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Natu=
ral
Contraceptive Methods=
Kirsten M. Vogelsong, PhD
UNDP/UNFPA/WHO/World Bank Special Programme of Research Development
and Research Training in Human
Reproduction
Training Course in Reproductive Health Research=
3;
Geneva 2006
Advantages of
Natural Methods=
•Kno=
wledge
of fertility
<=
/span>
Independence from med=
ical
services
•Freedom from drugs <=
/span>and devices
<=
span
class=3DHBB style=3D'position:absolute;left:-10.36%'>•Self-reliance
•<=
span
style=3D'visibility:hidden'>•=
•Free=
dom from
side-effects and risks
=
Communication and int=
imacy
with partner
•In
line with religious and=
/or
cultural norms=
<=
span
class=3DHBB style=3D'position:absolute;left:-9.34%'>•Reduced
or no costs
•Disadvantages =
of
Natural Methods=
•No pr=
otection
from STIs/HIV (except abstinence)
•Requ=
ires
training by qualified
instructor
•Unforgiving of incorrect use
•Requ=
ires
consent, co-operation of
partner
•Less effective for =
women with irre=
gular
cycles
•Requires regular monitoring and reco=
rding=
Ferti=
lity
Awareness
What is
it?
•Underst=
anding
basic information about fertil=
ity
and reproduction
•Identifying signs and symptoms of
fertility during the woman’s fertile
cycle
•Applying this information, discussing it with a partner and health providers
Ferti=
lity
Awareness
Why is
it important?
•Fundame=
ntal to
understanding and making inform=
ed
decisions about family planning choice=
s and
reproductive health
•Fundamen=
tal to
understanding and using natur=
al
family planning,whether to avoid or plan a
pregnancy
•Helps women and couples value and
protect their fertility and reproduct=
ive
health
Natural Regula=
tion
of Fertility
•Abstin=
ence
•Withdr=
awal
•Period=
ic
Abstinence/Rhythm
•Lactat=
ional
Amenorrhea
Distribution
of Contraceptive Use Prevalence
•World wide contraceptive use (Married Women of Reproductive age)
•=
•Contraceptive N=
o. of
users Users First year failure rate
=
• (Millions) (%) (%) - Typical use=
•
•Total users 648 <=
/span>61.9
Withdrawal
32 3.1
19.0
Rhythm
27 2.6
25.0
Lactational
Amenorrhea 0.2<=
span
lang=3DEN-GB style=3D'font-family:Arial;font-size:44%;color:black;mso-colo=
r-index:
3'> UN Population Di=
vision,
2001
Abstinence=
=
•Refrain f=
rom
all penetrative sexual activity
•Effective=
in
preventing pregnancy and STIs/H=
IV
•Effective
programs can be targeted to young peopl=
e and
unmarried adults in order to delay =
first
sex and reduce the number of partne=
rs
Withdrawal=
=
•<=
/span>Has been in use for centuries
•<=
/span>Only male-initiated natural method
•<=
/span>Failure rates 4-17% (perfect-typical use)
<=
/div>
•<=
/span>Prevalent and effective in several countries
•<=
/span>Reasons for use:
–<=
/span>concerns about side-effects of other methods
–=
partner preference
–=
no cost
Periodic Absti=
nence=
=
=
<=
span
style=3D'mso-special-format:nobullet;display:none'>•Periodic Abstinence refers to a variety =
of methods used to prevent =
pregnancy
<=
/div>
•
•Bas=
ed on
identifying the woman’s fertile days
•=
Abstinence OR avoiding unprotected se=
x during the fertile days prevents preg=
nancy
•
•
•
Use of Periodic
Abstinence
•Of mar=
ried
women world wide using some form of family planni=
ng, approximately 15% claim t=
o be
using a form of periodic abstinence.
•=
Periodic absti=
nence=
•Us=
e is
based on assumptions
•=
The oocyte (egg) lives for 1 day in the female reproductive tract
•=
The sperm can live for 4-5 days in the female reproductive tract
•=
ovulation occurs about 14 days before the next mensesPeriodic Absti=
nence=
•=
Probability
of Pregnancy from Intercourse on Days Relative to Ovulation
Periodic Absti=
nence=
•=
Periodic Absti=
nence=
•=
Perio=
dic
Abstinence
Calendar Methods=
Calendar Methods=
•Uses
calculations to determine the fer=
tile period of each cycle
•A vari=
ety of calculations are used.
•Effica=
cy
ranges between 85-91% in the first year of use
•=
Perio=
dic
Abstinence
Calendar Methods=
Calendar Methods=
•=
EXAMPLE
•Client #1=
’s
last 6 cycles ranged in length from <=
/span>27 to 30 days
•She is ta=
ught
the 11-18 rule: she will subtract 18 from=
the
number of days in her shortest cycle
(27-18=3D9) and 11 from the number=
of
days in her longest cycle (30-11=3D1=
9).
