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CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the ideas and studies taken from books, journal, literature and
previous studies that the researchers found to have relationships and significance in the study.
State of the Art
The researcher made use of various review of literature and studies both foreign and
local.
Added information was gathered from secondary sources like books, journals, former
thesis and online information from year 2000 up to present.

Review of Foreign Literature


Family Planning
According to the article of Moore and Fleischman (2010) the election of Barack Obama
has fundamentally changed the landscape for the debates around U.S. support for international
family planning (FP) programs. The personal engagement of top government officials, combined
with policy and budgetary announcements that make averting unintended pregnancies a priority
issue, clearly signal the administration's intention to promote family planning as part of a
comprehensive approach to global health.

Despite the polarization that often surrounds the debates on these issues in the United
States, largely over their perceived linkage to the highly charged issue of abortion, an
unprecedented opportunity now exists to significantly expand international FP programs based
on a common-ground approach. The core element of this approach is the need to move toward
universal access to FP servicesdefined throughout this paper as education, counseling, and
contraceptive commoditiesprovided on a voluntary basis to females and couples. The common
ground does not include abortion, which is prohibited by U.S. laws governing foreign assistance.
In most developed countries, a wide array of contraceptive options are available so people can
plan whether and when to have children. It is precisely that acceptance and availability of FP
services in the developed world that forms the basis for a common-ground policy toward
international FP services. (http://csis.org/publication/international-family-planning)
According to Coleman and Lemmon, Family Planning and U.S. Foreign Policy
(2011), Women today are recognized as critical to reducing poverty, boosting economic growth
and agricultural productivity, promoting environmental sustainability, and raising healthy and
well-educated childrensteps that are imperative to confronting myriad pressing foreign policy
challenges around the globe. Investments in international voluntary family planning programs
give women the tools to make important decisions about the size of their families and the spacing
of their pregnancies, better enabling them to be linchpins of positive change in their
communities. An increased prioritization of family planning has the additional benefit of
strengthening U.S. foreign policy priorities as they relate to economic development, international
security, and environmental sustainability.

Natural Family Planning


Fertility awareness based (FAB) methods is a term that includes all family planning
methods that are based on the identification of the fertile time. They are based on the woman's
observation of physiological signs of the fertile and infertile phases of the menstrual cycle. This
knowledge can be used to plan or avoid pregnancy. FAB methods depend on two key variables:
first the accurate identification of the fertile days of a woman's menstrual cycle (the fertile time)
and second the modification of sexual behaviour either to plan a pregnancy or to use this
knowledge to avoid pregnancy. When couples use FAB methods of family planning to avoid
pregnancy, they practice different sexual behaviour during the fertile time. When FAB methods
involve sexual abstinence during the fertile time, this method is called natural family planning
(NFP). When FAB methods involve occasionally using a barrier method during the fertile time,
the method is called FAB method with barriers. It must also be recognized that although many
couples state they are practising a FAB method, sometimes they do not adhere to the guidelines
and unprotected intercourse or other kinds of genital contact occur during the fertile time. The
efficacy of FAB methods to avoid pregnancy has been critically reviewed by several authors.
Several issues have been identified when attempting to compare the different FAB methods.
(http://humrep.oxfordjournals.org/content/22/5/1310.full)

Basal Body Temperature


According to Fehring and Barron (2005), BBT is the waking temperature of the body
before any activity. It reflects the ovarian cycle in two ways. Within 1 to 2 days before the LH
surge there is a nadir (low point) in BBT (Martinez et al., 1992). For over 30 years, this nadir in
temperature has been identified as possibly useful in predicting ovulation (Lundy et al., 1974).

Following ovulation, women generally experience an increase in the BBT of 0.5?F to 1.0?F; this
is called a biphasic pattern. This increase is thought to be due to the thermogenic effect of
pregnanediol, a metabolite of progesterone, which increases after ovulation and is secreted by the
corpus luteum. The biphasic shift can therefore be used as a confirmatory marker of ovulation.
Advising women to use BBT basically alerts them to this small increase in body temperature,
indicating that ovulation has occurred. However, it has long been recognized that some women
may ovulate without a clear rise in temperature; this is called a monophasic pattern (Morris,
Underwood, & Easterling, 1976). This makes the use of BBT as a method of timing intercourse
to achieve pregnancy less than useful. ( http://www.lifeissues.net/)
Basal body temperature can be used as a way to predict fertility or as a part of a method
of contraception, by helping you gauge the best days to have or avoid unprotected sex. Tracking
your basal body temperature for either fertility or contraception is inexpensive and doesn't have
any side effects. Some women may choose to use the basal body temperature method for
religious reasons. The basal body temperature method is often combined with another method of
natural family planning, such as the cervical mucus method. This combination is sometimes
referred to as the symptothermal method. (http://www.mayoclinic.org/)
Standard Days Method
Based on reproductive biology The Standard Days Method (SDM) is a new
fertility awareness-based family planning method which meets these criteria and as such, is
regarded as a modern method by international organizations and ministries of health around the
world. Below are reasons why the SDM is considered a modern method. SDM is based on
research that identifies the fertile window during the womans menstrual cycle when she can

