Hispanic Heritage Month
Attitudes toward Natural Family Planning in an Urban Hispanic Population
By: Rachel Bengart, DO
Director’s Note: In honor of Hispanic Heritage Month, we feature a research review written by Dr. Rachel Bengart, a first-year obstetrics and gynecology resident and former FACTS elective participant. Previous studies have surveyed the attitudes regarding natural family planning (NFP) methods and identified differing patterns of interest and use among Hispanic and non-Hispanic women. These findings prompt the exploration of factors that contribute to adoption of NFP. The 2006 study by Leonard et al  summarized below surveys attitudes regarding NFP, or fertility awareness-based methods (FABMs), in an urban Hispanic population. Of note, FACTS offers evidence-based patient education fact sheets in English and Spanish as downloadable pdfs via our website.
Natural family planning refers to the utilization of fertility awareness to either prevent or achieve pregnancy. Women are taught how to monitor their menstrual cycle and identify physical signs to achieve their reproductive goals.
Hispanic women in the United States have higher fertility rates and lower rates of contraceptive use than non-Hispanic white women. According to the CDC, 65.3% of women were using some form of contraception between 2017 and 2019.This rate was lower (60%) among Hispanic women, and the most popular forms did not include natural methods.While perfect use of NFP is difficult to achieve, when these modern FABMs are taught by qualified instructors and practiced according to guidelines, their efficacy is as high as 83-98%.
Despite the effectiveness of NFP or FABMs and the potential to broaden family planning options, these methods have not been widely adopted. Previous studies have demonstrated factors such as acculturation, family size, religiosity, and education are predictive of contraceptive practices, but none had examined Hispanic women’s desire to use NFP specifically. The study by Leonard et al summarized below titled, “Survey of attitudes regarding natural family planning in an urban Hispanic population” explores factors that may impact interest in NFP in this demographic.
“Despite the effectiveness of NFP or FABMs and the potential to broaden family planning options, these methods have not been widely adopted.”
The study used a cross-sectional design to survey reproductive age women (ages 18-44) presenting for ambulatory and hospital reproductive care in metropolitan Phoenix, Arizona. Women were provided an information sheet about NFP and then asked to gauge their interest in NFP using a five-point Likert scale. The survey was adapted from a previous study and included questions on demographics, reproductive history, family planning intention, and personal interest in using NFP to either achieve or prevent pregnancy. Acculturation, defined as the degree to which Hispanic immigrant women have adopted the values and practices of U.S. culture, was also an important measure. It was based on the participants’ language preferences, with a score of 5 indicating a ‘highly accultured’ individual, and a score of 1 representing the least accultured.
The study used chi-square analysis to identify factors associated with interest in using natural methods and Poisson regression analysis with a p value <0.1 to determine the independent effects of those factors. A sample size of 300 was determined to achieve sufficient statistical power for a correlational analysis (power >.80, two-tailed, p = .05).
Over the course of 4 months, 357 non-sterilized women completed the survey. Most study participants were Hispanic (81.8%) and preferred to complete the survey in Spanish (72.5%). The majority had an education level at or below 9th grade and a low acculturation level, with an average score of ≤ 3. The primary outcome assessing interest in NFP was separated into categorizes based on a five-point Likert scale. The study found 61% of participants were likely to use NFP to avoid pregnancy, while 50% would consider using NFP to achieve pregnancy.
Less acculturated Hispanic women and those with a lower level of education were more interested in using NFP to avoid pregnancy [low accultured: p< .01 1.44 (1.03, 2.01); low education: p < .01 1.30 (1.05, 1.60)]. Attending religious services, regardless of specific religious preference, showed a statistically significant association with interest in NFP to achieve pregnancy. Recent use of non-prescription methods of contraception was more likely to lead to an interest in using NFP than recent use of prescription methods. Recent use of natural methods did not significantly affect interest in NFP, and most women who had used natural methods had not used modern methods of NFP. Acculturation, education, and recent type of contraceptive were independently predictive of interest in using NFP to avoid pregnancy.
“Less acculturated Hispanic women and those with a lower level of education were more interested in using NFP to avoid pregnancy.”
The study also examined factors associated with using NFP to achieve pregnancy. Ethnic background, acculturation, education, and parity were not found to be associated with the likelihood to use NFP. On the other hand, age, family planning intention, and attendance in religious services were correlated with a higher probability of using NFP. Regression analysis showed that age and attendance in religious services were independent predictors of interest in using NFP to achieve pregnancy.