•Her ferti=
le
period is determined to be betwee=
n days 9 and 19 of her
next cycle.
Perio=
dic
Abstinence
Standard Days Method<= /span>=
Standard Days Method<= /span>=
•Simple
fertility awareness-based method
•No calculation or <=
span
style=3D'position:absolute;top:56.0%;left:55.61%;width:36.14%;height:6.0%'=
>observation
•“Stand=
ard
rule” or “fixed window”
•Identifies
days 8-19 of the cycle as
fertile
<=
span
style=3D'visibility:hidden'>•=
•=
Stand=
ard
Days Method
Tool for teaching and = use
Tool for teaching and = use
•<=
/span>The method is designe=
d for
women with regular cycles 26-32 days long
•The necklace has 32 beads&=
#13;
•=
Move the band to the red bead=
wh=
en
your period starts
Move the band every morning
Always move the band from
narrow to wi=
de end
of bead
Also mark this day on your ca=
lendar
Move the band to the red bead =
when your period starts=
Also mark this day on your calendar=
Move the band every morning
Always move the band from narrow to w=
ide end of bead
Standard Days Method
Tool
for teaching and use
Stand=
ard
Days Method
Tool for teaching and = use
Tool for teaching and = use
Band on WHITE bead, abstain from unprotected intercourse=
Band of BROWN bead, you may have intercourse
Stand=
ard
Days Method
Efficacy Trial= =
Efficacy Trial= =
•Multi-s=
ite
prospective efficacy trial recently comple=
ted
•Services
provided through existing program=
s in
Peru, Bolivia and the Philippines
<=
/span>
• Clients
followed monthly for 13 cycles
Stand=
ard
Days Method
Efficacy Trial - Study= Sites
Efficacy Trial - Study= Sites
Trinidad, BO
Juliaca, PE
Lima, PE
La Trinidad, PH
Tuba, PH
N=3D478 couples=
Stand=
ard
Days Method
Efficacy Trial - Resul= ts
Efficacy Trial - Resul= ts
Correct use is de=
fined as
abstinence or use
of another method during the fertile window (days 8-19).
Stand=
ard
Days Method
Efficacy Trial - Resul= ts
Efficacy Trial - Resul= ts
•
• =
•
•Correct use
•(w/abstinence)
•Correct use
•(abstinen=
ce +
other method)
•Typical use
•(Correct +
non-compliant)
•
•Cumulative
probability of pregnancy
over 13 cycles
•4.8%
•
•5.7%
•
•12.0%
Stand=
ard
Days Method
Efficacy Trial - Resul= ts
Efficacy Trial - Resul= ts
Stand=
ard
Days Method
Efficacy Trial - Lesso= ns Learned
Efficacy Trial - Lesso= ns Learned
•Sensitize=
and
train providers
•SDM is easy to learn and
use
•Many coup=
les
are willing and able to use the me=
thod
correctly
•Involving men is needed f=
or
successful use
•Many men can and do suppo=
rt use
of SDM
•The necklace is an effect=
ive
tool
•Some will
prefer to use with other methods
•Correct u=
se
increases over time
Perio=
dic
Abstinence
Observation-based Methods= =
Observation-based Methods= =
•<=
/span>Rely on the observ=
ation
of signs and symptoms of fertility
•Signs are induced by hormon=
es and
include:
–cervical secretions
–cervix
–=
basal body temperature
•=
Observation-ba=
sed
methods
Observation-ba=
sed
methods
Observation-ba=
sed
methods
Obser=
vation-based
methods
Temperature Method=
Temperature Method=
•Increase in temperature is an
indication that ovulation has occurred; it is used to indicate the <=
/b>end of the ferti=
le
time
•Abstain from unprotected
intercourse until after 3 days of continuous increased
temperatures
•Probability of pregnancy between 2-20%
Obser=
vation-based
methods
Temperature Method=
Temperature Method=
•=
Observation-ba=
sed
methods
Obser=
vation-based
methods
Mucus Method
Mucus Method
•Abstain during menses
•Abstain every other day during dry days
•Abstain between Day #1 of muc=
us and
4th day after peak mucus
•Can be used by women with irr=
egular
cycles
•Probability of pregnancy between 3-20%
Obser=
vation-based
methods
Mucus Method=
Mucus Method=
Early Mucus
Scanty, thick, =
white, sticky=
Transitional Mucus
More, Thinner, cloudy, stretchy=
Highly fertile mucus
Profuse, thin, transparent, Stretc=
hy=
Obser=
vation-based
methods
Symptothermal Method
Symptothermal Method
•Obse=
rvation
of more than one indicator =
of
fertility
•Cervical secretions and temperature
•Posi=
tion and
feel of cervix; calendar
<=
/b>=
•Probability
of pregnancy between 2-20%<=
/b>=
•=
Obser=
vation-based
methods
Symptothermal Method
Symptothermal Method
Observ=
ation-based
Methods
The TwoDay Method<= /b>=
The TwoDay Method<= /b>=
•Simple
observation-based method
•Based on =
the
presence or absence of cervica=
