Jennifer Quigley, DNP, RN, FNP-BC 
Erin Shankel, DNP, RN, FNP-BC 
Linda Wofford, DNP, RN, CPNP   
 
Perceptions of Natural Family Planning Among Health Providers: A Systematic Review 

Preventing unintended pregnancies in females of childbearing age is a major topic of global and domestic importance, having a substantial impact on maternal and newborn mortality, morbidity, and the economy. In 2013, almost 290,000 maternal deaths occurred due to complications of pregnancy or child-birth, 99% of which were in underdeveloped countries. 1 Infant mortality is just as devastating with 4.6 million deaths before the age of one year, a large number being attributed to multiple factors related to unhealthy timing of pregnancy. 2 The World Health Organization 2 continues to state that the ability of women to adequately control the timing and spacing of pregnancy can dramatically decrease maternal mortality due to pregnancy complications and unsafe abortions, decrease infant mortality, prevent the spread of HIV to infant populations, and reduce adolescent pregnancy. Reducing unintended pregnancy is a focus of both the 2015 United Nations Millennial Development Goals3  and the United States Healthy People 2020 objectives.4

A study by Finer, Zolna 5 indicated that in 2008 in the U.S., 51% of pregnancies were unintended at the time of conception, increasing 3% from 2001 despite advances in contraception. Because of this continued increase, The Healthy People 2020 initiative 4 includes objectives to decrease the rate of unintended pregnancies in the U. S. by 10% before the year 2020. Several of the interventions for this initiative consist of increasing publicaly funded clinics that offer contraception, expanding sexual and reproductive health education, and increasing the use of contraceptives and barrier methods in adolescents.4 However, Jones, Mosher, Daniels 6 reported that in 2010, out of 61.7 million women of childbearing age in the U.S, only 7% were sexually active and not using any method of contraception. One major contributing factor for unintended pregnancies among natural or artificial contraceptive users is failure to use the method correctly, which includes inconsistent application, abandonment, or drug interactions. 7 Studies report that the most common reason for discontinuation or inconsistent use of hormonal or artificial contraceptives is the presence or fear of side-effects, including but not limited to breast cancer, cervical cancer, liver cancer, weight gain, myocardial infarction, stroke, hyperlipidemia, hypertension, ocular lesions, gallbladder disease, and bleeding irregularities. 8-17

While current initiatives to prevent unintended pregnancy are focused toward increasing modern hormonal or artificial contraception, many women either cannot or will not partake in these methods due to adverse effects, unwanted side effects, religious affiliation, cost, or personal preference. It is important that providers offer culturally competent and individualistic care for these women and still meet the need to prevent unintended pregnancy.   

The past 40 years have seen major scientific advancements in fertility awareness methods of family planning. Specific markers of fertility have been discovered that, when observed, allow a woman to effectively recognize her time of fertility. 18 Studies by Alliende, Cabezón, Figueroa, and Kottmann,19 Fehring, 20 and Hilgers 21 determined that detectible cervical fluid changes and basal temperature spikes correlate with exact days of ovulation in 95-98% of cycles as determined by comparison with medical identification of ovulatory phases, such as ultrasound and hormonal detection either through urine samples or blood testing. Research and development around these markers has sparked development of several methods, which will be hereby referred to as modern methods of natural family planning (NFP) including the Billings Ovulation Method, the Creighton Model, basal body temperature (BBT), and the symptothermal method. The Billings Ovulation Method and the Creighton Model both rely on observable cervical mucus changes to detect fertility, whereas BBT relies upon the spike of body temperature that occurs with ovulation. The symptothermal method uses a combination of both of these approaches. Each of these methods has been shown to have evidence-based use-efficacy of preventing pregnancy of 98.8-99.4%. 22,23 A newer addition to modern methods of NFP that is gaining popularity is the StandardDays© method, a method developed from the calendar/rhythm method that involves more specific calculation of ovulation days, but does not use any observational markers. 24 This method has also been shown to have a 95% efficacy rate of preventing pregnancy. 25 

Modern methods of NFP have been shown to be equally as effective as hormonal contraceptives in preventing pregnancy; yet only 0.7% of women use these methods. 7 Pallone, Bergus 26 suggest that health care providers’ aversion to these methods could contribute to the lack of use in society. Therefore, an integrative review was conducted to determine the state of the literature on current North American health care providers’ attitudes toward or knowledge of fertility awareness based methods to prevent pregnancy.

