By Therese Bermpohl, Director of the Office for Family Life
Eight doctors, six of them from Virginia, take issue with an article entitled “Contraceptive Choices in Women with Chronic Disease” that appeared in the Sept 15, 2010, edition of American Family Physician because it fails to acknowledge the scientific advances that have been made with regard to natural methods of family planning. As they put it “not one of the options reviewed by the authors reference any currently available and scientifically validated non-contraceptive natural family planning method, all of which are 100% medically free of side effects.”
Because their letter was not printed in American Family Physician, I post it here in hopes it will encourage women looking for a natural, drug-free alternative, but who may not know they exist:
“In Contraceptive Choices in Women with Underlying Medical Conditions (American Family Physician, Sept. 15, 2010, a journal of the American Academy of Family Physicians), Bonnema et al. discuss what contraceptive options family physicians can recommend to women with specific chronic medical conditions. The emphasis in the article is on how physicians can select a contraceptive method that represents a lower medical risk profile for women diagnosed with diabetes, hypertension or lupus, are obese or women who engage in habits like smoking. Unfortunately, not one of the options reviewed by the authors reference any currently available and scientifically validated non-contraceptive natural family planning method, all of which are 100% medically free of side effects.
It is highly probable that the authors of the above article are not dissimilar from most physicians, including Obstetricians and Gynecologists. They likely are unfamiliar with the utility and wide applicability of natural methods of fertility regulation for purposes of avoiding pregnancy, which was established by the multi-center trial of the World Health Organization (WHO) in the 1980’s. WHO defined the umbrella term, natural family planning (NFP), as “methods for planning and preventing pregnancy by observation of the naturally occurring signs and symptoms of the fertile and infertile phases of the menstrual cycle, with the avoidance of intercourse during the fertile phase if pregnancy is to be avoided.”
Fortunately, natural methods of fertility regulation are currently being provided both nationally and internationally in a variety of ambulatory care settings. In the United States, the major methods in use include the Billings Ovulation Method, Creighton Model FertilityCare System, the Sympto-thermal Methods and the Marquette Method. Modern natural methods are not to be confused with calendar rhythm and are not dependent on the regularity of the woman’s cycle.
In addition, the authors of the above article made no reference to population-based surveys that have demonstrated a significant interest in NFP—about 25% of women are interested in NFP to avoid pregnancy, 33% are interested in NFP to conceive, and about 40% of men are interested as well. This interest is not associated with religion, education, age, or income (Journal of Family Practice 1998; 46: 65-71).
Natural methods have been evaluated in the medical literature (Journal of Reproductive Medicine, 1998, British Medical Journal, 1993, etc.) for their use-effectiveness to avoid pregnancy and have been found to be highly reliable. Effectiveness data was presented to the U.S. Department of Health and Human Services when the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was updated to include Counseling and instruction in natural family planning to avoid pregnancy (V25.04) and Procreative counseling and advice using natural family planning (V26.41). An overview presentation “Natural Methods of Family Planning” may be viewed at www.cdc.gov/nchs/data/icd9/att4_NFP_mar06.pdf
In the United States and increasingly in other countries including Ireland, England and Poland, increasing numbers of family physicians and obstetrician-gynecologists recognize that many hormone-based contraceptive pharmaceuticals and devices such as IUDs have mechanisms of action that have the potential to interrupt a pregnancy in embryonic development (see Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent, http://archfami.ama-assn.org/cgi/content/full/9/2/126).
Physicians trained in natural methods of fertility regulation and in the emerging field of NaProTechnology, frequently observe that women are seeking to enhance their fertility, particularly those who have experienced one or more spontaneous miscarriages or have never been able to achieve a pregnancy. By actively tracking their cycles, natural methods of fertility regulation empower women to be able to recognize gynecologic abnormalities sooner and come to appreciate their fertility as a sign of health, not of a disease.
In order for women in general and women with chronic medical conditions in particular to make an informed decision regarding family planning methods, physicians are ethically bound to provide their female patients with the option of learning effective methods of natural fertility regulation—methods which are free of all medical side effects.
We invite all physicians to develop confidence and competence in recommending a non-contraceptive, natural family planning system by attending an annual meeting of the American Academy of FertilityCare Professionals (see www.aafcp.org) or to contact a local natural family planning center (see www.fertilitycare.org; www.ccli.org; www.Boma-usa.org; www.nfp.marquette.edu).”
Robert F. Conkling, MD, FCP - Family Medicine and FertilityCare practitioner
P.O Box 7221, Woodbridge, VA
tel: 202-320-8834 email: firstname.lastname@example.org
Leslie Chorun, MD, CFCMC, FCP
FertilityCare Medical Consultant and Practitioner
4148 Booth Place #7 Kansas City, Kansas
Karen D. Poehalios, MD, Family Medicine
125 River Bend Dr. Suite 3, Charlottesville, VA
tel: 434-984-4200 email: email@example.com
John T. Bruchalski, MD Obstertrics and Gynecology
Tepeyac Family Center 11135 Lee Highway, Fairfax, VA
tel: 703-273-9440 email: firstname.lastname@example.org
Frank Dennehy, MD Family Practice
140 West 11th Street Front Royal, VA
Theodore F. O’Donnell, MD, CFCMC, Family Practice
100 Highline Drive, East Wenatchee, WA
tel: 509-884-0614 email: email@example.com
Lorna CVetkovich, MD FACOG (Obstetrics and Gynecology)
Tepeyac Family Center, 11135 Lee Highway, Fairfax, VA
Vivian Lugo-Eschenwald MD, DABFP, Family Medicine Ass. of Alexandria
2000 N. Beauregard Street, Alexandria, VA
tel: 703-370-2400 email: firstname.lastname@example.org