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How Natural Family How Natural Family Planning Fits into the Title X Planning Fits into the Title X

ProgramProgram

OFP Family Planning Research Grantee MeetingOFP Family Planning Research Grantee MeetingJanuary 14-15, 2009 January 14-15, 2009

Washington, DC Washington, DC 

Jule Hallerdin, MN, MPH, CNMJule Hallerdin, MN, MPH, CNMNurse Consultant Nurse Consultant

Office Family PlanningOffice Family PlanningOffice of Population AffairsOffice of Population Affairs

Family Planning and Public Family Planning and Public HealthHealth

1800-19001800-1900 Family size declined from 7.0 to 3.5Family size declined from 7.0 to 3.5

19001900• Six to nine of every 1000 women died in Six to nine of every 1000 women died in

childbirthchildbirth• One in five children died during the first 5 One in five children died during the first 5

years of lifeyears 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 Family Planning and Public HealthHealth

• 19001900 Distributing information and counseling Distributing information and counseling

patients about contraception and patients about contraception and contraception devices was illegal under contraception devices was illegal under federal and state lawsfederal and state laws

The timing of ovulation, the length of the The timing of ovulation, the length of the fertile period and other reproductive facts fertile period and other reproductive facts were unknownwere unknown

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Personal ExamplesPersonal Examples

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Family Planning and Public Family Planning and Public HealthHealth

• 19121912 The modern birth-control movement beganThe modern birth-control movement began Margaret Sanger initiated efforts to circulate Margaret Sanger initiated efforts to circulate

information about and provide access to information about and provide access to contraceptioncontraception

• 19161916 Sanger challenged the laws that suppressed Sanger challenged the laws that suppressed

the distribution of family planning the distribution of family planning information by opening the first family information by opening the first family planning clinic in Brooklyn, New Yorkplanning clinic in Brooklyn, New York

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Family Planning and Public Family Planning and Public HealthHealth

• The police closed her clinic, but the The police closed her clinic, but the court challenges that followed court challenges that followed established a legal precedent that established a legal precedent that allowed physicians to provide advice on allowed physicians to provide advice on contraception for health reasonscontraception for health reasons

• 1930’s- a few state health departments 1930’s- a few state health departments and public hospitals had begun to and public hospitals had begun to provide family planning servicesprovide family planning services

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Family Planning and Public Family Planning and Public HealthHealth

• 1940-19571940-1957

Family size increased average number of Family size increased average number of children per family peaked at 3.7children per family peaked at 3.7

1960- the era of of modern contraception 1960- the era of of modern contraception began – birth control pill and Intrauterine began – birth control pill and Intrauterine device became availabledevice became available

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Family Planning and Public Family Planning and Public HealthHealth

1965- Pill became the most popular method 1965- Pill became the most popular method followed by the condom and contraceptive followed by the condom and contraceptive sterilizationsterilization

1965 Supreme Court (Griswold vs 1965 Supreme Court (Griswold vs Connecticut) struck down stat laws Connecticut) struck down stat laws prohibiting contraceptive use by married prohibiting contraceptive use by married couplescouples

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Milestones in Family PlanningMilestones in Family Planning

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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

Milestones in Family PlanningMilestones in Family Planning

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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 OFPHistory of Natural Family Planning in OFP

Office of Family Planning:Office of Family Planning:• Guided by the Law, Regulations, and Guided by the Law, Regulations, and

Guidelines:Guidelines:

Congress enacted the Family Planning Congress enacted the Family Planning Services and Population Research Act of Services and Population Research Act of 1970 (Public Law 91-572), which added Title 1970 (Public Law 91-572), which added Title X, “Population Research and Voluntary X, “Population Research and Voluntary Family Planning Programs” to the Public Family Planning Programs” to the Public Health Service Act.Health Service Act.

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Natural Family PlanningNatural Family Planning

Section 1001 of the Act authorizes Section 1001 of the Act authorizes grants “to assist in the establishment grants “to assist in the establishment and operation of voluntary family and operation of voluntary family planning projects which shall offer a planning projects which shall offer a broad range of acceptable and broad range of acceptable and effective family planning methods effective family planning methods and services (and services (including natural family including natural family planning methodsplanning methods, infertility services , infertility services and services for adolescents)”and services for adolescents)”

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Natural Family PlanningNatural Family Planning

The mission of Title X is to provide The mission of Title X is to provide individuals the information and individuals the information and means to exercise personal choice in means to exercise personal choice in determining the number and spacing determining the number and spacing of their children.of their children.