SEARCH METHODS 

An exhaustive search of literature from 2009 to 2014 was conducted using various combinations of: attitudes, barriers, knowledge, natural family planning, fertility awareness, and ovulation method. Search engines included CINAHL Complete, MEDLINE Complete, PsycARTICLES, SocINDEX with Full Text, PsycINFO, and Religion and Philosophy Collection in order to capture studies from various disciplines. The authors limited the search to peer reviewed, primary research articles in the English language.   

RESULTS 

The initial search from the databases returned 338 results. The authors removed duplicate articles, any articles not conducted in North America, and those that were not relevant to the health care field, i.e. natural disaster, farming, and natural resources, leaving 36 articles. A preliminary scan of the titles and abstracts excluded an additional 16 articles that were irrelevant to natural or fertility-based family planning methods to prevent pregnancy, such as surrogate usage, family conferences, infertility, cancer quality of life, childhood obesity, pain sensation related to the menstrual phase, elderly quality of life, early pregnancy recognition, menstrual cycle and respiratory symptoms, abortion, and fertility preservation in cancer. Using the 20 remaining articles, a more thorough abstract review was conducted to include primary studies only pertaining to health care providers’, physicians’, or clinicians’ attitude, knowledge, barriers to, or perception of natural or fertility awareness based methods of family planning. This abstract screening process yielded three articles for this review. Sources referenced by the three included articles were then scanned for unique studies matching the inclusion criteria. Three additional studies matched the inclusion criteria, but were older than the authors’ original five-year time frame. However, these studies were included to further enhance knowledge of the subject matter. Figure 1 depicts the publication selection process.

FINDINGS

During the review process, the authors were able to distinguish four categories that emerged from the literature in respect to providers’ knowledge of NFP and application to practice: Amount of NFP education, perceptions of effectiveness, availability of resources, and religious or moral allegiances. These four categories emerged as the articles were analyzed for commonalities and distinguishing factors through noting patterns, clustering, and seeing plausibility.  The 6 selected articles’ quality were evaluated for authenticity, methodological quality and information value.  The Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was adapted for non-internet surveys and used to evaluate the 6 articles.27 The adapted checklist can be found in the Appendix. The findings can potentially impact policies and education programs of health care providers, including physicians and nurses, to add valuable NFP education in order to provide individualized care to all women of childbearing age who wish to prevent or postpone pregnancy. 

AMOUNT OF NFP EDUCATION

The first extrapolated category determines that providers are not adequately educated in modern methods of NFP (Table 1). Three of the six analyzed studies revealed that deficient education in modern methods of NFP is a common theme contributing to health care providers aversion from NFP as an option to prevent pregnancy.28, 29, 30 The study by Fehring28 showed that limited time frame of less than one hour total, if any, was spent on NFP instruction in basic medical and nursing education. Stanford, Thurman, Lemaire 30 found that 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. Fehring, Hanson, and Stanford 29 substantiated this trend in deficient education when they found that certified nurse midwives (CNMs), who had more education in modern methods of NFP were more likely than physicians to offer it to women as an option to prevent pregnancy. However, CNMs still reported less than adequate levels of comfort and preparation to recommend this form of natural contraception to patients. 