l
secretions
•If a women
notices any secretions o=
n the current or previous day, then she is probab=
ly in
her fertile phase
•If she no=
tices no secretions on
either day, then she is proba=
bly not fertile
•Clinical =
trials
ongoing to test efficacy
Lactational
Amenorrhea
•Post-pa=
rtum
breastfeeding to achieve contrac=
eption
•Suckling
stimulates the production and release=
of
prolactin and B-endorphin
•Prolact=
in
inhibits LH synthesis and release; endor=
phins
suppress GnRH release, and there=
fore
ovarian stimulation is inhibited and Ovu=
lation
is blocked
• Efficacy
is up to 98% for 6 months
Lactational
Amenorrhea
•=
Lactational
Amenorrhea
•=
Natur=
al
Contraceptive Methods
•The Future=
•=
Continue to simplify and test simple methods
<=
span
style=3D'mso-special-format:bullet;position:absolute;left:-4.65%'>•=
Streamline the training and follow-up
•=
Methods to assist in determining the fertile Home=
Test
Kits for Ovulation Pre=
diction
and Detection
•Uses urin=
ary
metabolites and a computer chip to identify the beginning and end
of the fertile time
•Can predi=
ct the
fertile window 94% of the time
•=
Currently available in certain
European countries
•=
PERSONA (Unipath, Ltd)
Home=
Test
Kits for Ovulation Pre=
diction
and Detection
BIOSELF
•=
Monitors temperature and cy=
cle
day
•Detects the fertile window in over 90% of
cycles
<=
span
style=3D'visibility:hidden'>•
•=
Natur=
al
Contraceptive Methods
•Fo=
r More
Information:
•=
Georgetown University Institute for Reproductive Health http://www.irh.org•The Ferti=
lity
Awareness and Natural Family Planning
Service UK http:=
//www.fertilityuk.org•The Billi=
ngs
Ovulation Method of NFP http://billings-centre.ab.ca/‹header›
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Ask participants to name some natural methods
What are advantages?
What are disadvantages?
How effective are natural methods?
These features of natural methods=
have
been described by users and providers of these methods.
Are there any here that weren’t mentioned by the class/participants?<=
span
lang=3DEN-GB style=3D'mso-special-format:lastCR'>
These features have been describe=
d as
disadvantages of natural methods =
– by users,
providers, etc.
Any here that were not mentioned by the class?
Fertility awareness is a concept =
that is
a complement to NFP=
……. Therefore, fertility awarenes=
s helps
decision-making and improves the use of all methods, natural or barrier or
hormonal…
There are 4 main types of=
natural
methods. We will discuss each of these today:
1.Abstinence
Other traditional methods including prolonged abstinenc=
e and
breastfeeding 0.6%
For each method, the % users is not the % of those usin=
g who
choose the method, rather it is the % of all WMR=
S who
rely on that method.
65% of the pregnancies occurred in cycles in which women
reported unprotected intercourse during days
8-19.
2.Withdrawal
3.Periodic abstinenc=
e or
rhythm methods, also known as calendar methods. And
4.Lactational
amenorrhea. This last method is, of course, only relevant for new
breastfeeding mothers.
Data reflect 1997 numbers
Total of 1.05 billion billion MWRA.in 2000
Other modern methods (implant, e.g.) 0.6%
56% use modern methods.
In order to correctlyor successfu=
lly use any method of Periodic abstinence,=
fertility
awareness is essential, as is partner cooperation.
According to the Institute for
Reproductive medicine at Georgetown University in the US, 15% of married w=
omen
using some method of family planning claim to use some form of periodic
abstinence
However, most of these women and couples have had no formal training or ed=
ucation
about when the appropriate time to abstain or use barrier methods may be. =
For
example, couples may have been instructed, erroneously, to avoid unprotect=
ed
sex during menstruation and no other time. Without knowledge of the fertile
period, couples cannot effectively
practice periodic abstinence, and therefore, failure rates are quite
high, since the methods are not typically used correctly.
This graph shows the probability =
of
pregnancy resulting from intercourse on various days relative to
ovulation. The data was collected=
from
couples who were trying to conceive and who agreed to report the days when
they had unprotected sex and to have ultrasound to determine the day of
ovulation.