become pregnant. Usually, this fertile window begins approximately five days prior to
ovulation and lasts up to 24 hours after ovulation. This is because of the life span of the sperm,
which remain viable in the womans reproductive tract for up to five days, and the fact that the
ovum can be fertilized for up to 24 hours following ovulation. At least 88% of ovulations occur
within +/- 3 days of the mid-point day of the menstrual cycle. (http://www.fhi360.org/)
Based on the article of http://www.thehindu.com/CycleBeads, a simple, inexpensive, nonclinical and easy-to-use natural family planning method, could well be the answer to the problem
of burgeoning population of India the second-most populous nation that recently welcomed
the footfall of world's seven billionth baby on its soil. Developed by researchers at Georgetown
University's Institute for Reproductive Health, Cyclebeads is based on the Standard Days
Method (SDM) and is claimed to be a very effective method for women to prevent unplanned
pregnancies. This method is designed for women with cycles between 26 and 32 days.
Lactation Amenorrhea Method
Based on the Fertility Awareness study in Italy, for years, scientists have recommended
using lactational amenorrhea as a method of fertility regulation. However, until the new research
was analyzed, the scientific basis for using breastfeeding for reliable contraception had not been
firmly established. To use LAM correctly, a woman must remain amenorrheic (no menstrual
bleeding) since delivery, fully or nearly fully breastfeed, and be within six months of delivery.
When any of these three criteria changes, the woman should begin immediately to use another
family planning method if she wishes to prevent pregnancy. The research indicates that
lengthening the six-month criterion to nine or even 12 months after delivery might be possible
under certain conditions, although more research is necessary before changing this criterion.

During breastfeeding, ovulation (the release of an egg) is inhibited by a series of physiological


responses to nipple stimulation. More frequent or intense suckling sends nerve impulses to the
mother's hypothalamus in her brain, which in turn inhibits ovarian activity. When breastfeeding
diminish and the chance of ovulation rises. (www.un.org)
The LAM Interagency Working Group, of which IRH was a founding member and cochair, was a collaboration of NGOs and stakeholders dedicated to improving the health of
individuals and families worldwide by enabling the use of LAM as a family planning method
and as a gateway to continued use of other methods. The LAM Interagency Working Group
developed a series of materials for programs to use in advocacy and implementation (e.g.
technical briefs, user cards, job aids). In 2011, having confidently completed its objectives, the
Interagency LAM Working Group expanded its focus to address the integration of maternal,
infant,

and

young

child

nutrition

with

family

planning

(MIYCN+FP).

(http://irh.org/projects/fam_project/)
Artificial Family Planning Method
Kelly (2010: 23) reports that Pope Paul VI in his 1968 encyclical letter Humanae
Vitae (14), prohibits the use of every barrier method, such as male and female condoms. He
further prohibited the use of contraceptives such as pills (especially the morning after pill) for the
specific purpose of preventing conception, since the morning after pill is often taken while
conception may have taken place. Hence, its users are considered to be performing abortion. In
this regard, several church bodies have issued statements that condemn condom distribution
because they are perceived to accelerate moral degradation in societies such as increased sexual
activity outside marriage. The Catholic Bishops of Zambia see abstinence before marriage and

fidelity in marriage as safe sex or protected sex (ibid.: 24). Furthermore, many Christians believe
that sex was created by God and designed it to be a sign of love between a man and a woman in
the context of marriage and that God wanted children to be seen as a gift, not as a burden.
Chaudhuri (2009: 9) highlighted that there are many methods of contraception used in
family planning. Moreover, the major categories are: barriers contraceptives (male and female
condom), oral contraception (combined oral contraceptives pills and progesterone-only pills),
non-oral hormonal contraceptives (implant, patch and injectable such as Depo-Provera),
intrauterine device, and emergency contraception (morning after pills), sterilization (male and
female sterilization).
However, Banda (2010: 59) holds that some of the methods of contraception used in
reproductive health implies that people are able to have a satisfying and safe sexual life and that
they have the capability to reproduce and the freedom to decide if, when and how often to do so.
It is a right for men and women to be informed and to have access to safe, effective, affordable
and acceptable methods of family planning of their choice. They also have a right to access other
methods of their choice for regulation of fertility, which are not against the law and the right of
access to appropriate health care services that enable women to go safely through pregnancy and
childbirth.
Pills
Its not the most common side effect, but its not unheard of either: For some women,
birth-control pills dull their libido to the extent that they defeat the purpose of taking it in the first
place. An Indiana University study presented this week at the American Public Health
Associations annual meeting examined the sexual side effects of all hormonal forms of birth

