Natural family planning offers patients contraception alternatives
Your patient says she wants to wait a while before having another child, but her religious beliefs preclude using contraception. A couple tell you they don't want to put chemicals in their bodies and don't like condoms, but also don't want to have children. What would you advise?
The clinical seminar "Contraception and Natural Family Planning" encouraged physicians to educate interested patients about natural family planning -- methods that enable a woman to predict fertility so she can avoid intercourse during that time.
Richard Lord Jr., M.D., assistant professor of family medicine at Rush University in Chicago, described four natural family planning methods:
- The ovulation method uses the presence and characteristics of cervical mucus to predict ovulation. Studies show that ovulation occurs in 98 percent of women within three days of experiencing stretchy, clear, lubricating cervical mucus -- the "peak mucus sign."
- The symptothermal method involves monitoring both the basal body temperature and cervical mucus to determine when a woman is ovulating. A rise in basal body temperature indicates ovulation.
- The less reliable rhythm (or calendar) method calculates when a woman ovulates based on her menstrual cycle. It can be effective for women with regular cycles, but it requires long periods of abstinence for women with cycles that vary in length.
- The lactational method assumes that a woman won't get pregnant during the six months after giving birth as long as she breast feeds exclusively and remains amenorrheic.
Studies show that more than 40 percent of women have an interest in learning about natural family planning, but misperceptions abound, Lord said. "We need to dispel the myths of what it is and what it is not." Although natural family planning is largely associated with the rhythm method, that method is generally not promoted because of high failure rates.
Find out more about natural family planning
During the "Contraception and Natural Family Planning" clinical seminar, speaker Richard Lord Jr., M.D., distributed this list of resources.
- Couple to Couple, (513) 471-2000
- Northwest Family Services, (503) 215-6377
- Families of the Americas, (301) 627-3346
- Creighton Model Natural Family Planning System, (402) 390-6600
- Natural Family Planning Center of Washington, D.C., (301) 897-9323 -- the center also has a toll-free number you can call to get the name of a teacher in your area who provides education in the ovulation method: (888) 637-6371.
Lord said the effectiveness of the other natural family planning methods rivals that of barrier contraceptives such as condoms. For example, the failure rate is just 2-3 percent for couples who use the ovulation method appropriately and abstain from intercourse during the woman's fertile period. However, the actual rate of pregnancy among couples using the method ranges from 13 to 45 percent, depending on the study. "That's where some of the big debate comes in," Lord said. "Is it the actual method that's failing, or is it the patients who are failing to adhere to the method?"
Other advantages of natural family planning, he said, include its low cost, lack of side effects, acceptance by religious organizations, opportunities for couples to explore aspects of their relationship other than sex, potential for increased communication between the man and woman, and education that will help the couple if they decide they do want to have a baby.
Couples who prefer not to abstain from intercourse during the woman's fertile period may opt for a barrier method of contraception during that time and use natural family planning during the rest of her cycle.
Lord pointed out that natural family planning won't meet the needs of every patient. For example, a couple trying to space out their children may be more inclined to try the methods than young, sexually active singles would. He encouraged FPs to broach the subject with female patients, and if they express an interest, make sure they get the information they need to learn natural family planning.
And that raises the issue of training women on how to identify the signs of ovulation, one obstacle to natural family planning, Lord said. "I can't think of how we could find time in our practices to do the training that some of our patients would need, so we need to find resources in the community where we can refer them."
