What’s Natural (in Family Planning) Is New Again
“Women are getting off birth control amid misinformation explosion.” “Birth control misinformation surges in fraught moment for reproductive care.” So read the headlines of a pair of March 2024 articles from the Washington Post. Another May 2024 article, this one from the New York Times, questions whether women are really quitting hormonal birth control “en masse,” but like the Post, bemoans a rise in birth control “misinformation” on the internet, particularly social media. The authors of each article worry that in a post-Roe world, increased uptake of natural methods of family planning will inevitably give rise to unintended pregnancies.
But is “misinformation” the only reason women are increasingly turning to fertility awareness methods (FAMs, also known as fertility awareness-based methods, natural family planning, or natural birth control) and FDA-approved “digital contraceptives?” Could it be that women are more aware than ever before that hormonal birth control (HBC) isn’t the unqualified good our mothers and grandmothers were promised? Could it be that women are learning about effective, evidence-based family planning methods that respect their bodies without compromising their health?
Hormonal Birth Control Skepticism: No Longer Just for the Religious
Decades ago, the Catholic Church was the lone voice decrying contraception. But now, questioning birth control is far less culturally taboo. Documentaries and books like The Business of Birth Control (2021), evolutionary psychologist Sarah E. Hill’s This is Your Brain on Birth Control (2019) and Holly Grigg-Spall’s Sweetening the Pill (2013) have no moral objections to HBC. Instead, they address its health impacts, relationship effects, and the inequitable, disproportionate responsibility women bear for family planning.
An April 2024 article on new moms rejecting birth control observed that some postpartum women have “a dawning realization that they have spent years—decades, even—taking on the bulk of the reproductive responsibility. And they are being asked to do it yet again after their bodies—and brains—have been through one of the biggest changes a person can possibly experience.” The same article noted that other moms stopped birth control due to an aversion to having something foreign (like an IUD) in their bodies, a desire to use something more natural, and/or confusion whether postpartum mood issues were caused by the hormonal contraceptives.
Exact numbers of how many women have come off the Pill in the last few years are hard to come by. This is in part because the National Survey of Family Growth (NSFG), which tracks women’s use of contraceptive methods, considers all natural methods as the outdated, ineffective, calendar-based rhythm method without separating out users of modern, evidence-based fertility awareness methods. Still, the most recent NSFG findings, released in 2019, report that between 2011 and 2015, 15.9 percent of U.S. women between the ages of fifteen and forty-four had tried a natural family planning method at some point.
There are other indirect indicators in secular, popular culture of an increasing number of women coming off HBC. The Natural Cycles app, founded in 2013, now has three million users worldwide, and Clue, founded in 2012, has twelve million worldwide users. According to this Oprah Daily article from March of 2024, videos on “#Gettingoffbirthcontrol have been viewed more than 24 million times on TikTok.” While details are scarce, in October of 2023, the Skimm reported: “In a recent [instagram] poll, of those who responded that they weren’t on birth control, 32% said they ditched it within the last year.”
But perhaps the most significant, though indirect, indicator is an April 2024 Medscape survey of physicians and other healthcare clinicians. Respondents were asked which “concerns about contraception that could be based on misinformation” they’d heard from patients, including “contraception can cause cancer” (it’s true), “birth control depletes your body of important vitamins or minerals” (it does) and “you don’t need contraception because you can control pregnancy through timing sex and menstrual cycles” (you can). This shows that interest in FAMs is widespread, so much so that healthcare professionals are taking notice.
Respecting Women’s Bodies: An Alternative Approach
It’s easy to get lost in the weeds sifting through claims that birth control’s “benefits” (while it decreases ovarian cancer risk, it also raises breast cancer risk, which is more common and more deadly) outweigh its risks. Fortunately, the rationale for adopting fertility awareness methods (FAMs) doesn’t just rely on the harms you’re avoiding. Its appeal has much to do with what you gain: an effective family planning method that respects the woman’s fertility and menstrual cycles, an increase in body literacy, and a tool to seek help for the same kinds of reproductive issues HBC cannot fix.
