The State of the Science of Natural Family Planning Fifty Years after Humane  Vitae: A Report from NFP Scientists' Meeting Held at the US Conference of  Catholic Bishops, April 4, 2018

Michael D Manhart; Richard J Fehring

doi:10.1177/0024363918809699

Fertility Awareness Effectiveness

The State of the Science of Natural Family Planning Fifty Years after Humane Vitae: A Report from NFP Scientists' Meeting Held at the US Conference of Catholic Bishops, April 4, 2018

Manhart MD, Fehring RJ

Published November 2018 The Linacre Quarterly, 85(4), 339-347

DOI 10.1177/0024363918809699 PMID 32431371 PMC PMC6322122

RRM Academy Synopsis

Fertility Awareness Experts Set Five Priorities For Research

A 2018 meeting of NFP researchers at the US Conference of Catholic Bishops set five priorities for future research, naming postpartum and perimenopausal women as gaps. The meeting marked fifty years of study since Humanae Vitae. A review found Sensiplan and Marquette had the lowest typical-use unintended pregnancy rates among NFP methods, under five per 100 women each year.

Key Findings

Manhart et al. (2013) reviewed studies since 1980 and found at least one high-quality cohort study per major method, with unintended pregnancy rates of under five to twenty-two per 100 women yearly.
Urrutia et al. (2018) screened fifty-one effectiveness studies and rated none high quality, twenty-one moderate, and thirty low quality.
Among NFP methods, the Sensiplan and Marquette urinary hormone methods had the lowest typical unintended pregnancy rates, both under five per 100 woman-years, versus ten to thirty-three for other methods.
A review of ninety-five cycle-tracking apps found fifty-six (59 percent) lacked evidence-based support or pregnancy-avoidance design; only six scored well on authority and accuracy.
Dumitru et al. (2016) found oral contraceptive studies since 2000 met high-quality criteria in five of forty-seven cases (11 percent), versus ten of thirty FABM studies since 1980 (30 percent).

Interpretation

This report sums up a one-day meeting of NFP researchers held fifty years after Humanae Vitae. The meeting drew on decades of cohort studies and set five priorities for future research. The authors note a gap in evidence on method use among US women. The authors say providers should keep recommending effective NFP methods. The findings support larger studies on the five priorities the meeting set.

RRM Context

The meeting followed a 2016 Canada gathering led by the International Institute for Restorative Reproductive Medicine. The Canada meeting shared the same goal: build more NFP research. One priority from this 2018 meeting was to test charting as a tool to screen for conditions like endometriosis. This fits RRM's view that cycle data can flag health issues beyond fertility alone.

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

Abstract

A one-day meeting of physicians, professional nurses, and scientists actively involved in Natural Family Planning (NFP) research was held to review the state of the science of NFP and consider future priorities. The meeting had four objectives: (i) determine the gaps in research evidence for secure methods of NFP among women of all reproductive categories, (ii) determine the gaps in the research and development of new technology for providing NFP services, (iii) determine the gaps in the research that determine the benefits and challenges with use of NFP among married couples, and (iv) provide prioritized ideas for future research needs from the analysis of evidence gaps from objectives above. This article summarizes the discussion and conclusions drawn from topics reviewed. While much has been accomplished in the fifty years since Humane vitae, there are still many gaps to address. Five areas for future research in NFP were identified as high priority: (1) well-designed method effectiveness studies among various reproductive categories including important subpopulations (postpartum, perimenopause, posthormonal contraceptive), normally cycling women (especially US women), and comparative studies between NFP methods; (2) validation studies to establish the benefit of charting fertility signs (both currently known and potential new indicators) as a screening tool for women's health issues; (3) ongoing independent evaluation of fertility monitoring apps to provide users perspective on the relative merits of each and to identify those most worthy of further effectiveness testing; (4) studies evaluating the impact of new technologies on NFP adoption, use, and persistence; and (5) creation of a shared database across various NFP methods to collaborate on shared research interests, longitudinal studies, and so on. This summarizes a meeting to review the scientific and medical progress related to natural family planning made in the 50 years since Humane Vitae and to define priorities for future work. Areas reviewed included the evidence for avoiding pregnancy in normally cycling, postpartum, and perimenopausal women, the impact of new technology, including fertility charting apps, on NFP, and the impact on relationships and personal well-being from use of NFP. Five priority focus areas for future research were also identified.

Read the guide

Fertility Awareness Methods Compared

Clinician-reviewed comparison of fertility awareness-based methods (Billings, Creighton, Sensiplan, Marquette, Standard Days, apps). Every effectiveness figure cited and labeled by metric.

30 min read

Topics

Fertility Awareness › Effectiveness › Comparative Effectiveness · Research Methods › Evidence Synthesis › Systematic Reviews · Menstrual Cycle › Cycle Biomarkers › Cervical Mucus

Michael D Manhart, Richard J Fehring

Mike Manhart, M Manhart, Rick Fehring, Dick Fehring, Rich Fehring, R Fehring

PMID 32431371 32431371 DOI 10.1177/0024363918809699 10.1177/0024363918809699 Manhart et al. 2018, Manhart 2018