Re: RE: Chinese study does not apply to free society?

[Guest guest]

6 days mucus before peak - 4 days after peak = 10 (or 11)add 5 days menstruationsomething like the number mentioned by Kambicactually you should know from your teaching experience - better you believe what you see instead of what somebody is telling yourafael

Six days of mucus before peak is actually on the very long side. Most women have 3-5 days. Peak is the last day of slippery, therefore the following day counts as the first of 3 days of abstinence. Intercourse is allowed at 12:01 AM on the fourth morning. Since volume, texture and elasticity of mucus are de-emphasized by the BOM, it is the sensation of change from the baseline infertile pattern to which the rules are applied. Therefore, using your assumption of 6 days of potential fertility, 3 days of abstinence after peak and 5 days of menstruation, I still come up with only 14 days.

I believe I am safe is saying that no one else in the world has a million hormonal assays which correlate signs and symptoms of fertility at the vulva and vagina as does Dr. Brown of the BOM.

W. , M.D., FACOG

[Guest guest]

Assuming that most months are 30 days, that would still allow a frequency of every two days, when averaged. However, we all know that there are, ordinarily, 4-6 days of mucus, +3, and then menses, average 5 days...So on average, the couple who is postponing pregnancy would find 16 days unavailable. On the other hand, Kathy Stein Greenblat's study of oral contraceptive users found an average intercourse frequency of twice of a week after the first year of marriage. "the Salience of Sexual Relations in Marriage. I can't find the reprint at the moment, it came from a sociological review.. There are 19 pages of entries for Greenblat on google, and I haven't the patience to go through them all.

Some couples I teach also find that their frequency of intercourse increases when they are practicing the Billings Method, because they make using the available days a priority (instead of figuring there is always time tomorrow, they make good use of tonight!). This is actually what the Billings trainers encourage us to teach - to encourage couples to seek out and USE the infertile days, if they are trying to avoid pregnancy. In my experience couples, many of whom are not Catholic, find that by being more aware of the fertile and infertile days, they make plans for more intercourse than previously.

Also, I know the 5 days of menstruation is an average, but I have found that many women with some experience at identifying the sensation of fertile mucus using Billings are able to shave off a day or two of spotting at the end of menstruation when they have a dry sensation. I believe the Billings rule is to avoid intercourse on days of "heavy bleeding" which could obscure the presence of mucus.

Pam Pilch, J.D.Lamaze Certified Childbirth Educator

Billings Method

[Guest guest]

(Dr. Fehring):

I will be happy to get your questions answered when I'm Down Under.

Bob Kambic's studies are quite old aren't they? I would be surprised

if 17 days of abstinence is a true reflection of the BOM. As the trainers

from Australia continuously tell us "this is not an abstinence method!"

Sue Ek

www.boma-usa.org

www.woomb.org

RE: Chinese study does not apply to free society?

Let us (at least for the moment) accept the proposition that the Chinese BOM 99.5% effectiveness represents a typical use effectiveness that is actually attainable by an extremely motivated group of users (ie, the threat of forced abortion).

For the vast majority of populations in free societies, users of NFP (whatever method) have much higher total pregnancy rates than 0.5% per year. Why the difference?

It is unlikely that much of the difference would be due to differences in underlying fertility (fecundity) of the couples involved.

Some of it might be due to differences in quality of teaching and understanding the method, but this can only go so far to explain the difference. In trials of different NFP methods that are well taught within the study, the total pregnancy rates are still typically in the 10-20% range. (Notice, I am saying total pregnancy rates, whether or not the pregnancies are classified as informed choice, achieving related, intended, or whatever.)

The main difference is in the number of couples who have intercourse during the fertile time and get pregnant. Yes, there are a few user errors and pregnancies despite proper use of the method, but the vast majority of pregnancies among NFP users are from intercourse on a day that the couple knows to be potentially fertile.

So what is the explanation for the difference between free society and China and NFP?

Why are couples in a free society more likely to have intercourse on a day known to be potentially fertile?

Possible hypotheses:

1) Couples in China just aren't having any intercourse at all? (It would be worth seeing whether the investigators have any data on frequency of intercourse among the Billings users and the IUD users.)