PERCEPTIONS OF EFFECTIVENESS

The second category was expressed in five studies that explored providers’ knowledge of modern methods of NFP. Each of the five studies showed that the providers had significantly lower perceptions of effectiveness than what has been reported in the literature (Table 2). Approximately 90% of 2,300 health care providers underestimated the effectiveness of modern methods of NFP as much as 30%, although CNMs and physicians who worked with local instructors reported more accurate estimates of effectiveness. 28, 32

AVAILABILITY OF RESOURCES

Two studies showed that lack of time to teach and availability of NFP information are contributing factors for providers’ aversion of NFP to prevent pregnancy (Table 3). 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. 33 Kelly, Witt, McEvers, Enriquez, Abshier, Vasquez, and McGee 34 found that Title X funded clinics, who serve a population that could benefit greatly from NFP, have very little time to spend teaching these clients any method of NFP, and have a lack of education materials or instructor resources to provide additional information to potential candidates. Another reviewed study by Stanford, Thurman, Lemaire 30 found 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.30

RELIGIOUS/MORAL ALLEGIANCES

The last category derived from the analysis is the effect of religious and/ or moral allegiances of providers toward providing NFP (Table 4). Lawrence, Rasinski, Yoon, Curlin 32 and Choi, Chan, Wiebe 31 found that 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. 31,32

DISCUSSION 

From reviewing the current literature, suggested barriers to effective implementation of modern methods of NFP from the health care provider standpoint include amount of NFP education, perceptions of effectiveness, availability of resources, and religious/ moral views. While the literature suggests these barriers, it could be possible that the categories may be correlated. For example, lack of education can lead to lack of familiarity with modern methods of NFP, which could contribute to inaccurate efficacy perceptions, whereas religious and moral allegiances could hold strong guidance in the provider’s decision to find resources in order to offer NFP as an alternative to hormonal or other artificial forms of contraception. A study by Gribble, Lundgren, Velasquez, Anastasi 35 showed that educating health care providers in modern NFP methods significantly decreased provider bias, improved attitudes, and increased presentation of NFP in contraceptive consultations as a viable method to prevent pregnancy. Gribble, Lundgren, Velasquez, and Anastasi 35 also reported an increase in informed decision and client selection of NFP when the providers were more educated and comfortable with NFP. This review can act as a basis of understanding to develop and integrate an education curriculum into nursing and medical education, so that providers feel more comfortable prescribing and teaching modern methods of NFP to their patient population as an evidence-based, effective, culturally accepted, and natural way to prevent or post-pone pregnancy.  
 
Another implication of this review could be to create and promote policies that enhance resources available to health care providers. By having education material, time-efficient teaching strategies, and possibly increase the number of qualified instructors, more providers may be able to offer modern methods of NFP and help decrease the gap of people who are currently at risk for pregnancy due to refusal or inability to take current modern hormonal or artificial contraceptives. Policy updates in nursing and medical education programs also could help integrate the above mentioned education programs for better familiarity of NFP methods. 

This review suggests that more research should be performed in understanding provider viewpoints, as well as interventions that can help overcome these barriers. Another research topic suggested by the review is determining if a standardized policy-implemented education program would create provider familiarity in modern methods of NFP so that effective prevention of unintended pregnancy can be provided to a more diverse population. 

LIMITATIONS

A limitation of this review is the scarce amount of research on clinician perceptions of NFP. No randomized controlled-trials were available to review, which could depreciate the value of the findings. Also, of the limited amount of studies that were available, many were authored or co-authored by the same people, potentially monopolizing the review.

CONCLUSION

With unintended pregnancy still on the rise in the United States, it is essential that providers offer reliable, safe, and evidence-based effective ways to prevent unintended pregnancy. While modern hormonal and artificial contraception is the current, most advertised way to prevent unintended pregnancy and ensure healthy timing and spacing of pregnancies, not all women can or will partake in these methods. Culturally accepted effective methods should be offered by all providers to ensure every woman has the ability to adequately postpone or space pregnancies. The purpose of the integrative review was to provide context into the perceptions, knowledge, and potential barriers to providing evidence-based effective modern methods of NFP of health care providers in North America. Through this review, four themes emerged that can provide a basis of understanding provider barriers on which to begin a framework that guides integration of modern methods of NFP into the contraception discussion between providers and clients; amount of NFP education, perceptions of efficacy, availability of resources, and religious/moral allegiances. Identifying the gaps in education and resources available to providers allows for the implementation of policies and education programs to enhance greater knowledge and allow NFP to reach a broader population of users.  
 

