In reply to Jim.

Hi again!

Everything you say about the challenges of NFP makes perfect sense -- to me, in the context of Guatemala, I would very much think of it as a method for spacing children, rather than a fail-proof method. Truth is, I haven't discussed it ONCE in my South Bronx practice! But I do think it is a valuable educational tool, and would love to have the time/context to talk about it more. And yes, I love Taking Charge of Your Fertility -- recommend it all the time, although these days mostly for women who are trying to GET pregnant.

The big problem, as I see it, isn't in the end really with the various contraceptive methods per se. Yes, there are side effects; yes, there are inconveniences with each method -- but when it comes right down to it, I think the primary reasons that people don't use birth control often have very little to do with the methods themselves. As you clearly articulate -- those issues of male resistance and oppression really cannot be addressed by handing out condoms. One thing that I've found interesting -- if frustrating -- as a provider is trying to come at the problem from a different angle. I've talked myself blue in the face trying to convince a 16 year old that she really *needs* to use contraception if she doesn't want to have *another* baby before she graduates (if she ever graduates) from high school -- but I mostly feel like that kind of lecturing on my end is, if anything, counterproductive. But it's so much harder to try to address the bigger picture...

And, a side note, just because I'm curious -- are you functioning as health care providers as well as educators in your town? Do you put in IUDs, for instance? Provide prenatal care? Are there local midwives? Do villagers go into Huehuetenango to give birth, or do they birth at home?

cheers!
esme