July 17, 2018
By Katie Douglas

Editor’s Note: This is a summary of a research [1] article titled Enrollment, Childbearing Motivations, and Intentions of Couples in the Creighton Model Effectiveness, Intentions, and Behaviors Assessment (CEIBA) Study. Written by Joseph B. Stanford and Christina A. Porucznik, it was published in Frontiers in Medicine in 2017. The research was reviewed and summarized by Katie Douglas, an intern with FACTS this summer.

Background
The Creighton Model FertilityCare System is a natural family planning method that focuses on observations of biomarkers, specifically cervical mucus and vaginal bleeding. Trained instructors, known as Creighton Model FertilityCare Practitioners (FCPs), can interpret these biological signs for health and fertility purposes and manage clients on a case by case basis. Past studies have examined the effectiveness of the Creighton Model to achieve or avoid pregnancy. However, many have failed to analyze possible links between pregnancy rates and personal intentions or behaviors. This prospective cohort study aimed to attain demographic data and information about individual motivations or intentions of couples that initially planned to use the Creighton Model to avoid pregnancy.

Methodology
From September 2009 to December 2011, this study recruited and enrolled couples from 17 Creighton Model FertilityCare Centers (16 across the United States, 1 in Canada). Initially, eligible couples had to be first-time users of Creighton with the intention to prevent a pregnancy. After one year of recruitment, these criteria were broadened to include couples who were starting to use Creighton again after six months or more without use (for example, following a pregnancy).

All participants had an introductory session, generally in a small group, and follow-up meetings were scheduled with each individual couple. The couples were followed for up to one year, with a maximum of eight follow-ups in that year, or until removal from the study due to pregnancy. All participants, men and women individually, completed: (1) an entrance questionnaire with medical history, demographic data, and initial intentions for using Creighton; (2) individual cycle questionnaires around the beginning of each cycle to determine current pregnancy intentions and fertility planning methods; and (3) an exit survey specific to their one year outcome (no pregnancy or pregnancy).

Results
Of 1,090 couples screened, 429 were deemed eligible. Overall, 305 women and 290 of their male partners agreed to participate. The majority of the participants were married (51%) or engaged (39%), Caucasian non-Hispanic (80% of women), and college graduates (77% women). Interestingly, 90.4% of women and 77.1% of men identified religion as an important aspect of their lives, and 80% of women in the study identified as Catholic. Reasons for using the Creighton Model included moral, ethical, and/or religious reasons, wanting to use a natural method, and desiring a lack of side effects.

The mean positive childbearing motivation score (as determined by significant variables related to childbearing and pregnancy motivation) was 3.3 for men and women, on a scale of 1 (least positive) to 4 (most positive). Positive correlations were found between the number of future children desired and positive childbearing scores in both men and women. On average, women intended to have three additional children and men intended to have two additional children. The majority of couples also intended to have another child within the next 1-3 years (62.5% of women and 61.8% of men). The number of children intended was most positively correlated with number of children wanted. Additionally, the intended number of children was positively associated with the perception of number of future children wanted by the partner or spouse.

Discussion
The couples in this study who were initially using the Creighton Model to avoid pregnancy had strong motivation, desire, and intention to have multiple children in the future. In general, natural methods are perceived to be less effective than conventional forms of birth control, because people who use methods such as the Creighton Model tend to have more children. However, this may not be due to a failure of the method, but rather due to the fact that such couples choose to have more children. An increased desire for children could derive from having supportive family members and friends in relation to childbearing and positive perceptions of children due to high religious involvement. While the Creighton Model provides education to couples, the decision to risk pregnancy while trying to avoid is entirely up to the couple.

In the past, many studies reporting effectiveness rates of the Creighton Model or other models of natural family planning have been based on actual behavior without considering the intentions of the couple. Because many couples using the Creighton Model may have more positive childbearing attitudes than the average couple, rates of effectiveness may be skewed negatively if intentions are not considered in research. This shows the need for studies like this one, which take participant attitudes and intentions into account. The researchers plan to assess the intentions, behaviors, and future desires of couples quantitatively and determine how these factors impact future pregnancy occurrence.

Editor’s Note: The original research article summarized above contains more than forty references to outstanding sources of information about fertility awareness based methods. Readers are encouraged to browse the list, keep it as a reference, and read more of the solid evidence that continues to expand regarding FABMs.

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Author Bio: Katie Douglas is a rising junior at the University of Illinois at Urbana-Champaign, where she studies Molecular & Cellular Biology. For the past year and a half, she has worked as a research assistant in the Nutrition and Cancer Epidemiology & Survivorship Lab on campus. We are delighted that Katie is working this summer as an intern for FACTS and for the Family Medicine Education Consortium (FMEC).

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References
[1] Stanford JB and Porucznik CA (2017) Enrollment, Childbearing Motivations, and Intentions of Couples in the Creighton Model Effectiveness, Intentions, and Behaviors Assessment (CEIBA) Study. Front. Med. 4:147. doi: 10.3389/fmed.2017.00147

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RESIDENTS and MEDICAL STUDENTS!

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