With variations in cycle length, =
only the
length of the pre-ovulatory infertile phase changes. You can see that the
length of the fertile period remains constant, as does the interval between
ovulation and the next menstrual period.
=
This diagram just shows a differe=
nt way
of looking at the same information, showing the fertile period at mid-cycl=
e.
Calendar methods require tracking=
the
length of menstrual cycles and determining, according to a set calculation,
the fertile period. The couple wo=
uld
then abstain or use a barrier method during the fertile period.
As an example of a rule used in
determining the fertile period according to a calendar method….
As her fertile period is day 9-19, she and her partner(s) wouldnot have un=
protected
sex during these days, unless they are willing to accept a risk of pregnan=
cy.
I can note here that these methods can also be used in planning a pregnanc=
y. By
being aware of the fertile days, a couple can plan to have intercourse on =
these
days and therefore maximize their chances of conception.
As several rules are used to calc=
ulate
the fertile days, and calculations should ideally be re-done at each cycle=
to
account for variations in cycle length, there have been efforts to develop=
a
simple or standard method that would not require extensive record-keeping =
and
calculation. The Georgetown Unive=
rsity Institute
for Reproductive Medicine has used large data sets that describe menstrual
cycle lengths to develop what they call the standard days rule. This rule identifies days 8-19 as being
fertile for women who regularly menstruate at 26-32 day intervals.
This method has integrated an int=
eresting
mnemonic device – a string of beads used to count cycle days.
DESCRIBE NECKLACE AS ABOVE
These simple instructions were gi=
ven to
women/couples who participated in a clinical trial of the standard days
method.
GO OVER INSTRUCTIONS
The SDM has been evaluated in a c=
linical
trial, with the aim to apply modern methodologies
and criteria to what could be considered a more traditional method of fami=
ly
planning.
The study was conducted in Peru, Bolivia and the Philippines – countries w=
here
the reported use of natural methods is relatively high. Women were followed
for13 cycles, or one year. The results of the trial have recently been pub=
lished.
92% of cycles =3D abstinence during fertile window=
5% of cycles =3D use of another method (condom or withd=
rawal)
in the fertile window)
3% of cycles =3D unprotected intercourse
Based on:
478 clients initially admitted
4035 cycles of method use
Typical use =3D all cycles/all pregnancies
43 pregnancies
9% of participants left the study for pregnancy,
overall.
15 pregnancies in “abstinence” cycles.
Comparison of several different user-dependent fam=
ily
planning methods.
Higher efficacy than female barriers; similar to m=
ale
condom.
Of course, pill has lower failure rates.
Now we will switch from calendar =
based
methods to observation based methods of periodic abstinence.
These methods rely on the observation signs and symptoms of fertility, as =
induced
by the reproductive hormones as they fluctuate throughout the menstrual cy=
cle.
Just as a reminder, I have includ=
ed a
simple diagram of the changes in estrogen and progesterone throughout the
cycle. Of course, estrogen rises just prior to ovulation (indicated by the
vertical dotted line) ,and then decreases.
Progesterone on the other hand, is released from the corpus luteum =
and therefore
rises after ovulation.
This diagram indicates the change=
s in
ovarian activity throughout the cycle, as related to hormone levels.
Basal body temperature is dependa=
nt on
these steroid hormones, and also changes throughout the cycle, rising after
ovulation, and staying elevated as long as progesterone levels are elevate=
d,
or until the next period of menstruation.
In fact, the changes in temperatu=
re offer
one way to track the fertile period. According
to the temperature method, the increase in temperature is a way to indicate
the end of the fertile time.
A couple who relies on this method would abstain from unprotected intercou=
rse
until3days after continuous increased temperature.
The efficacy of this method varies according to how well couples can adher=
e to
the requirements of daily temperature recording. The probability of the method failingis
between 2 and 20%.&=
#13;
This figure clearly indicates tha=
t the
fertile period is just before the rise in temperature, and that continued
elevated temperatures signify the end of the fertile period.
Along with changes in temperature=
, other
signs of ovulation can be detected. These
include the position of the cervix and the presence or absence of cervical
mucus.
<=
/div>
Studies are ongoing to determine if LAM can be effective for periods beyon=
d 6 months. Preliminary data indicate that this me=
thod
can be effective for at least 9 months.
