Modern Contraceptives Are Supported by Almost All U.S. Obstetrician-Gynecologists
Few U.S. obstetrician-gynecologists have moral or ethical problems with modern contraceptive methods, and most consider natural family planning a poor option for most women, according to a national survey of practicing physicians.1 Only 5% of doctors reported objecting to one or more common methods, and 7% would refuse to offer a method requested by a patient. The IUD was the method that the greatest proportion of physicians objected to and would refuse to offer (4% each). Doctors who considered religion highly important in their life and those who attended services more than monthly were more likely than others to object to and refuse to offer contraceptives (odd ratios, 1.9–7.4). Sixty-eight percent of physicians considered natural family planning a poor option for most women; religious physicians had reduced odds of holding this belief (0.4–0.6).
The survey was conducted among a random sample of obstetrician-gynecologists aged 65 or younger, who completed a self-administered questionnaire mailed between October 2008 and January 2009. The questionnaire asked physicians about their demographic and religious characteristics, if they had moral or ethical objections to any of six common contraceptive methods (the pill, the implant or injectable, the IUD, the diaphragm or cervical cap with spermicide, the condom and female sterilization) and whether they would offer each method if a patient requested it. In addition, respondents were asked how many women out of 100 using natural family planning with their partner they would expect to become pregnant over one year and whether they thought that natural family planning is the best contraceptive option for most women, the best option for some or a poor option for most. Multivariate logistic regression analyses were conducted to identify characteristics associated with physicians’ objecting to contraceptive methods, refusing to offer methods and believing that natural family planning is a poor option for most women.
Of the 1,760 obstetrician-gynecologists surveyed who were currently practicing and for whom researchers had a valid address, 1,154 responded to the questionnaire. Fifty-three percent were male; the greatest proportions reported being nonevangelical Protestant (27%) and Catholic (23%). Overall, 5% of doctors reported objecting to at least one contraceptive method, and 1% objected to all six methods. Seven percent would not offer one or more methods if requested by a patient; however, of those, two-thirds did not mention a moral or ethical objection to contraceptives. The IUD lacked support among the greatest proportions of physicians (4% each objected to and refused to offer it); the pill, among the smallest (1% each).
In multivariate analyses, religious characteristics were key predictors of physicians’ attitudes toward contraceptives. Jewish respon-dents were less likely than nonevangelical Protestants to object to one or more methods (odds ratio, 0.2). Physicians who considered religion a very important or the most important part of their life had greater odds than others of objecting to at least one method (6.0). And compared with doctors who attended religious services twice a year or less, those who did so twice a month or more were more likely to object to a method (7.4) and marginally more likely to be unwilling to offer a method that a patient requested (1.9). In addition, physicians located in western states had lower odds than those in the South of being unwilling to offer a method if requested (0.4); being male was marginally associated with objecting to a method (2.0).
On average, obstetrician-gynecologists estimated that 25% of women using natural family planning would become pregnant within one year. Compared with the estimates of nonevangelical Protestants, Catholics’ estimates were, on average, 3.4 percentage points lower; the average estimate of doctors who objected to one or more contraceptive methods was 5.9 points lower than that of doctors without objections. Sixty-eight percent of physicians considered natural family planning a poor option for most women; 31% thought it was the best option for some women, and 1% thought it was the best option for most. Being evangelical Protestant or Catholic, feeling that religion is very important or the most important part of one’s life and attending religious services at least three times a year were negatively associated with believing that natural family planning is a poor option for most women (odds ratios, 0.4–0.6).
The researchers point out several limi-tations of their study, including the cross--sectional design, the possibility of respon-dent bias and the chance that physicians’ self-reported beliefs do not represent their actual beliefs and practices. Even so, they comment that "obstetricians-gynecologist physicians generally support the use of contraception" and that "most physicians, even those with objections, would offer a contraceptive meth--od if a patient requested it." They conclude that "although controversy about contraception has by no means disappeared, it does not appear to be a significant source of division among obstetrician--gynecologist physicians in the United States."—J. Rosenberg