Choi, J., Chan, S., & Wiebe, E. (2010). Natural family planning: physicians' knowledge, attitudes, and practice. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, 32(7), 673-678. https://doi.org/10.1016/s1701-2163(16)34571-6
Choi J, Chan S, Wiebe E. Natural family planning: physicians' knowledge, attitudes, and practice. J Obstet Gynaecol Can. 2010;32(7):673-678. doi:10.1016/s1701-2163(16)34571-6
Choi, Joyce, et al. "Natural family planning: physicians' knowledge, attitudes, and practice." Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, vol. 32, no. 7, 2010, pp. 673-678.
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Surveyed doctors underestimated how well natural family planning works
Only 3 to 6 out of 100 doctors knew each method's perfect use effectiveness in a 2009 survey of doctors and residents in British Columbia. Forty-four out of 100 eligible doctors and residents sent the survey back. Half of those who answered said they skip natural family planning when patients ask about birth control.
Key Findings
Fewer than 6% of physicians gave the right perfect use effectiveness for each of the four methods. For typical use, 33% answered correctly.
Asked about contraception, 50% of participating doctors left NFP out. Another 24% raised it with reservations, 22% called it viable for selected patients, and 3% for most patients.
Asked about achieving pregnancy, 23% left NFP out, 7% raised it with reservations, 34% called it viable for selected patients, and 37% for most patients.
Family doctors and family medicine residents more often called NFP viable for contraception than gynecologists and gynecology residents (P = 0.003). None in the gynecology group did so for most patients.
Older physicians described the Standard Days, cervical mucus and basal body temperature methods to patients much more often (P < 0.001) and reported more personal NFP use for contraception (P < 0.001).
Interpretation
This cross-sectional survey measured what physicians in British Columbia knew about natural family planning in 2009, and what they told patients. Knowledge of true effectiveness was low across the board, and half of participating doctors left NFP out of contraceptive counseling altogether. The authors note the 44% response rate fell below the average for surveys of health care professionals. The findings support larger studies of how physician training shapes what patients hear about fertility awareness-based methods.
RRM Context
Cycle charting is the skill that fertility awareness-based methods teach, and restorative reproductive medicine builds on it. The authors cite studies finding that US nursing and medical schools gave NFP under one hour on average. A clinician who has not learned these methods has little to teach couples.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To assess physicians' knowledge, attitudes, and practice with respect to four evidence-based natural family planning (NFP)
methods: Standard Days, cervical mucus, basal body temperature, and the lactational amenorrhea method.
Methods
We undertook a cross-sectional survey of a random sample of family physicians and all gynaecologists in British Columbia (n = 460) who have women of reproductive age in their practice, as well as all affiliated residents (n = 239). Main outcome measures were (1) physicians' attitudes towards NFP and their perceptions of its effectiveness; (2) the relationship between physicians' demographic factors, their personal experience or beliefs, and their attitudes and knowledge; and (3) how these factors affect the counselling physicians offer their patients.
Results
The survey response rate was 44%. Only 3% to 6% of physicians had correct knowledge of the effectiveness in perfect use of the NFP methods cited in this study. Fifty percent of physicians who responded mention NFP to their patients as an option for contraception, and 77% of physicians mention NFP as an option to couples trying to conceive. Family physicians and residents were much more likely than gynaecologists or gynaecology residents to mention NFP during counselling. Older physicians were more likely to mention NFP than younger physicians and also had more personal experience with NFP.
Conclusion
Most physicians in our study underestimated the effectiveness of NFP methods, and only a small proportion of physicians provide information about NFP during contraceptive counselling. Physicians need better understanding of modern methods of NFP to provide evidence-based contraceptive counselling to selected highly motivated patients who prefer NFP as a contraceptive choice.
Contraception › Family Planning Use and Attitudes › Attitudes and Acceptability · Fertility Awareness › Effectiveness › Typical and Perfect Use
Joyce Choi, Sherry Chan, Ellen Wiebe
J Choi, S Chan, E Wiebe
PMID 20707956 20707956 DOI 10.1016/s1701-2163(16)34571-6 10.1016/s1701-2163(16)34571-6 Choi et al. 2010, Choi 2010
Keywords
Adult, Attitude of Health Personnel, British Columbia, Cross-Sectional Studies, Female, Gynecology, Humans, Male, Middle Aged, Natural Family Planning Methods, Physicians, Family, Practice Patterns, Physicians'/statistics & Numerical Data, Surveys and Questionnaires
03rmrcq20 