Fehring, R. J., Schneider, M., Barron, M. L., & Pruszynski, J. (2013). Influence of motivation on the efficacy of natural family planning. MCN. The American Journal of Maternal Child Nursing, 38(6), 352-358. https://doi.org/10.1097/NMC.0b013e3182a1ecc0
Fehring RJ, Schneider M, Barron ML, Pruszynski J. Influence of motivation on the efficacy of natural family planning. MCN Am J Matern Child Nurs. 2013;38(6):352-358. doi:10.1097/NMC.0b013e3182a1ecc0
Fehring, Richard J., et al. "Influence of motivation on the efficacy of natural family planning." MCN. The American Journal of Maternal Child Nursing, vol. 38, no. 6, 2013, pp. 352-358.
Highly motivated NFP couples had 8 pregnancies per 100 users in a year
High-motivation couples had 8 pregnancies per 100 users in a year of natural family planning, against 75 per 100 for low-motivation couples. In the prospective study of 358 women and their male partners, both partners rated motivation to avoid pregnancy before each cycle.
Study at a glance, prospective study of 358 women: Highly motivated NFP couples had 8 pregnancies per 100 users in a year. Source: Fehring RJ et al., 2013, PMID 24145489.
Key Findings
Of 667 registered participants, 358 supplied 2,621 cycles of use: 298 in the high-motivation group and 60 in the low-motivation group.
The study recorded 28 pregnancies among the 60 low-motivation participants and 16 among the 298 high-motivation participants.
The 12-month pregnancy rate was 75 per 100 women in the low-motivation group and 8 per 100 women in the high-motivation group.
A couple was rated high motivation when the woman and her partner each scored 9 or better on two questions about how hard and how much they wished to avoid pregnancy.
Motivation scores changed significantly over time, mostly in the electronic hormonal fertility monitor group, and the authors describe a significant decrease over 12 months of use.
Interpretation
The analysis was a secondary purpose of a prospective trial that lasted 12 months. Couples were randomly assigned to use an electronic hormonal fertility monitor or cervical mucus monitoring. They rated motivation before each cycle, and a urine test confirmed each pregnancy. The authors note that most participants were middle-class, educated, Caucasian Catholic couples. They call for studies in more diverse groups and recommend that users and teachers periodically assess both partners' motivation.
RRM Context
Fertility awareness-based methods involve both partners in using the chart, and this study measured the male partner's motivation as well as the woman's. Earlier Marquette Method studies reported 0-3 unintended pregnancies per 100 users in a year of correct use and 8-13 in a year of typical use. The authors propose testing simple ways to track and build shared motivation, which matches RRM's focus on body literacy for both partners.
Our editorial summary of this paper, not the article's abstract.
Abstract
Purpose
To determine the influence of mutual motivation on unintended pregnancy rates of couples who used natural family planning (NFP) methods to avoid pregnancy.
Study Design
Using an online taught NFP method, 358 women and (their male partners) indicated "how much" and "how hard" they wished to avoid pregnancy on a scale of 0 to 10 before each menstrual cycle charted over 12 month of use. This motivation scale is used in the National Survey of Family Growth as a measure of motivation. All pregnancies were verified with an online pregnancy evaluation and urine-based pregnancy test. A combined motivation score was used in analysis.
Results
There were 28 pregnancies among the low-motivation participants (N = 60) and 16 among the high-motivation participants (N = 298). At 12 months of use, there were 75 pregnancies per 100 users for the low-motivation group and only 8 for the high-motivation group. There was an 80% greater likelihood of a pregnancy with the low-motivation group (χ = 25.5, p < .001, odds ratio = 1.80; 95% confidence interval = 1.61-1.90).
Clinical Implications
High motivation to avoid pregnancy by both the female user of a behavioral method of family planning and her male partner is required for high efficacy. Assessing motivation of both the woman and her male partner before prescribing NFP methods is recommended.
Clinician-reviewed comparison of fertility awareness-based methods (Billings, Creighton, Sensiplan, Marquette, Standard Days, apps). Every effectiveness figure cited and labeled by metric.
