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
The study is a cross-sectional survey: answers were collected once, from physicians in one Canadian province in 2009. The authors call the 44% response rate suboptimal; it falls below the 56.5% average they cite for surveys of health care professionals. The authors found it hard to tell how age, career level, gender and years in practice each related to attitudes, because the four were highly interrelated. The survey records what physicians know and report doing. The authors did not observe appointments or test how well any method works.
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.
To assess physicians' knowledge and practices of modern methods of natural family planning. A questionnaire was mailed to 840 physicians selected randomly from Missouri state licensing records for obstetrics-gynecology, family practice, general practice, and general internal medicine. The response rate was 65%. A total of 375 physicians (69% of respondents) saw women for reproductive issues. About half (46%) of physicians reported that they mentioned natural family planning to at least some women when discussing family planning issues. Observing vaginal discharge of cervical mucus was discussed by 40% of physicians in the context of avoiding pregnancy and by 36% of physicians in the context of helping a couple achieve pregnancy. Twenty-two percent of physicians estimated the best possible effectiveness of natural family planning to avoid pregnancy to be greater than 90%, and 35% estimated the actual effectiveness to avoid pregnancy to be greater than 70%. (The threshold rates of 90% best possible effectiveness and 70% actual effectiveness were chosen to be somewhat less than those reported in medical literature.) Physicians who gave higher estimates of effectiveness of natural family planning and physicians who were aware of an instructor in their community were more likely to provide women with relevant information about natural family planning. Most physicians, especially those unaware of availability of instructors in their areas, underestimate the effectiveness of natural family planning and do not give information about modern methods to women.
Family Planning Use and Attitudes · Attitudes and Acceptability
Perinatal health professionals are in key positions to either promote or dissuade the use of Natural Family Planning (NFP). The purpose of this article is to describe a survey conducted with perinatal physicians and nurses on their knowledge and professional use of NFP. Four hundred and fifty physicians and nurses (150 MDs and 300 RNs) were sent a questionnaire on the use of and knowledge of NFP. One hundred sixty-six (or 37%) returned the completed questionnaires. Fifty-two percent of the nurses who returned the questionnaires and 48% of the physicians indicated they were taught about NFP in basic (generic) medical or nursing school. The average lecture time spent on the subject in either nursing or medical school was less than one hour. The majority learned about NFP through self-education or on-the-job training. Only four (1 RN and 3 MDs) are certified to teach NFP. Fifty-three percent of the nurses and 44% of physicians would not advise the use of NFP to avoid pregnancy. The most frequent reasons given for not promoting the use of NFP to either avoid or achieve pregnancy were that it is not effective, not natural, too difficult to learn, better methods are available, and it only works for highly motivated educated women.
Family Planning Use and Attitudes · Attitudes and Acceptability
Davidson AV et al., 2023·Kans J Med·Free full text on PubMed Central
Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols. They are preferred by some patients due to medical contraindications to hormonal contraceptives, lack of side effects, religious convictions, preference to avoid hormones or contraceptive devices, improved body literacy, or a combination of the above. FABMs are infrequently covered in medical school curricula and are often perceived by physicians to be of low efficacy. There is an opportunity for improvement of physicians' evidence-based knowledge of FABMs, which has the potential to improve patient understanding of and access to the full menu of family planning options. A self-administered, cross-sectional survey was distributed to assess physician knowledge and opinions of FABMs by key university contacts. Univariate and bivariate statistics were calculated for close-ended questions and responses to open-ended questions were analyzed for common themes. A total of 79 participants completed the entire survey. Another 11 submitted partially completed surveys. For completed surveys, questions assessing knowledge of key concepts underlying FABMs, performance by specialty was 55% correct for OB/GYN (n = 16), 55% (n = 47) correct for family medicine, 36% (n = 10) correct for internal medicine, and 35% (n = 6) correct for pediatrics. Negative, neutral, mixed, and positive opinions related to FABMs were represented. There are opportunities to improve physicians' evidence-based knowledge of FABMs; this may improve patient-centered contraceptive care.
Family Planning Use and Attitudes · Attitudes and Acceptability
Although modern methods of natural family planning (NFP) are effective both to avoid and to achieve pregnancy, relatively few women use these methods. It is not known whether this is due primarily to lack of interest or to other factors. We therefore explored the level of interest in NFP among female family practice patients. We mailed information about NFP to 400 female patients between ages 21 and 42 and conducted follow-up interviews by telephone. We excluded 162 women for whom we could not obtain accurate addresses or phone numbers, 68 women we could not reach by telephone, 67 women who were not currently at risk of pregnancy, and 15 women for other reasons. Twenty-eight women refused to participate in the study. Sixty women completed telephone interviews. Forty-three percent of respondents (n = 60) were interested in learning more about NFP, 24% said they were likely to use NFP to avoid pregnancy, and 32% were likely to use NFP to achieve pregnancy. Younger women and women who were Christian but not Catholic and not of a major Protestant denomination were more interested in NFP. Some female family practice patients are interested in learning and using NFP.
Contraception › Family Planning Use and Attitudes › Attitudes and Acceptability · Fertility Awareness › Effectiveness › Typical and Perfect Use
Ellen Wiebe, Sherry Chan, Joyce Choi
E Wiebe, S Chan, J Choi
PMID 20707956 20707956 DOI 10.1016/s1701-2163(16)34571-6 10.1016/s1701-2163(16)34571-6 Choi et al. 2010, Choi 2010
Cite this article
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.
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
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