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ii=3DgCurSld-1
if( ii > 0 ) {
obj=3DGetHrefObj(ii)
while ( obj && ( obj.mVis =3D=3D 0 ) && ( ii>0 ) )
obj=3DGetHrefObj(--ii)
if( ii =3D=3D 0 ) ii=3D1
GoToSldNum(ii)
}
}
function GoToFirst(){ GoToSld( GetHrefObj(1).mSldHref ) }
function GoToLast()
{
ii=3DGetSldList().mList.length
if( ii !=3D gCurSld )
GoToSld( GetHrefObj(ii).mSldHref )
}
function GoToSldNum( num )
{
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
obj =3D GetHrefObj( num )
obj.mVis=3D1
gPrevSld=3DgCurSld
gCurSld =3D num;
PPTSld.location.replace(MHTMLPrefix+obj.mSldHref)
if( IsFramesMode() ) {
UpdNavPane(); UpdOtlPane(); UpdNtsPane()
}
}
function GoToSld( href )
{
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
GetHrefObj( GetSldNum(href) ).mVis=3D1
PPTSld.location.replace(MHTMLPrefix+href)
}
function SldUpdated( id )
{
if( id =3D=3D GetHrefObj(gCurSld).mSldHref ) return
gPrevSld=3DgCurSld
gCurSld=3DGetSldNum(id)
if( IsFramesMode() ) {
UpdNavPane(); UpdOtlPane(); UpdNtsPane()
}
}
function PrevSldViewed(){ GoToSld( GetHrefObj(gPrevSld).mSldHref ) }
function HasPrevSld() { return ( gIsEndShow || ( gCurSld !=3D 1 && GetHrefO=
bj( gCurSld-1 ).mVis =3D=3D 1 )||( GetCurSldNum() > 1 ) ) }
function HasNextSld() { return (GetCurSldNum() !=3D GetNumSlds()) }
function CloseWindow() {
if( HideMenu() ) return;
=09
var event =3D PPTSld.event;
if( !IsFramesMode() && event && (event.keyCode=3D=3D27 || event.keyCode=3D=
=3D32 || event.type=3D=3D"click" ) )
window.close( self );
CatchNumKeys( self, event );
}
function Unload() { gIsEndShow=3D0; }
function SetupEndShow() {
gIsEndShow=3D1;
PPTSld.document.body.scroll=3D"no";
PPTSld.document.onkeypress=3DCloseWindow;
PPTSld.document.onclick=3DCloseWindow;
PPTSld.document.oncontextmenu=3D_CM;
}
function EndShow()
{
if( IsFramesMode() ) return
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
doc=3DPPTSld.document
var dir =3D doc.body.dir
if( dir !=3D "rtl" ) dir =3D "ltr";
doc.open()
doc.writeln(' 0) {
PushSldList(sldList,fEnd);
gCurSld =3D 1;
}
else
if( PPTSld.event ) PPTSld.event.cancelBubble=3Dtrue
}
function PushSldList(arr,fEnd) {
var ii =3D gSldStack.length;
gSldStack[ii] =3D new SldList(arr,gCurSld,fEnd);
GoToSld( gSldStack[ii].mList[0].mSldHref );
}
function PopSldList() {
if (gSldStack[gSldStack.length-1].fEndShow)
EndShow()
else {
gCurSld =3D gSldStack[gSldStack.length-1].mCurSld;
gSldStack[gSldStack.length-1] =3D null;
gSldStack.length--;
var sldList =3D gSldStack[gSldStack.length-1];
GoToSld( sldList.mList[gCurSld - 1].mSldHref );
}
}
var custShowList=3Dnew Array();
/*********************************************
Navigation button implementation
There are 2 types of buttons: ImgBtn, TxtBtn
implemented as function objects. They share
a similiar interface so the event handlers
can call SetActive, for example, on a button=20
object without needing to know exactly=20
what type of button it is.
