Re: NFP info for patients in the office- long

[Guest guest]

:

Interesting question and problem: i.e., to provide information on NFP and

menstrual cycles and women's health within a professional practice and a short

office visit. Or the broader question of integrating the teaching of NFP in a

busy office practice -- besides referring to certified NFP teachers or do it

yourself as a certified teacher outside of office hours.

Dr. Leo Latz, MD - addressed that problem many years ago (1932) and developed

what he called the three minute " rhythm " method for health professionals

(physicians, nurses, and social workers) to use in a short office visit.

My advice/recommendations - to consider (not knowing the background of your

patients described below:

1. For case one: providing the SDM and the Cyclebeads - for women/couples -- a

method that you can assess and provide in a short visit (if you are not

certified)-- you can through the town University Institute for NFP online

-- http://www.irh.org -- they have an online certification program for health

professionals -- and assessment forms. The SDM can be used as a method -- or as

a method that will lead to further interest in NFP and maybe more complex NFP

methods if needed.

2. For case two: providing the couples with infertility with the use of the

Clearblue Fertility monitor -- you can teach the use of the monitor in 5

minutes. Inverness Medical (Unipath Diagnostics, Inc) will provide you with a

free monitor (I believe) if interested in using with your infertility

couples/clients - a monitor for you as a health professional to learn how to

use. You can also obtain them through E-Bay for a very reasonable price.

Health professionals can purchase them at cost.

3. I have developed a short one page handout to use with the Clearblue to teach

a method of NFP for avoiding or achieving -- takes five minutes to explain -

requires monitor and simple charting system.

4. Suggest reading the upcoming January/February issue of the Journal of Nurse

Midwifery and Women's health.

5. I wish you well with your Creighton Model educational program.

J. Fehring, DNSc, RN

Professor

Marquette University

NFP info for patients in the office- long

I have a couple of questions for those of you who see women and/or

couples professionaly in the office setting.

In the way of a background, I am fairly well versed in the basics of

most methods of NFP, including The Cycle Beads, the Two-day method (a

no brainer for avoiding pregnancy), Billings, & STM.

I am currently an " official " Creighton Model Intern (combined

MC/Midwife/Practitioner program), and this is my favorite for many

reasons, but especially for the diagnostic ability inherent with the

method use.

Anyhow, I am wondering how you approach a woman who for example has

no or very little knowledge of her cycle, NFP etc, but whom seems to

be interested. I normally give a brief overview of an average cycle

of normal fertility, and then briefly explain the various methods

used for NFP, emphasis depending on whether she wants to avoid or

achieve. Invariably this leads to more questions at which point I do

what I can, but am usually well into a 1/2 hour, sometimes 45 minutes

if we had an exam as well. I write down web sites and book info and

depending on the level of interest, give a copy of an STM chart

and/or Billings chart (available off the internet), and info about

Introductory classes for the Creighton Model, but I still leave

feeling like I should do more.

What do you guys do??

A different example happened today...A couple came in for a 1/2hr

appt for " infertility " . The office made it with me because I am the

only person who will touch this area with a 10ft pole (time intensive

and resource intensive). The couple had been " trying " to concieve for

3 yrs. However, they had no real knowledge of a fertility cycle, and

had done no charting past marking when periods started for about a 6

mo period, 2 yrs ago. The woman (28 y/o) related to me a cycle of

what sounded like 45-52 days, and limited mucus- but without seeing a

chart, it is hard to decipher actual mucus in such a long cycle. So,

with this couple, I again did the basics, focusing on signs of

fertility, encouraging them to think really hard about charting and

tracking and fertility focused intercourse. I did sort of a mini-

Creighton inservice of sorts. I don't think at this point it would be

prudent to do blood work, or a semen analysis because I don't think

they have been aware of " when " to try. (and without knowing where

she is in her cycle, the bloodwork wouldn't be very helpful). I

encouraged them to get formal Creighton F/U, including the intro

session...gave them the other resources (STM, etc). So about an hour

later they left armed with some hopefully useful info

Any other ideas?

