Your Grandmother’s Birth Control Might Actually Work

Lately, our thinking about birth control seems to be shifting. Earlier this summer, the Guttmacher Institute released a study [2] showing that proper use of the withdrawal method is nearly as effective as condoms, and, as Double X’s Jessica Grose pointed out [3], lots of young, educated women are using it. Meanwhile, abstinence-only education funding has been zeroed out [4], and Guttmacher just published another study [5] that reveals young women often abandon birth control methods they don't like. Several different liberal media outlets have [6] been [7] hashing out [8] options beyond the trusty condom.

So why has nobody mentioned the highly effective, completely natural fertility awareness method, or its Catholic sister, natural family planning?

I was introduced to FAM when sex became inexplicably painful for me after using the NuvaRing for several years. It took three doctors to figure out what was going on before one gynecologist realized the NuvaRing wasn’t correctly replacing my body’s estrogen. Instead, it was actually thinning my vaginal walls, menopause-style. I’m 25. This was not good.

“Shouldn’t I go off birth control?” I asked, horrified. “It’s never really vibed with my body.”

My doctor’s response? “Don’t go off the Ring! Just use this extra estrogen cream every day.”

But putting more hormones in my body seemed counterintuitive. There must be another way, I thought.

My partner never liked condoms, and diaphragms make me vulnerable to urinary tract infections. Since I didn’t like the idea of an invasive vaginal procedure, an IUD was out, too. That’s when a friend lent me Toni Weschler [9]’s Taking Charge of Your Fertility [10]. The book explains a scientific birth control method that allows a woman to know her six-day fertility window: When a woman is fertile, her morning basal temperature rises and her discharge is slippery and stretchy. Unlike the mythological rhythm method, which assumes all women ovulate on the 10th day of their periods, FAM and NFP rely on signs, not day-counting, although charting is part of the process. When the signs all match up, the woman knows not to have sex or use a barrier method.

NFP and FAM were developed in the '50s, when scientists began to better understand how the menstrual cycle worked. They’re side-effect free, virtually cost-free and can be 95 percent to 98 percent [11] effective [12] when done correctly (although those numbers can slip down to anywhere from 91 percent to as low as 80 percent [13], depending upon how thoroughly the couple practices the method). Their effectiveness is akin to condoms, which are 98 percent effective with perfect use and 85 percent effective with typical use.

Of course, these “organic” alternatives entail considerably more effort than simply rolling down a layer of latex. I decided to do some research on whether FAM/NFP was worth the effort, so I sent out an e-mail asking for testimonials from women who use those methods. I got dozens of responses within days. “Megan,” 33, loves FAM because “I’m in touch with exactly what my body is going through.” Others like that FAM can be a team effort between the woman and her partner, who needs to be clued into his mate’s biological signals—“Jane,” 30, thinks it can “erase the dynamic of ‘woman as all-knowing gatekeeper’ and ‘man as ignorant beggar’ ” when it comes to sex and pregnancy.

Like me, many of these women had tried FAM after nixing the pill, for myriad reasons: “My brain felt cloudy and dull.” “I got yeast infections and nausea.” Or, as one of my friends put it: “My sex drive was like that of a paper plate.” Gynos don’t always like to admit it, but the pill affects some women quite negatively.

It’s understandable why our culture is hesitant to criticize the pill and similar methods like NuvaRing or the birth-control patch. Not only did their invention propel the sexual revolution—and let’s be real, feminism, too—but they’re also billion-dollar industries. FAM and NFP create self-reliant patients who don’t have to visit the doctor to get a prescription, which isn’t the best news for gynos. And many women’s bodies work perfectly well with hormonal birth control

Yet when our bodies don’t work perfectly well, doctors are hesitant to recommend more natural options. Sex educators almost never touch them. Tammi Kromenaker, the director of the Red River Women’s Clinic in Fargo, N.D., usually skips the FAM/NFP convo, not only because the methods don’t protect against STIs, but because “most patients won’t want to put in the effort.” Fiona, 25, agreed, writing, “No way could I ever be so conscientious every day. I can’t even take the stupid pill when I’m supposed to.”

Kromenaker also told me that many women aren’t used to being so intimate with themselves. “A lot of patients feel weird about using condoms,” she points out. “You think they’re going to stick their fingers in their vaginas?” “Sarah,” 24, said something similar: “Knowing the patterns of your body is important, but [I’m] not sure about literal discharge examination.”

But this mentality isn’t innate—we’re taught to think vaginas are gross and icky. Even as the media fling sex at us at ever-earlier ages, “there’s so much that discourages our society from talking about sexuality,” says Joan Schrammek, a sex educator at Cedar River Clinics in Washington, a facility that advocates fertility awareness. “So naturally lot of teachers are worried that [FAM] won’t be effective for teens because they don’t know their bodies well enough.”

But what if fertility awareness were a unit in sex ed, along with condoms and abstinence? What if those couples currently pulling-and-praying knew the days when pre-cum was a legitimate concern? I’m not suggesting that FAM/NFP is right for everyone, or that it should or will replace condom use; neither fertility awareness nor withdrawal nor the pill are effective for STI protection. But even if the single or polyamorous continue to use condoms, think of how many unplanned pregnancies would be avoided if women were taught at an early age about their ovulation patterns. “Knowing how to reduce the risk of pregnancy is something everyone should know,” says Rachel K. Jones, the researcher who headed the withdrawal study at Guttmacher, “whether it’s for family planning or just general information about how their bodies work.”

If this all sounds too radical to go mainstream, consider the bipartisan potential of the fertility awareness method. Its conservative counterpart, natural family planning, is a method that even the Catholic Church sanctions. It’s natural and family-friendly, and it’s a hell of a lot better than abstinence-only fear-mongering. "Kara,” 25, a devout Catholic who just started NFP classes with her fiancé, wrote: “Why didn’t we learn about this in eighth-grade health class? It’s not just about sex. It’s about appreciation of your own body.”

FAM practitioners also often run with the same crowd that eats organic food, avoids plastics, and uses natural dish soap—a lifestyle once attributed to bougie hippies but now, thanks to Trader Joe’s and Vitamin Water, has certifiably gone pop. It’s not a stretch to imagine FAM advocates jumping on the same holistic band wagon.

The pill can work fine and condoms can be lifesaving, but we haven’t yet been given a framework for more organic options. If FAM and NFP become readily included in our contraceptive repertoire, women—nay, everyone—could be saved a lot of split-decision, post-pullout agonizing.