Natural family planning
CHARTED
TERRITORY
Revolutionised birth
control has supposedly brought women greater freedom. But what is
the real cost of managed fertility, and are there less medicalised
alternatives? Sarah Tennant investigates.
In 1960, women celebrated as the FDA approved the first
hormonal birth control pill. Adding this pill to an already
sizeable list of birth control devices - condoms, IUDs,
spermicides, pessaries and cervical caps - it seemed that women
would never have to worry about being burdened by too many babies
again.
Fast-forward fifty years, and the birth rate has indeed declined -
but millions of women are finding they have simply swapped one
source of stress for another. Far from promoting a free and easy
lifestyle, modern forms of birth control, specifically hormonal
methods, mean that many women can suffer more physical and
emotional stress from preventing babies as they can from having
them. The price of managed fertility can be blood clots, breast
cancer, weight gain, mood swings and depression; for a small number
of women, it can be death.
Less dramatically, many women spend years or even
decades in a mentally and physically altered state due to
contraceptives, feeling "not quite right" or dealing with a litany
of unpleasant symptoms as their doctors fiddle around with doses
and prescriptions. A recent study found that the Pill alters
biochemistry to the point of affecting how women choose their life
partners - a side effect that would probably have Margaret Sanger
turning in her grave.
Another side effect of hormonal birth control is that it
medicalises fertility. Women cannot give themselves Depo-Provera
shots or mix up their own estrogen-progesterone
cocktails in the kitchen: Their bodies therefore
become managed by health care professionals, some of whom are only
too ready to hand out pills like popcorn. Several women I know were
put on the Pill as non-sexually active teenagers, for no better
reason than having "irregular" periods - in other words, periods
that were not exactly 28 days long. Clearly high school sex
education had failed these teens as surely as years of medical
training had failed their doctors, with the result that their
still-developing selves became guinea pigs for a risky chemical
cocktail.
Fortunately, there is an alternative. These women told me their
story on a forum devoted to FAM, or Fertility Awareness Management.
Like many practitioners of FAM, their stories sparkled with passion
and enthusiasm - rather unique attitudes in the contraceptive
world. (When did you last hear women rhapsodising en masse about
their IUDs?) To my knowledge, no other form of birth control
inspires such fanaticism: and the reason is that FAM is not simply
another way to prevent pregnancy. Instead, it is a working system
of knowledge about a woman's body with benefits that extend far
beyond making or avoiding babies. And to give it an added frisson
of chic, FAM is also ethically and ecologically conscious. Take
that, mini-Pill!
Users of FAM range from married Christian couples to single women,
teens, and breastfeeding mothers. The method is often confused with
NFP, the Catholic variant; or unfairly conflated with
the Rhythm Method, a highly dubious form of birth
control that only works if a woman ovulates on Day 14 (two weeks
after the start of her period) every single cycle. One of the first
things an FAM student learns is that she probably doesn't.
As a thorough understanding of the rules of FAM is essential to its
success, it would be irresponsible to attempt a complete how-to in
this article. Essentially, a woman notes her fertility symptoms
every day and records them on a chart (hence "charting" as a slang
term for FAM). In its simplest form, known as the Billings Method,
a woman checks her cervical fluid for signs of a consistency
capable of sustaining the life of sperm. Determining fertility this
way is not a new discovery - women in a certain tribe in Africa
have understood the message of cervical fluid for centuries.
More complex forms of FAM, such as the Sympto-Thermal
method, use the position of a woman's cervix and her wakin
g oral temperature to corroborate the fertility signs of
cervical fluid. Opinions vary on the necessity of using all three
signs, but either way, the results are impressive: both the
Billings and Sympto-Thermal methods of FAM boast an impressive
method success rate - 98% for Sympto-Thermal and 97% for the
Billings Method. (Condoms also have a 98% success rate: both forms
of FAM beat the rates of diaphragms, spermicides, and cervical
caps.)
Of course, simply charting fertility is not enough - for women who
wish to avoid pregnancy, abstinence or the use of barrier methods
is necessary during the fertile period. Understandably, this has
turned a large number of couples off the concept of FAM.