2) Unless you are highly highly motivated, NFP (or a particular method of NFP) is just a little bit too hard to use. Abstinence during the fertile time is too hard, and/or the method rules are too confusing and/or the couple can't adequately communicate. In other words, if NFP were just simpler, easier, and did not require as much abstinence, then couples in free societies could successfully achieve lower pregnancy rates (a better outcome).

3) NFP is a method that encourages couples who are able to have children to have them. NFP helps couples in a free society evaluate whether they really should put this much effort into avoiding having a child. Where couples lack "serious reasons" to avoid pregnancy, they end up having more pregnancies, even if they are not all announced in advance or do not all qualify as "planned." The higher pregnancy rate among free societies among NFP users is therefore a better outcome.

These hypotheses, particularly #2 and #3 are not value-neutral. They each have an embedded worldview and set of assumptions about whether pregnancy is a good or bad outcome, and under what circumstances.

Stated another way:

If you did a randomized trial (ethical issues aside) in a free society and randomized couples to use NFP or the IUD (like the China study) and the NFP users had a higher total pregnancy rate (which they certainly would in a free society where there is no forced abortion hanging over them), is that a better outcome or a worse outcome than the lower pregnancy rate among the group using the IUD?

NFP is not contraception only, and to evaluate it in exactly the same way as contraception only will always lead to distortions.

Joe

[Guest guest]

6 days mucus before peak - 4 days after peak = 10 (or 11)

add 5 days menstruation

something like the number mentioned by Kambic

actually you should know from your teaching experience - better you

believe what you see instead of what somebody is telling you

rafael

BOMA - USA wrote:

> (Dr. Fehring):

>

> I will be happy to get your questions answered when I'm Down Under.

>

> Bob Kambic's studies are quite old aren't they? I would be surprised

> if 17 days of abstinence is a true reflection of the BOM. As the trainers

> from Australia continuously tell us " this is not an abstinence method! "

>

> Sue Ek

> www.boma-usa.org <http://www.boma-usa.org>

> www.woomb.org <http://www.woomb.org>

>

> * RE: Chinese study does not

> apply to free society?

>

>

>

> Let us (at least for the moment) accept the proposition that

> the Chinese BOM 99.5% effectiveness represents a typical use

> effectiveness that is actually attainable by an extremely

> motivated group of users (ie, the threat of forced abortion).

>

>

>

> For the vast majority of populations in free societies,

> users of NFP (whatever method) have much higher total

> pregnancy rates than 0.5% per year. Why the difference?

>

>

>

> It is unlikely that much of the difference would be due to

> differences in underlying fertility (fecundity) of the

> couples involved.

>

>

>

> Some of it might be due to differences in quality of

> teaching and understanding the method, but this can only go

> so far to explain the difference. In trials of different

> NFP methods that are well taught within the study, the total

> pregnancy rates are still typically in the 10-20% range.

> (Notice, I am saying total pregnancy rates, whether or not

> the pregnancies are classified as informed choice, achieving

> related, intended, or whatever.)

>

>

>

> The main difference is in the number of couples who have

> intercourse during the fertile time and get pregnant. Yes,

> there are a few user errors and pregnancies despite proper

> use of the method, but the vast majority of pregnancies

> among NFP users are from intercourse on a day that the

> couple knows to be potentially fertile.

>

>

>

> So what is the explanation for the difference between free

> society and China and NFP?

>

> Why are couples in a free society more likely to have

> intercourse on a day known to be potentially fertile?

>

>

>

> Possible hypotheses:

>

>

>

> 1) Couples in China just aren't having any intercourse at

> all? (It would be worth seeing whether the investigators

> have any data on frequency of intercourse among the Billings

> users and the IUD users.)

>

>

>

> 2) Unless you are highly highly motivated, NFP (or a

> particular method of NFP) is just a little bit too hard to

> use. Abstinence during the fertile time is too hard, and/or

> the method rules are too confusing and/or the couple can't

> adequately communicate. In other words, if NFP were just

> simpler, easier, and did not require as much abstinence,

> then couples in free societies could successfully achieve

> lower pregnancy rates (a better outcome).

