1. How Natural Family Planning Fits into the Title X Program OFP Family Planning Research Grantee Meeting January 14-15, Washington, DC 
Jule Hallerdin, MN, MPH, CNM
Nurse Consultant
Office Family Planning
Office of Population Affairs

2. Family Planning and Public Health
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, : Family Planning
CDC MMR December 03, 1999 / 48(47);

3. 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

4. Personal Examples

5. 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

6. 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

7. Family Planning and Public Health
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

8. 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

9. Milestones in Family Planning
1900
First standard certificate of death created
1915
First federal birth registration area created
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

10. 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
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

11. 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 ), which added Title X, “Population Research and Voluntary Family Planning Programs” to the Public Health Service Act.
Factors affecting choice to use natural family planning identified
04 April 2003
Contraception 2003; 67: 253–8
Researchers have identified a number of factors that may influence women's use of natural family planning (NFP) methods.
"A discrepancy exists between the interest in modern methods of NFP and their actual use in developed countries," observe Rafael Mikolajczyk (Otto-von-Guericke-University, Magdeburg, Germany) and colleagues.
To investigate possible causes underlying this discrepancy, the researchers administered a questionnaire to 456 women who had recently given birth, to determine their knowledge, interest, and use of NFP. Of these women, 223 were residing in Berlin, Germany, and 233 in Cracow, Poland.
The results showed that women with knowledge of NFP and those who had used it in the past were more likely to express an interest in the method than other women, but these factors had no independent effect on their current decision to use or not use NFP. However, cultural factors such as religious belief affected whether interested women actually used NFP. In addition, both interest in and decision to use NFP were affected by women's perceptions of the reliability of the method, and acceptance of their own body.
"These results suggest that increased access and cultural support would likely lead to a higher prevalence of NFP use in developed countries," the team concludes.

12. 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)”
The authorities considered NFP to be important to spell out in the ACT- Or did they think it needed to be spelled out because it would be ignored? Empahsis on NFP- Any way the bottom line is it is an important part of the “broad range of acceptable effective family planning methods”.

13. 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.

14. Natural Family Planning
Natural Family Planning was one of the topics for which family planning research was solicited from :
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

15. Natural Family Planning Title X Service Delivery Improvement projects on the topic of Natural Family Planning:
1989
Don Kramer
Natural Family Planning Program Format Effectiveness
1989
John R. Weeks
Factors Affecting the Choice of Natural Family Planning

16. 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.

17. 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.

18. 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
Unofficial telephone survey

19. 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

20. 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

21. 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

22. Natural Family Planning
Questions?