What Do Physicians Actually Learn About NFP in Medical Training?

Natural Family Planning (NFP) is a highly effective and scientifically validated method for managing fertility and understanding reproductive health. Yet, if you were to ask the average physician about NFP, chances are you’d encounter skepticism, misinformation, or even outright dismissal. Why? Because most medical training barely scratches the surface of this topic. Take it from me! NFP was not taught at all during my medical school or residency training. In fact, my residency program actually asked me to do a presentation teaching about NFP since it was not included in traditional training, and neither my co-residents nor my attending physicians knew much of anything about the topic. This gap in education is critical for women to understand as they navigate their reproductive health and choose providers who respect their preferences.

The Reality of NFP Education in Medical School

In medical school, reproductive health is a required component of the curriculum, but the focus is almost exclusively on contraception. Students are taught the mechanisms, uses, and some side effects of various forms of birth control, including:

• Hormonal contraception (IUDs, arm implants [Nexplanon], oral contraception pills, the Depo shot, etc.)

• Barrier methods (i.e. condoms)

• Sterilization

  
  

Discussions about NFP, if they happen at all, are often brief, inaccurate, and dismissive. For instance:

• Effectiveness rates: NFP is often inaccurately presented as unreliable or ineffective. Physicians are commonly told that it has a failure rate of 25%, conflating modern NFP methods with outdated calendar-based approaches such as the rhythm method. This misinformation stems from flawed studies referenced for years on the CDC website. To learn more about why the information posted by the CDC is inaccurate and flawed, click here to read my blog post addressing the misinformation and true effectiveness rates.

• Methods: They do not teach about actual NFP methods such as the basal body temperature (BBT) method, sympto-hormonal (i.e. Marquette method), or the cervical mucus method (i.e. Creighton or Billings). Instead, I found that the majority of my colleagues were under the impression that NFP was equivalent to either the pull-out method, rhythm method, or simply just avoiding sex on day 14 of your cycle.

• Misconceptions: The science behind modern NFP methods—such as Creighton, Sympto-Thermal, or Marquette—is rarely covered. Instead, students might hear blanket statements about NFP being “unscientific” or “too complicated” for patients to use effectively. Additionally, since the actual methods and science behind NFP is not taught, most physicians believe that NFP can not be used with irregular cycles, which is far from the truth.

The Narrative in Residency Training

During residency, the emphasis shifts to practical applications of reproductive health care. For specialties like OB-GYN and family medicine, this means:

• Learning how to prescribe, insert, and manage all types of birth control.

• Counseling patients on contraceptive use, often using scare tactics against NFP. This is pushed to the point of trying to discuss postpartum contraception methods with women early on in their pregnancy.

• Rarely, if ever, learning how to support patients who choose NFP.

  
  

One thing that frustrated me was the educational PowerPoint that was shown for our Family Medicine board-review, which was put out by the American Academy of Family Physicians (AAFP). There were multiple slides dedicated to each specific type of contraception, but only one simple slide to cover everything about NFP. For example, the breakdown of the number of slides for each specific topic is as follows:

• General combined contraceptives (estrogen + progestin pills) = 8

• General progestin-only contraceptives (pills, IUDs, implants, Depo shot, ect.) = 3

• Depo shot = 2

• IUDs = 5

• Barrier methods (i.e. condoms) = 1

• Emergency Contraception = 7

• Natural Family Planning (NFP) = 1

The only slide referencing NFP did not even go into explanation of what Natural Family Planning is, the different methods that it consists of, or its effectiveness. Instead, it just had a short list of pros and cons to NFP. The pros were that it has no side effects, no cost, immediately reversible, acceptable to all religions, and improves a couple's communication. The cons included that it does not have the non-contraceptive health benefits that birth control has, and that it requires periodic abstinence and intensive education. This was the only time I was ever taught about NFP during my medical training! Thankfully, I had done my own research, did a couple of rotations with a NaPro (Natural Procreative Technology) OBGYN, and have since began my own NaPro Medical Consultant training.

Not only does this explain nothing about what NFP is, but it portrays hormonal birth control as being more beneficial to women's health. Ignoring the potential adverse effects of hormonal birth control such as depression, blood clots, and increased risk of breast cancer is very dangerous. To make matters worse, there were multiple slides that's entire focus was on strategies to get women to use long-acting birth control methods like IUDs and implants (i.e. Nexplanon), and to discourage them from using barrier methods or NFP. The emphasis is so strong to initiate hormonal birth control, that they actually recommend against doing any pelvic exams or breast exams prior to prescribing birth control. The presentation stated, "requiring pre-requisite preventative services such as cervical cytology, breast exam, or evaluation of STIs, diabetes mellitus, dyslipidemia, liver disease, or thrombophilia, can introduce unnecessary barriers to contraceptive care." The only recommendation prior to prescribing hormonal birth control is checking blood pressure and reviewing medical history.