>

>

>

> 3) NFP is a method that encourages couples who are able to

> have children to have them. NFP helps couples in a free

> society evaluate whether they really should put this much

> effort into avoiding having a child. Where couples lack

> " serious reasons " to avoid pregnancy, they end up having

> more pregnancies, even if they are not all announced in

> advance or do not all qualify as " planned. " The higher

> pregnancy rate among free societies among NFP users is

> therefore a better outcome.

>

>

>

> These hypotheses, particularly #2 and #3 are not

> value-neutral. They each have an embedded worldview and set

> of assumptions about whether pregnancy is a good or bad

> outcome, and under what circumstances.

>

>

>

> Stated another way:

>

> If you did a randomized trial (ethical issues aside) in a

> free society and randomized couples to use NFP or the IUD

> (like the China study) and the NFP users had a higher total

> pregnancy rate (which they certainly would in a free society

> where there is no forced abortion hanging over them), is

> that a better outcome or a worse outcome than the lower

> pregnancy rate among the group using the IUD?

>

>

>

> NFP is not contraception only, and to evaluate it in exactly

> the same way as contraception only will always lead to

> distortions.

>

>

>

> Joe

>

>

>

>

>

>

>

>

> ------------------------------------------------------------------------

> *

[Guest guest]

and I would add, , that this is what experience shows from teaching...

6 days mucus before peak - 4 days after peak = 10 (or 11)add 5 days menstruationsomething like the number mentioned by Kambicactually you should know from your teaching experience - better you believe what you see instead of what somebody is telling yourafael

Six days of mucus before peak is actually on the very long side. Most women have 3-5 days. Peak is the last day of slippery, therefore the following day counts as the first of 3 days of abstinence. Intercourse is allowed at 12:01 AM on the fourth morning. Since volume, texture and elasticity of mucus are de-emphasized by the BOM, it is the sensation of change from the baseline infertile pattern to which the rules are applied. Therefore, using your assumption of 6 days of potential fertility, 3 days of abstinence after peak and 5 days of menstruation, I still come up with only 14 days.

I believe I am safe is saying that no one else in the world has a million hormonal assays which correlate signs and symptoms of fertility at the vulva and vagina as does Dr. Brown of the BOM.

W. , M.D., FACOG

[Guest guest]

Assuming that most months are 30 days, that would still allow a frequency of every two days, when averaged. However, we all know that there are, ordinarily, 4-6 days of mucus, +3, and then menses, average 5 days...So on average, the couple who is postponing pregnancy would find 16 days unavailable. On the other hand, Kathy Stein Greenblat's study of oral contraceptive users found an average intercourse frequency of twice of a week after the first year of marriage. "the Salience of Sexual Relations in Marriage. I can't find the reprint at the moment, it came from a sociological review.. There are 19 pages of entries for Greenblat on google, and I haven't the patience to go through them all.

Hanna Klaus, M.D.

Natural Family Planning Center of Washington, D.C. and Teen STAR Program

8514 Bradmoor Drive

Bethesda, MD 20817-3810

Tel. , Fax

hannaklaus@...

http://www.teenstar.org

Why Wait? Move to EarthLink.

RE: Chinese study does not apply to free society?

Let us (at least for the moment) accept the proposition that the Chinese BOM 99.5% effectiveness represents a typical use effectiveness that is actually attainable by an extremely motivated group of users (ie, the threat of forced abortion).

For the vast majority of populations in free societies, users of NFP (whatever method) have much higher total pregnancy rates than 0.5% per year. Why the difference?

It is unlikely that much of the difference would be due to differences in underlying fertility (fecundity) of the couples involved.

Some of it might be due to differences in quality of teaching and understanding the method, but this can only go so far to explain the difference. In trials of different NFP methods that are well taught within the study, the total pregnancy rates are still typically in the 10-20% range. (Notice, I am saying total pregnancy rates, whether or not the pregnancies are classified as informed choice, achieving related, intended, or whatever.)