control through a survey of 1,101 women, half of whom were using non-hormonal contraception.
The women using the pill and other hormonal methods reported feeling generally less sexy than
those using non-hormonal protection. They had fewer orgasms and less-frequent sex, and found
it more difficult to get aroused. The pill is the most popular method of contraception in the
country, but it comes with a laundry list of possible side effects, from irksome nausea to breast
tenderness. It also carries a rare risk of heart attack, stroke, blood clots, high blood pressure, liver
tumors, and gallstones. (http://www.thedailybeast.com/articles)
Condom
According to the documentary of Martha Dodge, the female condom is currently the only
available dual protection tool that prevents both HIV/STIs and unintended pregnancy, and is
designed for women to initiate. It is available now. It is effective--evidence suggests that when
promoted and programmed alongside male condoms, female condoms increase the total number
of protected sex acts because they are sometimes used in instances that would not otherwise be
protected by male condoms. It is also acceptable--qualitative studies have also shown that
women view the female condom as a means for enhancing their ability to negotiate conditions
for safer sex within the relationship. Female condoms are particularly vital to the health and
well-being of women living with HIV. When used consistently and correctly, they reduce a
woman's risk of re-infection with differing strains of HIV, STI infection, and transmitting HIV or
other STIs to their partners. It also allows them to plan their pregnancies, a critical factor
considering that women living with HIV have an increased risk of maternal death.
(http://www.genderhealth.org/the_issues/us_foreign_policy/female_condoms_usforeignpolicy/)

Condom International Workshop: Condom use is often presented as a strategy or


technique which you just have to understand and implement. The assumption is that when a
person knows what condoms are, and has basic information about how to use them, condom use
should fall into place. However, heterosexual mens relationship to condom use is influenced by
gender roles. Men have to organize their bodies, minds and emotions for male condom use to
happen successfully. Most traditional gender systems have evolved with clear contrasts between
the role and perception of men and women. These contrasts allocate power differently, and are
value-laden and hierarchical. Boys and men feel they have to prove the legitimacy of masculine
status by prioritizing certain kinds of behaviour and attitudes over others. The fear of losing
status and risking humiliation are embedded within the sense of self that the boy acquires within
the gender system of his culture. Certain learned and socially enforced behaviours surface crossculturally. This can be seen in HIV prevention workshops in many different countries and
cultures. (http://www.rhmjournal.org.uk/)
Intrauterine Devices
Copper-bearing IUDs increase blood flow volumes by 20% to 50% above levels before
IUD insertion. Increased menstrual bleeding, often with pain, is the problem that women most
often report while using copper-bearing IUD. Many women who have these complaints keep
their IUDs nonetheless. Overall rates of removal because of bleeding and pain at 12 months of
use range from 1 to 17 per 100 women in major clinical trials (www.populationreports.org/b7).
According to Mcahit Kart et al. (March 2015), currently, intrauterine device (IUD) is the most
widely used method of reversible contraception because of its high efficiency and low
complication rate, used on over 100 million women. The use of IUD may cause complications

from slight discomfort to sepsis leading to death. Uterine perforation by an IUD is an uncommon
complication; incidence is 13 in 1000 applications. However, transvesical migration or
misplacement of an IUD is a very rare complication with a high ratio of calculi formation. The
aim of this case report is to show that persistent lower urinary tract symptoms (LUTS) of a
woman with IUD may be associated with intravesical migration and stone formation in bladder.
(http://www.hindawi.com/journals/criu/2015/581697/)
Injectable
Accourding to Spevack E., The Long-term Health Implications of Depo-Provera, the
reproductive health of adolescents and young adults is a major determinant of their future wellbeing. While Depo-Provera, or depot medroxyprogesterone acetate (DMPA), is highly effective
at preventing pregnancy, mounting evidence suggests that its side effects may have a negative
impact on long-term health. Together with mood changes, weight gain, menstrual irregularities,
and delayed return to fertility, recent data indicate a correlation between DMPA use and an
increased risk of fracture and HIV infection. These results have intensified concern about
whether the benefits of DMPA outweigh the long-term risks. This paper reviews the health
implications of DMPA and recommends alternative contraceptive methods that may have more
favorable outcomes. (http://www.imjournal.com/)
Bilateral Tubal Ligation
Tubal sterilization procedures are designed to be permanent, proper patient counseling
and informed consent is of paramount importance preoperatively in preparing the patient for a
sterilization procedure. There must be no contraindications to elective surgery. The decision for
sterilization should be made on an entirely voluntary basis following appropriate discussion

