Feb 2, 2017

Dr. Jones: How do you plan when and how many children to have? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is "Making Babies or Not," on "The Scope."

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on "The Scope."

Dr. Jones: Most of us want children and most of us want to have them when the time is right. However, how much are we really willing to do to accomplish this goal of family? Some people prefer to take a more natural approach and some a more technical approach. Natural family planning provides contraceptive methods and a fertility method for creating a family of the right size at the right time.

Today in "The Scope" studio, I'll be talking with Dr. Joseph Stanford, professor in the Department of Family and Preventative Medicine. Dr. Stanford has a special interest in natural family planning and in natural procreative technology. Dr. Stanford and I have spent our careers in helping people have the children they want, but we take different approaches and we're going to talk about that today. Welcome, Dr. Stanford.

Dr. Stanford: Thank you, great to be here.

Dr. Jones: So let's just throw it out there, what is family planning to you?

Dr. Stanford: Family planning, to me, means couples being able to choose how many children to have, and when and how to have them.

Dr. Jones: I agree with that 100%. So there is a large domain of knowledge and practice around natural family planning.

Dr. Stanford: There's some considerable science and there's also . . . my interest is a lot of things we're still learning, but yes, there's a considerable body of science behind it.

Dr. Jones: Okay. So tell me a little bit about your counseling couples or your practice of natural family planning. What does that mean?

Dr. Stanford: So natural family planning means couples understanding when the woman is ovulating, when the days are that intercourse would result in pregnancy, and then making choices to either have intercourse or abstain. Or we can talk about the various choices they might make around that time to decide to either try to get pregnant or not.

Dr. Jones: So how well does it work?

Dr. Stanford: If a couple understands the days that they may get pregnant and does not have intercourse on those days, it's highly effective for avoiding pregnancy. The controversy about effectiveness comes when couples take chances or say, "Well, maybe I'll see what happens." That's where the gray areas and the controversy come for effectiveness.

Dr. Jones: Right. Well, so, for me, I would say I take a more technical approach. I certainly was raised as a reproductive endocrinology with the science of contraception in terms of birth control pills, birth control hormones, IUDs and shots, because my training told me that people are the least predictable about their behavior when they're thinking about sex and that the difference between what they intend to do and what they really do is kind of big. We know that people want to take their birth control pills and they . . . 10% of them screw up and they don't take them right. Well, what about the natural family planning? You must be looking at a very unique group of people who are motivated, highly motivated.

Dr. Stanford: Yes and no. I would say that successful users in natural family planning are highly motivated for a variety of reasons and find a way to make that work, and find it beneficial to their relationship over time. So in that sense, yes, they're highly motivated. I would also say that they, on average, tend to have a little bit different view about when they want to have children. I think natural family planning users, on average, probably have a few more, one or two more children than the contraceptive users, and that's because of their worldview of how many children they want and what methods they want to employ to get there.

Dr. Jones: So I think the people who provide this service may have a unique worldview. That would be you versus what mine might be, and the people who come to practice this method reliably and successfully may have a little bit of a different worldview, so I think . . .

Dr. Stanford: But I would also say there's a spectrum of reasons people use natural family planning or what we might call fertility awareness methods. Some are coming at it from a religious point of view, some are coming at it from an ecological point of view, they don't want hormones, some are coming at it from a point of view of not wanting to have a barrier or they like that idea of understanding their bodies. So there's a spectrum. It's not a monolithic group that use natural family planning.

Dr. Jones: Right, and I understand that, having grown up sort of in the granola culture, that a lot of women didn't want to put anything in their body or take anything unnatural and preferred -- they were well-educated women -- to make their own personal choices, and I can see that that might be very useful for them if they practice it reliably through a lifetime of contraception.

Kids who might be sexually active, when they're still not reliably ovulating or women postpartum, or women in their 40s, are there special tools that you have to use for women who aren't reliably ovulating?

Dr. Stanford: Let's talk about the women in their 40s or women who are not reliably ovulating. Those are cases where I think we do need more research, but I do think we have adequate tools to make it work for those who want to make it work. Is it always the easiest thing? No, sometimes it requires a little more patience. It can work for that group. I hope we have better ways in the future to make it work a little more smoothly or easily.

The teenager, that's another question of motivation and the whole social context of . . . . I believe that teenagers should all be educated in their sexuality, including their fertility and their fertility cycles. Whether or not that means we rely on that as the only way of them not getting pregnant, I would think you need to look at social context and social norms, and other issues. And in some social context for some teenage populations and families, they may think contraception's part of that, but I think that for all teenagers, they should understand their fertility.

Dr. Jones: Right. I thought that if they had sex, they were reflex ovulators like cats, meaning, yes, grown-up women ovulate on a schedule and teenagers only ovulate when they have sex because it seems like it only takes once, at least that's what they've told me.

Dr. Stanford: Well, you know, that's an interesting question that I actually think we need a little more research on, but it's not true that . . . there's no evidence, let's put it that way, that women can go from no mature follicle to ovulating based on one intercourse.

Dr. Jones: Even I know that. Well, so I take it . . . I come at contraception from a perspective of wanting to have a very low failure rate with almost no input.

Dr. Stanford: Right.

Dr. Jones: So for those of us who are interested in what we call long-acting, reversible contraception, or highly effective reversible contraception, we want something that's highly effective and reversible, and you don't have to think about it, that has some side effects, though. It has some downside and women, the tradeoff for highly effective and reversible is some side effects, but I guess . . . what is the failure rate if you follow the rules? Did we talk about that?

Dr. Stanford: Yeah, 1% to 2%.

Dr. Jones: One to two percent, that's pretty good, per year?

Dr. Stanford: er year.

Dr. Jones: Per year.

Dr. Stanford: So I would say that is a fundamental difference in philosophy. Natural family planning is, in some ways, the complete opposite of long-acting, reversible effective contraception in the sense that the goal is to have as little user input as possible, make it completely independent of the user.

Dr. Jones: Right.

Dr. Stanford: Natural family planning is the radical opposite of that. The user, and not just the woman, but the woman and the man together, need to cooperate and understand what's going on and cooperate to make that happen for both of their intentions. So it is a radically user-dependent method, which I think some people see as a weakness, but it is also a strength.

Dr. Jones: I think it is for strength and what I really want is for women to have their choices.

Dr. Stanford: Right.

Dr. Jones: And for couples to have their choices.

Dr. Stanford: Right.

Dr. Jones: And I think that's important to both of us, and whether you choose a very technical approach to your personal contraception, or you want a, what I call radically . . .

Dr. Stanford: User-dependent . . .

Dr. Jones: . . . user-dependent method, meaning your control and your body

Dr. Stanford: Right.

Dr. Jones: We want to have both people to be successful.

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