REFERENCES
 
1. World Health Organization. Maternal mortality: Fact sheet N°348. 2014.
2. World Health Organization. Family planning: Fact sheet N°351 2012.
3. United Nations. Millennium development goals and beyond 2015. 2014.
4. U.S. Department of Health and Human Services. Healthy people 2020: Family planning. 2014.
5. Finer LB, Zolna MR. Shifts in intended and unintended pregnancies in the united states, 2001-2008. American Journal of Public Health. 2014;104(S1):S43-S48.
6. Jones J, Mosher W, Daniels K. Current contraceptive use in the United States, 20062010, and changes in patterns of use since 1995. National Health Statistics Reports. 2012(60):1-25.
7. Guttmacher Institute. Contraceptive use in the United States. 2014.
8. Bayer HealthCare Pharmaceuticals Inc. Highlights of health prescribing information. 2012.
9. Janssen Pharmaceuticals Inc. Ortho Tri-Cyclen Lo tablets prescribing information. Titusville, New Jersey: Janssen Pharmaceuticals, Inc; 2014.
10. World Health Organization. Combined hormonal contraceptives and venous thromboembolism. WHO Drug Information. 2014;28(1):21.
11. Gourbil M, Grandvuillemin A, Beyens M-N, et al. Thromboembolic events in women exposed to hormonal contraception or cyproterone acetate in 2012: A cross-sectional observational study in 30 french public hospitals. Drug Safety. 2014;37(4):269-282.
​12. Haarala A, Eklund C, Pessi T, et al. Use of combined oral contraceptives alters metabolic determinants and genetic regulation of C-reactive protein. The Cardiovascular Risk in Young Finns Study. Scandinavian Journal of Clinical & Laboratory Investigation. 2009;69(2):168-174.
13. Josse AR, Garcia-Bailo B, Fischer K, El-Sohemy A, Khan RH. Novel effects of hormonal contraceptive use on the plasma proteome. PLoS ONE. 2012;7(9):1-10. 
14. Soska V, Fiala J, Nebeska K, Jarkovsky J, Hruba D. The atherogenic index of plasma is increased by hormonal contraception. Scandinavian Journal of Clinical & Laboratory Investigation. 2011;71(2):94-100.
15. Brunner Huber LR, Hogue CJ, Stein AD, et al. Contraceptive use and discontinuation: Findings from the contraceptive history, initiation, and choice study. American Journal of Obstetrics and Gynecology. 2006;194(5):1290-1295.
16. Moreau C, Cleland K, Trussell J. Contraceptive discontinuation attributed to method dissatisfaction in the United States. Contraception. 2007;76(4):267-272.
17. International Agency for Research on Cancer. Monographs on the evaluation of carcinogenic risks to humans: Combined estrogen−progestogen contraceptives and combined estrogen− progestogen menopausal therapy. Vol 91. Lyons, France: International Agency for Research on Cancer; 2007.
18. Bo C, Dunson DB, Stanford JB. Dynamic model for multivariate markers of fecundability. Biometrics. 2010;66(3):905-913.
19. Alliende ME, Cabezón C, Figueroa H, Kottmann C. Cervicovaginal fluid changes to detect ovulation accurately. American Journal of Obstetrics & Gynecology. 2005;193(1):71-75.
20. Fehring RJ. Accuracy of the peak day of cervical mucus as a biological marker of fertility. Contraception. 2002;66(4):231-235.
21. Hilgers TW. Natural family planning. I. The peak symptom and estimated time of ovulation. Obstetrics and gynecology (New York. 1953). 1978;52(5):575.
22. Fehring RJ, Lawrence D, Philpot C. Use effectiveness of the Creighton model ovulation method of natural family planning. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing. 1994;23(4):303-309.
23. Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Human Reproduction (Oxford, England). 2007;22(5):1310-1319.
24. Arévalo M, Yeager B, Sinai I, Panfichi R, Jennings V. Adding the Standard Days Method® to the contraceptive method mix in a high-prevalence setting in Peru. Rev Panam Salud Publica. 2010;28(2):80-85. 
25. Arèvalo M, Jennings V, Sinai I. Efficacy of a new method of family planning: the Standard Days Method. Contraception. 2002;65:333-338.
26. Pallone SR, Bergus GR. Fertility awareness-based methods: another option for family planning. Journal of the American Board of Family Medicine. 2009;22(2):147-157.
27.  Eysenbach G. Improving the quality of web surveys: The checklist for reporting results of internet e-surveys (cherries). Journal of Medical Internet Research. 2004;6(3)e34. doi:10.2196/jmir.6.3.e34
28. Fehring R. Physician and nurses' knowledge and use of natural family planning. The Linacre Quarterly. 1995;62(4):22-28.
29. Fehring RJ, Hanson L, Stanford JB. Nurse-midwives' knowledge and promotion of lactational amenorrhea and other natural family-planning methods for child spacing. Journal of Midwifery & Women's Health. 2001;46(2):68-73.
30. Stanford JB, Thurman PB, Lemaire JC. Physicians' knowledge and practices regarding natural family planning. Obstetrics And Gynecology. 1999;94(5 Pt 1):672-678.
31. Choi J, Chan S, Wiebe E. Natural family planning: physicians' knowledge, attitudes, and practice. Journal Of Obstetrics And Gynaecology Canada: JOGC. 2010;32(7):673-678.
32. Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists' views on contraception and natural family planning: a national survey. American Journal of Obstetrics & Gynecology. 2011;204(2):124.e121-127.
33. Fehring RJ. Influence of Motivation on the Efficacy of Natural Family Planning. MCN, the American journal of maternal child nursing. 2013;38(6):352.
34. Kelly PJ, Witt J, McEvers K, et al. Clinician perceptions of providing natural family planning methods in title X funded clinics. Journal of Midwifery & Women's Health. 2012;57(1):35-42.
35. Gribble JN, Lundgren RI, Velasquez C, Anastasi EE. Being strategic about contraceptive introduction: the experience of the Standard Days Method®. Contraception. 2008​;77(3):147-154.