**********************************************/
//----------------------------------
function ImgBtn( oId,bId,w,action )
//----------------------------------
{
var t=3Dthis
t.Perform =3D _IBP
t.SetActive =3D _IBSetA
t.SetInactive=3D _IBSetI
t.SetPressed =3D _IBSetP
t.SetDisabled=3D _IBSetD
t.Enabled =3D _IBSetE
t.ChangeIcon =3D null
t.UserAction =3D action
t.ChgState =3D _IBUI
t.mObjId =3D oId
t.mBorderId=3D bId
t.mWidth =3D w
t.mIsOn =3D t.mCurState =3D 0
}
function _IBSetA()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 )
obj.style.posTop=3D0
}
}
function _IBSetI()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0=20
}
}
function _IBSetP()
{
if( this.mIsOn ) {
obj=3Dthis.ChgState( gShadowClr,gHiliteClr,2 )
obj.style.posLeft+=3D1; obj.style.posTop+=3D1
}
}
function _IBSetD()
{ =20
obj=3Dthis.ChgState( gFaceClr,gFaceClr,0 )
obj.style.posTop=3D0=20
}
function _IBSetE( state )
{
var t=3Dthis
GetObj( t.mBorderId ).style.visibility=3D"visible"
if( state !=3D t.mIsOn ) {
t.mIsOn=3Dstate
if( state )
t.SetInactive()
else
t.SetDisabled()
}
}
function _IBP()
{
var t=3Dthis
if( t.mIsOn ) {
if( t.UserAction !=3D null )
t.UserAction()
if( t.ChangeIcon ) {
obj=3DGetObj(t.mObjId)
if( t.ChangeIcon() )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-4)*t.mWidth
else
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-0)*t.mWidth
}
t.SetActive()
} =20
}
function _IBUI( clr1,clr2,nextState )
{
var t=3Dthis
SetBorder( GetObj( t.mBorderId ),clr1,clr2 )
obj=3DGetObj( t.mObjId )
obj.style.posLeft=3Dobj.style.posLeft+(t.mCurState-nextState)*t.mWidth-obj=
.style.posTop
t.mCurState=3DnextState
return obj
}
//-----------------------------------------
function TxtBtn( oId,oeId,action,chkState )
//-----------------------------------------
{
var t=3Dthis
t.Perform =3D _TBP
t.SetActive =3D _TBSetA
t.SetInactive=3D _TBSetI
t.SetPressed =3D _TBSetP
t.SetDisabled=3D _TBSetD
t.SetEnabled =3D _TBSetE
t.GetState =3D chkState
t.UserAction =3D action
t.ChgState =3D _TBUI
t.mObjId =3D oId
t.m_elementsId=3D oeId
t.mIsOn =3D 1
}
function _TBSetA()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gHiliteClr,gShadowClr,0,0 )
}
function _TBSetI()
{
var t=3Dthis
if( t.mIsOn && !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
}
function _TBSetP()
{
if( this.mIsOn )
this.ChgState( gShadowClr,gHiliteClr,1,1 )
}
function _TBSetD()
{ =20
this.ChgState( gFaceClr,gFaceClr,0,0 )
this.mIsOn =3D 0
}
function _TBSetE()
{
var t=3Dthis
if( !t.GetState() )
t.ChgState( gFaceClr,gFaceClr,0,0 )
else
t.ChgState( gShadowClr,gHiliteClr,1,1 )
t.mIsOn =3D 1
}
function _TBP()
{
var t=3Dthis
if( t.mIsOn ) {=20
if( t.UserAction !=3D null )
t.UserAction()
if( !t.GetState )
return
if( t.GetState() )
t.SetPressed()
else
t.SetActive()
} =20
}
function _TBUI( clr1,clr2,lOffset,tOffset )
{
SetBorder( GetObj( this.mObjId ),clr1,clr2 )
Offset( GetObj( this.m_elementsId ),lOffset,tOffset )
}
function Offset( obj, top, left ){ obj.style.top=3Dtop; obj.style.left=3Dle=
ft }
function SetBorder( obj, upperLeft, lowerRight )
{
s=3Dobj.style;
s.borderStyle =3D "solid"
s.borderWidth =3D 1=20
s.borderLeftColor =3D s.borderTopColor =3D upperLeft
s.borderBottomColor=3D s.borderRightColor =3D lowerRight
}
function GetBtnObj(){ return gBtnArr[window.event.srcElement.id] }
function BtnOnOver(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetActive() }
function BtnOnDown(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetPressed() }
function BtnOnOut(){ b=3DGetBtnObj(); if( b !=3D null ) b.SetInactive() }
function BtnOnUp()
{
b=3DGetBtnObj()
if( b !=3D null )
b.Perform()
else
Upd()
}
function GetNtsState(){ return parent.gNtsOpen }
function GetOtlState(){ return parent.gOtlOpen }
function GetOtlTxtState(){ return parent.gOtlTxtExp }
function NtsBtnSetFlag( fVal )
{
s=3Ddocument.all.item( this.m_flagId ).style
s.display=3D"none"
if( fVal )
s.display=3D""
else
s.display=3D"none"
}
function _BSetA_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etActive() }
function _BSetI_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etInactive() }