regarding risks, benefits, and alternatives. Patients should understand that tubal sterilization is
intended to be permanent and if they are not sure of their decision, there are effective long-acting
reversible contraceptive methods (such as implants and intrauterine contraceptives) that have
failure rates as good as or better than permanent surgical sterilization. (http://www.glowm.com/)
According to Lutala, P. (2011), Tubal ligation is the most popular family planning
method worldwide. While its benefits, such as effectiveness in protecting against pregnancies,
minimal need for long-term follow-up and low side-effects profile are well documented, it has
many reported complications. However, to date, these complications have not been described by
residents in Congo. Therefore, the study aimed at exploring the experience of women who had
undergone tubal ligation, focusing on perceptions of physical, psychological and contextual
experiences of participants.
Review of Local Literature
Natural Family Planning
According to Tan (2007) of Manila Bulletin in her article on natural method of family
planning, stated some natural techniques on how to prevent unintentional children. First is
abstinence, the avoidance of sexual activity. It is the most effective natural method of family
planning. Second, the calendar or rhythm method, it is suitable for women with regular 28 to 30
days cycle. The patient is aware of her safe and unsafe period in her regular monthly menstrual
cycle. The safe period includes 8 days of her monthly period, (beginning on the first day of her
menses) and 8 days before her expected menses of succeeding cycle. The days inclusive of these
periods are safe for unprotected sexual activity. The unsafe periods starts from the 9th day to the
21st day of menstrual cycle. The fertile period or ovulation of the woman is included in the

unsafe period. She is likely to get pregnant if she engages in sexual activity without any form of
contraception. During ovulation, the woman may observe moderate amount of slippery raw eggwhite like discharge.. I believe almost of every mature adult is familiar with its use. It is
disposable and never reusable. Fourth is the withdrawal method or coitus interruptus. This
method requires the withdrawal of the male sex organ prior to ejaculation during sexual act.
Ejaculation is achieved outside the female sex organ. This is the most unreliable method of
family planning. It requires good control of sexual emotions on the part of the male partner.
Small amounts of pre-ejaculatory seminal fluid may be released in the course of sexual act that
can lead to unexpected pregnancy. You should know your family planning methods and practices
responsible parenthood. No to ABORTION! Every child born is a gift of love. May we always be
delighted in Gods glorious mercy on us.
According to Ong (2013) of Philippine Star, in her article about natural family planning
method weve visited a poor family living beside the Sta. Mesa railway. They have seven
children, all with tuberculosis. The father and mother also have TB. We helped them for a span
of six months. The last time I saw them, the mother was again pregnant with her eighth child.
She confessed that she didnt know how to stop having babies. The only method approved by the
Catholic Church is the natural form of family planning. This method relies on the couples ability
to determine whether the woman is fertile or not. The womans fertile period occurs in the
middle of the menstrual cycle, from around 72 hours before ovulation (the regular release of the
female egg from the ovary) up to 24 hours after ovulation. Highly motivated couples can use this
method effectively.

Standard Days Method


According to Pallone and Bergus, the SDM and TDM are conducive to physician officebased instruction because they are simple to teach and ordinarily can be taught during a standard
15-minute clinic appointment. Information about instruction or becoming a certified instructor in
FABMs/NFP can be found through the method specific web sites and many of these are faithbased groups. Some practices employ a teacher to whom they can refer patients. Additional
courses are often offered through local churches, particularly if they are Catholic, and can
sometimes be found at local hospitals. (http://www.jabfm.org/)
As mentioned in a previous article on family planning in the Philippines, birth control
and sex education in this Catholic country can be difficult to come by. To combat this problem,
one city started requiring family planning courses for all couples planning to get married. In
Marakina City engaged couples attend courses on responsible parenting and go to a health center
to discuss their birth control options. There they are offered a full range of family planning
options from hormonal methods to natural methods such as the Standard Days Method using
CycleBeads. The couples receive their preferred contraceptive option free of charge from the
city through donations from the United Nations Population Fund, the Department of Health, and
other donors. After the couples are married, Family Health volunteers visit their homes to answer
questions and provide support. (http://www.cyclebeads.com/)
Basal Body Temperature
According to Pallone and Bergus, Basal body temperature (BBT) elevation, another older
method, retrospectively identifies fertility. The luteinizing hormone surge, which stimulates
ovulation, is associated with a 0.5- to 1F- (0.3- to 0.6C-) rise in BBT measured with highly

standardized methods. BBT can be taken orally, vaginally, or rectally with a sensitive
thermometer; the same site should be used daily. BBT is measured on awakening at
approximately the same time every morning, before getting out of bed or doing any other
activity. At least 6 hours of uninterrupted sleep the preceding night is necessary for accurate
measurement. BBT remains elevated throughout the luteal phase secondary to higher
progesterone levels. The woman is assumed to have ovulated after observing 3 consecutive days
of temperature elevation. Pregnancy is avoided by abstaining from the beginning of menstruation
until 3 to 4 days after the rise in BBT. All subsequent days until the beginning of her next menses
are considered infertile.
Because sperm survive 5 days, BBT alone does not predict ovulation far enough in
advance to identify all the potentially fertile days; it predicts only peak fertility, so thus the need
to abstain from the beginning of menstruation. Many other factors also limit the use of BBT.
Some women ovulate without a clear rise in BBT. Alcohol consumption, late nights or
oversleeping, disrupted sleep, travel, time zone differences, holidays, shift work, stress, illness,
gynecologic disorders and medications can all lead to inaccurate basal temperature measurement.
Moreover, the biphasic shift of BBT has been found to vary up to 1 day before and 3 days after
actual

ovulation.