Another example: A woman comes in for an annual exam. She has a hx of

PCO, is now single (divorced), sometimes sexually active (we had to

do STD testing), is wondering if it is normal for her to " all of the

sudden, for the past year " be having regular periods, tender breasts

and some mood swings and back aches the week before her period. This

woman is on Lamectil, Lexapro AND Wellbutrin daily for mood/anxiety

indications, including depression. I'm thinking I'd LOVE this woman

to do some charting so I can maybe get her off the mess of drugs she

is on, with what may be just hormonal adjustments needed because of

her PCOS. I honestly did not even bring it up in great detail because

this combo of meds seems to be " working " for her (we did discuss

other meds/combo's), but I feel like I've done her a misservice. I

see many such women a week. Most of them smile, nod, and have no

intention of charting for possible health reasons when I do bring it

up.

Do any of you, esp those familiar with the Creighton Model, bring up

options other than those the patient is currently using? (esp if they

don't seem to be working that great!). I just get frustrated and

saddened when I see situations like this where it seems the symptoms

are getting treated to a certain extent, but the real issues are

potentially being ignored.

Forgive the rambling please, but I'm hoping perhaps someone out there

can maybe give ideas for a better or simpler approach, or even just a

different approach. I *really* prefer the Creighton Model in my

setting, but so far without many patients actually charting yet, I

just go by my gut and by what they tell me verbally (I reconstruct

the chart in my head!). On the other hand, I don't feel like I am

giving them the whole picture without mentioning the other methods of

NFP out there that work very well, esp if the intent of the couple is

to avoid pregnancy.

Thanks for any tips you can give!

[Guest guest]

Dear CNM and list,

This situation is really no different in principle than many

other conundrums in medical practice. Someone comes in with

hypertension, depression, or obesity, and the optimal care would be to

discuss diet, exercise, and other lifestyle issues and healthy

habits. But you don't have time to do it adequately in a 20 or

10 minute office visit. So you do the best you can in the time

you have. Further, many, perhaps most, patients don't take you

up on what would be the best or the healthiest route- for example, a

minority will actually exercise when you tell them (truthfully) that

that would be the healthiest possible thing they could do and the

thing that would improve their health the most. Ideally, you

could refer them to a dietician, a counselor, or an exercise trainer

who can take the time they need, but often that is not practical nor

reimbursable. In these situations, which are perhaps the

majority of chronic conditions that people present with, all you can

do is do the best you can within the system you are in, and find ways

to expand and improve the system. If you don't have the

time or some of the other professionals around that you need to

provide optimum care, you simply do what you can, and/or work on

getting those other people around.

So it is with NFP and women's health care that respects

fertility. Yes there are methods of NFP that can be taught

5 or 10 minutes (and they may be better than nothing), but I believe

that the best NFP instruction will not generally fit into office

visits, but should be done as a separate service. It helps to

have the NFP instructor available in the same office or very

accessible close by.

I agree with you that the Creighton Model is optimum for many

health applications, GYN and infertility. The standardized

recording of biomarkers is very helpful.

It has been my observation over the years that roughly 25% of

patients not previously using NFP will respond to my 5-7 minute

recommendation on why it would be healthy to use it. Yes, it

would be nice to have 100%, but 25% is pretty good. Again, to

draw an analogy, only a few percent of patients actually respond to

advice to quit smoking, but it is still worthwhile to give it.

To extend this analogy, it is worth giving the advice over time and

not giving up. Some patients will finally decide to listen to

your recommendation to use NFP after years of mentioning it.

Just hang in there and recommend the best you can to patients

within what is available to you.

Joe Stanford

Do any of you, esp those familiar

with the Creighton Model, bring up

options other than those the patient is currently using? (esp if

they

don't seem to be working that great!). I just get frustrated and

saddened when I see situations like this where it seems the

symptoms

are getting treated to a certain extent, but the real issues

are

potentially being ignored.

--

______________________________

ph B. Stanford, MD, MSPH

Health Research Center

Dept. Family & Prev. Med.

University of Utah

jstanford@...

[Guest guest]

From a patient’s point of view, I

suggest “tricking” them into NFP. I had a friend that was

having trouble getting pregnant, so her OB had her take her temps for a while. He did not do much

explaining why, other than to “check for hormonal irregularities”.

He emphasized this was an inexpensive start to diagnosing the problem.

She never knew it was NFP related (and probably would have been upset to find

that out, as an anti-Catholic avid pill user). I never told her either,

for fear she would quit. Obviously this method might not work if you’re

talking about trying to get a patient off birth control.

