Natural Family Planning (NFP)
Research Study
David Fine
Karen Dluhosh
Sarah Goldenkranz
Center for Health Training
Seattle, WA
January, 2009
Study Aims/Goals
Exploratory and descriptive study which aims to:
1. Identify factors that affect the use of NFP
2. Assess predictors of contraceptive success
among NFP users
Focus will be on the following areas:
1. Social, cultural, and demographic indicators associated
with NFP use;
2. Individual and institutional barriers to use;
3. Factors that may impact compliance with NFP practices;
4. Indicators of self-efficacy among NFP users; and
5. Rate and indicators of contraceptive success in this
service population.
What is Natural Family Planning
(NFP)?
• Contraceptive method / prevent unintended
pregnancy
• Relies on identification of days in menstrual cycle
when woman is most fertile and most likely to be
come pregnant
• Teaches a woman to accurately monitor her cycle,
identify her fertile period and either abstain from
intercourse or use an alternative method of
contraception
Definitions
• Natural Family Planning (NFP)
• Fertility Awareness Method (FAM)
*FPAR definition: Broad term which includes “fertility
awareness methods include rhythm/calendar, Standard
DaysTM, Basal Body Temperature, Cervical Mucus, and
Sympto-Thermal methods.”
• Fertility Awareness-Based (FAB) methods
 Cluster 1 - calendar based
 Cluster 2 - sympto-thermal based
*Source: Family Planning Annual Report: 2007 National Summary, Table 7
Who are the users?
• Generally educated, young and single, or older and
married
• Most prevalent in sub-Saharan Africa, Latin America,
and the Caribbean
• NFP use in USA has decreased as more effective
methods of contraception have become available
Reasons they use NFP
• Limited availability of other methods to prevent
pregnancy (globally)
• Other reasons:
• cultural beliefs about self-discipline and self-restraint
• desire to use more natural methods of birth control
• fear of side effects and adverse health impacts of
modern hormonal methods
Research Population of Interest
Who:
• Title X providers (staff & clinicians)
• Clinic clients using NFP as their primary method of
contraception
Where:
• Title X-funded Family Planning clinics in Region X
• Focusing on Washington State in particular
Research Partners
• Washington State DOH Family Planning and
Reproductive Health
• Planned Parenthood of the Great Northwest
• Research partners will:
• assist with selection of project field sites
• participate in staff needs assessments, staff and client
interviews, staff focus groups & client interviews
Research Advisory Committee
• Provide input on all phases of the research
• Program-research linkages, NFP service financing
issues, clinical staff needs, and NFP client service
provision
• Membership will include:
•
•
•
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A state family planning grantee nurse consultant
A medical director from PPGNW
Title X grantee and delegate agency representatives
Key stakeholders from participating clinics
Research Methods & Data Sources
Quantitative Data
• Region X Title X needs assessment surveys
Use: Describe agency and staff perspectives on NFP,
program trends and variation in NFP service provision
Source: Supplemental NFP questions added to annual
web-based survey administered to clinic staff
• Clinic Visit Records, 2004-2008
Use: Characterize clients that use NFP and client
contraceptive success
Source: existing electronic records of clinic client visits,
regional data base used for program monitoring, FPAR
• Clinic Visit Records (CVRs)--Completed in each
Region X Title X FP site for client visits qualifying
as Title X events
• CVR domains
•
•
•
•
•
•
•
Client demographics
RH history
Medical and lab service provision
Counseling and education
Provider types
Contraceptive method, before/after visit
Referrals
Qualitative Data:
• Focus groups and interviews with clinic staff
Use: Explore knowledge and training on NFP,
experiences with clients, collect clinician-client
stories
Source: face-to-face and phone interviews, selected
FP clinics in WA state
• NFP client interviews
Use: Explore reasons for choosing NFP, methods
used, training and information received, experiences
at FP clinics, client expectations
Source: face-to-face and phone interviews, selected
FP WA state clinics
NFP Visits and Users
• Data from CVRs, 2004-2008 (through June ’08)
• 6,098 visits to FP clinics in Alaska, Idaho, Oregon and
Washington where NFP was listed as BC method
• 5,061 female patients using NFP methods,
before/after their clinic visit
• Aggregated by clinic and client ID
• An additional ~13,000 visits for these 5,061 patients,
2004-08, where NFP was not listed as BC method
• These records to be used to describe patterns of FP
client BC method, services
• Assess number of pregnancies and intention status
NFP Visits
• Visit data, n = 6,098
• NFP after visit
• NFP before visit
• NFP before/after visit
24%
29%
47%
NFP Visits—Contraceptive Methods
Contraceptive Method
%
Before Visit
NFP
76%
Barrier
4%
Hormonal
4%
Other
2%
None
14%
After Visit
NFP
71%
Barrier
4%
Hormonal
12%
Other
1%
None
12%
N = 6,098
NFP Users
Characteristic
%
State
Alaska
4%
Idaho
7%
Oregon
60%
Washington
29%
Population Density (RUCA)
Urban
75%
Large Rural
12%
Small Rural
7%
Isolated
6%
N= 5,061
NFP Clients
Characteristic
Age
< 20
20-24
25-29
30-34
35-39
> 39
Race/Ethnicity
White
Black
AI/AN
Hispanic
Asian
NH/PI
%
11%
27%
26%
16%
10%
9%
82%
2%
1%
10%
4%
1%
N= 5061
Characteristic
%
Number of Pregnancies
0
43%
1
21%
2
14%
3
10%
4 or more
12%
N= 5061
Next Steps—Regional CVR Data
• Update 2008 to annual data set
• Add other ~13,000 clinic visits where NFP was
not the BC method
• Explore visit patterns
• Generate aggregate patient data set (n=~5,000)
with all relevant data from the ~20,000 visits
• Pregnancy history (number/intention status), referrals,
BC methods used
Other Next Steps
• Implement regional needs assessment with NFP
items
• Finalize participating clinics
• Generate qualitative tools, client recruitment
protocols, consent procedures
• Implement field qualitative study component