Extensive

reviews

of

BBT

have

been

conducted

elsewhere.

(http://www.jabfm.org/)

According to Ong (2013), of Philstar, For most women, there is a slight rise in
temperature just after ovulation. The woman has to take and record her temperature every
morning, once she wakes up and before doing anything. For example, from an average of 36.5
degrees Centigrade during non-ovulation period, her temperature can rise 0.3 to 0.5 degrees
Centigrade during ovulation. For this method, you need to buy a special thermometer called a

basal thermometer, or an electronic thermometer. Remember, the woman is unsafe up to four


days after the rise in temperature, and four days before the rise in temperature. Hence, because
the temperature will rise only after ovulation, this method is not effective when used alone.
Review of Related Studies
Foreign Studies
Family Planning
Contraceptive use has increased in many parts of the world, especially in Asia and Latin
America, but continues to be low in sub-Saharan Africa. Globally, use of modern contraception
has risen slightly, from 54% in 1990 to 57.4% in 2014. Regionally, the proportion of women
aged 1549 reporting use of a modern contraceptive method has risen minimally or plateaued
between 2008 and 2014. In Africa it went from 23.6% to 27.6%, in Asia it has raised slightly
from 60.9% to 61.6%, and in Latin America and the Caribbean it rose slightly from 66.7% to
67.0%.
Use of contraception by men makes up a relatively small subset of the above prevalence
rates. The modern contraceptive methods for men are limited to male condoms and sterilization
(vasectomy). (who.int)
Family planning should have its importance in reducing maternal mortality according to
Thana (1995). She stated that at least half a million women die each year of pregnancy-related
causes. Ninety-nine percent (99%) live in developing countries. Two approaches can reduce
these deaths. First, make pregnancy and delivery safer once women become pregnant; second
reduce number of pregnancies through family planning. Family planning reduces maternal

mortality in several ways. At the individual level, family planning reduces number of times a
woman becomes pregnant. Generally speaking, women of higher parity face greater risks in
pregnancy. For, example, a woman who has been pregnant six times has twice the risk of dying a
maternal death as women who has been pregnant for only three times. Family planning reduces
the number of unintended and unwanted pregnancies. Unwanted pregnancies are far more likely
to end in induced abortion, and are far less likely to receive adequate prenatal care than wanted
pregnancies. In some situations, abortions account for up to half of all pregnancy-related deaths.
The potential for family planning to reduce these deaths is very great. At the national level,
family planning reduces the number of pregnancies and births. Even without any improvement in
obstetric care a 10% reduction in the number of pregnancies will produce a 10% (or greater)
reduction in the number of maternal deaths. Family planning can be targeted to reduce the
number of pregnancies to women in groups at increased risk maternal death, that is women who
are too young (<20), too old (>35 or >39), or women who are high parity (more than 5 previous
births). By far the most important way of reducing maternal deaths is simply y reducing the
number of pregnancies. By itself, this is very effective. But it is important to pay simultaneous
attention to improving obstetric care. Most women want have at least two children, and they
should have good quality care during pregnancy and for delivery. Ideally, these two
interventions, family planning and obstetric care should go hand in hand.
Natural Family Planning
According to the study of Gray, R. H., Epidemiological studies of natural family
planning. The prevalence of the use of natural family planning (NFP) can be estimated from
sample surveys of married women in the reproductive ages (MWRA). Surveys in developed and
developing countries during the past decade indicate that the prevalence of NFP use varies from

