Impact of Motivation on Natural Family Planning Efficacy: A Research Review
By: Kaitlyn Long, MD
Director’s Note: This week we feature research by Fehring et al [1] on motivation and efficacy rates of fertility awareness-based methods (FABMs) to avoid pregnancy. The study was summarized by former FACTS elective student, Dr. Kaitlyn Long, who highlights the value of open communication and mutual commitment to using an FABM. This review resonates with me as my husband and I celebrate our 20th wedding anniversary this week. In the early years of our marriage, we had serious reasons to prevent pregnancy. This meant we were highly motivated to use these methods effectively, and used them successfully for three and a half years before conceiving our third child, and then our fourth child a few years later. FABMs changed my life and shaped our family. I am deeply grateful for every person who continues to support the mission of FACTS to educate the medical community. In particular, I thank everyone who has donated recently to make our FABM elective accessible to students throughout the country and all over the world! We still have a way to go to reach our $20,000 goal, so YOUR support today will make a difference!
Introduction
For couples using natural or fertility awareness-based methods (FABMs), a high level of motivation has long been recognized as an important factor contributing to success. Yet, few studies have directly investigated its statistical significance. The purpose of this study by Fehring et al [1] was to determine how mutual motivation of couples influences the rate of unintended pregnancy when using FABMs to avoid pregnancy. It was hypothesized that if both partners were committed to the method, unintended pregnancy rates would be lower than if only one partner was committed.
“For couples using natural or fertility awareness-based methods, a high level of motivation has long been recognized as an important factor contributing to success.”
Methodology
This study used data from a prospective clinical trial comparing the efficacy of two online FABMs: one used an electronic hormonal fertility monitor while the other relied on self-observed cervical mucus monitoring. Both methods used an online fertility algorithm that automatically indicated when couples were potentially fertile, so there was no guessing as to whether they could have intercourse while avoiding pregnancy.
Participants were followed over 13 cycles. At the beginning of each cycle, each partner’s level of motivation to avoid pregnancy was assessed. Using a scale from 0 to 10, they answered two questions:
(1) How hard are you currently trying not to get pregnant?
(2) How much do you want to avoid pregnancy at this time?
Together, these questions gauged each partner’s level of commitment and dedication to avoiding pregnancy. Based on their answers, the couples were divided into high-motivation and low-motivation groups. To be classified as high-motivation, the woman and her partner had to score ≥ 9 on both questions. All pregnancies throughout the 13 cycles were recorded, and chi-square analysis was used to determine if any significant difference existed in pregnancy rates between the high- and low-motivation groups.
FACTS Executive Director, Dr. Marguerite Duane, with her family
Results
Participants came from all but four states in the United States. Although the high- and low-motivation groups were similar in mean age and body mass index (BMI), years married, ethnicity, and religion, the low-motivation group had fewer living children. The majority of participants were found to be middle class, educated White Catholic couples.
“Although the high- and low-motivation groups were similar in mean age and BMI, years married, ethnicity, and religion, the low-motivation group had fewer living children.”
A total of 358 couples contributed data from 2,621 cycles. Of the 358 couples, 298 were classified as high-motivation and 60 were low-motivation. There were 16 pregnancies among the 298 high-motivation couples, resulting in a 12-month pregnancy rate of 8 per 100 women. There were 28 pregnancies among the 60 low-motivation couples, and a 12-month pregnancy rate of 75 per 100 women. Results indicated a statistically higher proportion of pregnancies among low-motivation couples (p< .001).
Discussion
Results of this study showed that couples in which both partners were highly motivated to avoid pregnancy were more likely to use an FABM effectively. These findings are important to consider when discussing FABMs with patients, as the efficacy of the method is influenced by both partners’ motivation to use it. For optimal pregnancy prevention, the woman and her partner must be committed to timing intercourse outside of the fertile window. FABM teachers and physicians may facilitate open conversations between partners about desire and dedication to using their chosen method as directed to prevent pregnancy.
“Results of this study showed that couples in which both partners were highly motivated to avoid pregnancy were more likely to use an FABM effectively.”
Strengths of the study include a geographically broad sample population across the United States with participants who were similar in age. Assessing motivation regularly at the beginning of each woman’s cycle was another strength. Yet, the ability for the study results to be generalized is limited due to a small sample size of 358 couples similar in ethnicity, religious affiliation, and level of education. Future studies should attempt to draw from a larger and more diverse patient population.
Comparison of demographics between groups showed the low-motivation group to have fewer living children. A prior study by Rice et al [2] looked at the difference in unintended pregnancy rates between couples who have completed their family size (4.5 pregnancies per 100 over 12 months) versus couples who were delaying pregnancy to space children (14.5 unintended pregnancies per 100). It would be interesting to know how many of the unintended pregnancies in the low-motivation group were to couples who were trying to prevent versus delay pregnancy.
Future research should continue to monitor each couple’s motivation prior to each cycle while also examining other contributing factors that may influence motivation. Factors that could affect how accurately a couple uses an FABM include stress, illness, and financial hardship, among others. The number of confounding variables is likely substantial, but further studies may be able to highlight some of the most common reasons why couples struggle to use a method correctly. This will enable women and couples to make more informed decisions about which method is best for them.
References
[1] Fehring RJ, Schneider M, Barron ML, Pruszynski J. (2013). Influence of Motivation on the Efficacy of Natural Family Planning. MCN The American Journal of Maternal Child Nursing, 38(6), 352-358.
[2] Rice FJ, Lanctot CA, Gargia-Devesa C. (1981). Effectiveness of the symptom-thermal method of natural family planning: An international study. International Journal of Fertility, 26(3), 222-230.
ABOUT THE AUTHOR
Kaitlyn Long, MD
Kaitlyn Long, MD is a first-year resident at the Lee’s Summit Family Medicine Residency program in Missouri. She earned her medical degree at Kansas City University and a bachelor’s degree at Avila University. Dr. Long is passionate about patient education. She participated in the FACTS elective to gain an understanding of natural family planning methods to share with her future patients.