It took him very little time to explain

that the temp must be at the same time each day, and to notate any possible “disturbances”

(i.e. illness, alcohol consumption, etc). If she missed the temp time by

an hour or so, he had her take it late and write down the time. I’m

assuming he adjusted for it on his own, although a half-way intelligent woman

could understand how to adjust it herself.

After a few cycles, it turned out she had

a slightly short luteal phase, and he supplemented her with progesterone

through the first trimester. He just had told her to start taking it

after the temperature had been up for three days (though she called the nurses

first so they could confirm the temp shift). She had a healthy baby girl

nine months later.

Obviously this was an easier fix than

some, but after she was used to temp taking, he could have started having her

do mucus charting. Teaching it a little at a time, without ever

mentioning “Natural Family Planning” or the Church or all the

negative (and offensive) things about other infertility treatments or birth

control probably would have led her straight into it without even knowing it.

[Guest guest]

Stanford quote:   “Yes

there are methods of NFP that can be taught 5 or 10 minutes (and they may be

better than nothing), but I believe that the best NFP instruction will not

generally fit into office visits, but should be done as a separate

service. It helps to have the NFP instructor available in the same office

or very accessible close by.”

Dear Dr. Stanford (i.e., Joe):

Thank you for your perspectives on short

NFP methods, but for the sake of conversation (on this NFP discussion list) –

what standards or criteria would you use to define “the best NFP

instruction” -- and why do NFP methods that would only require a short 5 –

10 minutes be only “better than nothing”?

For the most part we are competing with

birth control methods that can be provided in a short office visits – e.g.,

hormonal pills; condoms; depo shots - methods that do not require a lot of

behavioral change.

When Sandrock, CNM mentioned that

the TwoDay method was a “no brainer”, I thought that is a good criterion

for a method of birth control i.e., “simple to use” and I would add

“simple to teach” and according to the latest study - it is

effective in helping couples avoid pregnancy.  If the method is effective in

helping couples to achieve their goal of avoiding pregnancy, it is simple to

use, and it does not separate the unitive from the procreation act, is that not

a good method?  You can reach many people with simple non-complex methods.  Not

always easy to do with complex methods – that require extensive training

of teachers and of the couple users.  And I am not saying that easy is always

the best. 

I would also add that changing behaviors

will occur faster when we can reduce behavior hurdles – like learning

complex methods of NFP and requiring extensive group teaching and/or follow-up. 

I believe that Larry Severy, PhD (psychology professor at the University of Florida) mentioned at the Marquette conference in 2002 – couples would

prefer to use nothing --- but if they have to use something – it needs to

be simple and accurate.  Furthermore, if health professionals could incorporate

teaching a NFP method into their busy office practice – then maybe more health

professionals would and could provide it.

Your thoughts?

Hope all is well.       

J. Fehring

Professor

Marquette University

PS -  please do not take this as an attack

on any one method of NFP --- it is a general comment on modern methods of NFP (OM, STM, etc) – including

the Marquette Model.  We have a hard time getting couples to come to one group

session and a follow-up.    

    

Re:

NFP info for patients in the office- long

Dear CNM and list,

This situation is really no different in principle

than many other conundrums in medical practice. Someone comes in with

hypertension, depression, or obesity, and the optimal care would be to discuss

diet, exercise, and other lifestyle issues and healthy habits. But you

don't have time to do it adequately in a 20 or 10 minute office visit. So

you do the best you can in the time you have. Further, many, perhaps

most, patients don't take you up on what would be the best or the healthiest

route- for example, a minority will actually exercise when you tell them

(truthfully) that that would be the healthiest possible thing they could do and

the thing that would improve their health the most. Ideally, you could

refer them to a dietician, a counselor, or an exercise trainer who can take the

time they need, but often that is not practical nor reimbursable.

In these situations, which are perhaps the majority of chronic conditions that

people present with, all you can do is do the best you can within the system

you are in, and find ways to expand and improve the system. If you

don't have the time or some of the other professionals around that you need to

provide optimum care, you simply do what you can, and/or work on getting those

other people around.

So it is with NFP and women's health care that

respects fertility. Yes there are methods of NFP that can be taught

5 or 10 minutes (and they may be better than nothing), but I believe that the

best NFP instruction will not generally fit into office visits, but should be

done as a separate service. It helps to have the NFP instructor available

in the same office or very accessible close by.

I agree with you that the Creighton Model is optimum

for many health applications, GYN and infertility. The standardized

recording of biomarkers is very helpful.

