In spite of constant efforts by health and social workers, existing family planning measures are not used by a vast majority of eligible couples. This is because of the fear that the method may affect their health and happiness. Billings' ovulation method is based on the scientific observation that by noting the changes in cervical mucus, which is clear, slippery and copious in periovulatory period, it is possible to prevent pregnancy by avoiding intercourse during this period. As this method does not require the use of drugs or devices it was decided to promote this method in the urban areas and slums of Patna, Bihar where couples were not using other methods. This is not a comparative study of the cost-effectiveness of Billings' ovulation method versus other contraceptive measures at all. An analysis of 501 cases (267 in urban and 234 in slums) over a period of 2 1/2 years has been presented and it is gratifying to note that the couples from all religions and strata of the society (nearly 47% were slum dwellers) agreed to continue this method.
PIP: In Patna, India, social workers underwent training to learn about reproductive biology and various aspects of the Billings' Ovulation Method (BOM) to teach couples about BOM. They made a survey of eligible couples in urban and slum areas and encouraged them to attend group discussions in the local schools. Then the social workers made home visits for training. They used diagrams, charts, and cassettes to explain to willing couples about dry and wet days in the menstrual cycle. Social workers made weekly visits for 3 months to verify the women's ability to correctly identify changes in cervical mucus. They followed 267 women in urban areas and 234 women in the slums for 2.5 years. 40% were married before they were 17 years old. 10.7% of all women were newly married, nulliparous, and wanted to delay pregnancy. 85.4% of the women living in the slums did not use any contraception before accepting BOM, compared to 30% of those living in the urban areas. 37% of urban women had used condoms. At the end of 2.5 years, 450 (89.8%) women still used BOM. Of the 51 who discontinued BOM, 62.7% lived in the slums, compared to just 37.3% for those from urban areas. The mean duration of continuation was 13 months among those who discontinued, 32 (6.3%) of the 501 women became pregnant. 9 (1.8%) women, all of whom were multiparous and wanted no more children, had accepted sterilization. 10 (1.9%) stopped relying on BOM because they could not manage it. These findings show that women who shun contraception, often due to fear of side effects, do accept simple, safe, and effective BOM. Workers who are already promoting maternal and child health services can be trained to train women about BOM. Workers who are already promoting maternal and child health services can be trained to train women about BOM without spending more money to hire BOM trainers.