Anthropological and Methodical Differences of Natural Family Planning and Fertility Awareness-based Methods

Reversible female contraceptives: historical, current, and future perspectives†

Contraception is a practice with extensive and complicated social and scientific histories. From cycle tracking, to the very first prescription contraceptive pill, to now having over-the-counter contraceptives on demand, family planning is an aspect of healthcare that has undergone and will continue to undergo several transformations through time. This review provides a comprehensive overview of current reversible hormonal and non-hormonal birth control methods as well as their mechanism of action, safety, and effectiveness specifically for individuals who can become pregnant. Additionally, we discuss the latest Food and Drug Administration (FDA)-approved hormonal method containing estetrol and drospirenone that has not yet been used worldwide as well as the first FDA-approved hormonal over-the-counter progestin-only pills. We also review available data on novel hormonal delivery through microchip, microneedle, and the latest FDA-approved non-hormonal methods such as vaginal pH regulators. Finally, this review will assist in advancing female contraceptive method development by underlining constructive directions for future pursuits. Information was gathered from the NCBI and Google Scholars databases using English and included publications from 1900 to present. Search terms included contraceptive names as well as efficacy, safety, and mechanism of action. In summary, we suggest that investigators consider the side effects and acceptability together with the efficacy of contraceptive candidate towards their development.

A Pilot Qualitative Case Study of Women's Experiences with Fertility Awareness-Based Methods

This pilot qualitative case study was able to elicit rich data enabling a description of how women went through the journey of achieving pregnancy using fertility awareness-based methods. Findings underscore that women preferred using natural ways to detect ovulation and would recommend other women to do so, but with healthcare providers' guidance. The findings of this case study can serve as a starting point to provide a framework to understand women's experiences of enduring trial and error with multiple fertility awareness-based methods before discovering their effective method. Findings emphasize the importance for healthcare providers to guide women in using fertility awareness-based methods.

Physician Dispositions Toward Noninvasive Non-Hormonal Contraception

Introduction

Evidence-based, nonbiased, counseling on contraceptive options, followed by shared decision-making, is key in facilitating reproductive justice in a diverse population. An estimated 3% of contraceptive users in the United States use fertility awareness-based methods (FABMs) for contraception, and demand for these methods is increasing. FABMs can be a highly effective form of family planning when used in accordance with evidence-based protocols. They are preferred by some patients due to medical contraindications to hormonal contraceptives, lack of side effects, religious convictions, preference to avoid hormones or contraceptive devices, improved body literacy, or a combination of the above. FABMs are infrequently covered in medical school curricula and are often perceived by physicians to be of low efficacy. There is an opportunity for improvement of physicians' evidence-based knowledge of FABMs, which has the potential to improve patient understanding of and access to the full menu of family planning options.

Methods

A self-administered, cross-sectional survey was distributed to assess physician knowledge and opinions of FABMs by key university contacts. Univariate and bivariate statistics were calculated for close-ended questions and responses to open-ended questions were analyzed for common themes.

Results

A total of 79 participants completed the entire survey. Another 11 submitted partially completed surveys. For completed surveys, questions assessing knowledge of key concepts underlying FABMs, performance by specialty was 55% correct for OB/GYN (n = 16), 55% (n = 47) correct for family medicine, 36% (n = 10) correct for internal medicine, and 35% (n = 6) correct for pediatrics. Negative, neutral, mixed, and positive opinions related to FABMs were represented.

Conclusions

There are opportunities to improve physicians' evidence-based knowledge of FABMs; this may improve patient-centered contraceptive care.

A Multidisciplinary Quality of Care Path For Couple Infertility: Development of An Integrated Approach Founded on A Multidisciplinary, Personalistic, and Ecological Model For Couple Fertility

The Path of Fertile Family (FFP) is a service for couples experiencing infertility, aimed to obtain natural conception, as an alternative to assisted reproductive techniques, developed in 2018 and provided by the Counseling Centre of Centro della Famiglia Foundation, an institute of culture and pastoral care of the Diocese of Treviso, in cooperation with the local socio-health unit. FFP offers to infertile couples a specific multidisciplinary path of care, including the involvement of specific gynecological, andrological, endocrinological, and psycho-relational competences, together with fertility awareness. It represents an “experiential laboratory” for the multidisciplinary diagnosis and treatment of infertility, for understanding relational processes, for the development of operational strategies and above all for the verification of the goodness of a lifestyle that is able to harmonize the couple’s project and the family’s project, couple satisfaction and parental openness. The setting of the service draws inspiration and reference from three paradigms from which significant ethical choices derive: the ecological perspective of fertility, the relational intimacy of the couple and a multidisciplinary approach. From the three founding paradigms, FFP model has been developed and progressively implemented in order to define a specific FFP Quality of Care Path (QCP) for couple infertility. Although further studies are needed to better clarify the role of each studied variable in a complex monitoring system, we identified for the first time a QCP Path based on 7 variables we present here two illustrative cases: the first one in which a natural conception has been obtained and the second one, in which the focus has been moved from natural conception to the reconstruction of relational competence. Further studies will demonstrate, on large scale, the efficacy of our protocol and of the analyzed variables.

Summary: This paper provides an overview of the conceptual and methodological process of implementing the monitoring of the path of infertile couples towards natural conception in harmony with their relational life project. A multi-professional team accompanies couples in overcoming the obstacles to fertility and in the progressive awareness that parenting is not only biological. The result is a range of goals to strive for. The reference paradigms of the service justify the ethical choices of the couple and the team. The operating protocol supports the couple commitment and guides professionals in their effective action if competent and concerted. The variables identified are the monitoring tool that gradually indicates the degree of the path progress.