Periodic Abstinence: How well do new approaches work?

 This report discusses the effectiveness, acceptability and feasibility of periodic abstinence in family planning programs.  The concept of periodic abstinence had its beginnings during the 1930's when Drs. Ogino of Japan and Knaus of Australia independently identified the time of ovulation in relation to the menstrual cycle and helped developed what became known as the calendar rhythm.  Over the years, different techniques of periodic abstinence were developed, (rhythm came to be known by the term natural family planning or NFP), including, in addition to Ogino-Klaus' calendar rhythm, the 1) temperature, or thermal method, 2) cervical mucus method, and 3) sympto-thermal method (STM).  These methods do not depend on regular menstrual cycles but on signs and symptoms of fertility.  Periodic abstinence is the only birth control method approved by the Roman Catholic Church.  Several factors affect the effectiveness of these methods:  1) obvious differences between new and experienced use, 2) differences in groups studied and differences in definitions and study design, 3) strength of motivation to avoid pregnancy, 4) quality and type of teaching and follow-up, and 5) the physiological characteristics of women, particularly when they are lactating, adolescent, or premenopausal.  Continuation rates for periodic abstinence methods are lower than those for pills and IUDs.  Studies using life-table analysis in the last decade showed that between 1/3 and 3/4 of acceptors discontinue practicing NFP methods within 1 year; this compares with about 20% to 30% discontinuing IUD use after 1 year.  Users of periodic abstinence methods tend to be couples who do not want to use other methods because of religious and philosophical reasons and fear of side effects, or couples who do not have access to other methods.  Complications associated with these methods include unplanned pregnancy with its attendant risk of maternal mortality, especially in developing countries; spontaneous abortion, and birth defects.  The use of periodic abstinence has markedly declined in the last few decades throughout the world, and program administrators are faced with scientific, behavioral and programmatic challenges if use of these methods is to continue.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program