Medical Practices Blend Health and Faith

The number of "NFP-only" practices is unknown, but an Ohio-based Web site promoting them has a registry of nearly 500 doctors who have pledged to practice this way. Most are obstetrician-gynecologists and family practitioners.

"We're trying to get doctors to see that contraception is not good medical practice," said Steve Koob, who runs the One More Soul site ( http://www.omsoul.com ). "Natural family planning for couples that need to space their children is as effective, and it builds a marriage."

Doctors on the registry say they converted their practices after struggling to reconcile their beliefs with their medical responsibilities, often after years of being penalized or shunned by colleagues.

"I've encountered a lot of resistance to how I practice over the years," said Lorna L. Cvetkovich, an obstetrician-gynecologist in Ann Arbor, Mich. "For one thing, contraception and sterilizations bring in a lot of revenue. But I finally found partners who feel the way I do, and we're scraping by."

The approach also provides a haven for women who have had a hard time finding a doctor who understands their beliefs.

"What happens is a patient says to her doctor, 'I don't want an abortion. I don't want to go on birth-control pills. I don't want to create 10 embryos and kill eight of them to have a baby,' " said Thomas W. Hilgers, who started the Pope Paul VI Institute for the Study of Human Reproduction in Omaha to do research in this area, offer patients alternatives and train doctors. "They end up getting ridiculed or told they are stupid."

Some of these doctors have solo practices. Some belong to groups where they are the only ones offering the approach. Others have formed group practices that are NFP-only. Often they carefully screen out prospective patients who might want care they do not provide. Some refer such patients elsewhere. But others feel uncomfortable doing even that, saying it would make them complicit in care they consider immoral.

"If you refer a patient, it makes you as responsible as the one who does the procedure," said Cynthia Jones-Nosacek, a family practitioner in Milwaukee.

Some women, however, report being dismayed after stumbling into one of these practices without realizing what they were.

"It never crossed my mind that it would be an issue," said Katie Green, 26, who was refused a birth-control prescription by Jones-Nosacek. "I was really irritated. It just rubbed me the wrong way."

"It caught me completely off guard," said Elizabeth Dotts, 25, who had a similar experience in Birmingham. "I felt like he was judging me and putting pressure on me. . . . I am the patient. I am the client. It should have been about me -- what I needed. Not what he needed or believed."

Some experts say such practices are providing substandard care if they do not fully inform patients about all options.