0 to 11%. In addition, if one considers NFP use in relation to other contraceptive methods, the
percentage of all current contraceptors who use NFP varies from 1 to 35%. This suggests that
NFP is an important method in certain countries. Pregnancy rates for NFP vary widely, but most
reliable studies report 1-year life-table pregnancy rates between 10 and 25/100 woman-years.
The Billings ovulation method consistently has higher pregnancy rates than the sympto-thermal
method and NFP users generally have among the highest pregnancy rates compared to other
methods. The major safety issue concerning NFP is the risk of adverse pregnancy outcomes
associated with aged gametes. There are suggestions from a number of investigations that
conceptions distant from ovulation have a higher risk of spontaneous abortion and a higher
proportion of male births. The findings with respect to birth defects or multiple pregnancies are
less consistent, although some studies have reported an increased risk of chromosomal
anomalies. (http://www.ncbi.nlm.nih.gov/pubmed/3170708)
Standard Days Method
According to the study of Arevalo M. et al., Contraception, In efficacy studies
conducted in several countries, researchers found that when used correctly the Standard Days
Method is more than 95% effective in helping women avoid pregnancy. This means that fewer
than 5 of every 100 women who keep track of their cycle days and do not have unprotected
intercourse on Days 8 through 19 of their cycles became pregnant during the first year of using
the Standard Days Method. The research also found that women who do not keep careful track of
their cycle days or have unprotected intercourse on Days 8 through 19 of their cycles, are much
more likely to get pregnant. When women sometimes used the method correctly, but sometimes
had unprotected intercourse on Days 8 through 19, 12 out of 100 got pregnant during their first
year of use. This means that in "typical use" the methods effectiveness is approximately 88%.

Lactational Amenorrhea Method


Based on the Fertility Awareness study in Italy, for years, scientists have recommended
using lactational amenorrhea as a method of fertility regulation. However, until the new research
was analyzed, the scientific basis for using breastfeeding for reliable contraception had not been
firmly established. To use LAM correctly, a woman must remain amenorrheic (no menstrual
bleeding) since delivery, fully or nearly fully breastfeed, and be within six months of delivery.
When any of these three criteria changes, the woman should begin immediately to use another
family planning method if she wishes to prevent pregnancy. The research indicates that
lengthening the six-month criterion to nine or even 12 months after delivery might be possible
under certain conditions, although more research is necessary before changing this criterion.
During breastfeeding, ovulation (the release of an egg) is inhibited by a series of physiological
responses to nipple stimulation. More frequent or intense suckling sends nerve impulses to the
mother's hypothalamus in her brain, which in turn inhibits ovarian activity. When breastfeeding
diminish and the chance of ovulation rises. (www.un.org)
Based on the study of Kennedy Kl, methods of natural family planning are sometimes
difficult for women to use during lactation. When this is so, the lactational amenorrhea method
may prove useful. Researchers agree that a fully breastfeeding woman who is amenorrheic is
98% protected from pregnancy for up to 6 months after delivery. The fertility status of 74 users
of natural family planning during the time they would have been protected by the lactational
amenorrhea method is examined. Underlying hormonal profiles show that there was little ovarian
activity during this time. Eight ovulatory events occurred during the period of protection by the
lactational amenorrhea method, of which four fulfilled minimum criteria for adequacy; there
were no pregnancies during this period. However, some women did report experiencing fertile

mucus symptoms during this time that were often unrelated to estrogen production. Using the
lactational amenorrhea method rather than natural family planning allows them to avoid
unnecessary abstinence. (http://www.ncbi.nlm.nih.gov/)
Artificial Family Planning
Matlab, Bangladesh in 1990, Contraceptive use. According to Matlab Bangladesh in his
study on Family Planning stated that family planning prevalence has risen to 57% in the maternal
and child health/family planning project area. Between 1984 and 1990 significant increases were
registered in the proportions of women using contraceptives for the purposes of spacing and
limiting births.
In 1990, he found out that fertility control in the intervention area had become so widely
diffused that educational differentials in contraceptive practice were no longer evident. Although
significant gains in contraceptive use were also evident in the neighboring comparison is during
this period, at 27%, prevalence there still remained substantially below the levels in the
intervention are. The disparity in contraceptive use between the two areas is adequately
explained neither by differences in socioeconomic conditions nor in the demand for family
planning, but rather by differences in the intensity, coverage and overall quality of their family
planning programs.
Lichtman, Simpson, Rosefield et. al. (2003), Pregnancy, Birth and Family Planning
emphasized that family planning is the way of controlling the population in the country.
According to their study, the human beings have attempted to control their numbers. Some
method of family limitation has always been employed. These methods have included celibacy,
often through taboos, abortion, or simple means of contraception. The average woman who