​J Integrative Review 4.29.16

During these winter months when many of us find getting enough natural Vitamin D through sunlight difficult at best, we are pleased to share this interesting case study of how a woman in Malaysia successfully achieved a much-desired pregnancy after her Vitamin D levels were discovered to be too low. Dr. Lek-Lim Chan, an Associate Director of WOOMB International and the President of Natural Fertility Awareness Service of Malaysia, has spoken at a few of our BOMA-USA conferences and received great reviews.

​by Dr. Lek-Lim Chan
 
Note: Permission has been granted by client to share this case study.
 
Case History & Background – This case was first referred in October 2012 by a Billings Ovulation Method® (BOM) teacher from Kuala Lumpur. The client was aged 31, married 6 years trying to conceive unsuccessfully. She had just learned BOM charting in July 2012.
 
Weight 46 kg; height 161 cm; waist 26 inch = 66 cm BMI=17.75
​
Maternal grandmother had diabetes for perhaps 15 years before she died aged 85. She was only on medication.
 
She said Vitamin D was tested in April 2012 and was well below normal, although she was not able to find her report.

She had seen a gynecologist in August 2012 who tested her female hormones and found her FSH to be “unreasonably high”. She was then told she may reach menopause in 2 years.
 
Author first met her on 8 November 2012. Her charts showed regular bleeds with follicular development, but no Peaks. This means there is follicular activity probably not reaching ovulation although there is some ovarian activity. (See chart below)

Chart of 7 July 2012 – 5 January 2013 is as follows (with a gap between 20 September and 17 November):

​The following tests were done on 24 November 2012:
​
Glucose

Note: At that time, author only did 2-point test for insulin to save money for patient. Now he is convinced that the full 5-point test as devised by Prof. Pilar Vigil must be done to ascertain for sure if the woman is insulin resistant. Sometimes, any one of the 5 readings can exceed Prof. Pilar’s reference range, already indicating insulin resistance.
 
