Stanford, J. B., Thurman, P. B., & Lemaire, J. C. (1999). Physicians' knowledge and practices regarding natural family planning. Obstetrics and Gynecology, 94(5 Pt 1), 672-678. https://doi.org/10.1016/s0029-7844(99)00388-9
Stanford JB, Thurman PB, Lemaire JC. Physicians' knowledge and practices regarding natural family planning. Obstet Gynecol. 1999;94(5 Pt 1):672-678. doi:10.1016/s0029-7844(99)00388-9
Stanford, J. B., et al. "Physicians' knowledge and practices regarding natural family planning." Obstetrics and Gynecology, vol. 94, no. 5 Pt 1, 1999, pp. 672-678.
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Most Missouri doctors underrate natural family planning effectiveness
A 1992 survey of 375 Missouri physicians seeing women for reproductive issues found that most underestimated how effective modern natural family planning is. Doctors aware of an instructor were more likely to mention the method. About 6 out of 10 mentioned it as a workable option to at least some women, against about 4 out of 10 of those unaware.
Key Findings
Of 840 questionnaires mailed to Missouri physicians, 547 were returned (65%), and 375 respondents who saw women for reproductive concerns formed the analysis group.
At cutoffs of greater than 90% (best possible) and 70% (actual), 78% and 65% of physicians underestimated effectiveness. The literature of the time reported 97–98% and 80%.
Among physicians aware of an instructor (n = 115), 63% presented natural family planning as a workable choice to at least some women, against 39% of those unaware (P < .001).
Awareness of an instructor was independently associated with referring women who asked about natural family planning to an instructor (odds ratio 26.7, 95% CI 12.3 to 49.6; 281 respondents).
Of physicians women had asked, 40% described the cervical mucus method. For couples having difficulty achieving pregnancy, 36% initially recommended mucus observation and 71% basal body temperature.
Interpretation
The authors surveyed Missouri doctors by questionnaire. The respondents practiced obstetrics and gynecology, family practice, general practice or internal medicine. In regression models that hold other traits constant, awareness of an instructor was associated with higher effectiveness estimates, with mentioning the method and with referral. Age and years in practice showed no significant correlation. The authors note that doctors who already favor the method may be more likely to look for instructors.
RRM Context
Fertility awareness-based methods teach a woman to chart her own signs, such as cervical mucus. Restorative reproductive medicine is cycle-charting-informed. Doctors who know these methods can link couples to cycle-based care.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To assess physicians' knowledge and practices of modern methods of natural family planning.
Methods
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.
Results
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.
Conclusion
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.
