2002 Science & Research Forum

Biosketch:

Minna Nikula, is a Medical Doctor with a Public Health degree in Population and Family Health Science. She has both clinical and program experience in reproductive health, particularly in family planning in developing countries. She is currently working as a research officer in the Institute for Reproductive Health in Georgetown University, where she is responsible for monitoring the field trials and providing technical assistance to the Institute’s research projects. Co-author: Marcos Arevalo, Senior Program Manager, Institute for Reproductive Health, Georgetown University, Washington, DC, USA.

Presentation Abstract:

The TwoDay Method: A Simple & Natural Way to Avoid Pregnancy

Abstaining from intercourse for a number of days during each menstrual cycle is an important practice couples use to try to avoid pregnancies. Approximately 30-35 million couples, mostly in developing countries, rely on some kind of periodic abstinence. However, worldwide studies indicate that most couples have little knowledge about their fertility and are not using an actual family planning “method”. This suggests the demand for simple, easily distributed and scientifically proven natural family planning methods.

Monitoring the cervical mucus can be an effective way for a woman to identify the fertile days of her menstrual cycle. The new TwoDay method developed by the Georgetown University Institute for Reproductive Health, is based on a simple algorithm that requires only that the woman determine the presence or absence of cervical mucus on a daily basis. It does not require that she evaluate the characteristics of the mucus.

The theoretical effectiveness of the TwoDay method is based on a statistical analysis of a large WHO data set of the Billings Ovulation method as well as cycle monitoring from several other NFP programs. The analysis included the variable probability of pregnancy vis a vis ovulation (Wilcox, 1995) as well as the variation in timing of ovulation (Hilgers, 1978). It indicates that the probability of pregnancy from intercourse of any given day is no more than 2.5 % for correct method use, with a mean length for the fertile period of 10 days.

A multi-center pilot study confirmed the potential effectiveness of the method and revealed that it is easy to teach, learn and use under conditions where providers have limited time with their patients, who may have little knowledge about their fertility. We found that women were aware of their cervical mucus but that it was not common to discuss this with their partners, and they did not know that mucus is related to fertility. Men played a key role in the decision about when to abstain, but they had very little, if any, knowledge about fertility in general.

The TwoDay method can offer an alternative to couples that seek a natural, safe, easy and effective way to plan their families. It can help couples to share the information about cervical mucus and fertility, which enables high efficacy and user satisfaction. To establish method efficacy, a full-scale study was initiated in January 2002 in three countries.

Commentary:

The TwoDay method - a simple and natural way to avoid pregnancy

This method is mucus based, easy to learn, and reasonably effective for couples wanting to avoid pregnancy. However, what is acceptable to the third world in terms of effectiveness may not be acceptable to couples in the industrialized world. This study once again highlights the lack of understanding of what cervical mucus means (even thought most women were aware of it). Periodic abstinence without fertility understanding leads to poorly motivated users and ineffective family planning. This pilot was expanded to a full-scale study in 3 countries, and it will be interesting to see further statistics on use effectiveness, one-year continuation, and couple satisfaction.