Natural Family Planning (NFP) Research Study

David FineKaren DluhoshSarah Goldenkranz

Center for Health TrainingSeattle, WAJanuary, 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: • 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, 2004-2008Use: 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 interviewsUse: 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 24%• NFP before visit 29%• NFP before/after visit 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 11%

20-24 27%

25-29 26%

30-34 16%

35-39 10%

> 39 9%

Race/Ethnicity

White 82%

Black 2%

AI/AN 1%

Hispanic 10%

Asian 4%

NH/PI 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