March 31, 2022
Integration of FABMs in Practice: An Interview with Dr. Kafie
By Sindhura Kolachana, MD
Executive Director’s Note: This compelling interview with a family physician in Ontario, Canada explores ways to integrate fertility awareness-based methods (FABMs) into clinical practice and medical education. Like many physicians, Dr. Kafie learned very little about FABMs in medical school, so she encourages her colleagues to “keep an open mind” and expand their knowledge through online opportunities. In addition to our online elective, FACTS is delighted to offer an online CME course and our virtual conferences for everyone! Registration is now open for our 2022 Conference: For the Future of Women’s Health, so sign up today!
Meet Dr. Stephanie Kafie, a Family Physician and NFP Educator
I was fortunate to interview Dr. Kafie, a family physician in Ontario, Canada, about her training, medical practice, and interest in fertility awareness-based methods (FABMs). Dr. Kafie completed medical school and residency at McMaster University, where she also received fellowship training in care of the elderly. Dr. Kafie currently works in a hospital, nursing homes, and retirement homes, providing specialized care for the elderly.
In addition, Dr. Kafie also provides natural family planning (NFP) instruction in the Marquette Model to couples through a virtual clinic. Dr. Kafie started this clinic in July of 2020 and has since worked with more than 120 couples! In Ontario, Canada, where Dr. Kafie practices, natural family planning counseling is covered for individuals if conducted by a physician, so she is able to provide free education. She explained that the fertility monitor and supplies are the only things that couples are required to pay for out of pocket if they are not covered by private insurance plans. Dr. Kafie’s evening clinic is so popular that there is currently a two-month waitlist!
Dr. Kafie was initially interested in fertility awareness and NFP after attending various conferences and learning about related organizations in medical school. She noted that the medical school curriculum alone did not teach much about FABMs, except in reference to outdated statistics claiming these methods were less effective than traditional hormonal and barrier methods. Despite this, she sought out groups such as FACTS for more information, as she wanted to learn specific methods to offer to her patients. However, since residency was exceptionally busy, she did not have enough time to pursue additional training until more recently. Fortunately, Canada provides generous maternity leave, and Dr. Kafie was formally trained online in the Marquette Method during her maternity leave after residency. The training was self-paced, and it is available to licensed health care professionals.
With regards to clinical practice, Dr. Kafie stated that she is extremely satisfied with the spectrum of care that her current work offers. Although working with the elderly and providing palliative care is extremely meaningful and grounding for her, she noted it can also take an emotional toll on an individual. For her, caring for the elderly complements her role as a Marquette instructor. She has found the balance in a beautiful spectrum of experience — from engaging in end-of-life discussions to assisting newly married couples as they attempt to have their first child.
Dr. Kafie spoke fondly of patients interested and eager to learn about natural family planning. She observed two main motivations for individuals seeking FABMs: 1) a religious background (typically Catholic) and/or 2) a desire for a natural option without the side effects associated with hormonal contraceptives. Many postpartum patients and newly married individuals in her practice had similar motivations for engaging in FABMs and ultimately were able to receive help achieving pregnancy and other issues such as breastfeeding, postpartum depression, and infant sleep. When working with patients in her virtual clinic, Dr. Kafie said she loves the ability to draw not only from her clinical knowledge of the Marquette Model and reproductive physiology, but also her personal experiences with childbirth and motherhood. She recalled a time when she helped a patient who had previously undergone expensive and time-consuming fertility treatments. After learning the Marquette Method, her patient became pregnant on the very next cycle! As Dr. Kafie noted,
“Simple things like teaching a woman when she is ovulating can be the solution for some couples with infertility. As doctors, we tend to jump to the most complicated medical solutions and therapies, but there is a lot of evidence in the field of natural family planning methods as well that should be explored before pursuing further treatments.”
Dr. Kafie insisted it is important to teach everyone about natural or fertility awareness-based methods of family planning and their role in reproductive health, stating:
“Natural family planning methods are not just an alternative means of preventing pregnancy. At the very root, they are based on the physiology of a woman’s reproductive system and it is essential that we teach this to everyone, especially women, so that they can learn about their bodies and feel more empowered to make decisions.”
In the final portion of this interview, we spoke about strategies to improve visibility and education about fertility awareness-based methods. Dr. Kafie noted the importance of social media and stated that it was important to let people know that these methods are based in science and are backed by many years of strong clinical data and peer-reviewed research. Furthermore, she pointed to modern medical education as a space where these methods can be discussed, specifically, the trials and clinical data that support the efficacy of these methods. Dr. Kafie mentioned the reproductive physiology units of pre-clinical years or the obstetrics/gynecology clerkship as places where medical students could potentially be exposed to this information. Unfortunately, there are not many individuals trained in these methods. As a result, exposure in a clinical clerkship is less feasible than integrating this teaching into the pre-clinical years.
For medical students and residents interested in pursuing NFP education, Dr. Kafie had a few pearls of advice: utilize online courses and training, but don’t rush into anything. Medical school and residency are exceptionally busy (as we know well), and there is not always time to engage in another type of training. She recommended utilizing these periods to learn as much as possible and identify where FABMs would fit into one’s future clinical practice. Perhaps the most essential piece of wisdom offered was to, “Keep an open mind during training, and don’t limit your ability to seek out educational opportunities and gain new skills beyond residency and medical school.”
About the Author
Sindhura Kolachana, MD
Sindhura Kolachana, MD is a fourth-year medical student at Georgetown University School of Medicine in Washington, DC. She completed her undergraduate education at the College of William and Mary in Williamsburg, VA. She plans to do her residency in internal medicine and is extremely interested in health equity and education. She enrolled in the FACTS elective to gain a better understanding of natural family planning methods and manners in which to share these methods with future patients so they can feel more empowered over their health and reproductive decisions.
