By Devan Truex, RN, BSN
January 29, 2020

Editor’s Note: This is a review of research[i] published in 2010 in the Journal of Obstetrics and Gynaecology titled, “Natural Family Planning: Physicians’ Knowledge, Attitudes, and Practice.” It was written by a nursing student as part of an online elective offered by FACTS at her nursing program. Although this 2010 study used the term Natural Family Planning (NFP), the term fertility awareness based methods (FABMs) is much more descriptive and highlights “fertility awareness” as an invaluable tool for women. Learning about biomarkers of fertility that tell the story of what’s occurring hormonally inside her body provides information that can impact a woman’s health—even beyond its applications for family planning. FABMs do triple duty as practical tools in family planning that also aid in the diagnosis and treatment of common conditions affecting women while providing ways for them to monitor their reproductive and general health.

Natural Family Planning (NFP) represents several fertility awareness based methods with which a woman can observe physical biological markers that reflect internal hormonal changes associated with ovulation. This information can be used by a woman and couple to avoid or achieve pregnancy. These markers include cervical mucus or fluid, basal body temperature, and/or hormonal metabolites excreted in urine.

It is vital for physicians to offer natural family planning methods as feasible options for their patients. Yet, despite the availability of information describing each method as well as scientific evidence supporting FABMs, several barriers remain that prevent patients from receiving all the necessary information to make an informed decision. To understand this better, three physician researchers examined the perceptions of Canadian family physicians and gynecologists toward NFP in their article, “Natural Family Planning: Physicians’ Knowledge, Attitudes, and Practice.”

The focus of this qualitative cross-sectional study was to determine the perceptions of medical professionals regarding NFP methods and their knowledge of effectiveness rates noted in the medical literature. Based on those factors, the physicians were asked how they counseled women about these methods in their everyday practice. The study focused on four specific evidence-based NFP methods: Standard Days Method, Basal Body Temperature Method, Cervical Mucus Method, and the Lactational Amenorrhea Method.

In the study, 138 surveys were collected from Canadian family medicine physicians, gynecologists, and their residents who treated women of childbearing age. The survey was divided into three parts: (1) how do physicians respond to women inquiring about NFP, (2) what do the physicians know about perfect use and typical use effectiveness rates of each NFP method, and (3) the physicians’ demographic information.

Most physicians underestimated the perfect use effectiveness of all four evidence-based FABMs, and less than 6% of survey respondents identified perfect use effectiveness rates correctly. Additionally, 33% of physicians (including residents) identified the typical use effectiveness rates of the four methods studied correctly.

During visits with patients seeking advice about contraception, only 3% of physicians reported mentioning NFP as a feasible contraceptive option to most of their patients, while 50% did not mention NFP at all. 24% of them mentioned NFP with reservations, while 22% mentioned it as a practical option only to some patients.

On the other hand, 37% of physicians mentioned NFP methods to most patients trying to achieve pregnancy, and 34% of them mentioned these methods as an option to selected patients hoping to conceive. This suggests that, in these practices, there is a higher likelihood that education about natural or fertility awareness based methods will be provided to those seeking to achieve pregnancy rather than pursuing contraception.

There were further divisions between the types of physicians when examining their areas of expertise and personal beliefs about NFP. Whereas 26% of family physicians and family medicine residents believed NFP enhanced a couple’s relationship, only 12% of gynecologists and gynecology residents agreed. The study found differences not only among physician practices but within each medical specialty as well. Differences were also noted according to level of training. Family medicine residents had less personal experience with NFP than family physicians (20% vs. 47%), and gynecology residents had less experience with NFP than gynecologists (5 vs. 29%, p=0.001).

The evidence gathered through this study highlights the need for more education and better access to such education among medical professionals. In fact, the article cites a study conducted in the United States where nursing and medical schools, on average, spent less than one hour educating students about NFP. To provide the best patient-centered care, physicians need to be well versed on all forms of contraception, including different FABMs. These methods may not be for every woman or couple, but they deserve to have access to all available information so they may make a fully-educated decision based on scientific evidence.

Editor’s Note: The cervical mucus method studied was the Billings Ovulation Method. The Creighton Model FertilityCare System and the TwoDay Method are also evidence-based cervical fluid methods that were not included in this study.



[i] Choi, J, et al. “Natural Family Planning: Physicians’ Knowledge, Attitudes, and Practice.” J Obstet Gynaecol Can., U.S. National Library of Medicine, July 2010,

Author Bio: Devan Truex, RN, BSN is a recent nursing graduate from Carroll College in Helena, Montana and is now a Progressive Care Unit nurse in Washington State. Women’s health remains a deep-rooted passion, and she looks forward to becoming more involved with FABMs and patient care in the Pacific Northwest. Through FACTS, she learned about the variety of FABMs available and how to share that information with patients. She believes there is much to be gained by providing patients evidence-based information so they can make the best and most educated decisions for themselves and their families.

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Below are the webinars we offer every month.
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The Female Cycle as the 5th Vital Sign
This presentation highlights the health of the female cycle and how the fertility awareness chart can aid in the diagnosis and management of common women’s health concerns.
Wednesday, February 19th, 6:30 pm EST
Wednesday, March 18th, 12:30 pm EST
Tuesday, April 7th, 8:00 pm EST


FABMs for Achieving & Avoiding Pregnancy
This presentation focuses on the use of FABMs to achieve pregnancy. It includes a case in which FABM charts assisted to diagnose and treat infertility. Evidence-based FABMs and their effectiveness rates to prevent pregnancy are also discussed.
Monday, March 9th, 7:00pm EST
Monday, April 27th, 1:00pm EST


The Signs of the Female Cycle Explained
Designed for a general audience, topics of this presentation include the science of charting a woman’s cycle, the benefits of using FABMs to monitor health, and how to choose a method that may be best for you!
Friday, February 14th, 1:00 pm EST
Monday, March 2nd, 12:00 pm EST


The Science Behind Fertility Awareness
Our flagship presentation, Fertility & Family Planning, reviews the latest research and science supporting FABMs and their effectiveness to prevent and achieve pregnancy.
Monday, February 3rd, 12:00 pm EST
Monday, March 30th, 5:00 pm EST
Thursday, May 21st, 1:00 pm EST

Our NEW 2020
Webinar Series!

Beyond our core webinars, FACTS is pleased to present a series of new webinars this year — one offered each month through June 2020! These bonus presentations reflect current research and topics of growing interest in the field of fertility awareness.

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Registration is now OPEN for these 1-hour webinars. To REGISTER, click on the dates below.

Smartphone Apps for Endometriosis & Menstrual Health  |  Tuesday, February 25th, 8:30 pm EST
Women’s Interest in FABMs  |  Tuesday, March 24th, 8:30 pm EST
What Can Be Learned from Millions of App Records  |  Tuesday, April 28th, 8:30 pm EST
App Comparison Study  |  Tuesday, May 26th, 8:30 pm EST
NeoFertility  |  Tuesday, June 23rd, 8:30 pm EST


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