The only abnormal reading was Vitamin D with a slight elevation of testosterone above Pilar’s limit.
 
The woman commenced Cholecalciferol (Vitamin D3) 1000 IU twice per day - one in morning and one in evening. Started in January 2013.
 
The next chart (5 April – 3 June 2013) shows she has reached Peak. However, not every bleed cycle has a Peak.
​
Chart of 5 April – 3 June 2013:

A Peak occurred on 17 April 2013, but there was no pregnancy although intercourse occurred on Peak day. However, there was no Peak in the next bleed cycle.
 
Author advised her to consider retesting the Vitamin D level. She hesitated. But on 4 pm, 21 Nov 2013, an SMS was received:

I used a home pregnancy kit yesterday, and it came out positive. Haven’t gone to the doctor to confirm result yet.
 
Chart of 24 Sep – 19 Nov 2013, during which pregnancy achieved:

She identified a Peak with only 2 days development on 6 October 2013; there was intercourse but no pregnancy. Then, she identified 4 November as a day of extreme slipperiness and therefore a day of very high fertility. But a Peak cannot be identified because there was no changing developing pattern. That does not mean there was no ovulation. It is just that ovulation cannot be confirmed if there is no Peak. And the one intercourse on this very slippery day without a Peak resulted in pregnancy.
 
Ultrasound scanning later estimated the date of conception as 5 November 2013, thus confirming that she did ovulate on or around that very slippery day.

Author then advised her to recheck her Vitamin D and testosterone, and her results were:

Vitamin D was then well within normal range, and testosterone had dropped slightly from 2.0 nmol/L to 1.9 nmol/L.
 
She continued with Vitamin D supplementation throughout pregnancy, and the baby girl was born on 25 July 2014.

Baby girl at birth

Girl at age 1

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.
 
 
Findings
 
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
​

Q.     When did you first hear about the Billings Method, and what inspired you to teach it?

We started our marriage in 1981 with another method, and it was quite some time before I heard about the Billings Ovulation Method®. I was searching for an accurate method based on science. Life is busy! The simplicity of the method was a real plus.

 Q.     You were perhaps the first teacher in the United States to become trained through WOOMB’s Correspondence Course. Now, as Education Chair for BOMA-USA, what are your thoughts on that specific format?

The Correspondence Course met my needs. The course was not offered yet through BOMA-USA so I completed the course through WOOMB. All communication was through “snail” mail. I anxiously awaited the return of my work every month. My trainer was Pauline Feehan, developer of the course. Her feedback was effective. The material progressed in an organized manner, so I was able to absorb the concepts accurately.  A real emphasis was placed on the goal of teaching the authentic Billings Ovulation Method®. Eventually I completed the work, as well as my case studies, and was certified. I felt completely supported throughout the process. Shortly after I completed the course through Australia, BOMA-USA began to offer the curriculum.  The course is conducted through email and is augmented with PowerPoint presentations. I frequently video-conference with my Trainees to provide additional support and teaching. I highly recommend this platform as a choice for individuals. 

Q.     It seems your life choices, both as a registered nurse and as a mother who homeschooled all of her children through high school, were providential stepping stones to your work with us, particularly as Education Chair.  Tell us how those two roles have been useful for your work with us.

The lifelong role of any nurse is to foster healthy lifestyles in others and to educate. Whether one is in the clinical area or using the principles in the family and community, nursing skills are valuable. I worked in cardiovascular recovery, pediatrics, postpartum, and was a breastfeeding educator. I have always been interested in preventive medicine and healthy lifestyles. Most nurses are familiar with the experience of others asking for explanation of medical concepts and being a knowledgeable resource. I think nurses are in a good position to educate and suggest referral if needed. As Education Chair, I use many of these skills listening and meeting the needs of the clients, Trainees, and Certified Teachers. The EC functions to ensure the authentic Billings Ovulation Method® is taught and communicated to others. Communication with the medical community is helpful with a background in nursing.

