A Mixed-Methods Assessment of Health Care Providers' Knowledge, Attitudes, and Practices Around Fertility Awareness-Based Methods in Title X Clinics in the United States

Shelby Webb; An-Lin Cheng; Rebecca Simmons; Rachel Peragallo Urrutia; Victoria Jennings; Jacki Witt

doi:10.1089/whr.2020.0065

Contraception Family Planning Use and Attitudes

A Mixed-Methods Assessment of Health Care Providers' Knowledge, Attitudes, and Practices Around Fertility Awareness-Based Methods in Title X Clinics in the United States

Webb S, Cheng AL, Simmons R, Peragallo Urrutia R, Jennings V, Witt J

Published April 2020 Women's Health Reports, 1(1), 354-365

DOI 10.1089/whr.2020.0065 PMC PMC7784735

RRM Academy Synopsis

Surveyed Title X staff know fertility signs but many doubt FABMs

Title X staff in a national online survey knew fertility signs well, and many felt neutral or doubtful about fertility awareness-based methods. The online survey included 329 family planning staff. Half (52.0%) answered all four fertility questions correctly. The most common view of FABMs was neutral (43.8%), and 24.6% called them nonviable for most women.

Key Findings

Of 329 eligible respondents, 52.0% answered all four fertility questions correctly. Correct answers: 91.2% luteal phase length, 94.2% ovulatory cervical fluid, 80.2% cycle length, 74.5% basal body temperature shift.
On the viability scale, 43.8% chose the neutral score of 3 and 24.6% chose 1, a nonviable option for most women.
When a patient asked for FABM information, 4.0% (13 of 329) said they tell her the methods do not work and recommend something else. Another 47.1% gave written information.
23.7% of respondents (78 of 329) said someone at their facility had formal FABM training. More FABMs in written materials went with higher odds of discussing a cervical mucus method (OR 1.54).
Of 200 comments on successes, 72 reported none. The most common barrier (n = 77 of 226 comments) was the belief that the methods were inappropriate for clients.

Interpretation

This cross-sectional online survey reached 329 family planning staff members nationally. The authors describe the findings as preliminary. Most respondents were women working in health departments. Staff with more FABMs listed in their written materials were more likely to discuss a cervical mucus method with patients. The findings support larger, nationally representative studies of FABM training and counseling practices among family planning staff.

RRM Context

The authors cite a systematic review of 12 FABMs. Typical use pregnancy estimates ranged from 2% to 33% per 100 woman/years, so the methods differ widely. Restorative reproductive medicine treats fertility awareness as distinct methods, each with its own rules and signs.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To understand how Title X providers currently engage with fertility awareness-based methods (FABMs) for pregnancy prevention in Title X clinics across the United States.

Materials and Methods

We developed a survey to assess knowledge of fertility for purposes of pregnancy prevention, attitudes toward FABMs use for pregnancy prevention, and practices when patients request FABMs for pregnancy prevention.

Results

In total, 329 participants who met all inclusion criteria completed the survey. Respondents were generally highly knowledgeable on fertility, felt neutrally toward FABMs or thought they were a nonviable option for most women, and were likely to respond to patient requests for FABMs for pregnancy prevention by providing information. Qualitative responses included several barriers to provision of FABMs for pregnancy prevention and few successes to provision.

Conclusions

Fertility knowledge and discussion of specific methods increased with the number of methods included in the clinic's written materials or with the number of different FABMs someone at that clinic had been trained on. Significant clinician or administrative barriers may exist to offering FABMs to patients. Incorporating up-to-date information on a range of FABMs-rather than treating them as one method-into contraceptive counseling represents an opportunity to increase the contraceptive offering for clients who want them, leading to increased patient satisfaction and successful family planning outcomes.

Topics

Contraception › Family Planning Use and Attitudes › Attitudes and Acceptability · Clinician Education and Training › Practice Adoption › Implementation in Practice

Shelby Webb, An-Lin Cheng, Rebecca Simmons, Rachel Peragallo Urrutia, Victoria Jennings, Jacki Witt

S Webb, A Cheng, Becky Simmons, R Simmons, R Urrutia, V Jennings, J Witt

DOI 10.1089/whr.2020.0065 10.1089/whr.2020.0065 Webb et al. 2020, Webb 2020

A Mixed-Methods Assessment of Health Care Providers' Knowledge, Attitudes, and Practices Around Fertility Awareness-Based Methods in Title X Clinics in the United States

Surveyed Title X staff know fertility signs but many doubt FABMs

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

Related research