It has been my observation over the years that roughly

25% of patients not previously using NFP will respond to my 5-7 minute

recommendation on why it would be healthy to use it. Yes, it would be

nice to have 100%, but 25% is pretty good. Again, to draw an analogy,

only a few percent of patients actually respond to advice to quit smoking, but

it is still worthwhile to give it. To extend this analogy, it is worth

giving the advice over time and not giving up. Some patients will finally

decide to listen to your recommendation to use NFP after years of mentioning

it.

Just hang in there and recommend the best you can to

patients within what is available to you.

Joe Stanford

Do any of you, esp those familiar with the Creighton

Model, bring up

options other than those the patient is currently

using? (esp if they

don't seem to be working that great!). I just get

frustrated and

saddened when I see situations like this where it

seems the symptoms

are getting treated to a certain extent, but the

real issues are

potentially being ignored.

--

______________________________

ph B. Stanford, MD, MSPH

Health Research Center

Dept. Family & Prev. Med.

University of Utah

jstanford@...

[Guest guest]

Dr. Fehring wrote:

"We have a hard time getting couples to come to one group session and a follow-up."

****************

I think that this is representative of our culture as a whole. I can remember when it was de rigeur for expectant couples to take a 6 to 8 week class to prepare for childbirth - now the most popular form of childbirth ed (for those who bother at all) seems to be a weekend seminar. Ditto marriage preparation. Instead of a 6 - 8 week pre-Cana series, it has become a one day or two day event.

The problem with this pattern is that effective learning takes time. As my mother in law was fond of saying, "Smaller bites chew easier".

I have lately been suggesting a book "Your Fertility SIgnals" by Merryl Winstein - as a basic background information. I also refer patients to a local teacher for an introductory class. I tell them that attending the class does not commit them to using a method of NFP, but don't they want to understand how their body works? I also spend maybe 5 minutes max drawing on the exam table paper a graph of the hormone fluctuations of the female cycle with the ups and downs and peaks and valleys - and then I draw across that the effect of hormonal contraception (straight line with a sudden drop at the end for combo methods, a slowly decreasing slope for the progestin only methods) because a big reason my patients want to get off hormonal contraception is the decrease of libido and/or the mood swings. I also don't have the time to teach them a complex method in an office visit, but I can help them find some motivation to learn it on their own. I can also have them come back for follow up visits to talk about their hormonal issues etc and can incorporate a little more learning into each visit.

But, as says, it is tough to promote NFP within our current health care chaos.

alicia cnm

[Guest guest]

Thank you, . Also, Dr. in Oklahoma City states that she teaches the Billings Method in 5 minutes to patients, I believe she is using the Billings Slide Rule as a teaching tool. You may want to contact her for more information.

Darcy Hemstad

on 12/14/04 9:35 PM, Fehring, at .Fehring@... wrote:

Stanford quote:   ³Yes there are methods of NFP that can be taught 5 or 10 minutes (and they may be better than nothing), but I believe that the best NFP instruction will not generally fit into office visits, but should be done as a separate service. It helps to have the NFP instructor available in the same office or very accessible close by.²

Dear Dr. Stanford (i.e., Joe):

Thank you for your perspectives on short NFP methods, but for the sake of conversation (on this NFP discussion list) ­ what standards or criteria would you use to define ³the best NFP instruction² -- and why do NFP methods that would only require a short 5 ­ 10 minutes be only ³better than nothing²?

For the most part we are competing with birth control methods that can be provided in a short office visits ­ e.g., hormonal pills; condoms; depo shots - methods that do not require a lot of behavioral change.

When Sandrock, CNM mentioned that the TwoDay method was a ³no brainer², I thought that is a good criterion for a method of birth control i.e., ³simple to use² and I would add ³simple to teach² and according to the latest study - it is effective in helping couples avoid pregnancy.  If the method is effective in helping couples to achieve their goal of avoiding pregnancy, it is simple to use, and it does not separate the unitive from the procreation act, is that not a good method?  You can reach many people with simple non-complex methods.  Not always easy to do with complex methods ­ that require extensive training of teachers and of the couple users.  And I am not saying that easy is always the best. 