We homeschooled all four of our children through high school. We recently celebrated finishing 29 consecutive years of homeschooling with a trip to Rome with our daughter Christy. The amount of networking and collaboration done with others to accomplish this goal was enormous. I taught classes at the homeschool learning cooperative when asked. Our family began the first homeschool basketball team in our community. Years later it is thriving and has grown to 5 teams. Our family participated in many other pursuits, as do most families. Parents are always rolling up their sleeves to help, and we were no different. These experiences taught me how to nurture a group project.  Life is full of opportunities to “stretch” and grow for all of us.

Q.     How can we motivate inactive teachers to begin again? 

If inactive teachers are waiting for an invitation to resume, consider this to be just that! We need you. Cultural trends are emphasizing a more holistic approach. You can make a difference in your community. Pull out the materials from your Teacher Training and begin to review. Start with the story of Drs. John and Evelyn Billings. Remember why you were called to teach. I think one of the advantages to teaching the Billings Ovulation Method® is the solid research and science which is the foundation. Look at the curriculum and remember your fascination when you first learned. Someone in your family, your church, your community wants to know this good news. Get in touch with the Education Committee and talk to us. We can help you with renewal of certification. Fr. Joseph Hattie, spiritual director of WOOMB, provides material which inspires those who teach, as does Fr. Daniel McCaffrey, spiritual director of BOMA-USA. Everyone has “seasons” in life. Perhaps you are being called to begin again. We are here for you!

Q.      How often does the Education Committee meet, and what are some of your goals this year?

We have an excellent group on the Education Committee. I am joined by talented individuals. We are continuing our quarterly webinars. These are designed to keep everyone connected and have continuing education. One of our members, Dr. Montserrat Ayala-Ramirez, is heading up a Focus Group Research Project. She completed the CITI Program Course through the University of North Carolina and will beginning soon. Our Medical Seminar for nurses and physicians occurs in May (https://www.boma-usa.org/medical-seminar.html). Continuing Medical Education (CMEs) and Continuing Nursing Education (CNUs) credits will be awarded for this live online event. It is a good opportunity for BOMA-USA Teachers and Members to get the word out to providers. In the fall we are planning an Extension Course. The course is a valuable component of ongoing education. Difficult charts are studied along with an in-depth look at the Billings Ovulation Method® and Prof. Brown’s studies on the Continuum.  Of course, Teacher Trainings and Practicum Supervision are always front and center.

 Q.     Tell us about the presentation you will be giving during the next Catholic Medical Association conference in September.

I will be giving a talk at the Catholic Medical Association (CMA) Conference in Nashville, TN titled, “Fertility Awareness Management Education in Medical Practices; Empowering Patients to Participate in Care, Simplifying the Office Visit”. I have received wonderful feedback from a survey sent to providers about the topic. The theme of the conference is “Physician, Heal Thyself”. I cannot say enough good things about the CMA and the work the organization does. Local communities can form CMA Guilds for support and education among the medical community. We are prayerfully forming a Guild in my diocese. BOMA-USA will have a table of information at the conference.

Q.      What about your family? Tell us about them.
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I am married to Earl. He is a professional baseball scout with the MN Twins. He is my support and strength, often accompanying me when I give talks. I am sure many of the Teachers can say this about their spouse. We have 3 grown and married sons and a daughter in college. Our six grandchildren are a joy, and we love grandparenting!  One of our sons and his wife were asked recently to give a witness talk about their marriage during a Mass for married couples. How humbling it was to hear them thank us for being a good example. I pray we continue to provide a good example. Our parish priest said in his homily that marriage is one of the best evangelization tools. Drs. John and Evelyn Billings reminded teachers of the method that they are teaching a “lifestyle.” I believe this is true. It is a lifestyle of love.