Women were also asked to indicate which aspects of NFP they liked and disliked. Popular aspects included being natural (29%), the absence of side effects (27%), and the opportunity to learn more about their own body and fertility (24%), while many disliked the perceived lack of reliability of the method.
This research provides valuable insights into the attitudes towards natural family planning among urban Hispanic populations. Many Hispanic women showed interest in using NFP, which is consistent with previous studies demonstrating a high level of interest when asked about NFP. The low rate of use despite interest may reflect a need for increased education and access to modern, evidence-based fertility awareness-based methods of family planning.
“Many Hispanic women showed interest in using NFP, which is consistent with previous studies demonstrating a high level of interest when asked about NFP.”
Hispanic women in this population with low acculturation and education levels were found to be more interested in using NFP to avoid pregnancy. In a study published in 2000, Unger and Molina determined that women who are less acculturated are more likely to view pregnancy and motherhood positively, and also have greater confidence in their ability to use family planning methods. Since NFP requires education, self-discipline, and cooperation, NFP may be a feasible option for them.
The women stated they are interested in NFP primarily because it’s free from side effects and provides the opportunity to learn more about their body and fertility. Similar to past studies, ethnicity, acculturation, education, religion, and previous contraceptive use were associated with interest in using NFP.
Despite the popular belief that Catholic faith influences interest in natural methods, this study did not find that being Catholic was a predictive factor, but attending religious services was predictive. These findings align with previous studies.
“Despite the popular belief that Catholic faith influences interest in natural methods, this study did not find that being Catholic was a predictive factor, but attending religious services was predictive.”
A limitation of this study is the inability to easily extrapolate the findings to other U.S. Hispanic populations, as this small sample from Phoenix is not representative of the diversity that exists throughout the U.S. The study also did not examine country of origin, time of residence, income or other socioeconomic factors, all of which likely contribute to an interest in these methods.
While this study added to the limited literature on Hispanic women’s interest in using NFP, further research, on a much larger scale, may provide additional insight into ways to address disparities in contraceptive use among Hispanic women in the U.S. One possibility is to explore other facets that may be contributing to decision making, such as socioeconomic factors. Another future investigation should determine actual use of these methods once taught, because interest is not synonymous with use. The high level of interest in using NFP among the Hispanic women in this study indicates the potential value of offering natural family planning as a viable choice for this demographic.
 Leonard CJ, Chavira W, Coonrod DV, Hart KW, Bay RC. Survey of attitudes regarding natural family planning in an urban Hispanic population. Contraception. 2006;74(4):313-317. doi:10.1016/j.contraception.2006.05.075. doi:10.1016/s0010-7824(97)00040-1.
 Sung S, Abramovitz A. National Institutes of Health. Natural family planning. Accessed March 6, 2023. https://www.ncbi.nlm.nih.gov/books/NBK546661/
 Rodriguez D, Fehring RJ. Family Planning, Natural Family Planning, and Abortion Use among U.S. Hispanic Women: Analysis of Data from Cycle 7 of the National Survey of Family Growth. Linacre Q. 2012;79(2):192-207. doi:10.1179/002436312803571429.
 Daniels K, Abma J. October 2020. Current Contraceptive Status Among Women Aged 15–49: United States, 2017–2019. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db388.htm. Published October 20, 2020. Accessed March 7, 2023.
 Duane M, Stanford JB, Porucznik CA, Vigil P. Fertility Awareness-Based Methods for Women’s Health and Family Planning. Front Med (Lausanne). 2022;9:858977. Published 2022 May 24. doi:10.3389/fmed.2022.858977.
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 Unger JB, Molina GB. Acculturation and attitudes about contraceptive use among Latina women. Health Care Women Int 2000;21:235–49.
 Mikolajczyk RT, Stanford JB, Rauchfuss M. Factors influencing the choice to use modern natural family planning. Contraception 2003; 67:253–8.
ABOUT THE AUTHOR
Rachel Bengart, DO
Rachel Bengart, DO is a first-year obstetrics and gynecology resident at Rochester General Hospital. She completed her undergraduate education at Ohio State University and earned her medical degree at the University of New England College of Osteopathic Medicine. Dr. Bengart is passionate about health equity and global women’s health. She enrolled in the FACTS elective to gain a better understanding of natural family planning methods to be able to educate and empower future patients, so they feel better equipped to make decisions about their reproductive health.