I would also add that changing behaviors will occur faster when we can reduce behavior hurdles ­ like learning complex methods of NFP and requiring extensive group teaching and/or follow-up.  I believe that Larry Severy, PhD (psychology professor at the University of Florida) mentioned at the Marquette conference in 2002 ­ couples would prefer to use nothing --- but if they have to use something ­ it needs to be simple and accurate.  Furthermore, if health professionals could incorporate teaching a NFP method into their busy office practice ­ then maybe more health professionals would and could provide it.

Your thoughts?

Hope all is well.       

J. Fehring

Professor

Marquette University

PS -  please do not take this as an attack on any one method of NFP --- it is a general comment on modern methods of NFP (OM, STM, etc) ­ including the Marquette Model.  We have a hard time getting couples to come to one group session and a follow-up.    

    

Re: NFP info for patients in the office- long

Dear CNM and list,

This situation is really no different in principle than many other conundrums in medical practice. Someone comes in with hypertension, depression, or obesity, and the optimal care would be to discuss diet, exercise, and other lifestyle issues and healthy habits. But you don't have time to do it adequately in a 20 or 10 minute office visit. So you do the best you can in the time you have. Further, many, perhaps most, patients don't take you up on what would be the best or the healthiest route- for example, a minority will actually exercise when you tell them (truthfully) that that would be the healthiest possible thing they could do and the thing that would improve their health the most. Ideally, you could refer them to a dietician, a counselor, or an exercise trainer who can take the time they need, but often that is not practical nor reimbursable. In these situations, which are perhaps the majority of chronic conditions that people present with, all you can do is do the best you can within the system you are in, and find ways to expand and improve the system. If you don't have the time or some of the other professionals around that you need to provide optimum care, you simply do what you can, and/or work on getting those other people around.

So it is with NFP and women's health care that respects fertility. Yes there are methods of NFP that can be taught 5 or 10 minutes (and they may be better than nothing), but I believe that the best NFP instruction will not generally fit into office visits, but should be done as a separate service. It helps to have the NFP instructor available in the same office or very accessible close by.

I agree with you that the Creighton Model is optimum for many health applications, GYN and infertility. The standardized recording of biomarkers is very helpful.

It has been my observation over the years that roughly 25% of patients not previously using NFP will respond to my 5-7 minute recommendation on why it would be healthy to use it. Yes, it would be nice to have 100%, but 25% is pretty good. Again, to draw an analogy, only a few percent of patients actually respond to advice to quit smoking, but it is still worthwhile to give it. To extend this analogy, it is worth giving the advice over time and not giving up. Some patients will finally decide to listen to your recommendation to use NFP after years of mentioning it.

Just hang in there and recommend the best you can to patients within what is available to you.

Joe Stanford

Do any of you, esp those familiar with the Creighton Model, bring up

options other than those the patient is currently using? (esp if they

don't seem to be working that great!). I just get frustrated and

saddened when I see situations like this where it seems the symptoms

are getting treated to a certain extent, but the real issues are

potentially being ignored.

[Guest guest]

Dear Friends,

Merry Christmas to all of you.

We are beginning to get more referrals from physician offices. I like to think it is because of our recent public awareness campaign of radio ads and billboards.

Women want to know about NFP and a picture is worth a thousand words. To be able to give out an attractive brochure or show the hormonal pattern diagram, when coming from a physician carries weight. Its been said that if a patient walks out of the office with something in their hand, they feel more satisfied.

Our pre-campaign research showed that 47% of women ages 18-45 were interested in learning a new natural method.

May you all be encouraged to keep promoting NFP,

Judith L. LeonardDirectorNatural Family PlanningDiocese of Wichita1515 S. Clifton, Suite 400Wichita, KS 67218Ph 316/685-6776Fax 316/685-7540

RE: NFP info for patients in the office- long

Stanford quote: “Yes there are methods of NFP that can be taught 5 or 10 minutes (and they may be better than nothing), but I believe that the best NFP instruction will not generally fit into office visits, but should be done as a separate service. It helps to have the NFP instructor available in the same office or very accessible close by.”

Dear Dr. Stanford (i.e., Joe):

Thank you for your perspectives on short NFP methods, but for the sake of conversation (on this NFP discussion list) – what standards or criteria would you use to define “the best NFP instruction” -- and why do NFP methods that would only require a short 5 – 10 minutes be only “better than nothing”?

For the most part we are competing with birth control methods that can be provided in a short office visits – e.g., hormonal pills; condoms; depo shots - methods that do not require a lot of behavioral change.