To be clear, “fertility awareness” isn’t just one method. It’s a constellation of methods that rely on the woman’s observable biomarkers of ovulation to determine when she’s fertile. Symptothermal methods like the Couple to Couple League, Sensiplan, and SymptoPro use basal body temperature (BBT), cervical mucus observations, and optional cervical checks to identify and then confirm ovulation. The Natural Cycles app, the original FDA-cleared “digital contraceptive,” is the only fertility awareness method to use BBT readings as its lone biomarker. The Creighton Method and the Billings Ovulation Method use cervical mucus observations only. The Marquette Method (whose developers are also in-process creating protocols using the Mira monitor, which gives quantitative, not qualitative, readouts) is a symptohormonal method testing urinary levels of the hormones estrogen and luteinizing hormone (LH).
Other hormone-free natural methods include calendar-based methods. These include the Standard Days Method, Cycle Beads, and popular apps like Clue. Like Natural Cycles, Clue is also an FDA-approved digital contraceptive, but because it doesn’t incorporate any biomarker observations, it is a slicker, predictive algorithm-driven version of the rhythm method. Because they don’t track any biomarkers, calendar-based methods are not, strictly speaking, fertility awareness methods.
Effective and Safe
Pregnancy prevention effectiveness statistics are reported in two ways: perfect use and typical use. Perfect use refers to following all protocols and instructions for use. Typical use refers to the way the average woman and couple use the method over the course of one year. The symptothermal method and the Marquette Method are 98 percent effective with typical use (comparable to new research on the IUD, which may be less effective than the “less than 1 percent” unintended pregnancy rate we often hear). With typical use, the Creighton Method is 96 percent effective and the Billings Ovulation Method is 90 percent effective. The Standard Days Method is 88 percent effective and the Two Day Method is 86 percent effective (comparable to condoms) with typical use. (More on why these numbers are so much higher than the CDC’s oft-cited “2-23 percent” pregnancy prevention statistic for FAMs can be found here.)
With numbers like these, it’s clear women don’t need to “alter, suppress, or destroy” their fertility to effectively plan their families. And, contrary to popular belief, women with irregular cycles, including women with PCOS, can use fertility awareness methods to reliably space pregnancies. Best of all, and unlike HBC—which can only be used to prevent pregnancy—couples can use FAMs to successfully conceive.
FAMs aren’t only used to space or indefinitely avoid pregnancies. When a woman learns to chart her menstrual cycle, she becomes in tune with the predictable cyclical rise and fall of her natural hormonal rhythms. This is the main principle behind cycle syncing, the now-trending practice of tailoring workouts, nutrition, and more to the follicular, luteal, or ovulatory phases of the cycle. Ovulation, not menstruation, is the main event of the cycle, and she becomes familiar with the signs that ovulation is approaching (her fertile window is opening) as well as when it’s passed (her fertile window closes). When she understands the complex, coordinated symphony of follicle stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone that occurs inside her each month without voluntary effort on her part, she is invited to admire and respect the goodness of her body.
She also knows what’s normal (for example, irregular cycles for the first few years after puberty starts) and what’s not (period pain that keeps her home from school or work). Though the menstrual cycle is understood in healthcare circles to be a “fifth vital sign” of overall health in the female body, this knowledge is so foreign to the average woman or girl that more than 22,000 people are Google searching “why do women have periods?” each month. But women and girls who chart their cycles know when to seek help, and healthcare providers trained in restorative reproductive medicine (like NaProTECHNOLOGY, FEMM, and Neo Fertility) can use cycle charting as a basis for diagnostic workups of PCOS, endometriosis, infertility, period pain, abnormal bleeding, Type 1 diabetes, and more.
FAMs Are No Longer Fringe: And That’s a Good Thing
The rising interest in FAMs, along with the availability and popularity of femtech devices that help women track their fertility, makes several things clear. First, many (not just religious) women want more, and real-time, information about what’s happening inside their bodies. Second, they seek family planning choices that don’t compromise their health in other ways, as hormonal birth control can. And finally, they want to address, not band-aid, the root causes of their reproductive health issues.
FAMs offer all of these benefits, and women are paying attention, increasingly embracing the reality that their cycles are beautiful, powerful, and healthy. They’re gaining body literacy, and in the process, they’re becoming less, not more, susceptible to the very misinformation the Washington Post and other outlets have been concerned about. This is truly, authentically, and enduringly empowering.
Image by Rido and licensed via Adobe Stock.