function _BSetP_Border(){ b =3D gBtnArr[this.mObjId]; if( b !=3D null ) b.S=
etPressed() }
function _BSetA_BorderImg()
{=20
b =3D gBtnArr[this.mBorderId]=20
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gHiliteClr,gShadowClr,2 )
obj.style.posTop=3D0
}
}
function _BSetI_BorderImg()
{=20
b =3D gBtnArr[this.mBorderId]
if( b !=3D null && this.mIsOn && !b.GetState() ) {
obj=3Dthis.ChgState( gFaceClr,gFaceClr,1 )
obj.style.posTop=3D0
}
}
var gHiliteClr=3D"THREEDHIGHLIGHT",gShadowClr=3D"THREEDSHADOW",gFaceClr=3D"=
THREEDFACE"
var gBtnArr =3D new Array()
gBtnArr["nb_otl"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOtlPan=
e,GetOtlState )
gBtnArr["nb_otlElem"] =3D new TxtBtn( "nb_otl","nb_otlElem",parent.ToggleOt=
lPane,GetOtlState )
gBtnArr["nb_nts"] =3D new ImgBtn( "nb_nts","nb_ntsBorder",10,parent.ToggleN=
tsPane )
gBtnArr["nb_nts"].SetActive =3D _BSetA_BorderImg;
gBtnArr["nb_nts"].SetInactive =3D _BSetI_BorderImg;
gBtnArr["nb_ntsBorder"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.=
ToggleNtsPane,GetNtsState )
gBtnArr["nb_ntsElem"] =3D new TxtBtn( "nb_ntsBorder","nb_ntsElem",parent.To=
ggleNtsPane,GetNtsState )
gBtnArr["nb_prevBorder"] =3D gBtnArr["nb_prev"]=3D new ImgBtn( "nb_prev","n=
b_prevBorder",30,parent.GoToPrevSld )
gBtnArr["nb_nextBorder"] =3D gBtnArr["nb_next"]=3D new ImgBtn( "nb_next","n=
b_nextBorder",30,parent.GoToNextSld )
gBtnArr["nb_sldshw"]=3D new ImgBtn( "nb_sldshw","nb_sldshwBorder",18,parent=
.FullScreen )
gBtnArr["nb_sldshwBorder"] =3D new TxtBtn( "nb_sldshw","nb_sldshwBorder",pa=
rent.FullScreen,null )
gBtnArr["nb_sldshwBorder"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwBorder"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_sldshwText"] =3D new TxtBtn( "nb_sldshw","nb_sldshwText",parent=
.FullScreen,null )
gBtnArr["nb_sldshwText"].SetActive =3D _BSetA_Border;
gBtnArr["nb_sldshwText"].SetInactive =3D _BSetI_Border;
gBtnArr["nb_voice"] =3D gBtnArr["nb_voiceBorder"] =3D new ImgBtn( "nb_voice=
","nb_voiceBorder",18,parent.ToggleVNarration )
gBtnArr["nb_otlTxtBorder"] =3D gBtnArr["nb_otlTxt"]=3D new ImgBtn( "nb_otlT=
xt","nb_otlTxtBorder",23,parent.ToggleOtlText )
gBtnArr["nb_ntsBorder"].m_flagId=3D "nb_nts"
gBtnArr["nb_ntsBorder"].SetFlag =3D NtsBtnSetFlag
gBtnArr["nb_otlTxt"].ChangeIcon=3D GetOtlTxtState
/*********************************************
Context menu implementation
_CM() is the function that's hooked up to
the oncontextmenu event. Once we're asked to
show the menu, we first build it by creating
DIVs on-the-fly. Then we position it=20
within the screen area so it doesn't get
clipped.
Creating the DIVs using createElement() means
we don't have to write out any extra HTML
into the slide HTML files.
**********************************************/
var sNext=3D"Next",sPrev=3D"Previous",sEnd=3D"End Show",sFont=3D"Arial",sAr=
row=3D"Arrow",sFreeform=3D"Freeform",sRect=3D"Rectangle",sOval=3D"Oval"
function ShowMenu()
{
BuildMenu();
var doc=3DPPTSld.document.body,x=3DPPTSld.event.clientX+doc.scrollLeft,y=
=3DPPTSld.event.clientY+doc.scrollTop
m =3D PPTSld.document.all.item("ctxtmenu")
m.style.pixelLeft=3Dx
if( (x+m.scrollWidth > doc.clientWidth)&&(x-m.scrollWidth > 0) )
m.style.pixelLeft=3Dx-m.scrollWidth
m.style.pixelTop=3Dy
if( (y+m.scrollHeight > doc.clientHeight)&&(y-m.scrollHeight > 0) )
m.style.pixelTop=3Dy-m.scrollHeight
m.style.display=3D""
}
function _CM()
{
if( !parent.IsFullScrMode() ) return;
if(!PPTSld.event.ctrlKey) {
ShowMenu()
return false
} else
HideMenu()
}
function BuildMenu()
{
if( PPTSld.document.all.item("ctxtmenu") ) return
var mObj=3DCreateItem( PPTSld.document.body )
mObj.id=3D"ctxtmenu"
mObj.style.visibility=3D"hidden"
var s=3DmObj.style
s.position=3D"absolute"
s.cursor=3D"default"
s.width=3D"120px"
SetCMBorder(mObj,"menu","black")
var iObj=3DCreateItem( mObj )
SetCMBorder( iObj, "threedhighlight","threedshadow" )
iObj.style.padding=3D2
CreateMenuItem( iObj,sNext,M_GoNextSld,M_True )
CreateMenuItem( iObj,sPrev,M_GoPrevSld,M_HasPrevSld )
=09
CreateSeparator( iObj )
CreateMenuItem( iObj,sEnd,M_End,M_True )
