PIP: Clients need both skill and motivation to effectively use natural family planning (NFP). Thus, NFP services must provide adequate counseling and training to clients. A good teacher of NFP does not need formal health care training but she/must have good communication skills. A teacher usually needs to meet with a client four times over a period of several months to teach NFP. Fertility awareness comprises the first step in NFP training. This involves helping couples to understand the reproductive system, menstrual cycles, and fertile periods. The NFP Training and Medical Services Center in Nairobi, Kenya, provides clients, many of whom live in slums and are illiterate, with an exercise book with small squares that they color so they can track their fertility signs. They tend to use the cervical mucus method rather than the basal temperature method which requires a thermometer. In Los Angeles, California, clients of one NFP program attend group sessions and individual counseling sessions to learn about the menstrual cycle, fertile period, and rules of NFP and how to apply them. The Twin Cities NFP Center in Minnesota found that individual counseling was 50% more expensive than group sessions and it affected changes in neither the pregnancy nor NFP continuation rates. Group training here involved more men. Catholic groups in Bangladesh, India, Kenya, South Korea, and the US conducted a study of NFP programs and found that client's willingness or ability to discuss NFP were not associated with socioeconomic status, previous family planning experiences, and education. Another study of the same users did find an association between higher education and lower unplanned pregnancy rate. The same was true for previous family planning use. Since limited resources prevent some family planning programs from training staff in NFP, the programs can refer clients to existing NFP services, sending one staff member to be trained in NFP, or having one staff member providing NFP advice.