Natural Family Planning (NFP), the Catholic version,
requires abstinence during the fertile period for theological
reasons; secular forms of FAM do not, but experts warn that a
condom break during the fertile period is quite likely to result in
a pregnancy. The bad news is that a woman's libido is often at its
peak during ovulation - the exact time couples must abstain to
avoid pregnancy.
Yet thousands of couples clearly find that the inconvenience is
worth it. Why? Perhaps because FAM only affects a couple in a few
specific ways. A woman must devote a few moments a day to observing
and charting her fertile signs: a couple must either abstain for a
chunk of every month or use barrier methods. The rest of the time,
they are free. Contrast this with many women's experience of
hormonal birth control. Every day, without reprieve, she
experiences the effects of the artificial hormones coursing through
her body. She may have wild mood swings, feel numbed or depressed;
when it comes time to have that wonderfully spontaneous any-time
sex, she may find body-image issues caused by weight gain, a
loss of libido and vaginal dryness mar the
experience.
A number of women also suffer a growing ethical unease about the
abortifacient qualities of hormonal birth control and its effects
on the environment. Adding all this up, FAM may not seem so
daunting after all.
The best
part of FAM for some couples is its reversibility. Women do not
have to wait several months after discontinuing Depo-Provera to
start ovulating again; the moment they decide to conceive, they can
consult their charts to see the best time for timing sex. Toni
Weschler, author of FAM bible Taking Charge of Your Fertility,
notes that FAM-ing couples with fertility issues are likely to spot
them even before trying to conceive, rather than waiting the
obligatory year of hit-and-miss trying before seeking
professional help. Problems such as a short luteal phase or
anovulatory cycles can be taken to a health care provider and
treated immediately - a bonus for older couples, who may not be
able to afford to wait a year.
For couples who really want to micromanage their
fertility, FAM can even be combined with the Shettles method to
give parents a fairly decent shot at choosing the sex of their
baby. The method is based on the principle that "male" sperm swim
faster, but "female" sperm live longer. Thus, by timing intercourse
very close to ovulation or a few days before it, couples can
maximise the chances that the right sperm will get to the egg
first. It sounds like an old wives' tale, and various studies have
either emphatically confirmed or drastically debunked the theory -
but for parents with a strong gender preference, it may be worth a
try.
The part that really gets women inspired about FAM, however, is its
ability to connect seemingly random symptoms to the menstrual
cycle. Savvy charters can pinpoint everything from nausea to
migraines to specific points in their cycles. My sister, a single
woman who charts out of pure medical geekery, has noticed perfume
smells better on her during her follicular phase. Other women have
correlated their cycles to food sensitivities, unusual dreams,
their desire for another baby and even their tendency to spend
money! These women can arrange their lives accordingly, whether
they schedule social functions during their most outgoing phase or
stock up on dark chocolate when they know their period is
due.
A lot of women who use FAM look at it from a Gaia-ish, fertility
goddess sisterhood perspective. I'm not one of them. To me, the
mysteries of the female body are generally a pain in the Fallopian
tubes - and last time I tried to tune into my body all I got was an
eerie certainty that my unborn child was a boy. She wasn't. But
when she enters her preteen years, I will be teaching her exactly
how the principles of Fertility Awareness Management can help her
understand the quirks of her body, and how she will one day be able
to use the method to achieve or avoid pregnancies if she chooses. I
believe that knowledge is her birthright.
Want to learn FAM?
Toni Weschler's book Taking Charge of Your Fertility is a hefty,
but worthwhile, read. Weschler approaches the subject with humour
and plenty of anecdotes, and drills the rules of FAM chapter after
chapter without becoming boring. The book includes examples of real
women's charts, photos of cervical fluid, and information about
using FAM during tricky times such as breastfeeding and
peri-menopause. Weschler has also written a book about charting for
teens, Cycle Savvy.
The Billings Method, by Drs Evelyn Billings and Ann Westmore is a
clear and readable how-to guide for the simpler form of FAM, which
uses only cervical fluid to indicate fertility.
The website www.naturalfertility.co.nz is an FAM teaching
organisation that works closely with other New Zealand
fertility-related organisations. Natural Fertility offers
accredited educators to teach couples FAM in
person.
Sarah Tennant lives in Hamilton with her husband
Dominic and daughter Rowan.
As seen in OHbaby! magazine
Issue 10: 2010
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