In a lot of circles, using fertility-based awareness methods (FABMs) gets a bad rap. When they hear the word “charting,” many women—and even doctors—still think of their mothers’ calendar or rhythm method, not a modern scientific technique. Others think that FABMs are only for women with clockwork cycles or those who are cool with having as many children as their bodies can handle. Others discount FABMs because, with proper use, sex can’t be spontaneous. Bummer.
At Verily, we recently did an informal survey to understand why modern women choose to chart their monthly cycles by observing basal body temperature, hormone levels, cervical mucus, or some combination thereof. A lot of these women had irregular periods, and they started charting their cycles to figure out why. Many wanted to stay off the Pill and other hormonal birth control options. Some wanted to get pregnant, whereas others needed to avoid conceiving. Still others found that their chosen method led to a deeper understanding and level of communication with their partner.
Collectively, these women’s experiences contradict popular beliefs about charting. So why the huge differences of opinion?
01. They Aren’t Taught in Med School
Dr. Marguerite Duane, family physician and executive director of Fertility Appreciation Collaborative to Teach the Science, was a first-year resident when she first heard about fertility awareness methods. That means she’d been through four years of medical school without FABMs coming up. In her subsequent research, she and her colleagues surveyed 120 family medicine residency programs and “found that more than one-half of women’s health faculty members were not familiar with modern methods of [fertility awareness].” A quarter of the programs don’t even include learning about fertility awareness methods in the curriculum.
Dr. Duane says that physicians who do know about charting are most familiar with the rhythm method, which was developed in the 1930s and based on research from the 1920s. Much research has been done in the ninety years since, yielding the Billings Ovulation Method in the 1960s, the Creighton Model in the 1970s, and the Marquette Method in the 1990s. The first antibiotic was developed in the 1940s, but not many doctors today suggest bloodletting as treatment. The science has changed, so why hasn’t the way it’s taught followed suit?
To address this gap in the medical school curriculum, Dr. Duane offers an online elective "Fertility Awareness for Women's Health and Family planning" at Georgetown University School of Medicine, where she is an Adjunct Associate Professor.
02. Sorry to Say It, But . . . Money
Avoiding hormonal birth control is only one reason women choose fertility awareness methods for family planning. But Dr. Duane cites the Pill—“the most widely prescribed drug given to healthy women”—as a $4 billion per year industry, which is why it’s focused on more. Many modern, science-based charting methods require little more than a piece of paper and a pencil. Charts can reveal imbalances that can sometimes be remedied through nutrition, exercise, and lifestyle changes without a prescription.
As in any area of study, “students study what they’re going to be tested on,” Dr. Duane says, and “much of medical education is influenced by pharmaceutical funding.” She gives her own experience as an example: She had just six weeks of nutrition training on Friday afternoons, but three months of pharmaceutical training.
03. The Myth of Effectiveness Rates
A study in the Journal of Obstetrics and Gynaecology Canada found that “only 3 to 6 percent of physicians had correct knowledge of the effectiveness in perfect use of the NFP [Natural Family Planning, another name for FABM] methods cited.” Many health care professionals rely on the Centers for Disease Control and Prevention for their information, but Dr. Duane says the statistics given there—twenty-four pregnancies per a hundred women per year—are “based on poor quality research” and perpetuate the belief that these methods are ineffective when used to avoid pregnancy.
Even the author of the study that yielded that stat “has acknowledged that it masks the differences in the effectiveness of FABM,” by grouping a variety of them together. When studied properly, “modern FABM have unintended pregnancy rates [of less than] five” pregnancies per a hundred women per year.
04. They Take Time (and Patience) to Learn
When women learn about fertility awareness methods, Dr. Duane says that more than 60 percent express interest in learning more—but too many women are trying to do it on their own. She likens learning a FABM to learning to drive a car. You wouldn’t operate a motor vehicle after reading a book or studying an app. You’d find an instructor who could show you how to use it. If you have a trained teacher to guide you, charting daily observations can become second nature.
Dr. Duane says, “We are seeing more and more interest from women, in large part because women are fed up with the side effects of birth control, and they’re tired of being told their fertility is a disease.” Yes, charting requires more effort than a pill or an injection, but it also yields more information about our bodies, such as whether a woman is likely to conceive on a given day.
In 2017, women have more access to information about their health than ever before. It’s time for charting to get the good reputation it deserves.
Photo Credit: Evgenia Kohan