The main difference is in the number of couples who have intercourse during the fertile time and get pregnant. Yes, there are a few user errors and pregnancies despite proper use of the method, but the vast majority of pregnancies among NFP users are from intercourse on a day that the couple knows to be potentially fertile.

So what is the explanation for the difference between free society and China and NFP?

Why are couples in a free society more likely to have intercourse on a day known to be potentially fertile?

Possible hypotheses:

1) Couples in China just aren't having any intercourse at all? (It would be worth seeing whether the investigators have any data on frequency of intercourse among the Billings users and the IUD users.)

2) Unless you are highly highly motivated, NFP (or a particular method of NFP) is just a little bit too hard to use. Abstinence during the fertile time is too hard, and/or the method rules are too confusing and/or the couple can't adequately communicate. In other words, if NFP were just simpler, easier, and did not require as much abstinence, then couples in free societies could successfully achieve lower pregnancy rates (a better outcome).

3) NFP is a method that encourages couples who are able to have children to have them. NFP helps couples in a free society evaluate whether they really should put this much effort into avoiding having a child. Where couples lack "serious reasons" to avoid pregnancy, they end up having more pregnancies, even if they are not all announced in advance or do not all qualify as "planned." The higher pregnancy rate among free societies among NFP users is therefore a better outcome.

These hypotheses, particularly #2 and #3 are not value-neutral. They each have an embedded worldview and set of assumptions about whether pregnancy is a good or bad outcome, and under what circumstances.

Stated another way:

If you did a randomized trial (ethical issues aside) in a free society and randomized couples to use NFP or the IUD (like the China study) and the NFP users had a higher total pregnancy rate (which they certainly would in a free society where there is no forced abortion hanging over them), is that a better outcome or a worse outcome than the lower pregnancy rate among the group using the IUD?

NFP is not contraception only, and to evaluate it in exactly the same way as contraception only will always lead to distortions.

Joe

[Guest guest]

The 14 to 17 days can be some random variation between samples. However

the 3-5 days of mucus (including peak?) seems pretty low to me - what

are the statistics on this you have?

obdoc2000@... wrote:

> In a message dated 2/18/2005 7:43:47 A.M. Central Standard Time,

> rafael.mikolajczyk@... writes:

>

> 6 days mucus before peak - 4 days after peak = 10 (or 11)

> add 5 days menstruation

> something like the number mentioned by Kambic

> actually you should know from your teaching experience - better you

> believe what you see instead of what somebody is telling you

> rafael

>

> Six days of mucus before peak is actually on the very long side. Most

> women have 3-5 days. Peak is the last day of slippery, therefore the

> following day counts as the first of *3 days* of abstinence. Intercourse

> is allowed at 12:01 AM on the fourth morning. Since volume, texture and

> elasticity of mucus are de-emphasized by the BOM, it is the sensation of

> change from the baseline infertile pattern to which the rules are

> applied. Therefore, using your assumption of 6 days of potential

> fertility, 3 days of abstinence after peak and 5 days of menstruation, I

> still come up with only 14 days.

>

> I believe I am safe is saying that no one else in the world has a

> million hormonal assays which correlate signs and symptoms of fertility

> at the vulva and vagina as does Dr. Brown of the BOM.

>

> W. , M.D., FACOG

>

> ------------------------------------------------------------------------

> *

[Guest guest]

1) My point was that Kambic calculated his 17 days in the usual way.

Maybe he had some women with longer mucus sign or some disturbed cycles

in the samples he used. There is nothing about old research, no reason

to believe physiology of the woman's cycle changed. 17 is somewhat high,

14 is probably somewhat low.

2) There is a difference between mean and median - mean is distorted by

unexpectedly high (or low) observations - all studies used mean (median

would be more appropriate), the number of mucus days was above 5 (WHO 1983).

3) I have seen plenty of cycles and 4 days of mucus were rare. Maybe my

sample was somehow selected. I would be happy to see your statistics.

, what is the distribution in your data?

Finally, I want to apologize. I am pretty alergic on the point of

evidence and invoking authorities in front of data, but I am sorry that

you have to deal with my alergic reactions. I am going to reduce this

part.

