Adaptation of Quigley’s “Perceptions of Natural Family Planning Among Health Providers: A Systematic Review”
Summary by Heather Turner
Pregnancies, especially unintended pregnancies, have a substantial impact on the economy as well as maternal and newborn health. Preventing unintended pregnancies is therefore a topic of global importance. The ability of women to control the timing of pregnancy can decrease infant and maternal mortality from pregnancy complications and abortions, prevent the spread of HIV to infant populations, and reduce adolescent pregnancy. The vast majority of women of childbearing age who are sexually active are using contraception and yet are still experiencing surprise pregnancies.
At the same time, many women either cannot or will not use these methods because of adverse effects, religious affiliation, cost, or personal preference. It is important for providers to offer culturally competent and individualized care for these women, while still meeting the need to prevent unintended pregnancies.
The past 40 years have seen major scientific advancements in fertility awareness methods of family planning. Modern methods of NFP have been shown to be as effective as hormonal contraceptives in preventing pregnancy, but only 0.7% of women use these methods. Past studies suggest that health care providers’ aversion to these methods could contribute to the lack of use in society. Therefore, Quigley and fellow authors did a thorough review of existing literature among North American health care providers to learn more about their knowledge of and attitudes toward NFP.
There are four factors that seem to determine providers’ knowledge of NFP and application to their medical practice: amount of NFP education, perceptions of effectiveness, availability of resources, and religious or moral allegiances.
Amount of NFP Education
Providers are not adequately educated in modern methods of NFP, leading to an aversion to NFP as an option to prevent pregnancy. One hour total, if any, was spent on NFP instruction in basic medical and nursing education. However, providers who had further education in modern methods of NFP, were aware of, and/or worked with qualified NFP instructors were more likely to view NFP as a reliable method for prevention of pregnancy and offer modern methods to qualifying patients.
Perceptions of Effectiveness
Providers had significantly lower perceptions of effectiveness than what has been reported in effectiveness studies. In one study, approximately 90% of health care providers significantly underestimated the effectiveness of modern methods of NFP. Certified nurse-midwives and physicians who worked with local instructors reported more accurate estimates of effectiveness.
Availability of Resources
Many providers do not have the time either to learn NFP themselves or to teach it to their patients. In order for NFP to be most effective, motivated clients need qualified instructors with ample time to teach the method of choice and to follow up with the client to ensure understanding. Title X funded clinics, which serve a population that could benefit greatly from NFP, have very little time to spend teaching these clients any method of NFP. They also do not have educational materials or instructor resources to provide additional information to potential candidates. Providers who had and were aware of qualified NFP instructors in the same ZIP code had more information available to them and were more likely to view NFP as a viable option to family planning. They were also more likely to refer women to receive instruction in an NFP method to prevent pregnancy.
Religious/ Moral Allegiances
Religious beliefs in general were a significant determinant of whether or not the provider viewed NFP as a viable option for most women. However, there were no statistically significant differences among religions, so long as the beliefs were held in high regard and considered important to uphold in practice.
Message for Instructors and Promoters of Billings
As instructors, Quigley’s study of health care providers and NFP attitudes can help spur us toward smart ways to increase NFP knowledge in the medical providers in our area. If we can offer providers educational material and time-efficient teaching strategies and if we can increase the number of qualified instructors in our area, more providers may be able to offer their patients modern methods of NFP. This increase in the use of NFP will help decrease the group of people who are currently at risk for pregnancy due to refusal or inability to use artificial contraceptives. We can also do our part to encourage policy updates in nursing and medical education programs for better familiarity with NFP methods.
To read Jennifer Quigley's full article, click HERE
J Integrative Review 4.29.16
BOMA-USA provides education and training for The Billings Ovulation Method® which is a natural method of fertility management that teaches you to recognize the body's natural signs of fertility.