History of Natural Family Planning in Office of Population Affairs

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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

1

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

2

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

3

Personal Examples

4

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

5

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

6

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

7

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

8

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

9

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

10

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.

11

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)”

12

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.

13

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

14

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.

16

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.

17

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

18

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

19

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

20

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

21

Natural Family Planning

Questions?

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