| Abstract: | The efficacy, the ability of Indian women to use the Billings' Ovulation Method, and its effectiveness in helping them to control their fertility was studied in a sample of urban poor living in the Delhi slums. No attempt was made to develop a design which would rigorously test the acceptability of the method because the study was concerned with: the question of the ability of poor women to define fertility and to avoid an unwanted pregnancy by avoiding sexual relations during the fertility period; and the efficacy and use-effectiveness of the modified method which had not been tested. The study, which extended over 36 months, recruited a sample of 5752 eligible acceptors of fertility living in the urban slums. Natural family planning (NFP) use requires recurrent decision making at 2 stages: in the beginning of the menstrual cycle to check for signs of fertility; and to abstain from sexual relations in the fertility period. Age was an important variable in the use of sexual abstinence oriented methods and fertility determining methods. 192 of the acceptors were below 19 years, 1545 between 20-24 years, 2089 between 25-29 years, 1236 between 30-34 years, 520 between 35-39 years, and 170 between 40-44 years. Of 4380 of the 5302 acceptors in Treatment 1 who began to use the method after menstruation, 7 (0.16%) had a profuse discharge and could not distinguish the change in mucus because of cervicitis which was treated in cycle 2. 663 (5.4%) acceptors did not see or feel fertile mucus but noticed patches of infertile mucus throughout the cycle. 419 (69.19%) of them had a family income of less than Rs300 and 25 (3.77%) were open cases of pulmonary tuberculosis. 16 acceptors (0.37%) noticed wetness and lubrication characteristic of fertile type mucus for about 2 hours, 145 (3.31%) for 3-4 hours, and 218 (4.98%) for nearly half a day. 867 (19.79%) had 1 day, 406 (9.27%) 1-1/2 days, 939 (21.44%) for 2 days, 291 (6.64%) 2-1/2 days, 636 (14.52%) for 3 days and 187 (4.27%) 3-1/2 to 4 days of fertile mucus. 1 acceptor had 5 days of fertile mucus. 4 acceptors failed to check regularly and therefore may have missed the fertile period. In Treatment 2 the initial decision to accept the use of the method was made by the 450 husbands before instructing their wives. The continuation rate of 91.86% for 12 months with a standard error of 0.67% was surprisingly high for a sample with low literacy and occupational status, low female work participation rates, small family size and a preference for sons with low motivation to use other methods. There were 9 unplanned pregnancies classified as method failures--pregnancies which occurred in acceptors who followed the method accoring to the instruction but got pregnant. The 1 year efficacy rate (life table analysis) was 99.86%. The 1-year use-effectiveness rate was 97.43% for the 5752 cohort. The high efficacy rate of the method can be due to 2 factors: the correct identification of the fertile mucus; and the ability to clearly distinguish between infertile and fertile mucus. |