The lack of education on NFP means most physicians leave residency with little to no understanding of how modern NFP/fertility awareness based methods work, their scientific basis, or their true effectiveness. Rather, most physicians leave residency with a negative impression of NFP due to the misinformation and bias presented during medical training.

What Physicians Aren’t Taught About NFP

Physicians are often unaware of the extensive research supporting NFP’s effectiveness and benefits:

• Effectiveness Rates: When used correctly, modern NFP methods can be over 99% effective at avoiding pregnancy, which is comparable to the most effective methods of hormonal birth control.

• Holistic Health Benefits: NFP empowers women to understand their cycles, identify potential health issues, and work with their body’s natural rhythms.

• Infertility Treatment: NFP can be used to diagnose and naturally treat infertility by using a root cause approach. This is an especially important topic for physicians to learn in medical training since according to the World Health Organization (WHO), infertility is on the rise and affecting 1 in 6 adults worldwide.

• Scientific Foundation: Modern NFP methods are rooted in decades of research on hormonal patterns, cervical mucus changes, and basal body temperature.

Why This Matters for Women

The lack of education on NFP in medical training has real consequences for patients:

1. Dismissive Attitudes: Many physicians, unaware of the science behind NFP, dismiss it as ineffective or outdated. This can discourage women from exploring natural options that align with their values and preferences. This can also cause more women to be pushed into using hormonal birth control, which can have negative side effects on their health.

2. Incomplete Counseling: Patients seeking alternatives to hormonal birth control may not receive comprehensive information about their options, including NFP. If physicians are uneducated on different types of NFP or where to direct a patient to go for proper instruction on use, women will not learn how to correctly use Natural Family Planning on their own. Women that are not properly counseled about true NFP options are much more likely to think that using their period app's predicted ovulation date is equivalent to NFP. Improper use will lead to the method being less effective.

3. Inability to Interpreting Cycle Charts: The fact that doctors are not taught how to read and interpret NFP charts for patients means that a woman's doctor may be missing important signs of health conditions, which can often times be first noticed in a woman's menstrual cycle chart. Missing signs of reproductive health issues can lead to delayed diagnosis.

   
   
   
   

What Can Women Do?

If you’re considering NFP, it’s important to recognize that most physicians lack training in this area. Here’s how to advocate for yourself:

1. Seek Out an NFP Physician: Physicians who specialize in NFP and NaPro Technology have additional training and can provide accurate information about the different methods and how they work. These doctors are educated on diagnosing and treating reproductive health issues based off of interpreting a woman's chart.

2. Do Your Own Research: Learn about the different NFP methods—Creighton, Marquette, Sympto-Thermal, Billings, etc.—and their effectiveness. Look for resources based on peer-reviewed studies. Click here to read my blog article about how to pick the best NFP method for you. Plus, to learn more about the actual effectiveness rates of NFP, click here.

3. Take Their Advice with a Grain of Salt: If your physician dismisses NFP without a clear understanding of the science or modern methods, remember that their perspective likely stems from inadequate training, not a true evaluation of its validity.

   
   
   
   

Hopeful for the Future of Medical Training

While the education on Natural Family Planning is definitely lacking during medical school and residency training, I am very hopeful that there will be change in the medical training curriculum for the future. Even though I was the only person in my residency program (residents and attendings included) that truly understood or practiced NFP, my colleagues were extremely interested in learning more about this topic. I was actually approached by one of our Chief Residents, who asked me if I would put together an educational presentation to teach the program more about fertility awareness and NFP. After doing my initial presentation, I had multiple attendings, co-residents, and medical students saying how interesting all of this was and how much they learned! In fact, there was such positive reactions from my program, that I was able to do it for the entire hospital in one of our Grand Rounds lectures! The feedback that I kept hearing was that this information is so interesting and critical to learn. Once medical professionals start to learn the actual truths about NFP, they thirst for even more knowledge. With more women getting off of birth control due to side effects, more people shifting to natural and hormone-free lifestyles, and more couples suffering with infertility, it is essential that Natural Family Planning is added into the medical school and residency training curriculum.

Conclusion

The lack of education about Natural Family Planning in medical school and residency means that most physicians are ill-equipped to provide accurate guidance on this important topic. Women deserve to know the truth: modern NFP methods are highly effective, scientifically validated, and offer a natural approach to fertility management. By seeking out informed providers and educating themselves, women can take control of their reproductive health and make decisions that align with their values and goals. Hopefully in the future, we will see Natural Family Planning and Fertility Awareness Methods as part of regular medical training.