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Fertility Awareness Based Methods

1.1 Method

Fertility Awareness-Based (FAB) methods of family planning involve identification of the fertile days of menstrual cycle, whether by observing fertility signs such as cervical secretion and basal body temperature or by monitoring cycle days.
FAB methods can be used in combination with abstinence or barrier methods during fertile period1.

The fertile period can be calculated by the woman herself using the following methods :

+ Calendar rhythm method

A woman counts calendar days to identify the start and the end of the fertile period based on the length of previous menstrual cycles. She calculates the fertile period by subtracting 18 days from the shortest cycle and 10 days from the longest cycle which give her the first and last days of the fertile period respectively.

For example, a woman’s menstrual cycle varies from 25 to 30 days, the fertile period will be from 7th (25-18) to 20th (30-10) day of the cycle, counting day one as the first day of the menstrual period. However, where such calculations are not possible, the couple can be advised to abstain between 8th to 22nd day of the cycle (Govt. of India 1978)2.

+ Cervical mucus method

The fertile period begins when woman notices cervical secretions at the introitus and lasts till 4 days after the peak day of slippery secretions.

+ Basal body temperature (symptothermic method)

Rise in temperature of 0.2 to 0.5oC (0.4o to 1.0oF) occurs around the time of ovulation. Thus the couple should abstain from 1st day of menstrual cycle till the rise of temperature remains for three days.

1.2 Advantages

• no systemic side-effects

• very little or no cost

• can be used by most couples, no major contraindication to use

• no effect on breast milk

1.3 Disadvantages

• efficacy is lower than other reversible methods

• requires couple motivation and commitment

• cannot be used reliably in women with vaginal discharge, fever or during breast-feeding

• calender method is unsuitable for women with irregular cycles.

• does not protect against STI/HIV

1.4 Contraindications and precautions

There is no medical contraindication to the use of FAB methods. Certain clinical conditions make the use of these methods either less efficacious or difficult, due to complexity in calculating the fertile days. e.g.

• women with vaginal discharge and fever cannot calculate accurately the fertile days based on cervical secretion and basal body temperature measurement.

• in immediate post-partum or post-abortal period and in nursing mothers, the ovarian function is not sufficient to produce detectable fertility signs.

• women with irregular cycles or on drugs which affect cycle length e.g., lithium, tricyclic anti-depressants, anti-anxiety drugs, certain antibiotics and anti inflammatory drugs, are not suitable for using calender method.

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