Newsweek Staff Writer Marie Solis is sounding the alarm that "the Trump administration wants to replace reliable birth control methods with ‘fertility awareness,' a dubious family planning method that fails nearly a quarter of women every year." Claiming that fertility awareness-based methods are the same as the "rhythm method," they imply that women with irregular periods or young girls can't learn to chart their cycle, and that this could be a "disaster for women's health."
However, Newsweek is wrong on all accounts.
Fertility awareness is not a family planning method equivalent to the "rhythm method." Fertility awareness-based methods, or FABMs, refer to a group of family planning methods that work by teaching a woman how to track specific signs to identify when she may be fertile, and when she is not. Unlike the rhythm method, which was developed in the 1930s and is based on retrospective calendar calculations to predict future fertility, modern fertility awareness-based methods allow women to use daily observable physical signs to identify her potential fertility in real time.
More importantly, these methods are based on solid scientific research. Women may not only use them to prevent pregnancy, but also to achieve pregnancy, as well as monitor their health.
With ovulation-based methods, including the Billings Ovulation Method and the Creighton Model, a woman tracks cervical fluid sensation and/or observations only, following certain guidelines to identify her fertile period or the three-to-six day window when she is capable of getting pregnant. With the sympto-thermal method, a woman tracks both cervical fluid and basal body temperature and uses these observations to identify her potential days of fertility. With the sympto-hormonal or Marquette Method, a woman tracks cervical fluid and/or urinary hormones to identify her fertile window.
This widely-quoted figure is based on retrospective surveys from 1995 and 2002 in which women with unintended pregnancies were asked to recall which family planning method they were using at the time of conception. From this number, the rates for all natural or fertility awareness-based methods were combined and one estimated unintended pregnancy rate was generated.
However, lumping together effectiveness rates for the 86 percent of women who reported using the outdated calendar rhythm method with a minority of women using newer methods masks the true effectiveness rates of modern FABMs. Modern FABMs incorporate different signs and guidelines for use, so reporting one combined rate for all natural methods, based on an overwhelming majority of women who reported using the rhythm method, misrepresents the actual effectiveness of individual modern FABMs.
The real effectiveness rates of modern FABMs with correct use range between 95.2 percent and 99.6 percent, based on the highest-quality published medical research. Even with typical use, the unintended pregnancy rates range from 2-14 percent per year, which are comparable to most commonly used forms of birth control. However, unlike conventional birth control methods, the World Health Organization recognizes FABMs as the only family planning methods that have no medical side effects.
Newsweek claims that "the calendar method asks a lot of young girls, who often learn little about sex and reproduction." Fortunately, with fertility awareness-based methods— again, not the calendar-rhythm method—the goal is to teach women of all reproductive ages to monitor their cycle to better understand their health and more importantly identify their ovulatory pattern and window of fertility.
This information is sorely lacking even among adult women, as a 2014 study showed that 40 percent of women between the ages of 18 and 40 were not familiar with the ovulatory cycle and their time of fertility. Yet a study of 235 girls, aged 15 – 17 years trained in the Billings ovulation method, "proved that teen-age women can distinguish patterns of ovulation and anovulation by self-detection of cervical mucus."
More importantly, another study showed a significant decrease in teen pregnancy rates with the implementation of TeenSTAR, a sex education program that aims to help youths manage their emerging sexuality and fertility through charting their cycle with the Billings method. Pregnancy rates for girls in the TeenSTAR program ranged from 3.3 - 4.4 percent, which was significantly less than those in the control group, where pregnancy rates ranged from 18.9 - 22.6 percent.
Dawn Laguens, an executive vice-president for Planned Parenthood, states that the Trump administration's encouragement of fertility awareness "reveals not only a disdain for women's health and lives, but a lack of understanding of the basics of sexual and reproductive health."
Actually, the opposite is true. Teaching all women to understand and monitor their fertility through the use of fertility awareness-based methods, shows a high level of respect for women.
It recognizes that women, even teenagers, can learn to monitor and manage their fertility without resorting to drugs and devices that suppress the normal function of their reproductive health system. It offers relief from birth control drugs and devices that often have numerous side effects—side effects which women are exposed to 365 days a year, even though science shows us women are only capable of getting pregnant 70-80 days a year. It gives women the tools they need to understand their bodies and take control of their health based on solid scientific evidence.
What could be more empowering?
Marguerite Duane is a contributor to the Washington Examiner's Beltway Confidential blog. She is a board-certified family physician and adjunct associate professor at Georgetown University. She is also co-founder and executive director of FACTS (the Fertility Appreciation Collaborative to Teach the Science). She is a member of Women Speak for Themselves.
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