When Sandrock, CNM mentioned that the TwoDay method was a “no brainer”, I thought that is a good criterion for a method of birth control i.e., “simple to use” and I would add “simple to teach” and according to the latest study - it is effective in helping couples avoid pregnancy. If the method is effective in helping couples to achieve their goal of avoiding pregnancy, it is simple to use, and it does not separate the unitive from the procreation act, is that not a good method? You can reach many people with simple non-complex methods. Not always easy to do with complex methods – that require extensive training of teachers and of the couple users. And I am not saying that easy is always the best.

I would also add that changing behaviors will occur faster when we can reduce behavior hurdles – like learning complex methods of NFP and requiring extensive group teaching and/or follow-up. I believe that Larry Severy, PhD (psychology professor at the University of Florida) mentioned at the Marquette conference in 2002 – couples would prefer to use nothing --- but if they have to use something – it needs to be simple and accurate. Furthermore, if health professionals could incorporate teaching a NFP method into their busy office practice – then maybe more health professionals would and could provide it.

Your thoughts?

Hope all is well.

J. Fehring

Professor

Marquette University

PS - please do not take this as an attack on any one method of NFP --- it is a general comment on modern methods of NFP (OM, STM, etc) – including the Marquette Model. We have a hard time getting couples to come to one group session and a follow-up.

-----Original Message-----From: ph B. Stanford Sent: Friday, December 10, 2004 6:15 AMTo: nfpprofessionals Subject: Re: NFP info for patients in the office- long

Dear CNM and list,

This situation is really no different in principle than many other conundrums in medical practice. Someone comes in with hypertension, depression, or obesity, and the optimal care would be to discuss diet, exercise, and other lifestyle issues and healthy habits. But you don't have time to do it adequately in a 20 or 10 minute office visit. So you do the best you can in the time you have. Further, many, perhaps most, patients don't take you up on what would be the best or the healthiest route- for example, a minority will actually exercise when you tell them (truthfully) that that would be the healthiest possible thing they could do and the thing that would improve their health the most. Ideally, you could refer them to a dietician, a counselor, or an exercise trainer who can take the time they need, but often that is not practical nor reimbursable. In these situations, which are perhaps the majority of chronic conditions that people present with, all you can do is do the best you can within the system you are in, and find ways to expand and improve the system. If you don't have the time or some of the other professionals around that you need to provide optimum care, you simply do what you can, and/or work on getting those other people around.

So it is with NFP and women's health care that respects fertility. Yes there are methods of NFP that can be taught 5 or 10 minutes (and they may be better than nothing), but I believe that the best NFP instruction will not generally fit into office visits, but should be done as a separate service. It helps to have the NFP instructor available in the same office or very accessible close by.

I agree with you that the Creighton Model is optimum for many health applications, GYN and infertility. The standardized recording of biomarkers is very helpful.

It has been my observation over the years that roughly 25% of patients not previously using NFP will respond to my 5-7 minute recommendation on why it would be healthy to use it. Yes, it would be nice to have 100%, but 25% is pretty good. Again, to draw an analogy, only a few percent of patients actually respond to advice to quit smoking, but it is still worthwhile to give it. To extend this analogy, it is worth giving the advice over time and not giving up. Some patients will finally decide to listen to your recommendation to use NFP after years of mentioning it.

Just hang in there and recommend the best you can to patients within what is available to you.

Joe Stanford

Do any of you, esp those familiar with the Creighton Model, bring upoptions other than those the patient is currently using? (esp if theydon't seem to be working that great!). I just get frustrated andsaddened when I see situations like this where it seems the symptomsare getting treated to a certain extent, but the real issues are

potentially being ignored.

--

______________________________ph B. Stanford, MD, MSPHHealth Research CenterDept. Family & Prev. Med.University of Utahjstanford@...

[Guest guest]

>Our pre-campaign research showed that 47% of women ages 18-45 were >interested

in learning a new natural method.

> May you all be encouraged to keep promoting NFP,

> Judith L. Leonard

Dittos. But looking at the new CDC report on contraceptive use, only 0.2 percent

of women use any kind of modern NFP; 0.6 percent use Calendar Rhythm; 2% use

withdrawal. Most everybody else is on the pill or " fixed " . Perhaps they took

this data the same places Kinsey did, e.g. prisons?

jim

________________________________________________________________

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