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Regular readers of Verily know that we’re fans of nurturing your natural fertility. Your cycle is a valuable tool to understanding your overall health and key to helping a doctor diagnose underlying issues such as infertility or PCOS. Studies have shown that several charting-based methods are effective in helping couples both avoid and achieve pregnancy.

But there are plenty of misconceptions and myths around fertility awareness-based methods, or FABMs, also known as just FAMs or as natural family planning (NFP). Some call FABMs crunchy, conservative, liberal, or even old-fashioned. Some assume they’re only for women who are trying to get pregnant or only for women with pristine menstrual cycles. Others think they’re like your grandmother’s “rhythm method.”

But modern FABMs are based on decades of scientific research, and women across the country have been sharing their stories with the #ThanksNFP hashtag on social media as part of NFP Awareness Week. To help demystify the expectations and assumptions surrounding FABMs, I interviewed Dr. Marguerite Duane, a family physician and the Executive Director of Fertility Appreciation Collaborative to Teach the Science.

Q. How do younger couples often react to FABMs?

Younger couples typically have mixed reactions to the idea or FABMs depending on their personal experience and experience of friends and family. For example, women who have suffered from the side effects of hormonal birth control are often thrilled to learn that there is an effective method of family planning that has no medical side effects.

But couples who have heard many of the myths associated with NFP are often skeptical about its effectiveness, presuming that NFP is their' "grandmother's rhythm method." However, modern natural FABMs rely on teaching women how to identify their fertile window based on prospective signs rather than on historical information only.

Some couples who reluctantly attend FABM classes as part of marriage prep courses are often pleasantly surprised by the strong science supporting these methods and are much more willing to use them.

Q. As opposed to other highly marketed options, FABMs have a relatively low mainstream presence. Why?

One of the main reasons FABMs have a low mainstream presence is due to the limited marketing done to advertise these methods. The reality is good marketing costs a lot of money and there is very little money to be made "selling" FABMs as opposed to the billions of dollars pharmaceutical companies make from the sale of birth control. 

More resources need to be invested to advertise the various evidence-based methods of FABMs. Fortunately there are organizations like Natural Womanhood and Guiding Star that are working to raise public awareness about these methods. 

Another reason why FABMs are not more widely used is due to the fact that the overwhelming majority of physicians are not familiar with modern evidenced-based methods, as up-to-date information has not been included in the medical curriculum. I co-founded FACTS to address this knowledge gap.

Q. What are some ways that FABMs empower women to work with their bodies?

FABMs is a better description of these methods because they teach women to be aware of specific physical signs so they can identify when they may be fertile. In addition, this information can empower women with a better understanding of their overall reproductive health.

With these methods, women can learn to chart cervical fluid observations, basal body temperature and/or urinary hormone measurements. These observations not only help a woman to identify when she may be fertile and when she is not, but also to predict when her period will start, for example. For women who suffer from severe menstrual cramps, this can be very empowering because they will know when to start taking medications like ibuprofen to prevent or significantly reduce their painful cramps. This is much better and more targeted treatment to reducing menstrual cramps than taking the Pill every day with its potential for side effects, which is the only option offered to most women

Q. So FABMs are natural, hormone-free, and free of side effects. Why is this important?

The Pill is the most widely used drug given to healthy people to suppress a normal physiologic function. Additionally, it exposes women to a myriad of side effects, including some very serious side effects such as blood clots, cancer, and even a risk of death. While some would argue that the risk of death is very low, even less than 1 percent, it still means a few hundred women will suffer a serious side effect or die with ten million healthy women taking hormonal birth control each year. Erika Langhart is just one of many healthy women who died at a young age (24) due to the side effects of birth control.

On the other hand, the World Health Organization recognizes that NFP is free from any side effects. More importantly, many of these methods are as effective in preventing pregnancy as hormonal birth control. Why would we want to expose healthy women to serious or a substantial number of side effects under the guise of preventing pregnancy when there are other effective options available that pose no health risk?

Q. Interesting point. So how reliable is it?

FABMs are indeed a very effective method of family planning and are comparable to most artificial methods of birth control when it comes to avoiding pregnancy. In fact FABMS or NFP are the only true methods of family planning because couples can use them to both avoid and achieve pregnancy. For the latest research on effectiveness, see this 2013 review article in Osteopathic Family Physician. It concludes, "When correctly used to avoid pregnancy, modern FABM have unintended pregnancy rates <5 (per 100 women years)."

Editor’s note: Each FABM has a different perfect and typical use rate. For instance, the Association of Reproductive Health Professionals lists the perfect use rate of the sympto-thermal method (observing cervical mucus and basal body temperature to determine a woman’s last fertile day) as 0.4 (per 100 women years). To give you a better idea of what this means, the ARHP notes the perfect use rate for condoms as 5, the Pill as 0.3, the Paragard IUC as 0.6, and female sterilization as 0.5.

Q. Could you point us to research indicating that using FABMs is linked to stronger relationships? How does it achieve this?

A 2003 study in the Journal of Nursing Scholarship of the effects of NFP on marital dynamics reports, "Although about one-fourth of the comments indicated that NFP presented challenges, the majority (74 percent) found it beneficial, often resulting in stronger bonds, better communication, and improved knowledge."

FABMs are linked to stronger relationships in part because it encourages couples to share responsibility for family planning rather than it being solely the woman's responsibility. Thus, couples usually have conversations on a monthly basis about their family planning goals. As such, this leads to improved communication and enhances their relationships.

If you’re new to NFP/FABMs, what do you find most skeptical or compelling? If you’re a fan, how has using NFP/FABMs been challenging or easy for you? Leave your thoughts in the comments below.

Photo Credit: UC Irvine