Transcript History of Natural Family Planning in Office of Population

How Natural Family
Planning Fits into the Title X
Program
OFP Family Planning Research Grantee Meeting
January 14-15, 2009
Washington, DC
Jule Hallerdin, MN, MPH, CNM
Nurse Consultant
Office Family Planning
Office of Population Affairs
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Family Planning and Public
Health

1800-1900
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Family size declined from 7.0 to 3.5
1900
• Six to nine of every 1000 women died
in childbirth
• One in five children died during the first
5 years of life

Public Health facts from :
• Achievements in Public Health, 1900-1999: Family Planning
CDC MMR December 03, 1999 / 48(47); 1073-1080
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Family Planning and Public
Health
• 1900

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Distributing information and counseling
patients about contraception and
contraception devices was illegal under
federal and state laws
The timing of ovulation, the length of the
fertile period and other reproductive facts
were unknown
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Personal Examples
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Family Planning and Public
Health
• 1912
The modern birth-control movement began
 Margaret Sanger initiated efforts to circulate
information about and provide access to
contraception

• 1916

Sanger challenged the laws that suppressed
the distribution of family planning
information by opening the first family
planning clinic in Brooklyn, New York
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Family Planning and Public
Health
• The police closed her clinic, but the
court challenges that followed
established a legal precedent that
allowed physicians to provide advice on
contraception for health reasons
• 1930’s- a few state health departments
and public hospitals had begun to
provide family planning services
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Family Planning and Public
Health
• 1940-1957

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Family size increased average number of
children per family peaked at 3.7
1960- the era of of modern contraception
began – birth control pill and Intrauterine
device became available
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Family Planning and Public
Health
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1965- Pill became the most popular method
followed by the condom and contraceptive
sterilization
1965 Supreme Court (Griswold vs
Connecticut) struck down stat laws
prohibiting contraceptive use by married
couples
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Milestones in Family Planning
1900
First standard certificate of
death created
1915
First federal birth registration
area created
1915
First family planning clinic closed
after 10 days
1925
First manufacture (in US) of
diaphragms
1928
Timing of ovulation established
1937
American Medical Association
endorses family planning
1955
First National fertility survey
conducted
1960
The birth control pill approved by
FDA
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Milestones in Family Planning
1960
IUD approved by FDA
1965
Supreme Court declares unconstitutional state laws
prohibiting contraceptive use by married couples
1970
Family Planning Services and Population Research Act
creates Title X of the Public Health Service Act
1972
Medicaid funding for family planning services authorized
1973
Supreme Court (Roe vs Wade) legalizes abortion
1973
First National Survey of Family Growth conducted7
1990
Norplant approved by FDA
1992
Depo-Provera approved by FDA
1993
Female condom approved by FDA
1997
Emergency use of oral contraceptives pill approved by FDA
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History of Natural Family Planning in OFP

Office of Family Planning:
• Guided by the Law, Regulations, and
Guidelines:

Congress enacted the Family Planning
Services and Population Research Act of
1970 (Public Law 91-572), which added Title
X, “Population Research and Voluntary
Family Planning Programs” to the Public
Health Service Act.
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Natural Family Planning

Section 1001 of the Act authorizes
grants “to assist in the establishment
and operation of voluntary family
planning projects which shall offer a
broad range of acceptable and
effective family planning methods
and services (including natural family
planning methods, infertility services
and services for adolescents)”
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Natural Family Planning

The mission of Title X is to provide
individuals the information and
means to exercise personal choice in
determining the number and spacing
of their children.
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Natural Family Planning

Natural Family Planning was one of the topics for
which family planning research was solicited
from 1985-1998:
• Topics included:
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Family Planning client behavior
Adolescent family planning clients
Male family planning clients
Targeting of family planning services
Clinic personnel behavior
Organization and management of family planning
services
Role of private physicians
Natural family planning
Infertility services
Counseling services
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Natural Family Planning
Title X Service Delivery Improvement projects on
the topic of Natural Family Planning:
• 1989
• John R. Weeks
• Factors Affecting
the Choice of
Natural Family
Planning
• 1989
• Don Kramer
• Natural Family
Planning Program
Format
Effectiveness
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Natural Family Planning Program
Format Effectiveness

1989- Don Kramer
• Summary of findings:
 Team Teaching format 36% more cost efficient than
the Creighton Model for instructing clients in the
Ovulation method of NFP.


Actual cost of service delivery for the Team Teaching
format client was 64% of the cost of a Creighton
model format client
Both formats produced extremely similar results, in a
broad array of relevant outcome variables, including
continuation and pregnancy rates.
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Factors Affecting the Choice of
Natural Family Planning

1989-John Weeks
• Summary of findings:
Private OB/GYN physicians were the least
informed about NFP, and just over one-third
knew about all three methods.
 NFP-only providers had the most
knowledge, while clinic providers and
administrators were in between.
 The single most identifiable barrier to the
availability of NFP is skepticism among
physicians about its use and effectiveness.

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Examples of Title X Training
Centers Focus on NFP

Region VII Development Systems, Inc.
Kansas City, MO
• NFP and Fertility Awareness: A
conference call discussion for Title X
clinicians about non-hormonal
contraception - held 4/10/08
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Examples of Title X Training
Centers Focus on NFP

Region III -TRAINING 3, Family Planning
Council, Inc.
Philadelphia, PA
• Planning a 2 hour on-line interactive
training for clinicians on Fertility
Awareness – projected date 6/30/09
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How Natural Family Planning Fits into
the Title X Program

NFP is a statutory requirement (FP Method)

NFP is not widely used


Need to find out why the method is not used
more
Provide accurate information to providers that
will enhance provision of NFP counseling
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Review of Program Goals for NFP
Grantees

Contribute to:
• Improved health outcomes
• Increased utilization of preventive
health care- particularly among
vulnerable and special needs
populations
• Increasing the proportion of pregnancies
that are intended
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Natural Family Planning

Questions?
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