Reporting non-recommended use of condoms and withdrawal in a study of a natural system of family planning


Opoku Agyemang D, Najmabadi S. [1] Stanford JB. [1]

[1] Office of Cooperative Reproductive Health, Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.


Background: The Creighton Model Fertility Care System (CrM) teaches women and couples to identify the potentially fertile phase of the menstrual cycle (i.e., the fertile window). The CrM encourages couples to abstain from genital contact when they intend to avoid pregnancy. However, couples sometimes use condoms or withdrawal as additional methods that were not recommended.  We were interested in how often this occurs and how completely it is reported.

Methods: We conducted the CrM Effectiveness, Intentions, Behaviors Assessment (CEIBA) study to assess the factors impacting the actual use and effectiveness of the CrM.  This particular analysis aimed to evaluate the reporting of condom use and withdrawal during the CEIBA study. We analyzed data from Creighton Model Chart (238 Couples), Creighton Model Follow-up Forms (284 couples), CEIBA Start of Cycle Questionnaire (287 couples), CEIBA Exit Questionnaires (270 couples). We calculated descriptive statistics and generated kappa statistics using the Landis and Koch definitions (95% CI) for couple concordance for withdrawal and condom use reporting.

Results: The mean age for the women was 27.1 ±4.2 years, with the majority (82%) of the participants being non-Hispanic white. In the CEIBA exit questionnaire, 27%, 22% and 38% of couples reported using condoms, withdrawal and either condom or withdrawal respectively at some point during the study. In the Follow-up form, 5%, 3% and 7% of couples were documented to have used condoms, withdrawals and either condoms or withdrawals, respectively. There was substantial agreement in exit questionnaire for woman and man reporting condom use (κ = 0.80; 95% confidence interval (CI): 0.69-0.90), but a fair agreement for woman and man reporting withdrawal (κ = 0.39, 95% confidence interval (CI): 0.20-0.58). Comparing follow up form and exit questionnaire, there was a poor agreement between couples reporting either condom or withdrawal (κ = -0.10, 95% CI: -0.10 - -0.04). There was also a fair agreement between couples reporting either condom use or withdrawal when comparing the CEIBA start of cycle and exit questionnaires (κ = 0.38, 95% CI: 0.27 – 0.49). When comparing the CrM chart and the exit questionnaires, there was also a fair agreement between couples reporting either condom use or withdrawal (κ = 0.39, 95%CI: 0.26 – 0.51). About twice as many reported condom or withdrawal use on the exit questionnaire (n=90) as CrM chart (n=31) or start of cycle questionnaires (n=43).

Conclusion: On the exit questionnaires, there was a substantial within-couple agreement between women and men for reporting condom use but less/fair agreement for withdrawal. Only a minority of couples (n=19) reported their condom or withdrawal use to the Creighton Model FertilityCare Practitioner, as assessed by the follow-up form. Studies of use and pregnancy rates of NFP must assess for use of condom or withdrawal.

North American Regional Conference for Restorative Reproductive Medicine.  July 21, 2020. 


Opoku Agyemang, Doctoral Student, University of Utah, USA.  

Daniel Opoku Agyemang, from Ghana, West Africa received his bachelor's degree from the University of Ghana in Animal Biology and Conservation Science (2010-2014). After a voluntary one-year service with Ghana Health Service in Maternal and Child Health, Mr. Opoku Agyemang earned a Masters in Public Health from the Ensign College of Public Health (ECOPH) in Ghana. As a graduate student, he was the lead research assistant on a collaborative project between the University of Utah and ECOPH to reduce maternal and child mortality in hard-to-reach rural areas in Ghana.

Currently, Daniel Agyemang is a public health doctoral trainee at the University of Utah, working under Dr. Joseph Stanford. His research interests are the impact of lifestyle on fertility, pregnancy, and maternal health on child development, especially postpartum.


North American Regional Conference for Restorative Reproductive Medicine.  July 22, 2020.