mObj.style.visibility=3D"visible"
}
function Cancel() { window.event.cancelBubble=3Dtrue; window.event.returnVa=
lue=3Dfalse }
function Highlight() { ChangeClr("activecaption","threedhighlight") }
function Deselect() { ChangeClr("threedface","menutext") }
function Perform()
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() )
e.Action()
else
PPTSld.event.cancelBubble=3Dtrue
}
function ChangeClr( bg,clr )
{
e=3DPPTSld.event.srcElement
if( e.type=3D=3D"menuitem" && e.IsActive() ) {
e.style.backgroundColor=3Dbg
e.style.color=3Dclr
}
}
function M_HasPrevSld() { return( parent.HasPrevSld() ) }
function M_GoNextSld() { if( gIsEndShow ) M_End(); else GoToNextSld() }
function M_GoPrevSld() { if( gIsEndShow ) { gIsEndShow=3D0; history.back();=
PPTSld.event.cancelBubble=3Dtrue; } else GoToPrevSld() }
function M_True() { return true }
function M_End() { window.close( self ) }
function CreateMenuItem( node,text,action,eval )
{
var e=3DCreateItem( node )
e.type=3D"menuitem"
e.Action=3Daction
e.IsActive=3Deval
e.innerHTML=3Dtext
if( !e.IsActive() )
e.style.color=3D"threedshadow"
e.onclick=3DPerform
e.onmouseover=3DHighlight
e.onmouseout=3DDeselect
s=3De.style;
s.fontFamily=3DsFont
s.fontSize=3D"9pt"
s.paddingLeft=3D2
}
function CreateSeparator( node )
{
var sObj=3DCreateItem( node )
SetCMBorder(sObj,"menu","menu")
var s=3DsObj.style
s.borderTopColor=3D"threedshadow"
s.borderBottomColor=3D"threedhighlight"
s.height=3D1
s.fontSize=3D"0px"
}
function CreateItem( node )
{
var elem=3DPPTSld.document.createElement("DIV")
node.insertBefore( elem )
return elem
}
function SetCMBorder( o,ltClr,rbClr )
{
var s=3Do.style
s.backgroundColor=3D"menu"
s.borderStyle=3D"solid"
s.borderWidth=3D1
s.borderColor=3DltClr+" "+rbClr+" "+rbClr+" "+ltClr
}
------=_NextPart_01C64780.3D25EF00
Content-Location: file:///C:/5409C636/Natural_Contraceptive_Methods_Vogelsong_2006_files/fullscreen.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="windows-1252"
Natural Contraceptive Methods - Kirsten M. Vogelsong
------=_NextPart_01C64780.3D25EF00--
Most methods - count 3 days after the PD before re=
suming
intercourse
Creighton mode=
l -
count 3 days and wait until the end of day 4 before resuming
intercourse. (98-99% effective in several studies)To use the mucus method, women are
instructed to check for the presence and type of cervical mucus, or to det=
ect
wetness in the vaginal area. When the mucus is abundant and stretchy, like=
in
the panel on the right, this indi=
cates that
the women is fertile, and is called peak day mucus.
Studies that have evaluated the timing of the peak day =
with
the occurrence of ovulation have demonstrated th=
at,
the PD falls on the day of ovulation about 35% o=
f the
time and that, in most (72%) cycles, the PD does come before or on the day of
ovulation. Concluded that PD is a=
very
accurate estimator of peak fertility in a woman’s
menstrual cycle and is a fairly accurate estimator of the day of ovulation
According to theoretical modelin=
g, this
method should be more than 80% effective in preventing pregnancy, when used
correctly and consistently
How can we determine if a woman =
is
meeting the criteria to use this method correctly? First we have to define=
the
level of breastfeeding as “full” “partial” or “token” Women who are fully breastfeeding are =
most
likely to benefit from the LAM approach.
…….
Several operations research stud=
ies are
ongoing to determine the best ways to introduce these methods alongside ot=
her
methods in family planning programs. In
many cases, NFP is introduced at separate facilities, and it is therefore important to integ=
rate
these methods into family planning services.
Additional studies are looking at ways to streamline training and follow up
of new acceptors of NFP methods.<=
span
style=3D'mso-spacerun:yes'> For example, some programs recommend t=
hat acceptors
be followed up frequently, but this puts a strain on the service delivery
system and may not be necessary.
' + ENDSHOW_MESG + '
![](3D"notes_flag.gif")
No=
tes![](3D"buttons.gif")
