No Condoms, No Hormones, No Babies: A Guide to Natural Family Planning
Every morning before I eat, drink, shower or even pee, I take my temperature and record it in an app. That’s because after tracking my period for over three years, I’ve started practicing FAM (Fertility Awareness Method), also known as natural family planning.
FAM is a way to track fertility that’s commonly used by women trying to get pregnant. It works the other way, too, though. More and more women are using subtle fertility cues to make informed decisions about when to have sex and what sort of protection to use. FAM’s a cost-effective form of contraception with no side effects, though I should note here that for it to be reliable, you must commit to actively tracking your fertility every day. It also requires an awareness and ability to read your own body. It’s certainly not for every woman (more on that below).
How It Works
FAM isn’t as easy as simply tracking your periods. To determine when you’re ovulating (either the danger zone or go time, depending on your baby or no baby goals — you’re only fertile around six days per month), there are a number of physical cues to monitor.
The basal body temperature method is perhaps the easiest to use, and requires taking one’s temperature at the same time every morning before getting out of bed (a woman’s body temperature increases approximately 0.3 at ovulation).
The cervical mucus method requires checking your underwear and/or inserting two fingers in your vagina to notice cervical fluid, which increases in quality and wetness and resembles egg whites just before ovulation.
Or, you can observe changes in the cervix (the lowest part of the uterus) which feels different to the touch throughout the menstrual cycle. If you’ve never felt your cervix, read Clue’s guide. Around ovulation the cervix is soft (like your earlobe), other times it’s firmer (like the tip of your nose).
Since body temperature can be impacted by many factors — such as stress, sleep or alcohol — it’s typical for women to use a combination of the above methods to ensure reliability. As more attention is directed to improving non-hormonal birth control options, additional metrics may emerge. Recently, Clue piloted a study with Fitbit showing that resting heart rate changes during the menstrual cycle.
Who’s Using FAM?
Women use FAM for all sorts of reasons; many find it attractive as an alternative to synthetic hormones. A study conducted by the CDC found 63% of 12,000 participants switched from the pill, an IUD or NuvaRing due to hormone-induced side effects such as depression, digestive issues, vaginal dryness, painful sex or lethargy. Others attribute the choice to their upbringing: natural beauty expert and FAM advocate Jessa Blades wasn’t given the option to go on the pill when she was younger due to her mother’s negative experiences with it.
If this is the first time you’re hearing about FAM, blame a lack of standardization and startling misinformation among educators, which increases the risk of misunderstanding and human error. Up until the 1980s, information about fertility awareness was only made available through Catholic sources. However, when used correctly, FAM is considered to be 95 to 99% effective, according to Bedsider and Planned Parenthood. London-based GP, Dr. Tamara Karni Cohen says, “If practiced accurately, FAM can be a hormone-free and effective method of birth control for certain women, typically in committed relationships. It’s important to note that it does not protect against STDs and STIs. Additionally, if you don’t have a 26 to 32 day cycle, it’s harder to know when your fertile days occur, increasing the risk of FAM not working. It requires extra awareness and training for women approaching menopause, have recently had a baby or use any medication that affects signs of fertility.” It also requires use of a barrier method or abstinence during fertile days. Effectiveness drops to 76 to 88% for couples that do not use the method correctly or consistently. Blades, who runs FAM workshops, adds, “It’s certainly not for every woman. There is no one-size-fits-all solution to contraception.”
Listening to Your Body
FAM requires starting a conversation with your own body, a topic still mired in cultural taboos, especially around menstruation and women experiencing sexual pleasure.
Ashley Spivak, a reproductive health advocate and the cofounder of CYCLES + SEX, knows this well. FAM is a way to “pay attention to my body.” Blades views cycle tracking “as a monthly report card for your health.”
FAM is hormone-free and affordable, but presents a learning curve. For Spivak, it took almost six months to get a good grasp of it. “We are not taught body literacy and so at first there are questions about when to measure, what to measure, how to measure and then interpreting what that all means. I now trust it because I have so much data about my body.”
Women are seeking the help of apps like Natural Cycles, Clue, Kindara and Daysy, meant to correctly predict a woman’s fertile days. Getting it 100% accurate can be difficult given that every woman’s body and cycle is different. Using a fertility app, a woman is able to calculate her fertile window. Using apps in conjunction with FAM can be very effective. However, as cycles vary in length and are impacted by a variety of variables, these algorithms have limits and are not a replacement to actually reading your own body. Cycle Technologies reported that two out of three women between the ages of 18 to 39 surveyed in the U.S. say they would use a fertility app to prevent pregnancy if they were confident it would work.
It’s Not For Everyone
For some, FAM can be a great option. For others, like those with irregular periods or who don’t yet feel comfortable reading their own bodies, it’s not ideal. FAM requires an active daily commitment. “It’s an ongoing conversation and relationship with yourself,” says Spivak.
It also opens the door for more open and honest conversations with your significant other; many women report feeling more deeply connected to their romantic partner when using FAM. Spivak explains, “there’s a pre-decision that has been made by both people before the actual moments of having sex. It requires being very clear with one another in order to be effective.” Katinka Locascio, FAM advocate and founder of Earth & Sky Healing who has used FAM with her husband for over a decade, says that his knowledge about her cycle allows them to make shared reproductive decisions, creating greater intimacy both psychologically and sexually. “I think it’s up to both partners to be aware of the responsibility,” explains Blades.
As more people become interested in the menstrual cycle (in case you missed it, ACOG just declared the menstrual cycle a fifth vital sign), and increasing resources support education and management of FAM and natural family planning, I believe we’ll see more people chart their cycle — whether for preventing pregnancy, trying to conceive or simply as a monthly report card for their health.
Ovary is a research platform and female community dedicated to improving the conversation around women’s health, hormones, fertility and productivity. Visit www.ovary.co for more information or follow us on Instagram @ovary.co. Ovary events take place in NYC, LA, SF and London. Illustrations by Maria Jia Ling Pitt.