Natural family planning: Title X family planning client and provider perspectives

The extent to which Title X family planning clients rely on - and family planning providers support the use of - such strategies as withdrawal, the rhythm method, and more formal methods of natural family planning (NFP) is relatively unknown. Our mixed methods study is exploring the attitudes, beliefs, and usage/service delivery experiences of Title X clients and providers relative to NFP. Provider focus groups suggested that family planning counselors and clinicians have mixed feelings concerning the promotion of NFP. Although they recognized that NFP methods may appeal to individuals not wishing to use hormonal contraceptives, they questioned whether clients possess the requisite reproductive health knowledge and skills needed to support the effective use of NFP. Providers indicated that current materials and clinic time to support client education were limited. Preliminary analysis of our ACASI survey of female Title X clients (ages 18-35) indicate that more than a quarter have ever relied primarily on withdrawal or rhythm method for pregnancy prevention for more than three months and half doing so became pregnant. Participants generally had a low level of knowledge of their fertility, reproductive health and specific NFP options. In addition to reviewing provider focus group and client ACASI findings, our qualitative interviews with women who have been experienced NFP users will illustrate barriers/facilitators to NFP use and contextual factors such as pregnancy intentions and the role of partners. Potential strategies for integrating NFP options into current contraceptive counseling services at Title X clinics will be discussed.