Raising Awareness of Fertility Awareness

Posted on 4.24.2012 by Kelly

Last week I read an article on Jezebel (“Women Try to Rebrand the Catholic Church’s Position on Contraception”) about efforts by some women in the Catholic Church to revitalize Natural Family Planning (NFP). This method of family planning is generally sanctioned by the Church, though there are some who think that it should only be used to space out children and to aid conception. The article argues that it is hypocritical for one method of pregnancy avoidance to be allowed and promoted as natural, “unmedicated, God-given rhythms,” while other contraceptive choices are prohibited. While overall I agreed with the sentiments of the article, as a practitioner of the Fertility Awareness Method (FAM), a secular form of natural family planning, I took issue with the article's dismissive and uninformed attitude towards NFP and FAM. It's an attitude I have received repeatedly from other feminists, health care providers, and others who claim to support a spectrum of reproductive options.

The article states that natural family planning is “also called the fertility awareness method (and sometimes called the rhythm method).” However, these are three different methods with very different efficacy rates. Both fertility awareness and natural family planning involve tracking fertility signs including basal body temperature, cervical mucus, and cervical position. However, NFP, in accordance with the rules of the Catholic Church, requires abstention from vaginal intercourse during fertile periods, about 7-10 days at the middle of the menstrual cycle. FAM allows the user to choose whether to refrain from vaginal penetration or to use a barrier method such as condoms during fertile times. Additionally, if a user chooses to have vaginal intercourse with a barrier while fertile and the method fails, FAM has no philosophical objections to the use of emergency contraception such as Plan B. The rhythm method is a completely different method which relies upon patterns of past menstrual cycles to determine when one might be ovulating. As a menstruating person's cycles can differ due to stress, diet, exercise, health problems, or normal variation, relying on past patterns is not the most reliable method. However, both FAM and NFP are based on daily tracking of fertility signs and having “irregular” menstrual cycles does not have an effect on efficacy. In fact, knowledge of FAM can help a person to determine whether or not ovulation is occurring and what might be causing cycle irregularity.

In reference to NFP the article goes on to say that “many fertility experts (and many people with unplanned babies) maintain that it's not terribly effective, since there's a lot of room for error.” However, according to a chart from the book Contraceptive Technology, fertility awareness has a typical use failure rate of 25% and a perfect (consistent and correct) use failure rate of 3-5%. This is comparable to male condoms (typical use 15% failure rate, perfect use 2%). Hormonal contraceptives are definitely more effective than both male condoms and FAM , with a typical use failure rate of 0.2-8% depending on the method and a perfect use failure rate of 0.2-0.3%. However, there are many factors to consider when comparing birth control methods such as side effects, cost, and ease of use. While FAM is initially more time-intensive to learn and requires diligence in tracking fertility signs, over time one becomes an expert in recognizing and understanding the patterns of one's body. After learning the method, FAM does not require a large time commitment on a daily basis, although it does require consistency. For example, while I generally wake up at different times everyday, when practicing FAM I set my alarm for a certain time at which I take my temperature before either getting up or going back to sleep.

I took oral contraceptives for over a year as prescribed by my doctor to treat extreme premenstrual depression and anxiety (diagnosed as Premenstrual Dysphoric Disorder, or PMDD, something I hope to delve into in a future post). I eventually decided that I wanted to seek other ways of dealing with my cyclical depression and no longer wanted to take hormonal contraception. While I did not experience many adverse reactions while taking the pill other than frequent exhaustion and slight weight gain, I did not like the idea of taking something that affected my body on a systemic level. A friend introduced me to fertility awareness, something I had always confused with the rhythm method, which had been drilled into my head as ineffective and only used by those who were “uneducated” about sexual health. I began to read as much as I could about FAM and charted my cycles for over a year before having vaginal intercourse without a barrier. Eventually I found it very exciting to be able to understand my menstrual cycle and be more familiar with my body. While I eagerly shared my experience with FAM with my feminist friends, initially I was met with resistance and the idea that I was doing something extremely risky. However, I was persistent in sharing my knowledge with others and asking, “Why do we trust a pill to control our fertility but not the cycles of our own bodies?”

Lack of knowledge of fertility awareness or other non-hormonal methods has been prevalent at the doctor's office as well. FAM is often not an option or grouped with the rhythm method on questionnaires of birth control methods. One doctor informed me that fertility awareness is effective only for those with regular 28-day cycles, which, as previously mentioned, is incorrect. I am not currently relying on FAM, instead using male condoms. When I recently mentioned this to my doctor she insisted that I consider an IUD, implying that as someone in a monogamous heterosexual relationship I should “upgrade” my method. While I have previously considered a copper IUD, I am currently comfortable and satisfied with my use of condoms and do not feel that I need to use a more “advanced” contraceptive technology (see this article, also from Jezebel, exploring this point “Why Do We Romanticize Bareback Sex?”). Instead of emphasizing one or two options over others for all people seeking birth control, conversations about contraceptive choices should include the many factors relating to a person's health, economic resources, and personal preference.

Many people with uteruses reap both health and contraceptive benefits from the use of hormonal birth control, and there should be no restrictions on access to these important drugs. But many people also suffer from physical or psychological side effects of hormonal birth control, and others simply prefer not to use a contraceptive that can have an effect on one's entire body. These are choices that must be respected just as much as the choice to take hormonal birth control. It is important to support and expand access to useful and safe contraceptive technologies as well as non-hormonal and “natural” options, while also being critical of those which may be unsafe or rushed to approval (for example, “Just How Safe is Yaz? Women Need to Know!”). Instead of dismissing and belittling those who choose fertility awareness based methods, we should seek to spread complete and up-to-date knowledge of all contraceptive choices.

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