A Mixed-Methods Assessment of Health Care Providers' Knowledge, Attitudes, and Practices Around Fertility Awareness-Based Methods in Title X Clinics in the United States.

Shelby Webb,Victoria Jennings,Rachel Peragallo Urrutia,Jacki Witt,Rebecca Simmons,An-Lin Cheng

doi:10.1089/whr.2020.0065

Shelby Webb, Victoria Jennings + Show 4 more

Open Access

https://doi.org/10.1089/whr.2020.0065

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Abstract

Objective: To understand how Title X providers currently engage with fertility awareness-based methods (FABMs) for pregnancy prevention in Title X clinics across the United States.Materials and Methods: We developed a survey to assess knowledge of fertility for purposes of pregnancy prevention, attitudes toward FABMs use for pregnancy prevention, and practices when patients request FABMs for pregnancy prevention.Results: In total, 329 participants who met all inclusion criteria completed the survey. Respondents were generally highly knowledgeable on fertility, felt neutrally toward FABMs or thought they were a nonviable option for most women, and were likely to respond to patient requests for FABMs for pregnancy prevention by providing information. Qualitative responses included several barriers to provision of FABMs for pregnancy prevention and few successes to provision.Conclusions: Fertility knowledge and discussion of specific methods increased with the number of methods included in the clinic's written materials or with the number of different FABMs someone at that clinic had been trained on. Significant clinician or administrative barriers may exist to offering FABMs to patients. Incorporating up-to-date information on a range of FABMs—rather than treating them as one method—into contraceptive counseling represents an opportunity to increase the contraceptive offering for clients who want them, leading to increased patient satisfaction and successful family planning outcomes.

Highlights

Fertility awareness-based methods (FABMs) of family planning rely on women interpreting their individual physiological signs, such as the timing of the menstrual cycle, changes in cervical fluid, basal body temperature, and/or increases in urinary hormones to predict current fecundity
Objective: To understand how Title X providers currently engage with fertility awareness-based methods (FABMs) for pregnancy prevention in Title X clinics across the United States
Respondents were generally highly knowledgeable on fertility, felt neutrally toward FABMs or thought they were a nonviable option for most women, and were likely to respond to patient requests for FABMs for pregnancy prevention by providing information

Summary

Introduction

Fertility awareness-based methods (FABMs) of family planning rely on women interpreting their individual physiological signs, such as the timing of the menstrual cycle, changes in cervical fluid, basal body temperature, and/or increases in urinary hormones to predict current fecundity. There are many different FABMs, each relying on different method rules and one or more physiological signs.[1] For example, the Standard Days method relies only on menstrual cycle timing, and women consider themselves fertile between days 8 and 19, whereas symptothermal methods utilize signs such as cervical fluid and basal body temperature in combination to School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA.

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