Family Planning in a Rural Nurse-Midwifery Program

Abstract

Nurse-midwives trained as family planning specialists are providing modern medical contraceptive services to isolated Appalachian women in 3 rural eastern Kentucky counties. In the area where the program is concentrated the nurse-midwives are reaching some 60% of the women estimated to be in need of subsidized services compared to from 5-40% of the need met in nearby counties. The Frontier Nursing Service (FNS) sponsors 1 of the very few family planning programs serving rural women. It was founded almost 50 years ago in order to provide maternal and child health care and it pioneered in the use of nurse-midwives to deliver this service. By the time the Food and Drug Administration approved oral contraceptives (OCs) for commercial distribution in 1960 the FNS had accumulated convincing evidence that nurse-midwives could adequately select postpartum patients for OC and supervise them in its use. The IUD was included among the methods offered to women interested in family planning in 1964. In 1967 FNS was the 1st midwifery service to report a statistical analysis of its family planning activities in the scientific literature. The 1st 10 years (1960-1970) of the FNS family planning program have been evaluated based on materials gathered from the permanent Hyden Hospital family planning records of each patient and that evaluation is reviewed. 47% of the 930 women in the program were still active participants at the end of the 10-year period. A smaller percentage of women who began as IUD users (26%) than as OC users (41%) were lost to follow-up. Analysis of the program for 1970 and 1971 shows the trend toward acceptance and utilization of contraception continuing. The nurse-midwifery family planning program has been associated with a sharp decline in the fertility and birthrates in the area served compared with other areas of the state. A major block to the widespread adoption of the nonphysician model is the attitude of the doctor and nurse.