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

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

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

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

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
1915
1915
1925
1928
1937
1955
1960
First standard certificate of death created
First federal birth registration area created
First family planning clinic closed after 10 days
First manufacture (in US) of diaphragms
Timing of ovulation established
American Medical Association endorses family planning
First National fertility survey conducted
The birth control pill approved by
FDA
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Milestones in Family Planning
1960 IUD approved by FDA
1965
1970
1972
1973
1973
Supreme Court declares unconstitutional state laws prohibiting contraceptive use by married couples
Family Planning Services and Population Research Act creates Title X of the Public Health Service Act
Medicaid funding for family planning services authorized
Supreme Court (Roe vs Wade) legalizes abortion
First National Survey of Family Growth conducted7
1990
1992
1993
1997
Norplant approved by FDA
Depo-Provera approved by FDA
Female condom approved by FDA
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Emergency use of oral contraceptives pill approved by FDA

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:










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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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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
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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
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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
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
18


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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
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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
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

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