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Natural Family PlanningNatural Family Planning Natural Family Planning was one of the topics for Natural Family Planning was one of the topics for

which family planning research was solicited which family planning research was solicited from 1985-1998:from 1985-1998:• Topics included:Topics included:

Family Planning client behaviorFamily Planning client behavior Adolescent family planning clientsAdolescent family planning clients Male family planning clients Male family planning clients Targeting of family planning servicesTargeting of family planning services Clinic personnel behaviorClinic personnel behavior Organization and management of family planning Organization and management of family planning

servicesservices Role of private physiciansRole of private physicians Natural family planningNatural family planning Infertility servicesInfertility services Counseling servicesCounseling services

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Natural Family PlanningNatural Family Planning

Title X Service Delivery Improvement projects on Title X Service Delivery Improvement projects on the topic of Natural Family Planning:the topic of Natural Family Planning:

• 19891989• John R. WeeksJohn R. Weeks• Factors Affecting Factors Affecting

the Choice of the Choice of Natural Family Natural Family PlanningPlanning

• 19891989• Don KramerDon Kramer• Natural Family Natural Family

Planning Program Planning Program Format Format EffectivenessEffectiveness

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Natural Family Planning Program Natural Family Planning Program Format EffectivenessFormat Effectiveness

1989- Don Kramer1989- Don Kramer• Summary of findings:Summary of findings:

Team Teaching format 36% more cost efficient than Team Teaching format 36% more cost efficient than the Creighton Model for instructing clients in the the Creighton Model for instructing clients in the Ovulation method of NFP. Ovulation method of NFP.

Actual cost of service delivery for the Team Teaching Actual cost of service delivery for the Team Teaching format client was 64% of the cost of a Creighton format client was 64% of the cost of a Creighton model format clientmodel format client

Both formats produced extremely similar results, in a Both formats produced extremely similar results, in a broad array of relevant outcome variables, including broad array of relevant outcome variables, including continuation and pregnancy rates. continuation and pregnancy rates.

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Factors Affecting the Choice of Factors Affecting the Choice of Natural Family PlanningNatural Family Planning

1989-John Weeks1989-John Weeks• Summary of findings:Summary of findings:

Private OB/GYN physicians were the least Private OB/GYN physicians were the least informed about NFP, and just over one-third informed about NFP, and just over one-third knew about all three methods. knew about all three methods.

NFP-only providers had the most knowledge, NFP-only providers had the most knowledge, while clinic providers and administrators while clinic providers and administrators were in between. were in between.

The single most identifiable barrier to the The single most identifiable barrier to the availability of NFP is skepticism among availability of NFP is skepticism among physicians about its use and effectiveness. physicians about its use and effectiveness.

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Examples of Title X Training Examples of Title X Training Centers Focus on NFPCenters Focus on NFP

Region VII Development Systems, Inc.Region VII Development Systems, Inc.Kansas City, MO Kansas City, MO

• NFP and Fertility Awareness: A NFP and Fertility Awareness: A conference call discussion for Title X conference call discussion for Title X clinicians about non-hormonal clinicians about non-hormonal contraception - held 4/10/08contraception - held 4/10/08

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Examples of Title X Training Examples of Title X Training Centers Focus on NFPCenters Focus on NFP

Region III -TRAINING 3, Family Planning Region III -TRAINING 3, Family Planning Council, Inc.Council, Inc.Philadelphia, PAPhiladelphia, PA

• Planning a 2 hour on-line interactive Planning a 2 hour on-line interactive training for clinicians on Fertility training for clinicians on Fertility Awareness – projected date 6/30/09Awareness – projected date 6/30/09

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How Natural Family Planning Fits into How Natural Family Planning Fits into the Title X Programthe Title X Program

NFP is a statutory requirement (FP Method)NFP is a statutory requirement (FP Method)

NFP is not widely used NFP is not widely used

Need to find out why the method is not used Need to find out why the method is not used moremore

Provide accurate information to providers that will Provide accurate information to providers that will enhance provision of NFP counselingenhance provision of NFP counseling

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Review of Program Goals for NFP Review of Program Goals for NFP GranteesGrantees

Contribute to:Contribute to:• Improved health outcomesImproved health outcomes• Increased utilization of preventive Increased utilization of preventive

health care- particularly among health care- particularly among vulnerable and special needs vulnerable and special needs populationspopulations

• Increasing the proportion of pregnancies Increasing the proportion of pregnancies that are intendedthat are intended

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Natural Family PlanningNatural Family Planning

Questions?Questions?