1. Natural Family Planning (NFP) Research Study
David Fine
Karen Dluhosh
Sarah Goldenkranz
Center for Health Training
Seattle, WA
January, 2009

2. Study Aims/Goals Exploratory and descriptive study which aims to:
Identify factors that affect the use of NFP
2. Assess predictors of contraceptive success among NFP users

3. Focus will be on the following areas:
Social, cultural, and demographic indicators associated with NFP use;
Individual and institutional barriers to use;
Factors that may impact compliance with NFP practices;
Indicators of self-efficacy among NFP users; and
Rate and indicators of contraceptive success in this service population.

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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,
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

12. 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

13. Focus groups and interviews with clinic staff
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

14. 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, , 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

15. NFP Visits Visit data, n = 6,098 NFP after visit 24%
NFP before visit 29%
NFP before/after visit 47%

16. NFP Visits—Contraceptive Methods%
Before Visit
NFP
76%
Barrier 4%
Hormonal
Other 2%
None
14%
After Visit
71%
12% 1%
No NFP at T1 and Yes NFP at T2=24%
Yes NFP at T1 and No NFP at T2=37%
N = 6,098

17. NFP Users Characteristic % State Alaska 4% Idaho 7% Oregon 60%
Washington
29%
Population Density (RUCA)
Urban
75%
Large Rural
12%
Small Rural
Isolated 6%
N= 5,061

18. 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
Asian 4%
NH/PI
N= 5061

19. Characteristic % Number of Pregnancies 43% 1 21% 2 14% 3 10% 4 or more
43% 1
21% 2
14% 3
10%
4 or more
12%
N= 5061

20. 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

21. 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