippines, eight groups were comprised of 27 men and 28 women; and in Hungary there were twenty groups with 13 men and 78 women. The majority of the Hungarian participants, unlike participants in the other countries, used primarily the Billings Ovulation method. The following is a summarization of the qualitative results.

Sources of information about natural methods

The men in the focus groups obtained information about natural methods from their wives or partners, friends, and older family members. The women obtained information from books, newspapers, health posts, friends and older family members.

Factors related to the identification of the fertile period

The participants in Peru, the Philippines, and Sri Lanka primarily used the calendar method, while those in Hungary used a mixture of natural methods including calendar, temperature, cervical self-examination and the Billings Ovulation Method. Participants in Peru and the Philippines did not apply the instructions for the Calendar Method consistently and the women in the Philippines often had a poor understanding of their menstrual cycle. For example one Philippine woman stated "A woman is fertile during the menstruation period. After menses she is no longer fertile." Only 26% of the ever users of the Calendar Method in the Philippines were able to correctly identify the fertile phase of the menstrual cycle.

The use of abstinence and alternatives during the fertile period

Most participants from each country reported the use of abstinence some time during the menstrual cycle to avoid pregnancy. However, participants in Peru, the Philippines and Sri Lanka reported the use of withdrawal, and those in Hungary and Peru commonly used condoms during the fertile time. Participants also reported the use of genital contact and "alternative sex" practices during the fertile period.

Perceptions of other contraceptives

All participants in the four countries reported that modern methods of contraception were available to them. Participants in all four countries also felt that oral contraceptives and the IUDs were unhealthy and dangerous to use or have some unacceptable side effects. Expense was viewed as a barrier to use of modern contraceptives in Hungary and Sri Lanka. Acceptability of calendar methods

Participants in the Philippines and Sri Lanka, liked the calendar methods and found them effective, while those in Peru and Hungary disliked the natural methods because of their unreliability. Participants in every center felt that the methods were difficult to learn, understand and use. They also disliked coping with abstinence. However, they did appreciate the fact that the natural methods cost little, were safe and did not have negative side effects. Participants in three centers also felt that the autonomy of use and self-sufficiency were positive characteristics of the natural methods.

Suggested ways to improve calendar methods

In Hungary the participants called for the development of more reliable methods in Sri Lanka participants were enthused about participation in NFP programs because they previously only had access to programs for modern contraceptive methods. In Peru, participants suggested the use of schoolteachers for promoting and teaching the use of the natural methods and in the Philippine participants asked for more counseling on alternative methods to be used during the fertile phase. All participants called for increased public knowledge, awareness and better public communication about calendar methods. They felt that credible persons in the mass media would be helpful. Credible and comprehensive counseling and support was also recommended.

Comments

The authors indicated that the participants in this study cannot be assumed to be representative of the population of Calendar Method users. However, the qualitative focus group approach does give a depth to the participants' responses and provides insights into their use of the methods. The authors also mentioned that many of the participants did not know how to use the Calendar Method and that the method could be more effective if the participants were taught how to use it and were given a better understanding of their menstrual cycles. Greater participation of the male in the use of the natural methods would also increase cooperation between the partners and efficiency of use. Helping couples to cope with abstinence during the fertile period -- coping methods that involve non-genital and non-contraceptive means in synch with Catholic sexual ethics -- is also a need.

The authors also stated that "in every study center, clear negative attitudes toward modern contraceptives were expressed among persons who had much experience with them as well as those who had little experience. In all centers, modern contraceptives were also clearly available." The authors then concluded that the survey findings challenge programs to both address these negative attitudes toward other methods and to enhance the effective use of natural methods. I agree that we need to enhance the effectiveness and ease of use of natural methods. We also need to address the use of contraceptives, not to promote them, but to point out that they are contrary to the nature of the human person and the true meaning of conjugal relationships. (RJF)

Endnote:

1 Research Group on Methods for the Natural Regulation of Fertility. Periodic abstinence and calendar method use in Hungary, Peru, the Philippines, and Sri Lanka. Contraception. 64 (2001): 209-215. [Back]

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