SALT LAKE CITY—Natural family planning, which has received short shrift from the medical community for years, may be starting to get more attention.
Or, at least, the inattention is starting to get attention.
A new study indicates that fewer than half the doctors who advise women on reproductive issues mention natural family planning as an option. What's significant is that the study appeared in the November issue of Obstetrics and Gynecology, a leading medical journal.
Joseph Stanford, assistant professor of family and preventive medicine at the University of Utah, is the author of the study.
“Obstetrics and Gynecology is one of the top two, if not the main journal for obstetrics and gynecology,” he said. “It's as mainstream as you can get in the field.” He added that in recent years there have been few articles supportive of natural family planning in mainstream publications.
The survey found that most doctors are ignorant of modern methods of natural family planning and underestimate its effectiveness in preventing pregnancy.
A team of four physicians led by Stanford sent questionnaires to 840 randomly selected doctors in Missouri, of whom 375, or 65%, responded. Of these, 46% reported mentioning natural family planning to at least some women patients.
Physicians surveyed were told that the current medical literature on natural family planning indicates that it is up to 90% effective for spacing births. Average effectiveness, they were told, is 70%. (Stanford said the rates are really higher than these, but because of controversy surrounding how to measure the rates, his team deliberately quoted them low.)
Doctors were then asked if they agreed with these estimates.
Stanford said that “70% to 80% of those surveyed wildly underestimated the effectiveness of natural family planning.”
The Utah researcher said modern methods of natural family planning can be 97% to 98% effective for spacing births, when used properly. The average rate of effectiveness, Stanford said, turns out to be 80%, which he said is very close to the rates for barrier methods of contraception such as condoms and diaphragms.
“Basically, we confirmed what we already suspected,” Stanford said. “Physicians don't routinely offer natural family planning as an option when they discuss birth control. Nor do they refer to it when talking to couples who are trying to get pregnant. And when they do talk about it, they talk about the calendar or the rhythm methods. … What they've been taught is outdated and incorrect.”
No Need to Be A ‘Rocket Scientist’
A resident physician at Yale-New Haven Hospital, who asked that her name not be printed, told the Register that students in medical school today don't learn much about natural family planning “because it has such a low success rate.”
She estimated natural family planning to be about 70% effective, and added that the real problem was motivating people to use it.
“Our patients wouldn't be reliable [for taking their own temperature],” she said. “The pill has a high failure rate” for the same reason, she added, because women forget to take it.
“If a woman is averse to taking the pill and is trying to prevent pregnancy, Depo-Provera is a better method,” the resident said.
Stanford disagreed. “You don't have to be a rocket scientist to use natural family planning effectively,” he contended. “Doctors have an unrealistically complicated view of it.”
Modern methods of natural family planning, developed in the last 20 years, include the Billings method and the symptothermal method. These are not to be confused, Stanford said, with the rhythm method, which, after its invention in the 1930s, gained notoriety only for being ineffective.
The new method does take some training, he said.
“The key finding in the study was that physicians were more likely to offer natural family planning if they reported knowing of a teacher in their area,” Stanford said. “More than half of those surveyed said they didn't know of one.
“One reason they don't offer [natural family planning], aside from not knowing about it, is that it's not something they can do alone. They can hand you a prescription for a pill and that's that. But when it comes to natural family planning, it takes time they don't have.”
Yet, the training is worth the time, insisted Jose Fernandez, an Oklahoma City physician. Fernandez said natural family planning requires a woman and her doctor to become cooperators.
“When a woman charts her own cycle, we can detect gynecological and reproductive problems,” he said. “When I treat a woman, I want to understand her body based on what she sees as well as what I see. With the pill you are working against a woman's body because all the pill does is shut a woman's system down. With natural family planning you are working with the body.”