Physicians' views of periodic abstinence methods: a study in four countries.

A study of the knowledge, perceptions, and behavioral intentions of physicians regarding periodic abstinence (PA) methods was undertaken in Mauritius, Peru, the Philippines, and Sri Lanka. Most respondents considered PA to be useful, although even the PA providers prescribed mainly non-PA methods. Detailed knowledge of PA methods was not evident, but most physicians were willing to initiate general discussion about PA with patients. Physicians favored methods perceived as "scientific" and "modern," which primarily prevent pregnancy and secondarily avoid other health risks. When carefully presented as "scientific" and "modern," methods presented to medical audiences may find acceptance and be more likely to result in referral.

PIP: This study attempts to assess the level of knowledge about periodic abstinence methods and willingness to communicate that knowledge to patients among a sample of 375 physicians from 4 developing countries: Mauritius, Peru, the Philippines, and Sri Lanka. For purposes of this study, periodic abstinence includes the calendar method (rhythm), the Billings method (ovulation method), the temperature method (basal body temperature), and the sympto-thermal method (temperature and cervical mucus observation). 54% of the doctors interviewed did not provide periodic abstinence services. 67% were male, 60% were over 40, 92% were not strongly Catholic, and 42% were general practitioners. Older doctors, female doctors, and strongly Catholic doctors were most likely to provide periodic abstinence services. 54% of providers were general practitioners, 46% were gynecologists, and 36% were clinicians. Both providers and nonproviders were most likely to recommend the pill or the IUD as a contraceptive method. The calendar method was the most commonly provided abstinence method. Providers, in general, had more knowledge about abstinence methods than did nonproviders, but even providers were deficient in knowledge about methods that they did not supply. Of the 3 main abstinence methods, the calendar method was perceived as most traditional, the Billings method as most modern. The sympto-thermal method was perceived as modern but also as "artificial." On a scale of 1 to 7 from bad/nonscientific to good/scientific, the pill scored highest (6.4), while the temperature, Billings, and calendar methods scored 5.2 or 5.1. 47% of all the physicians surveyed said that they would not recommend periodic abstinence to their patients. The majority said that they would respond to inquiries about these methods but would not initiate discussions about them. Among nonproviders, 12% said they would seek future training, but 17% said they had no future plans for either training or service.

[Periodic abstinence: its possibilities]. / La abstinencia periodica: sus posibilidades.

PIP: Experience with family planning mehods requiring periodic sexual abstinence has been varied. During the last decade interest has centered on 2 methods, the cervical mucus and the sympto-thermal, which are based on identifying the onset of the fertile period. During the 1970s, the Australian physicians John and Evelyn Billings developed the cervical mucus method, in which changes in the quanitity and characteristics of cervical mucus are used to determine the moment of ovulation. The sympto-thermal method depends on identification of the slight rise in basal body temperature that occurs in the latter part of the menstrual cycle as well as cervical mucus changes and sometimes the calendar to determine the fertile period. The Catholic Church has been the main proponent of periodic abstinence methods, but since 1973 the World Health Organization has invested US$3.3 million on research in such methods. The Billings method requires differentiating between dry, wet, and very wet mucus in the vagina and between different consistencies of mucus. The method ususally requires 1-3 months for instruction and sexual abstinence is usually recommended for the 1st month. The average number of days of required abstinence was 9 in a study of 66 women and 15-18 in a study of 870 women. Many women with short menstrual cycles do not experience postmenstrual dry days, in which case abstinence may be required as many as 13 days out of 23. 18.8% of users of periodic abstinence methods in 1 North American study became pregnant in the 1st year, but most were using the calendar method. Women who desired to terminate childbearing had only about 1/2 as many failures with periodic abstinence methods as did women wishing to postpone a birth.^ieng