begins her reproductive life as young as age 17 or 18 and makes no effort at family planning will
have thirteen children.
They found out that in recent years this degree of unrestrained fertility has been met only
occasionally. Today in this country it is seen in religious group such as the hutterites and Hasidic
jews. The ability to control reproduction effectively, however, and the freedom from fear that
your children will die in childhood are relatively recent occurrences in history of our species.
These advances have changed the lives of human beings as significantly as any medical or
technological innovation.
Family planning should have its importance in reducing maternal mortality according to
Thana (1995). She stated that at least half a million women die each year of pregnancy-related
causes. Ninety-nine percent (99%) live in developing countries. Two approaches can reduce
these deaths. First, make pregnancy and delivery safer once women become pregnant; second
reduce number of pregnancies through family planning. Family planning reduces maternal
mortality in several ways. At the individual level, family planning reduces number of times a
woman becomes pregnant. Generally speaking, women of higher parity face greater risks in
pregnancy. For, example, a woman who has been pregnant six times has twice the risk of dying a
maternal death as women who has been pregnant for only three times. Family planning reduces
the number of unintended and unwanted pregnancies. Unwanted pregnancies are far more likely
to end in induced abortion, and are far less likely to receive adequate prenatal care than wanted
pregnancies. In some situations, abortions account for up to half of all pregnancy-related deaths.
The potential for family planning to reduce these deaths is very great. At the national level,
family planning reduces the number of pregnancies and births. Even without any improvement in
obstetric care a 10% reduction in the number of pregnancies will produce a 10% (or greater)

reduction in the number of maternal deaths. Family planning can be targeted to reduce the
number of pregnancies to women in groups at increased risk maternal death, that is women who
are too young (<20), too old (>35 or >39), or women who are high parity (more than 5 previous
births). By far the most important way of reducing maternal deaths is simply reducing the
number of pregnancies. By itself, this is very effective. But it is important to pay simultaneous
attention to improving obstetric care. Most women want have at least two children, and they
should have good quality care during pregnancy and for delivery. Ideally, these two
interventions, family planning and obstetric care should go hand in hand.
Its not the most common side effect, but its not unheard of either: For some women,
birth-control pills dull their libido to the extent that they defeat the purpose of taking it in the first
place. An Indiana University study presented this week at the American Public Health
Associations annual meeting examined the sexual side effects of all hormonal forms of birth
control through a survey of 1,101 women, half of whom were using non-hormonal contraception.
The women using the pill and other hormonal methods reported feeling generally less sexy than
those using non-hormonal protection. They had fewer orgasms and less-frequent sex, and found
it more difficult to get aroused. The pill is the most popular method of contraception in the
country, but it comes with a laundry list of possible side effects, from irksome nausea to breast
tenderness. It also carries a rare risk of heart attack, stroke, blood clots, high blood pressure, liver
tumors, and gallstones. (http://www.thedailybeast.com/articles)
User satisfaction and the physical and psychological effects of five commonly used
contraceptive methods were investigated in a population survey among 1466 West German
women. The focus was on effects attributed by current and past users to these methods, rather
than objectively assessed effects, to shed further light on personal experiences that are highly

relevant to the user but often remain unknown to prescribers and unreported in the medical
literature. Within the overall sample, 1303 women were surveyed concerning their current or past
use of oral contraceptives (OC), 996 regarding condoms, 342 with respect to intrauterine devices
(IUD), 428 in regard to natural family planning (NFP), and 139 in relation to sterilization
(respondents completed questions about each method used). It emerged that satisfaction was
greatest with sterilization (92% of users), followed by OC (68% of ever users), IUD (59%), NFP
(43%), and condoms (30%). Almost one in three NFP users had experienced an unwanted
pregnancy during use of this method, as compared with one in 20 OC and condom users. The
majority of users reported no mood changes during use of the methods studied. The percentages
reporting negative mood changes (various items were scored) were up to 16% among OC users,
23% among condom users, and 30% among NFP users. The latter observations suggested that
subjective side effects of a contraceptive agent on mood generally reflected, at least in part, the
user's sense of confidence in the method concerned (notably, with regard to efficacy and safety).
Oral contraceptives, IUD, and sterilization had a broadly positive impact on sex life, whereas
that of condoms was often negative. Whereas OC users often reported less heavy and painful
menstruation (in up to 56% of cases), IUD were associated with heavier, prolonged, and more
painful menstruation (in up to 65% of cases), as also was sterilization, although to a lesser extent
(in up to 32% of cases). Overall, the study findings indicated that OC and sterilization had less
negative impact on physical and psychological functioning than the other methods studied, in
contrast to what the general public often believes. (pubmed.gov)

Local Studies
Natural Family Planning
A look back at natural planning by Julio Miguel Chavez, Junior Researcher, according to
his studies, a population of 86 million and growing, the Philippines needs to implement a sound
population policy which is deemed crucial to a countrys development.
In a discussion paper, economists from the UP School of Economics (UPSE) maintain
that although rapid population growth is not the countrys main problem, it nevertheless
exacerbates poverty.
They contend that an unequivocal and coherent national population policy backed by a
strong family planning program that provides relevant information and enables access to
contraceptives, is crucial to eradicating poverty and, ultimately, promoting economic
development.
To his day, however, many Filipino women and couples still do not have access to
various tolls for them to improve their sexual and reproductive health.
A joint study by the UP Population Institute and the Guttmacher Institute (UPPIGuttmacher) finds that more than half of all pregnancies in the country are unintended and that
the incidence of unintended pregnancies occurs more than often with women in the poorest fifths
of the Philippine population.
Sadly, the national government has been to promote a program to address this pressing
problem adequately. As was pointed out by the UP economists, the Catholic Churchs hand-lines
stance against modern family planning methods, plus pressures from interest groups, has

