Natural Family Planning in the Title X Program - A History and Research Overview

1. How Natural Family Planning Fits into the Title X ProgramOFP Family Planning Research Grantee MeetingJanuary 14-15, 2009 Washington, DC  Jule Hallerdin, MN, MPH, CNM Nurse Consultant Office Family Planning Office of Population Affairs

2. Family Planning and Public Health • 1800-1900 • Family size declined from 7.0 to 3.5 • 1900 • Six to nine of every 1000 women died in childbirth • One in five children died during the first 5 years of life • Public Health facts from : • Achievements in Public Health, 1900-1999: Family Planning CDC MMR December 03, 1999 / 48(47); 1073-1080

3. Family Planning and Public Health • 1900 • Distributing information and counseling patients about contraception and contraception devices was illegal under federal and state laws • The timing of ovulation, the length of the fertile period and other reproductive facts were unknown

4. Personal Examples

5. Family Planning and Public Health • 1912 • The modern birth-control movement began • Margaret Sanger initiated efforts to circulate information about and provide access to contraception • 1916 • Sanger challenged the laws that suppressed the distribution of family planning information by opening the first family planning clinic in Brooklyn, New York

6. Family Planning and Public Health • The police closed her clinic, but the court challenges that followed established a legal precedent that allowed physicians to provide advice on contraception for health reasons • 1930’s- a few state health departments and public hospitals had begun to provide family planning services

7. Family Planning and Public Health • 1940-1957 • Family size increased average number of children per family peaked at 3.7 • 1960- the era of of modern contraception began – birth control pill and Intrauterine device became available

8. Family Planning and Public Health • 1965- Pill became the most popular method followed by the condom and contraceptive sterilization • 1965 Supreme Court (Griswold vs Connecticut) struck down stat laws prohibiting contraceptive use by married couples

9. Milestones in Family Planning

10. Milestones in Family Planning

11. History of Natural Family Planning in OFP • Office of Family Planning: • Guided by the Law, Regulations, and Guidelines: • Congress enacted the Family Planning Services and Population Research Act of 1970 (Public Law 91-572), which added Title X, “Population Research and Voluntary Family Planning Programs” to the Public Health Service Act.

12. Natural Family Planning • Section 1001 of the Act authorizes grants “to assist in the establishment and operation of voluntary family planning projects which shall offer a broad range of acceptable and effective family planning methods and services (including natural family planning methods, infertility services and services for adolescents)”

13. Natural Family Planning • The mission of Title X is to provide individuals the information and means to exercise personal choice in determining the number and spacing of their children.

14. Natural Family Planning • Natural Family Planning was one of the topics for which family planning research was solicited from 1985-1998: • Topics included: • Family Planning client behavior • Adolescent family planning clients • Male family planning clients • Targeting of family planning services • Clinic personnel behavior • Organization and management of family planning services • Role of private physicians • Natural family planning • Infertility services • Counseling services

15. 1989 John R. Weeks Factors Affecting the Choice of Natural Family Planning 1989 Don Kramer Natural Family Planning Program Format Effectiveness Natural Family PlanningTitle X Service Delivery Improvement projects on the topic of Natural Family Planning:

16. Natural Family Planning Program Format Effectiveness • 1989- Don Kramer • Summary of findings: • Team Teaching format 36% more cost efficient than the Creighton Model for instructing clients in the Ovulation method of NFP. • Actual cost of service delivery for the Team Teaching format client was 64% of the cost of a Creighton model format client • Both formats produced extremely similar results, in a broad array of relevant outcome variables, including continuation and pregnancy rates.

17. Factors Affecting the Choice of Natural Family Planning • 1989-John Weeks • Summary of findings: • Private OB/GYN physicians were the least informed about NFP, and just over one-third knew about all three methods. • NFP-only providers had the most knowledge, while clinic providers and administrators were in between. • The single most identifiable barrier to the availability of NFP is skepticism among physicians about its use and effectiveness.

18. Examples of Title X Training Centers Focus on NFP • Region VII Development Systems, Inc.Kansas City, MO • NFP and Fertility Awareness: A conference call discussion for Title X clinicians about non-hormonal contraception - held 4/10/08

19. Examples of Title X Training Centers Focus on NFP • Region III -TRAINING 3, Family Planning Council, Inc.Philadelphia, PA • Planning a 2 hour on-line interactive training for clinicians on Fertility Awareness – projected date 6/30/09

20. How Natural Family Planning Fits into the Title X Program • NFP is a statutory requirement (FP Method) • NFP is not widely used • Need to find out why the method is not used more • Provide accurate information to providers that will enhance provision of NFP counseling

21. Review of Program Goals for NFP Grantees • Contribute to: • Improved health outcomes • Increased utilization of preventive health care- particularly among vulnerable and special needs populations • Increasing the proportion of pregnancies that are intended

22. Natural Family Planning • Questions?