In reply to esme.

Hi Esme,
This is actually Emily commenting under Jim's sign-in name because I'm using his computer. :P
Thank you for thoughts on the family planning issue. First, I would like to clarify that I am not opposed to hormonal birth control. My personal choice has been to use FAM, from the Toni Weschler book (Taking Charge of Your Fertility) I mentioned that in a previous comment, but it would be absurd to think that method is just the answer for everyone. Speaking of that book, if you've not seen or read it, I highly recommend it. It is full of interesting and useful information.
Jim and I discussed talking about natural family planning, and though we do not exclude it from discussion, so far we have decided to focus on the methods offered from the health center. The idea of and explanation of how NFP works definitely came up in the health talk that explained pregnancy and the cycle of the egg. Why don't we promote NFP and the beads? From the Weschler book and our own experiences we know that cycle beads are fixed. But a woman's cycle can vary greatly depending on how regular she is; if she's gone through any sort of mental, emotional, or physical stress; or if she's been ill. Malnutrition and spousal abuse are wide spread problems here, and they both directly affect the efficacy of the NFP and the beads. Because beads don't account for those fluctuations, I think they give a false impression of security. Also, even though the health center DOES give out explanatory pamphlets on the beads, they don't provide the beads themselves free of charge, and I have no idea where the women would get the cycle beads. While a resourceful American wouldn't have a problem making their own beads, people here do not think like that. They often wait on solutions to come to them. Checking mucus is a good way to back up the beads, but there are so many body taboos I think it would be very difficult for the women to start checking their mucus for fertility signs.
That said, many of them do know about NFP as it's been discussed through their various churches. One male town leader told me, "We really appreciate the information that you give us because through the church we only learn about NFP and what we see is that it doesn't work very well. Maybe you can space your kids out a little better, but it seems the women always end up with an unplanned pregnancy at some point. It's just very hard to go through the waiting period." He and his wife used it, successfully spacing out their children some, but they still ended up six children. She's given birth the sixth child been diagnosed with diabetes in the last year and they are really trying to prevent her from getting pregnant again for the benefit of the whole family. If what he says is the case, then I would say NFP definitely does some good, because spacing improves the health of both the mother and the child. However, if they really want to be more proactive in planning the number of children they have, or decide they are definitely done with childbearing, they have to know about more than just NFP and the cycle beads, including condoms.
The problem with condoms is that they're very, very unpopular amongst the men. One comment we heard second-hand was, "Having sex with a condom is like showering with your clothes on. What's the point?" Male condoms (which are free, provided by the health center, and could be used in conjunction with NFP) require full participation of the male partner in family planning. This is a problem. In many many cases here the man is opposed to using any method of family planning at all. Having many children is perceived as a demonstration of manhood. It's also a way of subjugating women. And there is a pervasive belief that if you and your wife use birth control she has more freedom to sleep with other men.
These are all very complex issues and sum up why we haven't focused our talks on NFP to this point. I think I will probably continue to consider the matter further. As I said, I use FAM, which is a permutation of NFP, so I do support the idea (though not to the exclusion of hormones). Thanks for your ideas and comments.

Best,
Emily