prevented the g debate still unresolved, it is but apt to ask how else the government can address
the population issue.
The current administration advocates various natural family planning (NFP) methods.
According to the handbook released by Population Commission (Popcom) on responsible
parenting, The NFP methods require couples to constantly observe the changes in the womans
body during her menstrual cycle to determine when it is right for them to have sexual
intercourse, whether they intend to have a child or not.
The handbook further highlights the advantages of the NFP program, asserting that it is
simple to learn, highly effective, and relatively inexpensive. Most important, the handbook
elaborates the role NFP plays in fostering positive communication between couples which, in
turn, leads to better relationships.
As a concrete illustration of NFP, we focus on the lactational amenorrhea methods, or
LAM, which is based on the physiology of breastfeeding.
Breastfeeding in the Philippines, information from the internet emphasize a Data from the
2003 National Demographic and Health Survey (NDHS) indicate that on average, the duration
for exclusive breastfeeding of a Filipino bay is 24 days, down from 1.4 months in 1998. The
NDHS also showed that only 16.1% of babies are exclusively breastfeeding for 45 months of
age, and only 1.6% of babies are breastfed for 6-7 months.
Research on the determinants of breastfeeding in the Philippines also underscores the
lack of a breastfeeding culture in the country. Although breast milk is widely regarded as
superior over typical baby formulation, Filipino women, especially the poor often regard breast
milk as inferior to commercial milk formula: Research indicates that they would rather feed their

babies with formula instead of breast milk if they had the money; Breastfeeding is also seen by
women as a costly activity: a 1990 research by Williamson indicates that breastfeeding
declines as a mothers educational level increases. The same study also notes that mothers with
modern jobs breastfeed the least, among employed and non-employed mothers. Tanaka
hypothesizes that this might probably be due to the opportunity cost of a Filipino mothers time
that comes with an increase in educational attainment, or the demands of the workplace.
Family planning has its economic and psychosocial influences on the lives of women in
Western Visayas, this research was conducted by the Social Science Research Institute, Central
Philippines University, in collaboration with the Womens Resource Center and the Family
Planning Organization of the Philippines. The principal investigators were Dr. Chin. Research
was supported by the Womens Study Project at Family Health International, through a
cooperative agreement funded by the U.S. Agency of International Development. Technical
assistance was provided by Dr. Eilene Bisgrove. Researchers interviewed 1,100 marries woman
of reproductive age, plus 50 key informants. Investigators also conducted nine pre-survey and 27
post-survey focus group discussions with women, men, community leaders, members of
womens group, and family planning service providers. Both rural and urban residents took part
in the study.
More than half of the women interviewed currently use contraception or had used family
planning at some point. 37 % are current users. The most popular are the pill, tubal ligation, and
injections while the most unpopular are male-oriented methods condoms and vasectomy. The
most common reason for choice of family planning methods was effectiveness, while the most
often cited side effects was dizziness. In focus group discussions, men and women expressed fear
about contraceptive side effects and gave this concern as a reason for not using family planning.

Family planning users were most likely to engage on paid work than were non-users.
Family planning use provided increased economic opportunities for women, including
opportunities to earn a living and to become more efficient workers.
Women who used family planning were more likely to participate in community
activities, such as Parent-Teacher Associations, religious organizations and beautification
projects. Women found community activities relaxing, and said these activities allowed them to
socialize and interact with their peers. Women reported that social participation gave them
satisfaction and increased their sense of self-worth.
More family planning users than non-users shared decision-making with their husbands in four
areas: the womans work outside the home; the womans travel outside the community; use of
family planning; and plans for future births. Non-users were more likely to report that their
husbands made decisions independently in the four areas.
More than one-third of the women reported they had been victims of physical abuse,
psychological abuse, or both. Most domestic violence happened when the perpetrator (usually
the husband) had been drinking. Among the perceived causes violence were jealousy, quarrels
due to suspected infidelity, and arguments over financial and other family matters. The most
common reported acts of physical abuse were beating, punching, slapping and kicking.
Contraceptive use did not reduce womens risks of violence, nor did work status.
There should be continuous efforts to improve the family planning program, including an effort
to provide integrated reproductive health. Special attention needs to be given to helping women
deal with side effects. Because of demands on womens time at home and in the workplace,
health services should be offered at times (and places) convenient to women; for example, on

weekends or after normal business hours. Policy-makers should be concerned about the need for
more employment opportunities for women, and should encourage women to take on greater
leadership roles in the community. Community leaders should develop strategies to minimize
and eliminate domestic violence and should develop referral system to respond to victims need
in a timely manner.