Mikolajczyk, MD wrote:

> The 14 to 17 days can be some random variation between samples. However

> the 3-5 days of mucus (including peak?) seems pretty low to me - what

> are the statistics on this you have?

>

>

>

>

>

>

> obdoc2000@... wrote:

>

> > In a message dated 2/18/2005 7:43:47 A.M. Central Standard Time,

> > rafael.mikolajczyk@... writes:

> >

> > 6 days mucus before peak - 4 days after peak = 10 (or 11)

> > add 5 days menstruation

> > something like the number mentioned by Kambic

> > actually you should know from your teaching experience - better you

> > believe what you see instead of what somebody is telling you

> > rafael

> >

> > Six days of mucus before peak is actually on the very long side. Most

> > women have 3-5 days. Peak is the last day of slippery, therefore the

> > following day counts as the first of *3 days* of abstinence. Intercourse

> > is allowed at 12:01 AM on the fourth morning. Since volume, texture and

> > elasticity of mucus are de-emphasized by the BOM, it is the sensation of

> > change from the baseline infertile pattern to which the rules are

> > applied. Therefore, using your assumption of 6 days of potential

> > fertility, 3 days of abstinence after peak and 5 days of menstruation, I

> > still come up with only 14 days.

> >

> > I believe I am safe is saying that no one else in the world has a

> > million hormonal assays which correlate signs and symptoms of fertility

> > at the vulva and vagina as does Dr. Brown of the BOM.

> >

> > W. , M.D., FACOG

> >

> > ------------------------------------------------------------------------

> > *

[Guest guest]

It's not that the physiology of the woman's cycle has changed when

we talk about 14 vs. 17 days of abstinence. It's that the tremendous

research coming out of Australia allows us to fine tune the Basic

Infertile Pattern and when Peak is identified.

Sue Ek

PS - I won't get into statistics because that's definitely not my area of expertise!

Re: RE: Chinese study does not apply to free society?

1) My point was that Kambic calculated his 17 days in the usual way. Maybe he had some women with longer mucus sign or some disturbed cycles in the samples he used. There is nothing about old research, no reason to believe physiology of the woman's cycle changed. 17 is somewhat high, 14 is probably somewhat low.2) There is a difference between mean and median - mean is distorted by unexpectedly high (or low) observations - all studies used mean (median would be more appropriate), the number of mucus days was above 5 (WHO 1983).3) I have seen plenty of cycles and 4 days of mucus were rare. Maybe my sample was somehow selected. I would be happy to see your statistics. , what is the distribution in your data?Finally, I want to apologize. I am pretty alergic on the point of evidence and invoking authorities in front of data, but I am sorry that you have to deal with my alergic reactions. I am going to reduce this part. Mikolajczyk, MD wrote:> The 14 to 17 days can be some random variation between samples. However> the 3-5 days of mucus (including peak?) seems pretty low to me - what> are the statistics on this you have?> > > > > > > obdoc2000@... wrote:> > > > >> > 6 days mucus before peak - 4 days after peak = 10 (or 11)> > add 5 days menstruation> > something like the number mentioned by Kambic> > actually you should know from your teaching experience - better you> > believe what you see instead of what somebody is telling you> > rafael> >> > Six days of mucus before peak is actually on the very long side. Most> > women have 3-5 days. Peak is the last day of slippery, therefore the> > following day counts as the first of *3 days* of abstinence. Intercourse> > is allowed at 12:01 AM on the fourth morning. Since volume, texture and> > elasticity of mucus are de-emphasized by the BOM, it is the sensation of> > change from the baseline infertile pattern to which the rules are> > applied. Therefore, using your assumption of 6 days of potential> > fertility, 3 days of abstinence after peak and 5 days of menstruation, I> > still come up with only 14 days.> > > > I believe I am safe is saying that no one else in the world has a> > million hormonal assays which correlate signs and symptoms of fertility> > at the vulva and vagina as does Dr. Brown of the BOM.> > > > W. , M.D., FACOG> >> > ------------------------------------------------------------------------> > *